PRC Assesses Health among Boston’s Public Housing Residents
Health Surveillance Systems Help Assess Health Status of Boston Public Housing Residents
Low-cost, ongoing surveillance methods obtain population-based health information for residents of Boston public housing
One question added to the Boston Behavioral Risk Factor Surveillance System (BBRFSS) allows health comparisons between public housing residents and nonresidents
Public housing residents report poorer health than other city residents, but similar access to and use of preventive health care
In the United States, more than 7.9 million people live in public housing. These residents are predominately from racial and ethnic minority groups and have low income—characteristics associated with increased health risks. Limited information is available to describe the health status of public housing residents. Further, no surveillance systems have been in place to monitor the health characteristics of this population over time.
About 10 percent of all Boston residents live in public housing, and most of these residents are Hispanic or African American. Since 2000, researchers from the Boston University Prevention Research Center have collaborated with the Boston Housing Authority (BHA), Boston Public Health Commission, and the Community Committee for Health Promotion to improve the health of public housing residents in the city. The partners have developed promising, low-cost methods to obtain ongoing population-based health data for public housing residents.
Since 2001, a single question has been added to the BBRFSS to determine public housing residency status. Administered by the Boston Public Health Commission, the BBRFSS is a biennial, random-digit-dialed household telephone survey of health-related behaviors and conditions among city adults aged 18 years or older. Results from the 2001 and 2003 surveys have been published and indicate that Boston public housing residents reported significantly poorer overall health status (including hypertension, asthma, and diabetes) than the general Boston population as well as significantly higher rates of current smoking. However, public housing residents reported access to health care and use of preventive health screenings similar to that of nonresidents. Age, gender, and race or ethnicity distributions from the survey results were similar to data collected by the BHA, suggesting that the survey findings may be generalizable to the entire population of residents of public housing developments.
Preliminary results from the BBRFSS are now available through 2006 and show that public housing residents continue to have poorer reported health than nonresidents, including higher percentages of obesity (31% vs. 16%), current smoking (28% vs. 17%), ever having diabetes (12% vs. 5%) or hypertension (32% vs. 19%), poorer mental health in the past month (20% vs. 8%), and loss of six or more permanent teeth (23% vs. 12%). Public housing residents were less likely to engage in binge (15% vs. 24%) or heavy drinking (5% vs. 13%).
In a second surveillance effort the PRC, in collaboration with the Massachusetts Department of Public Health, has linked data from the birth and death certificates of the residents of public housing developments by using home addresses. These linkages are performed in a manner that safeguards residents’ confidentiality. When the analyses are completed, rates of health events between these residents and other city residents can be compared. These events include cause-specific deaths, teen births, smoking during pregnancy, and adequacy of prenatal care.
These innovative efforts to establish ongoing public health monitoring of public housing residents have already yielded information that can be used to design, modify, and prioritize health research and services for public housing residents and monitor their health over time. The added question to the BBRFSS costs only $2,500–$3,000 for each year the survey is conducted and provides useful information for discussing health concerns with the residents and city policymakers. The Boston Public Health Commission is using the data in community and program planning to address health disparities between public housing residents and nonresidents. The state of Massachusetts instituted health insurance reform in 2006, and these surveillance systems may be useful in assessing the effects of this reform on public housing residents.
Analyses of more-recent data from the survey of Boston public housing residents are under way, and plans are in place to extend the analyses to characterize mammography use and to explore differences in health status and preventive care among demographic subgroups. The additional years of the BBRFSS data will enable the Boston researchers to explore trends over time in health conditions and risk factors. After completing analysis of the data linkage to birth and death certificates, the researchers will explore other potential linkages, such as with immunization and hospital discharge databases that could provide additional valuable information about the health status of Boston public housing residents.
National Association of Housing and Redevelopment Office. At a Glance. Available at http://www.nahro.org/at-a-glance
Digenis-Bury EC, Brooks DR, Chen L, Ostrem M, Horsburgh CR. Use of a population-based survey to describe the health of Boston public housing residents. American Journal of Public Health 2008;98:85–91.
Boston Public Health Commission, Boston University School of Public Health. Health and Public Housing Data, Oral Health, Boston, 2001–2005. Available at http://www.bphc.org/programs/cib/chronicdisease/oralhealth/oralhealthearlychildhood/Forms%20%20Documents/Oral%20Health%20Fact%20Sheet.pdf [PDF - 135K]
Boston Public Health Commission, Boston University School of Public Health. Residents Living in Boston Public Housing and Cardiovascular Disease Risk Factors. Available at http://www.nchph.org/wp-content/uploads/2011/10/Cardiovascular-Fact-Sheet.pdf [PDF - 228K]
Boston Public Health Commission, Boston University School of Public Health. Residents Living in Boston Public Housing and Mental Health/Substance Abuse. Available at http://www.nchph.org/wp-content/uploads/2011/10/Mental-Health-Substance-Abuse-Fact-Sheet.pdf [PDF - 225K]
Boston Public Health Commission, Boston University School of Public Health. Residents Living in Boston Public Housing and Diabetes. Available at http://www.nchph.org/wp-content/uploads/2011/10/Diabetes-Fact-Sheet.pdf [PDF - 215K]