A statewide examination of the address-level relationships between residential eviction proceedings and overdose events in Rhode Island - PROPOSAL SUMMARY In the wake of the COVID-19 pandemic, overdose mortality and affordable housing shortages have reached unprecedented levels in Rhode Island and across the United States. Housing insecurity is a known risk factor for overdose, yet the effects of residential eviction—a structural and policy-sensitive cause of housing insecurity—on overdose risks are understudied. Eviction is a complex legal process composed of a series of stages, each of which may impact overdose risk and thus offers opportunity for public health intervention. The objective of this proposal is to pursue a thorough examination of the relationship between residential eviction proceedings (i.e., filing, hearing, and enforcement) and overdose at the address level in Rhode Island, to better inform eviction prevention policies that complement ongoing harm reduction and overdose prevention efforts. The proposed research will leverage the wealth of centralized, high-resolution data available in Rhode Island—and our team’s established relationship with the state health department—to construct a longitudinal dataset with data linked from several administrative sources. We will first characterize the prevalence and time course of eviction proceedings relative to non-fatal or fatal overdose events by conducting sequence and cluster analyses to operationalize variation in the order, duration, and timing of eviction proceedings before and after a given overdose event (AIM 1). We will then estimate the address-level causal effect of residential eviction proceedings on risk of non-fatal and fatal overdose, both overall and by race and ethnicity of overdose decedents, using a sequential target trial approach (AIM 2). The proposed research will be among the first of its kind to link eviction records with address-level health data to characterize heterogeneity in the duration and timing of eviction proceedings, to examine a causal link between eviction and overdose, and to explore differential impacts of eviction on overdose death by race and ethnicity. Because eviction is an intervenable mechanism of housing vulnerability that may be associated with overdose risk, findings from this work may elucidate novel avenues for addressing the intersecting housing and overdose crises in tandem. The proposed research will be completed by the principal investigator with support and mentorship from collaborators with substantial expertise in advanced quantitative methods for life course epidemiology and causal inference. The training activities detailed in this application, focused on advancing skills in epidemiologic study design and longitudinal data analysis and developing a deep contextual knowledge of the social and legal implications of eviction proceedings, will prepare the principal investigator for a career as an independent social epidemiologist and academic researcher.
