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Principal Investigator: Patrick Dunn Smith
Organization: DREXEL UNIVERSITY
Fiscal Year: 2024
Award: $48,974
Funding agency: National Heart Lung and Blood Institute
Project Summary
Each year, millions of US renters are legally evicted from their homes, with structurally marginalized groups –
particularly Black and Latinx women – bearing the highest burden of evictions. Past research has shown that
personal exposure to eviction worsens physical and mental health via multiple pathways. Recent research also
suggests that eviction may create spillover effects on neighborhood health by increasing physiologic and
psychosocial stress (related to potential housing loss) and by eroding protective social structures within
communities. While individual and/or neighborhood exposure to eviction may make it more difficult to prevent
and/or manage highly prevalent stress-sensitive chronic conditions such as cardiovascular diseases (CVD),
few studies have examined how eviction influences CVD-related outcomes. Moreover, no studies have used
multilevel modeling to: (1) examine if neighborhood eviction rates affect individual-level CVD-related outcomes;
(2) test whether effects are worse for marginalized groups; or (3) parse out individual and spillover effects of
eviction on health. Lastly, few studies have used qualitative approaches to understand renters’ views on how
eviction affects health. Clarifying these relationships can inform practice and policy interventions by deepening
our knowledge of evictions’ effects on health equity. This study has two main objectives. First, using linked
data on neighborhood eviction rates (Eviction Lab) and individual-level health outcomes (from Panel 21 of the
Medical Expenditure Panel Survey), I will use multilevel models to (1) examine whether neighborhood eviction
rates are associated with individual-level CVD-related hospitalizations over time and (2) examine how these
associations vary by race/ethnicity and gender. Second, using data from an NIH-funded cohort study of 400
low-income adults in New Haven, CT, and newly collected qualitative data, I will conduct an explanatory-
sequential, mixed-methods study to: (1) examine how individual and neighborhood exposures to eviction affect
risk factors (smoking; psychological distress) and protective factors (social support; ambulatory care use)
pertinent to CVD prevention and management, and (2) understand participants’ views on health-related effects
of eviction. Informed by my clinical practice and my prior research, which includes a scoping review on eviction
and health, my central hypothesis is that neighborhood eviction rates will be associated with worse individual-
level CVD-related outcomes, that effects will be particularly strong for members of structurally marginalized
groups, and that participants will identify stress and compromised social support as key mechanisms through
which eviction affects health. Findings may inform the development and implementation of policies and
practices to prevent evictions and reduce their impacts on health. The proposed training plan will enhance my
conceptual knowledge, my skills in multilevel modeling, and my ability to translate research findings to policy
and practice. This research is vital in the wake of the COVID-19 pandemic, which has intensified low-income
renters’ risk of eviction, widened pre-existing inequities, and underscored the importance of housing for health.
Terms: <21+ years old><Accounting><Adult><Adult Human><Affect><Ambulatory Care><Attention><Behavior><Black><Black race><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><CVD prevention><Cardiovascular Diseases><Censuses><Chronic><Cohort Studies><Communities><Concurrent Studies><Data><Data Analyses><Data Analysis><Development><Disease Management><Disorder Management><Epidemic><Equity><Ethnic Origin><Ethnicity><Exposure to><Face><Financial Hardship><Funding><Gender><Generalized Growth><Goals><Growth><Health><Health Expenditures><Health Inequity><Health Promotion><Health behavior><Healthcare><History><Home><Hospital Admission><Hospitalization><Housing><Individual><Inequalities in Health><Inequities in Health><Inequity><Intervention><Intervention Strategies><Interview><Investigators><Judgment><Justice><Knowledge><Latine><Latinx><Legal><Link><Low income><Mental Health><Mental Hygiene><Methodology><Methods><Modification><NIH><National Institutes of Health><Neighborhoods><Nurses><Outcome><Outpatient Care><Participant><Pathway interactions><Physiologic><Physiological><Policies><Process><Psychological Health><Psychosocial Stress><Race><Races><Recommendation><Recording of previous events><Research><Research Infrastructure><Research Personnel><Research Resources><Researchers><Resources><Risk><Risk Factors><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Salutogenesis><Sampling><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Smoking><Social support><Stress><Structural Racism><Survey Instrument><Surveys><Testing><Time><Tissue Growth><Training><Translating><United States National Institutes of Health><Woman><Work><acute care><adulthood><cardiac disease prevention><cardiovascular disease prevention><cardiovascular disease risk><cardiovascular disorder><cardiovascular disorder prevention><cardiovascular disorder risk><cardiovascular health><clinical practice><cohort><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><data interpretation><developmental><faces><facial><financial adversity><financial burden><financial distress><financial insecurity><financial strain><financial stress><health care><health care expenditure><health equity><health inequalities><health related behavior><healthcare expenditure><histories><homes><housing instability><improved><innovate><innovation><innovative><instably housed><interventional strategy><marginalized group><marginalized individual><marginalized people><marginalized population><medical expenditure><member><methods to study multiple-level influences><multi-level analysis><multi-level model><multilevel analysis><multilevel model><multilevel modeling><nurse><ontogeny><outpatient treatment><pathway><physical conditioning><physical health><prevent><preventing><promoting health><protective factors><psychological distress><racial><racial background><racial origin><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><skills><social structural><social structure><social support network><socio-demographic factors><socio-structural><sociodemographic factors><sociostructural><stress buffering><stress management><timeline><unstable housing><unstably housed>