Project ReSIDe

Project ReSIDe is a five-year (2020-2025) study funded by the National Institutes of Health (RO1 DK124500-01). ReSIDe examines whether and how expanded access to affordable housing through rental assistance programs can improve type 2 diabetes self-management and control, ultimately reducing existing socioeconomic and racial disparities in diabetes outcomes. The study will examine the effect of rental assistance on diabetes self-management and control using nationally representative survey data, and by prospectively observing transitions from waitlists to rent-assisted housing through a longitudinal mixed-methods cohort study.

This project builds on pilot data that were collected with support from the Yale CTSA grant UL1TR000142 from the National Center for Advancing Translational Science (NCATS) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at NIH through grant P30DK045735 to the YSM Diabetes Research Center.

Low-income US renters face a severe affordable housing crisis that likely has adverse effects on population health. The current affordable housing shortage is likely to have particularly significant implications for the health of adults living with behaviorally managed chronic conditions such as type 2 diabetes. Type 2 diabetes requires complex and resource intensive daily management that is highly sensitive to social conditions such as housing. Furthermore, the rising prevalence of type 2 diabetes and diabetes related complications are unequally borne by low-income adults and racial minorities; two populations that are at greater risk of housing challenges. Rental assistance, provided by the US Department of Housing and Urban Development (HUD) is a primary source of affordable housing for low-income households. However, due to supply constraints, fewer than 1 in 4 eligible households receive this resource and waiting lists average 26 months nationally. Access to rental assistance may improve diabetes self-management and control by reducing housing costs that can compete with diabetes-related expenses and by providing stability that allows individuals to establish and maintain consistent self-management routines.

Big picture: We will link national data from HUD administrative records and the National Health and Nutrition Examination Study (NHANES) to examine the effects of rental assistance receipt on biological and behavioral indicators of diabetes control.

Local look: We will enroll 300 individuals in the Greater New Haven area who have Type 2 Diabetes and are on a rental assistance waitlist. These participants will answer questions about their housing and health via an on-line survey administered every six months spanning two and a half years. In addition at each study interval participants will provide objective health data to help the team assess trajectories in diabetes control associated with housing transitions, including transitions into rental assistance.

A deeper look: A subsample of participants will complete longitudinal qualitative interviews throughout the study. Qualitative data will provide nuanced insight into the relationships between rental assistance and diabetes outcomes, and into factors that may modify or mediate these effects.