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Targeting Health Disparities through Housing Redevelopment: A Natural Experiment of Housing Quality, Stability, and Economic Integration

通过住房重建消除健康差距：住房质量、稳定性和经济一体化的自然实验

基本信息

批准号：
10458753
负责人：
REBEKAH Levine COLEY
金额：
$ 65.01万
依托单位：
BOSTON COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-01 至 2026-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10458753
关键词：
Address Adult Affect Age American Boston Characteristics Child Clinical Communities Complex Control Groups Crime Data Development Disease Economics Effectiveness Elderly Emotional Engineering Environment Environmental Exposure Environmental Health Equation Ethnic Origin Evidence based intervention Funding Gender Glare Health Health Disparities Research Home Household Housing Income Individual Inequality Interview Investments Knowledge Longevity Longitudinal Studies Measurement Measures Mediating Mental Health Methods Modeling Morbidity - disease rate National Institute on Minority Health and Health Disparities Natural experiment Neighborhoods Outcome Pattern Personal Satisfaction Persons Physiological Policies Pollution Poverty Process Psychologist Public Housing Race Resources Respondent Social Problems Social Workers Sorting - Cell Movement Source Stress Surveys Techniques Testing arm behavioral health community based research design experience health disparity health economics housing instability improved innovation insight knowledge base longitudinal human study mortality neighborhood disadvantage neighborhood safety novel physical conditioning preservation residence response service providers social social determinants social health determinants stressor treatment effect

项目摘要

PROJECT SUMMARY/ABSTRACT Following decades of discriminatory policies and underinvestment in affordable housing, the 1.2 million households residing in our nation’s public housing (PH) developments often live in conditions of concentrated poverty, unhealthy and unstable housing and community contexts, and constrained social and economic opportunity. These social determinants of health drive substantial health disparities, with PH residents experiencing elevated levels of mortality and morbidity across numerous health domains. In response, current policy efforts seek to redevelop PH into mixed-income communities in order to deconcentrate poverty, create healthier housing environments, decrease community stressors, and enhance community resources. It is essential to delineate the repercussions of such policies on health disparities and to understand the mechanisms underlying effects. This project seeks to exploit a multi-arm natural experiment of PH redevelopment to evaluate whether improving housing quality, limiting external displacement, and creating mixed-income communities improve the physical, mental, and behavioral health of PH residents, including children, adults, and older adults. We will further assess the social, environmental, and physiological mechanisms underlying such effects. Finally, we will address whether effects vary across resident age, gender, and race/ethnicity. The study will employ a rigorous mixed-methods design to follow 1068 individuals from 600 households in a Boston PH community undergoing redevelopment. The redevelopment plan will move quasi-randomly selected subsets of residents into new high quality PH, or displace them offsite followed by a return into new high quality mixed-income housing. We will compare these residents to a matched control group who will remain in place. Our interdisciplinary team will collect four waves of in-person surveys, direct environmental assessments, and direct physiological stress measurements, as well as annual geocoded administrative data and intensive qualitative interviews with a subset of respondents. This innovative combination of sources will provide data on resident physical, mental and behavioral health; physiological stress; social connections and collective efficacy; housing quality and disorder; and neighborhood crime, pollution, social problems and resources. Intent-to-treat, difference-in-differences, and average treatment effect models will provide rigorous evidence of how housing quality, residential displacement, and residence in mixed-income housing affect resident health. Structural equation models and qualitative analyses will identify mechanisms underlying housing effects. Our results, unearthing causal and dynamic processes underlying health disparities, will provide innovative new data on social determinants of health to inform models of housing and community redevelopment in the context of concentrated poverty.

项目总结/文摘