Context
Extensive observational evidence indicates youth in high-poverty neighborhoods exhibit poor mental health, although not all children may be affected similarly.
Objective
To use experimental evidence to assess whether gender and family health problems modify mental health effects of moving from high- to low-poverty neighborhoods.
Design, Setting, Participants
The Moving to Opportunity Study, a randomized controlled trial, enrolled volunteer low-income families in public housing in 5 U.S. cities from 1994–1997. We analyze 4–7 year outcomes among youth aged 12–19 (n=2829, 89% effective response rate).
Intervention
Families were randomized to control (remaining in public housing) or experimental (receiving government-funded rental subsidies to move into private apartments) groups. Intent-to-treat analyses included intervention interactions by gender and health vulnerability (defined as pre-randomization health/developmental limitations or disabilities among family members).
Outcome measures
Past-year psychological distress (K6), and Behavioral Problems Index (BPI). Supplemental analyses used past-year major depressive disorder (MDD).
Results
Male gender and family health vulnerability significantly adversely modified the intervention effect on K6 (gender: p=.02, health vulnerability: p=.002); male gender, but not health vulnerability, significantly adversely modified the intervention effect on BPI (gender: p=.01, health vulnerability: p=.17). Female adolescents without baseline health vulnerabilities were the only subgroup to benefit on any outcome (K6 (B= −0.21, 95% CI: (−0.34–−0.07), p=.003); MDD (Odds Ratio =0.42 (0.20–0.85) p=0.024). For male adolescents with health vulnerabilities, intervention was associated with worse K6 (B=.26, (0.09–0.44), p=.003) and BPI (B=.24 (0.09–0.40) p=.002). Neither females with health vulnerability, nor males without health vulnerability, experienced intervention benefits. Adherence-adjusted instrumental variable analysis found intervention effects twice as large. Patterns were similar for MDD but estimates were imprecise due to low prevalence.
Conclusions
Although some girls benefited, boys and adolescents from families with baseline health problems did not experience mental health benefits from housing mobility policies, and may need additional program supports.