Arcaya Mariana C, Subramanian S V, Rhodes Jean E, Waters Mary C
Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA 02139;
Department of Psychology, University of Massachusetts, Boston, MA 02125; and.
Proc Natl Acad Sci U S A. 2014 Nov 18;111(46):16246-53. doi: 10.1073/pnas.1416950111. Epub 2014 Oct 20.
In contrast to a large literature investigating neighborhood effects on health, few studies have examined health as a determinant of neighborhood attainment. However, the sorting of individuals into neighborhoods by health status is a substantively important process for multiple policy sectors. We use prospectively collected data on 569 poor, predominantly African American Hurricane Katrina survivors to examine the extent to which health problems predicted subsequent neighborhood poverty. Our outcome of interest was participants' 2009-2010 census tract poverty rate. Participants were coded as having a health problem at baseline (2003-2004) if they self-reported a diagnosis of asthma, high blood pressure, diabetes, high cholesterol, heart problems, or any other physical health problems not listed, or complained of back pain, migraines, or digestive problems at baseline. Although health problems were not associated with neighborhood poverty at baseline, those with baseline health problems ended up living in higher poverty areas by 2009-2010. Differences persisted after adjustment for personal characteristics, baseline neighborhood poverty, hurricane exposure, and residence in the New Orleans metropolitan area, with baseline health problems predicting a 3.4 percentage point higher neighborhood poverty rate (95% confidence interval: 1.41, 5.47). Results suggest that better health was protective against later neighborhood deprivation in a highly mobile, socially vulnerable population. Researchers should consider reciprocal associations between health and neighborhoods when estimating and interpreting neighborhood effects on health. Understanding whether and how poor health impedes poverty deconcentration efforts may help inform programs and policies designed to help low-income families move to--and stay in--higher opportunity neighborhoods.
与大量研究邻里环境对健康影响的文献形成对比的是，很少有研究将健康视为邻里环境形成的一个决定因素。然而，根据健康状况将个体分类到不同邻里环境中，这一过程对多个政策部门而言具有重要意义。我们使用前瞻性收集的569名贫困的、主要为非裔美国人的卡特里娜飓风幸存者的数据，来检验健康问题在多大程度上预测了随后邻里环境的贫困状况。我们感兴趣的结果是参与者在2009 - 2010年的人口普查区贫困率。如果参与者在基线期（2003 - 2004年）自我报告诊断患有哮喘、高血压、糖尿病、高胆固醇、心脏问题或任何其他未列出的身体健康问题，或者抱怨有背痛、偏头痛或消化问题，那么他们在基线期被编码为有健康问题。尽管在基线期健康问题与邻里环境贫困无关，但到2009 - 2010年，那些在基线期有健康问题的人最终生活在贫困程度更高的地区。在对个人特征、基线邻里环境贫困、飓风暴露情况以及在新奥尔良大都市区的居住情况进行调整后，差异依然存在，基线期的健康问题预测邻里环境贫困率高出3.4个百分点（95%置信区间：1.41，5.47）。结果表明，在一个流动性高、社会脆弱的人群中，更好的健康状况能预防后期邻里环境的贫困。研究人员在估计和解释邻里环境对健康的影响时，应考虑健康与邻里环境之间的相互关系。了解健康状况不佳是否以及如何阻碍贫困分散化努力，可能有助于为旨在帮助低收入家庭搬到并留在机会更多的邻里环境中的项目和政策提供信息。
