Health, mental health and developmental outcomes as a function of residential instability: A five-year follow-up of young children in 20 American cities

While many homeless children are known to have physical, developmental, and mental health problems, it is unclear whether homelessness exacerbates children's health problems or other adverse life events, such as exposure to violence and extreme poverty, aggravate health problems. Additionally, little is known about the role of doubled-up arrangements, involving moving in with relatives or friends without paying rent, on health outcomes. We examine to what extent homelessness explains differences and changes in children's health outcomes and whether doubled-up children are different from homeless and other low-income groups in their health status.

This prospective cohort design study uses data on children in 20 large U.S. cities followed since their birth. The sample includes 260 homeless, 515 doubled-up, and 2,019 low-income children. Descriptive and logit analyses with GEE estimation are conducted.

Homeless children have a greater likelihood of physical disability (OR=1.65, p<.001) and doubled-up children had a lower likelihood of asthma (OR=0.85, p<.01) and a higher likelihood of emergency room visits (OR=1.25, p<.001). Despite homeless children's higher average rate of emotional/behavioral problems, homelessness did not show an independent effect on mental health.

This study produces national estimates of health status by residential instability for young children and reliable evidence of independent contributions of residential instability on health. High rates of asthma and mental health problems among low-income children, particularly homeless children, suggest the need for early screening and prevention efforts for this vulnerable population. Findings also suggest that children in doubled-up situations need adequate, timely access to healthcare.