Department Of Housing Research Articles

Struggle for Transdisciplinary Moments: Building Partnerships for Resettlement

The effects of climate change are both acute and chronic, leaving many communities in a perpetual state of uncertainty. For others, there is no such uncertainty—their communities will soon be uninhabitable. Some levels of government have begun to recognize and slowly respond to communities facing the possibilities of relocation. This paper considers the impact of transdisciplinary thinking and collaborative moments in the planning phase of one of the few community‐scale managed retreat attempts in the United States. In January 2016, the US Department of Housing and Urban Development (HUD) awarded the state of Louisiana $48.3 million to plan, design, and implement a structured and scalable resettlement with former and current residents of Isle de Jean Charles. The paper uses data from surveys and interviews with the practitioner team, fieldnotes, review of published reports, and a sample of more than 400 media accounts. Our analysis highlights how developing a transdisciplinary process may render a new understanding to the tasks and meanings of planning resettlements in the future.

Race and Ethnicity and Sex Variation in COVID-19 Mortality Risks Among Adults Experiencing Homelessness in Los Angeles County, California

Few studies have used precise age-specific data to construct age-standardized estimates of the relative risks (RRs) of COVID-19 mortality for people experiencing homelessness (PEH) vs the general population, and none to date has addressed race and ethnicity and sex variations in COVID-19 mortality among PEH with COVID-19 infection. To measure age-standardized mortality rate ratios for PEH vs the general population overall and by sex and race and ethnicity. In this cross-sectional study, crude and age-specific COVID-19 mortality rates per 100 000 people were calculated using 5-year age groups and standardized mortality ratios for PEH and the general population aged 25 years and older, assessing differences by race and ethnicity and sex, from January 1, 2020, to November 1, 2021. Mortality and population estimates came from COVID-19 mandatory case reporting conducted by the Los Angeles County Department of Public Health, the annual point-in-time homeless count, and the US Census. The main outcome was COVID-19 deaths sourced from clinician reports, death certificates, medical examiner reports, and vital records deaths. PEH status was determined using the US Department of Housing and Urban Development definitions for homelessness at the time of COVID-19 diagnosis or symptom onset. The study population included 25 441 deaths among an estimated 6 382 402 general population individuals and 256 deaths among an estimated 52 015 PEH. The race and ethnicity of the PEH sample was as follows: 15 539 Black (29.9%), 18 057 Hispanic (34.7%), 14 871 female (28.6%), 37 007 male (71.3%), and 3380 aged 65 years or older (6.5%), compared with the estimated general population of 6 382 402, which was 591 003 Black (9.3%), 2 854 842 Hispanic (44.7%), 3 329 765 female (52.2%), 3 052 637 male (47.8%), and 1 190 979 aged 65 years or older (18.7%). Crude death rates were 0.49% for PEH and 0.40% for the general population, but PEH experienced age-specific COVID-19 mortality risk 2.35 (95% CI, 2.08-2.66) times higher than the general population. There was significant risk associated with PEH status compared with their counterparts in the general population for Black PEH (RR, 1.69; 95% CI, 1.31-2.18), Hispanic PEH (RR, 2.34; 95% CI, 1.96-2.79), White PEH (RR, 8.33; 95% CI, 6.37-10.88), female PEH (RR, 3.39; 95% CI, 2.56-4.48), and male PEH (RR, 1.74; 95% CI, 1.52-2.00). This cross-sectional study of COVID-19 mortality among PEH with COVID-19 infection provides evidence suggesting excess risk of age-adjusted COVID-19 mortality among PEH compared with the general population. This study furthers understanding of the intersectional association between homelessness and race and ethnicity, as higher levels of mortality but narrower racial disparities among PEH than in the general population were observed.

Are excluding e-cigarettes a loophole in the smokefree public housing rule?

