Disruptive events have significant consequences for the individuals and families who experience them, but these effects do not occur equally across the population. While some groups are strongly affected, others experience few consequences. We review recent findings on inequality in the effects of disruptive events. We consider heterogeneity based on socioeconomic resources, race/ethnicity, the likelihood of experiencing disruption, and contextual factors such as the normativity of the event in particular social settings. We focus on micro-level events affecting specific individuals and families, including divorce, job loss, home loss and eviction, health shocks and deaths, and violence and incarceration, but also refer to macro-level events such as recession and natural disasters. We describe patterns of variation that suggest a process of resource disparities and cumulative disadvantage versus those that reflect the impact of non-normative and unexpected shocks. Finally, we review methodological considerations when examining variation in the effect of disruptive events.

How renters respond to economic hardship, and how landlords respond when tenants fail to make rent, are understudied questions, owing largely to limited data. We use experiences from the COVID-19 pandemic to begin answering these questions. Drawing on both new census data and two original surveys of renters in Los Angeles County, we test nine hypotheses about the sources of renter distress and landlord reactions to it. We find that lost work and lost income are the primary drivers of missed or late payments. Most tenants who fell behind entered into repayment plans with their landlords. Eviction threats were uncommon but increased as the pandemic persisted. Landlords were more likely to threaten eviction as tenants fell further behind, and smaller landlords were more likely than larger ones to cut tenant services and threaten or initiate evictions. Our evidence suggests that government income support helped tenants pay rent and thus helped stave off eviction threats. We also find that tenants took on other forms of debt, such as credit cards, loans from family, etc., to make rent. These debt burdens generally will not be relieved by housing assistance, and so require other policy responses.

To provide effective care physicians must attend, not just to medical issues, but also to the social determinants of health - racial factors, food insecurity, housing instability, transportation barriers and beyond. Social determinants also include a largely underrecognized dimension: legal vulnerabilities such as rental evictions and debt adjudications. Yet rarely do medical trainees have an opportunity to witness legal vulnerabilities, firsthand.

BACKGROUND: Housing instability is highly prevalent among intimate partner violence (IPV) survivors, and the coupling consequences of structural racism, sexism, classism, and the COVID-19 pandemic, may create more barriers to safe and adequate housing, specifically for Black women IPV survivors. In particular, the consequences of the COVID-19 pandemic had the potential to amplify disadvantages for Black women IPV survivors, yet very little research has acknowledged it. Therefore, the current study sought to assess the experiences of housing insecurity among Black women experiencing intimate partner violence (IPV) while navigating racism, sexism, and classism during the COVID-19 pandemic.
METHODS: From January to April 2021, we conducted in-depth interviews with 50 Black women experiencing IPV in the United States. Guided by intersectionality, a hybrid thematic and interpretive phenomenological analytic approach was used to identify sociostructural factors shaping housing insecurity.
RESULTS: Our findings demonstrate the various ways in which the COVID-19 pandemic shaped Black women IPV survivors\' ability to obtain and sustain safe housing. We derived five themes to capture factors contributing to housing experiences: challenges with separate and unequal neighborhoods; pandemic-related economic inequalities; economic abuse limitations; and strategies to maintain housing.
CONCLUSIONS: Obtaining and maintaining safe housing during the COVID-19 pandemic was difficult for Black women IPV survivors who were also navigating racism, sexism, and socioeconomic position. Interventions are needed to reduce the impact of these intersecting systems of oppression and power to facilitate the resources necessary for Black women IPV survivors to identify safe housing.

Evidence suggests that being evicted harms health. Largely ignored in the existing literature is the possibility that evictions exert community-level health effects, affecting evicted individuals\' social networks and shaping broader community conditions. In this narrative review, we summarize evidence and lay out a theoretical model for eviction as a community health exposure, mediated through four paths: 1) shifting ecologies of infectious disease and health behaviors, 2) disruption of neighborhood social cohesion, 3) strain on social networks, and 4) increasing salience of eviction risk. We describe methods for parsing eviction\'s individual and contextual effects and discuss implications for causal inference. We conclude by addressing eviction\'s potentially multilevel consequences for policy advocacy and cost-benefit analyses.

The lack of sufficient affordable housing in Los Angeles, California burdens many renter households with the threat of an eviction. Research has identified individual- and neighborhood-level sociodemographic correlates of eviction, but the uneven distribution of sociodemographic characteristics and housing conditions across neighborhoods likely produces broader patterns of spatial clustering in eviction prevalence across local areas. We use spatial autoregressive models to explain the spatial concentration and spillover effects for two types of formal eviction filings-court-based and no-fault Ellis Act petitions-within and across census tracts in Los Angeles. Court-based filings show greater and more persistent spatial concentration, particularly in neighborhoods with higher percentages of Black residents. We find evidence of spatial correlation for both types of eviction, however, suggesting that identifying the spatial distribution of eviction prevalence across local areas is important to understanding how location shapes eviction risk in metropolitan areas.

