Neighborhood opportunity and child health using a randomized trial of low-income mothers

项目摘要（30行） 最近一份有影响力的国家科学院报告得出结论，儿童早期的贫困（即，<3年） 可能会导致不良身体健康、心理健康和发育结果的风险增加。一个关键 现在的挑战是如何最好地干预贫困，以改善儿童健康。除了个别 在美国，基于收入的健康差距的一个关键方面涉及邻里贫困。贫困 在美国仍然是高度空间模式化的。广泛的研究记录了高水平的种族住宅 美国的种族隔离以及贫富的地理集中。黑人和西班牙裔 特别是少数民族儿童的童年机会分配比非少数民族儿童更差， 西班牙裔白色儿童。除了个人贫困之外，生活在弱势社区可能会 损害儿童健康，包括高度的居住隔离、健康食品店有限、绿色空间减少， 和更高的邻里贫困。 我们将使用R21机制来探讨搬到社区对儿童健康的潜在因果作用 以童年的机会为特点。我们将在NICHD资助的婴儿第一年（BFY）研究的基础上， 该计划于2018年启动，这是美国首次大规模向贫困家庭提供无条件现金转移的实验。 和婴儿一起。这项随机试验招募了1,000名有家庭现金收入的新生儿母亲 贫困线以下。治疗组的母亲每月获得333美元的现金补助（每名母亲4，000美元）。 在婴儿出生后的头52个月，母亲每月领取20美元。我们将 在一个意向治疗设计中，对高现金礼物进行随机化，以检查两个问题。首先，母亲们 随着现金限制的部分缓解， 机会？第二，在这个高收入群体中， 动作？我们还将利用BFY的居住地址和丰富的儿童健康数据， 作为童年机会的邻里指数和地理编码距离措施，以实现所有目标。为 儿童健康的目标，我们将集中在邻里调解的主要影响，已经出现的年龄-2： 睡眠质量，水果和蔬菜的消费增加，以及母亲减少购买香烟。 我们的工作在两个方面具有重要意义。首先，我们专注于纠正大，广泛和强大的收入为基础的 美国儿童健康的差距。其次，我们研究了低收入父母是否 那些部分摆脱了收入限制的人， 孩子的发展时期。鉴于严格的意向治疗研究设计和BFY的基础设施， 为了实现我们的目标，我们的分析可能会确定社区对儿童健康的因果估计。甚至精确地 社区/儿童健康目标的估计零发现具有很强的科学价值，因为它们 建议通过收入影响儿童健康的非邻里调解人。

Project Summary (30 lines) A recent influential National Academies Report concludes that poverty during early childhood (i.e., <3 years) may causally increase the risk of adverse physical health, mental health, and developmental outcomes. A key challenge now involves how best to intervene on poverty to improve child health. In addition to individual poverty, one critical aspect of income-based health disparities in the US involves neighborhood poverty. Poverty in the US remains highly spatially patterned. Extensive research documents high levels of racial residential segregation in the US as well geographic concentration of both poverty and affluence. Black and Hispanic racial minority children in particular have non-overlapping worse distributions of childhood opportunity than do non- Hispanic white children. Above and beyond individual poverty, living in disadvantaged neighborhoods may damage child health, including via high residential segregation, limited healthy food outlets, fewer green spaces, and higher neighborhood poverty. We will use the R21 mechanism to explore the potentially causal role on child health of moving to neighborhoods characterized by childhood opportunity. We will build on the NICHD-funded Baby's First Years (BFY) study, initiated in 2018, which is the first large-scale US experiment of unconditional cash transfers to poor families with infants. The randomized trial recruited 1,000 mothers of newborn infants with household cash incomes below the poverty line. Mothers in the treatment group receive monthly cash payments of $333 ($4,000 per year) for the first 52 months of the child's life, and mothers in the control group receive $20 per month. We will use randomization to the high-cash gift in an intent-to-treat design to examine two questions. First, do mothers with a partial alleviation of cash constraints move to neighborhoods characterized by greater childhood opportunity? And second, are gains in child health (by age-2) in this high-cash group mediated by neighborhood moves? We will leverage both residential address and rich child health data from BFY across three waves, as well as neighborhood indices of childhood opportunity and geocoded distance measures, to achieve all aims. For the child health aim, we will focus on neighborhood mediation of main effects that already have emerged by age-2: sleep quality, increased consumption of fruits and vegetables, and mother's reduced purchasing of cigarettes. Our work is significant in two ways. First, we focus on redressing large, widespread, and robust income-based disparities in child health in the US. Second, we examine the important question of whether low-income parents who are partially relieved of income constraints move to childhood opportunity neighborhoods at a sensitive period of their child's development. Given the rigorous intent-to-treat study design and the infrastructure of BFY to achieve our Aims, our analyses may identify causal estimates of neighborhoods on child health. Even precisely estimated null findings for the neighborhood/child health aim hold strong scientific value since they would suggest non-neighborhood mediators through which income affects child health.