Higher Opportunity Neighborhoods Research Articles

Pediatric Burn Unit Admission is Associated with School Holidays and Lower Home Childhood Opportunity Level.

Burn injury can have profound detrimental effects on quality of life and mental health of children. We collected demographics, burn etiology, burn date, and home zip code for pediatric patients admitted to our burn unit from 2016-2023. Age, burn date, and etiology of burn were used to assess temporal and mechanistic patterns of injury for pre-school-age and school-age children. Home zip code was used to determine each child's home Childhood Opportunity Index score, which is composed of sub-domains for Education, Health & Environment, and Social & Economic. We calculated the odds-ratio for odds of pediatric burn admission for each COI sub-domain quintile, using very high opportunity neighborhoods as the reference. Scald was the prevailing burn etiology (64%). In school-age children, July was the month with the most burn injuries (19%), attributable to firework injuries. School-age children were also more likely to be injured in a week without classroom instruction (p<0.001). There was a dose-response relationship between Childhood Opportunity Index and odds of burn admission, with the greatest odds of burn admission observed for children from very low educational opportunity areas (OR 5.21, 95% CI 3.67-7.39). These findings support interventions for burn prevention such as increased education about the dangers of fireworks, addressing inequities in access to childcare and extracurricular activities, and reducing the default water heater temperatures in multi-unit dwellings.

Neighborhood Child Opportunity and Preterm Birth Rates by Race and Ethnicity

In the US, infants born to non-Hispanic Black birthing parents are 50% more likely to be born preterm than those born to non-Hispanic White birthing parents, and individual-level factors do not fully account for this inequity. Neighborhood context, rooted in historic patterns of structural racism, may facilitate understanding patterns of inequity in preterm birth. To estimate the association between neighborhood opportunity level, measured by the Child Opportunity Index (COI), and preterm birth among infants in Massachusetts. In this cross-sectional, population-based study, Massachusetts birth certificates from 3 large metropolitan areas (Boston, Springfield, and Worcester) were linked to US Census tract-level data from the COI, and log binomial regression models and generalized estimating equations were fit to examine associations of different levels of opportunity with preterm birth. Singleton infants born in Massachusetts between February 1, 2011, and December 31, 2015, were included. Analyses were originally conducted in 2019 and updated in 2024. Level of child opportunity (measured by the COI) at the US Census tract level. Race and ethnicity were ascertained from the birth certificate, as reported by the birthing parent. Live birth before 37 completed weeks' gestation. The analytic dataset included 267 553 infants, of whom 18.9% were born to Hispanic, 10.1% to non-Hispanic Asian or Pacific Islander, 10.1% to non-Hispanic Black, and 61.0% to non-Hispanic White birthing parents. More than half of infants born to non-Hispanic Black and Hispanic birthing parents were born into very low opportunity neighborhoods, and in crude models, this was associated with greater prevalence of preterm birth relative to very high opportunity neighborhoods (prevalence ratio, 1.44; 95% CI, 1.37-1.52). After adjustment for covariates, infants born into very low opportunity neighborhoods still had a greater prevalence of preterm birth (prevalence ratio, 1.16; 95% CI, 1.10-1.23). In this cross-sectional study of neighborhood opportunity and preterm birth, elevated risk associated with exposure to a very low opportunity neighborhood, coupled with the disproportionate exposure by race and ethnicity, points to a modifiable factor that may contribute to racial and ethnic inequities in preterm birth. Future research should investigate interventions that seek to address neighborhood opportunity.

