Adverse neighborhood contexts predict poor mental health and externalizing behavior among adolescents, and the vast racial inequalities in neighborhood environment may play an important role in creating and maintaining racial disparities in health. 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, adolescents. Our study proposes a secondary analysis of data from a social experiment of voluntary neighborhood relocation using Section 8 Housing 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 unexpectedly adversely affected behavioral problems for boys over a 4-7 year period, and to inform the program's opposite gender effects on mental health. We will complement the existing data with additional neighborhood-level data collection to enrich the dataset. MTO is the only available large- scale study that has randomly assigned individuals to receive different neighborhood contexts, to support strong causal inferences of how neighborhoods shape mental health. Yet prior MTO analyses have not integrated theoretical understanding of adolescent development to motivate empirical analyses. Nor have prior analyses probed why neighborhood context may increase behavioral problems of boys, whether certain subgroups are more likely to be affected than others by neighborhood relocation, or whether there are important developmentally-sensitive periods when exposure to neighborhood deprivation may be especially influential on youth mental health. Our project proposes 3 aims:
Aim 1 : To test whether effects of moving to a low-poverty neighborhood on behavioral problems for boys are mediated by neighborhood characteristics, family context, or substance use.
Aim 2 : To examine, separately among boys and girls, whether the effect of moving to a low-poverty neighborhood on behavioral problems is modified by baseline health status, family/adolescent vulnerability, or program site.
Aim 3 : To compare the importance of alternative timing or sequencing patterns of exposure to neighborhood poverty on behavioral problems among boys. The project will leverage an interdisciplinary team of investigators, including fields of social epidemiology, psychiatric epidemiology, developmental psychology, demography, public policy, statistics, medicine. This project will capitalize on an experimental design, will innovatively apply causal methods to understand mediation, and will model time-varying neighborhood exposures, which will inform relevant early life course developmental timing of neighborhood exposure periods for adolescent well-being. Because of the rigorous experimental design, this project can provide strong policy-relevant evidence on the mechanisms by which social policies like Section 8 housing vouchers may influence population health and mental health.

Public Health Relevance

Neighborhood context may be an important cause of health disparities, especially taking into account risks which accumulate early in life. 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 behavioral problems among adolescents, including probing more specificity on when and for how long living in low-poverty neighborhoods may be most influential for affecting adolescent mental health. This knowledge will inform the next generation of interventions and policies to ensure that adolescents are not harmed by rental assistance policies;results from the experimental design will inform causal pathways and potential intervention points by which to reduce the population burden of mental health and subsequent health disparities.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project (R01)
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Special Emphasis Panel (ZMD1-PA (08))
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Alvidrez, Jennifer L
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Northeastern University
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United States
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Rudolph, Kara E; Schmidt, Nicole M; Glymour, M Maria et al. (2018) Composition or Context: Using Transportability to Understand Drivers of Site Differences in a Large-scale Housing Experiment. Epidemiology 29:199-206
Rudolph, Kara E; Sofrygin, Oleg; Schmidt, Nicole M et al. (2018) Mediation of Neighborhood Effects on Adolescent Substance Use by the School and Peer Environments. Epidemiology 29:590-598
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Schmidt, Nicole M; Glymour, M Maria; Osypuk, Theresa L (2017) Housing mobility and adolescent mental health: The role of substance use, social networks, and family mental health in the Moving to Opportunity Study. SSM Popul Health 3:318-325
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Glymour, M Maria; Rudolph, Kara E (2016) Causal inference challenges in social epidemiology: Bias, specificity, and imagination. Soc Sci Med 166:258-265
Nguyen, Quynh C; Rehkopf, David H; Schmidt, Nicole M et al. (2016) Heterogeneous Effects of Housing Vouchers on the Mental Health of US Adolescents. Am J Public Health 106:755-62
Glymour, M Maria; Nguyen, Quynh C; Matsouaka, Roland et al. (2016) Does Mother Know Best? Treatment Adherence as a Function of Anticipated Treatment Benefit. Epidemiology 27:265-75

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