Housing insecurity is a form of residential exclusion that critically affects the health and wellbeing of children and adolescents (CAA). From a life course perspective, CAA’s health should be understood as the cumulative and dynamic result of social, emotional, and material exposures occurring from the earliest stages of life [1]. This perspective aligns with the World Health Organization’s (WHO) approach to health, which emphasizes the social determinants shaping the environments where individuals grow, form relationships, and develop [2]. In keeping with these frameworks, early-life adversities can trigger toxic stress processes that create a cumulative wear-and-tear effect on both physical and mental health [3, 4]. Evidence suggests that such stress undermines key aspects of CAA’s wellbeing during a critical period of development, affecting their ability to develop secure attachments, self-esteem, sense of agency, and engage in community life [5, 6]. The concept of embodiment reinforces this view by illustrating how social inequalities—including housing insecurity—become embedded in both the body and lived experience, contributing to the social gradient in health [7].

Likewise, housing has been recognized by the WHO as a key social determinant of health [8]. Building on a previous framework developed by Novoa et al. [9], Vásquez-Vera et al. [10] conceptualize the relationship between housing and health as mediated by a complex web of structural factors (such as macroeconomic policies, the housing market, and prevailing social values) that influence both the tangible (such as physical quality, affordability, and legal security) and intangible (including emotional safety and social connectedness) dimensions of housing. Neighborhoods may amplify or buffer these effects through their physical attributes and community features.

In this context, housing insecurity is defined as a multidimensional condition marked by unstable, unaffordable housing and risk of eviction that reflects both material and emotional dimensions [11]. It encompasses experiences of frequent and involuntary residential mobility, housing stress, overcrowding, and inadequate or non-tenured living situations (such as doubling-up or squatting) [11, 12]. Multiple studies have shown that housing insecurity negatively impacts various dimensions of CAA’s health and wellbeing through different mechanisms. Frequent residential moves disrupt routines, social networks, and school connections, causing stress, poorer socio-emotional development, more chronic health conditions, reduced healthcare coverage, and unmet health needs [13, 14]. Financial hardship related to housing costs has been linked to higher infant mortality, low birth weight, delayed medical care, and poorer academic performance, including reduced likelihood of completing higher education [13, 15]. Overcrowding and noise disrupt sleep, hinder study, and harm the mental health of both CAA and caregivers, increasing the risk of family conflict, neglect, and abuse [16–18]. Evictions, in turn, have been associated with preterm births, food insecurity, hospitalizations, poorer cognitive and emotional outcomes, and increased likelihood of child welfare system involvement [17, 19–21].

Accordingly, interventions that mitigate the effects of housing insecurity on the health and wellbeing of CAA can be understood as acting at structural, intermediate, or individual/group levels—corresponding, respectively, to broader policy and housing market dynamics, housing and neighborhood conditions, and the everyday living conditions that shape people’s direct experiences of housing, as conceptualized by Vásquez-Vera et al. [10]. This typology also reflects deeper distinctions in terms of their redistributive logic and their capacity to decommodify housing. Structural-level interventions, such as rent control, the expansion of public or non-market housing, or strengthened tenant protections, are strongly decommodifying in nature [22, 23], reducing reliance on the private market and altering structural conditions that produce housing insecurity. In contrast, intermediate-level interventions—such as housing subsidies, vouchers, or the coordination of housing and community services—primarily operate as redistributive mechanisms [24, 25], reallocating resources within existing market structures without challenging the commodified logic of housing provision. Finally, individual or group-level interventions—including psychosocial support, case management, or vocational training—focus on alleviating the personal and social consequences of housing insecurity without altering housing conditions, operating within a residual redistributive logic [26, 27].

Although several reviews have explored housing-related interventions affecting children and adolescents [28–34], most remain fragmented, focusing on specific housing provision programs such as vouchers or public housing. To date, no synthesis has systematically examined the full range of existing interventions, which encompasses not only different forms of housing provision but also community-based services, multi-assistance approaches, and interventions that work through supportive or psychosocial mechanisms rather than through changes to housing itself. Examining this broader spectrum is essential for understanding how the diverse strategies that currently address housing insecurity relate to one another and where important gaps remain.

Furthermore, no review has examined these interventions through a conceptual lens that distinguishes their level of action. Such a distinction is crucial, because structural, intermediate, and individual/group interventions target fundamentally different determinants of housing insecurity and operate through distinct decommodifying and redistributive logics. Distinguishing these levels helps clarify whether current efforts primarily mitigate the consequences of housing insecurity or meaningfully engage with the structural conditions that produce it. By applying this typology, our study provides a novel perspective that goes beyond describing isolated initiatives, offering a clearer understanding of how different approaches align with or challenge the structural drivers of housing insecurity, and assessing the transformative potential of interventions regarding health equity and housing decommodification.

