Unequal Health and Race

After Moving to Opportunity: How Moving to a Low-poverty Neighborhood Improves Mental Health among African American Women

Kristin Turney1, Rebecca Kissane2, and Kathryn Edin3

Abstract

A large body of nonexperimental literature finds residing in a disadvantaged neighborhood is deleterious for mental health, and recent evidence from the Moving to Opportunity (MTO) program—a social experiment giving families living in high-poverty neighborhoods the opportunity to move to low-poverty neighbo- rhoods—suggests a causal effect of moving to a low-poverty neighborhood on adult mental health. We use qualitative data from 67 Baltimore adults who signed up for the MTO program to understand how mov- ing to a low-poverty neighborhood produced these mental health benefits. First, we document the vast array of mental health challenges, traumatic experiences, and stressors reported by both experimentals (those who received a housing voucher to move to a low-poverty neighborhood) and controls (those who did not receive a voucher). We then explore how changes in the physical and social environments may have pro- duced mental health benefits for experimentals. In particular, experimentals reported the following: improved neighborhood and home aesthetics, greater neighborhood collective efficacy and pride, less vio- lence and criminal activity, and better environments for raising children. Notably, we also document increased sources of stress among experimentals, mostly associated with moving, making the positive effects of MTO on adult mental health all the more remarkable. These findings have important implications for both researchers and policymakers.

Keywords

mental health, neighborhood, poverty, stress

Whether and how context matters for well-being

has been the subject of intense scientific debate.

In The Truly Disadvantaged, William Julius

Wilson (1987) revived this debate by arguing that

living in economically disadvantaged and racially

segregated neighborhoods can have negative ef-

fects on individual behavior. Theories abound

about what neighborhood characteristics pose the

most risk: troubled peers, poor institutional resour-

ces, few ties to people with jobs, or environmental

hazards (for reviews see Ellen, Mijanovich, and

Dillman 2001; Leventhal and Brooks-Gunn 2000;

Sampson, Morenoff, and Gannon-Rowley 2002;

Small and Newman 2001). A common thread,

1University of California, Irvine, CA, USA 2Lafayette College, Easton, PA, USA 3Harvard University, Cambridge, MA, USA

Corresponding Author:

Kristin Turney, Department of Sociology, University of

California at Irvine, 3151 Social Science Plaza, Irvine, CA

92697-51009, USA

Email: [email protected]

Society and Mental Health 3(1) 1–21

� American Sociological Association 2012 DOI: 10.1177/2156869312464789

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however, is that residing in disadvantaged neigh-

borhoods has deleterious effects on individuals’

physical (Boardman et al. 2005; Browning and

Cagney 2003; Ross and Mirowsky 2001) and men-

tal health (Diez Roux 2001; Mair, Diez Roux, and

Morenoff 2010; Ross 2000; Ross, Reynolds, and

Geis 2000).

A frequent critique of the neighborhood effects

literature is that it is difficult to disentangle the

causal effect of neighborhood conditions from

the effect of unmeasured characteristics on

observed inequalities in physical and mental health

(Sampson et al. 2002). The Moving to Opportunity

(MTO) social experiment, which randomly gave

4,608 families living in public housing develop-

ments in poor communities the chance to move to

low-poverty neighborhoods, addresses some of

these concerns and offers the opportunity to

explore how moving to a low-poverty neighbor-

hood may influence health. Residents in public

housing or Section 8 project-based housing in

extremely poor neighborhoods in Baltimore, New

York, Chicago, Los Angeles, and Boston applied

to the MTO program from 1994 through 1998 and

were randomly assigned into one of three groups:

experimental, Section 8, or control. Experimental

group members received a restricted Section 8 hous-

ing voucher they could use to rent a unit from a private

landlord in a low-poverty neighborhood (i.e., census

tracts with 1990 poverty rates of less than 10 percent),

for which they would be charged 30 percent of their

net income. 1

They also received housing counseling

and assistance finding a unit. The Section 8 group

received a housing voucher that could be used to

move to any neighborhood (and not necessarily

a low-poverty neighborhood). The control group

did not receive a housing voucher or other assistance

through the program but could continue to live in

public housing or apply for other available housing

programs. Across all five cities, about 47 percent as-

signed to the experimental group and 62 percent as-

signed to the Section 8 group moved through the

MTO demonstration (Orr et al. 2003:28).

Results from an interim survey (conducted 4 to

7 years after random assignment) and the final sur-

vey (conducted 10 to 12 years after random assign-

ment) show that despite the fact many experimental

group members left their low-poverty neighbor-

hoods over time and the experiment did not pro-

duce employment or earnings benefits (Kling,

Liebman, and Katz 2007; Orr et al. 2003), it did

produce strong effects on mental health (Ludwig

et al. 2012; Orr et al. 2003; Sanbonmatsu et al.

2011). Considering mental health problems are

associated with a host of social and economic dis-

advantages—including financial hardship, diffi-

culty in personal relationships, and child well-

being—it is especially important to understand

the processes through which neighborhoods affect

mental health (Coyne 1976; Miech and Shanahan

2000; Turney 2011). In this paper, we use qualita-

tive data from 67 adults in Baltimore who partici-

pated in the MTO program to understand how

moving to a low-poverty neighborhood produced

mental health benefits.

BACKGROUND

Stress Process Theory

Stress process theory provides a useful theoretical

framework for considering the mechanisms

through which neighborhood environments affect

health (Pearlin 1989; Pearlin et al. 1981; Turner,

Wheaton, and Lloyd 1995). This theory suggests

stressors emerge from the distinctive social contexts

characterizing the lives of disadvantaged groups

and that differential exposure to stressors contributes

to inequalities in physical and mental health (Pearlin

1989; Turner and Avison 2003). This is consistent

with social disorganization theory, which posits that

neighborhoods may be an important source of stress

and may contribute to a variety of deleterious mental

health outcomes (Sampson and Groves 1989).

Similarly, some have conceptualized the ecological

context as a chronic stressor (Downey and Van

Willigen 2005; Pearlin 1989) that develops ‘‘slowly

and insidiously as continuing and problematic condi-

tions in our social environments or roles’’ (Wheaton

1999:283). Ecological context, therefore, includes

social environs but also involves elements of physical

space and infrastructure that may act as stressors.

Though there is some overlap between the physical

and social aspects of neighborhoods, the two are con-

ceptually distinct and may each act as stressors that

differentially or cumulatively influence health (Diez

Roux and Mair 2010; also see Leslie and Cerin

2008; Macintyre, Ellaway, and Cummins 2002).

Moreover, neighborhoods may be an important

source of stress proliferation, the process through

which a primary stressor leads to an emergence of

additional, or secondary, stressors. Both primary

and secondary stressors have negative implications

for mental health (Pearlin, Aneshensel, and

Leblanc 1997). For example, social disorganization

theory suggests that disadvantaged neighborhoods

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are often characterized by stressors such as drug

trafficking, violence, and markers of physical dis-

order (abandoned buildings, graffiti), all of which

may directly influence mental health (Sampson

and Groves 1989). But these factors may also

lead residents to perceive their communities as

unsafe and, consequently, limit their interactions

with others or isolate themselves (Curry, Latkin,

and Davey-Rothwell 2008; Kim 2010). Strength

of connections with others in the community and

supportive ties are associated with positive mental

health outcomes (Ziersch et al. 2005). In sum, the

primary stressor of social disorganization may

lead to secondary stressors of low social capital

and social isolation, which may compound the

mental strain placed on residents of poor

neighborhoods.

Empirical Research Linking Neighborhood Conditions to Mental Health

Mental health problems are not equally distributed

across the population. A large body of research

considers individual-level differences in mental

health problems by race, socioeconomic status,

age, and marital status (Kessler et al. 2003).

Recently, however, social scientists have docu-

mented that neighborhood conditions also matter,

above and beyond individual-level characteristics

(for a recent review, see Mair, Diez Roux, and

Galea 2008). For example, neighborhood disadvan-

tage is associated with a higher probability of

depression (Aneshensel and Sucoff 1996; Ross

2000; Silver, Mulvey, and Swanson 2002), depres-

sive symptoms (Latkin and Curry 2003), anxiety

(Aneshensel and Sucoff 1996; Ross 2000), and sub-

stance abuse disorder (Silver et al. 2002). It also in-

creases the probability an individual will struggle

with anger (Schieman, Pearlin, and Meersman

2006), have difficulty trusting others (Ross,

Mirowsky, and Pribesh 2001), and report power-

lessness (Geis and Ross 1998).

Though a burgeoning body of (mostly nonex-

perimental) literature examines the mental health

consequences of living in a disadvantaged neigh-

borhood, the problems endemic to neighborhood

effects research more generally are widespread in

this work. Individuals are not randomly assigned

to neighborhoods and instead exercise preferences

and encounter structural constraints—given finan-

cial circumstances, housing availability, and family

concerns—regarding where they live and how long

they live there (Sampson et al. 2002; Tienda 1991).

Considering the positive association between eco-

nomic disadvantage and mental health problems

such as depression (Kessler et al. 2003), depressed

individuals may be more likely to select into disad-

vantaged neighborhoods and less likely to move

out of them.

As noted earlier, the MTO demonstration pro-

vides a unique opportunity to examine the causal

effect of neighborhoods—specifically, an offer to

move from public housing in high-poverty neigh-

borhoods to private housing in low-poverty neigh-

borhoods—on mental health. Researchers have

followed MTO families to assess the short- and

long-term effects of moving to low-poverty com-

munities for adults and children. The MTO experi-

mental treatment—receiving a housing voucher to

move to a neighborhood with a poverty rate of

less than 10 percent—altered the neighborhood tra-

jectories and environments of families, even

though many in the experimental group did not

remain in their placement neighborhood for the

long term. Indeed, 65 percent of this group moved

from their initial placement neighborhood within

four to seven years of random assignment, often

to a higher poverty neighborhood (Orr et al.

2003). Despite this, they spent considerably less

time (during those four to seven years) living in

high-poverty neighborhoods and more time

in low-poverty neighborhoods than those who

did not receive the experimental treatment.

