Mobility Opportunity Vouchers to Eliminate Disparities Study

Last registered on April 16, 2024

Pre-Trial

Trial Information

General Information

Title
Mobility Opportunity Vouchers to Eliminate Disparities Study
RCT ID
AEARCTR-0013232
Initial registration date
April 12, 2024

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
April 16, 2024, 3:18 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

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Primary Investigator

Affiliation

Other Primary Investigator(s)

PI Affiliation
Johns Hopkins Bloomberg School of Public Health

Additional Trial Information

Status
On going
Start date
2024-04-12
End date
2028-10-30
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
The Consolidated Appropriations Act, 2019 (Pub. L. 116-6) and the Further Consolidated Appropriations Act, 2020 (Pub. L. 116-94) authorized HUD to implement and evaluate the Community Choice Demonstration. As described in the Federal Register Notice Docket Number FR-6191-N-01, HUD is implementing a multi-site randomized controlled trial (RCT) to test and evaluate the effectiveness of the Demonstration. The primary purposes of the Demonstration are to provide voucher assistance and mobility-related services to families with children to encourage such families to move to lower-poverty areas, to expand their access to opportunity areas, and to evaluate the effectiveness of the strategies pursued under the Demonstration (AEARCTR-0009805).

The Mobility Opportunity Vouchers to Eliminate Disparities (MOVED) Study builds on the Demonstration and will investigate how and for whom neighborhoods shape obesity and diabetes risk by sampling 900 adults and children enrolled in the Community Choice Demonstration across 3 sites (Pittsburgh, PA; Cuyahoga, OH; and Nashville, TN). Researchers will collect baseline and 2-year follow-up data for one adult and one child in each household in the comprehensive mobility services group and the control group, will assess obesity and diabetes risk among adults (measured BMI and HbA1c) and obesity among children (measured BMI z-score) and will examine mechanisms by which housing mobility may impact health outcomes, including behavioral (adult-diet, physical activity, sleep), psychosocial (adult-mental health, social support), contextual (food outlets, walkability, health care access), and structural (family-racial discrimination, exposure to violence, neighborhood segregation, collective efficacy, utilization of social services) factors using surveys, accelerometry, and geospatial analyses. Specifically, the proposed research aims to:

Aim 1. Investigate (a) the extent to which adults who receive comprehensive mobility services (“treatment group”) exhibit changes in obesity and diabetes risk (BMI and HbA1c) after 2 years compared to a control group (no mobility services), and (b) the extent to which children in the treatment group exhibit changes in obesity (BMI z-score) after 2 years compared to a control group. We will explore whether these relationships vary by baseline characteristics.

Aim 2. Examine whether adults and families in the treatment group exhibit changes in behavioral, psychosocial, contextual, and structural factors after 2 years relative to the control group. We will explore to what extent these factors mediate changes in adult obesity and diabetes risk and changes in child obesity risk.
External Link(s)

Registration Citation

Citation
Deitch, Rachel and Craig Pollack. 2024. "Mobility Opportunity Vouchers to Eliminate Disparities Study." AEA RCT Registry. April 16. https://doi.org/10.1257/rct.13232-1.0
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
MOVED is an observational study that recruits families participating in the Community Choice Demonstration. The Community Choice Demonstration is a multi-site randomized controlled trial that will study the effects of two interventions. The first intervention, Comprehensive Mobility-Related Services (CMRS), will provide a comprehensive set of services that aims to address all of the principal obstacles that housing choice voucher participants experience accessing lower-poverty areas, including financial barriers, knowledge and skill gaps, hesitancy on the part of families to move to opportunity areas, hesitancy on the part of property owners in opportunity areas to participate in the housing choice voucher program, and challenges that affect families’ ability to stay in opportunity areas once there. The second intervention, Selected Mobility-Related Services (SMRS), will test up to three bundles of services selected from the broader CMRS to determine whether they can effectively assist families in accessing opportunity areas at a lower cost. The MOVED study will recruit families who are randomized to receive CMRS and to the control groups. Participants from the SMRS study intervention will not be recruited.
Intervention Start Date
2024-04-12
Intervention End Date
2028-10-30

Primary Outcomes

Primary Outcomes (end points)
Primary outcomes for adults
1) Body Mass Index
2) Hemoglobin A1c

