“I Was Scared over There.” Family Well-Being after Relocation from a Distressed Public Housing Development

By Frescoln, Kirstin; Nguyen, Mai Thi et al. | International Public Health Journal, April 1, 2017 | Go to article overview

“I Was Scared over There.” Family Well-Being after Relocation from a Distressed Public Housing Development


Frescoln, Kirstin, Nguyen, Mai Thi, Rohe, William, Webb, Michael, International Public Health Journal


Introduction

Adverse childhood experiences (ACE) such as abuse neglect, household dysfunction, and exposure to violence have been linked to poor behavioral decision-making and increased incidence of mental health diagnoses and chronic health conditions (1). Adverse experiences during childhood, which continue over a long period of time as opposed to single events or brief periods, may result in the development of toxic stress (1). Toxic stress occurs when the body's stress response system is activated over a long period of time. Children exposed to extreme poverty or hunger, repeated acts of violence, and abuse or neglect as a result of parental substance abuse and maternal depression experience chronic insecurity and fear resulting in toxic stress (1). The physiological responses to toxic stress causes the body to biologically embed these early adverse experiences and triggers the neuroendocrine, autonomic, metabolic, and immune systems to malfunction leading to an increased risk of early mortality (1).

While not specifically intended to address ACE or toxic stress, the Department of Housing and Urban Development's HOPE VI program delivered interventions that addressed both concerns. From 1993-2010, HOPE VI provided funding to local housing authorities to redevelop highly distressed public housing developments (2). During redevelopment, households could opt to relocate to another public housing development or to private-market housing with a Housing Choice Voucher (HCV) also known as Section 8. Many households - especially those relocating with a voucher - moved to higher-quality and safer neighborhoods, resulting in a reduction of ACE and improvements to health and well-being (3).

This paper explores how HOPE VI affects individual and family well-being when mothers with dependent children relocate from a highly distressed public housing development to better quality living environments. It adapts Shonkoffs framework of health disparities (4) to examine how the environment in which families live contributes to maternal health and well-being and how these, in turn, affect children's current and future well-being. We hypothesize that:

* Parents who report greater safety and neighborhood satisfaction post-relocation will report improved measures of well-being.

* Children will benefit from the move to better neighborhoods due to reductions in exposure to harmful environmental factors, increases in healthful factors, and improvements to maternal health and well-being.

We find that moving families away from a community marked by violent crime to new neighborhoods where families feel safer from violence and property crime had a significant impact on feelings of well-being.

In this paper, we explore how the socio-ecological environment in which individuals live affects their health and well-being either through increased exposure to stressors and risk, or protections from these potential harms. We then examine how housing mobility interventions may serve to remove households from many of the environmental risks associated with reductions in health and well-being. Finally, we discuss how HOPE VI, which combines mobility and support services interventions, seeks to address the socio-ecological environments of highly vulnerable public housing residents by moving the household from distressed public housing developments to better living conditions while providing up to five years of community support services to improve household economic mobility. Our study of the Charlotte Boulevard Homes HOPE VI project is used to illustrate how HOPE VI aims to intervene in the cycle of environmental health disparities experienced by children and adults living in distressed public housing. Finally, we recommend how policy makers can intervene in the cycle of health disparities and improve overall well-being by providing services to address the social determinants of health.

Neighborhood effects on well-being

We begin with a brief introduction to well-being. …

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