Federal Housing Assistance Programs, Food Insecurity and Health Care Hardship among Children in the United States: Differences Across Rental Market Affordability Contexts

Abstract Food insecurity and health care hardship are pressing public health problems for families with children in the United States and may be exacerbated by a worsening rental housing affordability crisis that is most acute in urban areas. Federal housing assistance programs funded by the U.S. Department of Housing and Urban Development (HUD) may be a powerful tool for preventing these hardships among children. Yet, little is known about the impact of housing assistance on child food insecurity and health care hardship, or whether any impact of housing assistance on these outcomes is amplified in areas facing greater rental housing affordability problems. We used linked National Health Interview Survey data (1999–2018) and HUD administrative records (1996–2019) and multivariable regression models to compare children currently receiving HUD housing assistance with a pseudo-waitlist comparison group of children who entered HUD housing within two years. We further examined whether associations varied based on whether children resided in counties having “low,” “moderate,” or “severe” rent burden, and by HUD program type. Current HUD recipients had 28% lower odds of food insecurity and significantly lower odds of several health care hardship measures, including 19% lower odds of having any unmet health need due to cost. These relationships were largest in magnitude in areas with the most severe rent burden and for recipients of Housing Choice Vouchers. These findings suggest an income-driven association between housing assistance and child health and hardship, with potentially greater benefits in communities with the worst affordability problems.