The U.S. Department of Housing and Urban Development (HUD) required all Public Housing Authorities to become smokefree in July 2018, following an 18-month implementation period that began February 2017. The HUD rule included all combustible tobacco products; e-cigarettes were not included. This purpose of this study is to characterize e-cigarette use overall and initiation after the implementation of the smokefree rule among tobacco users living in public housing. Data were collected from 396 adult (18+ years) current tobacco users at the time of rule implementation residing in the District of Columbia Housing Authority between July 2018 and November 2021. Measures include e-cigarette use, age of initiation, reasons for e-cigarette use, e-cigarette use susceptibility (among non-users), and sociodemographic characteristics. Descriptive and crosstab statistics were calculated to characterize e-cigarette use. Nearly-one-quarter of tobacco users reported lifetime use of e-cigarettes (24 %, n = 95) and 4.8 % (n = 19) indicated past 30-day e-cigarette use. Of the lifetime users, twenty-two (23.2 %) initiated their use after the smoke-free rule went into effect, with only two of those residents indicating they did so because of the rule. Of those who never used an e-cigarette, 23.5 % (n = 70) indicated being curious about e-cigarettes and 10.7 % (n = 40) said they may use e-cigarettes in the next year. Results indicate low use of e-cigarette products and low uptake due to the rule. Few tobacco users who never used e-cigarettes indicated intentions to use. Results suggest that omitting e-cigarettes from the HUD rule has not led to significant use of these products in this sample.

Identifying Graduation Rates and Practices in the U.S. Department of Housing and Urban Development-Veterans Affairs Supportive Housing Program.

Graduation from permanent supported housing program (PSH) is an important part of individuals' recovery and rehabilitation, yet little research has examined this process. We examined graduation rates, practices and policies in the U.S. Department of Veterans Affairs-Housing and Urban Development Supportive Housing (HUD-VASH) program, the largest PSH program in the United States. We used HUD-VASH administrative data from Fiscal Years 2016-2020 to summarize graduation rates from the program. Using a template analysis approach to open-ended online surveys from 65 HUD-VASH program managers, we identified key themes related to graduation practices. Graduations accounted for 21% of all HUD-VASH exits across all years. Graduation practices and policies varied across HUD-VASH programs, and staff expressed interest in having additional data to support graduation decisions. There may be value in developing standards for graduation criteria that is shared with clients and providers in supported housing programs in order to titrate care appropriately and support client independence.

Childhood Lead Poisoning 1970-2022: Charting Progress and Needed Reforms.

Childhood lead poisoning prevention in the United States was marked by a largely failed medical approach from 1971 to 1990; an emergent (but small) healthy housing primary prevention strategy from 1991 to 2015; and implementation of large-scale proven interventions since then. Childhood Lead Poisoning Prevention & Healthy Housing. Historic and recent health and housing data from the National Health and Nutrition Examination Survey (NHANES) and the American Healthy Homes Survey (AHHS) were retrieved to analyze trends and associated policy gaps. Approximately 590 000 US children aged 1 through 5 years had elevated blood lead levels of 3.5 μg/dL and greater in 2016, and 4.3 million children resided in homes with lead paint in 2019. Despite large improvements, racial and other disparities remain stubbornly and statistically significant. The NHANES and the AHHS require larger sample sizes. The Centers for Disease Control and Prevention has not published children's blood lead surveillance and NHANES data in several years; the Department of Housing and Urban Development (HUD) has no analogous housing surveillance system; and the Environmental Protection Agency (EPA) and the Occupational Safety and Health Administration (OSHA) have not updated training, Superfund, and occupational standards in decades. The nation has been without a plan and an associated budget for more than 2 decades. Congress has not reformed the nation's main lead poisoning prevention laws in more than 30 years. Such reforms include stopping US companies from producing new residential lead paint in other countries; enabling the disclosure law to identify all residential lead hazards; closing loopholes in federally assisted housing regulations and mortgage insurance standards; harnessing tax policy to help homeowners mitigate lead hazards; streamlining training requirements; increasing the size of health and housing surveys and surveillance systems; and updating housing codes, medical guidance, dust lead standards, training, Superfund, and worker exposure limits. Congress and the president should reauthorize a cabinet-level task force (dormant since 2010) to develop a new strategic plan with an interagency budget to implement it. These reforms will scale and optimize markets, subsidies, enforcement, and other proven interventions to end ineffective, costly, harmful, and irrational cost shifting that threatens children, workers, and affordable housing.

