The threat of home eviction and its effects on health through the equity lens: A systematic review

Eviction, Healthcare Utilization, and Disenrollment Among New York City Medicaid Patients

INTRODUCTION

Although growing evidence links residential evictions to health, little work has examined connections between eviction and healthcare utilization or access. In this study, eviction records are linked to Medicaid claims to estimate short-term associations between eviction and healthcare utilization, as well as Medicaid disenrollment.

METHODS

New York City eviction records from 2017 were linked to New York State Medicaid claims, with 1,300 evicted patients matched to 261,855 non-evicted patients with similar past healthcare utilization, demographics, and neighborhoods. Outcomes included patients' number of acute and ambulatory care visits, healthcare spending, Medicaid disenrollment, and pharmaceutical prescription fills during 6 months of follow-up. Coarsened exact matching was used to strengthen causal inference in observational data. Weighted generalized linear models were then fit, including censoring weights. Analyses were conducted in 2019-2021.

RESULTS

Eviction was associated with 63% higher odds of losing Medicaid coverage (95% CI=1.38, 1.92, p<0.001), fewer pharmaceutical prescription fills (incidence rate ratio=0.68, 95% CI=0.52, 0.88, p=0.004), and lower odds of generating any healthcare spending (OR=0.72, 95% CI=0.61, 0.85, p<0.001). However, among patients who generated any spending, average spending was 20% higher for those evicted (95% CI=1.03, 1.40, p=0.017), such that evicted patients generated more spending on balance. Marginally significant estimates suggested associations with increased acute, and decreased ambulatory, care visits.

CONCLUSIONS

Results suggest that eviction drives increased healthcare spending while disrupting healthcare access. Given previous research that Medicaid expansion lowered eviction rates, eviction and Medicaid disenrollment may operate cyclically, accumulating disadvantage. Preventing evictions may improve access to care and lower Medicaid costs.

Variation in State-Level Eviction Moratorium Protections and Mental Health Among US Adults During the COVID-19 Pandemic

Importance

Although evictions have been associated with adverse mental health outcomes, it remains unclear which stages of the eviction process are associated with mental distress among renters. Variation in COVID-19 pandemic eviction protections across US states enables identification of intervention targets within the eviction process to improve renters' mental health.

Objective

To measure the association between the strength of eviction protections (ie, stages blocked by eviction moratoriums) and mental distress among renters during the COVID-19 pandemic.

Design, Setting, and Participants

This cohort study used individual-level, nationally representative data from the Understanding Coronavirus in America Survey to measure associations between state eviction moratorium protections and mental distress. The sample of 2317 respondents included renters with annual household incomes less than $75 000 who reported a state of residence and completed surveys between March 10 and September 3, 2020, prior to the federal eviction moratorium order by the Centers for Disease Control and Prevention.

Exposures

Time-varying strength of state moratorium protections as a categorical variable: none, weak (blocking court hearings, judgments, or enforcement without blocking notice or filing), or strong (blocking all stages of the eviction process beginning with notice and filing).

Main Outcomes and Measures

Moderate to severe mental distress was measured using the 4-item Patient Health Questionnaire. Linear regression models were adjusted for time-varying state COVID-19 incidence and mortality, public health restrictions, and unemployment rates. Models included individual and time fixed effects as well as clustered standard errors.

Results

The sample consisted of 2317 individuals (20 853 total observations) composed largely (1788 [78%] weighted) of middle-aged adults (25-64 years of age) and women (1538 [60%]); 640 respondents (23%) self-reported as Hispanic or Latinx, 314 respondents (20%) as non-Hispanic Black, and 1071 respondents (48%) as non-Hispanic White race and ethnicity. Relative to no state-level eviction moratorium protections, strong protections were associated with a 12.6% relative reduction (risk ratio, 0.87; 95% CI, 0.76-0.99) in the probability of mental distress, whereas weak protections were not associated with a statistically significant reduction (risk ratio, 0.96; 95% CI, 0.86-1.06).

Conclusions and Relevance

This analysis of the Understanding Coronavirus in America Survey data found that strong eviction moratoriums were associated with protection against mental distress, suggesting that distress begins early in the eviction process with notice and filing. This finding is consistent with the idea that to reduce mental distress among renters, policy makers should focus on primary prevention of evictions.

Childhood eviction and cognitive development: Developmental timing-specific associations in an urban birth cohort

Eviction upends children's lives and exacerbates deprivation; it remains largely unexamined as a determinant of cognitive development. We assess whether children evicted in infancy, early childhood, and middle childhood exhibit lower scores on four cognitive assessments (measuring executive function, mathematical reasoning, written language skills, and vocabulary skills) at age 9. Using linear regression and selection weights, we analyze longitudinal data from the Fragile Families and Child Wellbeing Study, a national, urban birth cohort (N = 1724 for eviction during infancy, 2126 for early childhood, 1979 for middle childhood). These stages of childhood follow the timing of FFCWS' data collection waves, with "infancy" data collected in the first year of life, "early childhood" in the third and fifth years of life, and "middle childhood" in the ninth year. In adjusted models, children evicted in middle childhood exhibited scores 0.20-0.43 SDs below similar children who were not (depending on the assessment; p-values = 0.004-0.055), the equivalent of as much as a full year of schooling. Point estimates of the association between eviction in infancy and 3/4 cognitive skills at age 9 were also large, but imprecisely estimated (between -0.25 and -0.28 SDs; p-values = 0.053-0.101), while point estimates for eviction in early childhood were near zero and statistically insignificant. Our large estimates for middle childhood and infancy, compared to earlier residential mobility studies, indicate downwardly mobile moves may exhibit more severe associations with future cognition. Estimates suggest preventing eviction may be a powerful, cost-effective way to safeguard children's cognitive development.

American Indian/Alaska Native Child Health and Poverty

One in three American Indian/Alaska Native (AI/AN) children live in poverty. This rate is higher in some reservation communities. The alarming rates of physical, mental, and social health inequities (eg, poverty) experienced by AI/AN children are symptoms of genocide, a legacy of inhumane Federal Indian policy, and ongoing structural violence. The chronically underfunded Indian Health Service (IHS) is just one example where AI/AN children are not universally guaranteed equitable health care or opportunity to thrive. Poverty is highly predictive of educational achievement, employment opportunities, violence, and ultimately health outcomes. COVID-19 has not only exacerbated physical and mental health inequities experienced by AI/AN communities, but has also intensified the economic consequences of inequity. Thus, it is vital to advocate for programs and policies that are evidence based, incorporate cultural ways of knowing, and dismantle structurally racist policies.

Unemployment, religious disintegration and suicide fluctuations in Alberta

This study looks at the relationship between unemployment, religious disintegration and suicide in Alberta during 1997-2015. Religious disintegration is operationalized as the percentage of population with no religious affiliation. Economic theory predicts suicides increase when unemployment rates are high and decline when unemployment rates are low. Sociological theory calls for suicides to vary inversely with the degree of religious integration in society. Multivariate analysis supports both economic and sociological interpretations. In Alberta, periods of rising unemployment (recessions) produce more suicides, and increased levels of religious disintegration are positively associated with the incidence of voluntary deaths.

Expected and possible unexpected consequences of ending the eviction moratorium

The U.S. Supreme Court ended the federal moratorium on evictions that was in effect from May 2020-August 2021 during the Coronavirus Disease 2019 (COVID-19) pandemic. The end of an unprecedented national eviction moratorium has public health implications for housing, health, and homelessness. Accumulation of eviction filings, unpaid rent, tenant moral hazards, deteriorated tenant-landlord relationships, and increased transmission of COVID-19 and rates of homelessness are possible consequences that need to be prepared for as the federal eviction moratorium has ended. Innovative approaches and solutions can be taken that build upon existing knowledge and infrastructure for rental assistance, legal aid, and homeless prevention.

