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标题：The Effect of Neighborhood Socioeconomic Status on Education and Health Outcomes for Children Living in Social Housing
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作者：Patricia J. Martens ; Daniel G. Chateau ; Elaine M. J. Burland 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2014
卷号：104
期号：11
页码：2103-2113
DOI：10.2105/AJPH.2014.302133
语种：English
出版社：American Public Health Association
摘要：Objectives. We explored differences in health and education outcomes between children living in social housing and not, and effects of social housing’s neighborhood socioeconomic status. Methods. In this cohort study, we used the population-based repository of administrative data at the Manitoba Centre for Health Policy. We included children aged 0 to 19 years in Winnipeg, Manitoba, in fiscal years 2006–2007 to 2008–2009 (n = 13 238 social housing; n = 174 017 others). We examined 5 outcomes: age-2 complete immunization, a school-readiness measure, adolescent pregnancy (ages 15–19 years), grade-9 completion, and high-school completion. Logistic regression and generalized estimating equation modeling generated rates. We derived neighborhood income quintiles (Q1 lowest, Q5 highest) from average household income census data. Results. Children in social housing fared worse than comparative children within each neighborhood income quintile. When we compared children in social housing by quintile, preschool indicators (immunization and school readiness) were similar, but adolescent outcomes (grade-9 and high-school completion, adolescent pregnancy) were better in Q3 to Q5. Conclusions. Children in social housing had poorer health and education outcomes than all others, but living in social housing in wealthier areas was associated with better adolescent outcomes. Adequate housing is a critical determinant of health. Social housing (also known as public housing) is an important aspect of public policy, the purpose being to provide quality housing at affordable rents to individuals and families who could not otherwise afford this. In the province of Manitoba, Canada, social housing residents pay approximately one quarter of their income for rent. In 2009, there were approximately 13 000 social housing units, accommodating 31 000 Manitobans, nearly 50% of whom were younger than 20 years. 1 Because children constitute almost half the residents in social housing, it is important to investigate children’s health and education outcomes when one is exploring the impact of social housing. Is living in social housing associated with differential outcomes compared with not living in social housing? Does placement of the social housing unit itself, in wealthier or poorer neighborhoods, have an additional effect? A study of the provincial capital city, Winnipeg, is an ideal setting to answer these questions. Social housing units are distributed throughout Winnipeg’s neighborhoods ranging from low to high socioeconomic status (SES) based on average household income ( Figure 1 ). Open in a separate window FIGURE 1— Placement of social housing units in Winnipeg, by 72 Community Centre Areas and neighborhood income quintiles (2006 census data). Note . Neighborhood income quintile groupings of the Community Centre Areas are from lowest (Q1) to highest (Q5) income quintile. Many studies show associations between area-level SES and child health or education outcomes, such that the wealthier the area, the better the outcomes. 2–6 Studies around the world have shown an independent effect of neighborhood SES on child and adolescent educational outcomes, even after they controlled for family, peer, and school effects. 4,7–18 However, some studies contradict this, finding nonsignificant or trivial effects of neighborhood. 19–23 A review by Leventhal et al. 8 reinforces the importance of neighborhood SES effect on adolescent development, with those living in higher socioeconomic areas showing more positive results in educational achievement and behavioral and emotional outcomes, and less risky sexual activity (including reductions in adolescent pregnancy). The authors describe conceptual models relating this advantage to institutional resources, norms, and collective efficacy of neighborhoods, and relationships. But they also identify a weakness in most studies to date—people have a choice where they live, so some low-SES families may choose to live in a higher-SES area because of motivation, which may also influence outcomes. The strength of our study is that we controlled for this effect by researching those living in social housing where choice is limited because of allocation methods and high occupancy rates; thus, although families are given choice as to neighborhood when filling out an application, Manitoba Housing may not be able to accommodate applicants with their first location of preference because of the size of the unit required. As well, population-based analyses possible by using administrative databases housed at the Manitoba Centre for Health Policy allow for analyses of all children, not just those agreeing to primary data collection. There are mixed results in the literature concerning social housing and health or educational outcomes. The Moving to Opportunity study found limited effects in reading and mathematics scores 4 to 7 years after families were given the opportunity to move from social housing to private dwellings in a higher-SES area. 24 One limitation was that few families moved to a high-SES area; rather, most families moved to a “less poor” area where the school’s ranking was similar to the school in the families’ area of origin. As well, during the 4 to 7 years following, most families resided in a substantially less affluent neighborhood compared with their first move in the Moving to Opportunity study, whereas control families often moved to a more affluent area from their original neighborhood. Other evaluations of Moving to Opportunity found lower psychological distress for female youths and better adolescent male achievement scores among the intervention group. 25,26 The earlier Gautreaux Study in 1976 found that when families in Chicago, Illinois, received vouchers to move from low- to higher-SES neighborhoods, children were 4 times less likely to drop out of high school. 27,28 A more recent Chicago study by Burdick-Will et al., involving randomized allocation of housing vouchers, found a significant increase in mathematics and verbal skills when families relocated to higher-SES areas. 5 Jacob studied the effect of offering private housing vouchers for those involved in a social housing demolition in Chicago, compared with those in the same complex whose social housing was not being demolished. 29 They found no effect on educational outcomes of children, and concluded that social housing did not bestow an independent effect above and beyond neighborhood SES. However, the social housing residents mostly moved to similar-SES neighborhoods. All of these studies revolve around individual families leaving social housing and going into private housing by using voucher programs. None of the literature examined the effect of social housing itself, and the effect of surrounding neighborhood SES on those living in social housing. We examined the effect of living in social housing on health and educational outcomes of children. We specifically addressed the following: 1. Are there differences in the health and education outcomes of children living in social housing versus those who do not? 2. Is there an effect of area-level SES on health and education outcomes of children, both in social housing and not? 3. After adjustment for family poverty and other confounders, is there a relationship between placement of social housing in wealthier or poorer neighborhoods and the health and education outcomes of children living in social housing?