Quantifying Doubled-Up Homelessness: Presenting a New Measure Using U.S. Census Microdata

Some definitions of homelessness include doubling up—living with others because of economic hardship or housing loss. Doubling up can have negative consequences that should be addressed, but the U.S. Department of Housing and Urban Development’s methods for enumerating homelessness exclude these arrangements, and Department of Education counts of doubling up include only school children. We provide a new method for measuring doubled-up homelessness in the total population using American Community Survey public use microdata. Using this method, we find that 3.7 million people in the U.S. population were doubled up in 2019 and show significant differences in doubling up by geography, race and ethnicity, marital status, educational attainment, school enrollment, and employment status, and compare these findings with research on sheltered and unsheltered homelessness. Notably, rates of Hispanic/Latinx doubled-up homelessness were high, in contrast to their rates of literal homelessness, and some rural areas with low rates of sheltered and unsheltered homelessness had high rates of doubling up. To aid in future research and policy, supplemental materials provide open-source tools for replicating the measure. Findings suggest that policies addressing homelessness and housing insecurity consider those experiencing doubled-up homelessness and that the current measure can assist in those efforts.

Neighborhood Factors Associated with COVID-19 Cases in California.

There is a need to assess neighborhood-level factors driving COVID-19 disparities across racial and ethnic groups. To use census tract-level data to investigate neighborhood-level factors contributing to racial and ethnic group-specific COVID-19 caserates in California. Quasi-Poisson generalized linear models were used to identify neighborhood-level factors associated with COVID-19 cases. In separate sequential models for Hispanic, Black, and Asian, we characterized the associations between neighborhood factors on neighborhood COVID-19 cases. Subanalyses were conducted on neighborhoods with majority Hispanic, Black, and Asian residents to identify factors that might be unique to these neighborhoods. Geographically weighted regression using a quasi-Poisson model was conducted to identify regional differences. All COVID-19 cases and tests reported through January 31, 2021, to the California Department of Public Health. Neighborhood-level data from census tracts were obtained from American Community Survey 5-year estimates (2015-2019), United States Census (2010), and United States Department of Housing and Urban Development. The neighborhood factors associated with COVID-19 case rate were racial and ethnic composition, age, limited English proficiency (LEP), income, household size, and population density. LEP had the largest influence on the positive association between proportion of Hispanic residents and COVID-19 cases (- 2.1% change). This was also true for proportion of Asian residents (- 1.8% change), but not for the proportion of Black residents (- 0.1% change). The influence of LEP was strongest in areas of the Bay Area, Los Angeles, and San Diego. Neighborhood-level contextual drivers of COVID-19 burden differ across racial and ethnic groups.

Disability and subsidized housing residency: The adverse impacts of Winter Storm Uri in metropolitan Texas

BackgroundWhile natural disasters have been found to affect both disabled and subsidized rental housing residents negatively and disproportionately, previous studies have not examined if adverse disaster impacts experienced by disabled individuals in subsidized housing developments differ from those living in other housing. ObjectiveWe focused on Winter Storm Uri in Texas, USA, which lasted from February 10–20, 2021. We sought to: (1) compare differences in adverse impacts suffered by households with and without disabled persons; and (2) examine how residency in US Department of Housing and Urban Development (HUD)-assisted rental housing influences the severity of impacts for households with disabled persons. MethodsWe collected data from 790 randomly selected households in eight Texas metropolitan areas through a bilingual phone survey. Bivariate and multivariable statistical methods were utilized to compare adverse impacts suffered by households, based on both disability status and HUD-assisted housing residency. ResultsHouseholds with disabled persons were more severely impacted by Uri than households without disabled persons, in terms of service disruptions, colder temperatures, slower recovery, and adverse experiences that have important health implications. Households with disabled persons residing in HUD-assisted housing were more negatively impacted and suffered more adverse experiences than those living in other housing. ConclusionsResidency in federally-assisted rental housing can worsen severity of adverse impacts and amplify disaster vulnerability for disabled individuals. These disparities based on disability and subsidized housing status emphasize the need for additional research to understand the impacts of disasters on disabled residents and formulate interventions that provide equitable protections.