Specifically, experimental group members who

used their voucher resided in neighborhoods with

poverty rates of less than 20 percent for a median

of 32 months and a corresponding median of 11

months in neighborhoods in very high-poverty

neighborhoods (poverty rates greater than 40 per-

cent). Meanwhile, during these same four to seven

years, controls spent a median of 63 months in very

high-poverty neighborhoods but a median of zero

months in neighborhoods with poverty rates of

less than 20 percent (Clampet-Lundquist and

Massey 2008). Recent research—both from the

MTO demonstration and from other observational

studies—suggests cumulative exposure to disad-

vantaged neighborhoods may be especially detri-

mental to economic (Clampet-Lundquist and

Massey 2008), educational (Wodtke, Harding,

and Elwert 2011), and mental health outcomes

(Wheaton and Clarke 2003).

As indicated earlier, quantitative data demon-

strate that adults in the experimental group,

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compared to their control counterparts, experi-

enced reduced psychological distress (measured

by the Kessler 6 or K6; Kessler et al. 2002), less

depression (measured with the Composite

International Diagnostic Interview Short Form

[CIDI-SF] Version 1.0 November 1998; Kessler

et al. 1998), and increased calm and peaceful feel-

ings four to seven years after random assignment

(Kling et al. 2007; Orr et al. 2003). The magnitude

of these effects is large. For example, at the

interim survey, the experimental group reported

psychological distress that was 4 percentage

points lower than the control group, and those in

the experimental group who used their voucher

to move reported psychological distress that was

8 percentage points lower. Furthermore, 22 per-

cent of control respondents met the diagnostic cri-

terion for depression in the past year, but this was

true of only 18 percent of experimentals and 14

percent of experimentals who used their voucher

to move (Orr et al. 2003). These effect sizes are

comparable to those found in ‘‘some of the most

effective clinical and pharmacologic mental

health interventions’’ (Kling et al. 2007:102).

Moreover, the effects on psychological distress

persisted at the final survey (conducted 10 to 12

years after random assignment) (Ludwig et al.

2012; Sanbonmatsu et al. 2011).

Though the interim and final surveys provide

strong evidence linking an offer to move to a

low-poverty neighborhood to improved mental

health, they do not explain the processes through

which living in an advantaged neighborhood—

relative to a very disadvantaged one—confers

these benefits (Sampson 2008). What could

account for the large mental health benefits that

accrue from moving from a high-poverty neigh-

borhood to a low-poverty neighborhood, and

why do differences between program groups per-

sist even though those in the experimental group

who moved with an MTO voucher lived in low-

poverty neighborhoods for a median of only 32

months (Clampet-Lundquist and Massey 2008)?

The goal of this qualitative analysis is to shed

light on the processes underlying these results.

Though another qualitative analysis based on

MTO participants has focused on the impact of

MTO on the mental health of youth (Briggs,

Popkin, and Goering 2010), we know of no quali-

tative MTO study that specifically considers the

processes underlying the mental health effects

among adults.

DATA AND METHODS

We use data from in-depth, semi-structured inter-

views with Baltimore adult respondents who par-

ticipated in the MTO demonstration. Individuals

interviewed in Baltimore were a stratified random

subsample of all three program groups (experimen-

tal, Section 8, and control) across three household

types: households with children 8 to 13 years old,

households with children 14 to 19 years old, and

households with children in both age groups.

From 2003 to 2004 (six to nine years after random

assignment), we interviewed 124 of the 149 adult

respondents randomly selected for the in-depth in-

terviews (83 percent response rate). Reasons for

nonresponse include inability to locate, death, and

refusal. Of these 124 respondents, 51 were in the

experimental group, 53 were in the control group,

and 20 were in the Section 8 group.

At the time of both the interim and final surveys,

researchers found no differences in mental health

between adults in the Section 8 group and the con-

trol group (Orr et al. 2003:77; Sanbonmatsu et al.

2011:116). Given the MTO intervention did not

improve mental health outcomes for those in the

Section 8 group, we omit these 20 respondents

from our qualitative analysis. Instead, we compare

individuals in the experimental group to individu-

als in the control group, as this is where the exper-

imental impacts were observed.

We further restrict our analytic sample to exper-

imental adult respondents who took up the MTO

offer and complied with the MTO treatment

by moving to a low-poverty neighborhood

(n = 33, or 65 percent of the 51 experimental

respondents we interviewed), hereafter referred to

as ‘‘experimentals.’’ 2

To ensure the experimental

and control groups are as similar as possible, we

also restrict our analytic sample to 34 adult respond-

ents in the control group who likely would have

moved through MTO had they been assigned to

the experimental group (hereafter called ‘‘controls’’)

(see appendix; also see Turney et al. 2006). The 33

adult respondents in the experimental group and

the 34 adult respondents in the control group com-

prise the 67 members of our analytic sample.

In-depth semi-structured interviews with these

respondents were between two and five hours

long and were recorded and transcribed verbatim.

Among other things, we asked respondents to

describe, from random assignment onward, all

housing units and neighborhoods they lived in

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and all schools their children attended; the families’

experiences in these units, neighborhoods, and

schools; and mental health challenges they experi-

enced while living in and navigating these environ-

ments. For example, respondents were asked to

describe the last time they felt down for two weeks

or more, their circumstances at the time, and how

they coped with such feelings. We asked similar

questions of all respondents, though we varied the

question wording and timing to make the interview

flow as much as possible like a conversation. Adult

respondents were paid from $50 to $85 for their

time, depending on whether we asked them about

one or two children.

Trained graduate students conducted prelimi-

nary coding of the transcribed interviews and

entered these codes into a Microsoft Access data-

base. These initial codes were primarily descriptive

and were generated deductively, based on the

topics covered in the interview guide. For example,

one large descriptive field called ‘‘MHEALTH’’

included discussions of mental health, traumatic

experiences, and mental health treatment. We

then engaged in a second stage of coding using

NVivo software, which allows for an inductive

approach characteristic of qualitative analyses

(Charmaz 2006; Strauss and Corbin 1990).

During this stage, we organized the data into small

conceptual categories (or ‘‘nodes’’) and looked

for patterns that distinguished the experiences of

experimentals from the controls. Several of these

‘‘nodes’’ were derived deductively, based on find-

ings from previous research, but most analyses at

this point emerged from the coding process itself,

rather than from predetermined hypotheses or pre-

viously defined conceptual categories.

Sample Description

In Table 1, we present descriptive information for

the respondents in our qualitative sample, sepa-

rately for experimentals and controls. All house-

hold heads are women. Nearly all are African

American (one respondent identifies as multira-

cial). Respondents in both groups were, at the

time of the qualitative interview, 38 years old and

had about three dependent children on average.

Nearly half of both experimental and control re-

spondents lived in public housing as a child but

the two groups lived in somewhat different housing

and neighborhood conditions at the time of the

qualitative interview. For example, experimentals

were living in neighborhoods with average poverty

rates of 21 percent, about 12 percentage points

lower than average neighborhood poverty rates of

controls (33 percent). Both experimentals and con-

trols were also living in highly segregated neigh-

borhoods, consistent with prior MTO research

(Clampet-Lundquist and Massey 2008), though

the experimentals’ neighborhoods were slightly

less segregated. Additionally, experimentals, com-

pared to controls, lived in neighborhoods with

a higher percentage of residents with a college

degree (21 percent vs. 13 percent) and who were

employed (52 percent vs. 43 percent). Only 27

percent (9 of the 33) of experimentals remained

in their placement neighborhood at the time of

the qualitative interview (descriptives not shown).

Furthermore, on average, experimentals lived in

their current neighborhoods for only 3.45 years

(compared to 4.91 years among the controls).

Importantly, we did not administer diagnostic

measures of depression and thus cannot report

quantitative similarities or differences in the prev-

alence of depression across program groups. This

is, however, available from survey results (Orr

et al. 2003; Sanbonmatsu et al. 2011).

RESULTS

Our results proceed in three stages. We begin by

documenting stressors and mental health chal-

lenges typically faced by both experimentals and

controls. The random assignment ensures both

experimental and control group members were

similar when they enrolled in MTO, and indeed,

our analysis shows they faced many similar chal-

lenges prior to the intervention. Understanding

these pre-enrollment challenges is a critical first

step in understanding why the offer to move to

a low-poverty neighborhood might have had such

a substantial effect on mental health.

In the second analytic stage, we report how

experimentals described both the physical and

social characteristics of the neighborhoods they

moved to with their voucher, as well as any low-

poverty neighborhood they lived in subsequently.

We contrast these descriptions with descriptions

of the high-poverty neighborhoods that experimen-

tals and controls lived in at random assignment and

beyond.

In the final analytic stage, we document

several sources of increased stressors that respond-

ents said resulted from moving to low-poverty

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neighborhoods. These stressors are largely related

to challenges of moving into the private market

after years of living in public housing, but are

also related to distance from social networks and

public transportation.

Mental Health Challenges

The qualitative data show nearly all adults in both

experimental and control groups reported a wide

array of traumatic experiences and stressful life

events prior to enrollment in MTO. Although re-

spondents reported a range of mental health chal-

lenges including depression, anxiety, phobias,

intense mood swings, eating disorders, and drug

abuse, depressive symptoms were most common.

Experimentals and controls reported current and

past depressive symptoms such as feeling worthless

or losing interest in normally pleasurable activities,

with many saying they struggled with chronic,

Table 1. Descriptive Characteristics of Baltimore Qualitative Respondents at the Time of the Qualitative Study (2003-2004)

Experimental compliers Control compliers

Percentage or mean SD Percentage or mean SD

Female 100 100 African American 97 100 Age 38.39 5.74 37.53 6.49 Education

Less than high school 28 47 High school diploma or GED 59 53 College degree 9 0

Number of children in household 2.82 1.28 3.09 1.03 Number of people in household 3.42 1.52 4.47 2.15 Lived in public housing as child 48 48 Current housing

Public housing 9 21 Subsidized housing 58 42 Unsubsidized housing 15 18 Homeowner 12 18 Other 0 3

Percentage in neighborhood in poverty

21.0 33.3

Percentage in neighborhood with college degree

20.6 13.1

Percentage in neighborhood employed

52.4 42.5

Percentage African American in neighborhood

71.5 80.3

Years in current neighborhood 3.45 2.60 4.91 4.77 Employment status

Full time 46 32 Part time 21 24 Not employed 33 44

Receives TANF 9 24 Receives food stamps 41 39 Receives medical assistance 56 58 N 33 34

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severe, and debilitating depression that made it dif-

ficult to find and sustain employment, engage in

effective parenting behaviors, and maintain sup-

portive social relationships with friends and family

members. Respondents discussed myriad stressors

that underlie the onset, recurrence, or persistence

of depression, including financial difficulties, rela-

tionship problems with current romantic partners or

children’s fathers, and emotionally draining social

networks.

