Simulating desegregation through affordable housing development: an environmental health impact assessment of Connecticut zoning law

Residential segregation shapes access to health-promoting resources and drives health inequities in the United States. Connecticut's Section 8-30g incentivizes municipalities to develop a housing stock that is at least 10% affordable housing. We used this implicit target to project the impact of increasing affordable housing across all 169 Connecticut municipalities on all-cause mortality among low-income residents. We modeled six ambient environmental exposures: fine particulate matter (PM2.5), ozone (O3), nitrogen dioxide (NO2), summertime daily maximum heat index, greenness, and road traffic noise. We allocated new affordable housing to reach the 10% target in each town and simulated random movement of low-income households into new units using an inverse distance weighting penalty. We then quantified exposure changes and used established exposure-response functions to estimate deaths averted stratified by four ethnoracial groups: Asian, Hispanic or Latino, non-Hispanic Black, and non-Hispanic White. We quantified racialized segregation by computing a multi-group index of dissimilarity at baseline and post-simulation. Across 1,000 simulations, in one year (2019) we found on average 169 (95% CI: 84, 255) deaths averted from changes in greenness, 71 (95% CI: 49, 94) deaths averted from NO2, 9 (95% CI: 4, 14) deaths averted from noise, and marginal impacts from other exposures, with the highest rates of deaths averted observed among non-Hispanic Black and non-Hispanic White residents. Multi-group index of dissimilarity declined on average in all eight Connecticut counties post-simulation. Sensitivity analyses simulating a different population movement strategy and modeling a different year (2018) yielded consistent results. Strengthening desegregation policy may reduce deaths from environmental exposures among low-income residents. Further research should explore non-mortality impacts and additional mechanisms by which desegregation may advance health equity.

The Affordable Rental Housing Crisis and Population Health Equity: a Multidimensional and Multilevel Framework

The US is facing a severe affordable rental housing crisis that contributes to multiple forms of housing insecurity including homelessness, crowded and poor quality housing conditions, unstable housing arrangements, and cost burdens. A considerable body of evidence finds that housing insecurity is an important determinant of health. However, the existing literature may fall short of conceptualizing and measuring the full impact of housing insecurity on population health and on racial health equity. In this paper, we seek to expand the conceptualization of housing as a determinant of population health equity by considering housing insecurity as a manifestation of structural racism that intersects with other manifestations and impacts of structural racism to affect, not only the health of housing insecure individuals, but also the health of the networks and communities in which these individuals live. First, we situate the current housing crisis within larger systems of structural racism. We extend prior work documenting the confluence of ways that racist policies and practices have created unequal burdens of housing insecurity to also discuss the ways that the meanings and impacts of housing insecurity may be shaped by racism. Next, we consider how the health impacts of this unequal burden of housing insecurity can extend beyond individual households to affect networks and communities. Ultimately, we provide a multilevel framework that can inform research, policy, and practice to address housing and health equity.

Eviction from public housing in the United States

Neither academic researchers nor the U.S. Department of Housing and Urban Development have studied evictions from public housing in national perspective. Combining federal registers of public housing authorities (PHAs) with individual-level records from >25 million eviction filings issued between 2006 and 2016, this is the first national-level study to estimate the prevalence and dynamics of eviction in public housing units. We find that the average PHA files roughly 40 evictions each year or 7.6 cases for every 100 public housing households. Public housing complexes were responsible for approximately 5.8 out of every 100 eviction filings in our sample, while only 3.5 in 100 renting households resided in public housing. Controlling for socioeconomic factors, we show that PHAs with a higher percentage of Black residents have significantly higher eviction filing rates. Eviction filing rates in PHAs are associated with those in the surrounding private rental market, indicating that PHAs do not function independently from the social contexts in which they are embedded. These findings reveal significant variation in eviction filing rates across local PHAs and highlight the need for clear policies on lease terminations and improved documentation of eviction actions in public housing at the federal and local levels.

Does rental assistance improve mental health? Insights from a longitudinal cohort study

Almost half of renters in the United States are rent-burdened, meaning that they pay more than 30% of their income toward housing costs. Rental assistance through programs administered by the U.S. Department of Housing and Urban Development, alleviates these financial strains for around 5 million households. However, due to budgetary constraints, fewer than one in four eligible households actually receive this assistance and waitlists average two years nationally. Using longitudinal data from a cohort of 400 low-income adults living in New Haven, CT, this paper investigates how access to rental assistance affects mental health through two analytical methods that address selection into rental assistance. First, we performed a cross-sectional analysis to identify how psychological distress differs among those receiving and those on a waitlist for rental assistance. Second, we used a within-person fixed-effects analysis to compare changes in individuals following entry into rental assistance. We find that those receiving rental assistance report significantly less psychological distress than those on waiting lists and that transitions into rental assistance are associated with statistically non-significant decreases in psychological distress. Our findings suggest that expanding rental assistance may be one potential step toward improving the mental health of low-income individuals in the United States.

