Study: Living in poor neighborhood can hurt health

AppId is over the quota
AppId is over the quota
Annie Ricks, 55, poses in her public housing apartment Wednesday, Oct. 19, 2011, in Chicago. Local housing authorities paid for her to relocate to the South Side last year as part of its demolition plans for high-rise tenements, but Ricks says her new neighborhood is worse. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing given a chance to live in more affluent neighborhoods had lower rates of diabetes and extreme obesity. Ricks was not part of the study, but says such efforts should be expanded. (AP Photo/M. Spencer Green) Annie Ricks, 55, poses in her public housing apartment Wednesday, Oct. 19, 2011, in Chicago. Local housing authorities paid for her to relocate to the South Side last year as part of its demolition plans for high-rise tenements, but Ricks says her new neighborhood is worse. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing given a chance to live in more affluent neighborhoods had lower rates of diabetes and extreme obesity. Ricks was not part of the study, but says such efforts should be expanded. (AP Photo/M. Spencer Green) Annie Ricks, 55, poses in her public housing apartment Wednesday, Oct. 19, 2011, in Chicago. Local housing authorities paid for her to relocate to the South Side last year as part of its demolition plans for high-rise tenements, but Ricks says her new neighborhood is worse. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing given a chance to live in more affluent neighborhoods had lower rates of diabetes and extreme obesity. Ricks was not part of the study, but says such efforts should be expanded. (AP Photo/M. Spencer Green) Vickie Webb poses for a photograph at her apartment in Durham, N.C., Wednesday, Oct. 19, 2011. Webb, 43, lived in the projects in Durham, N.C. for several years before a housing agency helped relocate her and her husband to a better neighborhood. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing a chance to live in more affluent neighborhoods. had lower rates of diabetes and extreme obesity. Webb was not part of the study. (AP Photo/Jim R. Bounds) Vickie Webb checks her blood pressure in her apartment in Durham, N.C., Wednesday, Oct. 19, 2011. Webb, 43, lived in the projects in Durham, N.C. for several years before a housing agency helped relocate her and her husband to a better neighborhood. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing a chance to live in more affluent neighborhoods. had lower rates of diabetes and extreme obesity. Webb was not part of the study. (AP Photo/Jim R. Bounds) Vickie Webb stands in the door way of her apartment after checking her blood pressure in Durham, N.C., Wednesday, Oct. 19, 2011. Webb, 43, lived in the projects in Durham, N.C. for several years before a housing agency helped relocate her and her husband to a better neighborhood. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing a chance to live in more affluent neighborhoods. had lower rates of diabetes and extreme obesity. Webb was not part of the study. (AP Photo/Jim R. Bounds)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); ATLANTA (AP) — Back in the 1990s, the federal government tried an unusual social experiment: It offered thousands of poor women in big-city public housing a chance to live in more affluent neighborhoods.

A decade later, the women who relocated had lower rates of diabetes and extreme obesity — differences that are being hailed as compelling evidence that where you live can determine your health.

The experiment was initially aimed at researching whether moving impoverished families to more prosperous areas could improve employment or schooling. But according to a study released Wednesday, the most interesting effect may have been on the women's physical condition.

About 16 percent of the women who moved had diabetes, compared with about 20 percent of women who stayed in public housing. And about 14 percent of those who left the projects were extremely obese, compared with nearly 18 percent of the other women.

The small-but-significant differences offered some of the strongest support yet for the idea that where you live can significantly affect your overall health, especially if your home is in a low-income area with few safe places to exercise, limited food options and meager medical services.

"This study proves that concentrated poverty is not only bad policy, it's bad for your health," Shaun Donovan, secretary of the Department of Housing and Urban Development.

But no one believes the deficit-plagued federal government is going to expand the program and start moving low-income women to better neighborhoods en masse.

"It's not enough to simply move families into different neighborhoods," Donovan said. Instead, new ways must be found to help families "break the cycle of poverty that can quite literally make them sick." He did not mention specific proposals.

Public health experts have long thought that living in poor neighborhoods could ruin a person's health, but this study put the idea to a rigorous test.