Danielle, for example, a control with a history

of suicide attempts, reported her depression and

anxiety began in childhood when her mother

started abusing drugs. 3

She attributed her current

depression to her inability to provide financial

security for herself and her three children and re-

vealed she had little emotional or instrumental sup-

port from her immediate family. Danielle reported

her ongoing depression sharply limited her ability

to parent her children effectively:

My daughter started feeling like I didn’t care

because I just wanted to be by myself. I

didn’t want nobody to bother me. I lost the

thought that I had kids and that they needed

me. I felt really bad, you know, and even

though I was feeling really bad, I couldn’t

bring myself to actually hold a conversation

with my kids, play with ’em, I wasn’t doin’

no type of activities with ’em. . . . My kids

never understood.

Similarly, Billie, a control, reported depression

for the past three years, which she attributed to

ongoing difficulties in paying bills and to a painful

separation from her children’s father. She reported

‘‘the depression was so thick in the house’’ that it

was impossible for her teenage son to ignore it.

She said, ‘‘Sometimes this world is a little too

much, and I’m not afraid to admit that. I’m to a point

right now where I feel like just too stressed out, and

I really feel like I would like to give everything up

and just do nothing.’’

Both experimentals and controls also reported

other sources of depression, many of which began

long before random assignment. For example,

Edith, a control, reported severe depression that

stemmed from childhood sexual abuse and, more

recently, from the geographic separation from her

mother who moved to Virginia the year before

the interview. Edith was pregnant with her third

child when we spoke with her and said her

depression was so severe that only her children

and husband gave her a reason to live:

’Cause I already feel like my inside, like

everything inside me is just dead. I am living

for them children, and I am living for my

husband. I don’t feel like I am living for

myself; I got another baby in here [points

to her stomach] that I feel as though I got

to live for this baby. . . . I’m not going to

make it. If I keep going the way I am going,

I am not going to make it.

Wendy, also a control, described her depres-

sion, which she said was spawned in part by the

incarceration of two of her five children: ‘‘Some

mornings I wake up and I just be so sad. I’d be so

sad, and I just cry so bad, and I call [my friend]

up, and I cannot even tell her what’s hurting. I

don’t even know what’s wrong.’’ Experimentals re-

ported similar stressors. Coco, who had been caring

for her sister’s children until her physical health

prevented her from continuing, attributed her long-

standing depression to the burden of caring for her

mother, who suffered from both severe depression

and alcoholism since Coco’s childhood.

Even those without debilitating depressive

symptoms often experienced a multitude of trau-

matic and stressful life events that directly threat-

ened their mental health. For example, both

controls and experimentals spontaneously men-

tioned the death of a close friend or family mem-

ber—often resulting from health conditions such

as cancer or HIV/AIDS, from a drug overdose, or

from murder—as a stressor. Both groups also com-

monly reported domestic violence without prompt-

ing, as a direct question about partner abuse was not

asked.

For example, Tammy, a control who reported

struggling with depression and bulimia, pointed

to her father’s death during her childhood as

a source of her troubles. She and her siblings

were then placed in foster care, where she was

abused and attempted suicide. More recently,

Tammy’s mother died (from lung cancer) and, in

just an 11-month span, so did her son’s father and

all three of her sisters. Tammy herself was a survi-

vor of cervical cancer. Stories of multiple hard-

ships, like Tammy experienced, were common in

the interviews and highlight the already formidable

strain on the MTO participants’ mental health when

they entered the demonstration.

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The Physical Environments

In the previous section, we document the vast array

of mental health challenges, traumatic experiences,

and stressors reported by both experimentals and

controls. In trying to understand how MTO

improved mental health among experimentals,

among a very disadvantaged population, the

enhanced physical environment emerged as one

important theme. Controls often used strong pejo-

rative language to describe the high-poverty neigh-

borhoods and housing—mostly high-rise public

housing—they were living in at the time of random

assignment and beyond, indicating that such envi-

rons may have acted as a primary stressor that trig-

gered the emergence of secondary stressors. When

asked what it was like living in public housing,

Susan, a control, replied:

I felt like it was a mistake—somebody drop-

ped me off and didn’t come back and pick

me up. It was torture. It was sometimes

like a [bad] dream. . . . The elevators was

always broke. You had to walk 13 flights

of steps. My kids couldn’t go downstairs

all the time to the playground with the other

kids when the elevator was broke and people

would get to shooting down there, and I can’t

come running down 13 flights of steps to

save ’em.

Besides broken elevators, controls experienced

stress and frustration with roach and rodent infesta-

tion, trash buildup, dampness in the walls, and

extremely hot (or cold) interior temperatures.

LaNeesha, for example, complained about roaches

in the public housing unit she lived in for six years:

They got little soldiers, roaches. And it just

started—and I was a clean freak and they

just, just the roaches marching on, hoorah,

hoorah. . . . I don’t know if you ever seen pla-

ces where they just have [roach] nests and

it’s where you just like pull back the refrig-

erator, it be a nest, it be like, they just be

nests all around and stuff and you be tryin’

to kill ’em and stuff. That’s how it was at

[the project]. And my house would be clean,

my house would be clean. Like I had a couple

nests here and I was like, why I’m getting

nests when I be cleaning this place and stuff

like that. It’s because the people here, they

filthy.

Ayana, like other controls, complained about

leaks in her unit: ‘‘We was like on the corner of

the projects. . . . When it rain . . . , water gets running

down on the walls. And you can get sick off that.’’

Similarly, Charnette, still residing in public hous-

ing with her three children, reported significant

water damage in her unit, along with a litany of

other issues including problems with heat and

electricity:

I had a long list [of problems]. I think when

we went to court they had like 27 violations

on them. . . . The heat is just on [all the time].

. . . This heat is too hot for me because I have

asthma and my son has asthma and my

daughter has bronchitis. So we will have to

run fans in the winter when it’s hot like

that, or just leave the windows open to cut

the air down. But see, we don’t complain

with that because if we complain and they

turn our heat off; then when it’s cold, it’s

really cold in here. So you be [suffering] if

you do [complain] and if you don’t.

Tammy, the control who suffered from depres-

sion and bulimia, echoed the complaints of several

other respondents as she described the unit in her

high-poverty neighborhood that, like many, was

in a housing project:

It was, it was like an efficiency [apartment]

to me. It was, it was two bedrooms, but

these, these rooms were cells. They looked

like a prison cell. The whole house looked

like a cell. Concrete walls, concrete floors.

The kitchen should’ve been a coatroom,

you know? It was just, it was horrible. It

was a horrible design and um, the heatin-

g—you were in an oven because everybody

felt everything. It was no adjustment of the

heat. And that’s just how it was. It was a hor-

rible. . . . And then the windows [barely let

air in].

The controls also complained about the physical

environment outside of their immediate housing

developments and residence. Inadequate lighting,

for example, was one such complaint. Louise said

she was afraid coming home from work at night

because ‘‘there were no buses coming in our neigh-

borhood, you know, right there to drop us off in

front of the house. So I actually had to walk, and

there was a lot of dark places and there were a lot

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of places where women can be raped.’’ Navigating

dark spaces and crumbling, littered sidewalks was

a common safety concern of our respondents.

For experimental families, moving to a low-

poverty neighborhood meant a radical change in

the physical environments of both their home and

neighborhood, thus reducing a host of primary

stressors. Many who once lived in massive concrete

and brick projects, surrounded by cement and rid-

dled with graffiti and litter, now found themselves

living in two- or three-story, well-kept duplexes,

row homes, or even single-family detached homes

encircled by greenery—surroundings they may not

have known they desired, but which they came to

recognize as exercising a calming effect and a sense

of well-being. The experimentals were often quick

to note improvements in their units that resulted

from the move. Although there were exceptions,

experimentals repeatedly spoke highly of their

new housing, calling the housing ‘‘beautiful’’ and

acknowledging the improved amenities (e.g., new

appliances or two bedrooms). When asked to

describe her apartment, Stephanie replied, ‘‘It was

wonderful, beautiful. I had a balcony, two bed-

rooms, walk-in closet, a bathroom in my room, it

was nice, it was real nice, I mean beautiful. . . . I

loved that apartment.’’ Similarly, Niecy, who spent

two years in her MTO placement unit, recounted,

‘‘[MTO] helped me to find a beautiful apartment.

. . . Oh my goodness, it was so beautiful there. . . .

It was like everything was new. The floors, the

walls, it was beautiful, it was nice. And I had

a washer there, you know? I was happy. Two bed-

rooms.’’ She, like other experimentals, offered

a direct connection between the conditions of

her environment and her sense of what the future

holds:

[The MTO unit] wasn’t a high rise, it wasn’t

like that. It was a single home. It was not

detached . . . but just two apartments. And

it was grass. I could see grass, and I could

see trees and birds and squirrels. But [in

the housing project], it wasn’t nothing like

that. . . . It was just like day and night. I

had moved from night to day. So it was

just, it was clean. The [project] was not

clean. . . . I mean from me coming from

[the projects] and being here like this, this

is really nice. And you know, I know what,

you know what, it gets better. It’s gonna

get better.

Niecy reported few mental health challenges

prior to enrolling in MTO, but the intervention

also seemed to improve the well-being of some

women in the experimental group with fairly severe

mental health problems that predated the interven-

tion. Amy, an experimental who lived in her place-

ment neighborhood for six years, struggled with

a host of mental health problems such as depres-

sion, anger, and phobias. Though her move with

an MTO voucher did not ameliorate all of these

problems, she said the change in the physical envi-

ronment improved her outlook on life:

So moving up here, it’s a whole different

atmosphere, the greenery, you living in

a high-rise, you got a lot [of] cement. And

there’s something to that effect in the psy-

chology . . . , the hardness you get from all

that concrete. The greenery, it softens you.

