Social Determinants of Health: Tenant-Based Housing Voucher Programs

The CPSTF finding is based on evidence from a systematic review of 7 studies in 20 publications (search period January 1999 to July 2019).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to health equity and housing. This finding updates and replaces the 2001 CPSTF recommendation for Tenant-Based Rental Assistance Programs.

Housing is an established social determinant of health (Fullilove 2010, Healthy People 2030). In the United States, housing quality, housing security, and neighborhood characteristics have been associated with health and health-related outcomes (Alley et al. 2009; Cutts et al. 2011; Chetty 2016).

The U.S. Department of Housing and Urban Development (HUD) administers the Housing Choice Voucher program—a tenant-based voucher program designed to assist households with very low incomes. HUD conducted a ten-year randomized study the Moving to Opportunity experiment to assess the effectiveness of tenant-based voucher programs for households living with at least one child under the age of 18. The experiment provided pre-move counseling and required households to move to low poverty neighborhoods. Both the Housing Choice Voucher program and the Moving to Opportunity experiment are included in this review.

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 7 studies.

Households who used vouchers experienced the following outcomes when compared with households who were eligible, but not offered, assistance from voucher programs.

Housing quality:

• 7.9 percentage point increase in the proportion of adults who rated housing conditions as excellent or good (2 studies, 3 study arms)
• 35.5 percentage point decrease in housing insecurity (1 study)

Income:

• 6.7 percentage points decrease in the proportion of households living at or below the poverty line (2 studies, 3 study arms)
• 7.2 percentage point decrease in the proportion of households who had difficulties securing enough food (2 studies, 3 study arms)

Health:

• 4.0 percentage point decrease in the proportion of adults who reported one of five conditions (asthma, obesity, diabetes, high blood pressure, mobility limitation; 1 study, 2 study arms)
• 3.4 percentage point decrease in the proportion of adults with a mental health condition (1 study, 2 study arms)
• 1.6 percentage point decrease in youth asthma-related emergency department use (1 study)
• 4.1 percentage point decrease in the proportion of adults with unmet medical needs (3 studies, 4 study arms)

Children who were aged 12 years or younger when their families joined the voucher program experienced the following outcomes during adulthood when compared to their counterparts who did not enter the program.

• 3.4 percentage point increase in the proportion attending college (1 study)
• 3.0 percentage point increase in the proportion employed (1 study)
• 20.6% increase in income (1 study)

Children aged 13-18 years when their families joined the voucher program experienced the following outcomes during adulthood when compared to their counterparts who did not enter the program.

• 7.9 percentage point decrease in the proportion attending college (1 study)
• 4.0 percentage point decrease in the proportion employed (1 study)
• 1% increase in income (1 study)

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

A systematic review of economic evidence shows the societal benefits of Moving to Opportunity (MTO)-type housing voucher programs exceed the societal cost. MTO-type programs provide vouchers and counseling to households with young children living in public housing and move them to neighborhoods with greater opportunities. The cost-benefit evidence was mixed for housing voucher programs alone.

The economic review included 27 studies from the United States (search period 1980 to November 7, 2020). Studies evaluated housing voucher programs used alone (21 studies), MTO-type programs (12 studies), or both (6 studies).

Intervention cost

MTO-type programs (compared with public housing)

• Taxpayer cost reduced by $8 to $52 for every $100 of program spending per year by offering vouchers for rental units in the private market instead of offering rental units in public housing (6 studies)

Housing voucher program used alone (compared with no housing assistance)

• Taxpayer cost per household per year increased: $3,145; $7,697; $14,927 (3 studies)

Intervention benefits

MTO-type programs (compared with public housing)

On balance, total economic benefits for MTO-type housing voucher programs increased from employment income, consumption of housing, and reduced use of other assistance programs.

Housing voucher programs used alone (compared with public housing, no housing assistance, or no comparison group)

It was unclear whether there was an increase or decrease for the sum of economic benefits for the housing voucher programs used alone because the direction of change is mixed for employment, use of other assistance programs, and neighborhood property values.

