Evaluating the impact of PHLHousing+ on reducing health disparities

评估 PHLHousing 对减少健康差距的影响

• 批准号: 10835178
• 负责人: BENJAMIN S ABELLA
• 金额: $ 36.56万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-21 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10835178
• 关键词: 16 year old; Accident and Emergency department; Address; Adult; Affective; Age; Area; Authorization documentation; Behavior; Black race; COVID-19 pandemic; Censuses; Child; Cities; Competence; Control Groups; Crime; Data; Dimensions; Disease; Economics; Education; Effectiveness; Electronic Health Record; Eligibility Determination; Emergency Situation; Emergency department visit; Emotional; Evaluation; Exposure to; Family Sizes; Future; Goals; Health; Health Promotion; Home; Hospitalization; Hospitals; Household; Household Heads; Housing; Income; Injury; Link; Low income; Marketing; Measures; Medical; Mental Health; Minority Groups; Modeling; Molds; Moods; Neighborhoods; Neurodevelopmental Problem; Outcome; Pathway interactions; Patient Self-Report; Pennsylvania; Philadelphia; Police; Policies; Positioning Attribute; Problem behavior; Property; Psyche structure; Random Allocation; Randomized; Randomized, Controlled Trials; Reduce health disparities; Respondent; Risk; Role; Sampling; Section 8; Secure; Security; Surveys; Testing; Time; Translating; Trauma; U.S. Department of Housing and Urban Development; Waiting Lists; Woman; World Health Organization; anxiety symptoms; authority; coronavirus disease; depressive symptoms; experience; experimental study; health disparity; health equity; hospital utilization; indexing; minority health disparity; novel; pandemic disease; participant retention; payment; perceived stress; physical conditioning; programs; reduce symptoms; social health determinants; socioeconomics; voucher

The objective of the PHLHousing+ Evaluation is to test whether unconditional, monthly cash payments made directly to tenants increases housing security and thereby reduces health disparities for low-income renters who, in the city of Philadelphia, are disproportionately Black. This objective is aligned with the strategic aim of NINR to understand which pandemic-era housing policies would best be continued to advance health equity. The PHLHousing+ Evaluation comprises three groups, all of whom earn below 50% area median income and have at least one child under the age of 16 years living at home: 270 households who receive monthly cash payments in lieu of a rental voucher (Cash group), 225 households who are eligible for (or currently using) a rental voucher (Voucher group), and 789 households on the Philadelphia Housing Authority (PHA) waitlist who will not be offered a rental voucher for the foreseeable future because of their randomized position on the waitlist (Control group). Of the 1,284 households in the study, 82.5% are headed by single women and 82.8% are Black. There are 2,678 children in the sample, ranging in age from 1 to 19 years (median = 10, IQR = 5- 15). Monthly cash payments range from $89 to $2079, with a median payment of $881; payments vary based on household income, family size, and fair market rent. Households in the Cash group will receive monthly payments for 2.5 years. All three groups are surveyed every six months for three years via an online survey; the first wave of surveys was deployed in August 2022. Existing surveys include measures of self-reported mental and physical health and hospital utilization for adults and children. We propose to extend these data in three ways: (1) by extracting electronic health record (EHR) data on emergency department (ED) visits and hospital admissions linked to our survey respondents; (2) by administering brief, monthly surveys that will increase participant retention between biannual surveys and will measure mood and health-promoting behaviors that might be pathways by which PHLHousing+ promotes positive health outcomes; and (3) by linking household addresses with census-based data on neighborhood opportunity and Philadelphia Police Department crime data. Aim 1 is to test whether rental assistance (Cash + Voucher vs. Control) or type of assistance (Cash vs. Voucher) is associated with self-reported mental and physical health and with affective volatility and health-promoting behaviors. Aim 2 is to test whether the availability or type of rental assistance is associated with ED use or hospital admissions as recorded in EHR, specifically for problems that are disproportionately associated with housing insecurity (e.g., mental health problems). Aim 3 is to test whether availability or type of rental assistance is associated with exposure to housing problems (e.g., pests, mold), access to neighborhood opportunity, or exposure to crime. Study findings will have immediate implications for the City of Philadelphia's model for providing housing assistance, will inform efforts to establish similar programs in other cities, and will inform federal approaches to rental assistance.

PHLhouse+评估的目标是测试是否无条件地每月支付现金 直接面向租户增加了住房安全，从而缩小了低收入租户的健康差距 在费城，黑人占不成比例。这一目标与 NINR了解哪些大流行时代的住房政策将最好地继续推进卫生公平。 PHLhouse+评估由三个群体组成，他们的收入均低于50%的面积收入中位数和 至少有一个16岁以下的孩子住在家里：270户每月收到现金 支付租金代金券(现金组)，225个有资格(或目前正在使用)的家庭 租赁券(代金券组)，以及费城住房管理局(PHA)等候名单上的789户家庭 在可预见的将来不会被提供租赁券，因为他们在 等待名单(控制组)。在参与调查的1284个家庭中，82.5%的家庭由单身女性担任户主，82.8%的家庭由单身女性担任户主 都是黑人。样本中有2678名儿童，年龄从1岁到19岁不等(中位数=10，智商=5- 15)。每月现金付款从89美元到2079美元不等，付款中位数为881美元；付款根据 家庭收入、家庭规模和公平的市场租金。现金组中的家庭将每月收到 付款期限为两年半。这三组人在三年内每六个月通过在线调查进行一次调查； 第一波调查于2022年8月展开。现有的调查包括自我报告的衡量标准 成人和儿童的身心健康和医院利用情况。我们建议将这些数据扩展到 三种方法：(1)通过提取急诊科就诊的电子健康记录数据和 住院人数与我们的调查对象相关联；(2)通过管理简短的每月调查， 在两年一次的调查之间增加参与者留存率，并将衡量情绪和健康促进 可能是PHLHousing+促进积极健康结果的途径的行为；以及(3)通过 将家庭地址与基于人口普查的社区机会和费城警察局数据联系起来 部门犯罪数据。目标1是测试租赁援助(现金+代金券与控制)或 帮助(现金与代金券)与自我报告的身心健康和情感有关 波动和促进健康的行为。目标2是测试租赁援助的可用性或类型是否 与EHR中记录的ED使用或住院相关，特别是对于以下问题 不成比例地与住房不安全有关(例如，精神健康问题)。目标3是测试 租赁援助的可获得性或类型与住房问题(例如虫害、霉菌)有关， 获得邻里机会，或接触到犯罪。研究结果将对以下方面产生直接影响 费城提供住房援助的模式将为建立类似的 其他城市的计划，并将告知联邦政府对租赁援助的方法。