Neighborhoods, Obesity and Diabetes- A Randomized Social Experiment

Abstract Purpose: To study if neighborhood environments contribute directly to the development of diabetes From 1994 through 1998, the Department of Housing and Urban Development (HUD) studied 4498 women with children living in high poverty areas (more than 40% had incomes below federal poverty threshold)

Cont… The question of whether neighborhood environment contributes directly to the development of obesity and diabetes remains unresolved. study uses data from a social experiment to assess the association of randomly assigned variation in neighborhood conditions with obesity and diabetes.

Many studies have shown that neighborhood attributes such poverty and racial segregation are associated with increased risks of obesity and diabetes. In response, the U.S. surgeon general has called for efforts to "create neighborhood communities that are focused on healthy nutrition and regular physical activity, where the healthiest choices are accessible for all citizens.'"

Introduction

Methods Families assigned to one of three groups: Group 1: received housing vouchers if they moved to a lower poverty area w/ counseling on moving Group 2: received unrestricted housing vouchers w/ no counseling Group 3: control that was offered no opportunities

Methods Cont… Families took part in a survey about 13 years after randomization HUD engaged in health follow ups with one adult from from each family from Low poverty vouchers (Group 1) and control group (Group 3) Measures of obesity were determined by BMI (30+) Diabetes measured by glycated hemoglobin levels sing a auto-retractable finger stick (6.5%+) HUD tracked participant’s addresses from baseline to beginning of long-term follow up

Auto retractable finger stick

Results

Conclusion Participants that moved from a neighborhood with a high level of poverty to one with a lower level of poverty was associated with reductions in the prevalence of extreme obesity and diabetes Adults who spent more time in lower-poverty census tracts had greater improvements in diabetes and BMI outcomes Outcomes not involving health suggested that changes in the neighborhood environment, rather than the act of moving itself, are responsible for these effects Low-poverty vouchers and traditional vouchers had different associations with neighborhood attributes that may affect health

Strengths Large number of subjects Continuous collection of physical measurements for health outcomes Participants volunteered Wider range of neighborhoods than is usual for epidemiologic studies The increase in U.S. residential segregation according to income in recent decades suggests that a larger proportion of the population is being exposed to distressed neighborhood environments

Weaknesses BMI is not an accurate measure of obesity, doesn’t take into account body structure, muscle mass and body fat percentages Most women in the study were unmarried and either black or Hispanic