Citywide cluster randomized trial to restore blighted vacant land and its effects on violence, crime, and fear

The land cover paradox: Characteristics of blue- and green spaces within and beyond high-risk suicide clusters

Purpose

Urban suicide rates are rising, with disproportionate impacts on communities of color. While social determinants of suicide are well-established, the role of overlapping social, natural, and built environments remains underexamined.

Methods

We integrated National Land Cover Database (NLCD) data on developed open space, tree canopy, blue space, and a novel measure of land cover diversity with indicators of tree and park equity, built environment features, and socioeconomic vulnerability. Bayesian spatial Poisson models were used to estimate associations between these socioenvironmental variables and suicide risk at the Census Block Group (CBG) level in Chicago. We also identified and compared spatial clusters of high and low suicide risk using Local Moran's I.

Results

Blue space and developed, open spaces were associated with reduced suicide risk, with estimated decreases of 17.9 % and 15.1 %, respectively. In contrast, greater land cover diversity was associated with a 32.1 % increase in suicide risk. Suicide risk exhibited spatial structuring, with nearly half of the total variance explained by between-CBG differences (γ = 0.4971). Although spatial variability was modest (σS = 0.0214), suicide deaths were significantly clustered, with 261 spatial clusters identified-59 high-risk and 202 low-risk (p < 0.05). Socio-environmental characteristics differed significantly across cluster types, indicating that place-based exposures intersect with population-level vulnerabilities to shape suicide risk.

Conclusions

The findings reveal that the mental health impacts of environmental features are context-dependent and spatially patterned. While access to green and blue space may offer protective effects, these benefits are not uniformly experienced across urban neighborhoods. Suicide prevention efforts should consider not only individual and socioeconomic risk factors, but also spatial disparities in environmental quality and neighborhood-level disadvantage.

Community members' and community partners' perspectives on community readiness to address youth violence prevention in a low-income urban community

Youth violence is a significant public health concern in the U.S. The current study identified qualitative themes related to aspects of community readiness including biggest concerns about youth violence, knowledge of youth violence prevention efforts, community climate, priorities for mobilization, and community resources in an urban, economically marginalized community. A total of 10 community members and 26 community partners including service providers and organization leaders participated in qualitative interviews. Study findings identified themes across the above aspects of community readiness that highlighted the devastating costs of youth violence for families, including being a victim of violence and the continual worry about youths' safety that impacted day-to-day living and emotional health. In describing biggest concerns, community climate, and priorities for mobilization, participants focused on the need to address social and structural community-level risk factors for youth violence. Participants also described perspectives on barriers and supports related to community members' openness to change, and discussed community strengths and resources. These results offered a context-specific picture of community readiness that has implications for youth violence prevention.

The Effects of Neighborhood Violence on Physical Activity Following the COVID-19 Stay-at-Home Order: A Multilevel Analysis

OBJECTIVES

COVID-19 contributed to decreases in physical activity and residents from communities with more crime and fewer resources were less physically active during the pandemic. However, the direct effects of COVID-related increases in crime on leisure-time physical activity has not been studied, extensively. Therefore, we examined how individual perceptions of neighborhood violence, community-level perceptions of safety, and the prevalence of violent crime are associated with leisure-time physical activity across neighborhoods in Chicago, Illinois, following the COVID-19 stay-at-home order.

METHODS

We used cross-sectional data to build a multilevel logistic regression model in which the individual represented level 1 and the Chicago community area represented level 2. We used a stepwise approach, testing variables, one at a time, as random intercepts and then as random coefficients. We estimated adjusted odds ratios and 95% confidence intervals.

RESULTS

Respondents who reported violence occurring every day had significantly lower odds of leisure-time physical activity (OR = 0.65, 95% CI = 0.50-0.85). Compared to non-Hispanic Whites, Non-Hispanic Blacks (OR = 0.75, 95% CI = 0.57 - 0.99), non-Hispanic Asian American/Pacific Islanders (OR = 0.63, 95% CI = 0.45-0.89), and Hispanic/Latino respondents (OR = 0.69, 95% CI = 0.53-0.89) had lower odds of leisure-time physical activity. On the neighborhood level, the percent of adults who reported they feel safe in their neighborhood was significant (p < .001), but violence prevalence was not (p = 0.091).

CONCLUSIONS

These results can inform public health efforts to promote physical activity following the COVID-19 stay-at-home order.

Neighborhood Factors as Correlates of Alcohol Use in the N2 Cohort Study of Black Sexually Minoritized Men and Transgender Women

Sexually minoritized men (SMM), transgender women (TW), and particularly Black SMM and Black TW may be disproportionately impacted by alcohol-related problems. Few studies have empirically examined neighborhood factors that may contribute to alcohol use, specifically among these populations. Using data from the N2 longitudinal cohort study in Chicago, IL, survey data from the second wave of longitudinal assessment (n = 126) and GPS mobility data from enrollment were used to evaluate neighborhood alcohol outlet availability, neighborhood disorder, and neighborhood poverty as correlates of individual alcohol use. Neighborhood exposures were measured using 200-m-derived activity space areas, created from GPS data, using publicly accessible geospatial contextual data. Separate multivariable quasi-poison regression models tested for association between neighborhood alcohol outlet density (AOD), measured separately for on-premise (e.g., bars) and off-premise consumption outlets (e.g., liquor stores), neighborhood poverty (defined as the percentage of neighborhood areas at 150% or greater of the US poverty line), exposure to vacant buildings, and neighborhood violent crime density. Separate analytical models found no significant effect between alcohol use and exposure to on-premise consumption venue AOD (risk ratio (RR) = 0.99, p = 0.57), off-premise consumption AOD (RR = 0.94, p = 0.56), neighborhood poverty (RR = 1.04, p = 0.07), or neighborhood violent crime (RR = 1.00, p = 0.94). Exposure to higher levels of vacant buildings (RR = 1.03, p = 0.04) was found to be significantly associated with increased alcohol use. Among this population, opposed to geospatial access, neighborhood measurements indicative of disorder may have a greater influence on shaping alcohol use.

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.

