Housing hardship and health: Longitudinal evidence of the mediating role of health behaviors

Housing instability is widely recognized as a major environmental factor that significantly shapes both health and overall well-being. This study added to the existing literature by examining the longitudinal relationship between housing-related hardship and self-rated health. Moreover, this study explored health behaviors—specifically substance use and lifestyle behaviors—as potential mediators that link housing hardship to health. Using data from Waves I, III, IV, and V of the National Longitudinal Study of Adolescent to Adult Health (Add Health), this study estimated regression models with lagged dependent variables (LDVs) and conducted Sobel tests to formally assess mediation. In the LDV model, housing hardship in Wave III is longitudinally associated with lower self-rated health in Wave V. This relationship remained significant (p = 0.012), though it was substantially attenuated after adjusting for a comprehensive set of confounders, including personal earnings and educational attainment. Smoking emerged as the most significant mediator, accounting for approximately 26% (p < 0.001) of the association, while unhealthy eating behaviors and marijuana use explained 13% (p < 0.001) and 8% (p = 0.008), respectively. Binge drinking and physical activity did not significantly mediate the association. Collectively, the proposed mediating variables explained 34% (p < 0.001) of the association between housing hardship and self-rated health. These findings highlight the importance of tackling both the material aspects of housing hardship and the unhealthy coping mechanisms it fosters to more effectively improve the well-being of individuals experiencing housing instability.