It’s just so beautiful and peaceful, the space,

the open space. You got more space.

Amy’s appreciation of the new physical envi-

ronment—‘‘beautiful and peaceful’’—is illustrative

of other experimentals’ descriptions. Keona, like

others, said the peaceful atmosphere was the best

thing about both her MTO placement neighbor-

hood, where she only lived for a year, and the

low-poverty neighborhood she subsequently

moved to and still resided in at the time of our inter-

view. She described her current neighborhood as

a ‘‘ghost town’’—a positive characterization in

her view—where she ‘‘can hear the birds chirping.’’

Importantly, better physical environments also

may have reduced other stressors, such as worries

over children’s physical health. Many physical ail-

ments, such as asthma and lead poisoning, are

strongly linked to neighborhood and housing con-

ditions. Therefore, it is not surprising some exper-

imentals reported improvements in their

children’s health after the move. Jacquelyn, for

example, told us her daughter’s asthma disappeared

when the family moved from a public housing in

Baltimore to their MTO placement neighborhood.

The Social Environments

No one who has spent any time in a high-poverty,

inner-city neighborhood would find it difficult to

imagine the MTO intervention not only created

a dramatic contrast between the experimentals’

and controls’ physical environments but also in

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their social environments. Although some changes

in physical environment were certainly related to

the changed social environs (e.g., being able to

hear birds chirping requires that other neighbor-

hood noise is minimal), here we concentrate on

three themes of neighborhood social environments

that emerged from the qualitative interviews as

being linked to the improved mental health of ex-

perimentals: (1) greater neighborhood collective

efficacy and pride, (2) less violence and criminal

activity, and (3) better environments for raising

children.

Neighborhood collective efficacy and pride. To start, many experimentals reported high levels of

collective efficacy—‘‘social cohesion among

neighbors’’ and a willingness to work for common

values (Sampson, Raudenbush, and Earls

1997:918)—in their low-poverty neighborhoods.

They claimed that this collective efficacy fostered

a sense of community among neighbors, made

parenting less onerous, and cultivated self-

efficacy, all of which positively related to their

overall well-being. For example, Candy, an exper-

imental who reported her MTO unit was a ‘‘dream

home,’’ noted the greater sense of community she

felt in the low-poverty neighborhood she lived in

for two years:

We had cookouts together, we work it into

a routine [where] everyone kept the block

clean. . . . I was not a person that associated

with a lot of people [in the projects], but I

seen my neighbors always saying ‘‘hi,’’

‘‘bye,’’ going to work and whenever we

had a little event in the neighborhood. We

was always there to support each other.

Stephanie, quoted earlier, also noted observing

a higher degree of community cooperation in her

low-poverty neighborhood: ‘‘Everybody tried to

work together as far as when it snowed, and we

got out there and shoveled the walkway and stuff

like that. Everybody pitched in.’’ Similarly, Coco,

whose struggles with depression were noted earlier,

said the following about the placement neighbor-

hood she lived in for two years:

[My new neighborhood had] less people to

stand around doing nothing. Out in

[Baltimore] County, you don’t see that.

The people stick together, most of ’em are

homeowners and if anybody come around

that house, there is always the neighborhood

watching. . . . There wasn’t many situations

[where the police had to be called] because

a lot of people knew it was a [neighborhood

where people watched]. People own their

houses up there, and they weren’t going to

allow a lot of mess.

Experimentals described their low-poverty

neighborhoods as ‘‘more settled,’’ with residents

having lived there for many years. Jocelyn, who

lived in her placement neighborhood for nearly

eight years, attributed this to the ratio of homeown-

ers to renters:

[My MTO placement neighborhood] was

surrounded by homeowners, nothing but

homeowners. . . . So nine times out of 10

when you have an area with homeowners,

they actually care about their community

and what’s going on in their community

than people that’s renting. I believe it.

That’s what I think makes the difference.

In addition, experimentals also reported their

parenting was buttressed by the actions of their

neighbors, who they felt they could trust to watch

out for their children when playing outdoors.

When asked whether residents looked out for

each other’s children, Cookie responded:

[Yes.] That’s one of the biggest things out

here, because this is such a small commu-

nity. . . . We just had a meeting last month

about that with the kids, they aren’t sup-

posed to be really unattended out here on

the playgrounds if they’re under age any-

way. . . . But it’s always either myself watch-

ing, the lady next door, and the lady next

door to her. . . . And [at the meeting we

agreed that] if something happen or one of

the kids are doing something they’re not

supposed to be doing, we just contact [the

parent], go take ’em to the parent and that’s

how we handle it.

Cookie reported few worries about her

14-year-old daughter playing outdoors, and this

lack of anxiety stemmed directly from her trust

in her neighbors to look out for other children.

Accordingly, despite serious physical health prob-

lems that sometimes got her down (she suffered

chronic back pain since she plummeted four floors

in an elevator accident), Cookie was upbeat

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throughout our interview and said her ‘‘inner self

is calm and peaceful.’’

Coco, who told us a ‘‘burden’’ lifted off of her

when she moved into her MTO placement neigh-

borhood, said she also felt comfortable letting her

children play outside unsupervised:

. . . yeah, if [the neighbors] see a stranger or

something walking into your apartment or

looking for someone, everybody will pretty

much say, ‘‘Well, we’ll keep an eye out,

hold on, we’ll keep an eye out, there’s

a new guy in the area, we don’t know

him.’’ [They] were just gonna keep an eye

on him to make sure he wasn’t there to do

any harm to anybody that lived out in the

area.

Interestingly, many controls also said at least

some neighbors could be counted on to help keep

their children safe when violence was about to

occur. For example, Scola, a control who reported

feeling unsafe while living at her public housing

address, nonetheless maintained that one of the

redeeming qualities of the experience was that war-

ring gang members looked out for children when

violence was imminent. She explained, ‘‘If some-

thing is to happen or they get ready to shoot or

whatever, they’ll go right there, go around and be

like, ‘Take the kids in the house. Everybody take

the kids in the house.’’’ This is in contrast to

Scola’s current neighborhood—a high-poverty

neighborhood she has lived in for nearly 10

years—where she said people begin shooting with-

out warning while children are outside.

In addition to fostering a sense of community

and reducing parenting demands, experimentals

said living in a low-poverty neighborhood

increased their sense of self-worth and their moti-

vation to improve themselves, in part, because

they were surrounded by neighbors who were doing

positive things. Sonya described neighbors in her

low-poverty neighborhood, where she lived for

four years, as ‘‘respectable people’’ who held steady

jobs and owned their homes. Similarly, Peaches, an

experimental who also spent four years in her

placement neighborhood, told us ‘‘most of the

adults were workers, you know. They were home-

owners, you know. So they were doing something

positive.’’ The frequency with which experimentals

used the words ‘‘respectable,’’ ‘‘decent,’’ or

‘‘hardworking’’ to describe their neighbors in low-

poverty areas is notable, as is the pride they showed

when relating these descriptions. As indicated ear-

lier, respondents repeatedly note that these neigh-

borhoods contained homeowners—people who

have a special dose of concern for the neighbor-

hood, who ‘‘stick together’’ and who ‘‘care’’ enough

to invest time and energy to keep the neighborhood

clean and safe.

Experimentals were approving of these neigh-

bors, emulated them, and articulated that they

encouraged them to strive for more. Peaches

alluded to the greater sense of efficacy that came

from living in new surroundings:

And living in that area motivated me to get

more. I was still going to school, and I just

wanted more because I saw these people

get in their cars everyday, you know. Their

houses were immaculate, the yards were

done. I mean, you know, it’s like, God I

want that. I want more, you know, this is

a positive thing here. I got to get more.

Tina, an experimental still living in her low-

poverty neighborhood at the time of the qualitative

interview, also spoke to a behavioral change she as-

sociates with moving from the projects to the

Baltimore suburbs:

I’m more settled, I’m not as wild and wide

open as I was when I was in the city. In the

city, I stayed in the streets more. I did

work—that’s one thing. [But] it was basi-

cally all about drinking and hanging out.

Out here you gonna be responsible because

everyone I’m surrounded [with] works and

is responsible, you know? And it’s not

a bunch of sitting around and gossiping

about negative stuff.

Niecy, described previously, thought the resi-

dents of the project where she once lived seemed

to lack the ability to improve their situation, unlike

the residents of her ‘‘beautiful’’ placement neigh-

borhood: ‘‘[The projects] was everything where

people lived that just couldn’t help themselves,

didn’t care how to help themselves.’’

Correspondingly, many controls reported their

high-poverty neighborhoods failed to motivate

them and often described those who inhabited the

neighborhood’s public spaces as ‘‘worthless,’’ ‘‘dis-

gusting,’’ and ‘‘about nothing.’’ Rachel, a control,

recounted, ‘‘I really didn’t socialize with anybody

down there [in the projects]. [But] that’s one of

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the things that allowed me to continue to use drugs,

’cause I was always looking at people that was

worse than me, instead of looking at people that

were better, that were doing better than me.’’

Notably, Rachel subsequently managed to move

to a much lower-poverty neighborhood, albeit not

through MTO, and has managed to leave drugs

behind, a success she attributes to the change in

her neighborhood environment.

Both experimentals and controls also reported

that residence in high-poverty communities could

engender shame and that moving from these neigh-

borhoods may have diminished shame and

increased well-being. For example, thinking back

on her time in the projects, Amy, the experimental

described previously who reported a host of mental

health problems, said, ‘‘[The projects], high rise is

terrible. Yeah, I really felt the scorn of living there.

I was too ashamed to even get off the bus [in case I

would be] identified with the building.’’ Tammy,

a control (quoted previously) who nonetheless

moved out of public housing after random assign-

ment, also made explicit the psychological impact

that living in a high-poverty neighborhood had on

her sense of self-worth and efficacy:

That was the worst experience that I ever

experienced, living in an environment which

made you feel trapped, caged, and worthless,

just stuck into the atmosphere of absolutely

no progress. It was a whole little community

of pure dissatisfaction in everything. No one

encouraged no one.

