Differential Mental Health Effects of Neighborhood Relocation Among Youth in Vulnerable Families

Abstract

Context Extensive observational evidence indicates youth in high-poverty neighborhoods exhibit poor mental health, although not all children may be affected similarly. Objective To use experimental evidence to assess whether gender and family health problems modify mental health effects of moving from high- to low-poverty neighborhoods. Design, Setting, Participants The Moving to Opportunity Study, a randomized controlled trial, enrolled volunteer low-income families in public housing in 5 U.S. cities from 1994–1997. We analyze 4–7 year outcomes among youth aged 12–19 (n=2829, 89% effective response rate). Intervention Families were randomized to control (remaining in public housing) or experimental (receiving government-funded rental subsidies to move into private apartments) groups. Intent-to-treat analyses included intervention interactions by gender and health vulnerability (defined as pre-randomization health/developmental limitations or disabilities among family members). Outcome measures Past-year psychological distress (K6), and Behavioral Problems Index (BPI). Supplemental analyses used past-year major depressive disorder (MDD). Results Male gender and family health vulnerability significantly adversely modified the intervention effect on K6 (gender: p=.02, health vulnerability: p=.002); male gender, but not health vulnerability, significantly adversely modified the intervention effect on BPI (gender: p=.01, health vulnerability: p=.17). Female adolescents without baseline health vulnerabilities were the only subgroup to benefit on any outcome (K6 (B= −0.21, 95% CI: (−0.34–−0.07), p=.003); MDD (Odds Ratio =0.42 (0.20–0.85) p=0.024). For male adolescents with health vulnerabilities, intervention was associated with worse K6 (B=.26, (0.09–0.44), p=.003) and BPI (B=.24 (0.09–0.40) p=.002). Neither females with health vulnerability, nor males without health vulnerability, experienced intervention benefits. Adherence-adjusted instrumental variable analysis found intervention effects twice as large. Patterns were similar for MDD but estimates were imprecise due to low prevalence. Conclusions Although some girls benefited, boys and adolescents from families with baseline health problems did not experience mental health benefits from housing mobility policies, and may need additional program supports.

Examining mediators of housing mobility on adolescent asthma: Results from a housing voucher experiment

“…The MTO study randomized low-income families to receive a housing voucher to subsidize a private rental apartment and move out of public housing, thereby improving their neighborhood and housing environment compared to controls (Orr et al, 2003), which presumably should have reduced asthma. Although prior work has documented both beneficial and harmful effects of MTO on health (Kling et al, 2007; Ludwig et al, 2011; Orr et al, 2003; Osypuk et al, 2012a, 2012b), including harmful effects on asthma (Fortson and Sanbonmatsu, 2010), the mechanisms through which MTO affects asthma have not been formally tested. The MTO experiment provides a rich source of data that we use to test whether specific potential mediators can explain these unexpected adverse effects on asthma, including: mental health, tobacco exposure, housing characteristics, and housing-related stressors.…”

“…We hypothesize that changes in mental health, tobacco exposure, and housing characteristics induced by the MTO experiment will partially explain some of the adverse findings of MTO on asthma. Prior research has documented that gender modifies some of the mediators of interest (e.g., mental health and smoking (Orr et al, 2003; Osypuk et al, 2012a, 2012b)). Therefore, we further hypothesize that gender-specific pathways of mediation may be present.…”

Associations of Continuity and Change in Early Neighborhood Poverty With Adult Cardiometabolic Biomarkers in the United States: Results From the National Longitudinal Study of Adolescent to Adult Health, 1995–2008

“…For instance, adult women who were randomized to more affluent neighborhoods had a lower risk of severe obesity and diabetes than did controls who remained in low-income communities (42). The longterm benefits of upward residential mobility for adolescents were less clear, with higher adult educational attainment and earnings for treated versus controls (43) but poorer mental health and behavioral problems among adolescent males randomized to nonpoor neighborhoods, especially those with pretreatment health vulnerabilities or exposure to criminal victimization (44,45).…”

Challenges to an integrated population health research agenda: Targets, scale, tradeoffs and timing

“…Adverse effects overall or within subgroups can emerge from well-intentioned policies or programs. For example, along with discovering some of the expected benefits for families randomized to the Moving to Opportunity intervention, evaluators also found unexpected negative impacts (Gay, 2012;Goering and Feins, 2003;Jackson et al, 2009;Osypuk et al, 2012). In other cases, intervention participants actually may fare worse overall than controls.…”