Effects of a neighborhood experiment on adolescent female psychological distress

描述（由申请人提供）：邻里环境与邻里居民的心理健康有关，包括非特异性心理困扰，青少年可能特别脆弱。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。邻里健康研究通常对邻里的时间点暴露进行建模，而不是了解邻里暴露轨迹，并且对少数民族，贫困，青春期女孩的具体情况关注不够。我们的研究提出了一个二次分析的数据，从一个社会实验的自愿邻里搬迁使用第8节搬迁者在5个城市（移动到机会，MTO，研究），以测试如何以及为什么随机分配的报价移动到一个低贫困社区改善女性青少年的心理困扰超过4 - 7年的时间。我们将补充现有的数据与额外的邻里水平的数据收集，以丰富数据集。随机化是建立因果关系的黄金标准，而MTO是唯一一个随机分配个体接受不同邻里环境的大规模研究。然而，以往的MTO分析没有充分整合女性青少年发展的理论理解，以激励实证分析。先前的分析也没有探讨为什么邻里减少女孩的心理困扰，是否某些亚群比其他人更有可能从邻里搬迁中受益，或者是否有重要的发展敏感期，当暴露于邻里剥夺时，可能对十几岁的女孩的心理健康特别有影响。我们的项目提出了3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;目标2：为了检验搬到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的影响，或其他家庭或青少年的脆弱性;目标3：比较暴露于邻里贫困的替代时间或顺序模式对青少年苦恼的重要性。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，发展心理学，精神病学和统计学领域。该项目将利用MTO实验设计，应用流行病学中不常使用的创新方法来理解因果关系和中介（工具变量分析），并探索因果方法如何模拟随时间变化的邻里暴露（结构嵌套模型）可以告知我们对青少年健康发展过程的理解。由于严格的实验设计，该项目可以提供强有力的证据，说明社会政策（如第8条住房券）可以通过解决精神健康的上游决定因素（如基于场所的剥夺）来改善人口健康的机制。 公共卫生相关性：这个项目的结果，利用住房搬迁的社会实验，有可能告知文献为什么邻里环境是青春期女孩心理困扰的原因，包括探索更多的具体时间和多久生活在低贫困社区可能是最有益的青少年。这些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邻里搬迁中受益，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.