Effects of a neighborhood experiment on adolescent female psychological distress

描述（由申请人提供）：社区环境与社区居民的心理健康有关，包括非特异性心理困扰，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，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，青春期女孩所处的特定环境的关注不足。我们的研究对5个城市使用第8节代金券自愿社区搬迁的社会实验数据进行了二次分析（the Moving to Opportunity， MTO, study），以检验在4-7年的时间里，随机分配一个迁往低贫困社区的提议如何以及为什么会改善女性青少年的心理困扰。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。随机化是建立因果关系的黄金标准，MTO是唯一一项随机分配个体接受不同社区环境的大规模研究。然而，以往的MTO分析并没有充分整合对女性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社区会减少女孩的心理困扰，是否某些亚群体比其他人更有可能从社区搬迁中受益，或者是否存在重要的发育敏感期，在这个时期，社区剥夺可能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，测试迁移到低贫困社区和心理困扰之间的关联是否由社区特征、家庭背景或个人风险行为介导；目的2：研究移居低贫困社区对青春期女孩心理困扰的影响是否会受到基线健康状况或其他家庭或青少年脆弱性的影响；目的3：比较暴露于社区贫困的不同时间或顺序模式对青少年痛苦的重要性。该项目将利用一个跨学科的调查小组，包括社会流行病学、人口学/社会学、发展心理心理学、精神流行病学和统计学领域。本项目将利用MTO实验设计，应用流行病学中不常用的创新方法来理解因果关系和中介（工具变量分析），并探索因果方法如何模拟时变邻里暴露（结构嵌套模型），从而为我们理解青少年福祉的发展过程提供信息。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条住房券这样的社会政策可以通过解决基于地方的剥夺等心理健康的上游决定因素来改善人口健康的机制。

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.