Cost-effectiveness

MTO-type programs (compared with public housing)

• The lifetime net cost was a reduction of $7,448 per person and quality adjusted life year gained was 0.23 per person due to averted obesity and diabetes, indicating cost-savings with positive health benefit (1 study)

Housing voucher programs used alone

• None of the included studies reported this information.

Cost-benefit

MTO-type programs (compared with public housing)

• Cost savings for taxpayers was $9,215 per household and the societal economic benefit was $69,601 per household over the lifetime, indicating societal cost-savings (1 study)

Housing voucher programs used alone had mixed results (compared with no housing assistance)

• The societal cost was $9,012 per household and societal benefit was $10,882 per household over a period of 1 year, indicating benefit exceeded cost (1 study)
• Cost to taxpayer per household and societal benefits per household: $27,376 in cost and $24,912 in benefit over 8 years; $10,660 in cost and $6,958 in benefit over 1 year, indicating cost exceeded benefit (2 studies)

Based on results for interventions in different settings and populations, the finding should be applicable to families with low incomes who are living in urban areas.

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• How would the following policies influence the effectiveness of tenant-based housing voucher programs?
  • Source of income laws
  • Small Area Fair Market Rent laws
  • Inclusive zoning policies
• How would the following program factors influence the effectiveness of tenant-based housing voucher programs?
  • Allowing more time for a housing search
  • Recruitment and education of landlords to the voucher programs
  • Assistance for voucher users to move to high-opportunity areas (e.g. pre-move counseling)
  • Short-term payments to cover initial move expenses
• Young males whose families used vouchers reported worse physical and mental health outcomes than did their counterparts in comparison groups. What is needed to better address the underlying causes of these outcomes? What additional services might be offered to support young men in housing voucher programs?
• What is the program cost for public housing?
• What is the program cost for tenant-based housing voucher programs?
• What is the cost-effectiveness of these programs based on improvements in mental health and wellbeing?
• How do programs affect the economic condition of neighborhoods participants move out of?

• Studies were conducted in urban communities across the United States.
• All studies examined the HUD Housing Choice Voucher program. One study also examined the Moving to Opportunity experiment.
• Most households were headed by females (92%, 5 studies). Among studies that reported race or ethnicity, a median of 44% of participants were Black or African American (4 studies), and a median of 23% were Hispanic or Latino (5 studies).
• Study designs included individual randomized control trials (3 studies), prospective cohorts using data from databases (3 studies), and a cross-sectional comparison of Housing Choice Voucher program users to other renters with low incomes (1 study).

Finnie RKC, Peng Y, Hahn RA, et al. Tenant-based housing voucher programs: a Community Guide systematic review [PDF – 263 KB]. Journal of Public Health Management and Practice. 2022; 28(6), E795–E803.

Effectiveness Review

• Logic Model [PDF – 173 KB]
• Text Description [PDF – 126 KB]

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Economic Review

• Logic Model [PDF – 320 KB]
• Text Description [PDF – 88 KB]

The economic review team develops an analytic framework to align economic outcomes with each stage of the effectiveness review analytic framework. It informs the economic research questions and may be used to summarize the evidence for intervention cost, economic benefit, cost-effectiveness, and cost-benefit.

Effectiveness Review

• Summary Evidence Table – Effectiveness Review [PDF – 389 KB]

Economic Review

• Summary Evidence Table – Economic Review [PDF – 428 KB]

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Fenelon A, Mayne P, Simon A, et al. Housing assistance programs and adult health in the United States. AJPH 2017;107(4):571-8.

Garg A, Burrell L, Tripodis Y, Goodman E, Brooks-Gunn J, Duggan AK. Maternal mental health during children’s first year of life: association with receipt of Section 8 rental assistance. Housing Policy Debate 2013;23(2):281-97.

Lee WS, Beecroft E, Shroder M. The impacts of welfare reform on recipients of housing assistance. Housing Policy Debate 2005;16(3-4):433-68.

