title: Health Selection into Neighborhoods Among Families in the Moving to Opportunity Program.
abstract: Moving to Opportunity for Fair Housing was a randomized experiment that moved very low-income US families from high-poverty neighborhoods to low-poverty neighborhoods starting in the early 1990s. We modeled report of a child's baseline health problem as a predictor of neighborhood outcomes for households randomly assigned to move from high- to low-poverty neighborhoods. We explored associations between baseline health problems and odds of moving with the program upon randomization (1994-1997), neighborhood poverty rate at follow-up (2002), and total time spent in affluent neighborhoods and duration-weighted poverty. Among 1,550 households randomized to low-poverty neighborhoods, a smaller share of households reporting baseline child health problems (P = 0.004) took up the intervention (38%) than those not reporting a health problem (50%). In weighted and covariate-adjusted models, a child health problem predicted nearly 40% lower odds of complying with the experimental condition (odds ratio = 0.62, 95% confidence interval: 0.42, 0.91; P = 0.015). Among compliers, a baseline child health problem predicted 2.5 percentage points' higher neighborhood poverty at take-up (95% confidence interval: 0.90, 4.07; P = 0.002). We conclude that child health problems in a household prior to randomization predicted lower likelihood of using the program voucher to move to a low-poverty neighborhood within the experiment's low-poverty treatment arm and predicted selection into poorer neighborhoods among experimental compliers. Child morbidity may constrain families attempting to improve their life circumstances.
authors.forename: Mariana C
authors.initials: MC
authors.lastname: Arcaya
authors.forename: Corina
authors.initials: C
authors.lastname: Graif
authors.forename: Mary C
authors.initials: MC
authors.lastname: Waters
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
mesh_terms: D000328:Adult; D002648:Child; D005192:Family Health / Q000706:statistics & numerical data*; D005260:Female; D006078:Government Programs / Q000706:statistics & numerical data*; D006798:Housing / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data*; D011204:Poverty Areas; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D014481:United States
keywords: Moving to Opportunity; children; health; neighborhoods; poverty; residential mobility; selection