Primary outcomes for children
1) Body Mass Index z-score
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
1) Waist circumference (adults and children), continuous and categorical, measured in-person at the umbilicus using a measuring tape
2) Categorized BMI (adults) based on clinically meaningful cutpoints for obesity
3) Categorized BMI percentiles (children) based on clinically meaningful cutpoints for obesity
4) Categorized Hemoglobin A1c (adult) based on clinically meaningful cutpoints for prediabetes and diabetes.
5) Systolic and diastolic blood pressure, continuous and categorical cut-points based on clinical def-inition
6) Accelerometry measured physical activity, sedentary time, and sleep (adults and children)
7) Eating habits:
a. NCI Dietary Screener converted to predicted daily intake of fruits and vegetables (cup equivalents), added sugars (teaspoons), whole grains (ounce equivalent), fiber (grams), and frequency of red and processed meat consumption using publicly available formulas from the National Cancer Institute
b. Number of meals per week consumed away from home; meals consumed per week from fast food or pizza locations
c. Perception of nutritional environment regarding fruit and vegetables in neighborhood
d. Food shopping habits (i.e., typical stores for shopping, transportation and distance to stores)
e. Frequency of dieting in past year; binge eating behaviors in past year; medication use to lose weight or manage diabetes in past year
f. Eating to Cope using 5 item scale from the Emotional Eating Scale; weight stigma; satis-faction with body weight and shape
g. Home food environment based on 4 items concerning space to prepare meals, store food, have meals as a family, and cook
8) Food security based on the USDA 6-item short form food security survey module; receipt of food assistance (SNAP, WIC, school meals)
9) Physical activity defined as meeting minimal physical activity recommendations using IPAQ; MET minutes per week
10) Perceived walking environment; types of places participants go for physical activity
11) Sleep duration and quality based on 3 items from the Pittsburgh Sleep Quality Index
12) Mental health including screening for depression based on Patient Health Questionnaire-8 and anxiety based on Generalized Anxiety Disorder-2; perceived stress based on the Perceived Stress Scale-4
13) Experiences of discrimination based on Everyday Discrimination Scale
14) Perceived safety of streets during day and night; concerns about gun violence in neighborhood; policing based on 3 items
15) Current tobacco use
16) Frequency of binge drinking
17) Collective efficacy based on the 10 item Collective Efficacy Short Form
18) Bonding social capital (i.e., having friends from different educational and racial or ethnic back-grounds)
19) Perceived social support based on adapted 10 item survey of informal social support
20) Perceived constraints measured using 5 items from the sense of control perceived constraints subscale
21) Predictability based on single item
22) Self-rated happiness
23) Healthcare use and access based on type of insurance coverage; having a usual source of care, time since last check up and time since last dental visit; and overnight hospitalizations in the past 12 months; delays in care
24) Self-rated health
25) Diagnosed conditions including mental health, asthma, diabetes, and hypertension
26) Health-related quality of life measured using the EuroQOL 5-D
27) Transportation, including vehicle access, public transportation, and transportation to food store
28) Housing and neighborhood conditions measured by interviewer observation
29) Geospatial measures such as access to retail food, street connectivity, greenspace
30) Child-focused measures
a. Sugar-sweetened beverage and water intake, assessed using an adapted 9-item Bever-age Intake Questionnaire (BEVQ); frequency of eating breakfast and eating lunch at school; frequency of eating meals as a family
b. Physical activity assessed using single item from CDC Youth Risk Behavior Survey; sports team participation
c. Perceptions of neighborhood substance use
d. Criminal justice involvement using two items from the Family Options Study
e. Sleep quality, assessed using 3 items from the Family Options Study
f. Tobacco use
g. Average screen time and social media use
h. Mental health including depressive symptoms using the 2 item Patient Health Question-naire and anxiety based on 5 item Child Anxiety Related Emotional Disorders (SCARED)
i. Life satisfaction measured using four items from the NIDA Monitoring the Future Study
j. Experiences of bullying
k. Asthma diagnosis and exacerbations
l. Usual source of care; time since last check-up; emergency room use
m. Educational aspirations
n. Social connectedness
o. Perceived safety
p. Weight and body shape satisfaction; diet behavior; binge eating
q. Educational aspirations based on likelihood of graduating high school, vocational school, 2-year and 4-year college
r. Household chaos (i.e., environment interference/noise) measured using 6 items adapted from the Confusion, Hubbub, and Order Scale (CHAOS)
s. Perceived home quality measured using a single question from the HUD Rent Reform Demonstration
t. Perception of the home food environment
u. School-related measures including time spent at school; perception of school; number of schools attended; types of schooling/childcare received; disruptions to schooling (e.g., repeated grades; expulsion, changing schools mid-year, and missing days of school); and transportation and travel time to school
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
To minimize selection bias, we will use an intent-to-treat design, where individuals are analyzed according to the study group to which they were randomized, regardless of whether they moved to a lower-poverty neighborhood.
Experimental Design Details
Not available
Randomization Method
Computer
Randomization Unit
Household
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
900 households
Sample size: planned number of observations
900 adults, approximately 837 children
Sample size (or number of clusters) by treatment arms
450 adults in each treatment arm, 418 children
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
Johns Hopkins Bloomberg School of Public Health Institutional Review Board
IRB Approval Date
2023-06-09
IRB Approval Number
26470
IRB Name
Abt Associates Institutional Review Board
IRB Approval Date
2023-06-09
IRB Approval Number
2243
Analysis Plan

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