Social determinants of health (SDOH) are the nonmedical conditions that influence health, such as birthplace, living situation, work, and age (Braveman and Gottlieb, 2014; World Health Organization, n.d.). Within that context, access to safe, affordable, and stable housing is increasingly identified as an important SDOH (Krieger and Higgins, 2002; Swope and Hernández, 2019). A large share of American households experience “worst case housing needs,”¹ a long-standing U.S. Department of Housing and Urban Development (HUD) measure that seeks to quantify the national extent of unmet housing needs for affordable and quality rental housing. A recent HUD report to the U.S. Congress estimated that approximately 8 million renter households faced substantial worst case housing issues in 2019, including 2.2 million households with children, a number that translates to approximately 40 percent of U.S. families with children (Alvarez and Steffen, 2021).

HUD federal housing subsidy programs aim to reduce unmet housing needs by subsidizing rental costs for safe and affordable units and support HUD’s mission to “create strong, sustainable, inclusive communities and quality affordable homes for all” (HUD, n.d.b.). Although public rental assistance programs seek to alleviate housing affordability issues for households with lower incomes, the need for housing assistance greatly outweighs the demand. According to the 2021 American Housing Survey, only approximately one-quarter of renter households eligible for housing assistance receive it (U.S. Census Bureau, 2021).

Women and children represent more than 75 percent of HUD-assisted people. HUD provides housing rental assistance to approximately 9 million people annually, including approximately 4.2 million women and 3.2 million children, including foster children, from birth to age 17 (HUD, 2022). HUD is increasingly committed to better understanding the health and social needs of women and children living in public and assisted housing. The current HUD Strategic Plan for Fiscal Years (FY) 2022–2026 states that “housing is the foundation on which we live, grow, and thrive” and includes a milestone to “improve maternal and child health outcomes” (HUD, n.d.a.).

Further, to support the White House Blueprint for Addressing the Maternal Health Crisis report, HUD has committed to conducting interagency research to better understand the unique health and social needs of HUD-assisted women and children (The White House, 2022).

A growing body of research underscores a link between housing stability attributable to federal housing assistance programs and health outcomes. Housing assistance has been shown to be associated with reduced odds of self-reported fair or poor health and psychological distress for participants in the public housing program, but results were not consistent across HUD program types (Fenelon et al., 2017). Another study found that receipt of housing assistance was associated with lower uninsured rates and lower unmet healthcare needs (Simon et al., 2017). A HUD report highlighting the characteristics of HUD-assisted adults found that approximately 74 percent of adults identified as female reported high rates of health conditions, medical diagnoses, and healthcare utilization (Helms, Sperling, and Steffen, 2017).

Previous randomized control trials also showed a strong link between housing status and maternal and child health outcomes. The Family Options Study, a large-scale experiment for homeless families with young children, showed that families who received housing vouchers (the most sustainable and long-term intervention option) reported fewer child separations, decreased maternal psychological distress, decreased economic stress, fewer child behavior problems, and less household food insecurity (Gubits et al., 2016, Shinn et al., 2016). Still, limited data exist that allow for the examination of health outcomes for women with children receiving HUD assistance.

For more than a decade, the HUD Office of Policy Development and Research (PD&R) and the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention have partnered to link NCHS national health survey data with HUD administrative records² on people participating in federal public and assisted housing programs. The availability of those linked data sources provides a unique opportunity to examine housing status as an important social determinant of health for lower-income women with children.

Using the 2015–18 National Health Interview Survey (NHIS) data linked to HUD housing assistance data, this study examined women 18–44 years with children, who were renting their home and receiving HUD assistance, and a comparison population of women of the same age with children, who were low-income renters but did not link to HUD records at the time of their NHIS interview. Leveraging this linked data source may allow for a better understanding of the health status and healthcare access of women with children receiving HUD housing assistance compared with a group likely eligible for housing assistance but not receiving it.

Using the linked 2015–18 NHIS-HUD data, this article presents a descriptive summary of health characteristics and healthcare access for women with children receiving HUD assistance. The findings in this article build upon two recent HUD “health pictures” of adults and children receiving HUD assistance (Helms, Sperling, and Steffen, 2017; Helms et al., 2018) and further support initiatives to better understand the health needs of HUD-assisted women and children (HUD, n.d.a.; The White House, 2022). The study examined women 18–44 years old with children, who were renting their home and receiving HUD assistance, and a comparison population of women of the same age with children, who were low-income renters but did not link to HUD records at the time of their NHIS interview. Because income is a significant factor for HUD program eligibility and only approximately one in four households eligible for housing assistance receive it, the comparison population attempts to reflect women with children who are eligible for housing assistance but are not receiving it. The population of HUD-assisted women differed from the comparison group on key sociodemographic characteristics and health indicators.

Although HUD-assisted and unassisted women had similar percentages of women who were 18–24 years old, approximately 50 percent and 30 percent of HUD-assisted women were 25–34 and 35–44 years of age, respectively, compared with approximately 40 percent of unassisted women in each of those age groups. Most HUD-assisted women were Black non-Hispanic, although nearly one-half of unassisted women were Hispanic. Only approximately one in five HUD-assisted women reported being married or living with a partner, and two-thirds reported being the only adult in their household. Among unassisted women, most (61 percent) reported being married or living with a partner. Compared with unassisted women, a larger proportion of HUD-assisted women reported working in the past year and receiving some college education.

HUD-assisted women reported higher levels of fair or poor health status, with approximately one-fifth self-reporting this outcome (21 percent), compared with approximately 11 percent among unassisted women, although reported levels of serious psychological distress were similar between the two groups. Consistent with previous literature, nearly one-third of HUD-assisted women were current smokers at the time of their health interview (Helms, King, and Ashley, 2017), whereas less than 20 percent of unassisted women were current smokers. Demographic factors may account for differences in current smoking. For example, unassisted women were more likely to be Hispanic, and Hispanics have lower prevalence estimates of current smoking (Arrazola et al., 2023). HUD-assisted women had higher reported levels of public health insurance and lower levels of uninsured status compared with unassisted women. Fewer than 20 percent of HUD-assisted women and 28 percent of unassisted women reported no usual source of care, suggesting an area for future research between having health insurance and access to health care among this population.

The objective of this study has been to demonstrate how the NCHS-HUD linked data can serve as a resource for researchers and policymakers in further examining housing status as an important social determinant of health. The findings are exploratory and raise additional questions about the health of HUD-assisted women that could be addressed with additional research examining education level, work status, and receipt of housing assistance among lower-income, female-led households with children. For example, do HUD-assisted women have higher levels of public health insurance and lower levels of uninsured status because they can more successfully navigate complex social safety net systems due to their education? Does the stability of federal housing assistance programs allow women to pursue additional education? Do lower-income women with higher levels of education possess the skills and knowledge needed to obtain housing assistance?

The findings in this article are exploratory. The objective has been to present preliminary estimates and to demonstrate how the NCHS-HUD linked data can serve as a resource for researchers and policymakers in further examining housing status as an important social determinant of health.