Exploring the impact of housing insecurity on the health and well-being of children and young people: a systematic review
Authors: Hock Emma , Blank Lindsay , Fairbrother Hannah , Clowes Mark , Cuevas Diana Castelblanco , Booth Andrew , Goyder Elizabeth 
Published: December 2023

Background
Housing insecurity can be understood as experiencing or being at risk of multiple house moves that are (1) not through choice and (2) related to poverty. For example, due to short-term private rental tenancies, temporary or emergency housing, and homelessness. Housing insecurity has grown due to recent trends in the cost and availability of housing. The quality, affordability and stability of housing have all been shown to impact children’s health and well-being. However, the pathways linking housing and child health and well-being are complex and poorly understood.

Objectives
To identify, appraise and synthesise research evidence that explores the relationship between housing insecurity and the health and well-being of children and young people.

Data sources
MEDLINE via Ovid (searched 8 April 2022), EMBASE via Ovid (searched 8 April 2022), PsycINFO via Ovid (searched 8 April 2022).

Review methods
We undertook a systematic review synthesising qualitative data. We searched databases, reference lists and United Kingdom grey literature. We extracted and tabulated key data from the included papers, and appraised study quality. We synthesised the data qualitatively into an a priori conceptual framework using best-fit framework synthesis combined with thematic synthesis, and generated logic models to highlight links between specific exposures, impacts and outcomes.

Results
We included 59 studies and identified four populations: those experiencing housing insecurity in general (40 papers); associated with domestic violence (nine papers); associated with migration status (13 papers) and those forced to relocate due to demolition (two papers). Most published studies had an overall assessment of moderate-high quality, and most grey literature originated from known and valued sources.
Housing insecurity took many forms and resulted from several, often inter-related, situations, including being evicted or having a forced move, living in temporary accommodation, exposure to problematic behaviour, overcrowded/poor-condition/unsuitable property, and making multiple moves. The resultant housing insecurity had multiple impacts, including school-related, psychological, financial and family well-being impacts, long-distance travel to attend school and see friends, living in a poor-condition or unsuitable property, all of which could further exacerbate housing insecurity. These experiences impacted health and well-being, in terms of mental health problems (often manifesting physically/behaviourally) and physical health problems related to poor housing conditions. Some factors lessened the impact of housing insecurity, including friendship and support, staying at the same school, having hope for the future and protective parenting. The negative impacts of housing insecurity on health and well-being may be compounded by specific situations and life circumstances, such as escaping domestic violence, migration status, or a forced relocation due to housing demolition.

Limitations
Many accounts were from parents or other informants, and more data directly from children and young people may give a more nuanced picture. Likewise, there was little information relating to outcomes, and it is difficult to know whether the current evidence has captured all relevant outcomes, and the links from impacts to health and well-being outcomes are less well understood. The complexity and diversity of the data added additional challenges to the synthesis process.

Conclusions
Our findings suggest that policies should focus on reducing housing insecurity among families, particularly in relation to reducing eviction, improving and reducing the need for temporary accommodation, minimum requirements for property condition, and support to reduce multiple moves and moves far from families’ desired location. Those working with children and families experiencing housing insecurity should give them optimal choice and control over situations that affect them.

Future work
Future qualitative research should focus explicitly on the health and well-being of children and young people experiencing housing insecurity, and how it links with the impacts identified in the current review, foregrounding the accounts of children and young people themselves, including specific groups of young people who are likely to be marginalised. Qualitative research focusing on the impact of interventions to address housing insecurity among families in the United Kingdom is also needed.

Study registration
This study is registered as PROSPERO CRD42022327506.

Funding
This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (Award ref: NIHR135455) and is published in full in Public Health Research; Vol. 11, No. 13. See the NIHR Funding and Awards website for further award information.
The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.