Investigating strategic management roles of the corporate communication function in the Department of Housing

The first phase of this qualitative study employed the extended case method. Its aimwas to explore the role behaviour of the most senior corporate communicationpractitioner in the government Department of Housing, South Africa. It was foundthat the Director: Communication Services played a combination of roles: firstly, Dozier's(1984) media relations specialist (seen as part of the historic technician role) and secondly,she also performed certain generic managerial activities. The two (new) strategicmanagement roles of the corporate communication function, the strategist and theredefined manager, were not observed (Steyn, 2000a; 200Gb).The second phase entailed the development of a corporate communication strategy forthe Department by the Deputy Director, using action research. The unit of analysis washer communicative output, in the form of the strategy. Empowered by postgraduatestudies, she was found to possess the necessary strategic communication managementknowledge and skills to perform this important activity of a practitioner in the redefinedrole of manager successfully.

Service Coordination in HUD Housing During the COVID-19 Pandemic: Bridging the Gap

ABSTRACT During the COVID-19 pandemic, service coordinators increased the capacity of a large and diffuse inter-organizational network to support lower-income older adults. Researchers conducted two surveys of service coordinators who worked with older residents of US Department of Housing and Urban Development (HUD) multifamily properties in mid-2020 and late-2021. These residents experienced many pandemic-related disruptions to their support systems, and findings revealed ways that service coordinators assessed resident need, linked them to public benefits programs, improved their access to technology, translated public health responses, and facilitated access to partner organizations and professional supports. Through assessment and communication, and decision-management and problem solving, service coordinator work increased the efficiency and effectiveness of external supports available to help meet residents’ needs for food, medicine, supplies, personal care, and mental and physical healthcare. With an aging population and an increasing rate of unpredictable weather events, service coordination, which is inconsistently funded and is not mandated for HUD properties, may offer an opportunity to improve the adaptability and resilience of older supported housing residents.

Who Counts? Educational Disadvantage among Children Identified as Homeless and Implications for the Systems That Serve Them

The Department of Education’s (ED) definition of homelessness includes any child who lacks a fixed, regular, and adequate nighttime residence, but the Department of Housing and Urban Development (HUD) uses a narrower definition that excludes doubled-up families. These definitions determine how resources are prioritized for families, yet we know very little about the differences in risks faced by children identified by these departments. We leverage a data linkage between public schools and homeless management information systems in Minnesota to provide novel evidence on the educational risks faced by children identified as homeless by ED and HUD. We find that ED-identified-homeless and HUD-identified-homeless children experience comparable increases in chronic absenteeism and school instability in the year they experience homelessness, challenging the popular conception that doubled-up families face lower educational risks. Using these findings, we discuss strategies to integrate homelessness data better, assess needs, and prioritize resources for children experiencing homelessness.

Transforming the Homelessness Policy by Housing First Approach - The case study of Seoul -

The purpose of this study is to explore the necessity of housing first approach, taking the Seoul homelessness policy as an example, and to derive constraints and policy agendas in applying the housing first approach. For this purpose, this study conducted a literature study, an analysis of raw data from the homeless survey, and advisory meetings. The decrease in the number of homeless people in Seoul has slowed in recent years, and avoiding facilities by homeless people was confirmed. In addition, not only economic problems, but complex service needs are intensifying. It is necessary to critically review whether the policy so far is still effective. Therefore, this study suggested the need to adopt the housing first approach as an alternative. However, the long-established institutional factors are hindering progress toward the housing first approach. In conclusion, first, if the housing first approach is to be adopted, the existing facility-centered support system should be converted into a housing-centered support system. Second, the supply of public rental housing should be increased. Third, support services should be improved in cooperation with the local welfare system. Finally, it is necessary to establish a new governance structure that promotes cooperation between the housing and welfare departments.