Leech TG. Subsidized housing, public housing, and adolescent violence and substance use. Youth & Society 2012;44(2):217-35.

Lens M, Ellen I, O’Regan K. Do vouchers help low-income households live in safer neighborhoods? Evidence on the Housing Choice Voucher Program. Cityscape: A Journal of Policy Development and Research 2011;13(3):135-59.

Mills G, Gubits D, Orr L, et al. Effects of housing vouchers on welfare families. Cambridge, MA: U.S. Department of Housing and Urban Development, Office of Policy Development and Research.;2006. URL: https://www.huduser.gov/portal/publications/commdevl/hsgvouchers.html. Access date: June 3, 2020

Sanbonmatsu L, Ludwig J, Katz L, et al. Moving to Opportunity for Fair Housing Demonstration Program: final impacts evaluation. Cambridge, MA: U.S. Department of Housing and Urban Development; Office of Policy Development and Research;2011. URL: https://www.huduser.gov/publications/pdf/MTOFHD_fullreport_v2.pdf. Access date: June 3, 2020

Supporting Studies

Boudreaux M, Fenelon A, Slopen N, Newman SJ. Association of childhood asthma with federal rental assistance. JAMA Pediatrics 2020;174(6):592-8.

Chetty R, Hendren N, Katz LF. The effects of exposure to better neighborhoods on children: new evidence from the Moving to Opportunity Experiment. J Am Econ Rev 2016;106(4):855-902.

Clark W. Reexamining the Moving to Opportunity study and its contribution to changing the distribution of poverty and ethnic concentration. Demography 2008;45(3):515-35.

Gennetian L, Sciandra M, Sanbonmatsu L, et al. The long-term effects of Moving to Opportunity on youth outcomes. Cityscape 2012;14(2):137-68.

Jacob B, Kapustin M, Ludwig J. The impact of housing assistance on child outcomes: evidence from a randomized housing lottery. Quarterly J Econ 2015;130(1):465-506.

Kessler RC, Duncan GJ, Gennetian LA, et al. Associations of housing mobility interventions for children in high-poverty neighborhoods with subsequent mental disorders during adolescence. JAMA 2014;311(9):937-47.

Leventhal T, Brooks-Gunn J. Moving to Opportunity: an experimental study of neighborhood effects on mental health. AJPH 2003;93(93):1576-82.

Leventhal T, Dup r V. Moving to Opportunity: does long-term exposure to “low-poverty” neighborhoods make a difference for adolescents? Social Science & Medicine 2011;73:737-43.

Ludwig J, Sanbonmatsu L, Gennetian L, et al. Neighborhoods, obesity, and diabetes: a randomized social experiment. NEJM 2011;365(16):1509-19.

Nguyen Q, Rehkopf D, Schmidt N, Osypuk T. Heterogeneous effects of housing vouchers on the mental health of US adolescents. AJPH 2016;106:755-62.

Nguyen Q, Schmidt NM, Glymour M, Rehkopf DH, Osypuk TL. Were the mental health benefits of a housing mobility intervention larger for adolescents in higher socioeconomic status families? Health & Place 2013;23:79-88.

Orr L, Feins J, Jacob R, et al. Moving to Opportunity for Fair Housing Demonstration Program: interim impacts evaluation. Cambridge, MA: U.S. Department of Housing and Urban Development, Office of Policy Development and Research;2003. URL: https://www.huduser.gov/Publications/pdf/MTOFullReport.pdf. Access date: June 3, 2020

Osypuk TL, Joshi S, Schmidt NM, Glymour MM, Nelson TF. Effects of a federal housing voucher experiment on adolescent binge drinking: A secondary analysis of a randomized controlled trial. Addiction 2019a;114:48-58.

Osypuk TL, Schmidt NM, Kehm RD, Tchetgen Tchetgen EJ, Glymour MM. The price of admission: does moving to a low-poverty neighborhood increase discriminatory experiences and influence mental health? Social Psychiatry and Psychiatric Epidemiology 2019b;54:181-90.

