Effects of a Short-Term Rent Subsidy to Prevent Housing Instability on Cardiovascular Health Outcomes

Housing instability (e.g., difficulties paying rent, eviction) is a significant public policy and public health issue in the U.S., and is associated with 60-70% higher rates of cardiovascular diseases (CVD). One contributor to housing instability experiences such as eviction is a sudden economic shock (e.g., car breakdown) that can have cascading effects resulting in the nonpayment of rent. Recognizing this link, the state of Illinois’ Homeless Prevention Program provides short-term housing assistance (5 months of rental assistance + utilities) to families who are currently housed but who experience an economic shock outside of their control. However, the community organization that administers this subsidy, Connections for the Homeless, has capacity limits that fluctuate across the year (depending on staffing needs and availability). Once capacity has been reached, families who are eligible are turned away. This capacity limit at the community organization level creates a natural randomness in whether eligible families are served or not, allowing us to design a 2-group intervention trial. This natural experiment will test the impact of the housing subsidy among 430 individuals who are housed but who experience an acute economic shock that impacts their ability to pay rent. Effects of either receiving the housing subsidy (n=215) or not (n=215) will be tested on the primary outcome of CVD risk (PREVENT risk equations: risk estimates for total CVD developed by the American Heart Association, based on blood pressure, cholesterol, etc.); the outcomes of housing (moves, evictions, homelessness); and the outcomes of mental health (depression, anxiety), health behaviors (diet; sleep; physical activity; substance use), and biological measures (pro-inflammatory phenotype: immune cells mounting exaggerated cytokine responses to bacterial challenge and becoming insensitive to inhibitory signals from the hormone cortisol; endothelial function, indicated by flow-mediated vasodilation), all of which are important contributors and precursors to CVD. Assessments will occur both at baseline (when households first call to request housing assistance) and 1 year later (after the subsidy has either been received or not). We hypothesize that participants in the housing subsidy group will show lower CVD risk (PREVENT) at 1-year follow-up; will be less likely to have moved, be evicted or become homeless during the ensuing 1 year; and will exhibit better mental health, health behaviors, and biological profiles that are related to CVD risk at 1-year follow-up compared to the group that does not receive the subsidy. Findings from this project could have significant policy implications across multiple domains. Demonstrating that a short-term housing subsidy, provided at a crucial moment in an individual’s life, not only stabilizes housing but also protects cardiovascular health would suggest a high return on investment approach applicable to the rapidly growing population of Americans who experience housing instability.