Examining the Association between Heat Exposure and Crime in Cities across the United States: A Scoping Review

Growing evidence suggests exposure to high temperatures may result in increased urban crime, a known driver of health and health inequity. Theoretical explanations have been developed to describe the heat-crime relationship without consensus yet achieved among experts. This scoping review aims to summarize evidence of heat-crime associations in U.S. cities. Further examination of empirical and translational inconsistencies in this literature will ensure future studies of urban heat-crime relationships in the U.S., and their policy impacts are informed by a thorough understanding of existing evidence. We performed a comprehensive literature search of empirical studies on heat-crime relationships in U.S. cities published between January 2000 and August 2023. The included studies were qualitatively synthesized based on operationalized exposures, outcomes, covariates, methodologies, theoretical framing, and policy implications. In total, 46 studies were included in this review. Most studies (93%) reported significant, positive associations between urban heat exposure and both violent and non-violent crime outcomes. The shape and strength of these associations varied based on operational definitions of urban heat exposures, crime outcomes, and relevant covariates in employed methods. We also found inconsistencies in the theoretical explanations and policy implications reported across studies. Climate-driven extreme heat events are projected to increase in frequency and severity. Our findings underscore the urgency of refining the understanding and translation of the complex relationship between urban heat and crime. In this review, we highlight opportunities to improve the methodological quality and responsible policy translation of future research in U.S. cities, which has implications for research globally.

Spatial de-concentration of fatal and nonfatal firearm violence in Boston, MA, 2007-2021

BACKGROUND

It is a "law" of criminology that urban crime chronically recurs at the same microplaces (i.e., street segments and intersections). An influential study found high concentrations of firearm violence at microplaces in Boston, MA, from 1980 to 2008. The current study assessed whether this strong spatial concentration has persisted.

APPROACH

Fatal and nonfatal shooting incidents with one or more victims from January 2007 through September 2021 were included, obtained from the Boston Police Department. We matched shootings to the closest microplaces, i.e., intersections and street segments in Boston (n = 32,267). We operationalized spatial concentration as the probability of shootings occurring at the same microplace. We employed a case-only design, with shootings as the units of analysis; the outcome of interest was a binary indicator for whether another shooting in the dataset occurred at the same microplace in the past or future. We used log-linear regression to estimate this outcome as a function of study year.

RESULTS

Annual shootings decreased over the study period, except for a spike in 2020. Spatial concentration of shootings declined from 62% in 2007 to 55% in 2021. We estimated that spatial concentration declined by an average of 1.8% per year [95% CI (-1.1, -3.4), p < 0.001].

IMPLICATIONS

This declining trend in the spatial concentration of firearm violence has important implications for place-based interventions and underscores the need to monitor this trend over time. Social media, which reshapes social interactions and is linked to community violence, warrants further study as a potential cause.

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.

Community-Designed Park-Building and Maintenance With the Park in a Truck Initiative

Parks and green spaces have been shown to improve human health. Yet, in cities such as Philadelphia, people with lower incomes and racially minoritized populations have less access to these health-promoting spaces. Furthermore, there are more than 42,000 lots and properties which sit vacant in Philadelphia neighborhoods. Park in a Truck (PiaT) is a green space development initiative in Philadelphia that helps communities transform available lots into neighborhood parks. PiaT works with communities to acquire neighborhood land, design and build parks, and train local youth to program and maintain the parks. In this article, we present lessons learned and best practices generated from years of working with communities to design, build, and maintain parks through the PiaT initiative. We have found that transforming lots into community parks needs to be driven by communities, and particularly, champions on the ground who work to gain access to lots and motivate resident engagement. We have also found success in training neighborhood teens to maintain the parks-to keep them clean and organize park events. Finally, PiaT works to transmit the message that open lots can be transformed into community assets that bring people together. Overall, PiaT empowers residents to design, build, and maintain parks within their neighborhoods. This process can reduce park inequities, and if scaled, improve the health of populations.

Modeling a needs assessment approach for policymakers to investigate, understand, and reduce gun violence

We conducted a needs assessment evaluation as part of a community effort to plan tailored responses to reduce gun violence in a midwestern town. Various data sources were used to analyze factors leading to gun violence. The results guided the creation of evidence-based response strategies. Study findings demonstrate that even in a small town, the nature and drivers of gun violence vary considerably at the micro level and thus should be examined at this level. In this paper, we present the recommendations that followed from our study, not as solutions for other jurisdictions to adopt on their face, but rather as an example of 1) the types of solutions that follow from a thorough analysis of a local problem, and 2) a plethora of potential responses by social institutions. The goal of the paper is to provide an example process for policymakers from jurisdictions of various sizes and locales of the application of a problem-oriented approach to understanding and preventing gun violence. Undertaking a comprehensive, micro-focus to analyze the gun violence problem and its drivers in a jurisdiction provides essential information to guide the formulation of tailored, evidence-based responses.

From Neighborhood to Household: Connections Between Neighborhood Vacant and Abandoned Property and Family Violence

Rates of family violence, including intimate partner violence (IPV) and child maltreatment, remain high in the USA and contribute to substantial health and economic costs. How neighborhood environment may influence family violence remains poorly understood. We examine the association between neighborhood vacant and abandoned properties and family violence, and the role collective efficacy may play in that relationship. Data were used from a longitudinal cohort of 218 maternal-child dyads in a southern US city known for elevated rates of violence. Women were matched on their propensity score, for living in a neighborhood with elevated vacant and cited properties. Analyses accounting for clustering in neighborhood and matched groups were conducted to examine the association between neighborhood vacant and abandoned property and family violence and the potential mediating relationship of collective efficacy. The likelihood of experiencing child maltreatment at 12 months of age was more than twice as high for children living in neighborhoods with high vacant and cited property rates compared with women living in neighborhoods with fewer vacant and cited properties (OR = 2.11, 95% CI = 1.03, 4.31). Women living in neighborhoods characterized by high levels of vacant and cited properties were also more than twice as likely to report IPV (OR = 2.52, 95% CI = 1.21, 5.25). Associations remained mostly stable after controlling for key covariates. Collective efficacy did not act as a mediator in the relationship between vacant and cited properties and family violence. Reducing neighborhood vacant and cited properties may be an important target for interventions focused on reducing family violence.

