Gender, Neighborhood Context,

and Youth Development

PD&R Expert Convenings

Summary Report

August 2014

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Summary Report

Gender, Neighborhood Context,

and Youth Development

Prepared for:

U.S. Department of Housing

and Urban Development

Washington, D.C.

August 2014

The contents of this report are the views of the authors/participants and do not necessarily reflect the views or policies of the U.S. Department of Housing and Urban Development or the U.S. government.

Gender, Neighborhood Context, and Youth Development

Message From The Assistant Secretary

In the early 1990s, HUD initiated the Moving to Opportunity for Fair Housing (MTO) demonstration. HUD designed MTO to test whether offering housing vouchers to inner-city families living in public housing projects in high-poverty neighborhoods could improve their lives and the lives of their children by helping them move to lower-poverty neighborhoods. The original authorizing legislation for MTO charged HUD with describing “the long-term housing, employment, and educational achievements of the families assisted under the demonstration program.”

Between 1994 and 1998, MTO randomly assigned families to one of three groups: (1) the experimental group, which allowed families to use the voucher only in low-poverty neighborhoods; (2) the Section 8 group, which allowed the families to use the voucher in any neighborhood; and (3) the control group, which did not receive vouchers. HUD tracked and interviewed the families through 2010 and issued its final report in 2011.

Thanks to the generous support of other federal government agencies and private foundations, the scope of study of MTO families was expanded to include a number of outcome domains beyond those under HUD’s charge, most notably physical and mental health. MTO

has been further studied and featured in several academic journals, including, but not limited to, the New England Journal of Medicine, Science, and Cityscape.

In March 2014, MTO was the focus of an article published in the Journal of the American Medical Association. The study used MTO data to show that relocating to low-poverty neighborhoods affects the mental health of poor youth in surprising ways, including stark differences in the outcomes for boys compared with those for girls.

To better understand these findings and their potential policy implications, PD&R used its new Expert Convening Tool in June 2014

to bring together some of the leading researchers who have studied MTO, neighborhood context, psychology, and child and youth development. We held a half-day convening that provided an overview of the JAMA study, asked panelists if the findings were consistent with their own research, discussed the near-term implications for policy, and examined what future research is needed in the area. The discussions were both valuable and enriching.

This report summarizes the convening’s discussion. I want to thank all of our esteemed panelists for joining us as well as the HUD

employees who participated. Our hope is that the conversation does not end here; that this convening is just a first step in the larger discussion of how HUD’s programs can affect neighborhood context and lead to positive outcomes for children, youth, and families.

Katherine M. O’ Regan

Assistant Secretary for Policy Development

and Research

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Gender, Neighborhood Context, and Youth Development

Introduction

On June 10, 2014, HUD’s Office of Policy Development and Research (PD&R) convened a panel of experts to discuss the role of gender in shaping the impact of neighborhood context on youth development. The convening was motivated by studies that found puzzling differences in the effects of the Moving to Opportunity for Fair Housing (MTO) demonstration program on boys and girls. In particular, a recent study published in the Journal of the American Medical Association (JAMA) analyzing the outcomes of MTO found that girls and boys from MTO families were affected very differently when they moved from high- to low-poverty neighborhoods. The study found reduced rates of mental health problems among girls who moved out of high-poverty neighborhoods and increased rates of depression, posttraumatic stress disorder (PTSD), and conduct disorder among boys who did the same. HUD convened the panel to draw on the expertise of the study’s authors and other researchers to better understand the gender differences in the MTO outcomes, how policymakers should think about the role of gender in neighborhood effects, and how HUD programs should relate to them. Experts on the panel discussed the findings of the JAMA study, the near-term policy implications, and research needed to clarify issues related to this topic.

The MTO Demonstration Program

Mark Shroder, Associate Deputy Assistant Secretary for Research Evaluation and Monitoring at PD&R, opened the discussion with a presentation on MTO and its evaluation results. HUD’s MTO demonstration program was a randomized housing mobility experiment designed to study the effects on families of moving from high-poverty neighborhoods to low-poverty, opportunity-rich neighborhoods.1

Between 1994 and 1998, 4,608 very low-income families with children living in public or private assisted housing projects located in high-poverty neighborhoods in 5 cities — Baltimore, Boston, Chicago, Los Angeles, and New York — were randomly assigned to 3

groups. Families in the experimental group received housing choice vouchers (HCVs) to be used in tracts with less than 10 percent poverty and received mobility counseling. Families in the Section 8 group received HCVs but no counseling, and the control group did not receive any assistance as part of the program. The MTO families were tracked using administrative data, surveys of parents and children living at home, blood tests, educational achievement tests, and various open-ended and observational ethnographic studies.