The aim of this study was to map and synthesize the available literature on interventions that mitigate the effects of housing insecurity on the health and wellbeing of CAA, describing their characteristics, levels of action (structural, intermediate, or individual/group), and reported outcomes.

The database search yielded 6002 documents, with 1878 duplicates removed and 4033 excluded after title and abstract screening (Figure 1). After full-text review and reference list screening, 26 documents were included in the scoping review.

Table 1 summarizes the characteristics of the included documents. Most were published from 2010 onwards (73%) and were peer-reviewed articles (73.1%), while the remaining were gray literature, including reports, doctoral theses, and one letter to the editor. All but one study employed a quantitative design: eight were cross-sectional, fifteen longitudinal, one retrospective, and one a randomized controlled trial (RCT); the only mixed-methods study also incorporated an RCT design. All except one [48] included a comparison group. Half of them (53.9%) assessed two or three interventions.

As for the study quality scores, sixteen scored the maximum [49–64], while six scored 80% [48, 65–69], three scored 60% [70–72], and one scored 40% [73]. Across the ten studies scoring below 100%, the most frequent limitations reflected risks of bias related to confounding, completeness of data, and intervention delivery. Studies using randomized quantitative designs [65, 66] lacked blinded outcome assessment, which may have influenced how outcomes were measured and interpreted, even though other aspects of the design were robust. Non-randomized observational studies [48, 67–73] more often failed to account adequately for potential confounders [67, 69, 70, 73], had incomplete or differentially missing outcome data [68, 72, 73], or showed problems with how the intervention was delivered or targeted [71, 73], which limits internal validity and generalizability. Some differences were also apparent by document type: reports [65, 67, 70] and a letter to the editor [73] tended to provide less detailed methodological reporting, while peer-reviewed articles [48, 66, 68, 71, 72] and a doctoral thesis [69] described methods more fully but still exhibited constraints related to adherence and implementation of the intervention [71, 73], sample representativeness and attrition [71, 72], and the use of aggregated ecological data [48], which limits causal inference.

Most studies evaluated public housing and housing vouchers interventions (n = 16 each), while approximately one-third examined subsidies to private developers of affordable housing (n = 9), and two assessed multi-assistance programs. Interventions’ level of action was primarily intermediate (n = 22), followed by structural (n = 16), and individual/group (n = 2). All interventions were US-based, except one in Ecuador. Fourteen studies included CAA aged 0–2, eleven aged 3-5, thirteen aged 6–12, and thirteen aged 13–17; four did not report age. Follow-up lasted 2 years or less in seven studies, 3–9 years in five, 10 years or more in six, and there was no follow-up in eight studies.

Outcomes assessed included general and physical health, mental health (psychological distress and behavior), and maltreatment. Studies also examined healthcare use—such as urgency care, hospitalizations, and preventive care. Educational outcomes included short-term academic metrics, school attendance, and long-term educational attainment.

Supplementary Table 2 presents the studies’ aims, methodologies, instruments, and quality scores, along with descriptions of the interventions studied and main results. Table 2 summarizes the observed effects of the interventions on CAA’s health and wellbeing outcomes.

This review is the first to map the available literature on interventions that mitigate the effects of housing insecurity on the health and wellbeing of CAA. Structural-level interventions, specifically public housing, showed consistent positive effects on physical health, healthcare utilization, and nutritional outcomes. Intermediate-level interventions, including housing vouchers and subsidies to private developers, were most frequently evaluated and yielded mixed but sometimes positive effects—particularly on healthcare use and educational metrics—though mental health and long-term educational attainment outcomes were inconsistent. No interventions operated exclusively at the individual or group level. However, multi-assistance programs combining psychosocial or family support with intermediate measures (e.g., housing subsidies) showed promising effects on health and school attendance. Their value appears to lie in enhancing the impact of intermediate interventions by addressing families’ specific social needs.

As for the observed benefits of the interventions, it is important to note that all of them, regardless of their level of action, share a focus on housing assistance and affordability. These interventions contribute to financial and residential stability by redistributing housing costs away from low-income families, enabling greater investment in children’s health, nutrition, and education [74, 75]. Crucially, structural interventions like public housing also carry a degree of decommodification, as they expand the non-market supply of housing and reduce exposure to market volatility—thereby providing a more stable and secure foundation for CAA wellbeing. These interventions—whether redistributive within market frameworks or more structurally transformative—can help buffer families from the residential mobility linked to housing insecurity, which has been proven to be a major source of stress linked to poor health outcomes [13, 14].

