Effects of a federal housing voucher experiment on adolescent binge drinking: a secondary analysis of a randomized...

To test how a housing voucher generating residential mobility to lower-poverty neighborhoods, compared with public housing controls, influenced adolescent binge drinking, and whether gender modified effects.

A multi-site household-level three-arm randomized trial of a housing intervention executed 1994-98, evaluated 2001-02.

Five US cities: Baltimore, MD; Boston, MA; Chicago, IL; Los Angeles, CA; and New York, NY.

A total of 3537 adolescents in 4248 low-income eligible families were randomized; 2829 adolescents were analyzed at the interim evaluation (1950 in treatment; 879 in the control group). Attrition bias was accounted for with a 3-in-10 oversampling of hard-to-reach participants (effective response rate: 89%).

The Moving to Opportunity (MTO) trial randomized volunteer low-income families in public housing to receive (1) rental subsidies redeemable in neighborhoods with < 10% tract poverty plus housing counseling, (2) unrestricted Section 8 rental subsidies or (3) to remain in public housing. We pooled the subsidy ('treatment') groups because they were conceptually similar and there was no evidence of statistical differences between groups on binge drinking.

Primary outcome: past month binge drinking (five or more drinks in one sitting).

Adolescent binge drinking prevalence was 3.9% for treatment and 3.2% for control. The intention-to-treat (ITT) main effect of subsidy treatment (versus control) on binge drinking was non-significant, but treatment effects were different for girls and boys (treatment-gender interaction P = 0.002). MTO treatment reduced girls' binge drinking [odds ratio (OR) = 0.48, 95% confidence interval (CI) = 0.24-0.96, P = 0.037], but increased boys' binge drinking (OR = 2.37, 95% CI = 1.13-4.97, P = 0.023), compared with controls. Results were similar for secondary alcohol outcomes. Instrumental variable (IV) results adjusting for treatment compliance were comparable with ITT, but larger.

A housing subsidy treatment that enables low-income families to move from public to private housing appears to lessen girls' binge drinking but increases boys' binge drinking, compared with controls.