Living in a block group with a higher eviction rate is associated with increased odds of preterm delivery

BACKGROUND

Housing instability is associated with adverse pregnancy outcomes. Recent studies indicate that eviction, which may affect a larger segment of the population than other forms of housing instability, is also associated with adverse pregnancy outcomes. However, these studies evaluate eviction across large areas, such as counties, so it remains unclear whether these patterns extend to individual-level pregnancy outcomes.

METHODS

We used data on a cohort of all singleton live births at a single Chicago hospital between March 2008 and March 2018 to investigate the associations between block-group eviction rates and individual adverse pregnancy outcomes. Eviction data were obtained from the Eviction Lab at Princeton University. Generalised estimating equations were used to estimate associations and account for correlations among individuals living in the same block groups.

RESULTS

Individuals living in block groups in the highest quartile for eviction filing rate were 1.17 times as likely to deliver preterm (95% CI: 1.08 to 1.27) and 1.13 times as likely to deliver a small for gestational age infant (95% CI: 1.03 to 1.25) as compared with individuals living in block groups in the lowest quartile. Further, tests for linear trend indicated that for each quartile increase in eviction filing rate, there was a corresponding increase in odds of adverse outcomes (p<0.05). Results were strongest in magnitude for those with low neighbourhood and individual socioeconomic status, who are most likely to be renters and affected by local eviction policies.

CONCLUSION

Our results suggest that individuals living in block groups with higher eviction rates are more likely to deliver preterm. Future research should explore associations of individual experience with eviction on adverse pregnancy outcomes and examine whether policies to improve tenant protections also impact pregnancy outcomes.

Housing Instability and Depression among US Mothers Following a Nonmarital Birth

Mothers who had a nonmarital birth experience multiple risk factors for depression, including housing instability. Yet, important questions remain about the extent of long-term housing instability and its association with future depression among at-risk mothers. Using the Fragile Families and Child Wellbeing Study data, we examine cumulative housing instability over a 15-year period following nonmarital birth and its association with maternal depression. Based on a sample of 2279 mothers who had a nonmarital birth in 20 major US cities between 1998–2000, we examined their 15-year residential moves and housing arrangements. Then, we tested the associations between the cumulative residential moves and major depressive episodes (MDE) in Year 15 using logistic regression analysis. One in every four mothers had six or more residential moves in 15 years following a nonmarital birth. For each additional move, mothers reported up to 27.9% higher odds of having a past-year MDE in Year 15, translating into the prevalence increases from 6.0% (zero move) to 20.6% (10 moves). Our findings suggest that greater attention should be paid to housing needs among mothers following a nonmarital birth, including temporary housing assistance and more fundamental programs to reduce housing instability as preventive mental health services.

Longitudinal study of the housing and mental health outcomes of tenants appearing in eviction court

PURPOSE

Millions of people are evicted from rental properties in the U.S. annually, but little is known about them and their mental health. This study followed a cohort of eviction court participants over time and assessed their housing and mental health outcomes.

METHODS

One hundred and twenty-one tenants were recruited from an eviction court in New Haven, Connecticut, and their housing, mental health, and psychosocial status were assessed at baseline, 1, 3, 6, and 9 months following their encounter with the court. Inverse probability weighting was used for missing data.

RESULTS

At baseline, 42% of participants had appeared in eviction court before, 28% had experienced eviction, and 44% had been previously homeless. In addition, 39% screened positive for generalized anxiety disorder, 37% for posttraumatic stress disorder, 33% for major depressive disorder, and 17% reported suicidal ideation. At follow-up, participants experienced increased days of housing instability and homelessness over time with some persistent mental health symptoms. Less than one-quarter of participants received any mental health treatment during the 9-month follow-up period. About 54% of participants followed reported that they had to change their residence after their court appearance consistent with court records. Participants who had an eviction-related move experienced greater housing instability over time than participants who did not.

CONCLUSION

Together, these findings suggest that there is a sizable subgroup of adults who present to eviction court with persistent housing and mental health issues who do not receive adequate assistance in addressing these issues.

A multi-scalar perspective on health and urban housing: an umbrella review

With more than half the world's population living in cities, understanding how the built environment impacts human health at different urban scales is crucial. To be able to shape cities for health, an understanding is needed of planetary health impacts, which encompass the human health impacts of human-caused disruptions on the Earth's natural ecosystems. This umbrella review maps health evidence across the spatial scales of the built environment (building; neighbourhood; and wider system, including city, regional and planetary levels), with a specific focus on urban housing. Systematic reviews published in English between January 2011 and December 2020 were searched across 20 databases, with 1176 articles identified and 124 articles screened for inclusion. Findings suggests that most evidence reports on health determinants at the neighbourhood level, such as greenspace, physical and socio-economic conditions, transport infrastructure and access to local services. Physical health outcomes are also primarily reported, with an emerging interest in mental health outcomes. There is little evidence on planetary health outcomes and significant gaps in the research literature are identified. Based on these findings, three potential directions are identified for future research.

The Impact of U.S. Housing Type and Residential Living Situations on Mental Health during COVID-19

Residential environments could be associated with the mental health of residents, in general, and during the COVID-19 pandemic. However, limited studies have investigated the relationship between these two. This study used data from the Household Pulse Survey, collected between 23 April 2020 and 23 November 2020 to explore the relationship between mental health status as perceived by the residents and housing tenure (own or rent), building type, and the number of household members, while accounting for sociodemographic characteristics, general health-related variables, and week-specific unobserved heterogeneities. The findings suggest that renters had higher odds of experiencing mental health issues than homeowners. Residents in multifamily housing units had higher odds of experiencing mental health problems than single-family units. Further, more people in the household were associated with lower odds of experiencing mental health episodes during the COVID-19 pandemic.

'That house was a home': Qualitative evidence from New Zealand on the connections between rental housing eviction and poor health outcomes

ISSUE ADDRESSED

Eviction, or a forced move from rental housing, is a common experience for New Zealand renters, yet we know very little about its effects. This research investigated how eviction affects people's lives and health.

METHODS

We conducted semi-structured interviews with 27 people who had experienced eviction. We coded the transcripts and grouped them into themes using template analysis.

RESULTS

Participant experienced grief at the loss of the home. Moving out and searching for a new home was highly stressful on participants and on their relationships. After being evicted, people became homeless, often staying with family and friends and lived in poor quality or unaffordable housing. They reported health issues as a result of these circumstances.

CONCLUSIONS

Eviction harms health through causing stress, grief and a move to a risky living situation. Increasing the supply of housing and funding wide-ranging support services can help minimise the harm caused by eviction. SO WHAT?: Reducing the incidence and impact of eviction should be a priority for health promotion.

Health Effects of Housing Insecurity and Unaffordability in the General Population in Barcelona, Spain

While the negative effects of housing insecurity and unaffordability on health are well known, most of the studies in Spain have focused on very specific social groups so their findings cannot be extrapolated to the general population. The aim of this study is to assess the effects of housing stress and risk of displacement due to economic reasons, and their combined effect, on the mental and physical health of the general population from a middle-income neighborhood of Barcelona. We conducted a cross-sectional study using a household health survey which included respondents from a representative sample of 1202 non-institutionalized residents (> 18 years old) of the Horta neighborhood. We carried out a descriptive analysis, estimated the prevalence of poor mental and self-rated health (stratifying by the independent variables) and fitted robust Poisson regression models to estimate the effects of housing stress (HS) and the risk of forced displacement (RD) on self-rated health and mental health (GHQ-12). All analyses were stratified by sex. We found a higher likelihood of poor general and mental health among people affected by HS and/or RD compared to those not affected by HS and/or RD. A graded effect of HS and RD emerged mainly on mental health, even after adjusting by socioeconomic variables and housing tenure. The serious problem of housing insecurity and unaffordability in Spain is a widespread public health issue. Evidence-based public policies to improve well-being and health of people under this threat are urgently needed.