Race, Perceived Criminality and Housing Choice Voucher Recipients: Do Black Voucher Recipients’ Moves to the Suburbs Increase Crime Rates?

Public attention has focused on especially Black Housing Choice Voucher Recipients’ (HCVRs) residential mobility and whether and to what extent crime is influenced as a result. This paper adds to the growing empirical literature on this question by focusing on the race of HCVRs and examining whether changes in Black HCVRs presence in suburban areas over time is followed by changes in crime rates among the 100 largest metropolitan areas in the country. Multiple data sources are used to examine this question including data on voucher holders from the U.S. Department of Housing and Urban Development's (HUD) Picture of Subsidized Housing, on crime from the Uniform Crime Report (UCR) Offenses Known and Cleared by Arrest compiled by the FBI, and on important demographic data from the Census Bureau. First difference regression methods as well as lead and lag dependent (and independent) variable analysis, among other methods, are used to assess whether Black HCVRs influence crime in suburban areas. The results of the analysis indicate no support for the Black HCVRs – suburban crime hypothesis, consistent with previous research. The evidence indicates positive, statistically significant relationships between White HCVRs and suburban crime. However, lead and lag analysis suggests the relationship is not causal. If anything, the evidence points to White HCVRs moving to suburban areas where crime is increasing. Fears of increased crime resulting from increased presence of HCVRs are therefore not well supported by the studies’ results, and should allay any concerns about unintended crime costs of the HCV program.

Invited Commentary: Use of Epidemiologic Methods to Guide Comprehensive and Equitable Approaches to Policy.

Despite a dramatic reduction in the prevalence of commercial cigarette smoking in the United States, children are still commonly exposed to secondhand smoke (SHS), which is a cause of various pediatric health problems. Further, SHS exposure is patterned by race and class, exacting an inequitable toll on children from families with lesser social and economic advantage. In this issue of the Journal, Titus et al. (Am J Epidemiol. 2023;192(1):25-33) use natural experiment evaluation methods (difference-in-differences) to test whether the recently implemented US Department of Housing and Urban Development policy that forbade smoking in and around New York City Housing Authority buildings affected child respiratory health. The results from their work remind us that policies do not always impact outcomes as we might expect. Given that policy is one of the most potent tools for population health promotion, this work underlines the need for epidemiologists to engage in policy evaluation at all stages of the policy life cycle, in order to discover comprehensive approaches to policy development and implementation that prioritize equity and address structural racism.

Establishing behavioral health services in homeless shelters and using telehealth digital tools: best practices and guidelines

PurposeHomelessness is a growing concern across the globe that has multiplied during the pandemic. According to a recent report by the Department of Housing and Urban Development (HUD, 2018), 20% of the homeless population have a severe mental illness and 16% chronically used substances. This paper aims to address the effectiveness of in-shelter mental health services provided by qualified clinicians.Design/methodology/approachIn this study, clients from a homeless shelter were provided in-shelter mental health intake and resources by predoctoral clinicians. Their pre- and postdistress scores were recorded to establish the effectiveness of the intervention.FindingsNinety-eight guests were provided services of which 51% reported co-occurring mental health and substance use diagnoses. There was a clinically significant difference in the pre- to postsession distress levels based on the ratings at the intake session. It was noted that making services accessible increased the ability to provide triage services, help with housing options and integrate care with other providers and decrease distress levels.Research limitations/implicationsThe current program was implemented in only one shelter in Upstate New York, other similar settings need to be explored in different locations. Objective indicators will be analyzed in the future to establish the effectiveness of services.Practical implicationsThis paper outlines a procedure that can guide and help future projects to establish clinical care at homeless shelters across the USA and globally. This paper provides examples of the intake form, list of resources and basic coping strategies that can aid other clinicians and researchers to establish similar programs.Social implicationsThis paper sheds light on the mental health needs of an underserved and underrepresented population in the field of mental health – the homeless. The guidelines outlined in this paper can help set up more mental health clinics at homeless shelters and make mental health services more accessible, which can help prevent recurring homelessness.Originality/valueThis paper establishes guidelines for effective single session interventions that help decrease distress levels. This paper also establishes the need for in-shelter services to overcome barriers in mental health care for the homeless population.