Osypuk TL, Tchetgen EJT, Acevedo-Garcia D, et al. Differential mental health effects of neighborhood relocation among youth in vulnerable families: results from a randomized trial. J Arch of General Psychiatry 2012;69(12):1284-94.

Pollack CE, Blackford AL, Du S, Deluca S, Thornton RLJ, Herring B. Association of receipt of a housing voucher with subsequent hospital utilization and spending. JAMA 2019;322(21):2115-24.

Sciandra M, Sanbonmatsu L, Duncan GJ, et al. Long-term effects of the Moving to Opportunity residential mobility experiment on crime and delinquency. Journal of Experimental Criminology 2013;9(4):451-89.

Simon AE, Fenelon A, Helms V, Lloyd PC, Rossen LM. HUD housing assistance associated with lower uninsurance rates and unmet medical need. Health Affairs 2017;36(6):1016-23.

Wood M, Turnham J, Mills G. Housing affordability and family well-being: results from the housing voucher evaluation. Housing Policy Debate 2008;19(2):367-412.

Economic Review

Andersson F, Haltiwanger JC, Kutzbach MJ, Palloni GE, Pollakowski HO, et al. Childhood housing and adult earnings: a between-siblings analysis of housing vouchers and public housing. National Bureau of Economic Research Working Paper Series 2016;22721: doi:10.3386/w22721

Bergman P, Chetty R, DeLuca S, Hendren N, Katz LF, et al. Creating moves to opportunity: experimental evidence on barriers to neighborhood choice. National Bureau of Economic Research Working Paper Series 2019. doi: 10.3386/w26164

Carlson D, Haveman R, Kaplan T, Wolfe B. The benefits and costs of the Section 8 housing subsidy program: a framework and estimates of first year effects. Journal of Policy Analysis Management 2011;30(2):233-55.

Carlson D, Haveman R, Kaplan T, Wolfe B. Long-term earnings and employment effects of housing voucher receipt. Journal of Urban Economics 2012;71(1):128-50.

Chetty R, Hendren N, Katz LF. The effects of exposure to better neighborhoods on children: new evidence from the Moving to Opportunity Experiment. Am Econ Rev 2016;106(4):855-902.

Chyn E. Moved to Opportunity: the long-run effects of public housing demolition on children. Am Econ Rev 2018;108(10):3028-56.

Finkel M, DeMarco D, Morse D, Nolden S, Rich K. Status of HUD-insured (or held) multi-family rental housing in 1995. Prepared for: U.S. Department of Housing and Urban Development Office of Policy Development and Research. Available from URL: https://www.huduser.gov/publications/pdf/status.pdf; accessed 7/11/20

Galster GC, Tatian P, Smith R. The impact of neighbors who use Section 8 certificates on property values. Housing Policy Debate 1999;10(4):879-917.

Hendren N, Sprung-Keyser B. A unified welfare analysis of government policies. Quarterly Journal of Economics 2020;135(3):1209-318.

ICF-ORC Macro. Quality control for rental assistance subsidy determinations: final report for FY 2012. Prepared for: U.S. Department of Housing and Urban Development Office of Policy Development and Research. Available from URL: https://www.huduser.gov/portal//Publications/pdf/QC_2012_final.pdf; accessed 7/11/20.

Jacob BA, Ludwig J. The effects of housing assistance on labor supply: evidence from a voucher lottery. American Economic Review 2012;102(1):272-304.

Lee CM, Culhane DP, Wachter SM. The differential impacts of federally assisted housing programs on nearby property values: a Philadelphia case study. Housing Policy Debate 1999;10(1):75-93.

