142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

315227
Public housing relocations and relocaters' health: Post-relocation improvements in neighborhood conditions are associated with reductions in depressive symptoms, substance misuse, and biobehavioral HIV risk in a cohort of African-American adults

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 12:50 PM - 1:10 PM

Hannah LF Cooper, ScD, SM , Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA
Sabriya Linton, PhD, MPH , Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA
Danielle Haley , Emory, Atlanta, GA
Josalin Hunter-Jones, MSW, MPH , Department of Behavioral Sciences and Health Education, Emory University, Rollins School of Public Health, Atlanta, GA
Mary Kelley, PhD , Department of Biostatistics and Bioinformatics, Rollins School of Public Health at Emory University, Atlanta, GA
Conny Karnes, MA , Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA
Zev Ross , ZevRoss Spatial Analytics, Ithaca, NY
Carlos del Rio, MD , Department of Global Health, Emory University, Atlanta, GA
Adaora A. Adimora, MD, MPH , Division of Infectious Diseases, University of North Carolina-Chapel Hill, Chapel Hill, NC
Gina Wingood, ScD, MPH , Department of Behavioral Sciences & Health Education, Emory University Rollins School of Public Health, Atlanta, GA
Richard Rothenberg, MD, MPH , Institute of Public Health, Georgia State University, Atlanta, GA
Loida Bonney, MD, MPH , Division of General Medicine, Emory University School of Medicine, Atlanta, GA
Emily F. Dauria, MPH, PhD Candidate , Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
Background: The US is experiencing a major shift in public housing policies: while early policies sought to spatially concentrate recipients of housing subsidies into housing complexes, recent policies seek to disperse these households, often to voucher-subsidized rental units scattered across the city. These initiatives tend to move residents to neighborhoods that are less poor and less violent. Despite the scope of this policy shift (e.g., 50,000 people were relocated in Atlanta, Georgia), few studies have explored the health impacts of these relocations. We summarize the results of a longitudinal, multilevel study of the relationships between post-relocation changes in exposure to neighborhood characteristics and changes in (a) depressive symptoms, (b) substance misuse, and (c) biobehavioral HIV risk in a cohort of African-American adult relocaters in Atlanta; by design, most participants misused substances at baseline. Notably, this is among the first studies of place and health among adults that utilizes a multilevel longitudinal design.

Methods: Baseline data were collected from 172 public housing residents before relocations began; post-relocation data were collected every 9 months thereafter, generating four waves of data spanning 2009-2012. We tested participants’ urine for Chlamydia, Gonorrhea, and Trichomoniasis using PCR methods. Depressive symptoms, sexual risk behaviors (e.g., concurrency), and substance misuse (e.g., dependence) were ascertained at each wave via survey. Administrative data were analyzed to describe the census tracts where participants lived (e.g., poverty rates, alcohol outlet density) at each wave. Multilevel models were used to analyze relationships between post-relocation changes in neighborhood characteristics and each outcome.

 

Results: Participants experienced improvements in all tract-level conditions between baseline and Wave 2 (the first post-relocation assessment); improvements were sustained thereafter. Participants who experienced greater improvements in tract-level economic conditions had fewer depressive symptoms and “risky” sex partners, and had reduced odds of recent binge drinking and illegal drug use; reduced alcohol outlet density predicted reduced odds of binge drinking. Participants who moved to tracts with more equitable sex ratios were less likely to test positive for an STI.

Discussion: This policy shift represents an innovative approach to reducing neighborhood-level HIV vulnerability. Findings can inform future housing and public health policies.

Learning Areas:

Epidemiology
Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
Explain how public housing relocations in Atlanta (Georgia) altered adult relocaters' exposure to local socioeconomic conditions, social disorder, and sex ratios. Describe the relationships between post-relocation changes in these place-based exposures to a range of health outcomes among relocaters, including depressive symptoms, substance misuse, and sexually-transmitted infections.

Keyword(s): Geographic Information Systems (GIS), Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was PI on this study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.