Federally-assisted housing and blood lead levels in the United States, 1999-2016

Background/Aim: Despite declining blood lead levels (BLLs) in the US, lead exposure remains disproportionately high in older housing and for low-income and non-Hispanic Black households. Federal housing assistance is linked to lower BLLs among children, but has not been evaluated among all US residents and by program type. Methods: We used the National Health and Nutrition Examination Survey 1999-2016 data linked to the US Department of Housing and Urban Development (HUD) administrative records to identify HUD-assisted participants. We compared BLLs of those currently-assisted and those on the waitlist (will receive assistance within two years) using multivariable regressions for log-transformed and dichotomous (≥ 3 µg/dL) BLLs. We examined effect modification by program type (project-based: public and multifamily housing vs. housing choice vouchers) and race/ethnicity, and conducted subset analyses for women and children under 12. Results: Sociodemographic characteristics were similar in the currently-assisted and waitlist groups. BLL geometric means were 1.11 (SE: 1.03) and 1.41 (SE: 1.03), respectively (p<0.05). In adjusted models, HUD assistance was associated with 8% lower BLLs (95% CI: -13%, -2%). In stratified models, this association was stronger among project-based housing (-11%, 95% CI: -18%,-4%) compared to housing choice voucher (-5%, 95% CI: -12%, 2%) recipients. Non-Hispanic white participants experienced a stronger protective association (-16%, 95% CI: -25%, -6%) compared to Black participants (-3%, 95% CI: -10%, 5%) and Mexican-Americans (2%, 95% CI: -18%, 28%). The association was significant among women (-9%, 95% CI: -15%, -2%) but attenuated among children (-2%, 95% CI: -9%, 6%). Findings remained consistent for clinically-meaningful BLL cutoff ≥ 3 µg/dL. Conclusions: Housing assistance is an important social-structural determinant of health that can reduce residential environmental exposures through better quality housing, routine maintenance practices, and/or compliance with residential lead paint laws. Increasing access to affordable housing for very low-income households advances environmental health equity.

Long-Term Trends in Secondhand Smoke Exposure in High-Rise Housing Serving Low-Income Residents in New York City: Three-Year Evaluation of a Federal Smoking Ban in Public Housing, 2018-2021.

In July 2018, the U.S. Department of Housing and Urban Development passed a rule requiring public housing authorities to implement smoke-free housing (SFH) policies. We measured secondhand smoke (SHS) exposure immediately before, and repeatedly up to 36 months post-SFH policy implementation in a purposeful sample of 21 New York City (NYC) high-rise buildings (>15 floors): 10 NYC Housing Authority (NYCHA) buildings subject to the policy and 11 privately managed buildings in which most residents received housing vouchers (herein "Section 8"). We invited participants from nonsmoking households (NYCHA n = 157, Section-8 n = 118) to enroll in a longitudinal air monitoring study, measuring (1) nicotine concentration with passive, bisulfate-coated filters, and (2) particulate matter (PM2.5) with low-cost particle sensors. We also measured nicotine concentrations and counted cigarette butts in common areas (n = 91 stairwells and hallways). We repeated air monitoring sessions in households and common areas every 6 months, totaling six post-policy sessions. After 3 years, we observed larger declines in nicotine concentration in NYCHA hallways than in Section-8, [difference-in-difference (DID) = -1.92 µg/m3 (95% CI -2.98, -0.87), p = .001]. In stairwells, nicotine concentration declines were larger in NYCHA buildings, but the differences were not statistically significant [DID= -1.10 µg/m3 (95% CI -2.40, 0.18), p = .089]. In households, there was no differential change in nicotine concentration (p = .093) or in PM2.5 levels (p = .385). Nicotine concentration reductions in NYCHA common areas over 3 years may be attributable to the SFH policy, reflecting its gradual implementation over this time. Continued air monitoring over multiple years has demonstrated that SHS exposure may be declining more rapidly in NYCHA common areas as a result of SFH policy adherence. This may have positive implications for improved health outcomes among those living in public housing, but additional tracking of air quality and studies of health outcomes are needed. Ongoing efforts by NYCHA to integrate the SFH policy into wider healthier-homes initiatives may increase policy compliance.

