The Mobility Opportunity Voucher to Eliminate Disparities (MOVED) Study: Obesity and Diabetes Risk in HUD's Community Choice Demonstration

点击翻译按钮获取中文摘要

Project Summary An estimated 41% of adults in the US and one in five of children are estimated to have obesity; over 37 million Americans have diabetes and 96 million adults have prediabetes. Racial and socioeconomic disparities in obe- sity and diabetes prevalence are well-documented, widespread, and persistent. Policies addressing the root causes of health inequities are critical to understanding and ultimately eliminating disparities in obesity and dia- betes risk. The U.S. Department of Housing and Urban Development’s (HUD’s) new, $50 million Community Choice Demonstration seeks to test strategies that help low-income households overcome structural barriers and entrenched racism that constrain their ability to move to lower-poverty ‘opportunity’ neighborhoods. The Demonstration offers an exciting, time-sensitive chance to study the impact of this new targeted housing mobil- ity program on obesity and diabetes risk, and, more broadly, provides a window into the mechanisms through which neighborhoods impact obesity and diabetes risk for low-income populations. Starting in the Fall of 2022, approximately 16,000 households will take part in a randomized controlled trial: one group will receive compre- hensive mobility services such as security deposit assistance and landlord outreach to facilitate moving to a lower-poverty neighborhood and a control group will not receive mobility services. This proposed project, the Mobility Opportunity Vouchers to Eliminate Disparities (MOVED) Study, will recruit 900 households en- rolled in the Demonstration from three sites (Pittsburgh, PA; Cleveland, OH; Nashville, TN). We will conduct baseline and 2-year follow-up in-person surveys to investigate the extent to which the receipt of comprehen- sive mobility services is associated with changes in measured BMI and HbA1c among adult and changes in BMI z-score among children after 2 years compared to the control group (Aim 1). Aim 2 investigates outcomes along the causal pathway, focusing on potential behavioral, psychosocial, contextual, and structural factors that may differ between the intervention and control groups. Data for this aim includes validated question- naires, geographically-derived data, and, among a subset of participants, accelerometry data on physical activ- ity and sleep. Aim 3 uses in-depth qualitative interviews to delve deeper into potential mechanisms through which moving to a lower-poverty neighborhood influences obesity and diabetes risk. The proposed research answers recent national calls for innovative research on the impact of housing mobility and neighborhoods on health and, working with HUD and other stakeholders, offers a time-sensitive chance to provide foundational, policy-relevant knowledge designed to reduce inequities in obesity and diabetes.