Social Determinants of Pediatric Primary Care Telehealth and In-Office Visits During the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic

ObjectiveTo describe the use of primary care telehealth following the rapid reduction of in-person pediatric primary care availability during the severe acute respiratory syndrome coronavirus 2 pandemic and how this varied by community-level social determinants and individual-level social needs. MethodsWe conducted a retrospective cohort study of children 0 to 17 years across 16 sites within Nationwide Children’s Hospital Primary Care Network from March 22 to July 31, 2020, and a preceding comparator period (2019). The study population includes 107,629 patient encounters. We compared visit type (in-person vs telehealth), demographics, presence of individual social needs, and community social determinants using the Child Opportunity Index 2.0 (COI). To assess telehealth utilization, we compared the ratio of 2019 to 2020 primary care visits across levels of COI. We trained a linear regression model predicting the number of telehealth encounters in 2020 using individual patient characteristics and COI. ResultsPatients in census tracts with high and very high levels of opportunity maintained the highest relative encounter volume (2020:2019) at the beginning of the pandemic (0.78 and 0.73, respectively, compared to 65% for children living in very low opportunity neighborhoods; P < 0.001). Patients with caregiver-reported social needs (housing, transportation, utilities, food) had relatively greater telehealth use following the start of the public health emergency. ConclusionsVolume of primary care visits decreased least for high and very high-opportunity neighborhoods yet individual social needs were associated with higher relative use of telemedicine. Findings suggest that telehealth was an important modality to deliver care to children with social needs but does not overcome community-level barriers.

Creating Moves to Opportunity: Experimental Evidence on Barriers to Neighborhood Choice

Low-income families often live in low-upward-mobility neighborhoods. We study why by using a randomized trial with housing voucher recipients that provided information, financial support, and customized search assistance to move to high-opportunity neighborhoods. The treatment increased the fraction moving to high-upward-mobility areas from 15 to 53 percent. A second trial reveals this treatment effect is driven primarily by customized search assistance. Qualitative interviews show that the intervention relaxed bandwidth constraints and addressed family-specific needs. Our findings imply many low-income families do not have strong preferences to stay in low-opportunity areas and that barriers in housing search significantly increase residential segregation by income. (JEL D83, G51, R21, R23, R31, R38)

Association between social determinants of health and pediatric traumatic brain injury outcomes.

Social determinants of health (SDH) are factors that may impact outcomes following pediatric traumatic brain injuries (TBI). The purpose of this study was to investigate the relationship between race and functional outcomes in a diverse pediatric population. We further explored how this association may be modified by SDH factors, including insurance status, social vulnerability, and child opportunity. A cohort study (N = 401) of children aged 0-18 [median = 9.22 years (IQR: 3.56-13.59)] presenting to the Emergency Department at Level I and II Trauma Centers with mild to severe head injuries. Geocoded variables were used to evaluate SDH. The sample was described overall and by racial/ethnic group, which were adjusted for confounders using inverse propensity treatment weights (IPTW). Weighted and unweighted Firth logistic regression models (mortality) and generalized linear regression models (GOS-E scores) were reported without and then with potential effect modifiers. The sample is majority male (65.84%); race/ethnicity are as follows: White (52.37%), Black/African Americans (35.91%), and Hispanic (11.72%). Black (31.25%) and Hispanic (27.66%) patients had higher rates of severe TBI. 35.89% of White patients were categorized as more socially vulnerable compared to 62.68% Black and 70.21% Hispanic patients. A total 63.64% of White patients were from higher opportunity neighborhoods, compared to 25.87% of Black and 51.06% of Hispanic patients. A total 50.95% of White patients, 25.87% of Black patients, and 17.02% of Hispanic patients were privately insured. There were no differences found between racial and ethnic groups on mortality or GOS-E scores. Patients from minority backgrounds had more severe injuries, many resulting from pedestrian vs. motor vehicle accidents. Additionally, patients from minority backgrounds experience more social vulnerability and lower opportunity. Despite these discrepancies, we did not observe differences on rates of mortality or functional outcomes in either racial or ethnic groups. SDH were not found to impact outcomes. Further research is needed to determine how these complex social and environmental variables impact health outcomes.