Health Selection Into Eviction: Adverse Birth Outcomes and Children's Risk of Eviction Through Age 5 Years

Adverse birth outcomes put children at increased risk of poor future health. They also put families under sudden socioeconomic and psychological strain, which has poorly understood consequences. We tested whether infants experiencing an adverse birth outcome-low birthweight or prematurity, as well as lengthy hospital stays-were more likely to be evicted in early childhood, through age 5 years. We analyzed 5,655 observations contributed by 2,115 participants in the Fragile Families and Child Wellbeing Study-a national, randomly sampled cohort of infants born in large US cities between 1998 and 2000-living in rental housing at baseline. We fitted proportional hazards models using piecewise logistic regression, controlling for an array of confounders and applying inverse probability of selection weights. Having been born low birthweight or preterm was associated with a 1.74-fold increase in children's hazard of eviction (95% confidence interval: 1.02, 2.95), and lengthy neonatal hospital stays were independently associated with a relative hazard of 2.50 (95% confidence interval: 1.15, 5.44) compared with uncomplicated births. Given recent findings that unstable housing during pregnancy is associated with adverse birth outcomes, our results suggest eviction and health may be cyclical and co-constitutive. Children experiencing adverse birth outcomes are vulnerable to eviction and require additional supports.

"There's no place like home": Examining the associations between state eviction defense protections and indicators of biopsychosocial stress among survivors of intimate partner violence

Housing instability is prevalent among intimate partner violence (IPV) survivors and a source of biopsychosocial stress among this population. Eviction policies play an important role in determining housing instability of IPV survivors. However, few studies have investigated whether state-level policies that prevent evictions lessen vulnerability to biopsychosocial stress among IPV survivors. This study examined the relationship between state eviction defense policy and indicators of biopsychosocial stress among 6577 IPV survivors. State-level data on IPV-related housing policies were from a compendium on homelessness and violence. Individual-level data were collected from the National Intimate Partner and Sexual Violence Survey (NISVS), a nationally representative study of noninstitutionalized U.S. women and men from Wave 1 (2010). Multilevel regression models were conducted to investigate associations between the presence of an eviction defense policy and indicators of biopsychosocial stress (i.e., headaches, sleeping, safety concerns and PTSD symptoms). Stratified multilevel modeling was conducted to examine differences in the policy-stress associations across racial and ethnic groups and gender. Nearly 26% of states had an eviction defense policy for IPV survivors. Overall, residing in a state with an eviction defense policy (vs. none) was associated with no reports of frequent headaches (B [95% CI] = -0.21 [-0.41, -0.01], p < .05). For non-Hispanic Black survivors, residing in a state with an eviction defense policy (vs. none) was associated with reduced likelihood of reporting safety concerns (B [95% CI] = -1.36 [-2.16, -0.56], p < .001) and PTSD symptoms (B [SE] = -1.91 [-2.82, -1.01], p < .000). Among men survivors, residing in a state with an eviction defense policy was associated with reduced likelihood of reporting safety concerns (B [95% CI] = -0.63 [-1.26, -0.01], p < .05). State housing policies are important protective policies for IPV survivors. For IPV survivors, the eviction defense policy may interrupt the psychological sequeale of IPV and housing instability.

Housing Instability and HIV Risk: Expanding our Understanding of the Impact of Eviction and Other Landlord-Related Forced Moves

The study purpose is to comprehensively measure landlord-related forced moves (inclusive of, but not restricted to, legal eviction), and to examine whether landlord-related forced moves is associated with HIV risk. Baseline survey data was collected between 2017 and 2018 among 360 low-income participants in New Haven, Connecticut. We used multivariable logistic regression analyses to examine associations between landlord-related forced moves and HIV sexual risk outcomes. Seventy seven out of three hundred and sixty participants reported a landlord-related forced move in the past 2 years, of whom 19% reported formal eviction, 56% reported informal eviction and 25% reported both. Landlord-related forced moves were associated with higher odds of unprotected sex (AOR 1.98), concurrent sex (AOR 1.94), selling sex for money or drugs (AOR 3.28), exchange of sex for a place to live (AOR 3.29), and an HIV sexual risk composite (ARR 1.46) (p < .05 for all). We found robust associations between landlord-related forced moves and HIV sexual risk. Findings suggest that the social and economic consequences of landlord-related forced moves may impact sexual vulnerability.

Greenspace redevelopment, pressure of displacement, and sleep quality among Black adults in Southwest Atlanta

BACKGROUND

Little is known on how greenspace redevelopment-creating or improving existing parks and trails-targeted for low-income and/or majority Black neighborhoods could amplify existing social environmental stressors, increase residents' susceptibility to displacement, and impact their sleep quality.

OBJECTIVE

To examine the relationship between social environmental stressors associated with displacement and sleep quality among Black adults.

METHODS

Linear regression models were employed on survey data to investigate the association between social environmental stressors, independently and combined, on sleep quality among Black adults residing in block groups targeted for greenspace redevelopment (i.e., exposed) and matched with block groups that were not (i.e., unexposed).

RESULTS

The independent associations between everyday discrimination, heightened vigilance, housing unaffordability, and subjective sleep quality were not modified by greenspace redevelopment, controlling for other factors. The association between financial strain and subjective sleep quality was different for exposed and unexposed participants with exposed participants having a poorer sleep quality. The combined model revealed that the association between financial strain and sleep quality persisted. However, for different financial strain categories exposed participants slept poorer and/or better than unexposed participants.

SIGNIFICANCE

Our findings suggest a nuanced relationship between social environmental stressors, pressure of displacement related to greenspace redevelopment, and sleep quality among Black adults.

Unhealthy behaviours in urban Illinois communities affected by eviction: A descriptive analysis

Eviction of renter-occupied homes is an emerging public health crisis adversely impacting populations already at risk. Although housing quality and home-owner foreclosures have been linked to health outcomes, the relationship between eviction of renter-occupied homes and health has not been well established. The demographics and socioeconomic status of renters differs from homeowners, as such any relationship with health outcomes should be distinguished between the two. The aim of this study is to provide a descriptive analysis of the relationship between renter-specific eviction and unhealthy behaviours at the census tract level. Using data from the Centers for Disease Control and Prevention 500 Cities Project, the Eviction Lab and the U.S. Census Bureau, this study assesses the relationship between eviction rates and health indicators for 1,267 urban census tracts in Illinois in 2016. Binge drinking, current smoking, no leisure-time physical activity, obesity and sleeping <7 hr were used as indicators of unhealthy behaviour as categorised by the Centers for Disease Control and Prevention500 Cities Project. Unadjusted and adjusted linear regression models were used to assess and describe the relationship between each of the dependent variables and each of the independent variables. All five of the unhealthy behaviour indicators were found to be significantly associated with eviction rates and eviction filing rates after adjustment for confounding variables. This study contributes to the understudied area of research focused on how eviction rates contribute to the social determinants of health for already at-risk populations.

Mapping Housing Laws in the United States: A Resource for Evaluating Housing Policies' Impacts on Health

CONTEXT

Safe, stable housing is essential to good health. Housing hazards, including mold, vermin, and lead, can contribute to the development or exacerbation of chronic illnesses such as asthma and neurological disorders. In addition, eviction has been associated with poor physical and mental health outcomes. There are many laws aimed at maintaining healthy housing, or protecting access to stable housing, but their impacts are mostly unknown.

POLICY

Using scientific legal mapping, the Center for Public Health Law Research (the Center) created legal data sets on state landlord-tenant laws, state fair housing laws, and city nuisance property ordinances. These data sets track the incidence and key features of these laws, creating legal data that can be used for evaluation. Some important elements of these laws include property maintenance duties; protections against retaliation; protected classes under state fair housing laws; discriminatory acts prohibited by state fair housing laws; types of conduct that constitute nuisance activity; and required nuisance abatement actions.

