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Importance   Millions of low-income children in the United States reside in substandard or unaffordable housing. Relieving these burdens may be associated with changes in asthma outcomes. Objectives   To examine whether participation in the US Department of Housing and Urban Development’s (HUD) rental assistance programs is associated with childhood asthma outcomes and to examine whether associations varied by program type (public housing, multifamily housing, or housing choice vouchers). Design, Setting, and Participants   This survey study used data from the nationally representative National Health Interview Survey linked to administrative housing assistance records from January 1, 1999, to December 31, 2014. A total of 2992 children aged 0 to 17 years who were currently receiving rental assistance or would enter a rental assistance program within 2 years of survey interview were included. Data analysis was performed from January 15, 2018, to August 31, 2019. Exposures   Participation in rental assistance provided by HUD. Main Outcomes and Measures   Ever been diagnosed with asthma, 12-month history of asthma attack, and 12-month history of visiting an emergency department for the treatment of asthma among program participants vs those waiting to enter a program. Overall participation was examined, and participation in public or multifamily housing was compared with participation in housing choice vouchers. Results   This study included 2992 children who were currently participating in a HUD program or would enter a program within 2 years. Among children with an asthma attack in the past year, participation in a rental assistance program was associated with a reduced use of emergency departments for asthma of 18.2 percentage points (95% CI, −29.7 to −6.6 percentage points). Associations were only found after entrance into a program, suggesting that they were not confounded by time-varying factors. Statistically significant results were found for participation in public or multifamily housing (percentage point change, −36.6; 95% CI, −54.8 to −18.4) but not housing choice vouchers (percentage point change, −7.2; 95% CI, −24.6 to 10.3). No statistically significant evidence of changes in asthma attacks was found (percentage point change, −2.7; 95% CI, −12.3 to 7.0 percentage points). Results for asthma diagnosis were smaller and only significant at the 10% level (−4.3; 95% CI, −8.8 to 0.2 percentage points). Conclusions and Relevance   Among children with a recent asthma attack, rental assistance was associated with less emergency department use. These results may have important implications for the well-being of low-income families and health care system costs.

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Anticipated impacts from climate change act as stressors that motivate adaptation strategy development. And, while climate science projections extend from the global to regional scale, they can leave significant uncertainty at the local scale. In many jurisdictions, governance and environmental management professionals formulate and distribute information to guide climate change policy and preparation. In many rural or otherwise marginalized areas, however, relationships needed to promote clear understanding of impacts and to tackle cooperative adaptation planning alongside residents are lacking. This article discusses methods used by an interdisciplinary group of scientists to help a small community of rural coastal United States residents enhance their climate resilience. This was accomplished via participatory collaborative science and collaborative learning processes that facilitated relationships of trust among a broad group of stakeholders. Data gathered from our network and analyses of project activities show the benefits of collaboration across a social network representing the social-ecological system. The success of our efforts is evident in five ways: a) in localized application of climate and environmental knowledge, b) in building two-way knowledge across the local/nonlocal divide, c) in incorporating local community values, d) developing trust between residents, scientists, and environmental governance and management professionals, and e) in lessons learned transitioning from a learning to decision-making process. We strongly advocate those working with local groups on adaptation planning efforts begin with methods that help build knowledge, respect, trust, and capacity among residents.

Collaborative science brings together diverse stakeholders to share knowledge and form networks that in turn can be foundational to policies and practices to increase socio-ecological resilience. In this article, we present results from a collaborative science project that employed collaborative learning methods to develop a network of local, regional, state and academic stakeholders. These stakeholders had little social interaction prior to the project and represented a diversity of views, positions and responsibilities. They shared in common a concern for the effects of climate change on a coastal socio-ecological system and the desire to reduce vulnerabilities and enhance resilience. Through ethnographic and survey methods, we found that collaborative science and learning promoted the exchange of cultural and environmental knowledge and expertise among individuals who previously had no sustained interaction. Stakeholders perceived these exchanges as worthwhile in that they allowed individuals to express viewpoints and share knowledge and expertise, which was seen to have the potential to increase socio-ecological resilience. Our results suggest that social networks can emerge from collaborative science and learning projects and can become formally organized and help foster opportunities to enhance socio-ecological resilience.