Neighborhoods, Obesity, and Diabetes — A Randomized Social Experiment
By Jens Ludwig, L. Sanbonmatsu, L. Gennetian, E. Adam, G. Duncan, Lawrence F. Katz, Ronald C. Kessler, Jeffrey R. Kling, S. Lindau, R. Whitaker and 1 more. New England Journal of Medicine, 2011
921 citations recorded by the source corpus.
BACKGROUND The question of whether neighborhood environment contributes directly to the development of obesity and diabetes remains unresolved. The study reported on here uses data from a social experiment to assess the association of randomly assigned variation in neighborhood conditions with obesity and diabetes. METHODS From 1994 through 1998, the Department of Housing and Urban Development (HUD) randomly assigned 4498 women with children living in public housing in high-poverty urban census tracts (in which ≥40% of residents had incomes below the federal poverty threshold) to one of three groups: 1788 were assigned to receive housing vouchers, which were redeemable only if they moved to a low-poverty census tract (where <10% of residents were poor), and counseling on moving; 1312 were assigned to receive unrestricted, traditional vouchers, with no special counseling on moving; and 1398 were assigned to a control group that was offered neither of these opportunities. From 2008 through 2010, as part of a long-term follow-up survey, we measured data indicating health outcomes, including height, weight, and level of glycated hemoglobin (HbA1c). RESULTS As part of our long-term survey, we obtained data on body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) for 84.2% of participants and data on glycated hemoglobin level for 71.3% of participants. Response rates were similar across randomized groups. The prevalences of a BMI of 35 or more, a BMI of 40 or more, and a glycated hemoglobin level of 6.5% or more were lower in the group receiving the low-poverty vouchers than in the control group, with an absolute difference of 4.61 percentage points (95% confidence interval [CI], −8.54 to −0.69), 3.38 percentage points (95% CI, −6.39 to −0.36), and 4.31 percentage points (95% CI, −7.82 to −0.80), respectively. The differences between the group receiving traditional vouchers and the control group were not significant. CONCLUSIONS The opportunity to move from a neighborhood with a high level of poverty to one with a lower level of poverty was associated with modest but potentially important reductions in the prevalence of extreme obesity and diabetes. The mechanisms underlying these associations remain unclear but warrant further investigation, given their potential to guide the design of community-level interventions intended to improve health. (Funded by HUD and others.)
Subfields: Health, Public Health, Environmental and Occupational Health, Transportation
View Paper: https://www.semanticscholar.org/paper/d2caea4ef2c858feaad142ef68a15b20efeaa12c
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Citations in the corpus
- Social Determinants of Health and Diabetes: A Scientific Review (2020, neutral): “tract would have on multiple outcomes (102,103).”
- Long-Term Neighborhood Effects on Low-Income Families: Evidence from Moving to Opportunity (2013, neutral): “Evidence on “neighborhood effects” is of growing relevance because neighborhood residential segregation by income has been increasing in the United States since 1970 even beyond the amount expected from rising income inequality alone (Reardon and Bischoff 2011).”
- The Impact of Housing Assistance on Child Outcomes: Evidence from a Randomized Housing Lottery (2015, methodology): “(2011) and Ludwig et al. (2011, 2012). Similar issues are addressed by Rubinowitz and Rosenbaum (2000), Oreopoulos (2003), Sampson, Sharkey, and Raudenbush (2008), and Schwartz (2012).”
- Food Deserts and the Causes of Nutritional Inequality* (2019, background): “For example, Bitler and Haider (2011) discuss how zoning restrictions, crime, and other factors could raise costs for grocers in low-income areas, and results from the Moving To Opportunity experiment suggest that moving to lower-poverty neighborhoods reduces obesity (Kling, Liebman, and Katz, 2007;”
- The Production of Human Capital in Developed Countries: Evidence from 196 Randomized Field Experiments (2016, positive): “…impact parent’s economic outcomes, but they did significantly and persistently improve key aspects of mother’s (adult female’s) mental and physical health including substantial reductions in psychological distress, extreme obesity, and diabetes (Ludwig et al. 2011; Sanbonmatsu et al. 2011).”
- Neighborhood Socioeconomic Disadvantage and 30 Day Rehospitalizations: An Analysis of Medicare Data (2014, background): “In addition, important health indicators improve with moving persons to areas of less concentrated poverty (23, 24).”
- Spatial Foundations of Inequality: A Conceptual Model and Empirical Overview (2017, background): “…2007; DeLuca et al. 2010), public housing revitalization programs (Jacob 2004; Clampet- Lundquist 2007), assignment to public housing waiting lists (Ludwig et al. 2011), inclusionary zoning mandates (Schwartz 2010; Casciano and Massey 2012), combined assisted housing- education programs (Tach et…”
- Best (but oft-forgotten) practices: the multiple problems of multiplicity-whether and how to correct for many statistical tests. (2015, background): “For example, the Moving to Opportunity project (28) was an RCT that evaluated the effect of neighborhood on the development of obesity and diabetes.”