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

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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.