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Cited by 974Health disparities and outcomesUrban, Neighborhood, and Segregation StudiesObesity, Physical Activity, Diet

Neighborhoods, obesity, and diabetes—a randomized social experiment.

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Ludwig, Jens, Sanbonmatsu, Lisa, Gennetian, Lisa, Adam, Emma, Duncan, Greg J., Katz, Lawrence F., Kessler, Ronald C., Kling, Jeffrey R. +3 more·2011·New England Journal of Medicine
DOI 10.1056/nejmsa1103216PMC PMC3410541
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Abstract

BACKGROUND: The question of whether neighborhood environment contributes directly to the development of obesity and diabetes remains unresolved. The study reported on here uses data from a social experiment to assess the association of randomly assigned variation in neighborhood conditions with obesity and diabetes. METHODS: From 1994 through 1998, the Department of Housing and Urban Development (HUD) randomly assigned 4498 women with children living in public housing in high-poverty urban census tracts (in which ≥40% of residents had incomes below the federal poverty threshold) to one of three groups: 1788 were assigned to receive housing vouchers, which were redeemable only if they moved to a low-poverty census tract (where <10% of residents were poor), and counseling on moving; 1312 were assigned to receive unrestricted, traditional vouchers, with no special counseling on moving; and 1398 were assigned to a control group that was offered neither of these opportunities. From 2008 through 2010, as part of a long-term follow-up survey, we measured data indicating health outcomes, including height, weight, and level of glycated hemoglobin (HbA(1c)). RESULTS: As part of our long-term survey, we obtained data on body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) for 84.2% of participants and data on glycated hemoglobin level for 71.3% of participants. Response rates were similar across randomized groups. The prevalences of a BMI of 35 or more, a BMI of 40 or more, and a glycated hemoglobin level of 6.5% or more were lower in the group receiving the low-poverty vouchers than in the control group, with an absolute difference of 4.61 percentage points (95% confidence interval [CI], -8.54 to -0.69), 3.38 percentage points (95% CI, -6.39 to -0.36), and 4.31 percentage points (95% CI, -7.82 to -0.80), respectively. The differences between the group receiving traditional vouchers and the control group were not significant. CONCLUSIONS: The opportunity to move from a neighborhood with a high level of poverty to one with a lower level of poverty was associated with modest but potentially important reductions in the prevalence of extreme obesity and diabetes. The mechanisms underlying these associations remain unclear but warrant further investigation, given their potential to guide the design of community-level interventions intended to improve health. (Funded by HUD and others.).

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  • Unmet social needs are linked to clinical outcomes such as uncontrolled diabetes and hypertension and to higher levels of utilization including hospital readmissions.

    “Unmet social needs have been linked to important clinical outcomes such as uncontrolled diabetes and hypertension as well as higher levels of utilization, including hospital readmissions.4–7”

    From Documentation and review of social determinants of health data in the EHR: measures and associated insights (2021) · cites this paper as [4]

    The Results (Primary Outcomes; page unavailable) link a move to a lower-poverty neighborhood with a lower prevalence of diabetes, supporting the claim's broad link between a social condition and a clinical outcome. The Methods (Outcome Measures; page unavailable) define the measure as diabetes, not uncontrolled diabetes. Our copy does not report an association with hypertension, health care utilization, or hospital readmissions. (LLM, conf=0.87)

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  • Improving indoor air quality has reduced asthma illness.

    “For example, lead abatement and indoor air quality improvement interventions have reduced childhood lead poisoning and asthma morbidity, respectively.(35,36)”

    From Evaluating strategies for reducing health disparities by addressing the social determinants of health. (2016) · cites this paper as [36]

  • Lead abatement programs have lowered childhood lead poisoning.

    “For example, lead abatement and indoor air quality improvement interventions have reduced childhood lead poisoning and asthma morbidity, respectively.(35,36)”

    From Evaluating strategies for reducing health disparities by addressing the social determinants of health. (2016) · cites this paper as [36]

  • Ten to 15 years after poor public housing families had been randomized to move to less poor neighborhoods, those who had moved had lower levels of obesity, severe obesity and diabetes risk.

    “10 to 15 years after poor public housing families had been randomized to move to less poor neighborhoods, those who had moved had lower levels of obesity, severe obesity and diabetes risk [53].”

    From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [53]

  • Better-designed studies of programs such as Moving to Opportunity have found benefits for low income recipients, including improvements in housing, employment, and reductions in obesity, diabetes risk, and alcohol abuse.