But How Homeless Are You? Toward a More Just and Effective Response to Youth Homelessness

Each year, an estimated 4,200,000 unaccompanied youth ages 13 to 25 experience homelessness in the United States. The threats facing young people in housing crisis are many, and their potential impacts, harrowing. Youth are at high risk for physical and sexual victimization, mental and physical illness, and involvement with the criminal legal system and face serious threats to their education, their future economic stability, and their lives. Despite these dangerous consequences, the response to this issue in the United States continues to lack urgency, meaningful investment, and empirical support. This article critically examines the current approach to services for youth in situations of homelessness in the United States. Directly informed by the lived experiences of young people, it calls for a shift in understanding of the nature and scope of the problem and, consequently, the practice and policy strategies being implemented to address it. Specifically, the U.S. Department of Housing and Urban Development's definition of homelessness, along with corresponding procedures that further limit access to services, is examined in a call to change course in response to youth homelessness.

The Regeneración Urbana, Calidad de Vida y Salud - RUCAS project: a Chilean multi-methods study to evaluate the impact of urban regeneration on resident health and wellbeing

BACKGROUND

The available evidence of the health effects of urban regeneration is scarce In Latin America, and there are no studies focused on formal housing that longitudinally evaluate the impact of housing and neighborhood interventions on health. The "Regeneración Urbana, Calidad de Vida y Salud" (Urban Regeneration, Quality of Life, and Health) or RUCAS project is a longitudinal, multi-method study that will evaluate the impact of an intervention focused on dwellings, built environment and community on the health and wellbeing of the population in two social housing neighborhoods in Chile.

METHODS

RUCAS consists of a longitudinal study where inhabitants exposed and unexposed to the intervention will be compared over time within the study neighborhoods (cohorts), capitalizing on interventions as a natural experiment. Researchers have developed a specific conceptual framework and identified potential causal mechanisms. Proximal and more distal intervention effects will be measured with five instruments, implemented pre- and post-interventions between 2018 and 2021: a household survey, an observation tool to evaluate dwelling conditions, hygrochrons for measuring temperature and humidity inside dwellings, systematic observation of recreational areas, and qualitative interviews. Survey baseline data (956 households, 3130 individuals) is presented to describe sociodemographics, housing and health characteristics of both cohorts, noting that neighborhoods studied show worse conditions than the Chilean population.

DISCUSSION

RUCAS' design allows for a comprehensive evaluation of the effects that the intervention could have on various dimensions of health and health determinants. RUCAS will face some challenges, like changes in the intervention process due to adjustments of the master plan, exogenous factors -including COVID-19 pandemic and associated lockdowns- and lost to follow-up. Given the stepped wedge design, that the study capitalizes on within household changes over time, the possibility of adjusting data collection process and complementarity of methods, RUCAS has the flexibility to adapt to these circumstances. Also, RUCAS' outreach and retention strategy has led to high retention rates. RUCAS will provide evidence to inform regeneration processes, highlighting the need to consider potential health effects of regeneration in designing such interventions and, more broadly, health as a key priority in urban and housing policies.

Do changes in neighborhood social context mediate the effects of the moving to opportunity experiment on adolescent mental health?

This study investigated whether changes in neighborhood context induced by neighborhood relocation mediated the impact of the Moving to Opportunity (MTO) housing voucher experiment on adolescent mental health. Mediators included participant-reported neighborhood safety, social control, disorder, and externally-collected neighborhood collective efficacy. For treatment group members, improvement in neighborhood disorder and drug activity partially explained MTO's beneficial effects on girls' distress. Improvement in neighborhood disorder, violent victimization, and informal social control helped counteract MTO's adverse effects on boys' behavioral problems, but not distress. Housing mobility policy targeting neighborhood improvements may improve mental health for adolescent girls, and mitigate harmful effects for boys.

