The Effects of Rental Assistance on Housing Stability, Quality, Autonomy, and Affordability

Association Between Rental Assistance Programs and Undiagnosed Diabetes Among U.S

BACKGROUND

Rental assistance programs have been linked to better housing quality, stability, healthcare access, and reduced likelihood of uncontrolled diabetes. However, its direct association with diabetes screening is uncertain.

OBJECTIVE

To determine whether federal rental assistance programs are associated with lower odds of undiagnosed diabetes.

DESIGN

We used a quasi-experimental approach, comparing outcomes among adults receiving rental assistance to those who entered assisted housing within 2 years after their health data were collected. We test the a priori hypothesis that rental assistance will be associated with decreased odds of undiagnosed diabetes.

PARTICIPANTS

Participants in the National Health and Nutrition Examination Survey 1999-2018 who received rental assistance and who had diabetes.

INTERVENTION

Current rental assistance participation, including specific housing programs.

MAIN MEASURES

Undiagnosed diabetes based on having hemoglobin A1c ≥ 6.5% but answering no to the survey question of being diagnosed with diabetes.

KEY RESULTS

Among 435 eligible adults (median age 54.5 years, female 68.5%, non-Hispanic white 32.5%), 80.7% were receiving rental assistance programs at the time of the interview, and 19.3% went on to receive rental assistance within 2 years. The rates of undiagnosed diabetes were 15.0% and 25.3% among those receiving rental assistance programs vs. those in the future assistance group (p-value = 0.07). In an adjusted logistic regression model, adults receiving rental assistance had lower odds of undiagnosed diabetes (OR 0.52, 95% CI 0.28-0.94) than those in future assistance groups. Sex, race and ethnic group, educational level, and poverty ratio were not significantly associated with having undiagnosed diabetes, but individuals aged 45-64 years had significantly lower odds of undiagnosed diabetes (OR 0.21, 95% CI 0.08-0.53) compared with those aged 18-44.

CONCLUSIONS

Rental assistance was linked to lower odds of undiagnosed diabetes, suggesting that affordable housing programs can aid in early recognition and diagnosis, which may improve long-term outcomes.

Transitions into and out of housing cost burden and their asymmetric effects on depressive symptoms: the moderating role of housing tenure

OBJECTIVES

This study uses an approach that estimates the asymmetric effects of transitioning into and out of housing cost burden on psychological health.

STUDY DESIGN

We used data from 14 waves of the Korean Welfare Panel Study.

METHODS

We estimated an asymmetric fixed-effects model to examine whether transitioning into and out of housing cost burden is associated with depressive symptoms. Interaction models were used to assess whether these effects differ by housing tenure.

RESULTS

A standard fixed-effects model indicates that housing cost burden is associated with depressive symptoms (b = 0.126). However, the results of the asymmetric fixed-effects model suggest that transitioning out of housing cost burden reduces depressive symptoms (b = -0.171), while transitioning into housing cost burden is not associated with a change in depressive symptoms. These asymmetric effects of housing cost burden on depressive symptoms are more pronounced for renters than for owner-occupiers.

CONCLUSION

The findings suggest that alleviating housing cost burden can improve the psychological well-being of individuals, particularly among renters.

Hospitalization and Housing: A Qualitative Study Exploring the Perspectives of Hospitalized Patients Experiencing Housing Insecurity

Although housing insecurity has clear negative impacts on health, little is known about how it impacts patients' experience of hospitalization. In this qualitative study, we interviewed 22 hospitalized patients experiencing housing insecurity. The following three major themes emerged: 1) adverse social and environmental factors directly contribute to hospitalization, 2) lack of tailored care during hospitalization leaves patients unprepared for discharge, and 3) patients have difficulty recuperating after a hospital stay, leading to the risk of rehospitalization. Within these themes, participants described the roles of extreme physical and psychological hardship, chaotic interpersonal relationships, substance use, and stigma affecting participants' experiences before, during, and following hospitalization. Our results, based directly on the patient experience, suggest a need for hospital systems to invest in universal in-hospital screening for housing insecurity, incorporation of trauma-informed care, and robust partnerships with community organizations. Future research should explore the feasibility and impact of these interventions.