Regarding the few harms attributed to the interventions, some authors point to uncontrolled factors, such as neighborhood characteristics (e.g., safety or collective efficacy) [61], as well as the disruptive effects on social networks caused by interventions that involve family relocation, like housing vouchers [55]. We must also consider that, even with comparable control groups and adjustments for socioeconomic factors, comparing families receiving housing assistance with those who do not—as seen in studies with negative outcomes [55, 61, 68]—may still introduce selection bias. Families entering assistance programs are more likely to have lived in substandard housing, and their underlying motivations for seeking aid are often unobserved [51]. These pre-existing disadvantages may also make their children more prone to negative outcomes independent of the intervention. Precisely, one study found that assisted housing had divergent effects on behavioral and cognitive outcomes depending on children’s baseline performance [68], suggesting that those already facing greater adversity may benefit less or even be negatively affected by the intervention. This underscores the importance of early intervention in housing insecurity, as evidence suggests that while impacts can be mitigated, the cumulative effect of long-term adversity can still limit intervention effectiveness [28].

In contrast, only positive effects were observed in the two articles studying multi-assistance interventions. Despite the limited scope of individual/group-level interventions, we hypothesize that combining holistic support services—such as healthcare, education, and case management—with intermediate-level housing affordability measures can enhance CAA wellbeing, although only one study strongly supports this. The near absence of qualitative studies further limits understanding of lived experiences and mechanisms through which interventions impact CAA health. Qualitative research is essential to capture affected populations’ voices and understand the pathways linking interventions to wellbeing [76], including why similar interventions may yield different effects across contexts and population subgroups.

Similarly, many interventions potentially beneficial to CAA’s health and wellbeing lack impact evaluation on health outcomes and therefore are not included in this review. Nonetheless, policies addressing housing affordability, financial stability, and social inclusion are likely to improve health outcomes. This applies to structural- and intermediate-level measures such as mortgage regulation to prevent borrower abuse, household debt refinancing [9], foreclosure prevention counseling [77], or “inclusionary zoning” policies requiring new developments to include affordable units [78]. Anti-speculation and decommodifying policies like rent control [79], rent stabilization measures [77], and second-home purchasing restrictions [80] have also been associated with reduced housing costs and improved access for low-income households. Moreover, broader welfare state measures—universal healthcare, labor integration programs, unemployment benefits, and anti-exclusion policies—may also help mitigate the health impacts of housing insecurity by reducing financial hardship, protecting against mental distress, and maintaining access to essential services [81, 82].

This review has also excluded widely studied programs like Moving to Opportunity, as it targets families already stabilized through housing assistance. This intervention relocates low-income families to low-poverty areas using vouchers [83], but its mixed effects [84] and the criticism it has received for neglecting structural drivers of housing insecurity and disrupting vital social networks [85, 86] are significant.

Aside from this, our findings reveal a marked increase in the number of published studies from 2009 onward, possibly spurred by heightened attention to the topic following widespread housing insecurity during the global financial crisis. We also observe an overwhelming predominance of US-based studies, consistent with prior evidence [87]. This concentration mirrors the broader characteristics of the country’s liberal welfare regime [88], where housing is primarily treated as a market commodity and public interventions are residual and targeted [89]. These frameworks tend to favor redistribution without challenging the commodified nature of housing [24], constraining their capacity to address structural determinants of CAA health. More substantial effects might arise in contexts with stronger decommodification and universal welfare protections. Notably, no housing interventions have been evaluated for health impacts in such contexts.

Due to the USA’s dominance, this review has also unintentionally given greater weight to interventions like housing vouchers and subsidies to private developers, widely implemented and studied there [74]. These approaches reflect a broader neoliberal shift in the USA housing policy, where the state has reduced direct provision and turned to market-based solutions [90]. By channeling public funds into private housing markets, these programs frame housing as a commodity rather than a social right [91, 92]. While redistributive in nature, they preserve the commodified structure of provision—raising doubts about their ability to address the root causes of housing-related health inequalities.

Lastly, the current body of evidence is also characterized by a lack of age-disaggregated data. Most interventions targeted wide age ranges without differentiating between children and adolescents, making it impossible to assess potential differences in how these groups experience and benefit from them. Given the distinct developmental and social needs of these age groups, this gap significantly constrains the ability to capture age-specific outcomes—an important consideration for future evaluations.