Millions of American renter households every year are threatened with eviction, an event associated with severe negative impacts on health and economic well-being. Yet we know little about the characteristics of individuals living in these households. Here, we link 38 million eviction court cases to US Census Bureau data to show that 7.6 million people, including 2.9 million children, faced the threat of eviction each year between 2007 and 2016. Overall, adult renters living with at least one child in their home were threatened with eviction at an annual rate of 10.4%, twice that of adults without children (5.0%). We demonstrate not only that the average evicted household includes one child, but that the most common age to experience eviction in America is during childhood. We also find that previous studies have underestimated racial disparities in eviction risk: Despite making up only 18.6% of all renters, Black Americans account for 51.1% of those affected by eviction filings and 43.4% of those evicted. Roughly one in five Black Americans living in a renter household is threatened with eviction annually, while one in ten is evicted. Black-White disparities persist across levels of income and vary by state. In providing the most comprehensive description to date of the population of US renters facing eviction, our study reveals a significant undercount of individuals impacted by eviction and motivates policies designed to stabilize housing for children and families.

With the growth of community partnerships with housing providers to address social determinants of health, it may be time to rethink the term \"landlord.\" The term, landlord, may be antiquated as it originated from medieval Europe in the 9th century, denotes rank, is male, and may create further divisions between tenants and landlords. In the US, many average Americans rent their property; as data from the Internal Revenue Service and the Rental Housing Finance Survey indicate nearly 10 million Americans reported rental income in 2020 and most of them own only 1-2 rental units. This commentary argues that the term \"landlord\" is no longer relevant, may be counterproductive to building a culture of health across stakeholder groups, and should be replaced. Some alternative terms are suggested, including \"lessor\" or \"rental host.\" Accurate and neutral terms may be useful in engaging renters and property owners in addressing housing and homelessness issues in society.

The COVID-19 pandemic spurred an economic downturn that may have eroded population mental health, especially for renters and homeowners who experienced financial hardship and were at risk of housing loss. Using household-level data from the Census Bureau\'s Household Pulse Survey (n = 805,223; August 2020-August 2021) and state-level data on eviction/foreclosure bans, we estimated linear probability models with two-way fixed effects to (1) examine links between COVID-related financial hardship and anxiety/depression and (2) assess whether state eviction/foreclosure bans buffered the detrimental mental health impacts of financial hardship. Findings show that individuals who reported difficulty paying for household expenses and keeping up with rent or mortgage had increased anxiety and depression risks but that state eviction/foreclosure bans weakened these associations. Our findings underscore the importance of state policies in protecting mental health and suggest that heterogeneity in state responses may have contributed to mental health inequities during the pandemic.

Eviction during pregnancy has been shown to be associated with adverse birth outcomes. A safety net program focused on covering the costs of rent during pregnancy may aid in preventing adverse complications.
This study aimed to evaluate the cost-effectiveness of a program covering the cost of rent to prevent eviction during pregnancy.
A cost-effectiveness model using TreeAge software was designed to evaluate the cost, effectiveness, and incremental cost-effectiveness ratio associated with eviction compared to no eviction during pregnancy. The cost of eviction from a societal perspective was compared to the annual cost of housing in the no eviction group, which was estimated by the median contract rent in the United States from 2021 national census data. Birth outcomes included preterm birth, neonatal death, and major neurodevelopmental delay. Probabilities and costs were derived from the literature. The cost-effectiveness threshold was set at $100,000/QALY. We performed univariable and multivariable sensitivity analyses to assess the robustness of the results.
In our theoretical cohort of 30,000 pregnant individuals aged 15 to 44 years facing eviction annually, the no eviction during pregnancy strategy was associated with 1427 fewer preterm births, 47 fewer neonatal deaths, and 44 fewer cases of neurodevelopmental delay compared to eviction. At the median cost of rent in the United States, the no eviction strategy was associated with increased quality-adjusted life-years and decreased costs. Therefore, the no eviction strategy was the dominant strategy. In univariate sensitivity analysis varying the cost of housing, no eviction remained the cost-effective strategy and was cost-saving when rent was below $1016 per month.
The no eviction strategy is cost-effective and reduces cases of preterm birth, neonatal death, and neurodevelopmental delay. When rent is below the median of $1016 per month, no eviction is the cost-saving strategy. These findings suggest that policies supporting social programmatic implementation for rent coverage for pregnant people at risk of eviction have the potential to be highly beneficial in reducing costs and disparities in perinatal outcomes.