Person:

Katz, Lawrence

Background: The question of whether neighborhood environment contributes directly to the development of obesity and diabetes remains unresolved. The study reported on here uses data from a social experiment to assess the association of randomly assigned variation in neighborhood conditions with obesity and diabetes. Methods: From 1994 through 1998, the Department of Housing and Urban Development (HUD) randomly assigned 4498 women with children living in public housing in high-poverty urban census tracts (in which ≥40% of residents had incomes below the federal poverty threshold) to one of three groups: 1788 were assigned to receive housing vouchers, which were redeemable only if they moved to a low-poverty census tract (where <10% of residents were poor), and counseling on moving; 1312 were assigned to receive unrestricted, traditional vouchers, with no special counseling on moving; and 1398 were assigned to a control group that was offered neither of these opportunities. From 2008 through 2010, as part of a long-term follow-up survey, we measured data indicating health outcomes, including height, weight, and level of glycated hemoglobin (HbA(_{1c})).

Objectives: Using data from a randomized experiment, to examine whether moving youth out of areas of concentrated poverty, where a disproportionate amount of crime occurs, prevents involvement in crime. Methods: We draw on new administrative data from the U.S. Department of Housing and Urban Development’s Moving to Opportunity (MTO) experiment. MTO families were randomized into an experimental group offered a housing voucher that could only be used to move to a low-poverty neighborhood, a Section 8 housing group offered a standard housing voucher, and a control group. This paper focuses on MTO youth ages 15–25 in 2001 (n = 4,643) and analyzes intention to treat effects on neighborhood characteristics and criminal behavior (number of violent- and property-crime arrests) through 10 years after randomization. Results: We find the offer of a housing voucher generates large improvements in neighborhood conditions that attenuate over time and initially generates substantial reductions in violent-crime arrests and sizable increases in property-crime arrests for experimental group males. The crime effects attenuate over time along with differences in neighborhood conditions. Conclusions: Our findings suggest that criminal behavior is more strongly related to current neighborhood conditions (situational neighborhood effects) than to past neighborhood conditions (developmental neighborhood effects). The MTO design makes it difficult to determine which specific neighborhood characteristics are most important for criminal behavior. Our administrative data analyses could be affected by differences across areas in the likelihood that a crime results in an arrest.

Nearly 9 million Americans live in extreme-poverty neighborhoods, places that also tend to be racially segregated and dangerous. Yet, the effects on the well-being of residents of moving out of such communities into less distressed areas remain uncertain. Using data from Moving to Opportunity, a unique randomized housing mobility experiment, we found that moving from a high-poverty to lower-poverty neighborhood leads to long-term (10- to 15-year) improvements in adult physical and mental health and subjective well-being, despite not affecting economic self-sufficiency. A 1–standard deviation decline in neighborhood poverty (13 percentage points) increases subjective well-being by an amount equal to the gap in subjective well-being between people whose annual incomes differ by $13,000—a large amount given that the average control group income is $20,000. Subjective well-being is more strongly affected by changes in neighborhood economic disadvantage than racial segregation, which is important because racial segregation has been declining since 1970, but income segregation has been increasing.

Evidence about the effects of neighborhood environments on children and youth is central to the design of a wide range of public policies. Armed with long-term survey data from the Moving to Opportunity (MTO) for Fair Housing demonstration final impacts evaluation (Sanbonmatsu et al., 2011), we have the opportunity to understand whether neighborhood poverty and related characteristics exert an independent causal effect on the life chances of young people. Findings from analyses of youth in the long-term survey for the final impacts evaluation show that MTO had few detectable effects on a range of schooling outcomes, even for those children who were of preschool age at study entry. MTO also had few detectable effects on physical health outcomes. In other youth outcome domains, patterns of effects on youth were similar to, but more muted than, those in the interim impacts evaluation (Orr et al., 2003), with favorable patterns among female youth—particularly on mental health outcomes—and less favorable patterns among male youth.

Adults living in high-poverty neighborhoods often fare worse than adults in more advantaged neighborhoods on their physical health, mental health, and economic well-being. Although social scientists have observed this association for hundreds of years, they have found it difficult to determine the extent to which the neighborhoods themselves affect well-being versus the extent to which people at greater risk for adverse outcomes live in impoverished neighborhoods. In this article, we examine neighborhood effects using data from the 10- to 15-year evaluation of the Moving to Opportunity (MTO) for Fair Housing demonstration, which offered randomly selected families a housing voucher. The experimental design of MTO allows us to isolate the effects of neighborhoods from selection bias. We find that, 10 to 15 years after enrolling participants, the program had very few detectable effects on economic well-being but had some substantial effects on the physical and mental health of adults. For adults whose families received the offer of a housing voucher that could be used to move only to a low-poverty neighborhood, we find health benefits in terms of lower prevalence of diabetes, extreme obesity, physical limitations, and psychological distress. For adults offered a Section 8 voucher, we find benefits in terms of less extreme obesity and lower prevalence of lifetime depression.

Importance Youth in high-poverty neighborhoods have high rates of emotional problems. Understanding neighborhood influences on mental health is crucial for designing neighborhood-level interventions.

Objective To perform an exploratory analysis of associations between housing mobility interventions for children in high-poverty neighborhoods and subsequent mental disorders during adolescence.