The Association Between Street Construction Projects and Community Violence in New York City

Community violence is a major cause of injury and death in the USA. Empirical studies have identified that some place-based interventions of urban private places, such as remediations of vacant lots and buildings, are associated with reductions in community violence in surrounding areas. The aim of this study was to examine whether routine maintenance and repair of urban public places (e.g., street construction projects) are also associated with reductions in community violence, proxied by violent crime incidents. This staggered adoption difference-in-difference analysis investigated the association between street construction projects and community violence in New York City from 2010 to 2019, divided into 40 calendar quarters. The units of analysis were street-quarters (n = 155,280). Intervention street-quarters were those with completed projects in 2010-2019; control streets were those where projects were scheduled but not completed before 2019. The outcome of community violence was proxied by counts of crime and violence incidents reported to the New York Police Department, within street-quarters. There were 81,904 street-quarters with any community violence incidents (52.7%). We found that street construction projects were associated with a decrease in reckless endangerment (ATT = - 1.3%; 95% CI = - 2.1%, - 0.4%), robbery (ATT = - 3.4%; 95% CI = - 6.1%, - 0.7%), and weapons offenses (ATT = - 1.6%; 95% CI = - 3.0, - 0.08%) occurring on street-quarters. Street construction projects may be yet another type of place-based intervention to reduce community violence.

Firearm possession among emergency department youth and young adults: A latent class analysis

INTRODUCTION

Firearm injuries are a leading cause of death for youth/young-adults. We utilized latent class analysis to identify distinct motivational/behavioral patterns of firearm possession in a youth/young-adult emergency department sample to inform prevention strategies.

METHODS

Cross-sectional data were obtained from surveys conducted among youth/young-adults (age = 16-29; n = 1311) seeking emergency department treatment (7/10/2017-6/25/2018). Latent class analysis was performed for individuals reporting firearm possession (n = 223) using five variables: carriage frequency, social carriage, risky firearm behaviors, ownership/carriage for protection, and recreational ownership/carriage. Descriptive statistics were examined.

RESULTS

In this sample, 17.0 % reported having firearms (age-22.7; 48.0 %-male; 49.3 %-Black; 52.5 %-public assistance). Latent class analysis identified four classes: 1-recreational possession (n = 51); 2-possession for protection with low carriage (n = 60); 3-carriage for protection with low risky firearm behaviors (n = 76); and 4-carriage for protection with high risky firearm behaviors (n = 36). Class-1 (recreational possession) had low firearm victimization, violence exposure, and community violence. This class primarily kept long-guns with secure storage patterns. Class-2 (protection with low carriage) were mostly female youth/young-adults with children and reported moderately high rates of violence exposure. Nearly 20 % stored their firearm unlocked. Class-3 and -4 endorsed firearm carriage for protection, with Class-4 also engaging in risky firearm behaviors. Both classes had high violence exposure; however, Class-4 had higher risk profiles including higher marijuana misuse, mental health symptoms, and firearm victimization.

CONCLUSIONS

Among an emergency department sample, four distinct firearm possession classes emerged with different risk levels. Understanding firearm behaviors and risk/protective factors is critical to tailoring healthcare-focused interventions to address individual needs and reduce injury risk.

State-to-State Variation in Rates and Causes of Child and Adolescent Mortality in the US

This cross-sectional study uses national mortality data to evaluate state variations in rates and causes of child and adolescent deaths.

Gender and violent crime modify associations between greenspace and cardiovascular disease mortality in Philadelphia, PA

Few studies have explored variability of associations between greenspace and cardiovascular (CVD) mortality according to demographic or neighborhood contextual factors. We estimated overall and sex-stratified associations between greenspace and CVD mortality rates in Philadelphia, PA, and quantified effect modification of the sex-stratified associations by neighborhood violent crime rates. Sex- and age-stratified census tract CVD mortality rates (years 2008-2015) were linked with proportion tree canopy cover, grass/shrub cover, and total vegetation cover, and proportion of adult residents reporting access to a park. We used multivariable negative binomial models to estimate overall and sex-stratified associations between neighborhood greenspace and CVD mortality rates, and quantified effect modification by tract-level rates of violent crime. Higher proportion tree canopy cover and higher proportion adults reporting access to parks were associated with modestly lower rates of CVD mortality, with more pronounced estimates in males than females. In tracts with higher rates of crime, higher tree canopy coverage and perceived park access were associated with lower CVD mortality rates. We did not observe strong evidence of sex-based differences in interaction between neighborhood crime rates and greenspace. Results from this study reveal variability of associations between greenspace and CVD mortality rates according to sex categories, and according to neighborhood social environments. There is a need for further research exploring the extent to which differences in perceived safety explain gender-based differences in associations between greenspace and cardiovascular outcomes.

Using latent transition analysis to evaluate the impact of perceived threats on emotional and behavioral development

This study used latent transition analysis to examine the stability and change in perceived threats in youth's primary social contexts-neighborhoods, schools, and families-and associations with emotional and behavioral problems when youth transitioned from childhood to adolescence. The sample included 8208 racially and ethnically diverse youth enrolled in the Adolescent Brain Cognitive Development Study (47.4% female, M age_Baseline = 9.83, M age_Timepoint3 = 11.99). Results revealed that while perceived threats in youth's neighborhoods were considerably stable, perceived threats in youth's families fluctuated in relation to stressful life events. Further, subgroups of youth characterized by elevated perceived threat experiences in different contexts showed differential associations with emotional and behavioral problems. Overall, findings highlight the importance of considering the stability of perceived threats to direct appropriate interventions.

Contextual Factors Influencing Firearm Deaths Occurring Among Children

OBJECTIVES

Contextual factors that contribute to firearm injuries among children aged 0 to 10 are not well understood.

METHODS

A retrospective review of the National Fatality Review-Case Reporting System was conducted for firearm deaths of children aged 0 to 10 from 2004 to 2020. Descriptive analyses characterized child and parent demographics, incident details, firearm characteristics, and firearm use. Cluster analysis identified key clustering of contextual variables to inform prevention efforts.

RESULTS

Within the study timeframe, 1167 child firearm deaths were reported (Mage = 4.9; 63.2% male; 39.4% urban). At the time of the incident, 52.4% of firearms were reported unlocked and 38.5% loaded. Firearm deaths occurred primarily at the child's home (69.0%) or a friend or relative's home (15.9%), with most involving a handgun (80.6%). Children were supervised in 74.6% of incidents, and 38.4% of child supervisors were impaired during the incident. Cluster analysis identified incident contextual factors clustering in distinct groups, including unsupervised firearm play, long gun discharge while cleaning, hunting, or target shooting, supervised discharge within the child's home, murder-suicide events, deaths occurring in the context of intimate partner violence, and community violence firearm deaths.

