Evaluating the impact of PHLHousing+ on reducing health disparities

PHLHousing+评估的目的是测试是否无条件地每月支付现金， 直接提供给租户，增加了住房保障，从而减少了低收入租房者的健康差距 在费城，黑人的比例很高。这一目标符合以下战略目标： NINR了解哪些大流行时期的住房政策最适合继续推进卫生公平。 PHLHousing+ Evaluation包括三个群体，他们的收入都低于地区收入中位数的50%， 至少有一个16岁以下的孩子住在家里：270户每月领取现金 225户有资格（或目前正在使用） 租赁凭证（100组），和789户家庭的费城住房管理局（PHA）候补名单上， 在可预见的将来，由于他们在 waitlist（控制组）。在研究的1,284户家庭中，82.5%的户主是单身女性，82.8%的 都是黑人样本中有2，678名儿童，年龄从1岁到19岁不等（中位数= 10，IQR = 5- 15）。每月现金支付从89美元到2079美元不等，中位数为881美元;支付额因 家庭收入、家庭规模和公平的市场租金。现金组的家庭每月将收到 支付2.5年。所有这三个群体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月部署。现有的调查包括自我报告的措施， 成人和儿童的身心健康和医院利用率。我们建议将这些数据扩展到 三种方式：（1）通过提取急诊科（艾德）就诊的电子健康记录（EHR）数据， 与我们的调查受访者联系起来的住院人数;（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的保留率，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邻里机会数据和费城警方联系起来 部门犯罪数据。目标1是测试是否租金援助（现金+现金vs.控制）或 援助（现金与现金）与自我报告的心理和身体健康以及情感 波动性和健康促进行为。目标2是测试是否有租赁援助或援助类型是否 与EHR中记录的艾德使用或住院相关，特别是 不成比例地与住房不安全相关（例如，心理健康问题）。目标3是测试是否 租赁援助的可用性或类型与面临住房问题有关（例如，害虫、霉菌）， 获得邻里机会或接触犯罪。研究结果将直接影响到 费城市提供住房援助的模式，将为建立类似的 计划在其他城市，并将告知联邦的方法，以租金援助。

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.