More than just an eyesore: local insights and solutions on vacant land and urban health

Building a Culture of Health Through the Built Environment: Impact of a Cluster Randomized Trial Remediating Vacant and Abandoned Property on Health Mindsets

Changing built environment conditions to impact health mindsets and health equity may be a promising target for public health interventions. The present study was a cluster randomized controlled trial to test the impact of remediating vacant and abandoned properties on factors related to health mindset-including well-being, health interconnectedness, social capital markers, neighborhood disorder, and worry-as well as direct and indirect violence experiences and the moderating role of racial and income segregation on outcomes. A residential cohort of 405 participants from 194 randomly assigned geographic clusters was surveyed over five waves from 2019 to 2023. Compared to clusters with no treatment, participants in clusters where both vacant lots and abandoned homes were treated experienced significant increases in sense of community (83%, 95% CI = 71 to 96%, p = 0.01). Among participants in randomization clusters where only vacant lots were treated, there were declines in perceived neighborhood disorder (- 55%, 95% CI = - 79 to - 5, p = 0.06) and worry about community violence (- 56%, 95% CI = - 58 to - 12, p = 0.06). There was also a moderating effect of racial and income spatial polarization, with the greatest changes in sense of community observed among more deprived areas with both homes and lots treated, and the largest changes in neighborhood worry and disorder were seen in more deprived areas with only lots treated. Remediation of vacant and abandoned properties may be one approach to change some but not all mindsets around health, and the effects may depend on the type of remediation as well as larger neighborhood conditions such as segregation.

Community-engaged crime prevention through environmental design and reductions in violent and firearm crime

In the U.S., crime and violence are concentrated in cities that have lost industry and population due to economic disinvestment and structurally racist policies. Researchers, practitioners, and policymakers have called for community-level approaches that reduce violence in these cities by improving unsafe physical environments, increasing social equity and cohesion, and engaging community members in neighborhood change. We tested Busy Streets Theory by examining how community-engaged Crime Prevention through Environmental Design (CPTED) strategies implemented by a community coalition may reduce violent and violent firearm crime incidents in Flint, Michigan, a legacy city in the Midwestern U.S. We used linear mixed effects regression models to examine how the annual aggregate intensity of physical and social CPTED activities from 2015 to 2018 was associated with changes in annual violent crime levels from 2016 to 2019 for 505 street segments in Flint, MI. After adjusting for baseline violent crime density, neighborhood disadvantage, property maintenance, and spatially lagged violent crime density, we observed that higher levels of community-engaged CPTED intensity were associated with steeper declines in violent crime density over time (β = -0.14, p < 0.001). Similarly, higher levels of community-engaged CPTED intensity were associated with steeper declines in violent firearm crime density over time (β = -0.19, p < 0.001). The results suggest the vital role that creating busy streets through community-engaged CPTED may play in community violence prevention.

The Impact of City-Led Neighborhood Action on the Coproduction of Neighborhood Quality and Safety in Buffalo, NY

Creating and sustaining safe, healthy urban environments requires active collaboration between residents and local governments. Public safety and the upkeep of public spaces depend, in a large part, on residents' reports of crime and service needs. However, in underserved areas, factors such as urban decay, inadequate public services, and concentrated disadvantage have weakened these cooperative dynamics. This breakdown can exacerbate the underreporting of crime and service needs and deepen neighborhood inequalities. In Buffalo, NY, the city-led initiative "Clean Sweeps" works to reduce neighborhood disparities through rapid beautification and community outreach in targeted city blocks. The program aims to improve quality of life by reducing crime and blight while fostering greater community engagement. In an analysis of data from 77,955 matched properties (published elsewhere), we found that residents were more likely to report drug-related crimes (via 911) and blight-related service needs (via 311) compared to untreated properties in the 6 months following the Clean Sweep. In this study, we analyze data from 21 interviews with city staff and four focus groups with residents to explore how interventions in the social and physical environment of neighborhoods, like the Clean Sweep innovation, can influence residents' willingness to coproduce with local government. We identify improved responsiveness, trust, and self-efficacy as key mechanisms impacting residents' reporting behavior. The findings show how relatively simple environmental interventions paired with outreach can help create safer, healthier neighborhoods.

Using Geographic Momentary Assessment to Explore Spatial Environment Influences on Wellbeing in People With HIV

Place-based socio-economic and racial inequities contribute to health disparities among people with HIV (PWH). We used geographic ecological momentary assessment (GEMA) methodologies to explore the interplay between psychosocial outcomes in daily diaries and community spatial measures among PWH in New Orleans. PWH (N = 69) were recruited from a clinic-based cohort study. Micro-longitudinal data were collected via smartphone-based daily diaries and geospatial tracking over 14 days. First, correlations were run between diary derived outcomes (e.g., feeling safe in current location, stress), and spatial measures (e.g., violent crime, alcohol outlets, and vacant lots) within a half-mile buffer around each diary point to understand the real time associations between mood and space. Next, we fit multilevel models, controlling for between-person effects, to assess within-person associations between accumulative spatial daily violence exposure (50m, 100m and 200m buffers), and measures of daily mood and coping. Violent crime, alcohol outlets and vacant lots were inversely correlated with feeling safe and positively correlated with perceived ease of obtaining drugs. Vacant lots were positively associated with stress and inversely correlated with positive mood. Within individuals, higher daily accumulated violence exposure was associated with increased rumination at the 50m buffer level, decreased trust in oneself and others at the 100m buffer, and decreased ratio of positive/negative mood at all buffers. Our results emphasize the intricate interplay between mental wellness, coping mechanisms, and spatial measures in PWH. Future research and interventions for PWH should consider how spatial factors may influence PWH in terms of mental health and care engagement.

Applying the Principles of Trauma-Informed Care to the Evaluation and Management of Patients Who Undergo Metabolic and Bariatric Surgery

Evaluation of relevant psychosocial variables is an important aspect of comprehensive, high-quality metabolic and bariatric surgery (MBS) care. Given the high rates of adverse childhood experience (ACEs) and other forms of trauma experienced later in life reported by individuals with class III obesity, it is time to apply the principles of trauma-informed care to the multidisciplinary care of MBS patients. This narrative review begins with a summary of the literature on the psychosocial functioning of individuals who present for MBS. Emphasis is placed upon the relationship between ACEs, class III obesity, and MBS. Trauma-informed care is defined, and its principles are applied to the MBS care continuum. The paper ends with a recommendation on how the field of MBS can integrate trauma-informed care into clinical practice and future research.

Outdoor physical activity is not associated with better mental health in a sample of predominantly Black people, but spending time in parks is

Spending time outdoors may bolster mental health via relaxation and physical activity. Yet, most studies use self-report and involve majority White samples from higher income areas. Findings may not hold true using device-derived measurement, among minoritized participants, or in low-income neighborhoods. Our objectives were to test whether: i) time spent outdoors in physical activity is associated with mental health; ii) the effect is modified by the positive or negative outdoor conditions (amount of greenness or vacant houses/lots encountered while outdoors); iii) there is a correlation between our measures of outdoor conditions and perceived neighborhood conditions; and iv) there is a different relationship between time spent outdoors in parks (as an indicator of intentional nature exposure) and mental health. The sample of 112 participants (87% Black/African American persons) from 11 Detroit, MI neighborhoods wore a GPS and accelerometer for one week (May-Oct 2021) and completed a survey. We calculated exposure to greenness, vacant lots/houses while outdoors, and perceived neighborhood aesthetics. We fitted regression models for mental health measures separately and included time spent outdoors in PA, age, sex, and days with high precipitation. We then fitted models stratified by outdoor conditions. Last, we examined whether a similar relationship could be detected for time spent outdoors in parks. On average, ~30% of PA was conducted outdoors, and 56% of outdoor time involved PA. We observed an unexpected positive association between outdoor PA and anxiety (coef: 0.33, 95% CI: 0.14-0.51), depression (coef: 0.31, 95% CI: 0.15-0.47), and perceived stress score (coef: 0.18, 95% CI: 0.07-0.29). When stratified, we found consistent and/or larger associations for those exposed to high levels of vacant homes, high greenness (both aerial and street-level), low levels of vacant lots, and low perceived neighborhood aesthetics. Importantly and in contrast, we observed the opposite trend when examining time spent in parks (coef: -0.05, 95% CI: -0.10--0.01). These results contrast many studies showing positive relationships between time outdoors and mental health and highlight the need for research with diverse populations and better measures of outdoor conditions and intentionality of greenspace contact.