Here's how it worked: Women believed to be about the same in most respects were randomly assigned to one group or another and then followed through time, in a model customarily seen in pharmaceutical studies. That makes it more scientifically rigorous than most research linking health problems to a social environment.

The study's good design "provides a basis to infer cause and effect" between poverty and bad health, said Dr. Robert Califf, a noted Duke University cardiologist who is leading a massive study on neighborhoods and health outcomes.

The research was led by Jens Ludwig, a University of Chicago professor of public policy. It was published in Wednesday's New England Journal of Medicine.

The experiment started as a $70 million HUD project in Baltimore, Boston, Chicago, Los Angeles and New York. It morphed into a health study after a variety of other government agencies and private foundations pitched in with an additional $17 million more.

"In terms of scale, it's not soon or ever to be repeated," said Dr. Robert Whitaker, a Temple University pediatrician who was a study co-author.

The study involved women living in public housing in neighborhoods where 40 percent or more of residents were poor — areas like many of those on the South Side of Chicago or in the Bronx in New York City. The women all had children and were considered heads of households.

From 1994 to 1998, nearly 1,800 of them were offered vouchers to subsidize private housing, but the vouchers were only good in higher-income neighborhoods where fewer than 10 percent of the people were considered poor. They were required to live there at least a year.

The rest of the women were divided into two groups. One group got vouchers they could use in any neighborhood. The other women did not receive vouchers, with the expectation that they would stay put.

Ten years later, women in the study were weighed and gave a blood sample to check for diabetes.

The women who moved to richer areas had the lowest rates of extreme obesity and diabetes. The difference suggests that moving to a better neighborhood could help at least 1 in 25 women. Or, in other terms, a person's risk of diabetes or extreme obesity dropped by about 20 percent by moving to a higher-income neighborhood.

(However, even the women who moved were not exactly models of health. About 14 percent of them were extremely obese, which is twice the national average for women.)

The study has some notable flaws.

Because it did not start out looking at health, the women's medical condition and weight were not checked at the outset. The researchers believe the women in the different groups were about the same, because they matched up on more than 50 other indicators, such as age, race, employment and education. But that is an assumption.

Also, only about half the women offered a chance to move to a more prosperous zip code did so. And many who did move left after a year.

What's more, the study was not designed to answer what it is about more affluent neighborhoods that would cause someone to be healthier. But the authors listed four theories:

— The availability of healthier food is worse in lower-income neighborhoods.

— Opportunities for physical exercise are scarcer, and fear of crime can make people afraid to jog or play in parks.

— There may be fewer doctors' offices and other medical services.

— The long-term stress of living in such an environment may alter the hormones that control weight.

Some of those theories were supported by some women who live in the kind of situation targeted in the study.

Vickie Webb lived in the projects in Durham, N.C., for several years before a housing agency helped relocate her and her husband to a better neighborhood.

"There was too much violence, too much going on in the 'hood. It wasn't safe," said Webb, who was not part of the study.

Annie Ricks, who lives with her 14-year-old son and two grandchildren in a public housing unit on Chicago's South Side, was not involved in the study either. But she said efforts like the HUD experiment should be expanded.

Local housing authorities paid for her to relocate to the South Side last year as part of its demolition plans for high-rise tenements. But Ricks lost her child-care job after the move, and says her new neighborhood is worse.

At her old building, Ricks could walk across the street to a supermarket. In her new neighborhood, without a car, she has to take public transportation to get groceries or go to the doctor, and Ricks says there's more crime.

"I feel like it would be a blessing" to be able to move to a wealthier area, she said.

___

Associated Press writers Alicia Chang in Los Angeles and Lindsey Tanner in Chicago contributed to this report.

Associated Press

Technology

News

Read More

Study links neighborhood to obesity risk

AppId is over the quota
AppId is over the quota
Research has linked obesity to neighborhood features such as the number of supermarkets and fast-food restaurants.Rates of diabetes and severe obesity are about one-fifth lower in the women who movedFactors could contribute to better health in low-poverty areas, including healthy foodsJust 16% of the women who moved to low-poverty areas had diabetes

(Health.com) -- When federal housing officials created a program in the mid-1990s to help single-mother households in poor neighborhoods relocate to low-poverty areas, they weren't merely interested in providing access to better homes, jobs, and schools. They also wanted to study how the families who moved out changed over time compared to those who stayed put.

