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.

PHLHousing+ 评估的目的是测试是否无条件每月支付现金 直接向租户提供住房保障，从而减少低收入租户的健康差距 在费城，黑人比例过高。这一目标与战略目标一致 NINR 了解哪些大流行时代的住房政策最适合继续促进健康公平。 PHLHousing+ 评估由三组组成，他们的收入均低于地区中位收入的 50%，并且 家里至少有一名16岁以下的孩子：270户每月领取现金 代替租赁券的付款（现金组），有资格（或正在使用）的 225 个家庭 租赁券（券组），以及费城住房管理局 (PHA) 候补名单上的 789 个家庭 由于他们在可预见的将来的随机位置，将不会获得租赁凭证 候补名单（对照组）。在该研究的 1,284 个家庭中，82.5% 的户主是单身女性，82.8% 的户主是单身女性。 是黑色的。样本中有 2,678 名儿童，年龄范围为 1 至 19 岁（中位数 = 10，IQR = 5- 15）。每月现金支付范围为 89 美元至 2079 美元，支付中位数为 881 美元；付款方式因情况而异 家庭收入、家庭规模和公平市场租金。现金组的家庭每月将收到 付款期限为2.5年。所有这三个群体在三年内每六个月都会通过在线调查进行一次调查； 第一波调查于 2022 年 8 月部署。现有调查包括自我报告的措施 成人和儿童的心理和身体健康以及医院利用情况。我们建议将这些数据扩展到 三种方式：(1) 提取急诊科 (ED) 就诊的电子健康记录 (EHR) 数据，以及 与我们的调查受访者相关的住院情况； (2) 通过进行简短的月度调查， 提高参与者在半年一次的调查之间的保留率，并将测量情绪和促进健康 可能是 PHLHousing+ 促进积极健康结果的途径的行为；和（3）由 将家庭地址与基于人口普查的邻里机会和费城警察数据联系起来 部门犯罪数据。目标 1 是测试租赁援助（现金 + 优惠券与控制）或类型 援助（现金与优惠券）与自我报告的身心健康以及情感相关 波动性和促进健康的行为。目标 2 是测试租赁援助的可用性或类型是否符合要求 与 EHR 中记录的 ED 使用或入院相关，特别是针对以下问题 与住房不安全（例如心理健康问题）密切相关。目标 3 是测试是否 租赁援助的可用性或类型与住房问题（例如害虫、霉菌）有关， 获得邻里机会，或接触犯罪。研究结果将立即产生影响 费城提供住房援助的模式将为建立类似的努力提供信息 其他城市的计划，并将告知联邦租金援助的方法。