Hock Emma, Blank Lindsay, Fairbrother Hannah, Clowes Mark, Cuevas Diana Castelblanco, Booth Andrew, Goyder Elizabeth
School of Health and Related Research, University of Sheffield, Sheffield, UK.
Health Sciences School, University of Sheffield, Sheffield, UK.
Public Health Res (Southampt). 2023 Dec;11(13):1-71. doi: 10.3310/TWWL4501.
Housing insecurity can be understood as experiencing or being at risk of multiple house moves that are (1) not through choice and (2) related to poverty. For example, due to short-term private rental tenancies, temporary or emergency housing, and homelessness. Housing insecurity has grown due to recent trends in the cost and availability of housing. The quality, affordability and stability of housing have all been shown to impact children's health and well-being. However, the pathways linking housing and child health and well-being are complex and poorly understood.
To identify, appraise and synthesise research evidence that explores the relationship between housing insecurity and the health and well-being of children and young people.
MEDLINE via Ovid (searched 8 April 2022), EMBASE via Ovid (searched 8 April 2022), PsycINFO via Ovid (searched 8 April 2022).
We undertook a systematic review synthesising qualitative data. We searched databases, reference lists and United Kingdom grey literature. We extracted and tabulated key data from the included papers, and appraised study quality. We synthesised the data qualitatively into an a priori conceptual framework using best-fit framework synthesis combined with thematic synthesis, and generated logic models to highlight links between specific exposures, impacts and outcomes.
We included 59 studies and identified four populations: those experiencing housing insecurity in general (40 papers); associated with domestic violence (nine papers); associated with migration status (13 papers) and those forced to relocate due to demolition (two papers). Most published studies had an overall assessment of moderate-high quality, and most grey literature originated from known and valued sources. Housing insecurity took many forms and resulted from several, often inter-related, situations, including being evicted or having a forced move, living in temporary accommodation, exposure to problematic behaviour, overcrowded/poor-condition/unsuitable property, and making multiple moves. The resultant housing insecurity had multiple impacts, including school-related, psychological, financial and family well-being impacts, long-distance travel to attend school and see friends, living in a poor-condition or unsuitable property, all of which could further exacerbate housing insecurity. These experiences impacted health and well-being, in terms of mental health problems (often manifesting physically/behaviourally) and physical health problems related to poor housing conditions. Some factors lessened the impact of housing insecurity, including friendship and support, staying at the same school, having hope for the future and protective parenting. The negative impacts of housing insecurity on health and well-being may be compounded by specific situations and life circumstances, such as escaping domestic violence, migration status, or a forced relocation due to housing demolition.
Many accounts were from parents or other informants, and more data directly from children and young people may give a more nuanced picture. Likewise, there was little information relating to outcomes, and it is difficult to know whether the current evidence has captured all relevant outcomes, and the links from impacts to health and well-being outcomes are less well understood. The complexity and diversity of the data added additional challenges to the synthesis process.
Our findings suggest that policies should focus on reducing housing insecurity among families, particularly in relation to reducing eviction, improving and reducing the need for temporary accommodation, minimum requirements for property condition, and support to reduce multiple moves and moves far from families' desired location. Those working with children and families experiencing housing insecurity should give them optimal choice and control over situations that affect them.
Future qualitative research should focus explicitly on the health and well-being of children and young people experiencing housing insecurity, and how it links with the impacts identified in the current review, foregrounding the accounts of children and young people themselves, including specific groups of young people who are likely to be marginalised. Qualitative research focusing on the impact of interventions to address housing insecurity among families in the United Kingdom is also needed.
This study is registered as PROSPERO CRD42022327506.
This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (Award ref: NIHR135455) and is published in full in ; Vol. 11, No. 13. See the NIHR Funding and Awards website for further award information. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
住房不安全可被理解为经历多次非出于自身选择且与贫困相关的房屋搬迁，或面临这种风险。例如，由于短期私人租赁、临时或应急住房以及无家可归等情况。由于近期住房成本和可获得性的趋势，住房不安全问题有所增加。住房的质量、可负担性和稳定性均已表明会影响儿童的健康和幸福。然而，住房与儿童健康和幸福之间的联系途径复杂，人们对此了解甚少。
识别、评估和综合探索住房不安全与儿童及青少年健康和幸福之间关系的研究证据。
通过Ovid检索MEDLINE（检索日期为2022年4月8日）、通过Ovid检索EMBASE（检索日期为2022年4月8日）、通过Ovid检索PsycINFO（检索日期为2022年4月8日）。
我们进行了一项综合定性数据的系统综述。我们检索了数据库、参考文献列表和英国灰色文献。我们从纳入的论文中提取关键数据并制成表格，并评估研究质量。我们使用最佳拟合框架综合法结合主题综合法，将数据定性综合到一个先验概念框架中，并生成逻辑模型以突出特定暴露、影响和结果之间的联系。
我们纳入了59项研究，确定了四类人群：一般经历住房不安全的人群（40篇论文）；与家庭暴力相关的人群（9篇论文）；与移民身份相关的人群（13篇论文）以及因房屋拆除而被迫搬迁的人群（2篇论文）。大多数已发表的研究总体质量评估为中高，大多数灰色文献来自知名且有价值的来源。住房不安全有多种形式，由多种往往相互关联的情况导致，包括被驱逐或被迫搬迁、居住在临时住所、接触不良行为、过度拥挤/条件差/不合适的住所，以及多次搬迁。由此产生的住房不安全有多种影响，包括与学校相关的、心理的、经济的和家庭幸福方面的影响，长途上学和看望朋友，居住在条件差或不合适的住所，所有这些都可能进一步加剧住房不安全。这些经历在心理健康问题（通常表现为身体/行为问题）和与恶劣住房条件相关的身体健康问题方面影响了健康和幸福。一些因素减轻了住房不安全的影响，包括友谊和支持、就读同一所学校、对未来抱有希望以及保护性养育。住房不安全对健康和幸福的负面影响可能因特定情况和生活环境而加剧，例如逃离家庭暴力、移民身份或因房屋拆除而被迫搬迁。
许多描述来自父母或其他信息提供者，更多直接来自儿童和青少年的数据可能会呈现更细致入微的情况。同样，关于结果的信息很少，很难知道当前证据是否涵盖了所有相关结果，而且从影响到健康和幸福结果的联系也了解得较少。数据的复杂性和多样性给综合过程带来了额外挑战。
我们的研究结果表明，政策应侧重于减少家庭中的住房不安全，特别是在减少驱逐、改善和减少对临时住所的需求、房产条件的最低要求以及支持减少多次搬迁和远离家庭期望地点的搬迁方面。与经历住房不安全问题的儿童和家庭打交道的人员应给予他们对影响自身情况的最佳选择和控制权。
未来的定性研究应明确关注经历住房不安全问题的儿童和青少年的健康和幸福，以及这与当前综述中确定的影响之间的联系，突出儿童和青少年自身的描述，包括可能被边缘化的特定青少年群体。还需要进行侧重于干预措施对解决英国住房不安全家庭影响的定性研究。
本研究在PROSPERO注册，注册号为CRD42022327506。
本奖项由国家卫生与保健研究机构（NIHR）公共卫生研究项目资助（资助编号：NIHR135455），全文发表于《第11卷，第13期》。有关更多资助信息，请访问NIHR资助与奖项网站。所表达的观点为作者观点，不一定代表NIHR或卫生与社会保健部的观点。