After more than a decade, moving from high- to low-poverty areas seems to have had little impact on economic measures such as employment and income. But researchers have discovered an interesting side effect of the program: In a new follow-up study published this week in the New England Journal of Medicine, they report that rates of diabetes and severe obesity are about one-fifth lower in the women who moved than in those who did not.

The apparent improvements in health associated with low-poverty areas are comparable to the typical outcomes seen with programs that encourage healthy eating or exercise, or that provide medications to people with diabetes, says Jens Ludwig, Ph.D., the lead author of the study and a professor of social service administration, law, and public policy at the University of Chicago.

"For this program, health improvements were not the primary goal," Ludwig says. "But the fact that we're seeing effects in the ballpark of what you'd get with very direct, targeted interventions designed for weight loss, for example, [is] pretty striking."

Health.com: 11 ways to save money on healthy food

Several factors could contribute to better health in low-poverty areas, including greater access to healthy foods, a safer environment more conducive to outdoor exercise, and lower levels of psychological stress, Ludwig says. The move "changed a bunch of things at one time for these families, so it's hard to tease out exactly what made a big difference for them," he says. "But all of these things seem like plausible explanations."

Troy Blanchard, Ph.D., an associate professor of sociology at Louisiana State University, in Baton Rouge, who studies health and obesity in poor rural areas, says the findings draw attention to an often-ignored aspect of the obesity and diabetes epidemics.

"Oftentimes, research really focuses on people's decisions, and what they do wrong, and how they are at fault, essentially, for being obese or having a disease or a poor diet," says Blanchard, who was not involved in the study. "This provides evidence that it's not just the individual's decisions, but...also the environment -- the neighborhood -- that really does matter."

Health.com: 10 states that consume too much fast food

The idea that neighborhoods can have an impact on health is not new. Studies on this topic date back to the 1700s, Ludwig points out, and more recently a growing body of research has linked obesity and other health problems to neighborhood features such as the number of supermarkets and fast-food restaurants. But this is the first time researchers have been able to compare moving out of a neighborhood with staying behind, in the same way that new drugs are compared with placebos in clinical trials.

The relocation program, known as Moving to Opportunity, began in 1994 when the U.S. Department of Housing and Urban Development partnered with local housing authorities to recruit low-income families living in public housing in Baltimore, Boston, Chicago, Los Angeles, and New York.

The families who volunteered for the program were sorted into three groups via random lottery: Some received vouchers that enabled them to move into areas with a low poverty rate (below 10%) at the same rent they were paying in public housing, some received vouchers that could be used anywhere, and some -- the control group -- received no new vouchers or assistance.

Years later, between 2008 and 2010, Ludwig and his colleagues followed up with 3,186 women who participated in the program. The researchers calculated each woman's body mass index, or BMI (a simple ratio of height to weight), and collected blood samples, which they tested for a type of protein that indicates average long-term levels of blood sugar.

Health.com: 10 signs and symptoms of type 2 diabetes

Of the women who stayed in their original neighborhoods, 20% had blood-sugar levels consistent with diabetes and 18% had a BMI of at least 40 (the unofficial cutoff point for morbid obesity). These rates were not measurably different among the women who received unrestricted vouchers. By contrast, just 16% of the women who moved to low-poverty areas had diabetes and just 14% were morbidly obese.

"We went in wondering to what degree a real randomized experiment would confirm -- or not confirm -- what a lot of people already believed," Ludwig says. "The most surprising thing was not that it did confirm the belief, but the significant size of the effect."

The study doesn't claim that moving from a high- to low-poverty area guarantees weight loss or protection from diabetes. The health measures used in the study weren't recorded before 2008, so the researchers weren't able to track how moving affected the health of individuals over time. In addition, all of the Moving to Opportunity participants were volunteers, raising the possibility that they differ in key ways from the average public housing resident. (The volunteers were more likely than their neighbors to be concerned about crime, for instance.)

