Volume 169, April 2023, 107453Author links open overlay panel, , , , , Abstract

The U.S. is experiencing a severe housing affordability crisis, resulting in households having to make difficult trade-offs between paying for a place to live and basic health necessities such as food. Rental assistance may mitigate these strains, improving food security and nutrition. However, only one in five eligible individuals receive assistance, with an average wait time of two years. Existing waitlists create a comparable control group, allowing us to examine the causal impact of improved housing access on health and well-being. This national quasi-experimental study utilizes linked NHANES-HUD data (1999–2016) to investigate the impacts of rental assistance on food security and nutrition using cross-sectional regression. Tenants with project-based assistance were less likely to experience food insecurity (B = −0.18, p = 0.02) and rent-assisted individuals consumed 0.23 more cups of daily fruits and vegetables compared the pseudo-waitlist group. These findings suggest that the current unmet need for rental assistance and resulting long waitlists have adverse health implications, including decreased food security and fruit and vegetable consumption.

Section snippetsData source

This study used data collected between January 1999 to December 2016 from NHANES that has been linked with HUD administrative rental assistance records.(Lloyd et al., n.d.) Collected by the National Center for Health Statistics (NCHS), NHANES is a cross-sectional, multistage survey designed to assess health and nutritional status. The HUD administrative data provide a longitudinal record of entry and exit dates for rental assistance and the type of assistance received (project- vs

Demographics

The linked data file included 36,039 linkage-eligible adults, 18 years and older, who were interviewed in NHANES from 1999 to 2016 and had no missing information on the covariates and outcomes. Descriptive characteristics of the sample stratified by rental assistance status can be found in Table 1 for both the Food Insecurity and the Fruit and Vegetable samples. The sample in this analysis contains individuals who are at higher poverty levels than the broader linkage-eligible NHANES sample;

Discussion

Our national study uses a quasi-experimental approach to investigate if obtaining rental assistance impacts food insecurity and the consumption of fruits and vegetables. Our findings demonstrate that participants receiving rental assistance through project-based housing are significantly less likely to experience general and severe food insecurity. Additionally, both project- and voucher-based housing were associated with increased fruit and vegetable consumption, although this was only

Limitations

The current study has limitations that should be noted. First, data collected in WWEIA was based on recall in surveys, which can be inaccurate. However, this should not systematically be different between rent-assisted and pseudo-waitlist groups. Second, certain groups may be prioritized for rental assistance and be overrepresented in the current assistance group. But because they are mostly more disadvantaged groups such as families experiencing homelessness, pregnant women, or people with

Future research

This analysis contributes to growing literature on the health costs of unmet housing needs and has implications for population health equity. However, it does not address the racial disparities seen in food and housing security. Food insecurity and affordable housing challenges are unequally borne by communities of color owing to an ongoing history of discriminatory employment, incarceration, and housing policies and practices.(Swope and Hernandez, 2019; Swope et al., 2022; Odoms-Young and

Funding/support

Funding for this project was provided by grants R01 DK124500 from the NIDDK, NIH (D. Keene); UL1 TR001863 from the National Center for Advancing Translational Sciences (D. Esserman); and P2C HD041025 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (A. Fenelon). Role of the funder/sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of

CRediT authorship contribution statement

Whitney Denary: Writing – original draft, Conceptualization. Andrew Fenelon: Methodology, Formal analysis, Writing – review & editing. Shannon Whittaker: Writing – review & editing. Denise Esserman: Writing – review & editing. Kasia J. Lipska: Writing – review & editing. Danya E. Keene: Supervision, Writing – review & editing, Funding acquisition.

Declaration of Competing Interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:

W. Denary reported receiving grants from the NIDDK, NIH during the conduct of the study. A. Fenelon reported receiving grants from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) during the conduct of the study. S. Whittaker reported receiving grants from the NIMHD and Robert Wood Johnson

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