Leger ML, Kennedy SD. Final comprehensive report of the Freestanding Housing Voucher Demonstration. Prepared for: U.S. Department of Housing and Urban Development Office of Policy Development and Research. Available from URL: https://www.huduser.gov/Publications/pdf/HUD-005555.pdf; accessed 5/23/20

Liebman BJ, Kling JR, Katz L, Sanbonmatsu L. Moving to Opportunity and Tranquility: neighborhood effects on adult economic self-sufficiency and health from a randomized housing voucher experiment. John F. Kennedy School of Government, Harvard University, Faculty Working Paper Series. RWP04-035 2004. Available from URL: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=588942; accessed 5/8/2020.

Mayo SK, Mansfield S., Warner D, Zwetchkenbaum R. Housing allowances and other rental housing assistance programs: a comparison based on the housing Allowance Demand Experiment. Prepared for: U.S. Department of Housing and Urban Development Office of Policy Development and Research Abt Associates; 1980.

Abt Associates Inc., Mills G, Gubits D, Orr L, Long D. Effects of housing vouchers on welfare families. Prepared for: U.S. Department of Housing and Urban Development Office of Policy Development and Research. Available from URL: https://www.huduser.gov/publications/pdf/hsgvouchers_1_2011.pdf; accessed 5/7/20.

Olsen EO. The cost-effectiveness of alternative methods of delivering housing subsidies. Presentation at Thirty-First Annual APPAM Research Conference. Available from: http://economics.virginia.edu/sites/economics.virginia.edu/files/CESurvey2009.pdf; accessed 5/6/20.

Olsen EO, Barton DM. The benefits and costs of public housing in New York City. Journal of Public Economics 1983;20(3):299-332.

ORC Macro. Quality control for rental assistance subsidies determinations. Washington, DC: US Department of Housing and Urban Development. Available from URL: https://www.huduser.gov/Publications/pdf/qualitycontrol.pdf; accessed 5/11/20.

Pfeiffer D. Rental housing assistance and health: evidence from the survey of income and program participation. Housing Policy Debate 2018;28(4):515-33.

Pollack CE, Blackford AL, Du S, Deluca S, Thornton RL, et al. Association of receipt of a housing voucher with subsequent hospital utilization and spending. JAMA 2019;322(21):2115-24.

Reeder WJ. The benefits and costs of the section 8 existing housing program. Journal of Public Economics 1985;26(3):349-77.

Sanbonmatsu L, Ludwig J, Katz LF, Gennetian LA, Duncan GJ. Moving to opportunity for fair housing demonstration program: Final impacts evaluation. Prepared for: U.S. Department of Housing and Urban Development Office of Policy Development and Research 2011. Available from URL: https://www.huduser.gov/publications/pdf/MTOFHD_fullreport_v2.pdf; accessed 5/7/20.

Schwartz HL, Mihaly K, Gala B. Encouraging residential moves to opportunity neighborhoods: an experiment testing incentives offered to housing voucher recipients. Housing Policy Debate 2017;27(2):230-60.

Susin S. Longitudinal outcomes of subsidized housing recipients in matched survey and administrative data. Cityscape 2005:189-218.

Wallace JE, Bloom SP, Holshouser WL, Mansfield S, Weinberg DH. Participation and benefits in the Urban Section 8 Program: new construction and existing housing. Volume 1. Prepared for: U.S. Department of Housing and Urban Development Office of Policy Development and Research 1981.

Zafari Z, Muennig P. The cost-effectiveness of limiting federal housing vouchers to use in low-poverty neighborhoods in the United States. Public Health 2020;178:159-66.

Related Studies

Carlson D, Haveman R, Kaplan T, Wolfe B. Long-term Effects of Public Low-income Housing Vouchers on Work, Earnings, and Neighborhood Quality. Robert M. La Follette School of Public Affairs Working Paper Series 2008. Available from URL: https://lafollette.wisc.edu/images/publications/workingpapers/haveman2008-013.pdf; accessed 5/6/20.

Carlson D, Haveman R, Kaplan T, Wolfe B. Long-term effects of public low-income housing vouchers on labor market outcomes. Institute for Research on Poverty, University of Wisconsin-Madison. Available from URL: https://www.irp.wisc.edu/publications/dps/pdfs/dp136309.pdf; accessed 5/17/20.

