Childhood Housing Assistance and Adult Health: Life Course Critical Periods and Cumulative Impact

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Poverty-related housing needs during childhood increase the risk of chronic health conditions as an adult. In particular, cumulative exposure to poverty-related housing needs across childhood and exposure during specific critical periods of childhood elevate the risk of adult chronic health conditions. Government housing assistance assists ~5 million low income families with those poverty-related housing needs on a population- wide scale. However, prior research has not investigated whether housing assistance during childhood mitigates the impact of childhood poverty-related housing needs on the development of adult chronic health conditions. More specifically, prior research has not examined the impact of housing assistance during childhood on the development of adult obesity and two of its complications, diabetes and hypertension. Since these three chronic conditions are increasing at epidemic proportions, there is a critical need to identify whether government housing assistance in childhood impacts the development of adult obesity, diabetes, and hypertension. If so, expansion of government housing assistance could ameliorate the impact of childhood poverty-related housing needs on these adult conditions on a population-wide scale. This research has two specific aims: (1) Examine if the timing (“critical periods”) of government housing assistance (if any) during childhood is associated with adult obesity, and (2) Examine whether duration (“cumulative exposure”) of government housing assistance received during childhood (if any) is associated with adult obesity. To accomplish these aims, the investigators will utilize the Panel Study of Income Dynamics’s (PSID) 51-year longitudinal design (1968 - 2019) to follow over 7,000 low income individuals from before their birth into adulthood. They will also take advantage of PSID’s family structure to compare outcomes among siblings using family fixed effects. In addition, they will leverage PSID’s restricted linkages to HUD data and the exogenous variability of when counties adopted housing assistance. Their approach reflects the team’s public health and econometric perspectives: exposure to housing assistance will be examined in two ways--availability of housing assistance in a county (intent-to-treat) and actual receipt of housing assistance (treatment-on-treated.) Endogeneity is addressed through the intent-to-treat approach as well as through propensity score matching. The proposed research is significant because it will fill a critical gap in whether housing assistance can ameliorate the impact of childhood poverty-related housing needs on adult obesity, hypertension, and diabetes on a population-wide scale. Furthermore, it is significant by identifying the critical periods and cumulative exposures that are needed to optimize the administration of housing assistance to most improve health on a population-wide scale. This research is innovative through its unique restricted linkage to HUD data and its 51- year longitudinal design. It is also innovative by utilizing both intent-to-treat and treatment-on-treated approaches and leveraging the exogenous variability of when counties adopted housing assistance.