Effects of a housing policy experiment on youth behavioral problems

描述(申请人提供)：不利的邻里环境预示着青少年的心理健康不良和外化行为，而邻里环境中巨大的种族不平等可能在造成和维持健康方面的种族差异方面发挥重要作用。然而，由于大多数研究都是观察性的，而不是实验性的，所以它可能是有偏见的。社区健康研究通常模拟社区的时间点暴露，而不是了解社区暴露的轨迹，而且对少数族裔、贫困青少年导航的特定背景关注不足。我们的研究建议对5个城市使用第8条住房代金券自愿搬迁社区的社会实验数据进行二次分析，以测试随机分配的搬迁到低贫困社区的提议在4-7年期间如何以及为什么会意外地对男孩的行为问题产生不利影响，并告知该计划对心理健康的相反性别影响。我们将通过额外的邻居级数据收集来补充现有数据，以丰富数据集。MTO是唯一可用的大规模研究，它随机分配个人接受不同的社区背景，以支持社区如何塑造心理健康的强有力的因果推断。然而，以前的MTO分析并没有整合对青少年发展的理论理解来推动实证分析。之前的分析也没有探究为什么邻里环境会增加男孩的行为问题，是否某些亚群比其他亚群更有可能受到邻里搬迁的影响，或者是否存在重要的发展敏感期，当暴露在邻里剥夺中可能对年轻人的心理健康产生特别影响的时候。我们的项目提出了三个目标：目标1：测试搬到低贫困社区对男孩行为问题的影响是否通过社区特征、家庭背景或物质使用来中介。目的2：在男孩和女孩中分别检查搬到低贫困社区对行为问题的影响是否会受到基线健康状况、家庭/青少年脆弱性或项目地点的影响。目的3：比较不同的暴露于邻里贫困的时间或顺序模式对男孩行为问题的重要性。该项目将利用一个跨学科的调查小组，包括社会流行病学、精神流行病学、发展心理学、人口学、公共政策、统计学、医学等领域。这个项目将利用一个实验设计，将创新地应用因果方法来理解调解，并将建立随时间变化的邻里暴露模型，这将为青少年幸福的邻里暴露时期的相关早期生命过程发展时间提供信息。由于严格的实验设计，该项目可以为第8条住房券等社会政策可能影响人口健康和心理健康的机制提供强有力的政策相关证据。 公共卫生相关性：邻里环境可能是健康差距的一个重要原因，特别是考虑到生命早期积累的风险。该项目利用住房搬迁的社会实验，其结果有可能为文献提供信息，说明为什么社区环境是青少年行为问题的原因，包括探索更具体的问题，即何时以及在低贫困社区生活多长时间可能对青少年心理健康产生最大影响。这些知识将为下一代干预措施和政策提供信息，以确保青少年不会受到租房援助政策的伤害；实验设计的结果将为减少人口心理健康负担和随后的健康差距提供因果路径和潜在的干预点。

DESCRIPTION (provided by applicant): Adverse neighborhood contexts predict poor mental health and externalizing behavior among adolescents, and the vast racial inequalities in neighborhood environment may play an important role in creating and maintaining racial disparities in health. However, since most research has been observational rather than experimental, it is potentially biased. Neighborhood-health research typically models point-in-time exposures of neighborhoods, in lieu of understanding neighborhood exposure trajectories, and insufficient attention has been paid to the specific contexts navigated by minority, impoverished, adolescents. Our study proposes a secondary analysis of data from a social experiment of voluntary neighborhood relocation using Section 8 Housing Vouchers in 5 cities (the Moving to Opportunity, MTO, Study), to test how and why random assignment of an offer to move to a low-poverty neighborhood unexpectedly adversely affected behavioral problems for boys over a 4-7 year period, and to inform the program's opposite gender effects on mental health. We will complement the existing data with additional neighborhood-level data collection to enrich the dataset. MTO is the only available large- scale study that has randomly assigned individuals to receive different neighborhood contexts, to support strong causal inferences of how neighborhoods shape mental health. Yet prior MTO analyses have not integrated theoretical understanding of adolescent development to motivate empirical analyses. Nor have prior analyses probed why neighborhood context may increase behavioral problems of boys, whether certain subgroups are more likely to be affected than others by neighborhood relocation, or whether there are important developmentally-sensitive periods when exposure to neighborhood deprivation may be especially influential on youth mental health. Our project proposes 3 aims: Aim 1: To test whether effects of moving to a low-poverty neighborhood on behavioral problems for boys are mediated by neighborhood characteristics, family context, or substance use. Aim 2: To examine, separately among boys and girls, whether the effect of moving to a low-poverty neighborhood on behavioral problems is modified by baseline health status, family/adolescent vulnerability, or program site. Aim 3: To compare the importance of alternative timing or sequencing patterns of exposure to neighborhood poverty on behavioral problems among boys. The project will leverage an interdisciplinary team of investigators, including fields of social epidemiology, psychiatric epidemiology, developmental psychology, demography, public policy, statistics, medicine. This project will capitalize on an experimental design, will innovatively apply causal methods to understand mediation, and will model time-varying neighborhood exposures, which will inform relevant early life course developmental timing of neighborhood exposure periods for adolescent well-being. Because of the rigorous experimental design, this project can provide strong policy-relevant evidence on the mechanisms by which social policies like Section 8 housing vouchers may influence population health and mental health. PUBLIC HEALTH RELEVANCE: Neighborhood context may be an important cause of health disparities, especially taking into account risks which accumulate early in life. The results of this project, leveraging a social experiment of housing relocation, have the potential to inform the literature on why neighborhood context is a cause of behavioral problems among adolescents, including probing more specificity on when and for how long living in low-poverty neighborhoods may be most influential for affecting adolescent mental health. This knowledge will inform the next generation of interventions and policies to ensure that adolescents are not harmed by rental assistance policies; results from the experimental design will inform causal pathways and potential intervention points by which to reduce the population burden of mental health and subsequent health disparities.