Producing affordable housing in higher-opportunity neighborhoods: Incentives in California’s LIHTC program

ABSTRACT Housing policy shapes where low-income families live and whether they can access neighborhoods that promote children’s well-being. Since 2018, California’s Low-Income Housing Tax Credit (LIHTC) program has incentivized the development of family affordable housing in higher-resource areas. We examine how the location of proposed and funded LIHTC developments changed in response to these incentives. We find that the probability that large family projects—those eligible for incentives—were proposed in higher-resource areas increased from 0.19 to 0.29, comparing 2014-2017 and 2018–2021. The probability that funded large family projects were located in higher-resource areas doubled, from 0.15 to 0.30. The probability of location in higher-resource areas declined for developments ineligible for incentives. Interviews with affordable housing developers illuminate the role of mission and resources in shaping their responses to program incentives. We conclude with a broader discussion of the LIHTC program as a tool for reducing neighborhood inequality.

Neighborhood Opportunity and Mortality Among Children and Adults in Their Households.

Research has linked neighborhood opportunity to health outcomes in children and adults; however, few studies have examined neighborhood opportunity and mortality risk among children and their caregivers. The objective of this study was to assess associations of neighborhood opportunity and mortality risk in children and their caregivers over 11 years. Participants included 1 025 000 children drawn from the Mortality Disparities in American Communities study, a cohort developed by linking the 2008 American Community Survey to the National Death Index and followed for 11 years. Neighborhood opportunity was measured using the Child Opportunity Index, a measure designed to capture compounding inequities in access to opportunities for health. Using hazard models, we observed inverse associations between Child Opportunity Index quintile and deaths among child and caregivers. Children in very low opportunity neighborhoods at baseline had 1.30 times the risk of dying over follow-up relative to those in very high opportunity neighborhoods (95% confidence interval [CI], 1.15-1.45), and this excess risk attenuated after adjustment for household characteristics (hazard ratio, 1.15; 95% CI, 0.98-1.34). Similarly, children in very low opportunity neighborhoods had 1.57 times the risk of experiencing the death of a caregiver relative to those in very high opportunity neighborhoods (95% CI, 1.50-1.64), which remained after adjustment (hazard ratio, 1.30; 95% CI, 1.23-1.38). Our analyses advance understanding of the adverse consequences of inequitable neighborhood contexts for child well-being and underscore the potential importance of place-based policies for reducing disparities in child and caregiver mortality.

The Geography of Absence: Cities, Towns, and Suburbs with No LIHTC Housing

The Low-Income Housing Tax Credit (LIHTC) is the largest affordable housing production program in the United States. The program has been the subject of some criticism because it has done an unimpressive job of placing low-income renter households in high-opportunity neighborhoods, especially in suburban jurisdictions. This research examines, at the municipal level, what kinds of communities do not contain LIHTC properties. Communities with no LIHTC properties are compared with places that include LITHC housing in terms of geographic, demographic, socioeconomic, and housing-stock characteristics. The analysis focuses on all municipalities in the US and those that grew in population and multifamily housing from 2010 to 2019. It finds that 72% of all municipalities, and 52% of all growing municipalities contain no LIHTC housing. A logit analysis of the factors that influence the likelihood that LIHTC housing is absent from a municipality finds that the most important predictors are population size, being a suburb in a large metropolitan area, and the percentage of rental and multifamily housing.

Measuring and mapping neighborhood opportunity: A comparison of opportunity indices in California

Backed by decades of empirical research, there has been increasing acknowledgment in policy, practice and research of the importance of neighborhood opportunity in shaping well-being. This has led to the proliferation of opportunity maps in cities throughout the United States with the purpose of identifying low opportunity neighborhoods in need of investment and intervention and high opportunity neighborhoods that can offer access to resources and amenities to disadvantaged population groups. By explicitly linking investment to the identification of neighborhoods that are high or low in opportunity, opportunity indices have the potential to help transform local and regional landscapes of spatial inequality. Despite this common goal, indices rely on varying theoretical conceptualizations, data, variables, and statistical approaches. How much these opportunity definitions overlap has yet to be fully examined. In this study, we compared five approaches to measuring neighborhood opportunity in California. We found low to moderate overlap across the indices, with disagreement higher for low opportunity designations. As with any quantitative analysis, opportunity mapping is not a purely technical exercise and requires a series of subjective decisions. The only way to validate these decisions is for opportunity measures to be constructed transparently and vetted by the research community. This study is a first step in this process.