CONCLUSIONS

Data highlight the importance of primary prevention through secure firearm storage to prevent child firearm deaths. Efforts focused on identifying and reducing intimate partner violence, addressing community violence (eg, community greening), and implementing policy that limit firearm access (eg, domestic violence restraining orders, background checks), may reduce child firearm deaths.

Health Disparities in the Management and Outcomes of Critically Ill Children and Neonates: A Scoping Review

To date, health disparities in critically ill children have largely been studied within, not across, specific intensive care unit (ICU) settings, thus impeding collaboration which may help advance the care of critically ill children. The aim of this scoping review is to summarize the literature intentionally designed to examine health disparities, across 3 primary ICU settings (neonatal ICU, pediatric ICU, and cardiac ICU) in the United States. We included over 50 studies which describe health disparities across race and/or ethnicity, area-level indices, insurance status, socioeconomic position, language, and distance.

Historical Redlining and Contemporary Violent Victimization Over the Life Course

INTRODUCTION

This study assesses the relationship between living in historically redlined communities and the incidence of violent victimization and examines differences in this relationship across race and ethnicity.

METHODS

Data are from the U.S. National Longitudinal Study of Adolescent to Adult Health (Add Health) from Waves I (1994-1995; ages 12-17), III (2001; ages 18-26), IV (2008-2009; ages 24-32), and V (2016-2018; ages 34-44). Multi-level, within-between regression models were used to assess the relationship between residence in historically redlined areas and violent victimization from adolescence to adulthood. The study includes 8,266 participants, and data analysis was conducted in 2024.

RESULTS

Respondents who lived in redlined areas throughout adolescence and adulthood reported a 4.8% higher average probability of violent victimization relative to those who never lived in redlined areas. Respondents who moved from a non-redlined to a redlined area across waves also reported a 2.2% higher probability of victimization, on average. Although Black and Hispanic respondents were significantly more likely than their White peers to live in a redlined area and report violent victimization at each stage of the life course, the probability of experiencing victimization while living in a redlined area was similar between racial and ethnic groups.

CONCLUSIONS

These findings underscore the profound and enduring consequences of New Deal-era redlining policies for present-day safety, emphasizing the urgent need to confront and rectify historical injustices to enhance contemporary safety and well-being.

Access to land and nature as health determinants: a qualitative analysis exploring meaningful human-nature relationships among Indigenous youth in central Canada

BACKGROUND

Human relationships with and connections to nature and the "land" are a commonly accepted Social Determinant of Health. Greater knowledge about these relationships can inform public health policies and interventions focused on health equity among Indigenous populations. Two research questions were explored: (1) what are the experiences of meaningful human-nature relationships among Indigenous youth within central Canada; and (2) how do these relationships function as a determinant of health and wellness within their lives.

METHODS

Drawing from three community-based participatory research (CBPR) projects within two urban centers in Saskatchewan and Manitoba, the integrated qualitative findings presented here involved 92 interviews with 52 Indigenous youth that occurred over a period of nine years (2014-2023). Informed by "two-eyed seeing," this analysis combined Indigenous Methodologies and a Constructivist Grounded Theory approach.

RESULTS

Our integrative analysis revealed three cross-cutting themes about meaningful human-nature relationships: (1) promoting cultural belonging and positive identity; (2) connecting to community and family; and (3) supporting spiritual health and relationships. The experiences of young people also emphasized barriers to land and nature access within their local environments.

DISCUSSION

Policies, practices, and interventions aimed at strengthening urban Indigenous young peoples' relationships to and connections with nature and the land can have a positive impact on their health and wellness. Public Health systems and healthcare providers can learn about leveraging the health benefits of human-nature relationships at individual and community levels, and this is particularly vital for those working to advance health equity among Indigenous populations.

Association between neighborhood greenspace and child protective services involvement

BACKGROUND

Child maltreatment and child protective service (CPS) involvement negatively impacts families, and disproportionately impact families of color. Urban neighborhood greenspace is associated with improved mental health and decreased community violence, however correlations between greenspace and CPS involvement have not been evaluated.

OBJECTIVE

To examine the association between greenspace and CPS involvement.

METHODS

This is a secondary analysis of City of Philadelphia CPS report data from 2008 to 2018. Logistic regression was used to determine associations between greenspace and 3 CPS outcomes (substantiated reports, cases accepted for CPS services, and foster care placements) at the census block level, adjusting for sociodemographic information and area deprivation index, a composite measure combining education, employment, housing, and poverty characteristics at the census block group level. 13,336 census blocks were included, which had key exposure, covariate, and outcome data, and had a child population of at least 1.

RESULTS

66,043 CPS reports were included. In the adjusted model, compared to blocks with >30 % greenspace, blocks with <10 % greenspace had 1.52 times the odds of a substantiated report (95 % CI 1.30-1.76, p < 0.001) and 1.52 times the odds of a case accepted for CPS services (95 % CI 1.30-1.77, p < 0.001). Blocks with less greenspace had increased odds of foster care placement than blocks with >30 % greenspace, however the correlation was less strong.

CONCLUSION

Increased density of neighborhood greenspace is associated with decreased risk of substantiated child maltreatment and cases accepted for CPS services, suggesting that greenspace may confer protection against CPS involvement.

Comparing mapped park and greenspace boundaries in Philadelphia: implications for exposure assessment in health studies

An important consideration in studies of the relationship between greenspace exposure and health is the use of mapped data to assign geographic exposures to participants. Previous studies have used validated data from municipal park departments to describe the boundaries of public greenspaces. However, this approach assumes that these data accurately describe park boundaries, that formal parks fully capture the park and greenspace exposure of residents, and (for studies that use personal GPS traces to assign participant exposures) that time spent within these boundaries represents time spent in greenspace. These assumptions are tested using a comparison and ground-truthing of four sources of mapped park and greenspace data in Philadelphia, Pennsylvania: PAD-US-AR, Philadelphia Parks and Recreation, the Delaware Valley Regional Planning Commission, and Open Street Maps. We find several important differences and tradeoffs in these data: the incorporation of highways and building lots within park boundaries, the inclusion or exclusion of formal park spaces (federal, state, and nonprofit), the exclusion of informal parks and greenspaces, and inconsistent boundaries for a linear park. Health researchers may wish to consider these issues when conducting studies using boundary data to assign park exposure.

