Protocol - Housing Instability Due to Affordability

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The CDC BRFSS Social Context: Housing Affordability screening item assesses worry about being able to afford the rent/mortgage in the near future, which is an important aspect of housing insecurity.

Specific Instructions



1. Do you own or rent your home
[ ] 1 Own
[ ] 2 Rent
[ ] 3 Other arrangement
[ ] 7 Don’t know / Not sure
[ ] 9 Refused

INTERVIEWER NOTE: “Other arrangement” may include group home, staying with friends or family without paying rent.

NOTE: Home is defined as the place where you live most of the time/the majority of the year.

INTERVIEWER NOTE: We ask this question in order to compare health indicators among people with different housing situations.

Now, I am going to ask you about several factors that can affect a person’s health.

If Question 1 = 1 or 2 (own or rent) continue.

2. How often in the past 12 months would you say you were worried or stressed about having enough money to pay your rent/mortgage? Would you say---
Please read:
[ ] 1 Always
[ ] 2 Usually
[ ] 3 Sometimes
[ ] 4 Rarely
[ ] 5 Never
Do not read:
[ ] 8 Not applicable
[ ] 7 Don’t know / Not sure
[ ] 9 Refused

Personnel and Training Required

The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews. The interviewer should be trained to prompt respondents further if a “don’t know” response is provided.

Equipment Needs

The PhenX Working Group acknowledges these questions can be administered in a computerized or noncomputerized format (i.e., paper-and-pencil instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer/handheld computer to administer a computer-assisted questionnaire.

Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered questionnaire




Adults aged 18 or older

Selection Rationale

The U.S. Centers of Disease Control and Prevention (CDC) BRFSS Social Context: Housing Affordability screening item is an established, well-validated, interviewer-administered Likert-style response question used frequently as an indicator of housing insecurity.


English, Spanish

Derived Variables


Process and Review

Not Applicable

Protocol Name from Source

CDC Behavioral Risk Factor Surveillance System (BRFSS) Survey


Centers of Disease Control and Prevention. (2015). Behavioral Risk Factor Surveillance System (BRFSS), 2015. Washington, DC. Question number: Social Context, #1-2.

General References

Billioux, A., Verlander, K., Anthony, S., & Alley, D. (2017). Standardized screening for health-related social needs in clinical settings: the accountable health communities screening tool. [Discussion paper]. NAM Perspectives. National Academy of Medicine. https://doi.org/10.31478/201705b

O'Gurek, D. T., & Henke, C. (2018). A practical approach to screening for social determinants of health. Family Practice Management, 25(3), 7-12.

Aratani, Y., Chau, M., Wight, V. R., & Addy, S. (2011). Rent burden, housing subsidies and the well-being of children and youth. National Center for Children in Poverty. Available from https://www.nccp.org/publication/rent-burden-housing-subsidies-and-the-well-being-of-children-and-youth/

Bushman, G., & Mehdipanah, R. (2022). Housing and health inequities during COVID-19: findings from the national Household Pulse Survey. Journal of epidemiology and community health, 76(2), 121–127. https://doi.org/10.1136/jech-2021-216764

Protocol ID


Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX281201010000 Do you own or rent your home? N/A
PX281201020000 How often in the past 12 months would you more
say you were worried or stressed about having enough money to pay your rent/mortgage? Would you say--- show less
Individual Social Determinants of Health
Measure Name

Housing Instability Due to Affordability

Release Date

December 14, 2022


This measure evaluates how secure and stable housing is for an individual, with an emphasis on stability, safety, and low burden to the resident.


Stable housing indicates that it does not incur significant burden and stress, including financial, physical, and emotional, to its occupants. Stable housing implies that the occupant has a sense of affordability, stability, and safety within their housing situation. A lack of stable housing, including homelessness, is associated with increased risk of symptoms of chronic disease, as well as odds of disease such as diabetes and depression.


Housing, instability, housing insecurity, affordability, worry, living situation, address, shelter, environment, home, house, rent, mortgage, residence, Behavioral Risk Factor Surveillance System, BRFSS, Centers for Disease Control and Prevention, CDC, neighborhood built environment

Measure Protocols
Protocol ID Protocol Name
281201 Housing Instability Due to Affordability

Bart, T. A., et al. (2023) Measurement invariance of commonly used psychosis-screening scales in US Spanish- and English-speaking Hispanic participants. Psychological Assessment. 2023 April; 35(4): 300-310. doi: 10.1037/pas0001207

Purvis, R. S., et al. (2021) Trusted Sources of COVID-19 Vaccine Information among Hesitant Adopters in the United States. Vaccines. 2021 December; 9(12): 1418. doi: 10.3390/vaccines9121418