The effects of affordable housing access on type 2 diabetes self-management and control

经济适用住房对 2 型糖尿病自我管理和控制的影响

• 批准号: 10397074
• 负责人: Danya Keene
• 金额: $ 51.78万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10397074
• 关键词: Address; Adult; Adverse effects; Affect; Behavior; Behavior Control; Behavior Therapy; Behavioral; Biological; Blood Pressure; Body mass index; Caring; Chronic; Chronic Disease; Clinical; Cohort Studies; Complex; Complications of Diabetes Mellitus; Cross-Sectional Studies; Data; Data Collection; Data Linkages; Diabetes Mellitus; Disease Management; Disease Outcome; Face; Foundations; Gender; Glycosylated hemoglobin A; Goals; Health; Health Surveys; Health behavior; Household; Housing; Income; Individual; Intervention; Interview; Longitudinal cohort; Longitudinal cohort study; Low income; Mediating; Methods; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patients; Persons; Population; Prevalence; Process; Race; Records; Research; Resources; Risk; Sampling; Self Management; Shapes; Social Conditions; Source; Stress; Surveys; Time; U.S. Department of Housing and Urban Development; Wages; Wait Time; Waiting Lists; base; behavioral outcome; cohort; cost; diabetes control; diabetes management; diabetes self-management; experience; health data; improved; innovation; insight; nutrition; population health; prevent; programs; prospective; racial disparity; racial minority; racial minority population; recruit; social determinants; socioeconomic disparity; supported housing; therapy design; voucher

Project Abstract Low-income US renters face a severe affordable housing crisis that likely has adverse effects on population health. The current affordable housing shortage is likely to have particularly significant implications for the health of adults living with behaviorally managed chronic conditions such as type 2 diabetes. Type 2 diabetes requires complex and resource intensive daily management that is highly sensitive to social conditions such as housing. Furthermore, the rising prevalence of type 2 diabetes and diabetes related complications are unequally borne by low-income adults and racial minorities; two populations that are at greater risk of housing challenges. Rental assistance, provided by the US Department of Housing and Urban Development (HUD) is a primary source of affordable housing for low-income households. However, due to supply constraints, fewer than 1 in 4 eligible households receive this resource and waiting lists average 26 months nationally. Access to rental assistance may improve diabetes self-management and control by reducing housing costs that can compete with diabetes-related expenses and by providing stability that allows individuals to establish and maintain consistent self-management routines. Furthermore, the unmet need for rental assistance creates a unique opportunity to study the effects of affordable housing on health through rigorous approaches that compare waitlisted and rent-assisted individuals. The primary goals of this study are to estimate the effects of rental assistance on biological and behavioral indicators of diabetes self-management and control, and to examine the processes through which these effects occur. Our project has three aims: 1) To estimate the effects of rental assistance on type 2 diabetes self-management and control using a unique linkage of HUD administrative data and a nationally representative health survey. 2) To examine how transitions from rental assistance waiting lists into rent-assisted housing are associated with changes in diabetes self-management and control in a longitudinal cohort of adults with type 2 diabetes 3) To examine how experiences of waiting for and obtaining rental assistance shape diabetes behaviors and outcomes using qualitative interviews conducted with a sub-sample of aim 2 participants. Findings will inform whether and how rental assistance and other housing interventions can be leveraged to improve diabetes outcomes and to reduce diabetes disparities. Furthermore, by identifying processes that connect housing to health, findings will inform clinical and behavioral interventions to improve diabetes outcomes for inadequately housed adults, even in the absence of expanded housing access. Beyond diabetes, findings will serve as a model for understanding relationships between affordable housing access and chronic disease management behaviors more broadly.

项目摘要 美国低收入租房者面临严重的经济适用房危机，可能对人口产生不利影响 健康。当前的经济适用房短缺可能会对住房产生特别重大的影响。 患有 2 型糖尿病等慢性疾病的行为管理成年人的健康。 2型糖尿病 需要复杂且资源密集的日常管理，对社会条件高度敏感，例如 住房。此外，2 型糖尿病和糖尿病相关并发症的患病率不断上升 低收入成年人和少数族裔的负担不平等；住房风险更大的两个人群 挑战。美国住房和城市发展部 (HUD) 提供的租金援助是一项 低收入家庭经济适用住房的主要来源。但由于供应紧张，数量较少 超过四分之一的符合条件的家庭获得此资源，全国平均等待时间为 26 个月。访问 租金援助可以通过降低住房成本来改善糖尿病的自我管理和控制， 与糖尿病相关的费用竞争，并提供稳定性，使个人能够建立和 保持一致的自我管理惯例。此外，租赁援助需求未得到满足也造成了 通过严格的方法研究经济适用住房对健康的影响的独特机会 比较候补名单和租金援助个人。本研究的主要目标是估计以下因素的影响 糖尿病自我管理和控制的生物和行为指标的租金援助，以及 检查这些影响发生的过程。我们的项目有三个目标：1）估计 利用 HUD 的独特联系，租赁援助对 2 型糖尿病自我管理和控制的影响 行政数据和具有全国代表性的健康调查。 2) 研究如何从租赁转变 租金援助住房的援助等候名单与糖尿病自我管理的变化有关 并在 2 型糖尿病成人纵向队列中进行对照 3) 研究等待的经历 并通过进行定性访谈获得租金援助来塑造糖尿病行为和结果 目标 2 参与者的子样本。调查结果将告知是否以及如何提供租金援助和其他援助 可以利用住房干预措施来改善糖尿病结果并减少糖尿病差异。 此外，通过确定将住房与健康联系起来的过程，研究结果将为临床和 即使在没有条件的情况下，也可以通过行为干预来改善住房条件不足的成年人的糖尿病结局 扩大住房准入。除了糖尿病之外，研究结果将作为理解关系的模型 更广泛地说，经济适用住房的获取与慢性病管理行为之间的关系。