A final evaluation of MTO in 2011 showed that the program effectively reduced the level of neighborhood poverty in which families lived.2 The control group lived in communities of 40 percent poverty, on average, over 15 years, and the experimental group and the Section 8 group lived in areas of 20 percent and 29 percent poverty, respectively. All MTO groups lived in predominantly African American communities, suggesting that the mobility program was less effective at exposing MTO participants to communities with different racial and ethnic compositions. Some surprising findings from the evaluation included positive health outcomes for mothers, a lack of impact on employment and other financial metrics, and divergent mental health effects for adolescent boys and girls.

JAMA Study Overview

Ron Kessler, the McNeil Family Professor of Health Care Policy at Harvard Medical School and coauthor of the JAMA study, provided an overview of the study and his perspective on the findings as a starting point for a broader discussion on existing research, policy implications, and avenues for advancing future research on neighborhood context and gender.

n The JAMA study, which focused on children who were zero to eight years old when MTO participants were randomized and in their teens at the time of the long-term followup, found that MTO interventions were associated with positive mental health effects for girls and negative effects for boys. Compared with the control group, boys in the experimental or low-poverty voucher group were found to have higher rates of PTSD, major depression, and conduct disorder. Girls in the experimental group had lower rates of depression and conduct disorder than did girls in the control group.3

n These divergent outcomes could be linked to the different ways neighborhood residents react to boys compared with girls when they move into their new communities. Another potential explanation is the difference in the way boys and girls respond to their new environment or deal with a threatening situation. Where girls may be more prone to adapting, boys may be more likely to act in a rebellious manner.

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n The outcomes underscore the need for policymakers to recognize the complexity and interconnectedness of different risk factors and service interventions.

q Although housing may be identified as the primary intervention, adding supplemental interventions can help address this complex issue.

q Boys and girls may need different kinds of supports, and there may be a way to create and package multifaceted interventions that address the needs of both.

q Combining interventions in a way that addresses both housing and mental health issues may divert agencies such as HUD

away from their core purposes.

Panelists’ Responses

Panelists were asked to respond to the JAMA study’s findings. They spoke about whether the findings were consistent with their own research as well as the potential causes of these divergent outcomes.

Response to Findings

n Panelists noted that the results of the JAMA study are not surprising and are consistent with much of the existing research on MTO.

n The difference in social behaviors and norms for boys may explain some of the outcomes. Girls were found to spend more time in or near their homes, whereas boys were out on the street more often. This difference may also contribute to the different relationships the two groups have with community members.

n The true impact of neighborhood context on mental health outcomes needs to be better understood. The panelists emphasized that many of the individuals involved in the study did not remain in low-poverty neighborhoods. In some cases the poverty level in the neighborhoods changed; in other cases, MTO families moved back to high-poverty areas.

Additional MTO Research

n Qualitative research using MTO final evaluation survey data by Popkin et al. captured the gender-specific neighborhood phenomenon of coercive sexual environments. Research findings suggest that “neighborhood sexual context—specifical y, less harassment, violence, and pressure for early sexual initiation—in lower poverty neighborhoods may be a significant part of the explanation for why girls benefited so much from moves to these neighborhoods.”4

n Several studies of MTO adolescents (aged 5 to 15 at baseline and 12 to 19 in 2002) examined the effects of MTO on continuous measures of mental health included in the survey for the MTO interim report. The low-poverty and traditional voucher groups were found to have the same patterns of effects on mental health outcomes compared with controls, so these analyses combined the two voucher groups to compare them with the control group. The findings from this earlier cohort of adolescents were, on average, consistent with those of the JAMA study, suggesting that MTO had a positive impact on mental health outcomes for girls and a negative impact on boys. The studies also sought to test whether family baseline vulnerability led to differences in how MTO participation affected mental health — in other words, whether MTO’s effects on mental health would differ if families had a baseline vulnerability. Vulnerability was measured based on health indicators, including violent victimization and health-related or developmental problems at baseline, as well as socioeconomic status. The researchers also conducted instrumental variable models to understand the effect of leasing up on the vulnerability findings. The researchers found that the beneficial effects of MTO on girls’ mental health accrued primarily to girls who came from families without health vulnerabilities, whereas girls with baseline health vulnerabilities derived few if any mental health benefits from the MTO program. Although boys in the experimental group, on average, experienced more harmful effects on mental health than did those in the control group, these negative effects were concentrated mostly among boys with vulnerabilities at baseline.

