Screening Discordance and Characteristics of Patients With Housing-Related Social Risks

Emilia H. De Marchis, Stephanie A. Ettinger de Cuba, Lawrence Chang, Richard S. Sheward, Kelly M. Doran, Laura M. Gottlieb, Alicia J. Cohen, Eric W. Fleegler, Megan T. Sandel

Research output: Contribution to journalArticlepeer-review


Introduction: Healthcare systems are increasingly interested in identifying patients’ housing-related risks, but minimal information exists to inform screening question selection. The primary study aim is to evaluate discordance among 5 housing-related screening questions used in health care. Methods: This was a cross-sectional multisite survey of social risks used in a convenience sample of adults seeking care for themselves or their child at 7 primary care clinics and 4 emergency departments across 9 states (2018–2019). Housing-related risks were measured using 2 questions from the Accountable Health Communities screening tool (current/anticipated housing instability, current housing quality problems) and 3 from the Children's HealthWatch recommended housing instability screening measures (prior 12-month: rent/mortgage strain, number of moves, current/recent homelessness). The 2-sided Fisher's exact tests analyzed housing-related risks and participant characteristics; logistic regression explored associations with reported health (2019–2020). Results: Of 835 participants, 52% screened positive for ≥1 housing-related risk (n=430). Comparing the tools, 32.8% (n=274) screened discordant: 11.9% (n=99) screened positive by Children's HealthWatch questions but negative by Accountable Health Communities, and 21.0% (n=175) screened positive by the Accountable Health Communities tool but negative by Children's HealthWatch (p<0.001). Worse health was associated with screening positive for current/anticipated housing instability (AOR=0.56, 95% CI=0.32, 0.96) or current/recent homelessness (AOR=0.57, 95% CI=0.34, 0.96). Conclusions: The 5 housing questions captured different housing-related risks, contributed to different health consequences, and were relevant to different subpopulations. Before implementing housing-related screening initiatives, health systems should understand how specific measures surface distinct housing-related barriers. Measure selection should depend on program goals and intervention resources.

Original languageEnglish (US)
Pages (from-to)e1-e12
JournalAmerican journal of preventive medicine
Issue number1
StatePublished - Jul 2021


  • Adult
  • Child
  • Cross-Sectional Studies
  • Emergency Service, Hospital
  • Homeless Persons
  • Housing
  • Humans
  • Mass Screening

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Epidemiology


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