Planning for Opportunity

Problem, research strategy, and findings Although there is strong evidence that living in high-opportunity neighborhoods can improve the long-run educational and economic outcomes of children, translating this into practical advice for planners is difficult. There is little consensus about how to operationalize neighborhood opportunity, and planning discussions rarely consider how much that opportunity costs, even though planners around the country must grapple with the typically higher cost of providing housing in opportunity areas. We offer concrete guidance to planners about how to best overcome these barriers. We argue for a streamlined measure called the school–violence–poverty (SVP) index based on three contemporary metrics that research shows enhance economic mobility for children: school quality, violent crime, and poverty. Combining the SVP index with data on rental prices in New York City (NY) and Greater Boston (MA), we identified a collection of high-opportunity bargain neighborhoods with lower rents than expected given their opportunity metrics and housing characteristics. We found that high-opportunity bargain areas tended to be more affordable because they lacked amenities such as restaurants and proximity to the city center that are associated with higher rents but are unlikely to be very related to children’s economic mobility. Takeaway for practice Here we provide a streamlined, easy-to-use index for planners to identify high-opportunity bargain areas in their communities. It has direct implications for planners attempting to stretch limited budgets by helping planners decide where to get the most opportunity for their taxpayer dollars when building affordable housing and how to empower low-income families to weigh tradeoffs about where to live and achieve better neighborhood matches. The simplicity of the index can empower families to access areas that are more affordable and offer robust public services for their children.

Growing Up as Rents Rise: How Housing Affordability Impacts Children

Over the past several decades, housing costs have risen sharply, and as a result, an increasing number of families have become “housing cost burdened,” paying more than one third of their income toward rent and utilities. This integrative literature synthesis considers the known and potential impacts of families’ housing affordability problems on child development and schooling outcomes through a review of 64 studies published between 2000 and 2020. The synthesis proceeds in three sections: the first section examines research on the direct connection between affordability and child outcomes. The second section considers the empirical evidence on four pathways through which affordability problems are theorized to affect child outcomes: the residential mobility pathway (by causing residential mobility, school mobility, eviction, or homelessness), the living environment pathway (by reducing the quality of housing or living conditions), the neighborhood and school opportunity pathway (by restricting access to high-opportunity neighborhoods and schools), and the parental resources pathway (by reducing financial resources that could be invested in children and increasing parental stress). The third section of the synthesis considers affordability’s impact on children through an examination of the research literature on the impact of federal housing assistance. Future directions for policy are considered, including the expansion of housing assistance for families, and additional research is urged on the impacts of housing affordability on children by scholars within the field of education.

Predatory Inclusion in the Market for Rental Housing: A Multicity Empirical Test

Using a unique data set of millions of advertisements for rental housing and data on the geographic distribution of housing voucher holders, we examine the limits of housing market policies that rely on private-market landlords to meet public needs. We find that although advertised affordable housing is more prevalent in some zip codes than others, voucher households are more geographically clustered than affordable housing. Moreover, voucher holders are overly concentrated in “lower opportunity” zip codes, those with fewer resources for children’s well-being, despite the advertisement of affordable housing in higher opportunity neighborhoods. Using text-analysis techniques, we identify advertisements that explicitly accept or reject voucher holders and find that ads seeking voucher-holding tenants are overrepresented in lower opportunity neighborhoods. We evaluate the significance of these findings for theories of predatory inclusion.

Does pre-purchase counseling help low-income buyers choose and sustain homeownership in socially mixed destination neighborhoods?

