Is child health at risk while families wait for housing vouchers?

Abstract

Although the link between substandard housing and poor health has been recognized for more than a century,1 research now demonstrates significant associations between cockroach allergen and asthma,2 between lead paint and chronic neurologic damage,3 between substandard homes and fatal fires,4 and between unaffordable rent and inadequate childhood nutrition5 and growth.6 Families who live in housing units subsidized through the federal Section 8 program are protected by annual inspections that document adherence to strict housing codes and spend about 30% of their income on rent. However, the average waiting time for Section 8 was 28 months in 1998, with more than 660 000 families on 18 sampled metropolitan waiting lists.7 To our knowledge, the child health implications of waiting for housing assistance have not been studied. We surveyed families due to receive Section 8 vouchers at the Boston Housing Authority in the summer of 1999. Our survey included standardized questions from the American Housing Survey,8 the National Health Interview Survey,9 and the National Health and Nutritional Examination Survey.10 Respondents were also asked, “Do you believe that your living conditions or the expense of your living conditions has affected any of the health problems of [your child]?” We obtained an exemption from the Boston University institutional review board for our survey. We approached 158 of 170 eligible families; 74 (46.8%) participated. Families reported high rates of 17 housing hazards in their pre–Section 8 living conditions (Table 1 ▶). Of 33 families living with more than 2 housing hazards, 24.2% reported a child with fair or poor health status, as compared with 9.8% of 41 families living with fewer hazards (relative risk [RR] = 2.5, 95% confidence interval [CI] = 0.8, 7.5). Thirty-three percent of families living with more than 2 hazards reported a child with limited activity, as opposed to 14.6% of families living with fewer hazards (RR = 2.3, 95% CI = 0.9, 5.5). TABLE 1— Housing Hazards in Boston Families Waiting for Housing Vouchers in Summer 1999 and Comparison With Boston Families Living in Voucher-Supported Apartments: The 1998 American Housing Survey (AHS) Participants reported that 44.8% of children had suffered health consequences as a result of housing conditions. These health consequences included emotional disorders (e.g., “He's very tense in his room because he thinks the people we share an apartment with are going to scold or hit him”) and asthma (e.g., “The ceiling has mold all over; there is no heat in the hallway and bathroom; no window in the bathroom; rats everywhere; kids can smell the rats and can't do anything about it”). Despite this study's limitations, we directly assessed the risks facing families poised to benefit from a policy intervention: the Section 8 voucher. These risks appear to be substantial. In an additional analysis involving data from the 1998 Boston-area American Housing Survey, we determined that families in our study reported significantly worse housing conditions than did Boston-area families already living in voucherassisted apartments (Table 1 ▶). These findings merit attention, given the national crisis in regard to safe and affordable housing. Families in more than 5.3 million households, including 4.5 million children, spend over 50% of their available income on rent, live in substandard conditions, or both.7 Policymakers cannot ignore the growing evidence that housing policies have important health consequences.11–13 This study suggests that expanding access to vouchers may immediately improve the health of America's children.