Affordable HOME Study: Housing Mobility and Health Behaviors Earle C. Chambers, PhD, MPH Assistant Professor of Family and Social Medicine Tobacco Think Tank-December 14, 2010

Gautreaux Assisted Housing Program ( ) –The Gautreaux Assisted Housing Program was created as a result of a series of class-action law suits filed against the Chicago Housing Authority (CHA) and the U.S. Department of Housing and Urban Development (HUD), beginning in The suits alleged that the housing authority deliberately segregated African American families through its tenant selection and site selection policies while HUD continued to fund such civil rights violations. Chicago Housing AuthorityAfrican American –The purpose of the program was to remedy past segregation by offering interested members of the plaintiff class, made up of African American residents of CHA public housing and those on the waiting list, an opportunity to find housing in desegregated areas throughout the metropolitan region.public housing –The Gautreaux program gives low-income blacks housing vouchers to move to many different kinds of communities, including white middle-income suburbs and low-income black city neighborhoods.

Moving-to-Opportunity Demonstration ( ) –The U.S. Department of Housing and Urban Development (HUD) launched the Moving to Opportunity (MTO) demonstration in 1994 in five cities: Baltimore, Boston, Chicago, Los Angeles, and New York. MTO targeted families living in some of the nation’s poorest, highest-crime communities and used housing subsidies to offer them a chance to move to lower-poverty neighborhoods. –MTO families (n=4608) were required to use their vouchers in census tracts with poverty rates below 10 percent. –Eligibility was limited to very low-income families with children who live in public housing or Section 8 project-based housing located in central city neighborhoods with high concentrations of poverty.

Moving To Opportunities Demonstration MTO experimental group receives Section 8 rental certificates or vouchers usable only in low-poverty areas (census tracts with less than 10 percent of the population below the poverty line in 1989), along with counseling and assistance in finding a private unit to lease Section 8 comparison group receives regular Section 8 rental certificates or vouchers (geographically unrestricted) and the typical briefings and assistance from the PHA; and In-place control group continues to receive their current project-based assistance.

Results of Note –Adult obesity was significantly lower among those who moved. –MTO parents (who are mostly single mothers) and adolescent girls (age 12 to 19) had significant improvements in mental health, including reductions in psychological distress and depression (Orr et al. 2003). Boys, however, don’t benefit from mobility. –Hispanic families were less likely than black families to move successfully (Shroder 2003).

Investigator Team Principal Investigators –Earle Chambers Ph.D, MPH (Einstein) –Emily Rosenbaum Ph.D (Fordham University) MacArthur Foundation Award –Three years (01/ /2012)

Specific Aim Examine whether those using (a) section 8 housing vouchers are more likely to purchase healthy foods and engage in more physical activity than those living in –(b) public housing project; or –(c) private market

Study Objectives Community outreach Recruitment

Recruitment Areas Community Districts 1-7 Claremont-Bathgate Bedford Park-Fordham Belmont East Concourse- Concourse Village East Tremont Highbridge Hunts Point Kingsbridge Heights Longwood Melrose South-Mott Haven north Morrisania-Melrose University Heights-Morris Heights Mott Haven Fordham South Mount Hope Norwood West Concourse Crotona Park east

Participant Eligibility Latino Age: Bronx resident eligible for low-income housing assistance and living in: –Section 8 –Public housing –Private Market

Sample size 330 participants in each of the three groups: those in public housing (PH), those in Section 8 (S8) and those in private-market units (PM). If we assume that we’ll have a 65% response rate, then our target number for each group is 615 (400/.65).

Data collection 192 item questionnaire Clinical assessment

Paperless Data Collection Maintain confidentiality Reduce potential for loss of data Reduce errors and time/money in transfer of data between survey and database

Measures Screening for eligibility (age, ethnicity, income, housing type) Household roster Housing information (quality, satisfaction, crowding) Neighborhood (walkability, crime, food options, social cohesion/networks) Demographics Health (self rated, heart attack, asthma, diabetes, cancer, stroke, medication use, HTN, depression (CES-D), mobility, sleep, trait anxiety (Spielberger), smoking, alcohol) Anthropometrics Body fat (BIA scale) Blood Pressure Food Inventory (dairy, condiments, vegetables, fruits (frozen v. fresh v. caned), proteins, snack foods, beverages) Acculturation (language, social networks) Racism Energy Expenditure (accelerometer - 7 days) Physical Activity/ Sedentary behaviors Income and Benefits Tracking

Related projects Spatial Syntax Study (R21 October 2010) Child study-Asthma Epigenomics study