Design, Setting, and Participants The Moving to Opportunity Demonstration from 1994 to 1998 randomized 4604 volunteer public housing families with 3689 children in high-poverty neighborhoods into 1 of 2 housing mobility intervention groups (a low-poverty voucher group vs a traditional voucher group) or a control group. The low-poverty voucher group (n=1430) received vouchers to move to low-poverty neighborhoods with enhanced mobility counseling. The traditional voucher group (n=1081) received geographically unrestricted vouchers. Controls (n=1178) received no intervention. Follow-up evaluation was performed 10 to 15 years later (June 2008-April 2010) with participants aged 13 to 19 years (0-8 years at randomization). Response rates were 86.9% to 92.9%.

Main Outcomes and Measures Presence of mental disorders from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) within the past 12 months, including major depressive disorder, panic disorder, posttraumatic stress disorder (PTSD), oppositional-defiant disorder, intermittent explosive disorder, and conduct disorder, as assessed post hoc with a validated diagnostic interview.

Results Of the 3689 adolescents randomized, 2872 were interviewed (1407 boys and 1465 girls). Compared with the control group, boys in the low-poverty voucher group had significantly increased rates of major depression (7.1% vs 3.5%; odds ratio (OR), 2.2 [95% CI, 1.2-3.9]), PTSD (6.2% vs 1.9%; OR, 3.4 [95% CI, 1.6-7.4]), and conduct disorder (6.4% vs 2.1%; OR, 3.1 [95% CI, 1.7-5.8]). Boys in the traditional voucher group had increased rates of PTSD compared with the control group (4.9% vs 1.9%, OR, 2.7 [95% CI, 1.2-5.8]). However, compared with the control group, girls in the traditional voucher group had decreased rates of major depression (6.5% vs 10.9%; OR, 0.6 [95% CI, 0.3-0.9]) and conduct disorder (0.3% vs 2.9%; OR, 0.1 [95% CI, 0.0-0.4]).

Conclusions and Relevance Interventions to encourage moving out of high-poverty neighborhoods were associated with increased rates of depression, PTSD, and conduct disorder among boys and reduced rates of depression and conduct disorder among girls. Better understanding of interactions among individual, family, and neighborhood risk factors is needed to guide future public housing policy changes.

Observational studies have consistently found that youth in high-poverty neighborhoods have high rates of emotional problems even after controlling for individual-level risk factors.1 These findings raise the possibilities that neighborhood characteristics affect emotional functioning2 and neighborhood-level interventions may reduce emotional problems. Available data from observational studies are unclear and subject to selection bias and the possibility of reverse causality (ie, families with emotional problems end up in poorer neighborhoods). Despite this uncertainty, presumptive neighborhood effects have been characterized,3 causal pathways have been hypothesized,4 and interventions have been implemented.5

It is important to evaluate these causal claims regarding neighborhood effects experimentally. The US Department of Housing and Urban Development (HUD) enacted a housing mobility experiment known as the Moving to Opportunity for Fair Housing Demonstration by randomizing volunteer low-income public housing families with children to receive vouchers to move to lower-poverty neighborhoods.6,7 An interim evaluation 4 to 7 years after randomization showed that the intervention caused families to move to better neighborhoods with lower poverty and crime rates and increased social ties with more affluent people.8 Significant reductions in psychological distress and depression were also found among adolescent girls in the intervention group vs the control group but increased behavior problems were found among adolescent boys in the intervention group vs the control group.9- 11 Given the importance of these sex differences, clinically significant mental disorders were included in a long-term (10-15 years after randomization) follow-up assessment. Prior long-term follow-up reports documented effects on improved neighborhood characteristics,12,13 reduced adult extreme obesity and diabetes,14 and improved adult subjective well-being.13 No detectable effects on economic self-sufficiency were found.13 Although long-term evaluation found significantly reduced psychological distress among adolescent girls,15 measures of mental disorders were not examined in previous reports.

The primary objectives of the Moving to Opportunity study were to move families to lower-poverty neighborhoods and increase educational achievement and economic self-sufficiency. Mental disorders were measured as post hoc outcomes. The current report presents the first exploratory analyses evaluating long-term associations of housing mobility randomization with mental disorders among participants who were in early childhood at randomization and adolescence at follow-up.

Experimental estimates from Moving to Opportunity (MTO) show no significant impacts of moves to lower‐poverty neighborhoods on adult economic self‐sufficiency four to seven years after random assignment. The authors disagree with Clampet‐Lundquist and Massey's claim that MTO was a weak intervention and therefore uninformative about neighborhood effects. MTO produced large changes in neighborhood environments that improved adult mental health and many outcomes for young females. Clampet‐Lundquist and Massey's claim that MTO experimental estimates are plagued by selection bias is erroneous. Their new nonexperimental estimates are uninformative because they add back the selection problems that MTO's experimental design was intended to overcome.

We examine long-term neighborhood effects on low-income families using data from the Moving to Opportunity (MTO) randomized housing-mobility experiment. This experiment offered to some public-housing families but not to others the chance to move to less-disadvantaged neighborhoods. We show that ten to 15 years after baseline, MTO: (i) improves adult physical and mental health; (ii) has no detectable effect on economic outcomes or youth schooling or physical health; and (iii) has mixed results by gender on other youth outcomes, with girls doing better on some measures and boys doing worse. Despite the somewhat mixed pattern of impacts on traditional behavioral outcomes, MTO moves substantially improve adult subjective well-being.