Residents’ Attitudes and Social Innovation Management in the Example of a Municipal Property Manager

Corporate responsibility is an effective management strategy which, through conducting social dialogue at the local level, contributes to increasing the competitiveness of enterprises at a global level and simultaneously shaping favourable conditions for social and economic development. A review of the literature on the subject provided the theoretical motivation to undertake an emirical study of the implemented social innovations by the property manager and their reception by resource residents. The main aim of this study was to diagnose the attitudes of residents towards the implementation of social innovations by the municipal property manager. The research presented in the above article has been conducted in the first and second quarter of 2021 among residents of the Department of Housing “TBS” (ZGM TBS) in Częstochowa, Silesian voivoideship, Poland. The research was conducted using the survey method. The measurement instrument was a prepared questionnaire. The survey was completed by 362 respondents (n = 362). To confirm the hypotheses, an analysis using the Mann–Whitney U test and the Anov Kruskal–Wallis test were performed. In order to demonstrate the statistical significance of the assumptions made, the conducted tests were also supported by the p-value test. The research results undertaken made it possible to identify social innovations implemented by the municipal manager, both those which are expected by residents and those which tenants consider superfluous.

What Constitutes a Competitive Environment? A Case Study of the FQHCs Industry In California

Objective: This study aims to identify competitive forces in the FQHCs environment using Porter’s Five Force model. Data Sources: The study utilized various secondary data sources. The Health Resources and Services Administration (HRSA) requires FQHCs to submit a performance report using the measures defined in the Uniform Data System (UDS). The UDS provides data such as the scope and volume of services provided by FQHCs, staffing, number of delivery sites, and finances. The UDS consider being a census of aggregate level health center data for FQHCs. Secondly, the American Hospital Association Annual Survey (AHA), which provides organizational details regarding hospitals. The third dataset is the Area Health Resources File (AHRF). It includes county-level data about health services volume, demographics, and health professional supply. The fourth dataset is the Internal Revenue Service (IRS) Form 990, which was used was used to calculate FQHCs’ total margin. The fifth dataset is the California Health and Human Services Open Data Portal (CHHS), which includes county-level data such as the number of Medicaid eligible populations and the number of primary care clinics. Finally, the study used the U.S. Department of Housing and Urban Development (HUD) United States Postal Service Zip Code Crosswalk Files. The Crosswalk Files was used to allocate both FQHC’s and FQHC’s sites Zip-Codes to counties. Method: this was a descriptive study. Descriptive statistics included frequencies and percentages to describe categorical variables. In addition, means (standard deviations, SD) will describe continuous variables. The study utilized bivariate analysis, including the chi-square test and ANOVA test, to find differences regarding the competitive forces variables among counties that had a new established FQHCs and counties that did not have newly established FQHCs in California for the years 2014 and 2015. Result: the study found that the number of FQHCs sites and primary care clinics in a county is statistically different between counties that had a newly established FQHC compared to counties that did not have a newly established FQHC. Counties that had newly established FQHCs had on an average a lower number of FQHCs sites and primary care clinics. Competition for FQHCs might arise when more FQHCs exist in a market. More research can be conducted to understand how FQHCs behave in a competitive environment.

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

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