Academic journal article International Public Health Journal

Impact of Housing Instability on Child Behavior at Age 7 Years

Academic journal article International Public Health Journal

Impact of Housing Instability on Child Behavior at Age 7 Years

Article excerpt

Introduction

Housing instability is a growing problem in the United States, particularly for those living in urban, low-income neighborhoods (1, 2). Despite the importance of stable housing, current research has struggled to define and identify housing instability and its effects on children's health. Previous studies have used different parameters to measure housing instability, including frequent moves and living with relatives and friends (4-6) and the US Department of Health and Human Services has defined housing instability using housing cost, housing quality, neighborhood stability, crowding, and homelessness (3).

Recent research has begun to focus on the impact of housing instability, in its many forms, on child health and development (1). It is hypothesized that young children are at greater risk of adverse effects of living environments, as this time period serves as a critical window for establishing socialization and learning habits (7, 8). Additionally, the effects of housing instability may be compounded when combined with other challenges faced by low-income families, such as lack of resources (1). Previous studies have found that housing instability is associated with deficits in overall academic achievement (9), emotional regulation (7, 8), and verbal abilities (10). These health outcomes can have serious longterm effects as children progress through adolescence and adulthood, including decreased educational attainment (11), increased participation in risky behaviors (12, 13), and a greater risk of adult-onset chronic diseases (14).

In the present paper, we explore the predictors of housing instability, including physical characteristics of housing and measures of socioeconomic strain in a low-income urban population of minority mothers and children. We also evaluate how housing instability, characterized by frequency of residential moves, affects child behavior assessed at age 7 years. We expect these results will inform future public health programs focused on identifying appropriate intervention points at which to break the cycle between unstable housing and child health outcomes.

Methods

The Mothers and Newborns Study is a longitudinal birth cohort maintained by the Columbia Center for Children's Environmental Health (CCCEH). The study enrolled 727 pregnant women living in Northern Manhattan and the South Bronx between 1998 and 2006. Study participants were African American or Dominican and were between the ages of 18 and 35 years at the time of recruitment. Subjects were excluded from the cohort if they reported smoking cigarettes or using other tobacco products during pregnancy, used illicit drugs, had their first prenatal visit after the 20th week of pregnancy, or had one of the following pre-existing conditions: diabetes, hypertension, or known HIV infection. Cohort participants were excluded from the current analysis if they did not have complete information on residential history at the prenatal and ages 1, 2, 3, 5 and 7-year follow up visits or if the mother was not administered the Child Behavior Checklist (CBCL) at the 7-year visit (see Figure 1). All study protocols were approved by the Institutional Review Board of Columbia University. Before each visit, mothers were informed about all study procedures and provided written informed consent to participate.

Covariates

Mothers and their children were followed up at approximately 1, 2, 3, 5 and 7 years after birth. Research workers conducted a structured interview to ascertain demographic characteristics of the mother (i.e., age at delivery, ethnicity, education, relationship status) and child (i.e., gender). Maternal demoralization, defined as the extent to which a mother experiences nonspecific psychological distress, was additionally assessed at each study visit using the Psychiatric Epidemiology Research InstrumentDemoralization (PERI-D) scale (15).

Residential history, building disrepair, and housing satisfaction

At each study visit research assistants recorded all addresses at which the mother-child pair resided since the previous study visit. …

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