Health of Low-Income Adults in Subsidized Housing: Randomized Experiment, NY City

描述(由申请人提供)：从公共卫生的角度来看，搬到补贴住房、不那么贫困的社区、犯罪率较低的住房开发项目，或者更多样化的收入环境，可能会通过多种途径减少健康差距。拟议的实验研究将利用纽约市住房保护和发展部的抽签系统来识别、处理和控制符合我们研究标准的家庭。小组分配将包括搬到十个新建住房地点之一的补贴公寓的家庭(治疗)和没有获得住房的匹配家庭(控制)。我们估计，我们的实验样本将包括大约1,300个参与治疗的家庭和1,690个与彩票匹配的对照。该提案的设计改进和扩展了早期住房试验的设计，因为它(A)比较了搬到新社区与住在同一社区对接受补贴住房的人的影响，(B)比较了搬进混合收入建筑和单独入住低收入建筑的影响，(C)审查了补贴住房对近贫困家庭(而不仅仅是低于贫困门槛的家庭)的影响，(D)审查了接受补贴住房的影响，其中接受了90%的补贴住房(而不是以前补贴住房演示中的不到一半)，和(E)审查补贴住房的影响，其中家庭可能留在补贴住房中(与对代金券的研究相比，在这些研究中，确实搬家的人中有一半以上最终再次搬家，通常是回到贫困社区)。我们拟议的数据收集战略将包括在申请住房时使用自填式问卷收集基线数据，该问卷由一名成年家庭成员填写，并辅之以从住房申请本身获得的信息。后续电话采访将在搬入后12-18个月内进行，非搬家的电话采访将同等时间进行。将在基线和后续行动中收集关于当前健康状况和健康行为的各种信息，以便能够在后续行动中评估家庭内部的变化以及比较组之间的平均变化。实验分析将被用来量化在申请时搬到新社区的补贴住房相对于搬到同一居住社区的补贴住房的影响。探索性分析将比较两种类型的待遇：搬到混合收入住房和专门开发低收入住房。家庭、住房和社区特征之间的关系将被视为潜在结果以及个人水平健康结果的中介因素。 与公共健康相关：实验研究表明，搬到特定类型的社区的新住房可能会改善贫困家庭的生活机会；然而，之前的研究混淆了住房和社区的流动性，没有调查混合收入住房开发的好处。我们的随机实验将跟踪大约1300个获得城市补贴住房的家庭和大约1700个匹配的没有获得住房的家庭，以评估他们的身心健康和健康行为的变化。此外，我们还将探索物理、经济和社会环境的变化，这些变化可能会调解居住环境与低收入居民的健康和福祉之间的关系。

DESCRIPTION (provided by applicant): From a public health perspective, moving to subsidized housing, to less poor neighborhoods, to housing developments with low rates of crime, or to more mixed income settings might reduce health disparities through multiple pathways. The proposed experimental research will utilize the NYC Department of Housing Preservation and Development's lottery system to identify treatment and control households that fit our study criteria. Group assignment will include households who move to a subsidized apartment in one of ten newly constructed housing sites (treatment) and matched households who do not receive housing (control). We estimate that our experimental sample will be comprised of about 1,300 participating treatment households and 1,690 lottery- matched controls. This proposal's design improves and expands upon the design of earlier housing experiments in that it (a) compares the impact of moving to a new neighborhood versus staying in the same neighborhood among recipients of subsidized housing, (b) compares the impact of moving into mixed-income versus solely low- income buildings, (c) examines the impact of subsidized housing on near-poor families (rather than just families below the poverty threshold), (d) examines the effect of subsidized housing where the uptake of the offer is 90% (rather than less than one-half in previous demonstrations of subsidized housing), and (e) examines the effect of subsidized housing where the families are likely to stay in the subsidized housing (compared to studies of vouchers, where over half of those who did move ended up moving again, typically back to poor neighborhoods). Our proposed data collection strategy will include baseline data collection at time of application for housing using a self-administered questionnaire to be completed by a single adult household member and augmented by information obtained from the housing application itself. Follow-up telephone interviews will take place 12-18 months after move-in, or equivalent for non-movers. A variety of information on current health status and health behaviors will be collected at baseline and follow-up to enable assessment of within-household change as well as average change between comparison groups at follow-up. Experimental analyses will be used to quantify the impact of moving to subsidized housing in a new neighborhood relative to moving to subsidized housing in the same neighborhood of residence at time of application. Exploratory analysis will compare two types of treatment: moves to mixed-income housing and exclusively low-income housing developments. Relationships among household, housing, and neighborhood features will be examined as potential outcomes as well as mediators of individual-level health outcomes. PUBLIC HEALTH RELEVANCE: Experimental research has shown that moving to new housing in particular kinds of neighborhoods may improve the life chances of poor families; however, previous research confounded housing- and neighborhood mobility and did not investigate the benefits of mixed-income housing developments. Our randomized experiment will track about 1,300 households who receive city-subsidized housing and about 1,700 matched households who do not receive housing over the first 12-18 months after move-in to assess changes in physical and mental health, and health behaviors. In addition, we will explore changes in physical, economic, and social environments that may mediate the relationship between residential context and health and well-being of low-income residents.