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Original Investigation |

Associations of Housing Mobility Interventions for Children in High-Poverty Neighborhoods With Subsequent Mental Disorders During Adolescence

Ronald C. Kessler, PhD1; Greg J. Duncan, PhD2; Lisa A. Gennetian, PhD3; Lawrence F. Katz, PhD3,4; Jeffrey R. Kling, PhD3,5; Nancy A. Sampson, BA1; Lisa Sanbonmatsu, PhD3; Alan M. Zaslavsky, PhD1; Jens Ludwig, PhD3,6
[+] Author Affiliations
1Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
2School of Education, University of California Irvine, Irvine
3National Bureau of Economic Research, Cambridge, Massachusetts
4Department of Economics, Harvard University, Cambridge, Massachusetts
5Congressional Budget Office, Washington, DC
6Harris School of Public Policy, University of Chicago, Chicago, Illinois
JAMA. 2014;311(9):937-948. doi:10.1001/jama.2014.607.
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Importance  Youth in high-poverty neighborhoods have high rates of emotional problems. Understanding neighborhood influences on mental health is crucial for designing neighborhood-level interventions.

Objective  To perform an exploratory analysis of associations between housing mobility interventions for children in high-poverty neighborhoods and subsequent mental disorders during adolescence.

Design, Setting, and Participants  The Moving to Opportunity Demonstration from 1994 to 1998 randomized 4604 volunteer public housing families with 3689 children in high-poverty neighborhoods into 1 of 2 housing mobility intervention groups (a low-poverty voucher group vs a traditional voucher group) or a control group. The low-poverty voucher group (n=1430) received vouchers to move to low-poverty neighborhoods with enhanced mobility counseling. The traditional voucher group (n=1081) received geographically unrestricted vouchers. Controls (n=1178) received no intervention. Follow-up evaluation was performed 10 to 15 years later (June 2008-April 2010) with participants aged 13 to 19 years (0-8 years at randomization). Response rates were 86.9% to 92.9%.

Main Outcomes and Measures  Presence of mental disorders from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) within the past 12 months, including major depressive disorder, panic disorder, posttraumatic stress disorder (PTSD), oppositional-defiant disorder, intermittent explosive disorder, and conduct disorder, as assessed post hoc with a validated diagnostic interview.

Results  Of the 3689 adolescents randomized, 2872 were interviewed (1407 boys and 1465 girls). Compared with the control group, boys in the low-poverty voucher group had significantly increased rates of major depression (7.1% vs 3.5%; odds ratio (OR), 2.2 [95% CI, 1.2-3.9]), PTSD (6.2% vs 1.9%; OR, 3.4 [95% CI, 1.6-7.4]), and conduct disorder (6.4% vs 2.1%; OR, 3.1 [95% CI, 1.7-5.8]). Boys in the traditional voucher group had increased rates of PTSD compared with the control group (4.9% vs 1.9%, OR, 2.7 [95% CI, 1.2-5.8]). However, compared with the control group, girls in the traditional voucher group had decreased rates of major depression (6.5% vs 10.9%; OR, 0.6 [95% CI, 0.3-0.9]) and conduct disorder (0.3% vs 2.9%; OR, 0.1 [95% CI, 0.0-0.4]).

Conclusions and Relevance  Interventions to encourage moving out of high-poverty neighborhoods were associated with increased rates of depression, PTSD, and conduct disorder among boys and reduced rates of depression and conduct disorder among girls. Better understanding of interactions among individual, family, and neighborhood risk factors is needed to guide future public housing policy changes.

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Study Flow of the Moving to Opportunity Long-term Follow-up Evaluation of Adolescents

aTarget respondents for the adolescent long-term evaluation included all baseline residents of randomized households who were aged 0 through 8 years at randomization from 1994 to 1998, aged 13 through 17 years at selection in December 2007, and aged 13 through 19 years at interview from June 2008 to April 2010. All adolescents in the eligible age range who lived at baseline in households containing 3 or fewer youth between 10 and 20 years were targeted for follow-up, whereas a random 3 were targeted from baseline households with 4 or more youth. A weight of n/3, for which n equals the number of eligible youths in the baseline household, was used to adjust for the undersampling of youths from baseline households containing more than 3 eligible youth. Phase 1 data collection refers to the efforts made to contact and interview all target respondents until the end of the field period, at which point a random 35% of eligible target respondents (those who had not yet been interviewed, were not deceased or incapacitated, had not declined to participate) were selected for a more intensive Phase 2 data collection effort that included expanded tracing efforts and increased financial incentives. A weight of 1/.35 was used to adjust for the undersampling of the Phase 2 hard-to-recruit youths who were interviewed.bFor the 693 families excluded before randomization, the number excluded for each reason listed above is not known.

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