IMPLEMENTATION AND/OR DISSEMINATION

As of August 1, 2017, all 50 states and the District of Columbia have a state landlord-tenant law; all states except Mississippi have a state fair housing law; and 37 of the 40 most populous US cities have a local nuisance property ordinance.

EVALUATION

Evaluation of these laws is needed to determine their effectiveness and impacts and to spread the use of evidence-based policies. The creation of these legal data sets is the first step toward evaluation.

DISCUSSION

Law can play an important role in promoting healthy housing, but evaluating the law is essential to determining its impact. Tracking the prevalence and key elements of laws is an important first step in conducting evaluation. The legal data created by the Center can be used to evaluate the efficacy and impacts of state landlord-tenant laws, state fair housing protections, and city nuisance property ordinances.

The health impacts of eviction: Evidence from the national longitudinal study of adolescent to adult health

Eviction represents an urgent social and economic issue in the United States, with nearly two million evictions occurring annually in the U.S. Still, the population health impacts of evictions, as well as the pathways linking eviction to health, are not well documented or understood, particularly among young adults. Using nationally-representative, longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (1994-2008) (n = 9029), the present study uses a combination of analytic methods-including prospective lagged dependent variable regression models, inverse probabilities of treatment weighting, longitudinal first difference models, causal mediation techniques-to comprehensively assess whether and how evictions relate to depressive risk and self-rated health across early adulthood, paying particular attention to the stress-related pathways linking eviction and health. Results provide robust evidence of positive longitudinal associations between eviction and depressive risk, in particular. In the prospective regression models, young adults who experienced recent eviction had more depressive symptoms and worse self-rated health than those who were not evicted, net a host of background characteristics. Using treatment weighting techniques, results showed that young adults who experienced eviction had more depressive symptoms than those who were not evicted (5.921 vs. 4.998 depressive symptoms, p = 0.003). Perceived social stress mediated nearly 18 percent of the associations between eviction and the depressive symptoms (p < 0.001). In the first difference models, young people who experienced eviction between survey waves experienced greater increases in depressive symptoms over time compared to those who were not evicted, net of changes in other indicators of socioeconomic status and residential instability. Taken together, our results suggest that the recent surges in evictions in the U.S. serve as a potent threat to population health during the emerging adult period, with especially devastating consequences for low-income individuals and communities of color.

Eviction, Health Inequity, and the Spread of COVID-19: Housing Policy as a Primary Pandemic Mitigation Strategy

The COVID-19 pandemic precipitated catastrophic job loss, unprecedented unemployment rates, and severe economic hardship in renter households. As a result, housing precarity and the risk of eviction increased and worsened during the pandemic, especially among people of color and low-income populations. This paper considers the implications of this eviction crisis for health and health inequity, and the need for eviction prevention policies during the pandemic. Eviction and housing displacement are particularly threatening to individual and public health during a pandemic. Eviction is likely to increase COVID-19 infection rates because it results in overcrowded living environments, doubling up, transiency, limited access to healthcare, and a decreased ability to comply with pandemic mitigation strategies (e.g., social distancing, self-quarantine, and hygiene practices). Indeed, recent studies suggest that eviction may increase the spread of COVID-19 and that the absence or lifting of eviction moratoria may be associated with an increased rate of COVID-19 infection and death. Eviction is also a driver of health inequity as historic trends, and recent data demonstrate that people of color are more likely to face eviction and associated comorbidities. Black people have had less confidence in their ability to pay rent and are dying at 2.1 times the rate of non-Hispanic Whites. Indigenous Americans and Hispanic/Latinx people face an infection rate almost 3 times the rate of non-Hispanic whites. Disproportionate rates of both COVID-19 and eviction in communities of color compound negative health effects make eviction prevention a critical intervention to address racial health inequity. In light of the undisputed connection between eviction and health outcomes, eviction prevention, through moratoria and other supportive measures, is a key component of pandemic control strategies to mitigate COVID-19 spread and death.

Forced evictions and their social and health impacts in Southern Somalia: a qualitative study in Mogadishu Internally Displaced Persons (IDP) camps

BACKGROUND

Forced evictions are common in conflict-affected settings. More than 500 internally displaced persons (IDPs) are evicted daily in Mogadishu. Context specific research is necessary to inform responsive humanitarian interventions and to monitor the effectiveness of these interventions on IDPs health.

OBJECTIVE

This study explored the causes of forced evictions and their health impacts among IDPs in southern Somalia.

METHODS

We used a qualitative approach, conducting 20 semi-structured interviews, six key informant interviews and four focus group discussions. We used maximum variation sampling to include a wide range of participants and used the framework approach and Nvivo software to analyse the data.

RESULTS

In this context, landlords often rented land without proper tenure agreements, resulting in risk of forced evictions. Informal tenure agreements led to fluctuations in rent, and IDPs were evicted because tenancy laws were inadequate and failed to protect IDP rights. IDP settlements often increased the value of land by clearing scrub, and landlords often sought to profit from this by evicting IDPs at short notice if a buyer was found for the land. The effect of eviction on an already marginalised population was wide ranging, increasing their exposure to violence, loss of assets, sexual assault, disruption of livelihoods, loss of social networks and family separation. Evicted IDPs reported health issues such as diarrhoea, malaria, pneumonia, measles and skin infections, as well as stress, anxiety, psychological distress and trauma.

CONCLUSION

Forced evictions remain one of the biggest challenges for IDPs as they exacerbate existing vulnerabilities. Prioritizing implementation of legal protection for IDP tenure rights is necessary to prevent unlawful evictions of IDPs. Humanitarian agencies should aim to respond more effectively to protect evictees and provide support to prevent poor health outcomes. Further quantitative research is needed to further examine the relationship between forced evictions and health outcomes.

Low assets and financial stressors associated with higher depression during COVID-19 in a nationally representative sample of US adults

BACKGROUND

COVID-19 and related containment policies have caused or heightened financial stressors for many in the USA. We assessed the relation between assets, financial stressors and probable depression during the COVID-19 pandemic.

METHODS

Between 31 March 2020 and 13 April 2020, we surveyed a probability-based, nationally representative sample of US adults ages 18 and older using the COVID-19 and Life stressors Impact on Mental Health and Well-being survey (n=1441). We calculated the prevalence of probable depression using the Patient Health Questionnaire-9 (cut-off ≥10) and exposure to financial stressors by financial, physical and social assets categories (household income, household savings, home ownership, educational attainment and marital status). We estimated adjusted ORs and predicted probabilities of probable depression across assets categories and COVID-19 financial stressor exposure groups.

RESULTS

We found that (1) 40% of US adults experienced COVID-19-related financial stressors during this time period; (2) low assets (OR: 3.0, 95% CI 2.1 to 4.2) and COVID-19 financial stressor exposure (OR: 2.8, 95% CI 2.1 to 3.9) were each associated with higher odds of probable depression; and (3) among persons with low assets and high COVID-19 financial stressors, 42.7% had probable depression; and among persons with high assets and low COVID-19 financial stressors, 11.1% had probable depression. Persons with high assets and high COVID-19 financial stressors had a similar prevalence of probable depression (33.5%) as persons with low assets and low COVID-19 financial stressors (33.5%). The more assets a person had, the lower the level of probable depression.

CONCLUSION

Populations with low assets are bearing a greater burden of mental illness during the COVID-19 pandemic.

Severe Housing-Cost Burden and Low-Income Young Children's Exposure to Adverse Experiences: A Cross-Sectional Survey of WIC Participants in Los Angeles County

OBJECTIVE

Substantial literature has documented adverse childhood experiences' (ACEs) link with poor health in childhood and adulthood. Despite many American low-income families spending more than a third of their income toward housing costs, little research has been published about a link between severe housing-cost burden and ACEs. The objective of this study was to examine the association of severe housing-cost burden to the ACEs to which young, low-income children are exposed.

