Washington residents who were worried or stressed about paying their rent or mortgage were twice as likely to report poor or fair health status, according to a report from the Washington State Department of Health and the Centers for Disease Control and Prevention.

The report, which provides a closer look at the prevalence of housing insecurity and its relationship to certain unhealthy behaviors and outcomes, showed that housing insecurity may play an important role in a person’s health, even after accounting for demographics and socioeconomic measures.

“When we’re looking at someone’s health and health status and trying to understand what is really happening, we have to consider stress  [related to] housing, said Mandy Stahre, Ph.D., Chronic Disease Epidemiology Supervisor for Washington State Department of Health and the report’s lead author.

The report’s authors point to the need for broad-based strategies such as the one by the National Prevention Council Action Plan that connects access to affordable housing with healthy lifestyle choices as a way housing programs could have greater impact on public health.

“Such engagement represents an expansion of public health’s traditional housing-related efforts that focused on environmental health and safety, and encourages multi-sector collaboration as well as nuanced approaches toward health equity,” the authors wrote.

An estimated 41 million U.S. households paid more than 30 percent of their pre-tax income from housing, making it difficult to afford other necessities, including food, transportation and medical care.

Other studies have reported associations between housing insecurity and mental health problems or avoiding medical care, but not the association with health risk behaviors and outcomes, such as smoking, binge drinking and delaying trips to the doctor.

The report’s authors believe this is the first study to show associations between housing insecurity and health even after controlling for various socioeconomic and demographic measures.

The report analyzed data from 8,415 people responding to the 2011 Washington State Behavior Risk Factor Surveillance System to assess the frequency of housing insecurity, and associations between housing insecurity and health outcomes.

Housing insecurity was defined as respondents answering “always,” “usually,” or “sometimes” to “How often in the past 12 months would you say you were worried or stressed about having enough money to pay your rent/mortgage?”

Among all Washington respondents, 29.4 percent reported housing insecurity, although other demographic groups had a higher prevalence.

Of those reporting housing insecurity, 33.3 percent also reported delaying doctor visits because of costs, 26.9 percent were current smokers, and 26.3 percent had poor or fair health.

People who reported experiencing housing insecurity, also reported significant differences in health outcomes and health risk behaviors than those who were not reporting housing insecurity.  They were more likely to smoke and more likely to delay going to the doctor due to concerns over cost. Binge drinking was not associated with housing insecurity, the report showed.

Compared with people who were not housing insecure, respondents were nearly twice as likely to report poor or fair health status, 14 or more days of poor mental, or poor health that limited their daily activity in the past 30 days. People who reported housing insecurity were also about 1½ times as likely to report 14 days or more of poor physical health in the last 30 days.

The study was based data reflecting a snapshot in time, and was not able to determine if housing insecurity and health outcomes were causally related. It also excluded participants who were homeless. Additionally, data was self-reported through a telephone survey and could be subject to a participant’s memory and willingness share certain details.