Neighborhood Factors as Correlates of Alcohol Use in the N2 Cohort Study of Black Sexual Minority Men and Transgender Women

Sexually minoritized men (SMM), transgender women (TW), and particularly Black SMM and Black TW may be disproportionately impacted by alcohol-related problems. Few studies have empirically examined neighborhood factors that may contribute to alcohol use, specifically among these populations. Using data from the N2 longitudinal cohort study in Chicago, IL, survey data from the second wave of longitudinal assessment (n = 126), and GPS mobility data collected during study enrollment were used to evaluate neighborhood alcohol outlet availability, neighborhood disorder, and neighborhood poverty as correlates for individual alcohol use. Neighborhood exposures were measured using 200-m derived activity space areas, created from GPS data, and with publicly accessible geospatial contextual data. Separate multi-variable quasi-poison regression models tested for association between neighborhood alcohol outlet density (AOD), measured separately for on-premise (e.g. bars) and off-premise consumption outlets (e.g. liquor stores), neighborhood poverty (defined as the percentage of neighborhood areas at 150% or greater of the U.S. poverty line), exposure to vacant buildings, and neighborhood violent crime density. Separate analytical models found no significant effect between alcohol use and on-premise neighborhood AOD (IRR = 0.99, p = 0.35), off-premise consumption AOD (IRR = 0.92, p = 0.33), or neighborhood violent crime (IRR = 1.00, p = 0.65). Vacant buildings (IRR = 1.03, p = 0.05) and levels of neighborhood poverty (1.05, p = 0.01) were found to be significantly associated with increased alcohol use. Among this population, opposed to geospatial access, neighborhood measurements indicative of disorder and poverty may have greater influence on shaping alcohol use.

Defining Spatial Epidemiology: A Systematic Review and Re-orientation

BACKGROUND

Spatial epidemiology has emerged as an important subfield of epidemiology over the past quarter century. We trace the origins of spatial epidemiology and note that its emergence coincided with technological developments in spatial statistics and geography. We hypothesize that spatial epidemiology makes important contributions to descriptive epidemiology and analytic risk-factor studies but is not yet aligned with epidemiology's current focus on causal inference and intervention.

METHODS

We conducted a systematic review of studies indexed in PubMed that used the term "spatial epidemiolog*" in the title, abstract, or keywords. Excluded articles were not written in English, examined disease in animals, or reported biologic pathogen distribution only. We coded the included papers into five categories (review, demonstration of method, descriptive, analytic, and intervention) and recorded the unit of analysis (i.e., individual vs. ecological). We additionally examined articles coded as analytic ecologic studies using scales for lexical content.

RESULTS

A total of 482 articles met the inclusion criteria, including 76 reviews, 117 demonstrations of methods, 122 descriptive studies, 167 analytic studies, and 0 intervention studies. Demonstration studies were most common from 2006 to 2014, and analytic studies were most common after 2015. Among the analytic ecologic studies, those published in later years used more terms relevant to spatial statistics (incidence rate ratio =1.3; 95% confidence interval [CI] = 1.1, 1.5) and causal inference (incidence rate ratio =1.1; 95% CI = 1.1, 1.2).

CONCLUSIONS

Spatial epidemiology is an important and growing subfield of epidemiology. We suggest a re-orientation to help align its practice with the goals of contemporary epidemiology.

Leveraging biosocial methods to examine and address structural determinants of health and promote health equity

BACKGROUND

Biosocial approaches in nursing research have largely focused on the ways that social determinants of health influence individual-level outcomes, including symptom management, family and social support, and educational interventions.

PURPOSE

Theoretical, methodological, and practical strategies are needed to expand current biosocial methods for nursing science and focus on upstream, structural determinants of health and the policies that underlie health inequities.

METHODS

This paper summarizes presentations given at the 2023 Council for the Advancement of Nursing Science Advanced Methods Conference, Biosocial Methods to Advance Health Equity, in a panel titled "Individual, community, systems and policy related to biosocial methods."

DISCUSSION

Nurses are uniquely positioned to examine upstream, structural determinants of health by leveraging expertise in biosocial methods, collaborating with interdisciplinary researchers and community members, and advocating for policy change. By conducting theory-grounded biosocial research, nurse researchers can significantly advance scientific knowledge and promote health equity for individuals and communities.

CONCLUSION

Nurse scientists are conducting research using biosocial methods and provide recommendations for expansion of this approach in the field.

The Dynamic Relationship between Social Cohesion and Urban Green Space in Diverse Communities: Opportunities and Challenges to Public Health

Social cohesion is a key factor within social determinants of health and well-being. Urban green spaces can provide environments that potentially facilitate meaningful and positive social interactions that promote social cohesion, equity, human health, and well-being. However, the lack of integration of existing research on social cohesion, urban green spaces, and public health in diverse (e.g., racially and ethnically) communities limits culturally relevant strategies to address health disparities. In this manuscript, we synthesize research on the potential of urban green spaces to promote social cohesion and public health in historically excluded communities. Particularly, we explore the development of social cohesion as it relates to the social environment, built environment, leisure opportunities, green space maintenance, safety, and green gentrification. We highlight key factors and their application to meet opportunities and challenges to social and public health. A conceptual framework is presented to provide an overview and illustrate connections found in the literature.

A greening theory of change: How neighborhood greening impacts adolescent health disparities

Neighborhoods are one of the key determinants of health disparities among young people in the United States. While neighborhood deprivation can exacerbate health disparities, amenities such as quality parks and greenspace can support adolescent health. Existing conceptual frameworks of greening-health largely focus on greenspace exposures, rather than greening interventions. In this paper, we develop and propose a Greening Theory of Change that explains how greening initiatives might affect adolescent health in deprived neighborhoods. The theory situates greening activities and possible mechanisms of change in the context of their ability to modify distal social determinants of health factors, stemming from macrostructural and historical processes that lead to resource inequalities, affecting both the social and built environment in which adolescents live and develop. The framework illustrates both short- and long-term health, economic, and security effects of greening. We also describe how the theory informed the development of Project VITAL (Vacant lot Improvement to Transform Adolescent Lives) in Baltimore, MD, which aims to (1) build a citywide sharable database on vacant lot restoration activities, (2) evaluate the impact of greening initiatives on adolescent health outcomes, (3) conduct cost-effectiveness analyses, and (4) develop best practices for greening programs for improved adolescent health.

