Effects of a neighborhood experiment on adolescent female psychological distress

说明(申请人提供)：邻里环境与邻里居民的心理健康有关，包括非特定的心理困扰，青少年可能特别容易受到伤害。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。社区健康研究通常会模拟社区的时间点暴露，而不是了解社区暴露的轨迹，而且对少数民族、贫困的青春期女孩所处的具体环境没有给予足够的关注。我们的研究建议对5个城市使用第8条代金券自愿搬迁社区的社会实验数据进行二次分析，以测试随机分配搬到低贫困社区的提议如何以及为什么在4-7年期间改善女性青春期的心理困扰。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。随机化是确定因果关系的黄金标准，MTO是唯一可用的大规模研究，它随机分配个人接受不同的邻里环境。然而，以前的MTO分析并没有完全整合对青春期女性发展的理论理解来激励实证分析。之前的分析也没有探究社区为什么会减少女孩的心理痛苦，是否某些亚群比其他群体更有可能从社区搬迁中受益，或者是否存在重要的发展敏感期，在这些时期，社区被剥夺可能会对十几岁女孩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：在青春期女孩中，测试搬到低贫困社区与心理痛苦之间的联系是否通过社区特征、家庭背景或个人危险行为来中介；目标2：检验搬到低贫困社区对青春期女孩心理痛苦的影响是否会被基线健康状况或其他家庭或青少年的脆弱性所修正；目标3：比较不同的暴露于社区贫困的时间或顺序模式对青少年痛苦的重要性。该项目将利用一个跨学科的调查团队，包括社会流行病学、人口学/社会学、心理发展心理学、精神病学流行病学和统计学等领域。这个项目将利用MTO实验设计，应用流行病学中很少使用的创新方法来理解因果关系和中介(工具变量分析)，并探索如何通过因果方法来模拟时变的邻里暴露(结构嵌套模型)，以帮助我们理解青少年的幸福发展过程。由于严格的实验设计，该项目可以提供强有力的证据，证明像第8条住房代金券这样的社会政策可以通过解决心理健康的上游决定因素，如基于地点的剥夺，来改善人口健康。 公共卫生相关性：该项目的结果，利用住房搬迁的社会实验，有可能为文献提供信息，说明为什么社区环境是青春期女孩心理痛苦的原因，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最有益。这一知识将为下一代干预措施和政策提供信息，以确保所有女孩都能从社区搬迁中受益，和/或为社区改善干预措施提供信息，并最终减少妇女的痛苦。

DESCRIPTION (provided by applicant): Neighborhood context is associated with the mental health of neighborhood residents, including non-specific psychological distress, and adolescents may be especially vulnerable. 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, adolescent girls. Our study proposes a secondary analysis of data from a social experiment of voluntary neighborhood relocation using Section 8 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 improves female adolescent psychological distress over a 4-7 year period. We will complement the existing data with additional neighborhood-level data collection to enrich the dataset. Randomization is the gold standard for establishing causation and MTO is the only available large-scale study that has randomly assigned individuals to receive different neighborhood contexts. Yet prior MTO analyses have not fully integrated theoretical understanding of female adolescent development to motivate the empirical analyses. Nor have prior analyses probed why neighborhoods reduce the psychological distress of girls, whether certain subgroups are more likely to benefit than others from the neighborhood relocation, or whether there are important developmentally-sensitive periods when exposure to neighborhood deprivation may be especially influential on the mental health of teenage girls. Our project proposes 3 aims: Aim 1: To test, among adolescent girls, whether the association between moving to a low-poverty neighborhood and psychological distress is mediated by neighborhood characteristics, family context, or individual risky behavior; Aim 2: To examine whether the effect of moving to a low-poverty neighborhood on psychological distress among adolescent girls is modified by baseline health status, or other family or adolescent vulnerability; Aim 3: To compare the importance of alternative timing or sequencing patterns of exposure to neighborhood poverty on adolescent distress. The project will leverage an interdisciplinary team of investigators, including fields of social epidemiology, demography/sociology, develop- mental psychology, psychiatric epidemiology, and statistics. This project will capitalize on the MTO experimental design, to apply innovative methods infrequently used in epidemiology to understand causation and mediation (instrumental variable analysis), and to explore how causal methods to model time-varying neighborhood exposures (structural nested models) can inform our understanding of developmental processes for adolescent well-being. Because of the rigorous experimental design, this project can provide strong evidence on the mechanisms by which social policies like Section 8 housing vouchers may improve population health by addressing upstream determinants of mental health such as place-based deprivation. PUBLIC HEALTH RELEVANCE: 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 psychological distress in adolescent girls, including probing more specificity on when and for how long living in low-poverty neighborhoods may be most beneficial for adolescents. This knowledge will inform the next generation of interventions and policies to ensure that all girls may benefit from neighborhood relocation, and/or to inform community improvement interventions, and ultimately reduce distress among women.