Policy Brief #29

Housing Instability and Health: Findings from the Michigan Recession and Recovery Study
March 2012

Prepared by Meredith Horowski, University of Michigan, based on a paper by Sarah A. Burgard, University of Michigan, Kristin S. Seefeldt, Indiana University, and Sarah W. Zelner, University of Pennsylvania.

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Key Findings

The Great Recession that began in December 2007 and lasted through June 2009 has drawn attention to the issue of housing instability, as the number of Americans who have lost their homes or moved for financial reasons has increased dramatically (1). The number of foreclosures alone increased 127 percent between 2007 and 2009, hitting a record high of 2.8 million (2). While the potential effects of housing instability are numerous, one important aspect is the consequences for health. Using new data from the Michigan Recession and Recovery Study (MRRS), a population-based sample of working-aged adults, we examine the association between many different types of housing instability and several measures of health. Our findings suggest the importance of distinguishing different types of housing instability and using appropriate risk groups and comparison categories, as well as considering characteristics such as human capital and prior housing and health problems, since housing instability may be a link on the pathway between these factors and subsequent health problems, rather than a cause itself for health decline.

Existing Research

In previous studies, the term “housing instability” has referred to a variety of problems, from frequent moves or difficulty paying rent to being evicted or being homeless (3). Prior to the Great Recession, most research focused on the health consequences of severe forms of housing instability among disadvantaged populations. A 2001 study, for example, found increased risk for earlier death, chronic diabetes, and tuberculosis for homeless individuals (4). Studies also suggest that the stress associated with a housing loss, crowding faced by those who have to share housing to save money, or changes in environmental conditions after an involuntary move could link housing instability to changes in health or health behaviors. These health consequences can include anxiety and depression, cardiovascular disease, substance abuse, unhealthy eating, and disruption in important social networks and supports, such as friends, family, and trusted health care providers (5).

However, the literature on housing instability has a number of limitations, including:

Data and Methods

Our research examines the instability experiences of individuals from a variety of socioeconomic circumstances and housing statuses and the associations between the different types of instability and health. We use the Michigan Recession and Recovery Study (MRRS), a new study following a stratified random sample of non-institutionalized, English- speaking adults aged 19-64 who lived in Southeastern Michigan. The data were collected via in-person interviews occurring between late 2009 and early 2010. Reflecting the racial make-up of the Detroit metropolitan area, most respondents are either African Americans or non-Hispanic whites. For the analyses presented below, we include data from the 894 respondents who did not have any missing data (with the exception of missing income data, for which we included a missing category).

Types of Housing Instability

Table 1 describes the eight types of housing instability we examined and the different groups of respondents at risk for each type.

Table 1: Types of Housing Instability and Respondents Asked About Each Type**

Health Measures

We use four measures of health: self-rated health, depression, anxiety attack, and problematic alcohol use. Self-rated health is measured by the question, “Would you say that your health in general is excellent, very good, good, fair, or poor?”

Respondents reporting poor or fair health are coded as “1,” while those reporting excellent, very good, or good health are coded “0.” Depression and anxiety attacks were measured using scales developed for the Patient Health Questionnaire (PHQ ). We use the Alcohol Use Disorders Identification Test (AUDIT), a validated scale that measures recent alcohol use, alcohol dependence symptoms, and alcohol related problems.

We also include measures of prior health to address the possibility that preexisting health problems selected respondents into both housing instability and subsequent poor health. Prior problems include a measure of chronic health problems diagnosed at least three years before the baseline interview and an indicator of being diagnosed with any emotional, nervous, or psychiatric problems at least three years ago.

Results

In this section we present results first on the prevalence of housing instability in this sample, then on the profiles of those experiencing the various types of housing instability, and finally on the associations between the different types of housing instability and our health measures. We compare respondents with no housing instability to those who had a particular type of housing instability, considering each type of instability separately and for the appropriate risk group.

How Much Housing Instability Was There in the Wake of the Great Recession?

Table 2 shows the percent of MRRS respondents reporting each of the eight types of housing instability. While levels of each type of housing instability are relatively low (e.g., just under 12 percent of the sample reported multiple moves within the past three years; 13 percent of current homeowners were behind on their mortgage or in foreclosure), almost one-third of MRRS respondents recently experienced some type of housing instability.

Table 2: Housing Instability among
Eligible Respondents*

Who Experiences Housing Instability?

Experiences of different types of housing instability are not distributed equally among all groups. Table 3 below illustrates these results for several of the demographic characteristics we measured, using a "+" to show that a particular demographic group was significantly more likely to experience that type of housing instability, compared to those with no housing instability. Similarly, a "-" signifies that a demographic group was significantly less likely to experience that form of housing instability. Respondents reporting multiple moves, moves for cost, doubling up or homelessness were significantly more likely to be African American and to be poor or near poor. Respondents who moved for cost were less likely to be married or cohabiting compared to those with no housing instability and also less likely to hold a bachelor’s degree or more compared to the stably housed.