Lease-up differences did not account for the differential effects of MTO treatment on mental health outcomes, which were different by family vulnerability. It was not the case that the more vulnerable families failed to lease up, and even when they did lease up, children in these families had worse mental health outcomes as a result of their participation in MTO compared with the nonvulnerable families.

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Although the effects of MTO on adolescent mental health were different by baseline health and violent crime related victimization, there were no differences in program effects on adolescent mental health by socioeconomic status. The findings suggest the need for intersectoral solutions and additional supports for families — and particularly for boys — who move, especial y those with health or developmental vulnerabilities.5

n One study used qualitative methods to understand the surprises from the interim MTO report. Researchers relied on interviews with boys in the experimental and control groups to understand the difference between relationships with agents of informal social control, such as neighbors, and formal social control, such as the police. The study also sought to understand how moving back to high-poverty neighborhoods affected boys in the experimental group. This analysis found that boys in the experimental group were less aware of the social dynamics and landscape necessary to stay out of danger than were boys in the control group who never left.6

n Other research challenges the findings from the interim reports on MTO by matching cases that made it into both evaluations.

Researchers found that the earlier findings could not be replicated, suggesting response bias.

n Another study analyzed data from the five-year MTO evaluation to understand the effects on boys and girls of staying in low-poverty neighborhoods for extended periods (defined as five years or more). The analyses, based on propensity score methods, did not reveal the negative behavioral effects for boys found in other MTO research, suggesting that environmental stability has an impact on boys.7

Non-MTO Research

n The Housing Opportunity and Services Together Demonstration, or HOST, provides intensive wraparound services and case manage-ment to vulnerable families in distressed public housing in four cities. Promoting Adolescent Sexual Health and Safety is an initiative developed for one of the four sites — the Benning Terrace public housing development in Washington, DC — that is designed to test interventions that promote adolescent sexual health and safety, including education on gender norms, self-esteem, and self-efficacy.8

n The Project on Human Development in Chicago Neighborhoods offers a counterpoint to MTO as a place-based look at changes in neighborhoods and poverty levels. The project examined those who stayed and would be affected by neighborhood change. The study showed that any type of neighborhood change, especial y in low- and moderate-poverty neighborhoods, is harmful for boys.9

n Another study unrelated to MTO found that neighborhood affluence poses both risks and benefits for boys, but the risks outweigh the benefits. Girls, by contrast, benefit more from such affluence.

n A study to understand how housing and neighborhoods affect adolescents’ behavior found that housing quality affects girls more than boys, but neighborhood disorder affects boys more than girls. This difference may be the result of the previously mentioned differences between boys and girls in their choice of leisure activities, amount of time spent at home, and gender roles.10

n Another study focused exclusively on males that examined progression of their lives and family relationships (based on life history interviews) uncovered findings on how men deal with space, suggesting that they tend to carve out spaces that they feel safe in, even in the most dangerous neighborhoods. The interviewees had a mental map of where they could safely move to escape gang activity and police presence, and they were leery of leaving these “safe” areas, even to visit their children, based on past experiences and fear of past conflicts. They were also aware of where it was safe to travel based on the time of day. Even moving to a low-poverty neighborhood created stress among the men in the study. Many of the men recounted spending much of their late teens and 20s in a period of transition during which they were “couch surfing.” During this time, these men were developing their identities, much like their peers in college, although they were dealing with different issues. The research also found that having traumatic experiences, such as witnessing and surviving violence, caused the men to disengage social y.11

Policy Implications

The panelists were asked to discuss the policy implications of mobility programs and whether such programs were harmful to young men.

n Mobility programs without support services might harm the mental health of some adolescents. It is important to note that young men are dealing with a complex set of issues and this mobility component may just be compounding existing fundamental problems.