These feelings of worthlessness, engendered by

the poor physical and high-risk social environment,

could take a palpable toll. Tammy said the only

cure, in her view, was to find a way out of her

high-poverty neighborhood ‘‘because I knew that

in depression . . . I became stabilized in my depres-

sion. . . . I knew I could not do anything as long as I

was trapped in that situation.’’

Lack of violence and criminal activity. The lack of violence and criminal activity in the low-pov-

erty neighborhoods, and the pervasiveness of vio-

lence and criminal activity in the high-poverty

neighborhoods, may also have contributed to

improved mental health among experimentals.

Nearly two-fifths of controls spontaneously re-

counted how they witnessed shootings while liv-

ing in high-poverty neighborhoods, nearly three-

fifths reported seeing drug activity, and a smaller

number claimed resorting to violence to defend

themselves. Virtually no experimentals reported

these events in their low-poverty neighborhoods.

Tammy, a control quoted earlier, told us, ‘‘I’ve

seen people lying on the steps with bullet wounds

in their chest. I’ve seen people jump out of cars

and get beat.’’ Likewise, Scola, also quoted earlier,

described witnessing a young child get shot and

killed in the street just outside her front door.

LaNeesha recalled her three years in a high-poverty

area as ‘‘pure unadulterated hell’’ and described the

project and surrounding area where she had lived:

‘‘It was right in the heart of drug territory and I

mean just, oh, it was bad. It was bad. Nobody both-

ered me because I wasn’t no snitch. But people

would break into people’s houses and stuff and

steal the stuff.’’

Scola, quoted previously, like LaNeesha who

didn’t ‘‘snitch,’’ outlined keys to survival in her pro-

ject neighborhood: ‘‘In order for you to survive . . . ,

you had to know somebody, or you have to be

brought up down [there] or born down there or

had a family member down there. And you also

had to know how to fight because if you didn’t,

you wasn’t going to make it.’’ Kenya told us,

‘‘You would have to defend yourself all the time,

be on the defensive side all the time.’’ Such reports

were nearly absent in accounts of experimentals’

low-poverty neighborhoods.

Other controls isolated themselves from their

neighbors to cope with these risks. Patty explained,

‘‘I felt as though if I didn’t socialize with these peo-

ple, I wouldn’t have a problem.’’ Wendy, the con-

trol who reported depression resulting from her

sons’ incarcerations, described her philosophy:

‘‘See, I’m like this: I live in the inside, I don’t

live out[side].’’

Despite these strategies, however, living in

high-poverty neighborhoods was still stressful

and could place families at risk of mental health

difficulties. Jacquelyn, quoted earlier, revealed

she felt ‘‘blessed’’ to escape her baseline neighbor-

hood, where drugs and violence were rampant and

escalating:

I was living [in] what they call the danger

zone. . . . You don’t know how bad I wanted

to get out of that place . . . I got out just in

time, because it had gotten even worse

than it was when I first moved in . . . , it

got real bad. There was shooting and all

that. By me living on the corner, all the junk-

ies and all hung right on that corner. So I was

glad when I got that [MTO] apartment.

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Jacquelyn also told us participating in MTO

made her feel like ‘‘somebody’s looking out for

me,’’ even though she had to move on from her

MTO placement unit when her landlord sold the

property. Nonetheless, despite recent financial

and health problems, she says the experience of liv-

ing in the low-poverty neighborhood for a little

more than three years was pivotal. Now, she claims,

she feels calm and peaceful ‘‘all the time.’’

Neighborhoods as childrearing environments. The challenges of childrearing in high-poverty

neighborhoods go beyond our earlier discussion

of collective efficacy. Fully one-third of controls

explicitly said the neighborhood they lived in at

the time of random assignment was unsafe for

children, and many of the others did not explicitly

report unsafe environments but reported these

neighborhoods were, as LaNeesha argued,

‘‘lousy’’ places to raise children. The controls ex-

plained that their children witnessed crimes, were

victims of crimes, or got into fights, especially

while living in public housing developments. For

experimentals, the better childrearing environ-

ments in the low-poverty neighborhoods may

have lowered parenting stress and thus improved

mental health.

Tammy, whom we quoted earlier as having seen

people getting shot and beat up, told us, ‘‘You could

not raise a child or children in the projects. It was

just unthinkable. What could you teach them?

‘Don’t kill,’ when there’s killing going on? [Tell

them] ‘don’t kill,’ when you are willing to kill

somebody because you’re afraid for yourself?’’

Similarly, LaNeesha recounted the high level of

violence that her daughter could not avoid seeing:

It was real bad. I mean it was bad for [my

daughter] because anytime you go in the

playground and you see dead bodies and

you keep on playing, you know, or you just

see death, you see people get shot in the

head, knife wounds and stuff. . . . It tough-

ened her up.

Likewise, Pam, a control who stayed in the pub-

lic housing development she was living in when she

enrolled in MTO, revealed how having to raise her

kids in a high-poverty neighborhood caused nearly

constant worry:

The neighborhood, no, I don’t like it. Not for

my family. I don’t like it. . . . The drugs . . .

and the killings. [I tell my son], ‘‘When you

see them [neighborhood youth] up there

doing something wrong, selling the drugs

and all that, move away from ’em. Just . . .

remove yourself and take a walk. Do what-

ever. Come back when you think it’s cool.

But for real, don’t even be around them.’’

’Cause I don’t trust none of ’em. I don’t trust

none of ’em around here. . . . Worrying about

my kids and getting them away from here,

that really, that take a toll on me a lot.

Importantly, it was not just the violence that

made parenting difficult in these high-poverty

areas. Scola, a control, left the project she lived in

at random assignment due to demolition, but

landed in another project—a low-rise. Neither

environment, she says, is a good place for her chil-

dren to grow up.

It affects ’em in a big way, ’cause they don’t

have no opportunities here. None whatso-

ever. . . . Every neighborhood or wherever

you go has its problems. . . . But it’s how peo-

ple do things and how they go about doing

things that makes a difference or a big

impact on the children around them. . . .

And here in this [building], the things that

go on, the things that the kids down here

see, it’s not really nothing positive about,

about, or nothing positive that they see going

on.

LaNeesha also explained how the social envi-

ronment of high-poverty neighborhoods was not

conducive to raising children:

The parents [in this neighborhood] are

ghetto. You know what I mean by ghetto

mentality is that they don’t parent . . . ,

they be outside drinking beer, smokin’

weed, watching their kids and stuff like

that. . . . Mine deserve better. And it’s hard

on [my daughter] because she wants to go

out here and play. She got a bike and stuff

like that, but I wouldn’t trust her [to be

safe in the neighborhood] as far as I can

spit. . . . I gained more weight since I’ve

been here because I’ve been miserable.

LaNeesha said she suffered from bouts of

depression and expressed often feeling hopeless,

worthless, and restless. No doubt, a number of fac-

tors (including childhood sexual abuse, growing up

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with drug- and alcohol-addicted parents, and

a recent stint of homelessness) contributed to

LaNeesha’s poor mental health, but the stressful

neighborhood environment—and the parenting

stress it incurred—may have contributed to her dif-

ficulties as well.

Some controls, like LaNeesha, employed spe-

cific strategies to keep their children safe, such as

not letting them play outside, closely supervising

their outside activities, putting restrictions on

what friends they could spend time with, and

imposing early curfews. Marvelle, still living in

the same public housing neighborhood as at base-

line, says she spends a lot of time encouraging

her son to stay away from dangerous people or

street corners. She also reported giving her son

money so that he is not tempted to sell drugs.

But, as we saw in a prior section, some controls

were simply too dispirited to attempt to protect

their children.

Notably, a few controls made their way out of

these dangerous neighborhoods with the goal of

protecting their children. Rachel, for example,

moved out of her high-poverty neighborhood by

working three jobs ‘‘to get away from there and

save my son and save my daughter from being

a part of that lifestyle.’’ Unfortunately, however,

without the aid of the MTO program, most could

not manage a radical move to a low-poverty neigh-

borhood, even if they desired to improve the envi-

ronment in which they raised their children.

In contrast, many experimentals specifically

noted their low-poverty residences were safe and

decent places to raise their children. Almost all

said they felt safe while outside at night, walking

to the store, or walking home from the bus stop,

and only one specifically reported feeling unsafe

in her low-poverty neighborhood. In particular,

the lack of negative public behavior—groups of

men hanging out on the corner or neighbors who

‘‘bring their business out into the street’’ by shout-

ing and cursing out their children, kin, or romantic

partners in public—often translated into assess-

ments that the neighborhood is ‘‘decent’’ and

a good place to raise children. In many cases, ex-

perimentals reported that perceived safety of chil-

dren translated to increased calm and peaceful

feelings.

Experimentals’ accounts of their placement and

current neighborhoods were often strikingly differ-

ent than their recollections of the high-poverty

neighborhoods where they once lived and the chal-

lenges of parenting in such environments. Coco, an

experimental respondent described previously, told

us her son was jumped by other children in the

housing development in which she lived: ‘‘I was

afraid to let [my children] out much when we lived

[in the projects]. You never know when somebody

start shooting. The guys were shooting crack, found

these things all in the hallway. You just never knew

when something was going to happen.’’ Though

Coco reported struggles with depression and was

under the care of a psychiatrist when we spoke

with her, she says both she and her children felt

a ‘‘burden’’ lifted off of them when they moved

into their MTO placement neighborhood. Here

was a place she felt she could parent well.

Likewise, Amy, described previously, also says

she forbade her children to play outside in her base-

line public housing neighborhood, but ‘‘all of that

changed when I moved [with the MTO voucher].

They had their freedom and stuff.’’ Jacquelyn ex-

pressed her satisfaction in this way: ‘‘And it makes

me feel good that I can come home from work and

come in a nice neighborhood and not see drug ad-

dicts on the corner, and hollering and screaming

and cursing and all that, you know, bring my child

up in a decent neighborhood.’’