Collinson R, Ellen IG, Ludwig J. Low-income housing policy. National Bureau of Economic Research Working Paper Series 2015;21071.

Eggers FJ. Characteristics of HUD-assisted renters and their units in 2017. Prepared for: U.S. Department of Housing and Urban Development Office of Policy Development and Research. Available from URL: https://www.huduser.gov/portal/sites/default/files/pdf/HUD-Assisted-Renters-2017.pdf; accessed 5/23/20.

Jacob BA, Kapustin M, Ludwig J. The impact of housing assistance on child outcomes: evidence from a randomized housing lottery. Quarterly Journal of Economics 2015;130(1):465-506.

Ludwig J, Sanbonmatsu L, Gennetian L, Adam E, Duncan GJ, et al. Neighborhoods, obesity, and diabetes a randomized social experiment. New England Journal of Medicine 2011;365(16):1509-19.

Olsen EO. Housing programs for low-income households. Means-tested Transfer Programs in the United States. Editor: Moffitt RA. University of Chicago Press; 2003:365-442. Available from URL: http://www.nber.org/chapters/c10259; accessed 5/22/20.

Olsen EO, Zabel JE. US housing policy. Handbook of Regional and Urban Economics. Vol. 5. Elsevier; 2015:887-986.

Shroder M. Does housing assistance perversely affect self-sufficiency? A review essay. Journal of Housing Economics 2002;11(4):381-417.

Shroder MD. Housing subsidies and work incentives. 2010. Available from URL: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1691112/accessed 5/22/2020.

Wood M, Turnham J, Mills G. Housing affordability and family well being: results from the housing voucher evaluation. Housing Policy Debate 2008;19(2):367-412.

Effectiveness Review

CDC Librarians searched databases shown in the table through July 2019. Publications were included in the body of evidence if they evaluated tenant-based housing voucher programs in the United States, were published in English from 1999 to July 2019, compared outcomes among groups of people or households who received an intervention with outcomes among groups who did not, and reported outcomes of interest. These included access to determinants of health such as quality housing, safety, employment, income, education, food, social services, recreation, transportation, housing stability, physical health, mental health, healthcare use, or risky behavior (e.g. substance use, committing a crime).

Mesh Terms: Housing, Public Housing

Search Terms: Housing assistance OR housing certificate OR housing voucher OR housing subsidy OR public housing OR income based housing OR rental assistance

AND

“Section 8” OR “section 202” OR “section 811” OR “voucher program” OR “direct cash” OR “moving to opportunity” OR “MTO study” OR “housing allowance” OR “gautreaux study” OR “gautreaux program”

The following limits were applied English language and dates 1999-2019

For studies in the United States it is best to select during the elimination process.

Search References

Article from 2003 study completed by Community Guide.

Websites to search

Catalog of U.S. Government Publications (CGP)

HUD Bibliographic Database

Notes: Duplicates were identified using the Endnote automated “find duplicates” function with preference set to match on title, author and year, and removed from your Endnote library. There will likely be additional duplicates found that Endnote was unable to detect.

Economic Review

In November 2020, a research librarian used the terms listed below to search the following databases: Medline, EconLit, Scopus, and NTIS (which include publications from the Department of Housing and Urban development). The search period covered 1980 through November 2020.

The review team also screened reference lists of included studies and consulted subject matter experts about additional studies that may have been missed. Search terms and strategies were adjusted for each database, based on controlled and uncontrolled vocabularies and software.

Database: Medline

Date Searched: 11/06/2020
Results: 390

Search Strategy:

Housing/ OR Public Housing/

OR ((housing adj3 (assistance or certificate* or voucher* or subsid* or assistance or public or insecurity or affordable or (income adj3 based))) or ((rental or rent) adj3 (assistance or voucher* or subsid*))).ti,ab. OR

(“Section 8” or “section 202” or “section 811” or “voucher program” or “direct cash” or “moving to opportunity” or “MTO study” or “housing allowance” or “gautreaux study” or “gautreaux program”).mp.

