Conceptualizing Social Determinants of Neighborhood Health through a Youth Lens

Socioeconomic Status Based on Area Deprivation Index Does Not Affect Postoperative Outcomes in Patients Undergoing Endovascular Aortic Aneurysm Repair in the VA Healthcare System

INTRODUCTION

Living conditions and socioeconomic status are known to impact individual health and access to medical care. Prior research has validated the Area Deprivation Index (ADI) tool as a measure of socioeconomic disadvantage for a given locality. Living in a neighborhood with a higher ADI score has been associated with increased rates of hospital readmission due to complications following surgery. We set forth to identify the possible associations between a patient's ADI score and post-operative endovascular aneurysm repair (EVAR) outcomes in the Veterans Health Care Administration (VHA).

METHODS

We retrospectively analyzed the outcomes of patients who underwent EVAR from January 2010 to December 2021 at a Level 1A VHA Hospital. Patient demographics and intra-operative variables were obtained. ADI score was calculated based on home addresses and resulted in a local score on a scale of 1-10 and a national percentile on a scale of 1-100. We then further stratified these patients into local and national quintile groups. Local ADI 1 included scores of 1-2, and local ADI 5 included scores of 9-10. National ADI 1 comprised scores 1-20, and national ADI 5 scored 81-100. The other scores were equally divided into ADI 2, 3, and 4. Higher ADI scores were associated with lower socioeconomic status. We identified clinical outcomes, including wound infection, respiratory failure, urinary tract infection, acute kidney injury, limb stenosis, readmission, length of stay, and subsequent re-intervention rates.

RESULTS

241 patients underwent EVAR over the time period examined. 57.3% (n=138) of patients were in quintiles 4 and 5 for local ADI; when national ADI percentiles organized these same patients, 47.3% (n=114) were in quintiles 4 and 5. Patient demographics did not vary between the local and national groups. We saw no statistically significant difference in intra-operative variables, postoperative complications, readmission, loss to follow-up, or 1-year mortality rates across ADI quintiles at the local or national level. Binary Logistic Regression showed no statistical significance for local and national ADI quintiles for hospital readmission and overall postoperative complications.

CONCLUSION

We found that there was no statistical significance between hospital readmission rates or worse surgical outcomes across local and national ADI quintiles. This suggests that the VHA resources and multidisciplinary support may improve care across neighborhoods. This comprehensive care provided at VHA may mitigate post-operative complications in patients undergoing EVARs. Further research is warranted to investigate the role of area deprivation in healthcare and EVAR outcomes in a veteran population.

A Qualitative Exploration of the Built Environment as a Key Mechanism of Safety and Social Cohesion for Youth in High-Violence Communities

The characteristics of a neighborhood's built environment may influence health-promoting behaviors, interactions between neighbors, and perceptions of safety. Although some research has reported on how youth in high-violence communities navigate danger, less work has investigated how these youth perceive the built environment, their desires for these spaces, and how these desires relate to their conceptions of safety and perceptions of other residents. To fill this gap, this study used focus group data from 51 youth ages 13-24 living in New Orleans, Louisiana. Four themes were developed using reflexive thematic analysis: community violence is distressing and disruptive, youth use and want to enjoy their neighborhood, systemic failure contributes to negative outcomes, and resources and cooperation create safety. This analysis indicates that young people desire to interact with the built environment despite the threat of community violence. They further identified built environment assets that facilitate socialization and recreation, such as local parks, and social assets in the form of cooperation and neighbor-led civic engagement initiatives. In addition, the youth participants demonstrated awareness of structural inequities that influence neighborhood health and violence-related outcomes. This study contributes to efforts to understand how youth with high levels of community violence exposure understand and interact with the built and social environments.

Youth for Youth: Raising the voices of children of incarcerated parents and implications for policy and practice

The aims of our study were (1) to explore the impact of having an incarcerated parent on youth (ages 10-18) wellbeing; and (2) to identify recommendations from the youth based on their needs which address the challenges of having an incarcerated parent and promote individual and community flourishing. We utilized a Youth Participatory Action Research approach, including semistructured interviews, focus group discussions, storytelling, and photovoice with 20 participants, ages 10-18. Data were analyzed using qualitative content analysis and organized into five thematic categories: (1) youths' perceptions of their communities; (2) incarcerations' impact on families and communities; (3) incarcerations' influence on mental health and flourishing; (4) incarceration as a solution for community safety; and (5) addressing the impact of incarceration on children, families, and communities. Findings provide important implications for practice and policy with children of incarcerated parents and for promoting flourishing individuals and communities.

Neighborhood Physical and Social Environments and Social Inequalities in Health in Older Adolescents and Young Adults: A Scoping Review

Poor health and well-being are prevalent among young people. Neighborhoods may play a role in promoting good health. Little is known on if and how neighborhood characteristics affect health, and social inequalities therein, among young people. In this scoping review, we asked: (1) what features of the neighborhood physical and social environments have been studied in association with the physical and mental health and well-being of young people 15 to 30 years old; and (2) to what extent have social differentials in these associations been studied, and how? We identified peer-reviewed articles (2000 to 2023) through database and snowball searches. We summarized study characteristics, exposure(s), outcome(s) and main findings, with an eye on social inequalities in health. Out of the 69 articles reviewed, most were quantitative, cross-sectional, conducted among 18-year-olds and younger, and focused on the residential neighborhood. Neighborhood social capital and mental health were the most common exposure and outcome studied, respectively. Almost half of the studies examined social inequalities in health, mostly across sex/gender, socioeconomic status, and ethnicity. Evidence gaps remain, which include exploring settings other than residential neighborhoods, studying the older age stratum of young adulthood, and assessing a broader range of social inequalities. Addressing these gaps can support research and action on designing healthy and equitable neighborhoods for young people.

Youth Lens: Youth Perspectives on the COVID-19 Pandemic and its Impact on Well-being in an Urban Community

The COVID-19 pandemic has greatly altered the lives of children and youth throughout the world, with significant implications for their long-term health and well-being. Children were largely excluded from the development and implementation of the various pandemic mitigation strategies and policies, yet their lives were significantly affected. This study sought to shed light on children's perspectives and experiences during the COVID-19 pandemic, the various ways it impacted their health and well-being, along with the resources which allowed them to continue to flourish in the face of extreme hardship. We present a subset of findings regarding the COVID-19 pandemic from the Youth Lens study, with 65 youth (aged 10-18) from urban communities in Cleveland, OH, USA. We utilized a participatory methodology with youth, including the data collection techniques of photo voice, community mapping, group discussion, individual interviews, and journaling. This study highlights important and timely findings related to children's well-being during the COVID-19 pandemic from the youth's perspectives and underscores potential ways to address their challenges and concerns.