Housing and Health Among Children and Youth: Examining the Impacts of Housing Hardships across Household, Housing, and Neighborhood Contexts

Background & Purpose: Housing and neighborhood environments are critical social determinants of health for children and youth. Housing hardships – including housing stability, security, and affordability – are particularly salient for health. Additionally, neighborhood contexts – including safety, support, amenities, and adverse conditions – represent crucial pathways to health. Despite their significance, little is known about how these multiple co-occurring socioecological factors collectively impact health for children and youth. We address this gap in research by examining the effects of household-, housing-, and neighborhood-based risk and protective factors on health status among a nationally representative sample of children and youth from birth to 17 years old (N=54,103). The following research question guided the study: 1) To what extent do household-, housing-, and neighborhood-based risk and protective factors impact child and youth health status?

Methods: This study utilized data from the 2022 National Survey of Child Health (NSCH), a population-based, nationally representative household survey of civilian, noninstitutionalized children and youth in the U.S. The cross-sectional survey collected caregiver-reported information for 54,103 children and youth from birth to 17 years old regarding their health status, along with risk and protective factors in their household, housing, and neighborhood context. Logistic regression was utilized to examine associations between household (e.g., household ACEs, family resilience), housing (e.g., housing status, difficulties paying rent, frequent moves, homelessness, eviction stress), and neighborhood factors (e.g., safety, support, amenities, adverse conditions, community-based ACEs) on child and youth health status (1=fair or poor, 0=good, very good, excellent). Analyses occurred in Stata.

Results: The study sample consisted of children and youth who were predominantly White (76%), with lower representation among Black (7%), Asian (6%), American Indian and Alaska Native (1%), Native Hawaiian and Pacific Islander (<1%), and multi-racial (9%). The sample included males (52%) and females (48%) with ages ranging from 0 to 17 years old (M=8.60, SD=5.31). About 13% of households were below the federal poverty level (i.e., between 0-99% FPL) and 16% had low to moderate incomes (i.e., 100-199% FPL). About 14% of households experienced housing hardships, including difficulties paying rent, frequent moves, and homelessness. Additionally, 7% reported eviction-related stress over the past year. Results of logistic regression analysis indicated that poverty (OR=1.29, p<0.001), exposure to household ACEs (OR=1.27, p<0.05), and community-based ACEs (OR=2.31, p<0.001) increased the odds of poor health among children and youth. Additionally, eviction stress increased the odds of poor health (OR=2.41, p<0.01). Access to neighborhood amenities, like parks and community centers, decreased the odds of poor health (OR=0.86, p<0.05). Family resilience also reduced the odds of poor health (OR=0.75, p<0.01). Other housing and neighborhood characteristics were not significantly associated with child and youth health when accounting for co-occurring socioecological factors.

Conclusions & Implications: Findings highlight the urgent need for preventive interventions that address the intersectional effects of housing and neighborhood factors on the health and well-being of children and youth. Community-based initiatives targeting housing and neighborhood context can drive transformative change by reducing resource disparities, expanding opportunities, and tackling deeply rooted social, economic, and racial inequities.