Residential segregation and summertime air temperature across 13 northeastern U.S. states: Potential implications for energy burden

High ambient summertime temperatures are an increasing health concern with climate change. This is a particular concern for minoritized households in the United States, for which differential energy burden may compromise adaptive capacity to high temperatures. Our research question was: Do minoritized groups experience hotter summers than the area average, and do non-Hispanic white people experience cooler summers? Using a fine-scaled spatiotemporal air temperature model and U.S. census data, we examined local (within-county) differences in warm season cooling degree days (CDDs) by ethnoracial group as a proxy for local energy demand for space cooling across states of the northeast and mid-Atlantic U.S. in 2003-2019. Using state-specific regression models adjusted for year and county, we found that Black and Latino people consistently experienced more CDDs, non-Hispanic white people experienced fewer CDDs, and Asian populations showed mixed results. We also explored a concentration-based measure of residential segregation for each ethnoracial group as one possible pathway towards temperature disparities. We included the segregation measure as a smooth term in a regression model adjusted for county and year. The results were nonlinear, but higher concentrations of white people were associated with lower annual CDDs and higher concentrations of Latino people were associated with higher annual CDDs than the county average. Concentrations for Black and Asian people were nonmonotonic, sometimes with bowed associations. These findings suggest that present-day residential segregation, as modeled by spatially smoothed ethnoracial subgroup concentrations, may contribute to summertime air temperature disparities and influence adaptive capacity. We hope these findings can support place-based interventions, including targeting of energy insecurity relief programs.

Historical Structural Racism in the Built Environment and Physical Health among Residents of Allegheny County, Pennsylvania

Historical structural racism in the built environment contributes to health inequities, yet to date, research has almost exclusively focused on racist policy of redlining. We expand upon this conceptualization of historical structural racism by examining the potential associations of probable blockbusting, urban renewal, and proximity to displacement from freeway construction, along with redlining, to multiple contemporary health measures. Analyses linked historical structural racism, measured continuously at the census-tract level using archival data sources, to present-day residents' physical health measures drawn from publicly accessible records for Allegheny County, Pennsylvania. Outcome measures included average life expectancy and the percentage of residents reporting hypertension, stroke, coronary heart disease, smoking, insufficient sleep, sedentary behavior, and no health insurance coverage. Multiple regression analyses were conducted to examine separate and additive associations between structural racism and physical health measures. Redlining, probable blockbusting, and urban renewal were associated with shorter life expectancy and a higher prevalence of cardiovascular conditions, risky health behaviors, and residents lacking health insurance coverage. Probable blockbusting and urban renewal had the most consistent correlations with all 8 health measures, while freeway displacement was not reliably associated with health. Additive models explained a greater proportion of variance in health than any individual structural racism measure alone. Moreover, probable blockbusting and urban renewal accounted for relatively more variance in health compared to redlining, suggesting that research should consider these other measures in addition to redlining. These preliminary correlational findings underscore the importance of considering multiple aspects of historical structural racism in relation to current health inequities and serve as a starting point for additional research.

The Impact of Vacant and Abandoned Property on Health and Well-Being: A Qualitative Inquiry

This qualitative study explored the role of neglected properties and neighborhood environment characteristics on a sample of New Orleans, Louisiana residents' health and well-being, sense of community, sense of safety, and civic engagement. We hypothesized that residents would identify conditions of their neighborhood's physical environment, including neglected properties, as one factor that impacted their health and other aspects of well-being. Seventy-four (N = 74) participants, including women, men, youth, young adults, and community leaders, took part in 11 focus groups (n = 51) and 23 key informant interviews. Thematic content analysis through inductive and deductive coding cycles of interview transcripts revealed five main categories related to urban neighborhood-built and social environments: 1) health and well-being, 2) sense of community, 3) sense of safety, 4) civic engagement, and 5) youth and family violence. Ten themes were developed and included, for example, the role of neighborhoods in delineating access to health-promoting characteristics and resources; the role of neighborhood social networks as crime prevention strategies; resident-led decision-making in neighborhood improvements; the negative impact of neglected properties; and the role of the local government in improving physical infrastructure. These findings affirm that residents were aware of and impacted by the cyclical nature of built environment neglect on health and well-being, community violence, neighborhood cohesion, civic engagement, and youth violence. Participants recommended improving neighborhood conditions to shift resident mindsets about the health of neighborhoods, reduce violence, and improve quality of life.

Building a Culture of Health Through the Built Environment: Impact of a Cluster Randomized Trial Remediating Vacant and Abandoned Property on Health Mindsets

Changing built environment conditions to impact health mindsets and health equity may be a promising target for public health interventions. The present study was a cluster randomized controlled trial to test the impact of remediating vacant and abandoned properties on factors related to health mindset-including well-being, health interconnectedness, social capital markers, neighborhood disorder and worry-as well as direct and indirect violence experiences and the moderating role of racial and income segregation on outcomes. A residential cohort of 405 participants from 194 randomly assigned geographic clusters were surveyed over five waves from 2019 to 2023. Compared to clusters with no treatment, participants in clusters where both vacant lots and abandoned homes were treated experienced significant increases in sense of community (83%, 95% CI=71 to 96%, p=0.01). Among participants in randomization clusters where only vacant lots were treated, there were declines in perceived neighborhood disorder (-55%, 95% CI=-79 to -5, p=0.06) and worry about community violence (-56%, 95% CI=-58 to - 12, p=0.06). There was also a moderating effect of racial and income spatial polarization, with the greatest changes in sense of community observed among more deprived areas with both homes and lots treated; and the largest changes in neighborhood worry and disorder were seen in more deprived areas with only lots treated. Remediation of vacant and abandoned properties may be one approach to change some but not all mindsets around health, and the effects may depend on the type of remediation as well as larger neighborhood conditions such segregation.

Association between property investments and crime on commercial and residential streets: Implications for maximizing public safety benefits

Physical property investments enhance public safety in communities while alleviating the need for criminal justice system responses. Policy makers and local government officials must allocate scare resources for community and economic development activities. Understanding where physical property investments have the greatest crime reducing benefits can inform decision making to maximize economic, safety, and health outcomes. This study uses Spatial Durbin models with street segment and census tract by year fixed effects to examine the impact of physical property investments on changes in property and violent crime over an 11-year period (2008-2018) in six large U.S. cities. The units of analysis are commercial and residential street segments. Street segments are classified into low, medium, and high crime terciles defined by initial crime levels (2008-2010). Difference of coefficients tests identify significant differences in building permit effects across crime terciles. The findings reveal there is a significant negative relationship between physical property investments and changes in property and violent crime on commercial and residential street segments in all cities. Investments have the greatest public safety benefit where initial crime levels are the highest. The decrease in violent crime is larger on commercial street segments, while the decrease in property crime is larger on residential street segments. Targeting the highest crime street segments (i.e., 90th percentile) for property improvements will maximize public safety benefits.

The spatial relationship between long-term vacant housing and non-communicable diseases in U.S. shrinking and growing metropolitan areas

The rising prevalence of non-communicable diseases (NCDs) has led to increased attention on understanding how built environments affect NCD risks. However, there's a significant gap in the literature regarding the relationship between housing vacancy duration and NCDs in metropolitan areas with varying development rates. Our research addresses this gap by examining the association between housing vacancy duration and NCDs across all U.S. metropolitan areas, considering growing, shrinking, and fluctuating counties. We used a Multiscale Geographically Weighted Regression (MGWR) model to analyze this relationship, finding that longer-term vacant housing (over 3 years) is more positively associated with NCDs compared to short-term vacancies. We also discovered that this association is non-uniform across metropolitan counties, except for cancer and stroke outcomes. Shrinking counties in the Northeast are particularly affected, emphasizing the need for targeted public health interventions in these areas. This study underscores the importance of revitalizing vacant homes, especially those vacant for over 3 years, in both shrinking and growing regions to improve public health. Policymakers should adopt tailored strategies, engage public health experts, and invest in healthcare infrastructure to effectively address the health risks linked to vacant housing.

Top 5 Things Health Professions Students Should Know About Ecology and Waste Management

The environments in which we live affect individual and community risk for disease transmission and illness severity. Communities' and neighborhoods' waste stream management designs and health care organizations' spatial and structural architecture also influence individuals' and communities' pathogenic vulnerabilities and how well health sector industrial hygiene practices support them. This article describes a One Health approach to planetary environmental health and suggests strategies for implementing a One Health or Planetary Health approach in the context of climate change.