Of course, not all experimentals rated their

MTO address as a uniformly positive experience

for their children. Negative assessments usually

occurred among respondents whose MTO place-

ment neighborhoods were in rapid decline, which

was not uncommon in the inner suburban ring of

Baltimore. Across the MTO cities, a substantial

number of neighborhoods that qualified as ‘‘low-

poverty neighborhoods’’ under MTO guidelines,

which were based on the 1990 census, showed sub-

stantial decline by 2000 (Clampet-Lundquist and

Massey 2008; Orr et al. 2003). For example,

Peaches said her feelings about the neighborhood

as a place to raise her children changed as the

neighborhood changed. As the area took a turn

for the worse, her daughter began participating in

neighborhood fights, Peaches’ house was broken

into by a group of teenagers, and her son’s head

was split open after getting hit by a rock.

Overall, however, experimentals rated their

new neighborhoods as excellent places to raise

children and felt these communities offered them

a chance to parent their children in the way they

wanted to—in a manner more consistent with their

images of what kind of environments good parents

ought to provide for their children. The changes in

the social and physical environment, in addition to

the previously discussed sense that one could count

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on others to watch out for the neighborhood’s chil-

dren, seems to have relieved some of the stress and

mental strain of parenting for the experimentals. As

Peaches told us:

Oh God, when I first moved in . . . everything

was just so neat, clean, and well kept and

quiet and peaceful, I was like ‘‘Thank you

God. This is what I have been waiting for,’’

you know? And when I first moved in the

house, I just cried. I just really cried. I was

like ‘‘Oh my God, a house. Now I can raise

my family in the way I want to raise them,’’

you know?

Sources of Increased Stress

Although most respondents explicitly said a move

to a low-poverty neighborhood through an MTO

voucher relieved their stress, relocating produced

added stress for some. Typically, new sources of

stress were related to navigating the private hous-

ing market, with which few experimentals had

had much experience prior to their low-poverty

move. Finances were often a concern, especially

when winter utility bills, which they did not have

to pay in public housing, arrived or when the land-

lord increased the monthly rent (allowable after one

year). Peaches, for example, was forced out of her

home when her landlord raised the rent to an unaf-

fordable level. When asked what stressed her out

about the move, she said:

The whole thing [about] losing the house. I

was really attached to that house. That house

was like everything to me. . . . It was really

—it was crushing. And I just didn’t get

over that right away. And my mother would

say, ‘‘You need to let that thing go. Just let it

go and I just could not let it go.’’ I just stayed

with it, you know. And that was the real

thing that pushed me into that depressed

period in my life.

Similarly, Theresa, who only stayed in her

placement neighborhood for a year and a half, ex-

plained she moved because she could not afford

the utility bills and rent. She discussed the stress

it caused:

Moving to Opportunity. It was more like

moving—I hate to say it, but it was more

like moving to hell, to me. Because I’d

a did better [financially] just staying in the

projects. At least I had money to buy clothes

and everything else. When I got in that house

I couldn’t hardly buy nothin’. All my money

went to the rent, gas and electric, and when I

could pay the water bill, because sometimes

I couldn’t pay it.

Other experimentals expressed stress about

keeping up their new homes and, for those living

in duplexes or single-family homes with lawns,

maintaining the grounds (e.g., trimming the

bushes, mowing the lawn) to the standards of their

new communities. Peaches recounted the stress

associated with keeping up her new unit in the sub-

urbs, where she was supposed to care for the

grounds:

With the house, it’s a whole lot [of mainte-

nance]. . . . I had to trim the bushes, mow

the grass, you know, make sure the upkeep-

ing was kept up. And that’s what you are

supposed to do when you have a house. . . .

Working at night, taking care of house, and

doing the kids, and try to have time for

myself was impossible. And I was just really

stressed out. I mean, I had changed physi-

cally; I was losing hair. I had tremendous

bags under my eyes. I was just really going

through a bad stage.

Another added stressor noted by some experi-

mentals involved transportation. Most inner-city

neighborhoods, if nothing else, are well served by

public transportation, compared to some suburban

locales. Tisha, who only stayed in her placement

neighborhood for a year, explained:

I couldn’t stay in the County because I didn’t

have transportation. So I had to get back into

the City where more buses run on a frequent

basis than in the County. . . . If you missed it

[the bus in the county] . . . the next bus comes

an hour and half to two hours later. So that

was ridiculous, and there was a lot of stress.

And when I moved back to the city, I told my

sister, I said, ‘‘I feel so good.’’ And, much as I

hate the bus, I was never so happy to be back

in the city where I could catch any bus to get

me anywhere I needed to get to.

Finally, some experimentals identified that

moving away from friends and family was

Turney et al. 15

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associated with increased stress. Others, though,

noted that moving away from draining ties actually

was a relief (for details, see Kissane and Clampet-

Lundquist 2012). All in all, the increased sources of

stress described in this section were real, but re-

spondents who shared stories of this kind almost

always pointed to aspects of the low-poverty neigh-

borhoods as sources of decreased stress as well. It

also should be said that these stressors seemed to

be of a lesser caliber than those the controls contin-

ued to manage.

DISCUSSION

In this article, we use qualitative data from in-

depth, semi-structured interviews with MTO par-

ticipants in Baltimore (n = 67) collected six to

nine years after random assignment to better under-

stand the processes through which neighborhoods

may improve adult mental health, an outcome

that has great implications for family processes,

child well-being, and social policy. We systemati-

cally examine narratives drawn from those in the

experimental group who moved to a low-poverty

neighborhood through the MTO program, as well

as from individuals assigned to the control group

who likely would have moved through the program

if given the opportunity. We find that though both

experimentals and controls reported a wide array

of traumatic experiences, stressful life events, and

mental health challenges, experimentals spoke of

improved physical environments that were both

directly and indirectly related to their mental

health. Additionally, experimentals reported

improved social environments—characterized by

greater neighborhood collective efficacy and pride,

less pervasive violence and criminal activity, and

better childrearing environments—that contributed

to their improved mental health.

As should be evident from the narratives pre-

sented here, MTO participants are far from a ran-

dom slice of the American population, or even

the population in poverty, and this fact has some-

times been lost in debates surrounding the impacts

of MTO. For some, underlying stressors and mental

health problems were a large part of why they

ended up in, or remained in, public housing. For

others, it was primarily the exposure to high-

poverty neighborhoods that generated these

challenges. And for many, both were no doubt

occurring simultaneously, making many MTO par-

ticipants incredibly vulnerable.

Having to deal with stressful events and circum-

stances is a common experience for the poor and

non-poor alike. But what often differentiates the

poor from others is the nature of these stressors

and the resources at their disposal to help cope

with them. As outlined previously, without a doubt,

the experimentals and controls faced both common

and extraordinary stressors currently and in the

past. They had family members, friends, and boy-

friends who often had serious health and/or addic-

tion problems; they had taxing jobs that did not

pay enough and frequently conflicted with the de-

mands of home; and they faced daily and signifi-

cant financial strain and hardships. Like the

controls, the death or incarceration of loved ones,

incidents of domestic violence, and exposure to

violent crime were common in the lives of experi-

mentals. This vulnerability, evidenced by the high

incidence of stressors and mental health issues for

both groups of women, makes the significant men-

tal health effects of the experimental group even

more remarkable and may help explain why the

MTO demonstration did not markedly improve

outcomes in other areas (e.g., employment).

In addition, in line with stress process theory,

the respondents experienced stressors associated

with the physical and social environments of their

neighborhoods. For many controls, in particular,

who were living in substantially more disadvan-

taged neighborhoods than experimentals years

after random assignment, they had to deal with

the stress of living in dangerous and drug-riddled

neighborhoods that threatened both their safety

and the safety of their families, prompting many

to express they wanted to move (e.g., Scola,

Ethel). Though, certainly, some experimentals

eventually moved to neighborhoods where they re-

mained stressed about their and their children’s

safety, most did perceive improvements in this re-

gard after moving through MTO. By and large,

they reported their residences and neighborhoods

were clean, peaceful, and safe for themselves and

their children, and that these improved physical

and social environments had positive psychologi-

cal effects.

There were also indirect benefits and, perhaps,

a reduction in secondary stressors associated with

improved neighborhood conditions. For one, mov-

ing to a low-poverty neighborhood was a source of

enhanced self-efficacy and reduced shame. In addi-

tion, many respondents told us that in their

improved neighborhoods, they could finally parent

their children in the kind of environments they

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believed were ideal. Both experimentals and con-

trols relied on their neighbors to keep their children

safe (experimentals were more likely to say so,

however), but the same level of child monitoring

across two very different environments may yield

sharply different results when it occurs within envi-

ronments where the stakes are much different. In

high-poverty neighborhoods, having a neighbor

with a watchful eye may possibly prevent a child

from falling victim to random violence or witness-

ing a crime (and it also might not). Absent the high

incidence of these high-stakes problems, a watchful

eye in a low-poverty neighborhood may possibly

prevent minor injuries and fighting among chil-

dren. And, removed from high-crime neighbor-

hoods with low collective efficacy, the

experimentals, perhaps, could feel safe enough to

leave their homes and interact with others. Given

the strength of the contrasts with the controls and

the myriad of ways respondents said moving

brought relief, the sharp increases in mental health

may be less surprising. Our findings suggest that

scholars interested in neighborhood effects on

mental health, who traditionally rely on social dis-

organization theory (Sampson and Groves 1989),

may consider stress theory (and, specifically, stress

proliferation theory) along with social disorganiza-

tion theory to shed insight into causal processes

linking neighborhoods to mental health.

Our findings highlight the need for sociologists

to theorize more aspects of neighborhoods that

urban planners have spent considerable time under-

standing—namely, aesthetics. When urban sociol-

ogists and neighborhood effects researchers

discuss how physical aspects of the urban ecology

are important to well-being, often they are con-

cerned about poor families’ proximity to amenities

(e.g., social services, supermarkets, banking, or

transportation) or their perception and navigation

of degraded physical space (e.g., ill-lit streets lit-

tered with garbage, drug paraphernalia, and graf-

fiti). What seems to be lost is how perceptions of

what is ‘‘beautiful’’ may actually enhance mental

well-being. Although this article cannot unpack

how pleasing aesthetics may improve mental

health—that is, whether perceiving one is living

in a ‘‘beautiful’’ space leads directly to improved

self-worth or decreased stress or whether it impacts

neighborhood satisfaction and this leads to

improved mental health (as others have suggested,

cf. Leslie and Cerin 2008)—the narratives of the

women in this study suggest that they associate

moving from ‘‘prison-like’’ concrete complexes to

areas with green spaces, well-kept blocks, and

‘‘beautiful’’ homes with improving their mental

health.