The association between street construction projects and community violence in New York City

Introduction

Community violence is a major cause of injury and death in the United States. Empirical studies have identified that some place-based interventions of urban private places, such as remediations of vacant lots and buildings, are associated with reductions in community violence in surrounding areas. The aim of this study was to examine whether routine maintenance and repair of urban public places (e.g., street construction projects) are also associated with reductions in community violence, proxied by violent crime.

Method

This staggered adoption difference-in-difference analysis investigated the association between street construction projects and community violence in New York City from 2010-2019, divided into 40 calendar quarters. The units of analysis were street-quarters (n = 155,280). Intervention street-quarters were those with completed projects in 2010-2019; control streets were those where projects were scheduled but not completed before 2019. The outcome of community violence was proxied by counts of crime and violence incidents reported to the New York Police Department, within street-quarters.

Results

There were 79,592 street-quarters with any community violence incidents (51.2%). We found that street construction projects were associated with a decrease in reckless endangerment (ATT = -0.013; 95% CI = -0.021, -0.004), robbery (ATT = -0.035; 95% CI = -0.063, -0.007), and weapons offenses (ATT = -0.016; 95% CI = -0.031, -0.001) occurring on street-quarters.

Conclusion

Street construction projects may be yet another type of place-based intervention to reduce community violence.

Resident perspectives on a pre-booking diversion program

Numerous cities are experimenting with pre-booking diversion programs that allow police officers to divert community members to supportive services in instances that would otherwise result in arrest and prosecution. These programs aim to decrease harmful involvement with the criminal justice system while reducing crime and public disorder. Although previous research has explored the experiences of people receiving diversion referrals and of police officers initiating them, none have examined the perspectives of community members who can offer crucial insights into planning, evaluation, and implementation barriers. We administered a survey to 293 people living in four police districts where the Philadelphia Police Department operates a pre-booking diversion program. The survey explored residents' perspectives on the program as well as their broader views on associated issues like decriminalization of substance use, sex work, and minor theft. Bivariate χ2 tests and multivariate logistic regression examined differences in responses between subgroups. Perspectives were diverse and varied based on demographic attributes of the respondents as well as on district level attributes, like crime patterns. Most surveyed community members perceived pre-booking diversion to be a valuable tool for improving the experiences and outcomes of policing. However, residents living in areas with more crime and with more public disorder held significantly less positive perspectives. Their skepticism may reflect the possibility that pre-booking diversion and similar reforms are necessary but not sufficient to transforming individual health and public safety in some areas.

Community-Academic Partnership to Assess the Role of Physical Disinvestment on Firearm Violence in Toledo, OH

Reversing physical disinvestment, e.g., by remediating abandoned buildings and vacant lots, is an evidence-based strategy to reduce urban firearm violence. However, adoption of this strategy has been inconsistent across US cities. Our community-academic partnership sought to support adoption in Toledo, OH, USA, by generating locally relevant analyses on physical disinvestment and firearm violence. We used a spatial case-control design with matching. Physical disinvestment measures were derived from a citywide parcel foot audit conducted by the Lucas County Land Bank in summer 2021. Firearm violence outcomes were incident-level shootings data from the Toledo Police Department from October 2021 through February 2023. Shooting locations were matched to controls 1:4 on poverty rate, roadway characteristics, and zoning type. Exposures were calculated by aggregating parcels within 5-min walking buffers of each case and control point. We tested multiple disinvestment measures, including a composite index. Models were logistic regressions that adjusted for the matching variables and for potential spatial autocorrelation. Our sample included N = 281 shooting locations and N = 1124 matched controls. A 1-unit increase in the disinvestment score, equal to approximately 1 additional disrepair condition for the average parcel within the walking buffer, was associated with 1.68 times (95% CI: 1.36, 2.07) higher odds of shooting incidence. Across all other measures, greater disinvestment was associated with higher odds of shooting incidence. Our finding of a strong association between physical disinvestment and firearm violence in Toledo can inform local action. Community-academic partnership could help increase adoption of violence prevention strategies focused on reversing physical disinvestment.

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.

Dementia, dementia's risk factors and premorbid brain structure are concentrated in disadvantaged areas: National register and birth-cohort geographic analyses

INTRODUCTION

Dementia risk may be elevated in socioeconomically disadvantaged neighborhoods. Reasons for this remain unclear, and this elevation has yet to be shown at a national population level.

METHODS

We tested whether dementia was more prevalent in disadvantaged neighborhoods across the New Zealand population (N = 1.41 million analytic sample) over a 20-year observation. We then tested whether premorbid dementia risk factors and MRI-measured brain-structure antecedents were more prevalent among midlife residents of disadvantaged neighborhoods in a population-representative NZ-birth-cohort (N = 938 analytic sample).

RESULTS

People residing in disadvantaged neighborhoods were at greater risk of dementia (HR per-quintile-disadvantage-increase = 1.09, 95% confidence interval [CI]:1.08-1.10) and, decades before clinical endpoints typically emerge, evidenced elevated dementia-risk scores (CAIDE, LIBRA, Lancet, ANU-ADRI, DunedinARB; β's 0.31-0.39) and displayed dementia-associated brain structural deficits and cognitive difficulties/decline.

DISCUSSION

Disadvantaged neighborhoods have more residents with dementia, and decades before dementia is diagnosed, residents have more dementia-risk factors and brain-structure antecedents. Whether or not neighborhoods causally influence risk, they may offer scalable opportunities for primary dementia prevention.

Leveraging Implementation Science to Advance Environmental Justice Research and Achieve Health Equity through Neighborhood and Policy Interventions

Environmental justice research is increasingly focused on community-engaged, participatory investigations that test interventions to improve health. Such research is primed for the use of implementation science-informed approaches to optimize the uptake and use of interventions proven to be effective. This review identifies synergies between implementation science and environmental justice with the goal of advancing both disciplines. Specifically, the article synthesizes the literature on neighborhood-, community-, and policy-level interventions in environmental health that address underlying structural determinants (e.g., structural racism) and social determinants of health. Opportunities to facilitate and scale the equitable implementation of evidence-based environmental health interventions are highlighted, using urban greening as an illustrative example. An environmental justice-focused version of the implementation science subway is provided, which highlights these principles: Remember and Reflect, Restore and Reclaim, and Reinvest. The review concludes with existing gaps and future directions to advance the science of implementation to promote environmental justice.

