Medical Student Georgetown University School of Medicine Washington, District of Columbia, United States
Background: As the primary childhood environment, Housing Quality (HQ) can impact children’s physical and socioemotional health. Families with low incomes are more likely to experience poor HQ including conditions such as mold, rodents, bugs, leaking water, and peeling paint. While the link to physical health has been studied, further research is needed to elucidate the link to pediatric behavioral and developmental health. Results can inform practice and policy to decrease HQ disparities affecting pediatric health outcomes. Objective: Evaluate the association of HQ with developmental and behavioral health outcomes in children from families with low income in an urban area. Design/Methods: This retrospective study utilized data from well-child screenings of 808 children ages 0-17yo between January 2019 and June 2023 at an urban clinic serving families on Medicaid or uninsured, in Washington, D.C. The independent variable is HQ derived from the following question: “Have you seen mold, bugs, mice, rats, peeling paint or water leaking where you live?” with Yes classified as positive. Dependent variables include adverse behavioral and developmental outcomes: Strengths and Difficulties Questionnaire (SDQ) for ages 4-17yo, with High/Very High classified as adverse behavioral outcome; ICD-10 codes for adverse behavioral or developmental diagnoses in ages 0-17yo. Statistics included prevalence (%) and Odds Ratios (OR), unadjusted and adjusted for food insecurity. Results: The prevalence of poor HQ was 38%, adverse developmental outcomes 16% and adverse behavioral outcomes 27%, and either adverse behavioral or developmental diagnoses was 37% (Table 1). Poor HQ was significantly associated with adverse behavioral outcomes (OR = 1.83, p< 0.001) and adverse developmental outcomes (OR = 1.91, p< 0.001). After adjusting for food insecurity, a potential confounder and proxy for poverty, these significant associations persist, with adjusted OR ranging from 1.65 to 2.21 and p-values typically less than 0.01 (Table 2).
Conclusion(s): Poor HQ is prevalent among families with low income in D.C. and may be an important and modifiable social determinant of health for pediatric behavioral and developmental outcomes. Limitations included self-reported HQ and other potential confounders, but this study could help inform pediatric screening tools, interventions, and policy. Table 5 - 1.jpeg