Effects of a housing policy experiment on youth behavioral problems

描述（由申请人提供）：不良的社区环境预示着青少年不良的心理健康和外化行为，社区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中发挥重要作用。然而，由于大多数研究都是观察性的，而不是实验性的，因此可能存在偏见。社区健康研究通常对社区的时间点暴露进行建模，而不是了解社区暴露轨迹，并且对少数民族，贫困青少年所处的特定环境的关注不足。我们的研究对来自5个城市的自愿社区搬迁的社会实验数据进行了二次分析（移动到机会，MTO，研究），以测试如何以及为什么随机分配到低贫困社区的提议意外地影响了4-7年期间男孩的行为问题，并告知该计划对心理健康的异性影响。我们将补充现有的数据，增加社区层面的数据收集，以丰富数据集。MTO是唯一一项大规模的研究，它随机分配个体接受不同的社区环境，以支持社区如何塑造心理健康的强有力的因果推论。然而，先前的MTO分析并没有整合青少年发展的理论认识来激励实证分析。先前的分析也没有探讨为什么邻里环境可能会增加男孩的行为问题，是否某些亚群比其他亚群更容易受到邻里搬迁的影响，或者是否存在重要的发育敏感期，在这个时期，邻里剥夺可能对青少年的心理健康产生特别的影响。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由社区特征、家庭背景或物质使用介导。目的2：分别在男孩和女孩中，研究移居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：比较暴露于社区贫困的不同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。该项目将利用实验设计，将创新地应用因果方法来理解中介，并将建立时变邻里暴露模型，这将为青少年健康的邻里暴露期的相关早期生命历程发展时间提供信息。由于实验设计严谨，本项目可以为第8条住房券等社会政策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。

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.