Despite the study's limitations, Ludwig and his colleagues conclude that public health programs that target obesity and diabetes in high-poverty neighborhoods "could generate substantial social benefits." This message is important for policymakers and community organizers, but also for individuals living in these neighborhoods, Blanchard says.

"It shows that being active in your community and working to make safer, healthier environments can really affect the health of the people who live there," he says. "Not everyone can move out of their neighborhood, but maybe there's a chance to improve what's there."

Copyright Health Magazine 2010

Education Information

Technology

Read More

Study: Living in poor neighborhood can hurt health

AppId is over the quota
AppId is over the quota
Annie Ricks, 55, poses in her public housing apartment Wednesday, Oct. 19, 2011, in Chicago. Local housing authorities paid for her to relocate to the South Side last year as part of its demolition plans for high-rise tenements, but Ricks says her new neighborhood is worse. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing given a chance to live in more affluent neighborhoods had lower rates of diabetes and extreme obesity. Ricks was not part of the study, but says such efforts should be expanded. (AP Photo/M. Spencer Green) Annie Ricks, 55, poses in her public housing apartment Wednesday, Oct. 19, 2011, in Chicago. Local housing authorities paid for her to relocate to the South Side last year as part of its demolition plans for high-rise tenements, but Ricks says her new neighborhood is worse. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing given a chance to live in more affluent neighborhoods had lower rates of diabetes and extreme obesity. Ricks was not part of the study, but says such efforts should be expanded. (AP Photo/M. Spencer Green) Annie Ricks, 55, poses in her public housing apartment Wednesday, Oct. 19, 2011, in Chicago. Local housing authorities paid for her to relocate to the South Side last year as part of its demolition plans for high-rise tenements, but Ricks says her new neighborhood is worse. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing given a chance to live in more affluent neighborhoods had lower rates of diabetes and extreme obesity. Ricks was not part of the study, but says such efforts should be expanded. (AP Photo/M. Spencer Green) Vickie Webb poses for a photograph at her apartment in Durham, N.C., Wednesday, Oct. 19, 2011. Webb, 43, lived in the projects in Durham, N.C. for several years before a housing agency helped relocate her and her husband to a better neighborhood. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing a chance to live in more affluent neighborhoods. had lower rates of diabetes and extreme obesity. Webb was not part of the study. (AP Photo/Jim R. Bounds) Vickie Webb checks her blood pressure in her apartment in Durham, N.C., Wednesday, Oct. 19, 2011. Webb, 43, lived in the projects in Durham, N.C. for several years before a housing agency helped relocate her and her husband to a better neighborhood. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing a chance to live in more affluent neighborhoods. had lower rates of diabetes and extreme obesity. Webb was not part of the study. (AP Photo/Jim R. Bounds) Vickie Webb stands in the door way of her apartment after checking her blood pressure in Durham, N.C., Wednesday, Oct. 19, 2011. Webb, 43, lived in the projects in Durham, N.C. for several years before a housing agency helped relocate her and her husband to a better neighborhood. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing a chance to live in more affluent neighborhoods. had lower rates of diabetes and extreme obesity. Webb was not part of the study. (AP Photo/Jim R. Bounds)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); ATLANTA (AP) — Back in the 1990s, the federal government tried an unusual social experiment: It offered thousands of poor women in big-city public housing a chance to live in more affluent neighborhoods.

A decade later, the women who relocated had lower rates of diabetes and extreme obesity — differences that are being hailed as compelling evidence that where you live can determine your health.

The experiment was initially aimed at researching whether moving impoverished families to more prosperous areas could improve employment or schooling. But according to a study released Wednesday, the most interesting effect may have been on the women's physical condition.

About 16 percent of the women who moved had diabetes, compared with about 20 percent of women who stayed in public housing. And about 14 percent of those who left the projects were extremely obese, compared with nearly 18 percent of the other women.

The small-but-significant differences offered some of the strongest support yet for the idea that where you live can significantly affect your overall health, especially if your home is in a low-income area with few safe places to exercise, limited food options and meager medical services.

"This study proves that concentrated poverty is not only bad policy, it's bad for your health," Shaun Donovan, secretary of the Department of Housing and Urban Development.

