摘要：Objectives. We investigated the association between housing insecurity and the health of very young children. Methods. Between 1998 and 2007, we interviewed 22 069 low-income caregivers with children younger than 3 years who were seen in 7 US urban medical centers. We assessed food insecurity, child health status, developmental risk, weight, and housing insecurity for each child's household. Our indicators for housing insecurity were crowding (> 2 people/bedroom or > 1 family/residence) and multiple moves (≥ 2 moves within the previous year). Results. After adjusting for covariates, crowding was associated with household food insecurity compared with the securely housed (adjusted odds ratio [AOR] = 1.30; 95% confidence interval [CI] = 1.18, 1.43), as were multiple moves (AOR = 1.91; 95% CI = 1.59, 2.28). Crowding was also associated with child food insecurity (AOR = 1.47; 95% CI = 1.34, 1.63), and so were multiple moves (AOR = 2.56; 95% CI = 2.13, 3.08). Multiple moves were associated with fair or poor child health (AOR = 1.48; 95% CI = 1.25, 1.76), developmental risk (AOR 1.71; 95% CI = 1.33, 2.21), and lower weight-for-age z scores (–0.082 vs −0.013; P = .02). Conclusions. Housing insecurity is associated with poor health, lower weight, and developmental risk among young children. Policies that decrease housing insecurity can promote the health of young children and should be a priority. In the United States, as in other countries, housing is considered a strong social determinant of health. 1 Poor housing conditions have been linked to multiple negative health outcomes in both children and adults. The Department of Health and Human Services has defined housing insecurity as high housing costs in proportion to income, poor housing quality, unstable neighborhoods, overcrowding, or homelessness. 2 Crowding in the home and multiple moves from home to home have clear negative associations for children. Crowding is negatively associated with mental health status, 3 ability to cope with stress, 4 child and parent interaction, 5 social relationships, 3 and sleep. 3 It also increases the risk for childhood injuries, 6 elevated blood pressure, 5 respiratory conditions, 7 and exposure to infectious disease. 7 Adults 8 and children 9 living in crowded households are less likely to access health care services than are those in noncrowded households, and families with multiple moves are less likely to establish a medical home and seek out preventive health services for their children than are securely housed families. 10 In older children and adolescents, a history of multiple moves has been associated with mental health concerns, 11 substance abuse, 12 increased behavior problems, 13 poor school performance, 13 , 14 and increased risk of teen pregnancy. 15 Multiple moves in childhood can have lifelong impact, as evidenced by higher rates of adverse childhood events, 16 lower global health ratings in adulthood, 17 and increased mental health and behavior concerns lasting through adolescence and into adulthood. 16 Grade-school children with more than 2 school moves are 2.5 times more likely to repeat a grade, 18 and adolescents who experience school moves are 50% more likely not to graduate from high school. 19 Access to affordable housing is likely to reduce the chances that a family will live in crowded conditions or make multiple moves within a short period of time. Since the Housing Act of 1937 was passed, 20 30% of monthly adjusted income has been used as the threshold for affordable housing costs. But affordability by this definition is becoming increasingly less common. In 2008, half of renter households paid more than 30% of their income in rent, and nearly a quarter paid more than 50%. 21 Increases in unemployment and the poverty rate since 2008 have likely increased the number of families living in housing that they are hard pressed to afford. Although poverty is higher among young children than among any other age group, 22 little is known about the effects of housing insecurity on very young children who are considered housed, albeit precariously. We examined the health, developmental, and anthropometric correlates of housing insecurity among children younger than 3 years, using crowding and multiple moves as indicators.