The legacy of the Home Owners' Loan Corporation and the political ecology of urban trees and air pollution in the United States

This study examines the persistent impacts of historical racebased discriminatory housing policies on contemporary urban environments in the United States. Specifically, we examine the relationships between Home Owners' Loan Corporation (HOLC) grades assigned to neighborhoods in the 1930s and the current distribution of tree canopy and level of exposure to air pollution hazards. Our results indicate a clear gradient in tree canopy by HOLC grade, with better neighborhood grades associated with significantly higher percentage of tree canopy coverage. The pattern also exists for airborne carcinogens and respiratory hazards, with worse neighborhood grades associated with significantly higher hazards exposure. Our findings indicate that early 20th century discriminatory housing policies exert a contemporary influence on patterns of green space exposure in American cities, with implications for health and health inequities. Our findings suggest that, in order to achieve equitable access to the benefits of urban greenspace, we must acknowledge these historical influences and consider policies and practices that directly counter these influences, for example, through targeted greenspace development in areas historically identified as unfit for investment.

Strengths, weaknesses, opportunities, and threats to housing first in Metro Vancouver

OBJECTIVES

To understand the experience of Metro Vancouver's Homelessness Partnering Strategy-funded Housing First program and how it is functioning from the perspective of a representative sample of providers and clients who deliver and receive HF services.

METHODS

Thirty-four clients and providers who currently or formerly delivered HF in Metro Vancouver participated in one-on-one interviews (n = 26) or focus groups (n = 8) between March and April 2017 and data were thematically analyzed.

RESULTS

Strengths of the HF program included: the ability to transition persons from the street into housing with individualized service supports and, in certain cases, with 12-month rent subsidies, household goods, and connection to community resources. Identified program weaknesses were: eligibility criteria, limited rent subsidy funds, limited provider capacity, and workload burden. Suggested opportunities to improve HF were: streamlining federal and provincial reporting and rent subsidy systems and building friendly landlord networks. Potential threats to HF described were: limited affordable housing, stigma and discrimination toward clients, inadequate income assistance, and limited opportunity for cross-sector collaboration.

CONCLUSIONS

The delivery of HF in regions that have limited affordable housing presents unique challenges. Recommendations are provided to improve HF practice and policy in these contexts.

Housing needs of grandparent caregivers: grandparent, youth, and professional perspectives

This qualitative study examined the housing needs of grandparent caregivers and the youth in their care in New York State. Nine focus groups were conducted separately with grandparent caregivers (n = 46) and youth (n = 34), and interviews were conducted with key informants (n = 17) knowledgeable about housing and issues. Housing needs of greatest priority, contextual differences, and potential barriers to securing housing and social services were identified. Key themes indicated that housing challenges stem from four problem domains: the experience of poverty, which creates affordability challenges that trap grandparent caregivers and their grandchildren in unsuitable homes and unsafe neighborhoods; physical challenges of aging grandparents, which require specific housing accommodations; changes in family composition when taking in grandchildren, which necessitate moving out of prior accommodations or changing housing plans due to regulatory issues; and obstacles to obtaining needed benefits, including a lack of information, burdensome application processes, ineligibility, and a shortage of resources. These issues are discussed with implications for policy and practice.

Rent increase strategies and distributive justice: the socio-spatial effects of rent control policy in Amsterdam

Rent controls and rent setting regulation in different contexts incorporate and balance different aims, in particular when securing affordability and the effective distribution of scarce housing by incorporating market mechanisms. As rent policy is frequently discussed in terms of affordability or market functioning in broad terms, small-scale distributive socio-spatial effects are often not regarded. In this paper, three strategies under the new rent sum policy are compared against the former policy and practice for Amsterdam, the Netherlands, to observe the effects of distributive justice. The new rent policy partly decentralizes rent increase decisions from the national level to local authorities and housing associations. Using microdata on all social housing units and their tenants' distributive justice, outcomes under the former policy and practice are observed for a 6-year period (2008-2014) and the effects of three different rent increase strategies under the new rent sum policy are forecasted for the same period, combining an ex ante and an ex post evaluation. The possibilities for housing associations to vary rent increases for different groups of tenants in order to improve distributive justice outcomes are explored. Results show that all three possible strategies decrease the observed affordability gap between new and long-term tenants. Valuing the distributions of these strategies by applying two different standards for distributive justice shows the rent sum policy may only result in modest improvements.

The association between residential eviction and syringe sharing among a prospective cohort of street-involved youth

BACKGROUND

Syringe sharing is a high-risk practice associated with the transmission of infectious diseases, such as HIV and HCV. While youth who contend with housing instability are known to be more likely to engage in high-risk substance use, the potential relationship between being evicted from housing and syringe sharing has not been examined. This study assessed whether residential eviction was associated with syringe sharing among street-involved youth in Vancouver, Canada.