AND

Economics/ or “costs and cost analysis”/ OR

((economic adj1 model*) or cost minimi* or cost-utilit* or health utilit* or economic evaluation* or economic review* or cost outcome* or cost analys* or economic analys*).ti,ab. OR

(cost-effective* or cost-benefit or costs).ti. OR

(life year* or qaly* or cost-benefit analys* or cost-effectiveness analys*).ti,ab. OR

(cost or economic*).ti. and (costs or cost-effectiveness or markov).ti,ab

Limit yr=”1980 to present, abstract

Database: EconLit (EBSCO)

Date Searched: 11/07/2020
Results: 121

Search Strategy:

S1 AB ( (Housing N3 (assistance OR certificate* OR voucher* OR subsid* OR assistance OR public OR voucher OR insecurity OR assistance OR (income N3 based)) OR (rental N3 assistance) ) ) OR TI ( (Housing N3 (assistance OR certificate* OR voucher* OR subsid* OR assistance OR public OR voucher OR insecurity OR assistance OR (income N3 based)) OR (rental N3 assistance) ) )

S2 TX (“Section 8” OR “section 202” OR “section 811” OR “voucher program” OR “direct cash” OR “moving to opportunity” OR “MTO study” OR “housing allowance” OR “gautreaux study” OR “gautreaux program”)

S3 TX ( ((cost or economic*) and (cost* or cost-effectiveness or markov)) ) OR TX ( (life year or life years or qaly* or daly* or cost-benefit analys?s or cost-effectiveness analys?s) ) OR TX ( (cost minimi* or cost-utilit* or health utilit* or economic evaluation* or economic review* or cost outcome or cost analys?s or economic analys?s or budget* impact analys?s) ) OR TX ( (cost-effective* or cost-benefit or cost* or income) )

S4 S1 AND S2

S5 S3 AND S4

S6 S3 AND S4 Limiters – Published Date: 19800101-20201231

Database: Scopus

Date Searched: 11/09/2020
Results: 218

Search Strategy:

( ( ( ( TITLE-ABS ( “housing” ) W/3 ( TITLE-ABS ( “assistance” ) OR TITLE-ABS ( “certificate*” ) OR TITLE-ABS ( “voucher*” ) OR TITLE-ABS ( “subsid*” ) OR TITLE-ABS ( “assistance” ) OR TITLE-ABS ( “public” ) OR TITLE-ABS ( “insecurity” ) OR ( TITLE-ABS ( “income” ) W/3 TITLE-ABS ( “based” ) ) ) ) OR ( ( TITLE-ABS ( “rental” ) OR TITLE-ABS ( “rent” ) ) W/3 ( TITLE-ABS ( “assistance” ) OR TITLE-ABS ( “voucher*” ) OR TITLE-ABS ( “subsid*” ) ) ) ) ) ) AND ( ( ( TITLE-ABS-KEY ( “Section 8” ) OR TITLE-ABS-KEY ( “section 202” ) OR TITLE-ABS-KEY ( “section 811” ) OR TITLE-ABS-KEY ( “voucher program” ) OR TITLE-ABS-KEY ( “direct cash” ) OR TITLE-ABS-KEY ( “moving to opportunity” ) OR TITLE-ABS-KEY ( “MTO study” ) OR TITLE-ABS-KEY ( “housing allowance” ) OR TITLE-ABS-KEY ( “gautreaux study” ) OR TITLE-ABS-KEY ( “gautreaux program” ) ) ) ) AND ( ( TITLE-ABS-KEY ( ( cost OR economic* ) AND ( cost* OR cost-effectiveness OR markov ) ) ) OR ( TITLE-ABS-KEY ( life AND year OR life AND years OR qaly* OR daly* OR cost-benefit AND analys* OR cost-effectiveness AND analys* ) ) OR ( TITLE-ABS-KEY ( “cost minimi*” OR “cost-utilit*” OR “health utilit*” OR “economic evaluation*” OR “economic review*” OR “cost outcome” OR “cost analy*” OR “economic analys*” OR “budget* impact analys*” ) ) OR ( TITLE-ABS-KEY ( “life year” OR “life years” OR qaly* OR daly* OR “cost-benefit analys*” OR “cost-effectiveness analys*” ) ) OR ( TITLE-ABS-KEY ( “cost minimi*” OR “cost-utilit*” OR “health utilit*” OR “economic evaluation*” OR “economic review*” OR “cost outcome” OR “cost analy*” OR “economic analys*” OR “budget* impact analys*” ) ) OR ( TITLE-ABS-KEY ( cost-effective* OR cost-benefit OR cost* OR income ) ) ) AND ( LIMIT-TO ( LANGUAGE,”English” ) )

