More and more, housing practitioners and health care providers are connecting the dots between people’s health and their home. Housing quality can determine a person’s exposure to allergens and health hazards. This is particularly true for asthma, where indoor triggers, such as mold, pests, and tobacco smoke, can induce symptoms and may even influence the development of chronic lung disease.
Although many people are vulnerable to asthma, certain groups seem to suffer more, including low-income households, renters, and children. A growing body of evidence shows that the overall health of people receiving rental assistance is worse than other low-income renters not receiving assistance.
A study sponsored by the US Department of Housing and Urban Development (HUD) found that adults in HUD-assisted rental housing face significant health barriers. Compared with unassisted low-income renters and the general adult population, assisted renters are more likely to report poor health, higher emergency room use, greater rates of psychological distress, and greater prevalence of chronic conditions, including asthma.
In addition to its standard housing-related questions, the 2015 American Housing Survey included a new module on asthma in school-age youth and indoor asthma trigger exposure. We looked into whether assisted renters—those who live in public housing or other HUD-assisted multifamily buildings or who use housing vouchers—were more likely to have a child with asthma in the household than other low-income renters not receiving assistance.
The answer was striking. Even when taking into account socioeconomic and demographic characteristics and differences in exposure to indoor asthma triggers, assisted renters are more likely to have a school-age child with asthma in their household than other low-income unassisted renters.
- Assisted renters with children have higher exposure to certain indoor asthma triggers. Assisted renters with children with or without asthma were significantly more likely than other low-income unassisted renters with kids to be exposed to smoke (32.9 versus 21.8 percent), and mold (11.4 versus 7.9 percent).
- The proportion of assisted renters with a kid with asthma is high. More than one in three (34.7 percent) assisted renter households with children had at least one child with asthma, compared with about one in five (21.4 percent) low-income unassisted renters with children.
- These vulnerable households have even higher exposure to indoor asthma triggers. For mold and pests, assisted renters with at least one child with asthma reported exposure twice as often as low-income unassisted renters with kids with asthma: 57.6 versus 22.8 percent for mold and 46.2 versus 24.1 percent for pests. Exposure to water leaks (40.6 versus 25.7 percent) and smoke (38.5 versus 22.1 percent) were also significantly higher.
- But higher rates of exposure to indoor triggers do not appear to be linked to higher asthma rates for their kids. Our analysis points to the need to consider factors beyond those in the American Housing Survey dataset—including basic demographic characteristics (e.g., race, ethnicity, and income), housing age and type (single-family or multifamily), and exposure to indoor asthma triggers—to understand why kids in assisted renter households suffer from asthma at higher rates.
How HUD can reduce asthma triggers
This research supports the critical need to reduce kids’ exposure to mold, smoke, and pests at home and highlights the need for a better understanding of what drives higher asthma rates among school-age kids of assisted renters. We suggest three paths for HUD rental assistance programs:
- Implement HUD’s new smoke-free public housing rule. In addition to general information available on eliminating smoking in multifamily housing, HUD has provided a detailed guide for public housing authorities on implementing the new smoke-free policy.
- Improve HUD’s housing quality inspections. HUD requires regular housing quality inspections of its financed units and any units leased by a household with a HUD voucher, but these inspections do not identify certain critical asthma triggers, such as mold, musty smells, leaks, and exposure to smoke. HUD could revise its inspection checklist to include mold identification and remediation to reduce asthma symptoms and improve its pest identification. It could also link property owners to resources to fix problems.
- Learn about and address other asthma triggers in the lives and living environments of assisted renter households. There are questions we cannot answer with the American Housing Survey data that are critical to understanding and reducing childhood asthma in assisted renter households. For example, premature birth or low birth weight can influence asthma onset. Some innovative programs, such as the Healthy Start in Housing partnership between the Boston Housing Authority and Boston Public Health Commission, are trying to minimize this risk.
Other household circumstances, such as stress, and neighborhood characteristics, such as environmental quality and community violence can also affect asthma symptoms. HUD should pay attention to such findings and promote evidence-based initiatives to reduce exposure for assisted households and children.