METHODS

Participants were 2-5-year-olds who participated in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in Los Angeles County. We used data from the 2017 Los Angeles County WIC Survey, a survey of a random sample of all WIC participants living in Los Angeles County. Separate multiple logistic regression analyses were conducted to examine the association of severe housing-cost burden (very difficult to pay for housing) with the ACEs of financial hardship (household food insecurity, extreme poverty, parent's unemployment and underemployment), household dysfunction (parent's poor mental well-being and parent's separation), housing insecurity (doubled up and residential instability), and parent's experience with homelessness.

RESULTS

Sixteen percent of children lived in severe housing-cost burdened households and 14% experienced at least 4 ACEs. After adjusting for sociodemographic characteristics and social support, severe housing-cost burden was associated with an increase in the odds of each of the ACEs.

CONCLUSIONS FOR PRACTICE

While further research is needed, findings highlight the need for policymakers to provide resources and support for housing-cost burdened children. Also, service providers should identify ACEs among housing cost-burdened children.

"They don't know who they have in here": Sense of community in budget hotels

The purpose of this study was to understand older residents descriptions of socio-spatial guest interactions and sense of community in budget hotels. Due to financial vulnerability, some people move into budget hotels when other housing options are unavailable. Little is known about how older residents perceive other hotel guests who frequent the commercial establishment and how a mix of various consumer interactions can potentially influence health. Theoretically framing this inquiry with sense of community constructs, we conducted a secondary data analysis of 20 interviews with residents aged 50 and older. Through thematic analysis strategies, we identified temporal and socio-spatial interactions of hotel guests, then discussed sense of community based on these insider/outsider relationships. We conclude with research, policy, and practice implications of our findings.

Can Medicaid Expansion Prevent Housing Evictions?

Evictions are increasingly recognized as a serious concern facing low-income households. This study evaluated whether expansions of Medicaid can prevent evictions from occurring. We examined data from a privately licensed database of eviction records in fourteen states (286 counties) and used a difference-in-differences research design to compare rates of eviction before and after California's early Medicaid expansion (51 counties). Early Medicaid expansion in California was associated with a reduction in the number of evictions, with 24.5 fewer evictions per month in each county from a pre-expansion average of 224.7. These results imply that for every thousand new Medicaid enrollees in California, Medicaid expansion was associated with roughly twenty-two fewer evictions per year. Additionally, we found a 2.9-percentage-point reduction in evictions per capita associated with early expansion. The effects were concentrated among counties with the highest pre-expansion rates of uninsurance. We conclude that health insurance coverage is associated with improved housing stability.

In utero exposure to threat of evictions and preterm birth: Evidence from the United States

OBJECTIVE

To estimate county-level associations between in utero exposure to threatened evictions and preterm birth in the United States.

DATA SOURCES

Complete birth records were obtained from the National Center for Health Statistics (2009-2016). Threatened evictions were measured at the county level using eviction case filing data obtained from The Eviction Lab (2008-2016). Additional economic and demographic data were obtained from the United States Census Bureau and Bureau of Labor Statistics.

STUDY DESIGN

We conducted a retrospective cohort analysis using 7.3 million births from 1,633 counties. We defined threatened eviction exposures as the z-score of average case filings over the pregnancy and by trimester. Our primary outcome was an indicator for preterm birth (born < 37 completed weeks of gestation). Secondary outcomes included a continuous measure for gestational length, a continuous measure for birth weight, and an indicator for low birth weight (born < 2500 g). We estimated within-county associations controlling for individual- and time-varying county-level characteristics, state-of-residence-year-and-month-of-conception fixed effects, and a county-specific time trend.

DATA COLLECTION/EXTRACTION

We merged birth records with threatened eviction data at the county-month-year level using mother's county of residence at delivery and month-year of conception. We supplemented these data with information on county-level annual 18-and-over population, annual poverty rate, and monthly unemployment rate.

PRINCIPAL FINDINGS

Increased levels of eviction case filings over a pregnancy were associated with an increased risk of prematurity and low birth weight. These associations appeared to be sensitive to exposure in the second and third trimesters. Associations with secondary outcomes and within various population subgroups were, in general, imprecisely estimated.

CONCLUSIONS

Higher exposure to eviction case filings within counties, particularly in the latter stages of a pregnancy, was associated with an increased risk of adverse birth outcomes. Future research should identify the causal effect of threatened evictions on maternal and child health outcomes.

Importance of Housing and Cardiovascular Health and Well-Being: A Scientific Statement From the American Heart Association

Cardiovascular disease disparities are shaped by differences in risk factors across racial and ethnic groups. Housing remains an important social determinant of health. The objective of this statement is to review and summarize research that has examined the associations of housing status with cardiovascular health and overall health. PubMed/Medline, Centers for Disease Control and Prevention data, US Census data, Cochrane Library reviews, and the annual Heart Disease and Stroke Statistics report from the American Heart Association were used to identify empirical research studies that examined associations of housing with cardiovascular health and overall well-being. Health is affected by 4 prominent dimensions of housing: stability, quality and safety, affordability and accessibility, and neighborhood environment. Vulnerable and underserved populations are adversely affected by housing insecurity and homelessness, are at risk for lower-quality and unsafe housing conditions, confront structural barriers that limit access to affordable housing, and are at risk for living in areas with substandard built environment features that are linked to cardiovascular disease. Research linking select pathways to cardiovascular health is relatively strong, but research gaps in other housing pathways and cardiovascular health remain. Efforts to eliminate cardiovascular disease disparities have recently emphasized the importance of social determinants of health. Housing is a prominent social determinant of cardiovascular health and well-being and should be considered in the evaluation of prevention efforts to reduce and eliminate racial/ethnic and socioeconomic disparities.

Perceived pathways between tourism gentrification and health: A participatory Photovoice study in the Gòtic neighborhood in Barcelona

Tourism gentrification is as process of urban change and neighborhoods transformation, according to the needs of affluent visitors, increasing in some global cities. However, the link between tourism gentrification and resident's health is still an understudied topic. Using Photovoice, a participatory action research method, the aim of this study was to identify the perceived pathways that underlie the relationship between tourism gentrification and health among residents of Gòtic neighborhood, in Barcelona. The study was conducted between January 2018 and January 2019. Thirteen residents, recruited from two neighborhood organizations, took photographs of how tourism gentrification of the neighborhood was affecting their health. Participants analyzed and critically discussed their photographs in small group sessions. Through a consensus-building process, participants categorized 35 photographs and identified 7 emerging categories acknowledged as possible pathways between tourism gentrification and health, in Gòtic neighborhood: 1) decline of social networks; 2) loss of identity; 3) environmental changes; 4) pollution; 5) changes in services and stores; 6) property speculation/eviction and; 7) activism by residents. This Photovoice study recognizes important pathways underlying the relationship between tourism gentrification in the Gòtic neighborhood and the health of its residents, by altering the built environment, the social environment or psychological factors. Among them, six pathways were related to negative health outcomes, both physical and mental (respiratory diseases; worse nutrition habits; sleep deprivation; stress, anxiety and depression). 'Activism by residents' was perceived to buffer the negative health effects of living in a touristic area. The study also provides recommendations to tackle this serious urban health issue.