ABSTRACT For 3 decades, U.S. federal housing policies have sought to increase access to socially diverse and high opportunity neighborhoods and improve the quality of life for low-income families. Absent from current discussions of the costs and benefits of socially mixed communities is the potential value that they may have to low-income families seeking to purchase their own homes. In this paper, we examine the extent to which participation in homebuyer education and counseling programs supports sustainable low-income homeownership in socially mixed neighborhoods. Using quasi-experimental methodologies and longitudinal data from the Denver Housing Study for a sample of 533 low-income homebuyers, this study examines whether, compared with a comparison group of public housing residents who purchased homes on their own, participants in Denver Housing Authority’s (DHA) homebuyer education and counseling program (HOP) were (1) more likely to purchase homes in socially mixed destination neighborhoods; and (2) sustain homeownership over time. Results show that low-income homebuyers purchased homes in destination neighborhoods characterized by considerable ethnic and income mix. When compared to non-HOP homebuyers, HOP homebuyers also were better off in terms of 2018 home value appreciation and fewer foreclosures, suggesting that homebuyer education and counseling improves long-term sustainability of homeownership.

The LIHTC Program, Racially/Ethnically Concentrated Areas of Poverty, and High-Opportunity Neighborhoods

The Low-Income Housing Tax Credit (“LIHTC”) program remains the na- tion’s largest affordable housing production program. LIHTC units are under-represented in the neighborhoods that both promote movement to high- opportunity neighborhoods and affirmatively further fair housing. State and local officials should play an active role in guiding site selection decisions and ensuring that LIHTC developments are located in a manner that affirmatively furthers fair housing. Planners can use newly available data discussed herein to identify high-opportunity tracts.

Racial And Ethnic Inequities In Children's Neighborhoods: Evidence From The New Child Opportunity Index 2.0.

Neighborhoods influence children's health, so it is important to have measures of children's neighborhood environments. Using the Child Opportunity Index 2.0, a composite metric of the neighborhood conditions that children experience today across the US, we present new evidence of vast geographic and racial/ethnic inequities in neighborhood conditions in the 100 largest metropolitan areas in the US. Child Opportunity Scores range from 20 in Fresno, California, to 83 in Madison, Wisconsin. However, more than 90percent of the variation in neighborhood opportunity happens within metropolitan areas. In 35percent of these areas the Child Opportunity Gap (the difference between Child Opportunity Scores in very low- and very high-opportunity neighborhoods) is higher than across the entire national neighborhood distribution. Nationally, the Child Opportunity Score for White children (73) is much higher than for Black (24) and Hispanic (33) children. To improve children's health and well-being, the health sector must move beyond a focus on treating disease or modifying individual behavior to a broader focus on neighborhood conditions. This will require the health sector to both implement place-based interventions and collaborate with other sectors such as housing to execute mobility-based interventions.

Rethinking “Opportunity” in the Siting of Affordable Housing in California: Resident Perspectives on the Low-Income Housing Tax Credit

ABSTRACTIn 2017, California revised its Qualified Allocation Plan to encourage more Low-Income Housing Tax Credit (LIHTC) development in high-opportunity neighborhoods, with the goal of improving residents’ economic mobility. However, very little research exists on LIHTC residents, their barriers to economic mobility, or their neighborhood preferences. In this article, I draw on qualitative surveys and interviews with residents living in 18 LIHTC developments across California to explore the linkages between housing affordability, neighborhood conditions, and access to educational and economic opportunity. Although largely exploratory, the research sheds light on the experiences of LIHTC residents and reveals both the benefits of affordable housing and the barriers households face to improving their economic circumstances. The findings problematize the idea of high-opportunity neighborhoods, revealing that residents’ barriers to opportunity are driven not necessarily by neighborhood factors but rather by the lack of a ladder in labor and housing markets. Further, residents’ own perceptions of desirable neighborhoods are significantly more nuanced than the opportunity maps—which will determine where California’s LIHTC investments go—can capture. The article discusses the policy implications of these findings, and calls for more research to specifically understand the linkages between LIHTC subsidy, neighborhood conditions, and access to opportunity for lower income households.

Can Landlords Be Paid to Stop Avoiding Voucher Tenants?

