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

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.