Associations between land bank ownership and stewardship of vacant properties and crime, violence, and youth victimization in Flint, MI

Land banks across the United States are managing expanding vacant property inventories. By maintaining vacant properties and engaging residents in the process, land banks facilitate processes integral to building safe neighborhoods and may play a role in violence prevention. Using generalized additive mixed model regression, adjusted for spatial and temporal dependencies, we examined whether land bank ownership and stewardship of vacant properties in Flint, Michigan were associated with trends in serious, violent, and firearm-involved crime, between 2015 and 2018. We tested for differences in trends in crime density between properties owned by the Genesee County Land Bank Authority (GCLBA; n = 7151) and comparison properties not owned by the land bank (n = 6,245). In addition, we tested for differences in crime density trends between vacant properties that received different levels of land bank stewardship, including biannual mowing, GCLBA standard stewardship, and GCLBA-sponsored community-engaged stewardship. We found that GCLBA ownership was associated with net declines in densities of all types of crime and violence, over time, relative to properties not owned by the GCLBA. When we distinguished between levels of stewardship, we found that GCLBA stewardship, both with and without community engagement, was associated with net declines in serious and violent crime relative to comparison properties. Only community-engaged GCLBA stewardship was associated with declines in firearm-involved crime and firearm-involved crime with a youth victim over time, relative to comparison properties. Land bank stewardship of vacant properties may be protective against crime, violence, and youth victimization in legacy cities like Flint, MI that experience high rates of vacant properties and violent crime.

Using neighborhood characteristics to predict vacancy types: Comparing multi-scale conditions surrounding existing vacant lots

Vacant and abandoned land can be public eyesores that can potentially result in neighborhood distress in the long term. In some cases, the contextual conditions of a neighborhood have been shown to have more of a negative effect on communities than the vacant property itself. Maximum opportunities to actually reuse vacant and abandoned land is known to primarily exist in cases where the surrounding area has locational benefits or when local economic conditions are hopeful. This study examines and compares neighborhood socioeconomic characteristics around vacant lots in Minneapolis, Minnesota, USA, to identify spatial heterogeneity within vacancy types and neighborhood characteristics. Specifically, we examine 1) if the socioeconomic characteristics of a neighborhood can predict existing vacant lots and 2) what neighborhood characteristics are associated with certain vacant lot types. Three logistic regressions were tested with different buffers around each vacant lot, and a total of eighteen regressions were performed to capture the effects on six vacancy types. Results suggest that there are various types of vacancies interacting differently at the neighborhood scale, and that a large-scale neighborhood context matters when predicting vacancy types. The results also indicate three salient points. First, minority populations are a strong predictor of residential and commercial vacancies. Second, high-income areas tend to predict vacancies with potential investment opportunities or vacancies as a part of an existing park or recreational system. Third, vacant properties designated for institutional land uses tend to be found in lower-income areas, yet, not necessarily in areas with high minority populations. Managing and repurposing vacant and abandoned land should be handled more progressively with a better understanding of the socioeconomic characteristics of neighborhoods. Further, examining vacancy types by community can be a way to diagnose potential neighborhood risks associated with vacant and abandoned land.

The Contribution of Neighborhood Characteristics to Psychological Symptom Severity in a Cohort of Injured Black Men

BACKGROUND

Traumatic injury is not evenly distributed by race and class in the USA. Black men are marginalized in the society, often reside in disadvantaged neighborhoods, and are at higher risk for injury mortality and ongoing physical and psychological problems following injury. Post-traumatic stress disorder (PTSD) and depressive symptom severity are among several problematic and disabling conditions faced by injury survivors. While much research has examined individual factors that lead to increased post-injury psychological symptom severity, the contribution of the social and physical environment has been relatively understudied.

OBJECTIVE

To examine the contribution of neighborhood characteristics to PTSD and depressive symptom severity in Black men following traumatic injury.

DESIGN

Prospective cohort study. Participant data were linked via GIS to neighborhood characteristics (constructs established by factor analysis) to spatially model factors associated with increased post-injury psychological symptom severity using a GEE regression analysis, adjusting for injury mechanism and severity, age, and insurance.

PARTICIPANTS

Four hundred fifty-one adult Black males hospitalized for traumatic injury.

RESULTS

The 4 constructs were neighborhood disconnectedness, concentrated disadvantage/deprivation, crime/violence/vacancy, and race/ethnicity. High depressive and PTSD symptom severity was reported by 36.8% and 30.4% of participants, respectively. Higher PTSD symptom severity was associated with crime/violence/vacancy, and higher depressive symptom severity was associated with neighborhood disconnectedness. PTSD and depressive symptom severity were associated with intentional injury mechanisms and Medicaid/no insurance. Higher injury severity was associated with depressive symptoms.

CONCLUSION

Neighborhood characteristics are associated with psychological symptom severity after injury.

Lessons learned from local vacant land management organizations for engaging youth in greening

Youth living in areas with high concentrations of vacant properties may be at particular risk for poor health outcomes given the associations between deteriorated vacant properties, poor mental health, and community violence. Vacant lot greening has emerged as a key strategy to mitigate the harms of deteriorated properties. Youth engagement in greening has documented benefits for youth, yet few organizations responsible for managing vacant properties currently engage youth. Further, few researchers have examined the best practices that organizations can employ to effectively engage youth in greening programs. The purpose of this study was to understand how high functioning vacant land management organizations with robust youth engagement capabilities engage youth in their greening work. Based on in-depth interviews with staff from vacant land management organizations, we explored three research questions: (1) what are their identified best practices for youth engagement?; (2) what are the major challenges that impede their youth engagement work?; (3) what solutions are these organizations employing to address these challenges? Findings from this study emphasize the important themes of engaging youth in vacant lot greening in areas of planning, leadership, and decision-making. Youth engagement in vacant lot greening may be a key mechanism for preventing violence through cultivating youth empowerment and development.

Brownfield land and health: A systematic review of the literature

BACKGROUND

Brownfield land is vacant or derelict land that was previously used for industrial or commercial purposes. Brownfield land is increasingly being targeted for housing development, however, depending on the previous use and remediation activity, it might pose potential risks to the health of residents on or in the vicinity of redeveloped sites. This systematic review of the literature synthesises the empirical evidence on the associations between brownfield land and health.

METHODS

We systematically searched EMBASE, MEDLINE, Global Health, Web of Science, Scopus and GreenFile using a study protocol registered on PROSPERO (CRD42022286826). The search strategy combined the keywords "brownfield" and its interchangeable terms such as "previously developed land", and any health outcomes such as "respiratory diseases" and "mortality". Publications identified from the search were screened for eligibility by two authors, and data were extracted from the selected articles. Study quality was assessed based on the Newcastle-Ottawa Scale.

RESULTS

Of the 1,987 records retrieved, 6 studies met the inclusion criteria; 3 ecological studies, 2 cross-sectional studies, and 1 longitudinal study. There was considerable heterogeneity in the exposure metrics and health outcomes assessed. All studies found significant positive associations between brownfield land proximity or density with at least one health relevant outcome, including poorer self-reported general health, increased mortality rates, increased birth defects, increased serum metal levels, and accelerated immune ageing.

CONCLUSIONS

Brownfield land may negatively affect the health of nearby residents. The epidemiological evidence on health effects associated with brownfield land in local communities, however, remains inconclusive and limited. Further studies are required to build the evidence base to inform future housing policies and urban planning.

A spatial and contextual exposome-wide association study and polyexposomic score of COVID-19 hospitalization

Environmental exposures have been linked to COVID-19 severity. Previous studies examined very few environmental factors, and often only separately without considering the totality of the environment, or the exposome. In addition, existing risk prediction models of severe COVID-19 predominantly rely on demographic and clinical factors. To address these gaps, we conducted a spatial and contextual exposome-wide association study (ExWAS) and developed polyexposomic scores (PES) of COVID-19 hospitalization leveraging rich information from individuals' spatial and contextual exposome. Individual-level electronic health records of 50 368 patients aged 18 years and older with a positive SARS-CoV-2 PCR/Antigen lab test or a COVID-19 diagnosis between March 2020 and October 2021 were obtained from the OneFlorida+ Clinical Research Network. A total of 194 spatial and contextual exposome factors from 10 data sources were spatiotemporally linked to each patient based on geocoded residential histories. We used a standard two-phase procedure in the ExWAS and developed and validated PES using gradient boosting decision trees models. Four exposome measures significantly associated with COVID-19 hospitalization were identified, including 2-chloroacetophenone, low food access, neighborhood deprivation, and reduced access to fitness centers. The initial prediction model in all patients without considering exposome factors had a testing-area under the curve (AUC) of 0.778. Incorporation of exposome data increased the testing-AUC to 0.787. Similar findings were observed in subgroup analyses focusing on populations without comorbidities and aged 18-24 years old. This spatial and contextual exposome study of COVID-19 hospitalization confirmed previously reported risk factor but also generated novel predictors that warrant more focused evaluation.