Eviction in early childhood and neighborhood poverty, food security, and obesity in later childhood and adolescence: Evidence from a longitudinal birth cohort

Eviction affects a substantial share of U.S. children, but its effects on child health are largely unknown. Our objectives were to examine how eviction relates to 1) children's health and sociodemographic characteristics at birth, 2) neighborhood poverty and food security at age 5, and 3) obesity in later childhood and adolescence. We analyzed data from the Fragile Families and Child Wellbeing Study, a longitudinal cohort of children born in 20 large U.S. cities. Children who lived in rental housing with known eviction histories and measured outcomes were included. We compared maternal and infant health and sociodemographic characteristics at the time of the child's birth. We then characterized the associations between eviction and neighborhood poverty and food security at age 5 and obesity at ages 5, 9, and 15 using log binomial regression with inverse probability of treatment and censoring weights. Of the 2556 children included in objective 1, 164 (6%) experienced eviction before age 5. Children who experienced eviction had lower household income and maternal education and were more likely to be born to mothers who were unmarried, smoked during pregnancy, and had mental health problems. Evicted and non-evicted children were equally likely to experience high neighborhood poverty at age 5 (prevalence ratio (PR) = 1.03, 95% CI 0.82, 1.29) but had an increased prevalence of low food security (PR = 2.16, 95% CI 1.46, 3.19). Obesity prevalence did not differ at age 5 (PR = 1.01; 95% CI 0.58, 1.75), 9 (PR = 1.08; 95% CI 0.715, 1.55); or 15 (PR = 1.05; 95% CI 0.51, 2.18). In conclusion, children who went on to experience eviction showed signs of poor health and socioeconomic disadvantage already at birth. Eviction in early childhood was not associated with children's likelihood of neighborhood poverty, suggesting that eviction may not qualitatively change children's neighborhood conditions in this disadvantaged sample. Though we saw evidence supporting an association with low child food security at age 5, we did not find eviction to be associated with obesity in later childhood and adolescence.

•

Children who experience eviction have health and socioeconomic disadvantages at birth.

•

Eviction was not associated with neighborhood poverty or childhood obesity.

•

Evicted children (vs. not) had over twice the prevalence of food insecurity at age 5.

•

Interventions to prevent eviction can protect children from hunger and adversity.

Provision of Social Services and Health Care Quality in US Community Health Centers, 2017

Objectives. To describe the types of social services provided at community health centers (CHCs), characteristics of CHCs providing these services, and the association between on-site provision and health care quality.Methods. We surveyed CHCs in 12 US states and the District of Columbia during summer 2017 (n = 208) to identify referral to and provision of services to address 8 social needs. Regression models estimated factors associated with the provision of social services by CHCs and the association between providing services and health care quality (an 8-item composite).Results. CHCs most often offered on-site assistance for needs related to food or nutrition (43%), interpersonal violence (32%), and housing (30%). Participation in projects with community-based organizations was associated with providing services on-site (odds ratio = 2.48; P = .018). On-site provision was associated with better performance on measures of health care quality (e.g., each additional social service was associated with a 4.3 percentage point increase in colorectal cancer screenings).Conclusions. Some CHCs provide social services on-site, and this was associated with better performance on measures of health care quality.Public Health Implications. Health care providers are increasingly seeking to identify and address patients' unmet social needs, and on-site provision of services is 1 strategy to consider.

The effect of evictions on accidental drug and alcohol mortality

OBJECTIVE

To assess the relationship between county-level eviction rates and drug and alcohol mortality rates.

DATA SOURCES

Eviction rates from 2003 to 2016 provided by the Princeton University Eviction Lab were merged with Multiple Cause-of-Death Mortality Files and aggregated to the county-year level.

STUDY DESIGN

All opioid (prescription and heroin), cocaine, psychostimulant, benzodiazepine, antidepressant, and alcohol poisoning-related deaths per 100 000 people, eviction rates, and socioeconomic indicators were merged at the county-year level from 2003 to 2016. We estimated a series of mortality rate models with county and year fixed effects and used a control function (2SRI) method to adjust for the endogeneity of eviction rates.

DATA COLLECTION/EXTRACTION METHODS

We matched retrospectively collected datasets.

PRINCIPAL FINDINGS

Higher levels of eviction rates were consistently associated with higher rates of mortality across six of nine substance categories studied when all counties were combined. Subanalysis by USDA population density measures indicated this positive association was almost entirely driven by urban counties; few systematic associations between the eviction rate levels and mortality were observed for suburban or rural counties.

CONCLUSIONS

Risk of eviction appears to exacerbate the current "deaths of despair" crisis associated with substance use. Proposed changes to Housing and Urban Development policy that are expected to substantially increase the risk of eviction may worsen an already-acute mortality crisis.

Intergenerational photovoice perspectives of place and health in public housing: Participatory coding, theming, and mapping in/of the "structure struggle"

This paper details an intergenerational photovoice project exploring spatial and perceptual differences of "place" and health among adult and youth public housing residents in a small urban rustbelt city in the Midwestern United States. It specifically highlights the value of fully participatory photovoice processes-participatory narrative-coding and digital web-based photo-mapping-in furthering conceptual and analytical understanding of "place" and health. Results indicate the critical import of accounting for non-residential locations (i.e. activity spaces), and the significance of engaging the generationally- and spatially-specific social and physical landscapes of residents' lived "place" to improve health opportunities within place-based strategies involving public housing.

[How does the employment status influence the effects of residential insecurity on health?]

OBJECTIVE

This study aims to analyze the effects of housing insecurity on health and if those are modified by employment status of people belonging to "Treball als Barris" program in Barcelona between 2015 and 2016.

METHODS

We conducted a longitudinal study using a survey which included sociodemographic, employment and housing status information. This was administered to 469 individuals attended by "Treball als Barris" at baseline and after one year of follow-up. Then, we carried out a descriptive analysis and fitted regression models to estimate the effects of housing insecurity and employment status on health, and the interaction between them.

RESULTS

Among women, we found negative effects of housing insecurity on health (PR of poor self-reported health among women who stayed under housing insecurity was 2.29 [IC95%: 1.36-3.84] compared to those who stayed secured), while, among men, main effects on health were due to employment status (PR of poor self-reported health among men who were unemployed without subsidy was 3.16 [IC95%: 1.02-6.15] compared to those who were employed after follow-up). In addition, results suggest an interaction between housing and employment status on mental health among.

DISCUSSION

Housing insecurity rates have increased in last years. It produces negatives effects on health and can interact with other social determinants such as employment, mainly on men's mental health.

Risk of suicide in households threatened with eviction: the role of banks and social support

Background

One of the greatest effects of the financial crisis in Spain has been the enormous increase in the number of evictions. Several studies have shown the association of evictions with different aspects of the physical and mental health. Furthermore, evictions have been associated with an increased risk of suicide. Our objective was to evaluate the risk of suicide among victims of eviction and investigate whether it is associated with specific characteristics of households and interviewees, the eviction process and social support, and health needs.

Methods

A total of 205 participants from households threatened with eviction in Granada, Spain, and 673 being the total number of members of these households, were interviewed in one-on-one sessions between April 2013 and May 2014. Through a questionnaire, information was obtained on physical and mental health, characteristics of their eviction process and support networks, and the use of health services.

Results

Almost half of the sample (46.7%) were at low (11.8%), moderate (16.9%), or high suicide risk (17.9%). Household and interviewee features had a limited association with suicide risk. On the contrary, the risk of suicide is greater with a longer exposure to the eviction process. In addition, threatening phone calls from banks increased significantly the risk of suicide, especially among men. Suicide risk was also associated with low social support, especially among women. Interviewees at risk of suicide received more help from nongovernmental organizations than those who were not at risk. In interviewees at risk, the main unmet needs were emotional and psychological help, especially in men. A high percentage of those at risk of suicide declare having large unmeet health needs. Finally, there was a tendency among the evicted at risk of suicide to visit emergency room and primary care more often than those not at risk, especially among women.

Conclusions

To our knowledge, this is the first study showing that when banks adopt a threatening attitude, suicide risk increases among the evicted. As hypothesized, when the evicted felt socially supported, suicide risk decreased. Emotional help was the main mediator of suicide risk and the main unmet need, especially among men.