Furthermore, epidemiologists, medical sociolo-

gists, and public health scholars have for some time

emphasized how housing conditions impact physi-

cal health (e.g., the likelihood of lead poisoning and

asthma). Our findings indicate that perceptions of

the quality and nature of one’s housing seem to

relate to one’s sense of worth and depressive symp-

toms. This is a point that may be missed by focusing

on neighborhood-level effects on well-being. In

essence, our results suggest that ‘‘neighborhood

effects’’ may operate not only at the census tract

or block level but also in terms of the physical lay-

out and characteristics of homes in neighborhoods.

Despite the compelling narratives offered by

MTO respondents, several limitations must be

kept in mind when interpreting our findings. First,

all individuals in our analytic sample self-selected

into the MTO program (Clampet-Lundquist and

Massey 2008). This means that all were, at one

time or another, interested in leaving their public

housing unit. It is also possible the controls, frus-

trated and feeling helpless by their not being chosen

to receive a MTO housing voucher, experienced

increased stress after MTO. Surely, this is possible,

but this theme did not appear in our narratives.

Second (and relatedly), the mental health bene-

fits associated with MTO potentially conflate mov-

ing to a low-poverty neighborhood and leaving

public housing. Although also plausible, we sus-

pect the benefits are indeed more about moving

to low-poverty neighborhoods than about getting

out of public housing. Recall that members of the

Section 8 group, who primarily remained in high-

poverty neighborhoods, did not exhibit the mental

health gains the experimentals did. Those Section

8 group members in the qualitative study (analysis

not shown) only rarely discuss notable improve-

ments in neighborhood aesthetics, collective effi-

cacy, self-worth and self-efficacy, violence and

criminal activity, or environments for raising their

children after moving out of the projects with their

unrestricted Section 8 vouchers. Moreover, the

majority of controls (about 80 percent) had also

left public housing by the time of the qualitative in-

terviews—further suggesting that it is a low-poverty

move that matters for mental health, as it more rad-

ically changes individuals’ physical and social con-

text, not just getting out of public housing.

Third, we do not have diagnostic measures of

depression for our qualitative respondents at the

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time of the qualitative interview, and it is possible

our respondents who discuss mental health prob-

lems or report improved mental health are those

who did not meet the criteria in the first place.

However, diagnostic (and dichotomous) measures

of depression are limited, and indeed, any dimen-

sional improvement in mental health may improve

well-being (Mirowsky and Ross 2002). Finally, in

some cases, we use women’s retrospective ac-

counts of prior neighborhoods, and it is possible

that recall bias affects their discussion of these

neighborhoods. However, given nearly all MTO

participants, both experimentals and controls,

moved from their baseline neighborhoods by the

time of the qualitative interview, we would not

expect recall bias to differentially affect experi-

mentals and controls.

Despite these limitations, these findings have

several policy implications. For one, when design-

ing or implementing housing policy, policymakers

should be attentive to the debilitating mental health

conditions reported by public housing residents and

perhaps consider mental health interventions as

part of their services. Additionally, in the context

of housing redevelopment programs, policymakers

should consider stressors associated with moving

and offer services to mitigate or eliminate some

of these stressors. Moreover, our findings suggest

the physical and social characteristics of neighbor-

hoods, as well as the physical condition of housing,

have important implications for quality of life and,

accordingly, mental health. As such, our findings

suggest promise for both place-based policies that

improve such environs in high-poverty neighbor-

hoods but also for those that help poor families

move to neighborhoods where such environs

already exist.

APPENDIX

We match 18 experimental noncompliers to 19 likely con-

trol noncompliers, with the reasoning that both the exper-

imental and control groups would have the same fraction

of adults who would not use the voucher to move. We use

STATA to first select 100,000 random samples of 19 re-

spondents in the control group. For each of these 100,000

random samples, we compare the distribution of 14 demo-

graphic, neighborhood, and employment covariates to

that of the 18 experimental noncompliers (e.g., age, num-

ber of children, high school dropout). The 19 likely con-

trol noncompliers is the sample that is most similar to the

18 experimental noncompliers, with similarity defined as

the sum of the difference in means for each variable

divided by the control group standard deviation for that

variable (essentially, the sum of the difference between

groups in the average z-scores for the 14 covariates).

Each variable receives equal weight in the calculation.

Based on this matching procedure, we select a group

of control noncompliers that are similar, on average, to

the experimental noncompliers. The qualitative analysis

excludes experimental noncompliers and control

noncompliers.

ACKNOWLEDGMENTS

We are grateful to Todd Richardson and Mark Shroder of

the Department of Housing and Urban Development; to

Eric Beecroft, Judie Feins, Barbara Goodson, Robin

Jacob, Stephen Kennedy, Larry Orr, and Rhiannon

Patterson of Abt Associates; to our collaborators Jeanne

Brooks-Gunn, Greg Duncan, Lawrence Katz, Tama

Leventhal, Jeffrey Liebman, Jens Ludwig, and Lisa

Sanbonmatsu; to staff members of the Moving to

Opportunity Qualitative Study Project; to research assis-

tant Jana Pohorelsky; and to Susan Clampet-Lundquist

and Stefanie Deluca for feedback.

FUNDING

The author disclosed receipt of the following financial

support for the research, authorship, and/or publication

of this article: Primary support for this research was pro-

vided by grants from the Russell Sage Foundation and the

William T. Grant Foundation.

NOTES

1. The federal government uses Section 8, currently

known as the Housing Choice Voucher (HCV), to

deconcentrate its federally subsidized housing units.

Households employ the HCV in the private housing

market; thus, they may locate wherever they choose,

as long as they find a willing landlord and the rent

falls within the range covered by their voucher and

income. Tenants pay a portion of the rent based on

their income, with the government covering the

remainder up to a certain threshold. We use Section

8 (rather than HCV) terminology in this article, as

the study’s respondents used this language in the

interviews.

2. Thus, not all individuals assigned to the experimental

group used their voucher to move to a low-poverty

neighborhood. Participants had a limited period (typ-

ically 120 days) to use the voucher and sometimes re-

ported difficulty finding a suitably sized unit in a low-

poverty neighborhood or a landlord who would accept

the voucher. It is also possible participants in the

experimental group changed their mind about wanting

to move from public housing.

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3. To protect confidentiality, we refer to all respondents

by the pseudonym they chose prior to the interview.

We also eliminated any information in the quotes

that could identify respondents.

REFERENCES

Aneshensel, Carol S. and Clea A. Sucoff. 1996. ‘‘The

Neighborhood Context of Adolescent Mental

Health.’’ Journal of Health and Social Behavior 37:

293-310.

Boardman, Jason D., Saint Onge Jarron M., Richard G.

Rogers, and Justin T. Denney. 2005. ‘‘Race

Differentials in Obesity: The Impact of Place.’’

Journal of Health and Social Behavior 46:229-43.

Briggs, Xavier de Souza, Susan J. Popkin, and John

Goering. 2010. Moving to Opportunity: The Story of

an American Experiment to Fight Ghetto Poverty.

New York: Oxford University Press.

Browning, Christopher R, and Kathleen A. Cagney. 2003.

‘‘Moving Beyond Poverty: Neighborhood Structure,

Social Processes, and Health.’’ Journal of Health

and Social Behavior 44:552-71.

Charmaz, Kathy. 2006. Constructing Grounded Theory:

A Practical Guide through Qualitative Analysis.

Thousand Oaks, CA: Sage Publications.

Clampet-Lundquist, Susan and Douglas S. Massey.

2008. ‘‘Neighborhood Effects on Economic

Self-sufficiency: A Reconsideration of the Moving

to Opportunity Experiment.’’ American Journal of

Sociology 114:107-43.

Coyne, James C.1976. ‘‘Depression and the Response of

Others.’’ Journal of Abnormal Psychology 85:186-93.

Curry, Aaron, Carl Latkin, and Melissa Davey-Rothwell.

2008. ‘‘Pathways to Depression: The Impact of

Neighborhood Violent Crime on Inner-city

Residents in Baltimore, Maryland, USA.’’ Social

Science and Medicine 67:23-30.

Diez Roux, Ana V.2001. ‘‘Investigating Neighborhood

and Area Effects on Health.’’ American Journal of

Public Health 91:1783-89.

Diez Roux, Ana V. and Christina Mair. 2010.

‘‘Neighborhoods and Health.’’ Annals of the New

York Academy of Sciences 1186:125-45.

Downey, Liam and Marieke Van Willigen. 2005.

‘‘Environmental Stressors: The Mental Health

Impacts of Living Near Industrial Activity.’’ Journal

of Health and Social Behavior 46:289-305.

Ellen, Ingrid G., Tod Mijanovich, and Keri-Nicole

Dillman. 2001. ‘‘Neighborhood Effects on Health:

Exploring the Links and Assessing the Evidence.’’

Journal of Urban Affairs 23:391-408.

Geis, Karlyn J. and Catherine E. Ross. 1998. ‘‘A New Look

at Urban Alienation: The Effect of Neighborhood

Disorder on Perceived Powerlessness.’’ Social

Psychology Quarterly 61:232-46.

Kessler, Ronald C., Gavin Andrews, Daniel Mroczek,

Bedirhan Ustun, and Hans-Ulrich Wittchen. 1998.

The World Health Organization Composite

International Diagnostic Interview Short Form

(CIDI SF). International Journal of Methods in

Psychiatric Research 7:171-185.

Kessler, Ronald C., Gavin Andrews, Lisa J. Colpe, Eva

Hiripi, Daniel K. Mroczek, Sharon-Lise T.

Normand, Ellen E. Walters, and Alan M. Zaslavsky.