Table 3: Sociodemographic Profiles of Each Type of Housing Instability

Is Housing Instability Related to Health?

Many of these types of housing instability are associated with the measures of health used in the MRRS study, but we assess associations net of the sociodemographic characteristics that predict housing instability, including those presented in Table 3. Even after adjustment for individuals’ sociodemographic characteristics, we find that many forms of housing instability are associated with negative health outcomes. Table 4 illustrates these results, using "+" to indicate that those experiencing a type of housing instability are also significantly more likely to experience a negative health outcome.

Table 4: Associations between Health Outcomes and Housing Instability from Multivariate Regression Models*

Foreclosure, homelessness, and being behind on rent are significant predictors of major or minor depression, while moving for cost, being behind on mortgage payments or in the foreclosure process, and having been through a recent foreclosure were associated with anxiety attacks. Homelessness and being behind on one's mortgage or in the process of foreclosure were associated with fair/poor self-rated health, while only recent homelessness was associated with harmful or hazardous alcohol use. However, we find that housing instability experiences like frequent moves, doubling up, and eviction are not associated with substantially poorer health after adjusting for the characteristics of respondents who had these experiences. While our sample is small (and thus some caution should be exercised when interpreting results), our findings highlight the importance of distinguishing various types of housing instability experiences and their respective associations with health.

Conclusion

The results of our study show that while some of the associations between health and housing are explained by lower incomes, education, or other social disadvantages of people who experience housing instability, some forms of instability common in the wake of the Great Recession may have an independent influence on health. Consequently, our findings highlight the importance of distinguishing different types of housing instability, their respective associations with health, and having a sample of respondents from across the socioeconomic spectrum.

Additionally, our study suggests that focusing only on those who lose their housing is insufficient. Those who have not yet lost their housing (for example, those who are behind on housing payments) may experience negative health outcomes and should thus be considered in policy discussions on housing and health. Taken together, our results suggest the need for continued exploration of the nature and extent of housing instability, its connections with health, and potential ways to intervene and groups to target. Such information will be critical for both academics and policymakers in the long shadow of the Great Recession.

Footnotes

(1) Bennett, Gary G., Melissa Scharoun-Lee, and Reginald Tucker-Seeley. 2009. “Will the Public’s Health Fall Victim to the Home Foreclosure Epidemic?” PLoS Med 6:e1000087; Pollack, Craig Evan and Julia Lynch. 2009. “Health status of people undergoing foreclosure in the Philadelphia region.” American Journal of Public Health 99:1833-1839.

(2) Wong, Venessa 2010. “Foreclosures: An Increase of 21% in 2009 and Climbing.” Bloomberg BusinessWeek, January 14, 2010.

(3) Gilman, S.E., I. Kawachi, G.M. Fitzmaurice, and L. Buka. 2003. “Socio-economic status, family disruption and residential stability in childhood: relation to onset, recurrence and remission of major depression.” Psychol Med 33:Psychol Med; Kushel, M.B., R. Gupta, L. Gee, and J.S. Haas. 2006. “Housing instability and food insecurity as barriers to health care among low-income Americans.” Housing instability and food insecurity as barriers to health care among low-income Americans 21: 71-77;

(4) Hwang, Stephen W. 2001. “Homelessness and health.” Canadian Medical Association Journal 164:229-233.

(5) Nettleton, S and R. Burrows. 2000. “When a capital investment becomes an emotional loss: the health consequences of the experience of the mortgage possession in England.” Housing Studies 15:463-479; Ross, Lauren M and Gregory D. Squires. 2011. “The personal costs of subprime lending and the foreclosure crisis: A matter of trust, insecurity, and institutional deception.” Social Science Quarterly 92:140-163.

(6) Pollack, Craig Evan and Julia Lynch. 2009. “Health status of people undergoing foreclosure in the Philadelphia region.” American Journal of Public Health 99:1833-1839.

(7) March, Elizabeth, Stephanie Ettinger de Cuba, John T. Cook, Kathryn Bailey, Diana Becker Cutts, Alan F. Meyers, and Deborah A. Frank. 2011. “Behind closed doors: The hidden impacts of being behind on rent.” Children's HealthWatch, Boston, MA.


About the Authors

Sarah A. Burgard is an Associate Professor of Sociology, an Associate Professor of Epidemiology, and a Research Associate Professor at the Population Studies Center at the University of Michigan. burgards@umich.edu

Kristin S. Seefeldt is an Assistant Professor at the Indiana University School of Public and Environmental Affairs and a Research Affiliate of the National Poverty Center. kseefeld@indiana.edu

Sarah W. Zelner is a Ph.D. student in the Department of Sociology at the University of Pennsylvania. szelner@sas.upenn.edu

Meredith Horowski is a Research Assistant at the National Poverty Center at the Gerald R. Ford School of Public Policy at the University of Michigan. horowski@umich.edu


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