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To have positive effects on boys, mobility programs need to be paired with other services.

n Mobility is destabilizing for some families, who would benefit more from having services brought to them.

n Different interventions work best for different individuals, so policymakers should employ various approaches to meet these different needs.

n Policymakers have implemented a number of mobility programs, but they have not been rigorously evaluated, particularly not for their effects on participants’ health. Different sites throughout the United States vary in the amount and quality of health and mental health services offered and service referrals. Administering implementation reviews and evaluations is necessary to understand the impact of services provided. The Special Mobility Housing Choice Voucher Program in Baltimore was cited as an example of a mobility program

with services and a review process.

n Although researchers and policymakers need to determine how to adjust mobility programs to help boys, they should also acknowl-edge the benefits these programs have for girls. Also, evidence exists that some boys in low-poverty neighborhoods are developing well and avoiding traumatic experiences.

n Services need to be identified and created to help boys better acclimate to and become more accepted in their new communities.

Additional services should address substance abuse and crime prevention.

n More education is needed on services that are available to help men transition to adulthood and independence.

n The focus on mobility will need to move away from MTO to begin to understand what can be done within the voucher program.

q Some jurisdictions are using practices such as term limiting to administer their voucher programs.

n Agencies could include criteria on how to find an opportunity neighborhood.

q Brandeis University recently launched Diversitydatakids.org, an online opportunity index for children that uses health as one of the indicators to understand other locational outcomes.

n Agencies should develop policies that lengthen voucher periods and expedite waiting lists for families who would benefit from HCVs or housing mobility programs.

n A recent study found that place-based work also has a negative effect on boys, suggesting that change of any sort has negative implications.

n In addition, the one-strike rule for eviction from public housing is vague and can cause tension within families; as a result, teenage boys may be forced out of their homes by families fearful of being evicted.

New Research Directions

The panelists were asked to discuss ideas for new research directions that would clarify the ways mobility programs affect boys and girls.

The experts discussed methods for understanding and analyzing complex issues without the use of a major demonstration program such as MTO.

n It is important to identify methods for integrating experimentation and practice. The use of an actuarial capturing of existing data sources to make rational analyses would provide more detail to what is known now. An abundance of institutional data exists that spans years and could il ustrate long-term trends. Over time, researchers will be able to use advances in data gathering methods to analyze issues in real time.

n New records and data need to be collected to learn the different ways that governments nationwide implement the HCV program.

These efforts should focus on how effectively government agencies are affirmatively furthering fair housing, including whether voucher holders are educated on where and how to use the vouchers and whether the agencies offer linkages to additional services, including mental health services.

n It is also important to identify ways to combine data across different existing studies using meta-analysis to better understand housing mobility.

n The term “choice” needs to be questioned when discussing housing choice. Researchers and policymakers need to understand how those receiving the services and programs feel about them. Although quantitative data are helpful, hearing from those involved in the PD&R Expert Convenings

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program provides the qualitative data needed to understand what they mean.

n Another area of research that should be further explored is the impact of early life interventions on childhood development.

n HUD’s expert convenings are another way to shape thinking about these issues and ways to advance research.

Broader Discussion

Following the conversation on needed research, panelists answered several questions from attendees about integrating services for all ages in a mobility program, changing institutions such as schools to better serve youth, encouraging relationships with positive male role models, and understanding the role of violence.

Integrated services

n In programs that combine services and mobility programs, pairing services for adults and children can be difficult. Although the needed services for adults are easy to identify, tailoring services for children — especial y boys — is more challenging because of the range in ages and the variety of issues they face.

n It is important to ask why housing is not included in the recently announced My Brother’s Keeper initiative. Fluidity of residence significantly affects young men’s personal stability and their effectiveness as parents. Housing needs to be incorporated into the services offered to young men.

Schools

n Within schools, there are examples of counselors or staff that challenge students and remain committed to their success. Developing a mentor program would help create a more positive school environment and help students adjust to their new surroundings.

n Although students in low-income areas have somewhat better access to school options and mobility, there is little outreach to teach parents how to exercise their options in finding and helping their kids attend better schools.

n More research is needed to understand how schools manage developmental and behavioral problems, especial y because boys are being expelled from school for these reasons.

Mentors

n In many neighborhoods, boys turn to older males who know how to take care of themselves on the street. Boys also often develop mentor relationships with uncles and older brothers.

n The absence of their fathers plays out throughout these men’s lives. Many young men meet their fathers for the first time when they are in their 20s, and they value these relationships and learn from their fathers’ mistakes. Embedded neighborhood networks make these relationships possible.

n Many nonbiological mentor relationships, such as with uncles or pastors, develop organical y, making it difficult for boys to think about developing such relationships inorganical y.