2002 ‘‘Short Screening Scales to Monitor Population

Prevalences and Trends in Non-specific Distress.’’

Psychological Medicine 32:959-76.

Kessler, Ronald C., Patricia Berglund, Olga Demler,

Robert Jin, Doreen Koretz, Kathleen R. Merikangas,

A. John Rush, Ellen E. Walters, and Philip S. Wang.

2003. ‘‘The Epidemiology of Major Depressive

Disorder: Results from the National Comorbidity

Survey Replication (NCS-R).’’ Journal of the

American Medical Association 289:3095-105.

Kim, Joongbaeck. 2010. ‘‘Neighborhood Disadvantage

and Mental Health: The Role of Neighborhood

Disorder and Social Relationships.’’ Social Science

Research 39:260-71.

Kissane, Rebecca Joyce and Susan Clampet-Lundquist.

2012. ‘‘Social Ties, Social Support, and Collective

Efficacy among Families from Public Housing in

Chicago and Baltimore.’’ Journal of Sociology and

Social Welfare 34(4):155-179.

Kling, Jeffrey R., Jeffrey B. Liebman, and Lawrence F.

Katz. 2007. ‘‘Experimental Analysis of Neighborhood

Effects.’’ Econometrica 75:83-119.

Latkin, Carl A. and Aaron D. Curry. 2003. ‘‘Stressful

Neighborhoods and Depression: A Prospective

Study of the Impact of Neighborhood Disorder.’’

Journal of Health and Social Behavior 44:34-44.

Leslie, Eva and Ester Cerin. 2008. ‘‘Are Perceptions of the

Local Environment Related to Neighbourhood

Satisfaction and Mental Health in Adults?’’

Preventive Medicine 47:273-78.

Leventhal, Tama and Jeanne Brooks-Gunn. 2000. ‘‘The

Neighborhood They Live in: Effects of

Neighborhood Residence on Child and Adolescent

Outcomes.’’ Psychological Bulletin 126:309-37.

Ludwig, Jens, Greg J. Duncan, Lisa A. Gennetian,

Lawrence F. Katz, Ronald C. Kessler, Jeffrey R.

Kling, and Lisa Sanbonmatsu. 2012. ‘‘Neighborhood

Effects on the Long-term Well-being of Low-income

Adults.’’ Science 337:1505-10.

Macintyre, Sally, Anne Ellaway, and Steven Cummins.

2002. ‘‘Place Effects on Health: How Can We

Conceptualise, Operationalise and Measure Them?’’

Social Science and Medicine 55:125-39.

Mair, Christina, Ana V. Diez Roux, and Sandro Galea. 2008.

‘‘Are Neighborhood Characteristics Associated with

Depressive Symptoms? A Review of Evidence.’’

Journal of Epidemiology and Community Health 62:

940-46.

Turney et al. 19

at ASA - American Sociological Association on March 18, 2013smh.sagepub.comDownloaded from

Mair, Christina, Ana V. Diez Roux, and Jeffrey D.

Morenoff. 2010. ‘‘Neighborhood Stressors and Social

Support as Predictors of Depressive Symptoms in the

Chicago Community Adult Health Study.’’ Health

and Place 16:811-19.

Miech, Richard Allen and Micahel J. Shanahan. 2000.

‘‘Socioeconomic Status and Depression over the

Life Course.’’ Journal of Health and Social

Behavior 41:162-76.

Mirowsky, John and Catherine E. Ross. 2002.

‘‘Measurement for a Human Science.’’ Journal of

Health and Social Behavior 43:152-70.

Orr, Larry, Judith D. Feins, Robin Jacob, Erik Beecroft,

Lisa Sanbonmatsu, Lawrence F. Katz, Jeffrey B.

Liebman, and Jeffrey R. Kling. 2003. Moving to

Opportunity Interim Impacts Evaluation.

Washington, DC: U.S. Department of Housing and

Urban Development, Office of Policy Development

and Research.

Pearlin, Leonard I.1989. ‘‘The Sociological Study of

Stress.’’ Journal of Health and Social Behavior 30:

241-56.

Pearlin, Leonard I., Carol S. Aneshensel, and Allen J.

Leblanc. 1997. ‘‘The Forms and Mechanisms of

Stress Proliferation: The Case of AIDS Caregivers.’’

Journal of Health and Social Behavior 38:223-36.

Pearlin, Leonard I., Morton A. Lieberman, Elizabeth

Menaghan, and Joseph T. Mullen. 1981. ‘‘The Stress

Process.’’ Journal of Health and Social Behavior 22:

337-56.

Ross, Catherine E.2000. ‘‘Neighborhood Disadvantage

and Adult Depression.’’ Journal of Health and

Social Behavior 41:177-87.

Ross, Catherine E. and John Mirowsky. 2001.

‘‘Neighborhood Disadvantage, Disorder, and Health.

’’ Journal of Health and Social Behavior 42:258-76.

Ross, Catherine E., John Mirowsky, and Shana Pribesh.

2001. ‘‘Powerlessness and the Amplification of

Threat: Neighborhood Disadvantage, Disorder, and

Mistrust.’’ American Sociological Review 66:568-91.

Ross, Catherine E., John R. Reynolds, and Karlyn J. Geis.

2000. ‘‘The Contingent Meaning of Neighborhood

Stability for Residents’ Psychological Wellbeing.’’

American Sociological Review 65:581-97.

Sampson, Robert J.2008. ‘‘Moving to Inequality:

Neighborhood Effects and Experiments Meet Social

Structure.’’ American Journal of Sociology 114:

189-231.

Sampson, Robert J. and W. Byron Groves. 1989. ‘‘Community

Structure and Crime: Testing Social-disorganization

Theory.’’ American Journal of Sociology 94:

774-802.

Sampson, Robert, Jeffrey D. Morenoff, and Thomas

Gannon-Rowley. 2002. ‘‘Assessing ‘Neighborhood

Effects’: Social Processes and New Directions

in Research.’’ Annual Review of Sociology 28:

443-78.

Sampson, Robert J., Stephen W. Raudenbush, and Penton

Earls. 1997. ‘‘Neighborhoods and Violent Crime: A

Multilevel Study of Collective Efficacy.’’ Science

277:918-24.

Sanbonmatsu, Lisa, Jens Ludwig, Lawrence F. Katz, Lisa

A. Gennetian, Greg J. Duncan, Ronald C. Kessler,

Emma Adam, Thomas McDade, and Stacy Tessler

Lindau. 2011. Moving to Opportunity for Fair

Housing Demonstration Program: Final Impacts

Evaluation. Washington, DC: U.S. Department of

Housing and Urban Development, Office of Policy

Development and Research.

Schieman, Scott, Leonard Pearlin, and Stephen C.

Meersman. 2006. ‘‘Neighborhood Disadvantage and

Anger among Older Adults: Social Comparisons as

Effect Modifiers.’’ Journal of Health and Social

Behavior 47:156-72.

Silver, Eric, Edward P. Mulvey, and Jeffrey W. Swanson.

2002. ‘‘Neighborhood Structural Characteristics and

Mental Disorder: Faris and Dunham Revisited.’’

Social Science and Medicine 55:1457-70.

Small, Mario Luis and Katherine Newman. 2001. ‘‘Urban

Poverty after the Truly Disadvantaged: The

Rediscovery of the Family, the Neighborhood, and

Culture.’’ Annual Review of Sociology 27:23-45.

Strauss, Anselm and Juliet Corbin. 1990. Basics of

Qualitative Research: Grounded Theory Procedures

and Techniques. Newbury Park, CA: Sage Publications.

Tienda, Marta. 1991. ‘‘Poor People and Poor Places:

Deciphering Neighborhood Effects on Poverty

Outcomes.’’ Pp. 244-62 in Macro-micro Linkages in

Sociology, edited by J. Huber. Thousand Oaks, CA:

Sage Publications.

Turner, R. Jay and William Avison. 2003. ‘‘Status

Variations in Stress Exposure among Young Adults:

Implications for the Interpretation of Prior Research.

’’ Journal of Health and Social Behavior 44:488-505.

Turner, R. Jay, Blair Wheaton, and Donald Lloyd. 1995.

‘‘The Epidemiology of Social Stress.’’ American

Sociological Review 60:104-24.

Turney, Kristin. 2011. ‘‘Chronic and Proximate Depression

among Mothers: Implications for Child Well-being.’’

Journal of Marriage and Family 73:149-63.

Turney, Kristin, Susan Clampet-Lundquist, Kathryn

Edin, Jeffrey Kling, and Greg Duncan. 2006.

‘‘Neighborhood Effects on Barriers to Employment:

Results from a Randomized Housing Mobility

Experiment.’’ Pp. 137-72 in Brookings-Wharton

Papers on Urban Affairs, edited by G. Burtless and

J. R. Pack. Washington, DC: Brookings Institution

Press.

Wheaton, Blair. 1999. ‘‘Social Stress.’’ Pp. 277-300 in

Handbook of the Sociology of Mental Health, edited

by C. S. Aneshensel and J. C. Phelan. New York:

Springer.

Wheaton, Blair and Philippa Clarke. 2003. ‘‘Space Meets

Time: Integrating Temporal and Contextual

20 Society and Mental Health 3(1)

at ASA - American Sociological Association on March 18, 2013smh.sagepub.comDownloaded from

Influences on Mental Health in Early Adulthood.’’

American Sociological Review 68:680-706.

Wilson, William J.1987. The Truly Disadvantaged: The

Inner City, the Underclass, and Public Policy.

Chicago: University of Chicago Press.

Wodtke, Geoffrey T., David J. Harding, and Felix Elwert.

2011. ‘‘Neighborhood Effects in Temporal Perspective:

The Impact of Long-term Exposure to Concentrated

Disadvantage on High School Graduation.’’ American

Sociological Review 76:713-36.

Ziersch, Anna M., Fran E. Baum, Colin MacDougall, and

Christine Putland. 2005. ‘‘Neighbourhood Life and

Social Capital: The Implications for Health.’’ Social

Science and Medicine 60:71-86.

Turney et al. 21

at ASA - American Sociological Association on March 18, 2013smh.sagepub.comDownloaded from