An external exposome-wide association study of opioid use disorder diagnosed during pregnancy in Florida

The prevalence of opioid use disorder (OUD) during pregnancy has quadrupled in recent years and widely varies geographically in the US. However, few studies have examined which environmental factors are associated with OUD during pregnancy. We conducted an external exposome-wide association study (ExWAS) to investigate the associations between external environmental factors and OUD diagnosed during pregnancy. Data were obtained from a unique, statewide database in Florida comprising linked individual-level birth and electronic health records. A total of 255,228 pregnancies with conception dates between 2012 and 2016 were included. We examined 82 exposome measures characterizing seven aspects of the built and social environment and spatiotemporally linked them to each individual record. A two-phase procedure was utilized for the external ExWAS. In Phase 1, we randomly divided the data into a discovery set (50 %) and a replication set (50 %). Associations between exposome measures (normalized and standardized) and OUD initially diagnosed during pregnancy were examined using logistic regression. A total of 15 variables were significant in both the discovery and replication sets. In Phase 2, multivariable logistic regression was used to fit all variables selected from Phase 1. Measures of walkability (the national walkability index, OR: 1.23, 95 % CI: 1.17, 1.29), vacant land (the percent vacant land for 36 months or longer, OR: 1.06, 95 % CI: 1.00, 1.12) and food access (the percentage of low food access population that are seniors at 1/2 mile, OR: 1.47, 95 % CI: 1.38, 1.57) were each associated with diagnosis of OUD during pregnancy. This is the first external ExWAS of OUD during pregnancy, and the results suggest that low food access, high walkability, and high vacant land in under-resourced neighborhoods are associated with diagnosis of OUD during pregnancy. These findings could help develop complementary tools for universal screening for substance use and provide direction for future studies.

Identifying environmental risk factors for post-acute sequelae of SARS-CoV-2 infection: An EHR-based cohort study from the recover program

Post-acute sequelae of SARS-CoV-2 infection (PASC) affects a wide range of organ systems among a large proportion of patients with SARS-CoV-2 infection. Although studies have identified a broad set of patient-level risk factors for PASC, little is known about the association between "exposome"-the totality of environmental exposures and the risk of PASC. Using electronic health data of patients with COVID-19 from two large clinical research networks in New York City and Florida, we identified environmental risk factors for 23 PASC symptoms and conditions from nearly 200 exposome factors. The three domains of exposome include natural environment, built environment, and social environment. We conducted a two-phase environment-wide association study. In Phase 1, we ran a mixed effects logistic regression with 5-digit ZIP Code tabulation area (ZCTA5) random intercepts for each PASC outcome and each exposome factor, adjusting for a comprehensive set of patient-level confounders. In Phase 2, we ran a mixed effects logistic regression for each PASC outcome including all significant (false positive discovery adjusted p-value < 0.05) exposome characteristics identified from Phase I and adjusting for confounders. We identified air toxicants (e.g., methyl methacrylate), particulate matter (PM2.5) compositions (e.g., ammonium), neighborhood deprivation, and built environment (e.g., food access) that were associated with increased risk of PASC conditions related to nervous, blood, circulatory, endocrine, and other organ systems. Specific environmental risk factors for each PASC condition and symptom were different across the New York City area and Florida. Future research is warranted to extend the analyses to other regions and examine more granular exposome characteristics to inform public health efforts to help patients recover from SARS-CoV-2 infection.

Factors influencing vulnerability to climate change-related health impacts in cities - A conceptual framework

Climate change will have adverse impacts on human health, which are amplified in cities. For these impacts, there are direct, indirect, and deferred pathways. The first category is well-studied, while indirect and deferred impacts are not well-understood. Moreover, the factors moderating the impacts have received little attention, although understanding these factors is critical for adaptation. We developed a conceptual framework that shows the pathways of climate impacts on human health, focusing specifically on the factors of urban environment moderating the emergence and severity of these health impacts. Based on the framework and literature review, we illustrate the mechanisms of direct, indirect, and deferred health impact occurrence and the factors that exacerbate or alleviate the severity of these impacts, thus presenting valuable insights for anticipatory adaptation. We conclude that an integrated systemic approach to preventing health risks from climate change can provide co-benefits for adaptation and address multiple health risks. Such an approach should be mainstreamed horizontally to all sectors of urban planning and should account for the spatiotemporal aspects of policy and planning decisions and city complexity.

Impact of Contextual-Level Social Determinants of Health on Newer Antidiabetic Drug Adoption in Patients with Type 2 Diabetes

BACKGROUND

We aimed to investigate the association between contextual-level social determinants of health (SDoH) and the use of novel antidiabetic drugs (ADD), including sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1a) for patients with type 2 diabetes (T2D), and whether the association varies across racial and ethnic groups.

METHODS

Using electronic health records from the OneFlorida+ network, we assembled a cohort of T2D patients who initiated a second-line ADD in 2015-2020. A set of 81 contextual-level SDoH documenting social and built environment were spatiotemporally linked to individuals based on their residential histories. We assessed the association between the contextual-level SDoH and initiation of SGTL2i/GLP1a and determined their effects across racial groups, adjusting for clinical factors.

RESULTS

Of 28,874 individuals, 61% were women, and the mean age was 58 (±15) years. Two contextual-level SDoH factors identified as significantly associated with SGLT2i/GLP1a use were neighborhood deprivation index (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.81-0.94) and the percent of vacant addresses in the neighborhood (OR 0.91, 95% CI 0.85-0.98). Patients living in such neighborhoods are less likely to be prescribed with newer ADD. There was no interaction between race-ethnicity and SDoH on the use of newer ADD. However, in the overall cohort, the non-Hispanic Black individuals were less likely to use newer ADD than the non-Hispanic White individuals (OR 0.82, 95% CI 0.76-0.88).

CONCLUSION

Using a data-driven approach, we identified the key contextual-level SDoH factors associated with not following evidence-based treatment of T2D. Further investigations are needed to examine the mechanisms underlying these associations.

Lessons Learned from a Citywide Abandoned Housing Experiment

Problem research strategy and findings

The negative impact of vacant and abandoned housing in city neighborhoods is extreme, affecting health and quality of life, promoting violence, and leading to further abandonment. One approach to addressing abandoned housing is to intervene with low-cost interventions that provide a visual sense of ownership. We tested whether a low-cost remediation of abandoned and vacant houses or a trash cleanup intervention would make a noticeable difference in the levels of nearby disrepair, disorder, and public safety. The abandoned housing remediation and trash cleanup interventions were a test of compliance with municipal ordinances. We used an experimental design to test the causal effects of the ordinances, and because the scale of abandonment was too large to provide treatment to all abandoned houses in the city. We used systematic social observation methods to rate changes in disrepair, disorder, and litter at housing sites and on the city blocks they were located, and police reported data on gun violence and illegal substance uses. Our experimental design allowed us to see if observed disrepair, disorder, and public safety improved after working windows and doors were installed on abandoned houses compared with a trash cleanup around properties or a no-intervention control condition. Our results showed significant changes in observed disrepair, disorder, and gun violence and illustrate the benefits of experimental evaluations of place-based changes to the built environment.

Takeaway for practice

Improving compliance with ordinances to remediate abandoned housing can make a noticeable difference in disrepair in neighborhoods and contribute improved public safety. We illustrate how planners can use field experiments in partnership with city agencies, nonprofit community groups, and local universities to discover novel approaches to advance place-based changes to the built environment that can help economically disadvantaged communities abate problems of physical disorder.

The right to the unhealthy deprived city: An exploration into the impacts of state-led redevelopment projects on the determinants of mental health

Research shows mental health is impacted by poor-quality physical and social-environmental conditions. Subsequently state-led redevelopment/regeneration schemes focus on improving the physical environment, to provide better social-environmental conditions, addressing spatial and socioeconomic inequities thus improving residents' health. However, recent research suggests that redevelopment/regeneration schemes often trigger gentrification, resulting in new spatial and socioeconomic inequalities that may worsen health outcomes, including mental health, for long-term neighborhood residents. Using the right to the city and situating this within the framework of accumulation by dispossession and capitalist hegemony, this paper explores the potential mechanisms in which poor mental health outcomes may endure in neighborhoods despite the implementation of redevelopment/regeneration projects. To do so, we explored two neighborhoods in the city of Glasgow - North Glasgow and East End - and conducted a strong qualitative study based on 25 in-depth semi-structured interviews with key stakeholders. The results show that postindustrial vacant and derelict land spaces and socioeconomic deprivation in North and East Glasgow are potential mechanisms contributing to the poor mental health of its residents. Where redevelopment/regeneration projects prioritize economic goals, it is often at the expense of social(health) outcomes. Instead, economic investment instigates processes of gentrification, where long-term neighborhood residents are excluded from accessing collective urban life and its (health) benefits. Moreover, these residents are continually excluded from participation in decision-making and are unable to shape the urban environment. In summary, we found a number of potential mechanisms that may contribute to enduring poor mental health outcomes despite the existence of redevelopment/regeneration projects. Projects instead have negative consequences for the determinants of mental health, reinforcing existing inequalities, disempowering original long-term neighborhood residents and only providing the "right" to the unhealthy deprived city. We define this as the impossibility to benefit from material opportunities, public spaces, goods and services and the inability to shape city transformations.