Violence

n Young men are navigating the issues of violence and the social constructs around it. Violence affects status, and this culture around violence influences the decisions boys make about where they live and what services they seek.

1 “Moving to Opportunity for Fair Housing,” U.S. Department of Housing and Urban Development website (portal.hud.gov/hudportal/HUD?src=/programdescription/mto). Accessed 9 July 2014.

2 Lisa Sanbonmatsu, Jens Ludwig, Lawrence Katz, Lisa Gennetian, Greg Duncan, Ronald Kessler, Emma Adam, Thomas McDade, and Stacy Lindau. 2011. “Moving to Opportunity for Fair Housing

Demonstration Program: Final Impacts Evaluation,” U.S. Department of Housing and Urban Development, Office of Policy Development and Research.

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3 Ronald Kessler, Greg Duncan, Lisa Gennetian, Lawrence Katz, Jeffrey Kling, Nancy Sampson, Lisa Sanbonmatsu, Alan Zaslavsky, and Jens Ludwig. 2014. “Associations of Housing Mobility

Interventions for Children in High-Poverty Neighborhoods With Subsequent Mental Disorders During Adolescence,” Journal of the American Medical Association 311:9, 937–48.

4 Robin Smith, Megan Gal agher, Susan Popkin, Amanda Mireles, and Taz George. 2014. “Coercive Sexual Environments: What MTO Tel s Us About Neighborhoods and Sexual Safety, ” Cityscape 16:1, 107.

5 Theresa Osypuk, Eric Tchetgen Tchetgen, Dolores Acevedo-Garcia, Felton James Earls, Alisa Lincoln, Nicole Schmidt, and M. Maria Glymour. 2012. “Differential Mental Health Effects of

Neighborhood Relocation Among Youth in Vulnerable Families: Results From a Randomized Trial, ” Archives of General Psychiatry (renamed JAMA Psychiatry) 69:12, 1284–94; Theresa Osypuk, Nicole Schmidt, Lisa Bates, Eric Tchetgen Tchetgen, Felton Earls, and M. Maria Glymour. 2012. “Gender and Crime Victimization Modify Neighborhood Effects on Adolescent Mental Health,”

Pediatrics 130:3, 472–81; Quynh Nguyen, Nicole Schmidt, M. Maria Glymour, David Rehkopf, and Theresa Osypuk. 2013. “Were the mental health benefits of a housing mobility intervention larger for adolescents in higher socioeconomic status families?” Health & Place 23, 79–88.

6 Susan Clampet-Lundquist, Kathryn Edin, Jeffrey Kling, and Greg Duncan. 2011. “Moving Teenagers Out of High-Risk Neighborhoods: How Girls Fare Better than Boys, ” American Journal of Sociology 116:4, 1154–89.

7 Tama Leventhal and Véronique Dupéré. 2011. “Moving to Opportunity: Does long-term exposure to ‘low-poverty’ neighborhoods make a difference for adolescents? ” Social Science & Medicine 73:5, 737–43.

8 “HOST: Housing Opportunity and Services Together,” Urban Institute website (www.urban.org/projects/host/). Accessed 15 July 2014.

9 Tama Leventhal and Jean Brooks-Gunn. 2011. “Changes in neighborhood poverty from 1990 to 2000 and youth’s problem behaviors, ” Developmental Psychology 47:6, 1680–98.

10 Margaret Elliot, Leventhal, et al. (forthcoming). The home and the ‘hood: Associations between housing and neighborhood contexts and adolescent functioning.

11 Kevin Roy. 2006. “Father Stories: A Life Course Examination of Paternal Identity Among Low-Income African American Men,” Journal of Family Issues 27:1, 31–54.

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List of Participants

Panelists

HUD Staff

n Susan Clampet-Lundquist

n Danielle Bastarache

Saint Joseph’s University

n Michael Dennis

n Ron Kessler

Harvard Medical School

n Claire Desjardins

n Tama Leventhal

n Anne Fletcher

Tufts University

n Rachelle Levitt

n Theresa Osypuk

University of Minnesota

n Katherine O’Regan

n Susan Popkin

n Todd Richardson

Urban Institute

n Lynn Ross

n Kevin Roy

University of Maryland

n Elizabeth Rudd

n Mark Shroder

n Carol Star

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