METHODS

Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth who use drugs age 14-26 in Vancouver, Canada. The study period was June 2007 to May 2014, and the potential relationship between residential eviction and syringe sharing was analyzed using multivariable generalized estimating equations (GEE) logistic regression.

RESULTS

Among 405 street-involved youth who injected drugs, 149 (36.8%) reported syringe sharing, defined as borrowing or lending a syringe, at some point during the study period. In a multivariable GEE analysis, recent residential eviction remained independently associated with syringe sharing (adjusted odds ratio (AOR) = 1.72, 95% confidence interval (CI): 1.16-2.57), after adjusting for potential confounders.

CONCLUSIONS

Syringe sharing was significantly elevated among youth who had recently been evicted from housing. These findings indicate that policy and programmatic interventions that increase housing stability may help mitigate high-risk substance use practices among vulnerable youth.

[Impact of the crisis on the relationship between housing and health. Policies for good practice to reduce inequalities in health related to housing conditions]

Housing conditions can impact on physical and mental health through 4 interrelated dimensions: 1) the home (the emotional housing conditions), 2) the physical housing conditions, and 3) the physical environment, and 4) the social (community) environment of the neighborhood where the house is located. In Spain, the use of the construction market as an engine for economic growth and the promotion of private property as the main type of housing tenure has led to the use of housing as a speculative good instead of its being considered a first-necessity good. While Spain is the Organisation for Economic Co-operation and Development (OECD) country with the largest housing stock per inhabitant, this stock is highly underutilized, thus excluding the most deprived sector of the population from access to housing. The impact of the current economic crisis on housing has mainly been due to a reduction in household income, which has increased the number of families or persons struggling to cover their housing costs or being evicted. Evidence indicates that this type of problem has a negative impact on health, especially on mental health, but financial problems also make it difficult to meet other basic needs such as eating. There are several instruments to reduce the impact of the economic crisis, such as debt financing or deed of assignment in payment. In the long-term, the creation of a social housing stock should be promoted, as well as rental assistance mechanisms.

The influence of HOPE VI neighborhood revitalization on neighborhood-based physical activity: A mixed-methods approach

OBJECTIVES

This study uses a mixed methods approach to 1) identify surrounding residents' perceived expectations for Housing Opportunities for People Everywhere (HOPE VI) policy on physical activity outcomes and to 2) quantitatively examine the odds of neighborhood-based physical activity pre-/post-HOPE VI in a low socioeconomic status, predominantly African American community in Birmingham, Alabama.

METHODS

To address aim one, we used group concept mapping which is a structured approach for data collection and analyses that produces pictures/maps of ideas. Fifty-eight residents developed statements about potential influences of HOPE VI on neighborhood-based physical activity. In the quantitative study, we examined whether these potential influences increased the odds of neighborhood walking/jogging. We computed block entry logistic regression models with a larger cohort of residents at baseline (n = 184) and six-months (n = 142, 77% retention; n = 120 for all informative variables). We examined perceived neighborhood disorder (perceived neighborhood disorder scale), walkability and aesthetics (Neighborhood Environment Walkability Scale) and HOPE VI-related community safety and safety for physical activity as predictors.

RESULTS

During concept mapping, residents generated statements that clustered into three distinct concepts, "Increased Leisure Physical Activity," "Safe Play Areas," and "Generating Health Promoting Resources." The quantitative analyses indicated that changes in neighborhood walkability increased the odds of neighborhood-based physical activity (p = 0.04). When HOPE VI-related safety for physical activity was entered into the model, it was associated with increased odds of physical activity (p = 0.04). Walkability was no longer statistically significant.

CONCLUSIONS

These results suggest that housing policies that create walkable neighborhoods and that improve perceptions of safety for physical activity may increase neighborhood-based physical activity. However, the longer term impacts of neighborhood-level policies on physical activity require more longitudinal evidence to determine whether increased participation in physical activity is sustained.

