Targeting Health Disparities through Housing Redevelopment: A Natural Experiment of Housing Quality, Stability, and Economic Integration

通过住房重建消除健康差距：住房质量、稳定性和经济一体化的自然实验

• 批准号: 10296767
• 负责人: REBEKAH Levine COLEY
• 金额: $ 69.04万
• 依托单位: BOSTON COLLEGE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10296767
• 关键词: Address; Adult; Affect; Age; American; Boston; Characteristics; Child; Clinical; Communities; Complex; Control Groups; Crime; Data; Development; Disease; Economics; Effectiveness; Elderly; Emotional; Engineering; Environment; Environmental Exposure; Environmental Health; Equation; Ethnic Origin; Evidence based intervention; Funding; Gender; Glare; Health; Home; Household; Housing; Income; Individual; Inequality; Interview; Investments; Knowledge; Longevity; Longitudinal Studies; Measurement; Measures; Mediating; Mental Health; Methods; Modeling; Morbidity - disease rate; Natural experiment; Neighborhoods; Outcome; Pattern; Personal Satisfaction; Persons; Physiological; Policies; Pollution; Poverty; Process; Psychologist; Public Housing; Race; Research; Resources; Respondent; Social Problems; Social Workers; Sorting - Cell Movement; Source; Stress; Structure; Surveys; Techniques; Testing; arm; behavioral health; community based research; design; experience; health disparity; health economics; housing instability; improved; innovation; insight; knowledge base; longitudinal human study; mortality; neighborhood disadvantage; neighborhood safety; novel; physical conditioning; preservation; residence; response; service providers; social; social determinants; social health determinants; stressor; treatment effect

PROJECT SUMMARY/ABSTRACT Following decades of discriminatory policies and underinvestment in affordable housing, the 1.2 million households residing in our nation’s public housing (PH) developments often live in conditions of concentrated poverty, unhealthy and unstable housing and community contexts, and constrained social and economic opportunity. These social determinants of health drive substantial health disparities, with PH residents experiencing elevated levels of mortality and morbidity across numerous health domains. In response, current policy efforts seek to redevelop PH into mixed-income communities in order to deconcentrate poverty, create healthier housing environments, decrease community stressors, and enhance community resources. It is essential to delineate the repercussions of such policies on health disparities and to understand the mechanisms underlying effects. This project seeks to exploit a multi-arm natural experiment of PH redevelopment to evaluate whether improving housing quality, limiting external displacement, and creating mixed-income communities improve the physical, mental, and behavioral health of PH residents, including children, adults, and older adults. We will further assess the social, environmental, and physiological mechanisms underlying such effects. Finally, we will address whether effects vary across resident age, gender, and race/ethnicity. The study will employ a rigorous mixed-methods design to follow 1068 individuals from 600 households in a Boston PH community undergoing redevelopment. The redevelopment plan will move quasi-randomly selected subsets of residents into new high quality PH, or displace them offsite followed by a return into new high quality mixed-income housing. We will compare these residents to a matched control group who will remain in place. Our interdisciplinary team will collect four waves of in-person surveys, direct environmental assessments, and direct physiological stress measurements, as well as annual geocoded administrative data and intensive qualitative interviews with a subset of respondents. This innovative combination of sources will provide data on resident physical, mental and behavioral health; physiological stress; social connections and collective efficacy; housing quality and disorder; and neighborhood crime, pollution, social problems and resources. Intent-to-treat, difference-in-differences, and average treatment effect models will provide rigorous evidence of how housing quality, residential displacement, and residence in mixed-income housing affect resident health. Structural equation models and qualitative analyses will identify mechanisms underlying housing effects. Our results, unearthing causal and dynamic processes underlying health disparities, will provide innovative new data on social determinants of health to inform models of housing and community redevelopment in the context of concentrated poverty.

项目摘要/摘要 经过数十年的歧视性政策和负担得起的住房投资不足之后，120万 居住在我们国家公共住房（PH）发展的家庭通常生活在集中的条件下 贫穷，不健康和不稳定的住房和社区环境，并受到限制的社会和经济 机会。这些健康的社会决定者带来了巨大的健康差异，pH居民 众多健康领域的死亡率和发病率升高。作为响应，当前 政策努力旨在将pH开发为混合收入社区，以解散贫困，创造 更健康的住房环境，减少社区压力并增强社区资源。这是 描述此类政策对健康差异的影响并了解 基础效应的机制。 该项目旨在探索pH重建的多臂自然实验，以评估是否是否 提高住房质量，限制外部流离失所并创建混合收入社区改善 pH居民的身体，心理和行为健康，包括儿童，成人和老年人。我们将 进一步评估这种影响的基础的社会，环境和身体机制。最后，我们 将解决居民年龄，性别和种族/种族的影响是否有所不同。 该研究将采用严格的混合方法设计，跟随来自600个家庭的1068个人 波士顿pH社区正在进行重建。重建计划将移动准随机选择 居民的子集进入新的高质量pH值，或将其取代，然后将其归还新的高质量 混合收入住房。我们将将这些居民与匹配的对照组进行比较。 我们的跨学科团队将收集四波面对面调查，直接环境评估和 直接的身体压力测量以及年度地理编码的管理数据和密集的 与一部分受访者进行定性访谈。这种创新的来源组合将提供有关的数据 居民的身体，精神和行为健康；身体压力；社会联系和集体效率； 住房质量和混乱；以及邻里犯罪，污染，社会问题和资源。 意图对治疗，差异差异和平均治疗效果模型将提供严格的证据 混合收入住房中的住房质量，住宅流离失所和住所如何影响居民的健康。 结构方程模型和定性分析将确定住房效应的基础机制。我们的 结果是健康差异的基本因果和动态过程，将为创新的新 有关健康决定者的数据，以告知在本文中的住房和社区重建模型 集中贫困。