Landlords in high-opportunity neighborhoods screen out tenants using vouchers. In our correspondence experiment, signaling voucher status cuts landlord responses in half. This voucher penalty increases with posted rent and varies little with signals of tenant quality and race. We repeat the experiment after a policy change and test how landlords respond to raising voucher payment limits by $450 per month in high-rent neighborhoods. Most landlords do not change their screening behavior; those who do respond are few and operate at small scale. Our results suggest a successful, systematic policy of moving to opportunity would require more direct engagement with landlords.

Section 8 Vouchers and Rent Limits: Do Small Area Fair Market Rent Limits Increase Access to Opportunity Neighborhoods? An Early Evaluation

ABSTRACTOne critique of the U.S. Department of Housing and Urban Development (HUD)’s Housing Choice Voucher program is that its maximum rent limit is set at the metropolitan level, making more expensive neighborhoods effectively off limits to households who receive rental assistance. As a result, the design of the program limits a voucher household’s access to opportunity neighborhood. In response, HUD created the Small Area Fair Market Rent (SAFMR) demonstration program, which calculates the maximum voucher rent at the zip code level so that HUD’s rent limits more closely align with local neighborhood rents. In theory, this program should improve a voucher household’s choice set and location outcomes. Looking at changes in the location of beneficiaries in the six sites that participated in the SAFMR demonstration program, we find a significant amount of regional variation in the results. Specifically, introduction of the SAFMR rent calculations results in voucher households living in higher opportunity neighborhoods in Dallas, Texas, in lower opportunity neighborhoods in Chattanooga, Tennessee, and mixed effects in other areas. These mixed results highlight some of the potential incremental benefits of the program and reinforce the importance of viewing this policy over a longer period of time, and in the context of other constraints voucher households face in accessing neighborhood opportunity.

Family Socioeconomic Status, Cortisol, and Physical Health in Early Childhood: The Role of Advantageous Neighborhood Characteristics.

Children from families with lower socioeconomic status (SES) evidence greater physiological dysregulation and poorer health. Despite recognition of environmental contributors, little is known about the influence of neighborhood characteristics. The present study examined the moderating role of community-level risks and resources on the relation of family SES to children's daily cortisol output and physical health during the kindergarten year. In fall and spring of kindergarten, children's (N = 338) daily total cortisol was measured and parents and teachers rated children's global physical health. Parents reported family SES. Neighborhood characteristics were assessed using the Child Opportunity Index, a population-level tool that evaluates the quality of multiple domains of neighborhood attributes. In fall, children reared in lower SES family environments had higher cortisol when residing in lower quality (lower opportunity) neighborhoods (b = -.097, p < .001), but there was no relation between family SES and children's cortisol in more advantaged (higher opportunity) neighborhoods (b = -.023, p = .36). Lower family SES was prospectively associated with poorer physical health in spring (controlling for fall health) only among children living in lower opportunity neighborhoods (b = -.250, p = .018) and was unrelated to physical health among children residing in higher opportunity neighborhoods (b = .042, p = .70). Higher opportunity neighborhoods may protect against the negative consequences of low family SES on children's stress physiology and physical health. Public health interventions that bolster neighborhood opportunities may benefit young children reared in socioeconomically disadvantaged family environments.

Gateway to Opportunity? Disparities in Neighborhood Conditions Among Low-Income Housing Tax Credit Residents

A key goal of housing assistance programs is to help lower income households reach neighborhoods of opportunity. Studies have described the degree to which Low-Income Housing Tax Credit (LIHTC) developments are located in high-opportunity neighborhoods, but our focus is on how neighborhood outcomes vary across different subsets of LIHTC residents. We also examine whether LIHTC households are better able to reach certain types of neighborhood opportunities. Specifically, we use new data on LIHTC tenants in 12 states along with eight measures of neighborhood opportunity. We find that compared with other rental units, LIHTC units are located in neighborhoods with higher poverty rates, weaker labor markets, more polluted environments, and lower performing schools, but better transit access. We also find that compared with other LIHTC tenants, poor and minority tenants live in neighborhoods that are significantly more disadvantaged.