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Open AccessArticle

Severe Housing Insecurity during Pregnancy: Association with Adverse Birth and Infant Outcomes

1
Department of Health Policy and Management, Los Angeles Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA
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Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
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Institute for Health Policy Studies, University of California, San Francisco School of Medicine, San Francisco, CA 94118, USA
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Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
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Department of Sociology, Princeton University, Princeton, NJ 08544, USA
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School of Public and International Affairs, Princeton University, Princeton, NJ 08544, USA
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Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
12
RTI International, Research Triangle Park, NC 27709, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(22), 8659; https://doi.org/10.3390/ijerph17228659
Received: 18 October 2020 / Revised: 17 November 2020 / Accepted: 18 November 2020 / Published: 21 November 2020
Introduction: Housing insecurity is increasingly commonplace among disadvantaged women and children. We measured the individual- and population-level impact of severe housing insecurity during pregnancy on adverse birth and infant outcomes. Methods: We analyzed data from 3428 mother–infant dyads enrolled in the Fragile Families and Child Wellbeing Study, a prospective cohort study representing births in 20 large U.S. cities from 1998 to 2000. Severe housing insecurity was defined as threatened eviction or homelessness during pregnancy. Outcomes included low birth weight and/or preterm birth, admission to a neonatal intensive care unit (NICU) or stepdown facility, extended hospitalization after delivery, and infant health and temperament. We estimated exposure–outcome associations with risk ratios adjusted for pre-pregnancy maternal sociodemographic and heath factors and calculated a population attributable fraction (PAF) of outcomes attributable to severe housing insecurity. Results: We found statistically significant associations between severe housing insecurity during pregnancy and low birth weight and/or preterm birth (risk ratio (RR] 1.73, 95% confidence interval (CI) 1.28, 2.32), NICU or stepdown stay (RR 1.64, CI 1.17, 2.31), and extended hospitalization (RR 1.66, CI 1.28, 2.16). Associations between housing insecurity and infant fair or poor health (RR 2.62, CI 0.91, 7.48) and poor temperament (RR 1.52, CI 0.98, 2.34) were not statistically significant. PAF estimates ranged from 0.9–2.7%, suggesting that up to three percent of adverse birth and infant outcomes could be avoided by eliminating severe housing insecurity among low-income, pregnant women in US cities. Conclusions: Results suggest that housing insecurity during pregnancy shapes neonatal and infant health in disadvantaged urban families. View Full-Text
Keywords: housing; eviction; homeless persons; birth weight; premature birth; neonatal intensive care units; infant health housing; eviction; homeless persons; birth weight; premature birth; neonatal intensive care units; infant health
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Leifheit, K.M.; Schwartz, G.L.; Pollack, C.E.; Edin, K.J.; Black, M.M.; Jennings, J.M.; Althoff, K.N. Severe Housing Insecurity during Pregnancy: Association with Adverse Birth and Infant Outcomes. Int. J. Environ. Res. Public Health 2020, 17, 8659.

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