Association of Neighborhood Racial and Ethnic Composition and Historical Redlining With Built Environment Indicators Derived From Street View Images in the US

Importance

Racist policies (such as redlining) create inequities in the built environment, producing racially and ethnically segregated communities, poor housing conditions, unwalkable neighborhoods, and general disadvantage. Studies on built environment disparities are usually limited to measures and data that are available from existing sources or can be manually collected.

Objective

To use built environment indicators generated from online street-level images to investigate the association among neighborhood racial and ethnic composition, the built environment, and health outcomes across urban areas in the US.

Design, Setting, and Participants

This cross-sectional study was conducted using built environment indicators derived from 164 million Google Street View images collected from November 1 to 30, 2019. Race, ethnicity, and socioeconomic data were obtained from the 2019 American Community Survey (ACS) 5-year estimates; health outcomes were obtained from the Centers for Disease Control and Prevention 2020 Population Level Analysis and Community Estimates (PLACES) data set. Multilevel modeling and mediation analysis were applied. A total of 59 231 urban census tracts in the US were included. The online images and the ACS data included all census tracts. The PLACES data comprised survey respondents 18 years or older. Data were analyzed from May 23 to November 16, 2022.

Main Outcomes and Measures

Model-estimated association between image-derived built environment indicators and census tract (neighborhood) racial and ethnic composition, and the association of the built environment with neighborhood racial composition and health.

Results

The racial and ethnic composition in the 59 231 urban census tracts was 1 160 595 (0.4%) American Indian and Alaska Native, 53 321 345 (19.5%) Hispanic, 462 259 (0.2%) Native Hawaiian and other Pacific Islander, 17 166 370 (6.3%) non-Hispanic Asian, 35 985 480 (13.2%) non-Hispanic Black, and 158 043 260 (57.7%) non-Hispanic White residents. Compared with other neighborhoods, predominantly White neighborhoods had fewer dilapidated buildings and more green space indicators, usually associated with good health, and fewer crosswalks (eg, neighborhoods with predominantly minoritized racial or ethnic groups other than Black residents had 6% more dilapidated buildings than neighborhoods with predominantly White residents). Moreover, the built environment indicators partially mediated the association between neighborhood racial and ethnic composition and health outcomes, including diabetes, asthma, and sleeping problems. The most significant mediator was non-single family homes (a measure associated with homeownership), which mediated the association between neighborhoods with predominantly minority racial or ethnic groups other than Black residents and sleeping problems by 12.8% and the association between unclassified neighborhoods and asthma by 24.2%.

Conclusions and Relevance

The findings in this cross-sectional study suggest that large geographically representative data sets, if used appropriately, may provide novel insights on racial and ethnic health inequities. Quantifying the impact of structural racism on social determinants of health is one step toward developing policies and interventions to create equitable built environment resources.

Methodological Challenges in Spatial and Contextual Exposome-Health Studies

The concept of the exposome encompasses the totality of exposures from a variety of external and internal sources across an individual's life course. The wealth of existing spatial and contextual data makes it appealing to characterize individuals' external exposome to advance our understanding of environmental determinants of health. However, the spatial and contextual exposome is very different from other exposome factors measured at the individual-level as spatial and contextual exposome data are more heterogenous with unique correlation structures and various spatiotemporal scales. These distinctive characteristics lead to multiple unique methodological challenges across different stages of a study. This article provides a review of the existing resources, methods, and tools in the new and developing field for spatial and contextual exposome-health studies focusing on four areas: (1) data engineering, (2) spatiotemporal data linkage, (3) statistical methods for exposome-health association studies, and (4) machine- and deep-learning methods to use spatial and contextual exposome data for disease prediction. A critical analysis of the methodological challenges involved in each of these areas is performed to identify knowledge gaps and address future research needs.

Effect of Abandoned Housing Interventions on Gun Violence, Perceptions of Safety, and Substance Use in Black Neighborhoods: A Citywide Cluster Randomized Trial

Importance

Structural racism has resulted in long-standing disinvestment and dilapidated environmental conditions in Black neighborhoods. Abandoned houses signal neglect and foster stress and fear for residents, weakening social ties and potentially contributing to poor health and safety.

Objective

To determine whether abandoned house remediation reduces gun violence and substance-related outcomes and increases perceptions of safety and use of outdoor space.

Design, Setting, and Participants

This cluster randomized trial was conducted from January 2017 to August 2020, with interventions occurring between August 2018 and March 2019. The study included abandoned houses across Philadelphia, Pennsylvania, and surveys completed by participants living nearby preintervention and postintervention. Data analysis was performed from March 2021 to September 2022.

Interventions

The study consisted of 3 arms: (1) full remediation (installing working windows and doors, cleaning trash, weeding); (2) trash cleanup and weeding only; and (3) a no-intervention control.

Main Outcomes and Measures

Difference-in-differences mixed-effects regression models were used to estimate the effect of the interventions on multiple primary outcomes: gun violence (weapons violations, gun assaults, and shootings), illegal substance trafficking and use, public drunkenness, and perceptions of safety and time outside for nearby residents.

Results

A master list of 3265 abandoned houses was randomly sorted. From the top of this randomly sorted list, a total of 63 clusters containing 258 abandoned houses were formed and then randomly allocated to 3 study arms. Of the 301 participants interviewed during the preintervention period, 172 (57.1%) were interviewed during the postintervention period and were included in this analysis; participants were predominantly Black, and most were employed. Study neighborhoods were predominantly Black with high percentages of low-income households. Gun violence outcomes increased in all study arms, but increased the least in the full remediation arm. The full housing remediation arm, compared with the control condition, showed reduced weapons violations by -8.43% (95% CI, -14.68% to -1.19%), reduced gun assaults by -13.12% (95% CI, -21.32% to -3.01%), and reduced shootings by a nonsignificant -6.96% (95% CI, -15.32% to 3.03%). The trash cleanup arm was not associated with a significant differential change in any gun violence outcome. Instances of illegal substance trafficking and use and public drunkenness outcomes were not significantly affected by the housing remediation or trash cleanup treatment. Perceptions of neighborhood safety and time spent outside were unaffected by the intervention. The study arms did differ in a baseline characteristic and some preintervention trends, which raises questions regarding other potential nonmeasured differences between study arms that could have influenced estimates. No evidence of displacement of gun violence outcomes was found.

Conclusions and Relevance

In this cluster randomized controlled trial among low-income, predominantly Black neighborhoods, inexpensive, straightforward abandoned housing remediation was directly linked to significant relative reductions in weapons violations and gun assaults, and suggestive reductions in shootings.

Trial Registration

isrctn.org Identifier: ISRCTN14973997.

Effects of building demolitions on firearm violence in Detroit, Michigan

Former industrial cities facing economic challenges and depopulation often experience high levels of firearm and other forms of violence. Within these cities, violent crime often clusters in neighborhoods affected by high levels of vacant and abandoned housing. This study estimates the effects of building demolition in Detroit, Michigan on the subsequent risk of violent crime using property-level data and longitudinal targeted maximum likelihood estimation. The primary outcome is violent Crime Index crimes (homicide, rape, robbery and aggravated assault). We estimate effects for this category of crimes as a whole and for the subset involving firearms. Drug and other lower-level crimes are included as secondary outcomes. We compare the risk of experiencing each crime type following building demolition in Census blocks and block groups to an estimate of the risk had there been no demolition in the 1-3 quarters prior in 2017. There were >2600 total demolitions in about 1700 blocks in 2017 in Detroit. Nearly all demolished buildings were sourced from tax foreclosures. Estimates suggest the risk for all crime types tested would have been statistically indistinguishable from the observed crime risk had demolitions in the prior 1-3 quarters of 2017 not occurred. Our results run counter to most previous research on this topic, which tends to show a protective effect of demolition on violent crime. Understanding why our results differ may provide important insights into the types of demolition programs with the greatest potential to reduce violent crime.

