Housing insecurity is defined by the Department of Health and Human Services to include housing conditions of high cost in proportion to income, poor quality, unstable neighborhoods, overcrowding, and homelessness. It is an important social determinant of health that is linked to a number of negative health outcomes for children that persist throughout the lifespan. For example, issues such as crowding, multiple moves, doubling up, and poor housing conditions have been shown to be particularly harmful experiences for children. Prior research has revealed negative consequences to mental health, stress, parent-child interactions, development, sleep, and a number of health outcomes associated with housing insecurity. Additionally, families who experience hardships such as housing insecurity are also more likely to experience child welfare involvement.
Despite the severity of outcomes associated with housing insecurity, the issue remains highly prevalent in the United States, particularly among families with young children. In a recent study of Head Start families, more than half who were screened for housing instability identified having significant to severe barriers to housing. However, existing measurement tools apply inconsistent definitions that often do not capture this construct comprehensively or cannot be easily administered in practice. The objective of this paper is to describe the development and validation of a comprehensive survey measure of housing instability that includes housing quality, housing instability, neighborhood disorder, and neighborhood danger.
This study is a measurement pilot conducted as part of a larger study partnering with nine pediatric clinics in three states. The purpose of the overall study is to examine pediatric healthcare innovations designed to prevent and mitigate toxic stress experienced by young children, with a focus on screening and supports for social determinants of health. For this sub-study, we obtained a pilot sample (N = 201) to test the robustness of a comprehensive measure of housing insecurity comprised of four existing unvalidated housing measures, each capturing one component of housing instability. Scales included the Housing Instability Index, Housing Quality Scale, Neighborhood Danger Scale, and Neighborhood Disorder Scale (Leventhal, Brooks-Gunn, 2004; Rollins, et al., 2012). We fielded the electronic survey and obtained data for a sample of respondents who were reflective of our anticipated study sample. Tests of construct validity and internal consistency reliability for diverse samples, including Confirmatory and Exploratory Factor Analyses and Cronbach’s alpha were conducted.
This study resulted in preliminary establishment of reliability and construct validity of the key constructs of the comprehensive survey measures of housing insecurity. The model demonstrated acceptable to close model fit, all indicator loadings were statistically significant, and Cronbach’s alpha indicated sufficient reliability (CFI = .96, TLI = .956, WRMR = 1.0). All pilot analyses will be repeated with study data to confirm results.
Conclusion & Implications:
Housing Insecurity is an important social determinant of health for families of young children. Comprehensive screening tools are needed to adequately capture and address this issue in an effort to mitigate the impact of exposure to early adverse experiences. This study addresses a critical measurement gap.