Financial Fraud, Mental Health, and Quality of Life: A Study on the Population of the City of Madrid, Spain

Over the past few decades, the financial system has engaged in abusive practices that meet the definition of fraud. Our objective is to compare the prevalence of psychological distress and levels of health-related quality of life according to having been exposed to financial fraud and its economic impact on family finances. The City of Madrid Health Survey 2017 included specific questions on exposure to financial fraud-this section was administered to half of the participants (n = 4425). Mental health need or caseness was defined by a score greater than two on the 12-item version of the Goldberg health questionnaire. Health-related quality of life was assessed by the Darmouth Coop Functional Health Assessment Charts/WONCA (COOP/WONCA). The prevalence of financial fraud was 10.8%. The prevalence rate ratio for caseness of those who experienced severe economic impact due to fraud was 1.62 (95%, CI 1.17-2.25; reference: no fraud), after adjustment by age, sex, social class, and immigrant status. Women experienced a decreased quality of life, even with a moderate impact of fraud, while men experienced a decreased quality of life related to fraud with severe economic impact. The current study contributes to a growing body of literature showing the effects of economic shocks on health as a result of financial fraud.

[Biopsychosocial consequences in Spanish population affected by an eviction process]

The biopsychosocial consequences in Spanish population affected by an eviction process were described in this paper. A scoping review was conducted, consulting the following databases: PubMed, Scopus, PsycINFO, CINAHL, LILACS, CSIC, MEDES, Scielo, Dialnet, Cuiden Plus and Cochrane. The search strategy was (Eviction OR "Home eviction" OR "Housing eviction" OR "Households at risk of eviction" OR Foreclosure) AND ("Health" OR "Mental Health" OR "Psychosocial impact" OR "Impacts on health" OR "Social impact indicators" OR "Social Determinants of Health" OR "Social Indicators").Eleven articles published between 2008 and September 2018 were selected. They followed a quantitative or qualitative methodology. The research quality was measured, and the results were organized according to the biopsychosocial model. From the physical perspective, results described a poor self-perception of health, as well as an increase of chronic diseases, pain, drug consumptions. From the psychological perspective, it was found negative thoughts, recurrent emotions and increased anxiety, depression, mental disorder and post-traumatic stress. From the social perspective, it was found that family, the offspring and the guarantor were affected, as well as the health system with greater medical visits and emergencies. This review showed worse health indicators among women, such as a headache, smoking habits, worse self-perception of health and more mental health disorders (depression, anxiety and other types of psychological distress). Daughters revealed worse self-perception of health than sons. It is necessary an approach from public health, epidemiological surveillance, action protocols and health programs, to advise, diagnose, prevent, protect and promote the health of the Spanish population affected.

The Effects of the ACA Medicaid Expansion on Nationwide Home Evictions and Eviction-Court Initiations: United States, 2000-2016

Objectives. To evaluate the effect of the Affordable Care Act (ACA) Medicaid expansions on national rates of home eviction and eviction initiation in the United States.Methods. Using nationally representative administrative data from The Eviction Lab at Princeton University, we estimated the effects of the ACA Medicaid expansions on county-level evictions and filings from 2000 to 2016 with a difference-in-difference regression design.Results. We found that Medicaid expansions were associated with an annual reduction in the rate of evictions by 1.15 per 1000 renter-occupied households (P < .001), a reduction of 1.59 eviction filings per 1000 renter-occupied households (P < .001), and a reduction in the average number of evictions by 46 (P < .05). We found additional evidence that increasing rates of African American residents in a county was associated with a greater rate of evictions filed, and increased rates of poverty and rent burdens relative to income were associated with more evictions both filed and completed.Conclusions. Evictions decreased after Medicaid expansion, demonstrating further evidence of the substantive financial protections afforded by this coverage. The reduction in the eviction filing rate suggests that Medicaid expansion could be reducing evictions by preventing the court proceeding entirely.

Housing Disadvantage and Poor Mental Health: A Systematic Review

CONTEXT

This study reviews collective evidence on the longitudinal impact of housing disadvantage (based on tenure, precarity, and physical characteristics) on mental health. It is focused on temporally ordered studies where exposures preceded outcomes, a key criterion to establishing causal evidence.

EVIDENCE ACQUISITION

A systematic review of evidence on housing disadvantage and mental health was performed. The literature search used six electronic databases including MEDLINE (PubMed and Ovid platform), Embase, PsycINFO, Web of Science, SciELO, and Sociological Abstracts. Population-based longitudinal studies where exposure to housing disadvantage (excluding exposure to homelessness) preceded mental health were included. Methodologic quality of selected studies was examined using the Newcastle-Ottawa Quality Assessment Scale. Because of definitional and methodologic heterogeneity among studies, narrative synthesis rather than meta-analysis was used to summarize research findings.

EVIDENCE SYNTHESIS

Of the 1,804 unique titles identified in the literature search, 12 met the selection criteria for inclusion in the systematic review. Housing disadvantage was measured by overcrowding, mortgage delinquency, housing mobility, housing tenure, subjective perceptions of inadequate housing, eviction, and physical housing conditions. Mental health was measured as depression, psychological impairment, anxiety, allostatic load, mental strain, and psychological health. Study sample sizes ranged from 205 to 16,234 people, and the follow-up period ranged from within 1 year to 34 years. Each study indicated a positive association between housing disadvantage and mental health for at least one housing disadvantage measure and mental health outcome.

CONCLUSIONS

This systematic review confirms that prior exposure to housing disadvantage may impact mental health later in life.

Housing insecurity and health among people in South Korea: focusing on tenure and affordability

OBJECTIVES

Housing is one of the social determinants of health, and the evidence of its impact in this area has been increasingly expanded. However, in spite of its importance, there have been few studies to investigate an association between housing and health in Korea. Our study aimed to investigate housing tenure and affordability and their effects on health outcomes in Korea.

STUDY DESIGN

We selected 9456 participants from the 10-11th wave of the Korea Welfare Panel Study, after excluding missing variables. Housing tenure and affordability were chosen as independent variables, and depressive symptoms and self-rated health were selected as dependent variables.

METHODS

Logistic regression was implemented to investigate the association between housing tenure/affordability and health outcome, and all covariates such as sex, age, and household income were adjusted.

RESULTS

Compared with homeowners, renters are more likely to have depressive symptoms (odds ratio [OR]: 1.26, 95% confidence interval [CI]: 1.08, 1.47) and poor self-rated health (OR: 1.38, 95% CI: 1.19-1.61). Also, health effects of housing unaffordability were observed differently by tenure, showing that the likelihood of having depressive symptoms (OR: 1.56, 95% CI: 1.15, 2.13) and poor self-rated health (OR: 1.51, 95% CI: 1.10, 2.06) is significantly high among renters who reported unaffordability.

CONCLUSION

This study could provide evidence of housing as a determinant of health by showing that both housing tenure and affordability are significantly related to health outcomes.

Systematic review of psychosocial factors associated with evictions

Evictions from rented accommodations are a common pathway to homelessness and can negatively impact the lives of individuals and communities worldwide. There have been only few interventions developed to address evictions, and it is important to first understand factors associated with evictions. This systematic review included all available peer-reviewed articles on the topic published in the international literature from 1900 to 2017 and identified 10 peer-reviewed studies of evictions conducted in the United States, Canada, Amsterdam and Britain. From these studies, four categories of factors associated with evictions were identified. These factors were financial hardships, sociodemographic characteristics, substance use and other health problems. While many studies had large sample sizes, the majority of studies were cross-sectional. Together, our review found that there were several salient factors known to be associated with evictions which may benefit from intervention. However, more prospective studies on evictions and development of interventions are needed.

Effects of Superblocks on health and health inequities: a proposed evaluation framework

The following essay outlines the intervention and presents a framework that will serve as a guide in the evaluation of the different effects of the Superblocks. Superblocks consist of amalgamations of blocks throughout the city, with the goal of improving the habitability of public spaces, advancing sustainable mobility, increasing urban green, and promoting residents' participation and coresponsibility, while ultimately influencing residents' health and health inequities. The evaluation framework considers the following aspects: the interventions implemented in the Superblock strategy, the changes that occur at neighbourhood and individual level and the population turnover as intermediate factors and finally the health outcomes. Inequity dimensions are also considered.

