1. Adolescents with moderately and highly insecure housing had lower odds of excellent or very good self-reported overall health (SRH) compared to those with secure housing. demographic factors such as age, sex, and body mass index (BMI) category.

2. Adolescents with highly insecure housing reported the highest rates of anxiety symptoms.

Evidence Rating Level: 2 (Excellent) 

Study Rundown: Housing insecurity, which may be defined as the experience of an unstable and unsafe home, has been recognized as a negative social determinant of health and has been associated with poorer health outcomes in adults. However, the long-term impact of childhood housing insecurity on adolescent health outcomes is not well understood.

This longitudinal study examined data from the Future of Families and Child Wellbeing Study (FFCWB), an ongoing national birth cohort study across 20 cities in the United States, to evaluate the impact of housing insecurity on overall health outcomes as well as depressive and anxiety symptoms in adolescents.

The primary outcomes studied were SRH, depressive and anxiety symptoms when adolescents were 15 years old. SRH was assessed using a Likert scale question: “In general, how is your health?” with responses from “poor” to “excellent”. Depressive symptoms were assessed using a modified version of the 5-item Center for Epidemiologic Studies Depression Scale tailored for adolescents. Anxiety symptoms were evaluated with six adapted questions from the Brief Symptom Inventory 18, Anxiety Subscale. Higher scores indicated more severe depressive and anxiety symptoms.

According to the study results, three housing insecurity patterns from ages 1 to 15 were identified: secure (no insecurity), moderately insecure (intermittent-moderate insecurity), and highly insecure in early childhood with improvement in adolescence. The majority of children fell into the secure (47.3%) and moderately insecure (46.4%) categories, with a smaller portion (6.3%) in the highly insecure group. Adolescents in the moderately and highly insecure groups had 19%-33% lower odds of reporting “very good” or “excellent” SRH than adolescents in the secure housing group.

This study was limited by its reliance on self-reported measures of health outcomes, and using a composite measure that includes only five indicators, which might not encompass the entire range of housing instability experiences. Moreover, the study focused on broad health outcomes, potentially overlooking other important health outcomes affected by housing insecurity.

Click to read the study in AAP

Relevant Reading: Prospective associations of childhood housing insecurity with anxiety and depression symptoms during childhood and adulthood

In-depth [prospective cohort]: Out of 4898 participants recruited from the FFCWB study, 4714 individuals had at least 1 housing measure, 73% of whom had at least 1 outcome measure available (i.e., 3437 individuals).  An adjusted regression analysis was used for the study which controlled for other sociodemographic factors such as racial identity, biological sex, and baseline household income. The results of the adjusted analysis showed that adolescents with moderately and highly insecure housing showed decreased odds of excellent or very good SRH (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.69–0.95; OR, 0.67; 95% CI, 0.50–0.92, respectively).

Adolescents with moderately and highly insecure housing also reported higher rates of depressive symptoms than their counterparts with secure housing (1.05 and 1.1 times higher, respectively). While anxiety symptoms were not significantly different between moderately insecure and secure housing groups, the highly insecure housing group reported a higher rate of anxiety symptoms than the secure housing group.

Overall, findings from this study suggest that housing security earlier in life may have a significant impact on health outcomes in adolescents, and as such, emphasize the importance of screening families for housing security to intervene early.

Image: PD

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