Do you really believe that? The effect of economic incentives on the acceptance of real-world data in a polarized context

Attitudes and expectations towards others are major drivers of political polarization. However, there is limited understanding of their relevance when decisions with high stakes are taken. In this study, we compare self-reported attitudes against economically incentivized estimates of data coming from official sources and offer participants financial rewards for accuracy. Our methodology yields three principal findings. (i) Extreme attitudes from a small partisan subgroup primarily account for the observed partisan divide; this subgroup diminishes when incentivized estimates are considered. (ii) There is a weak correlation between economically incentivized and unincentivized measures within individual respondents. (iii) We introduce a novel metric for assessing perceived polarization. This metric allows participants to estimate data points for those with opposing political views, rewarding accurate predictions financially. Interestingly, this measure of perceived polarization correlates with attitudes but not with incentivized data estimates. This is in line with the concept of 'false polarization', attributing polarization more to expectations towards others than to genuine differences. These findings challenge the reliability of standard attitude surveys and suggest avenues for mitigating perceived polarization in contentious issues.

From neighborhood to household: connections between neighborhood vacant and abandoned property and family violence

Rates of family violence, including intimate partner violence (IPV) and child maltreatment, remain high in the U.S. and contribute to substantial health and economic costs. How neighborhood environment may influence family violence remains poorly understood. We examine the association between neighborhood vacant and abandoned properties and family violence, and the role collective efficacy may play in that relationship. Data were used from a longitudinal cohort of 218 maternal-child dyads in a southern U.S. city known for elevated rates of violence. Women were matched on their propensity score, for living in a neighborhood with elevated vacant and cited properties. Analyses accounting for clustering in neighborhood and matched groups were conducted to examine the association between neighborhood vacant and abandoned property and family violence, and the potential mediating relationship of collective efficacy. The likelihood of experiencing child maltreatment at 12-months of age was more than twice as high for children living in neighborhoods with a high vacant and cited property rates compared to women living in neighborhoods with fewer vacant and cited properties (OR=2.11, 95% CI=1.03, 4.31). Women living in neighborhoods characterized by high levels of vacant and cited properties were also more than twice as likely to report IPV (OR=2.52, 95% CI=1.21, 5.25). Associations remained mostly stable after controlling for key covariates. Collective efficacy did not act as a mediator in the relationship between vacant and cited properties and family violence. Reducing neighborhood vacant and cited properties may be an important target for interventions focused on reducing family violence.

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.

Addressing sleep deserts: A proposed call for action

Sleep deserts are a major cause of health inequity. They occur primarily in disadvantaged neighborhoods because of structural racism, social and environmental factors, and dearth of medical services. We describe several strategies that can serve as a feasible action plan to target structural racism, environmental pollution, and impact of climate change. We also suggest ways healthcare providers in these underserved areas can incorporate sleep medicine into their practice. Lastly, we highlight strategies to increase community awareness of sleep health in a culturally sensitive manner. There are several ways, from a policy level to healthcare that we can begin to eliminate sleep deserts, which is urgently needed.

Does poor health influence residential selection? Understanding mobility among low-income housing voucher recipients in the Moving to Opportunity Study

Housing mobility programs and housing choice vouchers provide low-income families with a potentially-transformative opportunity to move to low-poverty neighborhoods. However, families often face barriers to attaining upward residential mobility; poor health may be one important barrier, although few studies have examined this hypothesis. We used the experimental Moving to Opportunity (MTO) Study, constructed residential trajectories, and linked neighborhood opportunity measures to over 14,000 addresses of 3526 families across 7 years. We used latent growth curve longitudinal models to test how baseline health modified effects of MTO housing voucher treatment on neighborhood opportunity trajectories. Results show that poor baseline health adversely influenced how the voucher induced upward mobility. Voucher receipt strongly promoted residential mobility if families were healthy; moreover the low-poverty neighborhood voucher plus counseling treatment promoted higher opportunity neighborhood attainment compared to controls, regardless of the baseline health of the family. However families with health vulnerabilities did not retain the same initial neighborhood gains conferred by the housing choice voucher treatment, as families without health vulnerabilities. These results suggest that housing counseling may be one necessary element to expand neighborhood choice into higher opportunity neighborhoods for families with health challenges. Providing housing vouchers alone are insufficient to promote low-income family high opportunity moves, for families who have disabilities or special needs. The implications of these results point to scaling up housing mobility programs, to provide tailored support for low-income families to use housing choice vouchers to make high opportunity moves, which is particularly necessary for families with health challenges.

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.

Community identified characteristics related to illegal dumping; a mixed methods study to inform prevention

Illegal dumping is a public health burden for communities suffering from historical disinvestment. We conducted a mixed methods study to answer: 1) What are stakeholder perspectives on social/environmental determinants of illegal dumping? and 2) Do these or other characteristics predict known locations of illegal dumping? We employed an exploratory sequential design in which we collected and analyzed in-depth interviews (n=12) with service providers and residents and subsequently collected and analyzed data from multiple secondary sources. Stakeholders endorsed nine determinants of illegal dumping: Economic Decline, Scale of Vacancy, Lack of Monitoring, Poor Visibility, Physical Disorder, Illegal Activity, Norms, Accessibility, and Seclusion. Results demonstrate important community-identified, modifiable, social, and environmental characteristics related to illegal dumping with the potential to inform effective prevention.