Twenty Years of Neighborhood Effect Research: An Assessment

This paper reviews the magnitude and empirical findings of social epidemiological neighborhood effects research. An electronic keyword literature search identified 1369 empirical and methodological neighborhood effects papers published in 112 relevant journals between 1990 and 2014. Analyses of temporal trends were conducted by focus, journal type (e.g., epidemiology, public health, or social science), and specific epidemiologic journal. Select papers were then critically reviewed. Results show an ever-increasing number of papers published, notably since the year 2000, with the majority published in public health journals. The variety of health outcomes analyzed is extensive, ranging from infectious disease to obesity to criminal behavior. Papers relying on data from experimental designs are thought to yield the most credible results, but such studies are few and findings are inconsistent. Papers relying on data from observational designs and multilevel models typically show small statistically significant effects, but most fail to appreciate fundamental identification problems. Ultimately, of the 1170 empirically focused neighborhood effects papers published in the last 24 years, only a handful have clearly advanced our understanding of the phenomena. The independent impact of neighborhood contexts on health remains unclear. It is time to expand the social epidemiological imagination.

Social movements and the struggle for shelter: A case study of eThekwini (Durban)

The needs of informal settlement dwellers across towns and cities in the global South are acute. While much emphasis has been placed on income poverty, for urban dwellers affordable access to improved secured accommodation and basic services such as water and sanitation is essential for well-being. In part due to the lack of such access, urban citizens organize in multiple ways to address these needs and to press for state investment and redistribution. South Africa, despite relatively high levels of income and a state with redistributive capacity, is no exception. Indeed, this country is particularly interesting for those seeking to understand effective approaches to addressing housing need because of the efforts that have been made and the resultant scale of state investment in the housing sector. This paper draws on the experiences of urban social movement organizations in South Africa to understand better how shelter needs can be addressed. We reflect on their goals, strategies and activities and explore what this means for themes discussed within the social movement literature. The research has a specific focus on the city of eThekwini/Durban primarily because of the scale of social movement activities there. The paper describes the core concerns with respect to shelter as elaborated by social movement activists, staff of other civil society agencies and officials. While there is a broad consensus about the shelter problems, there is less agreement about solutions. The discussion summarises the shelter objectives and core strategies used by the social movement activists, and considers the success they have had. This includes reviewing their understanding of what success is and how success is achieved. Movement organisations have been able to secure access to the housing subsidy scheme for their members. However, their progress has been limited. The paper concludes that there is a primary focus on what is offered through state programmes and policies despite evident shortcomings. While there is an awareness of the misfit between available programmes, the needs of movement members and more general shelter needs, no fundamental challenge is being made to the dominant approach. A second finding is that while movement members and leaders have an explicit focus on material improvements, underlying their motivations and some of their strategies and actions is the more fundamental goal to be treated as equal citizens. In this dimension, movement organizations seek both recognition of their citizenship as well as the redistribution of state resources. Third, we argue that while social movement progress is related to the political opportunity structures, it also depends on the ability of movement organizations to manage the emerging opportunities, particularly their relationships with the state, professional support organizations and other movement organizations. Relations shift between contention and collaboration to improve negotiating positions, secure access to shelter and achieve greater political inclusion.

Were the mental health benefits of a housing mobility intervention larger for adolescents in higher socioeconomic status families?

Moving to Opportunity (MTO) was a social experiment to test how relocation to lower poverty neighborhoods influences low-income families. Using adolescent data from 4 to 7 year evaluations (aged 12-19, n=2829), we applied gender-stratified intent-to-treat and adherence-adjusted linear regression models, to test effect modification of MTO intervention effects on adolescent mental health. Low parental education, welfare receipt, unemployment and never-married status were not significant effect modifiers. Tailoring mobility interventions by these characteristics may not be necessary to alter impact on adolescent mental health. Because parental enrollment in school and teen parent status adversely modified MTO intervention effects on youth mental health, post-move services that increase guidance and supervision of adolescents may help support post-move adjustment.

Housing and harm reduction: what is the role of harm reduction in addressing homelessness?

Homelessness and drug use often overlap and the harms of substance use are exacerbated by homelessness. Responding to the twin problems of homelessness and substance use is an important aspect of strategies to end homelessness. The introduction and development of ten year plans to end homelessness in North America heralds a new era of systemic responses to homelessness. Central to many of these plans is the adoption of 'Housing First' as a policy response. Housing First focuses directly on housing people regardless of current patterns of substance use. As such, harm reduction is a key principle of Housing First. In this paper, we examine Housing First as an example of the integration of housing and harm reduction and then put forth a community level policy framework to further promote the integration of harm reduction as part of a response to homelessness. Drawing on Rhodes' risk environment framework and current evidence of Housing First and harm reduction, we describe four key policy areas for action: (1) social inclusion policies; (2) adequate and appropriate supply of housing; (3) on demand harm reduction services and supports and (4) systemic and organizational infrastructure. We conclude by identifying areas for future research.