But no one believes the deficit-plagued federal government is going to expand the program and start moving low-income women to better neighborhoods en masse.

"It's not enough to simply move families into different neighborhoods," Donovan said. Instead, new ways must be found to help families "break the cycle of poverty that can quite literally make them sick." He did not mention specific proposals.

Public health experts have long thought that living in poor neighborhoods could ruin a person's health, but this study put the idea to a rigorous test.

Here's how it worked: Women believed to be about the same in most respects were randomly assigned to one group or another and then followed through time, in a model customarily seen in pharmaceutical studies. That makes it more scientifically rigorous than most research linking health problems to a social environment.

The study's good design "provides a basis to infer cause and effect" between poverty and bad health, said Dr. Robert Califf, a noted Duke University cardiologist who is leading a massive study on neighborhoods and health outcomes.

The research was led by Jens Ludwig, a University of Chicago professor of public policy. It was published in Wednesday's New England Journal of Medicine.

The experiment started as a $70 million HUD project in Baltimore, Boston, Chicago, Los Angeles and New York. It morphed into a health study after a variety of other government agencies and private foundations pitched in with an additional $17 million more.

"In terms of scale, it's not soon or ever to be repeated," said Dr. Robert Whitaker, a Temple University pediatrician who was a study co-author.

The study involved women living in public housing in neighborhoods where 40 percent or more of residents were poor — areas like many of those on the South Side of Chicago or in the Bronx in New York City. The women all had children and were considered heads of households.

From 1994 to 1998, nearly 1,800 of them were offered vouchers to subsidize private housing, but the vouchers were only good in higher-income neighborhoods where fewer than 10 percent of the people were considered poor. They were required to live there at least a year.

The rest of the women were divided into two groups. One group got vouchers they could use in any neighborhood. The other women did not receive vouchers, with the expectation that they would stay put.

Ten years later, women in the study were weighed and gave a blood sample to check for diabetes.

The women who moved to richer areas had the lowest rates of extreme obesity and diabetes. The difference suggests that moving to a better neighborhood could help at least 1 in 25 women. Or, in other terms, a person's risk of diabetes or extreme obesity dropped by about 20 percent by moving to a higher-income neighborhood.

(However, even the women who moved were not exactly models of health. About 14 percent of them were extremely obese, which is twice the national average for women.)

The study has some notable flaws.

Because it did not start out looking at health, the women's medical condition and weight were not checked at the outset. The researchers believe the women in the different groups were about the same, because they matched up on more than 50 other indicators, such as age, race, employment and education. But that is an assumption.

Also, only about half the women offered a chance to move to a more prosperous zip code did so. And many who did move left after a year.

What's more, the study was not designed to answer what it is about more affluent neighborhoods that would cause someone to be healthier. But the authors listed four theories:

— The availability of healthier food is worse in lower-income neighborhoods.

— Opportunities for physical exercise are scarcer, and fear of crime can make people afraid to jog or play in parks.

— There may be fewer doctors' offices and other medical services.

— The long-term stress of living in such an environment may alter the hormones that control weight.

Some of those theories were supported by some women who live in the kind of situation targeted in the study.

Vickie Webb lived in the projects in Durham, N.C., for several years before a housing agency helped relocate her and her husband to a better neighborhood.

"There was too much violence, too much going on in the 'hood. It wasn't safe," said Webb, who was not part of the study.

Annie Ricks, who lives with her 14-year-old son and two grandchildren in a public housing unit on Chicago's South Side, was not involved in the study either. But she said efforts like the HUD experiment should be expanded.

Local housing authorities paid for her to relocate to the South Side last year as part of its demolition plans for high-rise tenements. But Ricks lost her child-care job after the move, and says her new neighborhood is worse.

At her old building, Ricks could walk across the street to a supermarket. In her new neighborhood, without a car, she has to take public transportation to get groceries or go to the doctor, and Ricks says there's more crime.

"I feel like it would be a blessing" to be able to move to a wealthier area, she said.

___

Associated Press writers Alicia Chang in Los Angeles and Lindsey Tanner in Chicago contributed to this report.

Associated Press

Technology

News

Read More