Abstract
BACKGROUND: Residential instability and neighborhood conditions may shape children's health and development, but it is unclear whether all residential moves are equally destabilizing, and the extent to which moving to neighborhoods with different conditions can improve children's outcomes. Most studies estimating causal effects of these factors on children's health or development use smaller, geographically constrained, urban cohorts. OBJECTIVE: In a racially/ethnically and socioeconomically diverse statewide cohort including urban and rural communities, we investigate effects of residential instability, neighborhood deprivation, and their intersection on childhood educational outcomes. METHODS: We construct a statewide dataset that links North Carolina birth records (2002-2005) with lead testing data (2003-2015) and 4th grade standardized test scores (2013-2016). A composite census tract-level neighborhood deprivation index (NDI) is linked with individuals based on residence at birth, lead testing, and 4th grade. Outcomes of interest are 4th grade test scores in reading and mathematics. We use multinomial propensity scores to estimate effects of residential instability and neighborhood deprivation on test scores. RESULTS: Children who moved between only high deprivation neighborhoods had lower reading test scores (-0.29 [95% CI: -0.59, -0.015]) compared to children who resided in high deprivation neighborhoods but did not move. Children who resided in a high deprivation neighborhood at birth and subsequently moved to a low deprivation neighborhood(s) had higher test scores compared to those who moved between only high deprivation neighborhoods (1.59 [0.90, 2.28]). Additionally, children who move from high to low deprivation neighborhoods earlier had larger improvements. CONCLUSION: Being residentially stable, even while residing in a high deprivation neighborhood, is associated with improved educational outcomes. However, there is also a larger positive effect of moving from high to low deprivation neighborhoods. Our findings have important implications, particularly given the increasing segregation of neighborhoods by socioeconomic status and the housing affordability crisis in the United States. Partnerships between housing programs, early childhood education and services, and health care providers, which address evictions and broader issues, may help address health inequalities rooted in childhood exposures and experiences.