title: Role of health in predicting moves to poor neighborhoods among Hurricane Katrina survivors.
abstract: In contrast to a large literature investigating neighborhood effects on health, few studies have examined health as a determinant of neighborhood attainment. However, the sorting of individuals into neighborhoods by health status is a substantively important process for multiple policy sectors. We use prospectively collected data on 569 poor, predominantly African American Hurricane Katrina survivors to examine the extent to which health problems predicted subsequent neighborhood poverty. Our outcome of interest was participants' 2009-2010 census tract poverty rate. Participants were coded as having a health problem at baseline (2003-2004) if they self-reported a diagnosis of asthma, high blood pressure, diabetes, high cholesterol, heart problems, or any other physical health problems not listed, or complained of back pain, migraines, or digestive problems at baseline. Although health problems were not associated with neighborhood poverty at baseline, those with baseline health problems ended up living in higher poverty areas by 2009-2010. Differences persisted after adjustment for personal characteristics, baseline neighborhood poverty, hurricane exposure, and residence in the New Orleans metropolitan area, with baseline health problems predicting a 3.4 percentage point higher neighborhood poverty rate (95% confidence interval: 1.41, 5.47). Results suggest that better health was protective against later neighborhood deprivation in a highly mobile, socially vulnerable population. Researchers should consider reciprocal associations between health and neighborhoods when estimating and interpreting neighborhood effects on health. Understanding whether and how poor health impedes poverty deconcentration efforts may help inform programs and policies designed to help low-income families move to--and stay in--higher opportunity neighborhoods.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA 02139;
authors.forename: Mariana C
authors.initials: MC
authors.lastname: Arcaya
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA 02139;
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.affiliation: Department of Psychology, University of Massachusetts, Boston, MA 02125; and.
authors.forename: Jean E
authors.initials: JE
authors.lastname: Rhodes
authors.affiliation: Department of Sociology, Harvard University, Cambridge, MA 02138 mcw@wjh.harvard.edu.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Waters
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology; D002755:Choice Behavior; D055867:Cyclonic Storms; D004190:Disasters / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008962:Models, Theoretical; D055820:New Orleans; D010290:Parents / Q000523:psychology; D011204:Poverty Areas; D011446:Prospective Studies; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data; D014505:Urban Population; D035862:Vulnerable Populations; D044465:White People / Q000523:psychology; D055815:Young Adult
keywords: disaster; health; migration; neighborhood; selection