January 2008, Vol 98, No. 1 | American Journal of Public HealthDigenis-Bury et al. | Peer Reviewed | Research and Practice | 85
RESEARCH AND PRACTICE
Objectives. We compared the health of public housing residents with other
Boston residents through a random-digit-dial survey.
Methods. We used data from the Boston Behavioral Risk Factor Surveillance
System collected in 2001 and 2003 to make crude and demographically adjusted
comparisons between public housing residents and other city residents on mea-
sures of health status, access and utilization, and health behaviors.
Results. Public housing residents were more likely to report fair or poor over-
all health status, ever-diagnosed hypertension, current asthma, ever-diagnosed
diabetes, obesity, disability, loss of 6 or more teeth, and feelings of depression
for 15 days or more in the past month. Public housing residents were slightly
more likely than others to be without health insurance or report financial barri-
ers to medical care. Public housing residents reported more smoking and phys-
ical inactivity, less past-month binge drinking and past-year marijuana use, and
similar levels of lifetime drug use.
Conclusions. Public housing residents reported substantially poorer health
than did other city residents across a variety of conditions but similar levels of
access to and utilization of health care. Public health departments may be able
to use established surveys to measure health among public housing residents.
(Am J Public Health. 2008;98:85–91. doi:10.2105/AJPH.2006.094912)
Use of a Population-Based Survey to Describe
the Health of Boston Public Housing Residents
| Eleni C. Digenis-Bury, MPH, Daniel R. Brooks, DSc, MPH, Leslie Chen, BS, Mary Ostrem, DrPH, MPH, and C. Robert Horsburgh, MD, MPH
We found no previous description of a pop-
ulation-based health survey of persons whose
housing was entirely or partially supported by
public funding (including both residents of
public housing developments and those who
lived in private residences subsidized by
voucher programs such as Section 8). We
compared the overall health of residents living
in publicly supported housing with the health
of other city residents in the city of Boston
with data from a local population-based health
department survey based on the BRFSS, an
established surveillance system that is con-
ducted in every state in the United States.1 7
Public housing in Boston is administered by
the Boston Housing Authority (BHA), a public
agency that provides subsidized housing to
low- and moderate-income individuals and
families, disabled individuals, and elderly indi-
viduals. BHA is the largest landlord in Boston,
housing approximately 26000 people in
public housing developments and supporting
approximately 25000 people with rental as-
sistance vouchers in each of the last several
years. In 2000, the Boston University School
of Public Health, in collaboration with the
Boston Public Health Commission, BHA, and
public housing community representatives, es-
tablished the Partners in Health and Housing
Prevention Research Center to improve the
health of public housing residents in the city.
Boston BRFSS Survey
Since 1999, the Boston Public Health
Commission, the city’s public health agency,
has biennially administered the Boston
BRFSS (a modified version of the Massachu-
setts BRFSS), a random-digit-dialed house-
hold telephone survey of health-related be-
haviors and conditions among adults 18 years
and older.1 7
Beginning in 2001, the Boston BRFSS was
selected by the Prevention Research Center
as one vehicle to measure the health of public
housing residents. To determine public hous-
ing residency status, all respondents were
asked, “Are you (1) a public housing resident
Residents of public housing are more likely
than the community at large to be poor and
members of a racial or ethnic minority, fac-
tors frequently associated with poorer health.
Despite a greater potential for disease burden
in this population, there have been few de-
scriptions of the overall health status of public
The majority of studies on the health of
public housing residents have been limited to
single health outcomes, including breast can-
cer screening,1–5mental health in elderly resi-
dents,6,7HIV risk among women,8,9and phys-
ical activity levels.10,1 1Some studies have
examined measures of health care access and
utilization12or health outcomes associated
with the physical conditions of public hous-
ing, including child blood lead levels,13respi-
ratory health,1 4,15and child injury risk.15
The only report we found that addressed
a range of health issues among public housing
residents was an abbreviated article by Rivo
and Gray, who reported on a demonstration
project conducted in Washington, DC, that
sought to reduce chronic disease risk
among predominantly Black public housing
residents.16A second objective of their study
was to assess whether public housing residents
experienced greater chronic disease risk than
did the general population. Data from a health
questionnaire administered to public housing
residents were compared with a District-wide
sample of Black residents interviewed through
the Behavioral Risk Factor Surveillance Sys-
tem (BRFSS). Questionnaire results suggested
that Black public housing residents had a
much higher prevalence of chronic disease
risk factors than did the general population
in the city. Both men and women in public
housing reported twice the prevalence of hy-
pertension and smoking compared with other
city residents. Women living in public housing
reported twice the prevalence of obesity and
more than 3 times the prevalence of diabetes
compared with Black women living in the city.
housing: a community-based survey and action agenda.
Plann Pract Res. 2000;15:31–49.
16. Rivo ML, Gray K. Health corners: reducing
chronic disease risks among black public housing resi-
dents in the nation’s capital. Am J Public Health. 1992;
Ga: Centers for Disease Control and Prevention; 2003.
Behavioral Risk Factor Surveillance System. Atlanta,
18. Centers for Disease Control and Prevention. Body
mass index. Available at: http://www.cdc.gov/nccdphp/
dnpa/bmi. Accessed September 20, 2005.
19. Boston Housing Authority. Administrator’s message.
Available at: http://www.bostonhousing.org/detpages/
admin71.html. Accessed August 16, 2005.
20. Shavers VL, Shankar S. Trend in the prevalence
of overweight and obesity among urban African Amer-
ican hospital employees and public housing residents.
J Natl Med Assoc. 2002;94:566–576.
21. Brugge D, Melly S, Finkelman A, et al. A community-
based participatory survey of public housing conditions
and associations between renovations and possible
building-related symptoms. Appl Environ Sci Public
22. Meyers A, Cutts D, Frank DA, et al. Subsudized
housing and children’s nutritional status: data from a
multisite surveillance study. Arch Pediatr Adolesc Med.
23. Manski RJ, Macek MD, Moeller JF. Private dental
coverage: who has it and how does it influence dental
visits and expenditures? J Am Dent Assoc. 2002;133:
24. DeStefano F, Anda RF, Kahn HS, Williamson DF,
Russell CM. Dental disease and risk of coronary heart
disease and mortality. BMJ. 1993;306:1195–1196.
25. Montebugnoli L, Servidio D, Miaton RA, Prati C,
Tricoci P, Melloni C. Poor oral health is associated with
coronary heart disease and elevated systemic inflam-
matory and haemostatic factors. J Clin Periodontol.
26. Scannapieco FA, Ho AW. Potential associations
between chronic respiratory disease and periodontal
disease: analysis of National Health and Nutrition Ex-
amination Survey III. J Periodontol. 2001;72:50–56.
27. Curry SJ, Ludman E, Grothaus L, Donovan D,
Kim E, Fishman P. At-risk drinking among patients
making routine primary care visits. Prev Med. 2000;
28. US Census Bureau, American Fact Finder, Census
2000 Summary File 3–Sample Data, QT-H9 Occu-
pancy, Telephone Service, Housing Facilities, and Meals
Included in Rent: 2000. Available at: http://factfinder.
September 6, 2005.
January 2008, Vol 98, No. 1 | American Journal of Public Health Digenis-Bury et al. | Peer Reviewed | Research and Practice | 91
RESEARCH AND PRACTICE