Understanding Neighborhood Effects of Eviction on Cardiovascular Health: A mixed-methods study - 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.