Neighborhood segregation, tree cover and firearm violence in 6 U.S. cities, 2015-2020

Neighborhood segregation by race and income is a structural determinant of firearm violence. Addressing green space deficits in segregated neighborhoods is a promising prevention strategy. This study assessed the potential for reducing firearm violence disparities by increasing access to tree cover. Units of analysis were census tracts in six U.S. cities (Baltimore, MD; Philadelphia, PA; Richmond, VA; Syracuse, NY; Washington, DC; Wilmington, DE). We measured segregation using the index of concentration at the extremes (ICE) for race-income. We calculated proportion tree cover based on 2013-2014 imagery. Outcomes were 2015-2020 fatal and non-fatal shootings from the Gun Violence Archive. We modeled firearm violence as a function of ICE, tree cover, and covariates representing the social and built environment. Next, we simulated possible effects of "tree equity" programs, i.e., raising tract-level tree cover to a specified baseline level. In our fully-adjusted model, higher privilege on the ICE measure (1 standard deviation, SD) was associated with a 42% reduction in shootings (incidence rate ratio (IRR) = 0.58, 95% CI [0.54 0.62], p < 0.001). A 1-SD increase in tree cover was associated with a 9% reduction (IRR = 0.91, 95% CI [0.86, 0.97], p < 0.01). Simulated achievement of 40% baseline tree cover was associated with reductions in firearm violence, with the largest reductions in highly-deprived neighborhoods. Advancing tree equity would not disrupt the fundamental causes of racial disparities in firearm violence exposure, but may have the potential to help mitigate those disparities.

Revisiting revitalization: exploring how structural determinants moderate pathways between neighborhood change and health

Vacant housing can produce many issues that affect residents’ quality of life, especially in historically segregated communities of color. To address these challenges, local governments invest in strategic, place-based revitalization initiatives focused on the regeneration of vacant housing. Yet, the outcomes of these efforts remain contested. To maximize health benefits of revitalization investments, a more nuanced understanding of pathways between neighborhood changes and residents’ responses, adaptations, and ability to thrive is necessary, though, remains largely absent in the literature. Using the Vacants to Value initiative in Baltimore, MD as a case study, we explore (1) how health manifests among certain groups in the context of vacant housing revitalization; (2) how vacant housing and its regeneration engender social and cultural environmental change i.e., gentrification; and (3) what structural determinants (cultural norms, policies, institutions, and practices) contribute to the distribution of material resources and benefits of revitalization. Results suggest that vacant housing revitalization requires more than just physical remedies to maximize health. Our findings demonstrate how vacant housing revitalization influences the physical environment, social environment, and structural determinants of material resources and community engagement that can ultimately impact residents’ physical, mental, and social health. This study recommends that because housing disparities are rooted in structural inequalities, how policies, practices, and processes moderate pathways for residents to adapt and benefit from neighborhood changes is consequential for health and health equity. Establishing shared governance structures is a promising approach to foster equitable decision-making and outcomes. Going forward in urban regeneration, pathways to retain and strengthen the social environment while revitalizing the physical environment may be promising to achieve healthy communities.

The association between vacant housing demolition and safety and health in Baltimore, MD

We measured the association between vacant housing demolitions and changes in crime and emergency department (ED) visits in Baltimore, MD. We included 646 block groups in Baltimore, 224 of which experienced at least one demolition from 2012 to 2019. The exposure was the number of demolitions completed in a block group during the previous quarter. Crime (all, property, and violent) and ED visits (all, adults, children, and for specific causes) were examined as the change in the rate per 1000 people from the previous quarter to the current quarter and analyzed using multivariable mixed effects regression models. Demolitions were associated with a small decrease in total ED visits (difference = -0.068 per 1000 people from the previous quarter to the current quarter, 95% CI -0.119, -0.018) but no significant change in crime. For each demolition, the rate of total child ED visits was 0.452 lower compared to the previous quarter (95% CI -0.777, -0.127). Demolitions were associated with small decreases in adult injury-related ED visits in the short term.

Neighborhood influences on the development of self-regulation among children of color living in historically disinvested neighborhoods: Moderators and mediating mechanisms

We present a conceptual model of the ways in which built and social environments shape the development of self-regulation in early childhood. Importantly, in centering children of color growing up in historically disinvested neighborhoods, we first describe how systemic structures of racism and social stratification have shaped neighborhood built and social environment features. We then present evidence linking these neighborhood features to children's development of self-regulation. Furthermore, we take a multilevel approach to examining three potential pathways linking neighborhood contexts to self-regulation: school environment and resources, home environment and resources, and child health behaviors. Finally, we consider how racial-ethnic-cultural strengths and multilevel interventions have the potential to buffer children's development of self-regulation in disinvested neighborhood contexts. Advancing multilevel approaches to understand the development of self-regulation among children of color living in historically disinvested neighborhoods is an important step in efforts to promote equity in health and education.

Identifying Contextual and Spatial Risk Factors for Post-Acute Sequelae of SARS-CoV-2 Infection: An EHR-based Cohort Study from the RECOVER Program

Post-acute sequelae of SARS-CoV-2 infection (PASC) affects a wide range of organ systems among a large proportion of patients with SARS-CoV-2 infection. Although studies have identified a broad set of patient-level risk factors for PASC, little is known about the contextual and spatial risk factors for PASC. Using electronic health data of patients with COVID-19 from two large clinical research networks in New York City and Florida, we identified contextual and spatial risk factors from nearly 200 environmental characteristics for 23 PASC symptoms and conditions of eight organ systems. We conducted a two-phase environment-wide association study. In Phase 1, we ran a mixed effects logistic regression with 5-digit ZIP Code tabulation area (ZCTA5) random intercepts for each PASC outcome and each contextual and spatial factor, adjusting for a comprehensive set of patient-level confounders. In Phase 2, we ran a mixed effects logistic regression for each PASC outcome including all significant (false positive discovery adjusted p-value < 0.05) contextual and spatial characteristics identified from Phase I and adjusting for confounders. We identified air toxicants (e.g., methyl methacrylate), criteria air pollutants (e.g., sulfur dioxide), particulate matter (PM 2.5 ) compositions (e.g., ammonium), neighborhood deprivation, and built environment (e.g., food access) that were associated with increased risk of PASC conditions related to nervous, respiratory, blood, circulatory, endocrine, and other organ systems. Specific contextual and spatial risk factors for each PASC condition and symptom were different across New York City area and Florida. Future research is warranted to extend the analyses to other regions and examine more granular contextual and spatial characteristics to inform public health efforts to help patients recover from SARS-CoV-2 infection.

Longitudinal effects of Youth Empowerment Solutions: Preventing youth aggression and increasing prosocial behavior

Youth violence remains a significant public health problem despite efforts to address it. We describe the evaluation results of Youth Empowerment Solutions (YES), an after-school active learning program implemented by trained local teachers and designed to engage middle school youth in multi-systematic promotive behaviors at the individual-, interpersonal-, and community-level to make lasting positive changes within the context of institutional disadvantages, such as racism. First, we used a modified randomized controlled trial design to examine the direct and indirect influence of YES on prosocial and delinquent behaviors 12 months after the conclusion of the program, through youth empowerment. Next, we evaluated these models by race, to determine if the intervention equitably promotes prosocial outcomes and decreases aggressive behaviors. Among 329 middle school students, YES participation enhanced prosocial behaviors through empowerment, and directly reduced aggressive behaviors a year after the conclusion of the program. This trend was particularly pronounced for African American youth. These effects were found after controlling for age, sex, and behavioral outcomes at baseline, and across different schools and teachers, suggesting that YES can also be sustainable and readily implemented by communities. The implications of the results for youth violence prevention, empowerment theory and intervention development and practice for ethnic minority youth who face structural disenfranchisement are discussed.

Agent-Based Modeling: an Underutilized Tool in Community Violence Research

Purpose of Review

Recent Findings

Summary

Examining the Built Environment for Healthy Living via Virtual Street Audits

During the fall 2019 and spring 2020 semesters, 156 MPH students enrolled in the Integrative Learning Experience at the University of Alabama at Birmingham School of Public Health explored concepts of the built environment and health by auditing 2500 street segments in 4 urban neighborhoods in Birmingham, Alabama. In teams of 4 to 5, in-class and online students worked collaboratively to assess 63 built environment variables related to transportation, land use, advertisement, and neighborhood physical disorder. This type of "community assessment" is the first stage of the Evidence-based Public Health Framework and consistent with the applied nature of an MPH degree. Authors conducted secondary data analysis of final team assignments to demonstrate how students translated observations and ratings into practical recommendations for neighborhood improvements to promote physical activity. Students recommended improvements in neighborhood infrastructure and services, specifically: creating exercise space, providing outdoor exercise equipment, improving neighborhood safety, and cultivating a culture of health. The Integrative Learning Experience course encouraged students to use their knowledge and skills to prioritize recommendations to improve neighborhood conditions. Variable ratings and observations increased student awareness of the built environment and its potential to impact individual and community health. Moreover, the project helped students make connections between proximal outcomes, such as improving neighborhood walkability, and distal outcomes, such as improved health outcomes among residents. Finally, this project modeled for students the use of evidence-based strategies for making data-informed decisions, which are essential skills for new and emerging public health professionals.

