Neighborhoods, Obesity, and Diabetes – A Randomized Social Experiment

Study Questions:

Do neighborhood environments affect development of obesity and diabetes?

Methods:

From 1994 to 1998, the Department of Housing and Urban Development randomly assigned 4,498 women and children living in public housing to one of three groups (receipt of housing vouchers valid only of a low-poverty census tract [<10% of residents were poor]) and counseling on moving; receipt of unrestricted traditional vouchers; and a control group which received no vouchers). All subjects had been living in census tracts within high poverty areas defined as 40% or more of residents having incomes below the federal poverty threshold. Follow-up was conducted from 2008 to 2010. Outcomes included height, weight, and glycated hemoglobin (HgA1c) levels.

Results:

A total of 1,788 women received the vouchers redeemable for a low poverty area, 1,312 women received traditional vouchers, and 1,398 women were assigned to the control group. Data on body mass index (BMI) were obtained for 84.2% of participants. Data on HgA1c were obtained for 71.3% of participants. Response rates were similar for the three groups. Prevalence of BMI ≥35 kg/m2, BMI of ≥40 kg/m2, or HgA1c of ≥6.5% was lower for those receiving the low-poverty vouchers compared to the control group, with an absolute difference of -4.61% (95% confidence interval [CI], -8.5 to -0.69) for BMI ≥35 kg/m2; -3.38% (95% CI, -6.39 to -0.36) for BMI ≥40 kg/m2; and -4.31% (95% CI, -7.82 to -0.80) for HgA1c ≥6.5%. There was no significant difference between the group receiving traditional vouchers and the control group.

Conclusions:

The authors concluded that opportunities to move from a neighborhood with a high poverty level to one with a low poverty level were associated with a lower prevalence of obesity and diabetes. Future research is needed to understand the mechanisms underlying such associations.

Perspective:

This study provides data on associations between neighborhood and health outcomes, which are of significant public health concern. The intervention examined here suggests that reducing high poverty neighborhoods may improve overall health, with reductions in diabetes and obesity.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement

Keywords: Follow-Up Studies, Counseling, Poverty Areas, Residence Characteristics, Hemoglobin A, Glycosylated, Child, Prevalence, Body Mass Index, Censuses, Cardiovascular Diseases, Obesity, Environment, Confidence Intervals, Public Housing, Diabetes Mellitus


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