    “Better-designed studies of programs such as Moving to Opportunity have found benefits for low income recipients—including improvements in housing, employment, and reductions in obesity, diabetes risk, and alcohol abuse (Sanbonmatsu et al. 2011; Fauth, Leventhal & Brooks-Gunn, 2004; Ludwig et al., 2011).”

    From Civil rights as determinants of public health and racial and ethnic health equity: Health care, education, employment, and housing in the United States (2018) · cites this paper as Ludwig et al., 2011

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Research works printed but not linked: 6

  1. [5]Office of the Surgeon General The surgeon general’s vision for a healthy and fit nation 2010 Rockville, MD Department of Health and Human Services 20669507
  2. [13]Goering J Feins JD Richardson TM Goering J Feins JD What have we learned from housing mobility and poverty deconcentration? Choosing a better life? Evaluating the Moving to Opportunity social experiment 2000 Washington, DC Urban Institute Press 3 36
  3. [16]Feins JD Holin MJ Phipps AA Moving to Opportunity for fair housing demonstration: program operations manual (revised) 1996 9 Cambridge, MA Abt (http://www.abtassociates.com/reports/D19960002.pdf.)
  4. [17]Feins JD Holin MJ Phipps AA Magri D Implementation assistance and evaluation for the Moving to Opportunity demonstration: final report 1995 4 Cambridge, MA Abt (http://www.abtassociates.com/reports/D19950045.pdf.)
  5. [20]Groves RM Fowler FJ Jr Couper MP Lepkowski JM Singer E Tourangeau R Survey methodology 2004 Hoboken, NJ John Wiley
  6. [33]Stata 11.0 special edition 2009 College Station, TX Stata (http://www.stata.com.)

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Authors
Ludwig, J., Sanbonmatsu, L., Gennetian, L., Adam, E., Duncan, G. J., Katz, L. F., Kessler, R. C., Kling, J. R., Lindau, S. T., Whitaker, R. C., & McDade, T. W.
Affiliations
  • National Bureau of Economic Research (US)
  • Brookings Institution (US)
  • Northwestern University (US)
  • University of California, Irvine (US)
  • Harvard University (US)
  • Congressional Budget Office (US)
  • University of Chicago (US)
  • Temple University (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2011-10-20
Volume
365
Issue
16
Pages
1509-1519
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmsa1103216
PMC
PMC3410541
OpenAlex
W2116429669
Cited by
964
References
26
Citations by year
2026: 32 · 2025: 47 · 2024: 62 · 2023: 69 · 2022: 79 · 2021: 62 · 2020: 70 · 2019: 67 · 2018: 80 · 2017: 64 · 2016: 83 · 2015: 73 · 2014: 64 · 2013: 59 · 2012: 41
FWCI
57.29
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
  • National Science Foundation (0527615)
  • Bill and Melinda Gates Foundation
  • John D. and Catherine T. MacArthur Foundation
  • Annie E. Casey Foundation
  • Russell Sage Foundation
  • Smith Richardson Foundation
  • Sid W. Richardson Foundation
  • Spencer Foundation
  • Sage Foundation
  • Bristol-Myers Squibb
  • Eli Lilly and Company
  • Pfizer
  • GlaxoSmithKline
  • Sanofi
  • PepsiCo
  • SRA International
  • Kaiser Permanente
  • University of Chicago
  • University of Michigan
  • Janssen Scientific Affairs
  • National Institutes of Health (R01-HD040444)
  • Centers for Disease Control and Prevention (R49CE000906)
  • Institute of Education Sciences (R305U070006)
  • Center for Health Administration Studies
  • Nutrition Obesity Research Center, University of North Carolina
  • National Institute on Aging (P30AG012857, R01AG031259, R56AG031259, P01-AG005842-22S1, AG005842, K23AG032870, P01AG005842)
  • National Institute of Mental Health (R01MH077026)
  • National Institute of Child Health and Human Development
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD040444, R01HD040404, R24HD051152)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Sociology and Political Science › Urban, Neighborhood, and Segregation Studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
neighborhood environment, neighborhood poverty, obesity, diabetes mellitus, housing vouchers, public housing, body mass index, HbA1c, morbid obesity, community-level interventions, social experiment, women with children, urban poverty, health disparities, social determinants of health, long-term follow-up
MeSH terms
Adult, Diabetes Mellitus, Female, Humans, Middle Aged, Obesity, Poverty Areas, Residence Characteristics, Social Conditions

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