People’s Attitudes and Emotions towards Different Urban Forest Types in the Berlin Region, Germany

In an era of urbanization, forests are a key component of the urban green infrastructure, providing multiple benefits to urban residents. While emerging forests on urban wasteland could increase the urban forest area, it is unclear how residents view such novel forest types. In a comparative self-administered online survey, we assessed attitudes and emotions of residents (n = 299) from the Berlin region, Germany, towards forest types that represent transformation stages from natural to novel forests: (1) natural remnants, (2) silvicultural plantings, (3) park forests and (4) novel wild forests in wastelands. Respondents expressed positive attitudes and emotions towards all forest types, including the novel wild forest. Ratings were most positive towards natural remnants and least positive towards the novel wild forest. The indicated prevalence of non-native trees (Ailanthus altissima, Robinia pseudoacacia) did not evoke negative responses. Women and younger people were more positive towards the novel wild forest compared to other respondents, and men were most positive towards natural remnants. Place attachment was positively related to the park forest. Results indicate support for a wide range of forest types, including novel wild forests and non-native tree species, which can be used to expand urban forest areas and enhance opportunities for nature experience in cities.

Advancing health equity through integrated biology and population health research: A community-based sample cortisol feasibility and exploratory study

Background

Community-based research inclusive of self-assessment and objective environmental metrics can be enhanced by the collection of biomarker data in unity toward assessing the health impacts of the totality of environmental stress driven by structural racism. Cortisol dynamic range (CDR), a measure of chronic stress burden, may underpin place-based connections to health, but a gap remains in elucidating community-based CDR methodology.

Purpose

To 1) assess the feasibility of cortisol collection and CDR measurement in a community-based study with home-based, participant-directed specimen collection, and 2) explore the association between CDR and other individual and environmental measures in a sample of predominantly Black participants. Methods: In this cross-sectional, observational study in predominantly Black urban neighborhoods, participants (n = 73) completed health assessments and in-home, self-collected salivary cortisol. For feasibility, CDR (peak-nadir) was compared to cortisol awakening response (CAR) slope over time. Comparisons of CDR quartile by person and place variables were explored (ANOVA).

Results

The cohort (77% Black, 39.7% <$15 k/year income, high perceived stress) completed 98.6% of cortisol collection timepoints. CDR was calculated in all participants without interruptions to sleep-wake cycle as seen with CAR collection. Participants in the lowest quartile of CDR were the oldest (p = 0.03) with lowest reported mental health (p = 0.048) with no associations seen for CAR.

Conclusion

Participant-collected 10.13039/501100011622CDR is more feasible than cortisol measures dependent on slopes over time in a community-based, predominately Black cohort with exploratory findings supporting relevance to outcomes of interest to future work. Future community-based studies should integrate CDR with environment and psychosocial measures.

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Biological and social metrics can enhance community studies of structural racism.

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Cortisol dynamic range (CDR) may reflect the burden of chronic stress in a community.

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In-home, participant-collected salivary cortisol is feasible with in-field guidance.

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CDR may be more feasible in community-based study than measures dependent on time.

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Greatest CDR is seen with youngest age and best self-reported mental health.

Neighborhood Blighted Property Removal and 311 Calls for Non-Emergency Services: A Test of a Marker of Social Control

Many studies have demonstrated that collective efficacy is associated with positive health outcomes, lower crime, and violence in urban communities, and residents' emotional connection to their community. Remediation of blighted properties has been theoretically linked to increases in collective efficacy. The purpose of this study was to examine the impact of blighted property remediation on city non-emergency 311 calls for public incivilities and deterioration, as potential markers of collective efficacy. We used a quasi-experimental design to test whether 311 calls for service changed around remediated vacant lots in New Orleans, Louisiana, United States, many of which were left vacant after Hurricane Katrina in 2005. In six city neighborhoods eligible for blighted property remediation as part of a city program, 203 treated vacant lots were matched 1:3 without replacement to control lots that were eligible for but did not receive treatment. This yielded a total of 812 vacant lots partitioned within 48 months, or 38,976 lot-months. Controls were in the same New Orleans neighborhoods as their matched treatment lots but were at least 250 feet away to minimize contamination. Overall difference-in-differences models detected postintervention declines in calls related to dumping and garbage, and slight but mostly non-significant changes in calls between intervention and control lots in all but calls for dumping and vehicles. Blighted property remediation may have an impact on dumping and garbage, which is important. Despite being geographically specific, low-cost and longitudinal, the nature of 311 calls and structural and historic factors at play in both the concentration of vacant properties in communities and residents' willingness to call must be considered. Further analyses of changes in 311 data and additional qualitative inquiry are warranted to more fully determine the utility of these data.

Spaces Eliciting Negative and Positive Emotions in Shrinking Neighbourhoods: a Study in Seoul, South Korea, Using EEG (Electroencephalography)

Although shrinking neighbourhoods are places where urban citizens experience negative emotions, some evidence suggests that people in some shrinking neighbourhoods feel less negative emotions than in other areas. Nevertheless, empirical studies that analyse environmental and personal elements that affect people's emotions in a shrinking neighbourhood remain insufficient. This is rather surprising, considering an increasing interest in the effects of negative emotions on individuals' health. Thus, this study used electroencephalography (EEG) to examine the impacts of environmental and personal characteristics on people's emotional levels in a shrinking area of Seoul, South Korea. A multilinear regression model was used to analyse emotional valence levels between sites with different urban designs and management levels. The results revealed that people felt positive emotions at sites where both urban design factors and their management were both satisfactory at appropriate levels. The results also found that people who had lived or worked in the neighbourhood for a long time and were women experienced more positive emotions than visitors and men. This finding implies that a shrinking neighbourhood can maintain a sense of satisfaction as long as the area is carefully managed. Revealing the emotional effects of environmental and personal characteristics in a shrinking neighbourhood can be used for planning practices and policy-making to create healthy and liveable urban neighbourhoods.

Community Greening, Fear of Crime, and Mental Health Outcomes

Unmaintained vacant land in urban areas is associated with a number of negative outcomes for residents of urban areas, including mental and physical health, safety, and quality of life. Community programs which promote land parcel maintenance in urban neighborhoods have been found to reverse some of the effects that unmaintained land has on nearby residents. We explored how land parcel maintenance is associated with mental health outcomes using data collected in Flint, MI in 2017-2018. Trained observers assessed the maintenance of approximately 7200 land parcels and surveyed 691 residents (57% Female, 53% Black, M age = 51). We aggregated resident and parcel rating data to 463 street segments and compared three structural equation models (SEM) to estimate the mediating effects of fear of crime on the association of parcel qualities on mental distress for residents. We found that fear of crime mediated the association between parcel maintenance values and mental distress indicating that poor maintenance predicted more fear of crime which was associated with mental distress. Our findings add to our understanding about the mechanism by which vacant lot improvements may operate to enhance psychological well-being of residents who live on streets with vacant and unkept lots.

A cross-sectional study of brownfields and birth defects

BACKGROUND

Brownfields are a multitude of abandoned and disused sites, spanning many former purposes. Brownfields represent a heterogenous yet ubiquitous exposure for many Americans, which may contain hazardous wastes and represent urban blight. Neonates and pregnant individuals are often sensitive to subtle environmental exposures. We evaluate whether residential brownfield exposure is associated with birth defects.

METHODS

Using North Carolina birth records from 2003 to 2015, we sampled 753,195 births with 39,495 defects identified. We examined defect groups and 30 distinct phenotypes. Number of brownfields within 2,000 m of the residential address at birth was summed. We utilized mixed effects multivariable logistic regression models adjusted for demographic and environmental covariates available from birth records, 2010 Census, and EPA's Environmental Quality Index to estimate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

We observed positive associations between cardiovascular and external defect groups (OR [95% CI]: 1.07 [1.02-1.13] and 1.17 [1.01-1.35], respectively) and any brownfield exposure. We also observed positive associations with atrial septal and ventricular septal defects (1.08 [1.01-1.16] and 1.15 [1.03-1.28], respectively), congenital cataracts (1.38 [0.98-1.96]), and an inverse association with gastroschisis (0.74 [0.58-0.94]). Effect estimates for several additional defects were positive, though we observed null associations for most group and individual defects. Additional analyses indicated an exposure-response relationship for several defects across levels of brownfield exposure.

CONCLUSIONS

Our results indicate that residential proximity to brownfields is associated with birth defects, especially cardiovascular and external defects. In-depth analyses of individual defects and specific contaminants or brownfield sites may reveal additional novel associations.