"The Squeaky Wheel Gets the Grease": Rental Assistance Applicants' Quests for a Rationed and Scarce Resource

In 2016, only one in five eligible U.S. households received rental assistance and waiting lists averaged two years nationally. The gap between available rental assistance and need requires systems to allocate this scarce resource. The way potential rental assistance recipients experience and navigate these systems is likely to shape who ultimately receives assistance. We draw on repeated qualitative interviews (N=238) with low-income New Haven residents (N=54) to examine how participants understand and navigate rental assistance applications and waiting lists. Participants encountered multiple challenges in their search for rental assistance. They described an opaque and complex application and waiting process requiring significant knowledge to navigate. They also described considerable labor associated with monitoring waiting lists, a challenge made more difficult for some by their lack of a stable address. Additionally, participants described significant labor and knowledge required to strategically navigate prioritization systems that often required them to advocate for their deservingness of scarce housing resources. Our findings suggest that the allocation of rental assistance through complex processes that depend on applicant knowledge, labor, and advocacy may create barriers to housing, particularly for more vulnerable and marginalized housing seekers.

Association Between Rental Assistance Programs and Hemoglobin A1c Levels Among US Adults

Importance

Programs that provide affordable and stable housing, such as federal rental assistance, may be associated with improved mean blood glucose levels and related diabetes outcomes.

Objective

To assess whether 2 different types of federal rental assistance programs are associated with glycated hemoglobin A1c (HbA1c) levels among middle-aged and older US adults.

Design, Setting, and Participants

This cohort study used data from the National Health and Nutrition Examination Survey (NHANES) linked with US Department of Housing and Urban Development records of rental assistance participation. Adults aged 45 years or older who were receiving 2 types of rental assistance (project-based housing or housing vouchers) at the time of the NHANES interview and those who would receive rental assistance within the subsequent 2 years (waitlist group) were included. Data were collected from January 1999 to December 2016 and analyzed in October 2021.

Exposures

Rental assistance participation, including project-based housing (subsidized housing developments including public housing) and housing vouchers (tenant-based subsidies for private market housing).

Main Outcomes and Measures

The primary outcome was continuous HbA1c level, a common measure of blood glucose reflecting diabetes control. Linear regression was used to estimate the association between the 2 rental assistance programs and HbA1c level. Logistic regression was used to assess the association between rental assistance programs and HbA1c cut points (prediabetes: 5.7% to ≤6.5%; diabetes: >6.5%; uncontrolled diabetes: ≥9% [to convert to proportion of total Hb, multiply by 0.01]). Analyses used weights created by the National Center for Health Statistics that adjust for linkage eligibility.

Results

Among 1050 adults in the study (41.6% aged ≥65 years; 70.1% female), 795 were receiving rental assistance at time of the NHANES interview (450 lived in project-based housing, and 345 had housing vouchers), and 255 received rental assistance within 2 years after the interview. Participants in project-based housing had lower HbA1c levels compared with individuals in the waitlist group (β, -0.290; 95% CI, -0.599 to 0.020), but the difference was not significant. No significant differences in HbA1c levels were found between those receiving housing vouchers and those in the waitlist group (β, 0.051; 95% CI, -0.182 to 0.284). Receiving project-based housing was associated with a reduced likelihood of uncontrolled diabetes (-3.7 percentage points; 95% CI, -7.0 to -0.0 percentage points) compared with being in the waitlist group.

Conclusions and Relevance

In this cohort study of a nationally representative sample of US adults, living in project-based, federally subsidized housing was associated with a reduced likelihood of uncontrolled diabetes. The findings suggest that affordable housing programs may be associated with improved diabetes outcomes.