Our lives in boxes: perceived community mediators between housing insecurity and health using a PHOTOVOICE approach

Background

While the negative effects of housing insecurity on health are well known, the mechanisms and mediators of these effects have been less well studied. The aim of this study is to identify perceived mediators involved in the relationship between housing insecurity and health.

Methods

We used a participatory action research approach, the Photovoice methodology. It promotes a reflective process where participants critically discuss housing insecurity and human health and make recommendations to find solutions for the issues identified. This study was conducted with 18 members of the Platform for People Affected by Mortgages who were living in a situation of housing insecurity in Barcelona during the first half of 2017.

Results

Participants took 990 photographs, of which 147 were printed for analysis in discussion sessions. 109 of these photographs were then selected for categorization by the participants. 11 major categories emerged, representing various factors related to housing insecurity and health. Most categories were acknowledged as possible mediators of the housing/health problem, including: psychological changes; housing-related material aspects; health-related behaviors; eviction; harassment by financial institutions; and family, neighbors and social network. Others were considered as modifiers that could alter the effects of housing insecurity on health. Co-existing determinants may interact with housing insecurity, thereby increasing negative effects on health.

Conclusions

Through this participatory approach, the Photovoice project gives insight into the mechanisms underlying the relationship between housing insecurity and human health, and provides valuable recommendations to combat this serious public health issue.

Electronic supplementary material

The online version of this article (10.1186/s12939-019-0943-0) contains supplementary material, which is available to authorized users.

Eviction From Renter-occupied Households and Rates of Sexually Transmitted Infections: A County-level Ecological Analysis

BACKGROUND

Housing instability is linked to numerous health outcomes, but the specific impact of eviction from renter-occupied households, an event that has immediate implications for residential stability for low-income individuals, on sexually transmitted infections (STI) rates has not been adequately studied.

METHODS

We examined county-level associations between eviction rates in 2014 and rates of chlamydia and gonorrhea in the following year using publicly available data sources (Eviction Lab National Database and AtlasPlus, respectively). Descriptive statistics compared medians and nonparametric distributions with Krusal-Wallis tests. Linear regression was used to compare tertile categories of eviction rates and STI rates while controlling for potential confounders.

RESULTS

Median rates of chlamydia in counties with low, medium, and high rates of eviction were 229, 270, and 358 cases per 100,000 population, respectively (P < 0.001). The corresponding median rates of gonorrhea were 25, 37, and 75 cases per 100,000 population (P < 0.001). These associations remained statistically significant after controlling for all covariates in adjusted models. The beta coefficients and 95% confidence intervals (95% CI) for chlamydia and gonorrhea comparing high to low county-level eviction rates were 63.8 (95% CI, 45.1-82.5) and 20.4 (95% CI, 13.5-27.4), respectively. Similar associations were observed across levels of poverty and in both metropolitan and nonmetropolitan counties.

CONCLUSIONS

County-level eviction rates are associated with chlamydia and gonorrhea rates in a significant and robust way independent of other known predictors of STI. These results suggest that evictions result in residential instability in a way that may increase STI risk.

Analyzing Policies Through a DOHaD Lens: What Can We Learn?

Social, health, and environmental policies are critical tools for providing the conditions needed for healthy populations. However, current policy analyses fall short of capturing their full potential impacts across the life course and from generation to generation. We argue that the field of Developmental Origins of Health and Disease (DOHaD), a conceptual and research framework positing that early life experiences significantly affect health trajectories across the lifespan and into future generations, provides an important lens through which to analyze social policies. To illustrate this point, we synthesized evidence related to policies from three domains-family leave, nutrition, and housing-to examine the health implications for multiple generations. We selected these policy domains because they represent increasing distance from a reproductive health focus, each with a growing evidence base to support a potential impact on pregnant women and their offspring. Each of these examples represents an opportunity to extend our understanding of policy impact using a DOHaD lens, taking into account the potential life course and intergenerational effects that have previously been overlooked.

Development and validation of a search filter to identify equity-focused studies: reducing the number needed to screen

Background

Health inequalities, worse health associated with social and economic disadvantage, are reported by a minority of research articles. Locating these studies when conducting an equity-focused systematic review is challenging due to a deficit in standardised terminology, indexing, and lack of validated search filters. Current reporting guidelines recommend not applying filters, meaning that increased resources are needed at the screening stage.

Methods

We aimed to design and test search filters to locate studies that reported outcomes by a social determinant of health. We developed and expanded a ‘specific terms strategy’ using keywords and subject headings compiled from recent systematic reviews that applied an equity filter. A ‘non-specific strategy’ was compiled from phrases used to describe equity analyses that were reported in titles and abstracts, and related subject headings. Gold standard evaluation and validation sets were compiled. The filters were developed in MEDLINE, adapted for Embase and tested in both. We set a target of 0.90 sensitivity (95% CI; 0.84, 0.94) in retrieving 150 gold standard validation papers. We noted the reduction in the number needed to screen in a proposed equity-focused systematic review and the proportion of equity-focused reviews we assessed in the project that applied an equity filter to their search strategy.

Results

The specific terms strategy filtered out 93-95% of all records, and retrieved a validation set of articles with a sensitivity of 0.84 in MEDLINE (0.77, 0.89), and 0.87 (0.81, 0.92) in Embase. When combined (Boolean ‘OR’) with the non-specific strategy sensitivity was 0.92 (0.86, 0.96) in MEDLINE (Embase 0.94; 0.89, 0.97). The number needed to screen was reduced by 77% by applying the specific terms strategy, and by 59.7% (MEDLINE) and 63.5% (Embase) by applying the combined strategy. Eighty-one per cent of systematic reviews filtered studies by equity.

Conclusions

A combined approach of using specific and non-specific terms is recommended if systematic reviewers wish to filter studies for reporting outcomes by social determinants. Future research should concentrate on the indexing standardisation for equity studies and further development and testing of both specific and non-specific terms for accurate study retrieval.

Electronic supplementary material

The online version of this article (10.1186/s12874-018-0567-x) contains supplementary material, which is available to authorized users.

Evicted children and subsequent placement in out-of-home care: A cohort study

Background

Evictions may have serious consequences for individuals’ health and wellbeing. Even though an eviction may be experienced as a significant crisis for the family, there is little previous knowledge on consequences for evicted children. This study represents the first attempt to examine to what extent children from evicted households were separated from their parents and placed in out-of-home care (foster family or residential care) using population-based data, net of observed confounding factors related to the socioeconomic and psychosocial circumstances of their parents.

Methods

This study takes advantage of information from a Swedish national database, consisting of about 8 000 evicted individuals and a random sample of 770 000 individuals from the national population, linked to individual-level, longitudinal data from Swedish national registers. Our analytical sample consists of information for more than 250 000 children born in 1995–2008, including 2 224 children from evicted households. We used binary logistic regression based on the Karlson/Holm/Breen method to account for observed imbalances at baseline between evicted and non-evicted children.

Results

Compared to non-evicted children, the crude odds ratio for placement in out-of-home care in evicted children was 12.10 (95% CI 8.54–17.14). Net of observed confounding factors related to the socioeconomic and psychosocial circumstances of the parents, evicted children had a twofold elevated risk of being placed in out-of-home care (odds ratio 2.26, 95% CI 1.55–3.27). Crude OR for evicted children in comparison with children under threat of eviction (eviction not formally executed) was 1.71 (95% CI 1.17–2.49) and adjusted OR 1.58 (95% CI 1.06–2.35).

Conclusion

Children who experience eviction constitute a disadvantaged group and are at significant risk of being separated from their parents and placed in out-of-home care. These results demonstrate the importance of providing support for these children and their parents. Strategies to prevent households with children from being evicted seem to be an important and viable intervention path.