Database: NTIS (EBSCO)

Date Searched: 11/09/2020
Results: 75

Search Strategy:

S8 S4 AND S5 Limiters – Published Date: 19800101-20201231

Expanders – Apply equivalent subjects

S5 ( (MM “Costs and Cost Analysis+”) ) OR (MM “Economics”) OR ( TX ((cost or economic*) and (cost* or cost-effectiveness or markov)) ) OR ( TX (life year or life years or qaly* or daly* or cost-benefit analys?s or cost-effectiveness analys?s) ) OR ( TX(cost minimi* or cost-utilit* or health utilit* or economic evaluation* or economic review* or cost outcome or cost analys?s or economic analys?s or budget* impact analys?s) ) OR ( TX(cost-effective* or cost-benefit or cost* or income) )

S4 S2 AND S3

S3 TX (“Section 8” OR “section 202” OR “section 811” OR “voucher program” OR “direct cash” OR “moving to opportunity” OR “MTO study” OR “housing allowance” OR “gautreaux study” OR “gautreaux program”)

S2 AB ( Housing N3 (assistance OR certificate* OR voucher* OR subsid* OR assistance OR public OR voucher OR insecurity OR assistance OR (income N3 based)) OR (rental N3 assistance) ) OR TI ( Housing N3 (assistance OR certificate* OR voucher* OR subsid* OR assistance OR public OR voucher OR insecurity OR assistance OR (income N3 based)) OR (rental N3 assistance) )

Alley DE, Soldo BJ, Pag n JA, et al. Material resources and population health: disadvantages in health care, housing, and food among adults over 50 years of age. Am J Public Health 2009;99 (Suppl 3):S693-S701. doi:10.2105/AJPH.2009.161877.

Bergman P, Chetty R, DeLuca S, Hendren N, et al. Creating moves to opportunity: Experimental evidence on barriers to neighborhood choice. National Bureau of Economic Research, 2020. Available from URL: https://www.nber.org/papers/w26164. Accessed July 16, 2020.

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Healthy People 2030. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Available from URL: https://health.gov/healthypeople/objectives-and-data/social-determinants-health. Accessed September 22, 2020.

The following considerations for implementation are drawn from studies included in the existing evidence review, the broader literature, and expert opinion from the CPSTF, as noted below.

• Voucher programs could reduce barriers to participation for eligible households by giving them more time to search for and arrange housing (i.e., more than 60 days), offering intensive pre-move counseling, providing short-term financial assistance to cover initial moving expenses, or recruiting landlords to participate in the program (Bergman et al. 2020).
• State and local source of income laws or ordinances could be enacted to address market constraints by prohibiting discrimination against renters based on the source of their income.
• Establishing voucher amounts at the neighborhood level rather than metropolitan rental level would allow vouchers to pay more in high-rent neighborhoods. This policy, known as Small Area Fair Market Rents, can increase the number of available rental units in high-opportunity neighborhoods (Dastrup et al. 2018).
• The CPSTF suggests research is needed to identify effective individual, community, and societal-level interventions to support male youth in new environments.

Healthy People 2030

Healthy People 2030 includes the following objective related to this CPSTF recommendation.

• Reduce the proportion of families that spend more than 30 percent of income on housing SDOH-04