ImportanceHousing instability is an important public health issue, particularly for children. This study provides nationally representative estimates of unstable housing among US children.ObjectiveTo examine unstable housing prevalence; differences by sociodemographic characteristics, health, and state of residence; and associations with other hardships.Design, Setting, and ParticipantsThis survey study examined data from the 2022 National Survey of Children’s Health, a population-based, nationally representative survey of randomly selected children whose parent or caregiver responded to an address-based mail or web-based survey. Participants were children aged 0 to 17 years living in households in the 50 US states and District of Columbia (N = 54 103). Bivariate analyses tested for observed differences in unstable housing between groups; logistic regression models tested for significant disparities. Associations between unstable housing and health care and food-related hardships, neighborhood conditions, and adverse childhood experiences were examined.ExposureUnstable housing experiences.Main Outcomes and MeasuresUnstable housing, comprising 3 indicators: inability to pay mortgage or rent on time in the past 12 months, 2 or more moves in the past 12 months, and homelessness in the child’s lifetime. Analyses were adjusted for child age and family poverty ratio. Secondary analyses examine caregiver-reported stress or worry about eviction, foreclosure, or condemned housing in the past 12 months. Weighted prevalence estimates accounted for probability of selection and nonresponse.ResultsIn 2022, 17.1% (95% CI, 16.4%-17.8%) of children living in US households, representing more than 12.1 million children, experienced 1 or more forms of unstable housing: 14.1% (95% CI, 13.4%-14.7%) lived in households that were unable to pay mortgage/rent, 2.9% (95% CI, 2.6%-3.3%) moved frequently, and 2.5% (95% CI, 2.2%-2.8%) experienced lifetime homelessness. Additionally, 9.0% (95% CI, 8.5%-9.5%) of children had caregivers who reported stress/worry over housing. Prevalence of unstable housing varied across states (range, 12.0%-26.6%). Unstable housing was highest among American Indian or Alaska Native children (27.9%; 95% CI, 21.3%-35.6%), Black or African American children (30.4%; 95% CI, 27.8%-33.1%), and Native Hawaiian or Pacific Islander children (27.6%; 95% CI, 16.6%-42.1%) and also differed by special health care needs, family poverty ratio, caregiver education and unemployment status, and whether the family rented or owned their home. Unstable housing was associated with all other types of hardships examined.Conclusions and RelevanceThis study found that 1 in 6 US children experienced unstable housing, varying by state and sociodemographic factors. The prevalence is likely underestimated because the sample excluded children who are currently institutionalized or experiencing homelessness. Results may help move the field toward a unified national definition of unstable housing for families with children and lead to clinically appropriate and evidence-based screening and interventions to support housing stability and improve children’s health.

中文翻译：

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美国儿童不稳定住房的患病率及其相关性


重要性住房不稳定是一个重要的公共卫生问题，特别是对于儿童而言。本研究提供了对美国儿童中不稳定住房的全国代表性估计。目的检查不稳定住房的流行率；社会人口特征、健康状况和居住状况的差异；设计、背景和参与者这项调查研究检查了 2022 年全国儿童健康调查的数据，这是一项基于人口的全国代表性调查，对象是随机选择的儿童，这些儿童的父母或看护人对基于地址的邮件或网络做出了回应为基础的调查。参与者是居住在美国 50 个州和哥伦比亚特区家庭中的 0 至 17 岁儿童 (N = 54 103)。双变量分析测试了观察到的组间不稳定住房差异；逻辑回归模型测试了显着差异。研究了不稳定的住房和医疗保健以及与食品有关的困难、邻里条件和不良童年经历之间的关联。暴露不稳定的住房经历。主要成果和措施不稳定的住房，包括 3 个指标：过去 12 个月内无法按时支付抵押贷款或租金、过去 12 个月内搬家 2 次或以上，以及孩子一生无家可归。根据儿童年龄和家庭贫困率对分析进行了调整。二次分析检查了护理人员报告的过去 12 个月内对驱逐、丧失抵押品赎回权或报废住房的压力或担忧。加权患病率估计考虑了选择和不答复的概率。结果2022 年，居住在美国家庭的儿童中有 17.1%（95% CI，16.4%-17.8%）（代表超过 1210 万儿童）经历过一种或多种形式的不稳定住房： 14.1%（95% CI，13。4%-14.7%）生活在无力支付抵押贷款/租金的家庭中，2.9%（95% CI，2.6%-3.3%）经常搬家，2.5%（95% CI，2.2%-2.8%）经历过一生无家可归。此外，9.0%（95% CI，8.5%-9.5%）的儿童的照顾者报告对住房有压力/担忧。各州不稳定住房的发生率各不相同（范围为 12.0%-26.6%）。美洲印第安人或阿拉斯加原住民儿童（27.9%；95% CI，21.3%-35.6%）、黑人或非裔美国儿童（30.4%；95% CI，27.8%-33.1%）以及夏威夷原住民或原住民儿童的住房不稳定程度最高。太平洋岛民儿童（27.6%；95% CI，16.6%-42.1%）也因特殊医疗保健需求、家庭贫困率、看护者教育和失业状况以及家庭是否租用或拥有自己的房屋而有所不同。不稳定的住房与所有其他类型的困难有关。结论和相关性这项研究发现，六分之一的美国儿童经历过不稳定的住房，具体情况因州和社会人口因素而异。患病率可能被低估，因为样本排除了目前被收容或无家可归的儿童。结果可能有助于推动该领域对有儿童家庭的不稳定住房做出全国统一的定义，并导致临床上适当且基于证据的筛查和干预措施，以支持住房稳定性和改善儿童的健康。