Absolute versus relative socioeconomic disadvantage and homicide: a spatial ecological case-control study of US zip codes

BACKGROUND

Homicide is a major cause of death and contributes to health disparities in the United States. This burden overwhelmingly affects people from racial and ethnic minority populations as homicide occurs more often in neighborhoods with high proportions of racial and ethnic minority residents. Research has identified that environmental factors contribute to variation in homicide rates between neighborhoods; however, it is not clear why some neighborhoods with high concentrations of racial and ethnic minority residents have high homicide rates while neighborhoods with similar demographic compositions do not. The aim of this study was to assess whether relative socioeconomic disadvantage, (i.e., income inequality), or absolute socioeconomic disadvantage (i.e., income) measured at the ZIP code- and state-levels, is associated with high homicide rates in US ZIP codes, independent of racial and ethnic composition.

METHODS

This ecological case-control study compared median household income and income inequality in 250 ZIP codes with the highest homicide rate in our sample in 2017 (cases) to 250 ZIP codes that did not experience any homicide deaths in 2017 (controls). Cases were matched to controls 1:1 based on demographic composition. Variables were measured at both the ZIP code- and state-levels.

RESULTS

Lower median household income at the ZIP code-level contributed most substantially to the homicide rate. Income inequality at the state-level, however, was additionally significant when controlling for both ZIP code- and state-level factors.

CONCLUSIONS

Area-based interventions that improve absolute measures of ZIP code socioeconomic disadvantage may reduce gaps in homicide rates.

Strategic Assessment of Neighbourhood Environmental Impacts on Mental Health in the Lisbon Region (Portugal): A Strategic Focus and Assessment Framework at the Local Level

Scientific evidence shows that each place/environment generates specific conditions with associated impacts on the mental health and well-being of the population. A holistic, multilevel and integrated environmental approach to mental health enhances the understanding of this phenomena, supporting the local decision-making processes to improve spatial planning of neighbourhood environments. The aim of this study is to develop a strategic assessment framework, based on four municipalities in the Lisbon Region (Portugal), that explores policy and planning initiatives capable of generating favourable neighbourhood environmental conditions for mental health while also detecting risks. Using baseline results of significant statistical associations between individuals’ perceptions of their neighbourhood environment and their mental health in the Lisbon Region, a Strategic Focus on Environmental and Mental Health Assessment framework (SEmHA) was built, by applying the methodology “Strategic Thinking for Sustainability” in Strategic Environmental Assessment, developed by Partidário in 2012. Taking into account the promotion of the population’s mental health, four critical decision factors of neighbourhood environments were identified: (1) public space quality (e.g., improving sense of place), (2) physical environment quality (e.g., low levels of noise exposure), (3) professional qualification and creation of economic activities (e.g., attracting new economic activities), and (4) services and facilities (e.g., improving access to health and education services). The proposed strategic focus and assessment framework contributes to ensuring that interventions in neighbourhood environments truly achieve community mental health benefits and reduce inequalities, thus helping policy makers to assess impacts at the local level.

Ambient lighting, use of outdoor spaces and perceptions of public safety: evidence from a survey experiment

Observational evidence suggests that better ambient lighting leads people to feel safer when spending time outdoors in their community. We subject this finding to greater scrutiny and elaborate on the extent to which improvements in street lighting affect routine activities during nighttime hours. We report evidence from a survey experiment that examines individuals’ perceptions of safety under two different intensities of nighttime ambient lighting. Brighter street lighting leads individuals to feel safer and over half of survey respondents are willing to pay an additional $400 per year in taxes in order to finance a hypothetical program which would replace dim yellow street lights with brighter LED lights. However, poor lighting does not change people’s willingness to spend time outdoors or to engage in behaviors which mitigate risk. Results suggest that street lighting is a means through which policymakers can both control crime and improve community well-being.

Healthy, happy places-a more integrated approach to creating health and well-being through the built environment?

INTRODUCTION

This paper explores how the built environment impacts upon health and well-being and suggests that there are opportunities for more integrated working between professionals and citizens to create healthier, happier places.

SOURCES OF DATA

Policy and practice guidance is presented from the urban planning and design fields. Evidence and data are presented from a range of disciplines on housing, green infrastructure and mental well-being.

AREAS OF AGREEMENT

There is an overwhelming agreement around the principles and rationale of incorporating health in planning and design processes.

AREAS OF CONTROVERSY

These principles are not always implemented in practice. Challenges also exist around how different disciplines create and use evidence.

GROWING POINTS

More innovative ways of working which incorporates health, public health, planners, designers and citizens, which responds to the needs of communities, should be tested.

AREAS TIMELY FOR DEVELOPING RESEARCH

Health and public health professionals can contribute to the evidence base using objective measures to assess the impact of the built environment on mental health and well-being.

Gender Differences in Impacts of Place-Based Neighborhood Greening Interventions on Fear of Violence Based on a Cluster-Randomized Controlled Trial

Maintained green space in underserved urban neighborhoods may be an important environmental pathway to improving community health and safety, though effects may vary across population subgroups and by time of day. We examined survey responses from 442 participants (178 men and 264 women), living near vacant lots in a cluster-randomized controlled trial of a cleaning and greening intervention, on perceived safety during the day and at night. At the intervention sites after the intervention, only men reported feeling less unsafe during the day. Women reported more fear, and men reported less fear, after the intervention, although these results and tests for effect modification were not statistically significant. The clean-and-green intervention may have allayed fears for men during the day and supported their ease of movement throughout their neighborhoods. However, at night, it may have had the opposite effect on women. Though our study was under-powered, not designed to test associations stratified by gender, directions and magnitudes of associations differed substantially, indicating a need for further investigations into potential gender differences in the benefits of green space, to inform and better tailor interventions to improve perceived safety for all.

Pathways between objective and perceived neighborhood factors among Black breast cancer survivors

BACKGROUND

Mounting evidence supports associations between objective neighborhood disorder, perceived neighborhood disorder, and health, yet alternative explanations involving socioeconomic and neighborhood social cohesion have been understudied. We tested pathways between objective and perceived neighborhood disorder, perceived neighborhood social cohesion, and socioeconomic factors within a longitudinal cohort.

METHODS

Demographic and socioeconomic information before diagnosis was obtained at interviews conducted approximately 10 months post-diagnosis from participants in the Women's Circle of Health Follow-up Study - a cohort of breast cancer survivors self-identifying as African American or Black women (n = 310). Neighborhood perceptions were obtained during follow-up interviews conducted approximately 24 months after diagnosis. Objective neighborhood disorder was from 9 items audited across 23,276 locations using Google Street View and scored to estimate disorder values at each participant's residential address at diagnosis. Census tract socioeconomic and demographic composition covariates were from the 2010 U.S. Census and American Community Survey. Pathways to perceived neighborhood disorder were built using structural equation modelling. Model fit was assessed from the comparative fit index and root mean square error approximation and associations were reported as standardized coefficients and 95% confidence intervals.

RESULTS

Higher perceived neighborhood disorder was associated with higher objective neighborhood disorder (β = 0.20, 95% CI: 0.06, 0.33), lower neighborhood social cohesion, and lower individual-level socioeconomic factors (final model root mean square error approximation 0.043 (90% CI: 0.013, 0.068)). Perceived neighborhood social cohesion was associated with individual-level socioeconomic factors and objective neighborhood disorder (β = - 0.11, 95% CI: - 0.24, 0.02).

CONCLUSION

Objective neighborhood disorder might be related to perceived disorder directly and indirectly through perceptions of neighborhood social cohesion.

Google Street View-Derived Neighborhood Characteristics in California Associated with Coronary Heart Disease, Hypertension, Diabetes

Characteristics of the neighborhood built environment influence health and health behavior. Google Street View (GSV) images may facilitate measures of the neighborhood environment that are meaningful, practical, and adaptable to any geographic boundary. We used GSV images and computer vision to characterize neighborhood environments (green streets, visible utility wires, and dilapidated buildings) and examined cross-sectional associations with chronic health outcomes among patients from the University of California, San Francisco Health system with outpatient visits from 2015 to 2017. Logistic regression models were adjusted for patient age, sex, marital status, race/ethnicity, insurance status, English as preferred language, assignment of a primary care provider, and neighborhood socioeconomic status of the census tract in which the patient resided. Among 214,163 patients residing in California, those living in communities in the highest tertile of green streets had 16–29% lower prevalence of coronary artery disease, hypertension, and diabetes compared to those living in communities in the lowest tertile. Conversely, a higher presence of visible utility wires overhead was associated with 10–26% more coronary artery disease and hypertension, and a higher presence of dilapidated buildings was associated with 12–20% greater prevalence of coronary artery disease, hypertension, and diabetes. GSV images and computer vision models can be used to understand contextual factors influencing patient health outcomes and inform structural and place-based interventions to promote population health.