Associations between vacant urban lands and public health outcomes in growing and shrinking cities

Vacant urban land, although not officially designated as a green space, often exhibits a semi-wild natural state due to being left open to colonization by nature. Attention to the effects of vacant urban land on human health has increased due to both rising urban vacancy rates and non-communicable diseases (NCDs). However, relationships between many vacant land characteristics (such as vegetation coverage, size, duration, and location) and NCDs have not been comprehensively examined, especially comparing shrinking (depopulating) and growing (populating) cities. This study evaluates St. Louis, MO (shrinking), and Los Angeles, CA (growing) to explore these relationships using ordinary least squares (OLS) interaction analysis with a moderator approach. Results show that associations between vacancy rate, duration, location, and NCDs differ significantly between city types. Vegetation coverage and size are associated with specific NCDs, but there are no differences between city types. Unlike the largely dilapidated vacant lands in the shrinking city, which tend to harm public health, vacant lots in the growing city were more functional green spaces that can, in some cases, even mitigate NCDs. Interestingly, In St. Louis, the shorter the average duration of the vacant land, the greater the risk of NCDs in a shrinking city. This is because vacant land can be contagious to nearby lots if not treated, leading to more newly emerged vacant lands and reducing the average duration of vacant land. In such cases, census tracts with the lower duration of vacant lands in St. Louis tend to be areas facing persistent environmental degradation and high public health threats. Regarding location, vacant lands near industrial areas were linked to negative health outcomes in the Los Angeles (growing), while those near single-family and commercial areas posed higher risks of NCDs in the St Louis (shrinking). The findings aid decision-making for land supply regulation and regeneration as well as urban green space management to promote human health and well-being.

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.

Philadelphia Towards Racial and Environmental Equity (Philly TREEs): how a medical school can advance health equity through urban forestry in Philadelphia, PA, USA

Inequity in access to urban greenspaces might contribute to health disparities in the USA via multiple pathways. Academic medical centres can promote health equity in their surrounding communities by partnering with community organisations to improve greenspace access in urban environments. Academic medical centres are also uniquely positioned to advance health-equity leadership among the next generation of doctors through medical-education initiatives; of particular importance is that medical professionals are involved in advocating for the expansion of greenspace access due to its direct relationship with human health and wellness. Furthermore, by focusing educational, research, and service endeavours on addressing the most important health issues within their communities, institutions could allocate some of their resources towards community greening as a form of preventive health investment. This Personal View describes our medical-student-led pilot project Philadelphia Towards Racial and Environmental Equity (Philly TREEs) at the Perelman School of Medicine (University of Pennsylvania, Philadelphia, PA, USA), which aims to improve tree equity and community wellness in Philadelphia. We highlight this project to show how academic medical institutions can help cities to achieve urban tree-canopy goals in an equitable way through community partnership and address disparities in the environment and in health.

Shaping undergraduate public health education through critical race theory: a case study

In 2020, the American Public Health Association declared structural racism a public health crisis acknowledging the long-lasting and harmful effects of prejudice, including relatively high rates of morbidity and mortality in many communities of color. Critical Race Theory (CRT) has become an essential lens to view and reconsider education's role in perpetuating racial and ethnic discrimination. Debates over integrating CRT in higher education with the intent to acknowledge and address racial equality and justice are more present than ever, and the discussions held in public health classrooms are no different. We present a case study of CRT integration into the Bachelor of Arts in Public Health (BAPH) program at the University of Hawai'i at Mānoa. In line with Solorzano's framework of CRT in education, initial goals of integrating CRT in instruction and advising included fostering discussions of race and racism, using a social justice framework to highlight opportunities to reduce health inequities, and validating the experiential knowledge of people of color. By engaging in active discussions with community leaders and participating in experiential learning throughout the program, students develop empathy and many underrepresented and marginalized students engage actively in their home communities. Specific examples of CRT integrated in the curriculum and examples of student projects that integrate a CRT lens are provided for educators and researchers.

Vacant Building Removals Associated with Relative Reductions in Violent and Property Crimes in Baltimore, MD 2014-2019

Vacant and abandoned buildings are common features in many post-industrial US cities, and are consistent predictors of violence. Demolition programs are regularly employed as an urban land use policy to stabilize housing markets and mitigate public health problems including violence. The objective of this research was to examine the effect of vacant building removals on violent and property crimes in Baltimore, MD from 2014 to 2019. We conducted a difference-in-differences analysis using spatio-temporal Bayesian mixed models on six crime types on block faces with and without building removals, before compared with after removal. There were significant reductions in total, violent crimes (with and without assaults), thefts, and burglaries on block faces with building removals relative to their controls. Total crimes decreased 1.4% per mi2 (CrI: 0.5 - 2.3%), which translates to a relative reduction ~ 2.6 total crimes per mi2 per year. The largest relative decreases in crime were found among assaults (4.9%; CrI: 3.4 - 6.3%) and violent crimes (3.0%; CrI: 1.9 - 4.1%). Building removals were associated with relative reductions in crime in Baltimore City. The relative reductions in crime, at building removals compared to at control vacant lots, were found among assaults and violent crimes, the crimes of greatest public health concern. Building removals provide co-benefits to their communities, and may be considered part of a crime reduction strategy compatible with other approaches. A systematic effort to understand the role of care for remaining vacant lots could further inform our findings, and efforts to further decrease violence and improve community health.

Structural and Intermediary Social Determinants of Health and the Emotional and Behavioral Health of US Children

Children grow up in homes where varying environmental and socioeconomic contexts have a bearing on their emotional and behavioral health (EBH). This study used data from a representative sample of the child supplement of the US National Health Information Survey (NHIS) and applied the social determinants of health (SDoH) framework to explore factors associated with child EBH. We conducted a path analysis of the child's EBH measured by the strengths and difficulties questionnaire (SDQ) from their macro and socioeconomic contexts, e.g., policy, household, and other health system risk factors. For children in the sample, aged 4 to 17 years old (n = 9205), most path relationships to child SDQ scores were statistically significant. The total effects from a child's visit to a mental health specialist (0.28) and child's age (0.22) had the highest coefficients to child SDQ scores. A modified model showed a better fit with X2 (4) = 22.124, RMSEA = 0.021, and 90% CI [0.013-0.03], CFI = 0.98. Findings indicate that child factors such as being older, the use of mental healthcare services, and family socioeconomic status were significantly associated with EBH, calling attention to the need for more responsive policy and behavioral health interventions that address household/familial and child-level factors, critical determinants of child wellbeing.

Curbing the Epidemic of Community Firearm Violence after the Bruen Decision

The Supreme Court's decision in New York State Rifle & Pistol Association Inc. v. Bruen undermines the ability of cities and states to regulate firearms safety. Nonetheless, we remain hopeful that firearm violence can decline even after the Bruen decision. Several promising public health approaches have gained broader adoption in recent years. This essay examines the key drivers of community firearm violence and reviews promising strategies to reverse those conditions, including community violence intervention (CVI) programs and place-based and structural interventions.