Community change and resident needs: Designing a Participatory Action Research study in Metropolitan Boston

Structural changes in a Danish social housing area: The impact of forced permanent rehousing on contact frequency with general practitioner and use of antidepressants

There is a lack of knowledge about the health consequences of politically initiated forced permanent rehousing (FPR) of residents in social housing areas. This study investigates if FPR is associated with the contact frequency with general practitioner (GP) and the proportion of residents who use antidepressants. The study included 432 rehoused residents matched 1:2 with remaining residents and residents from a comparable neighbouring area without exposure to rehousing. For GP contact frequency, we conducted a difference-in-difference analysis while the proportion of residents who used antidepressants was investigated through descriptive statistics. We found high GP contact frequency in the three groups, but no significant differences. Further, we found a low proportion of residents who used antidepressants in all groups, but a small increase from baseline to follow-up. Our results thus suggest that FPR neither affected the rehoused residents' GP contact frequency nor the proportion who used antidepressants.

Exploring ownership of change and health equity implications in neighborhood change processes: A community-led approach to enhancing just climate resilience in Everett, MA

Traditional planning processes have perpetuated the exclusion of historically marginalized communities, imposing vulnerability to climate (health) crises. We investigate how ownership of change fosters equitable climate resilience and community well-being through participatory action research. Our study highlights the detrimental effects of climate gentrification on community advocacy for climate security and health, negatively impacting well-being. We identify three key processes of ownership of change: ownership of social identity, development and decision-making processes, and knowledge. These approaches emphasize community-led solutions to counter climate health challenges and underscore the interdependence of social and environmental factors in mental health outcomes in climate-stressed communities.

A qualitative study on the Virtual Emergency Department care experiences of equity-deserving populations

Patients from equity-deserving populations, such as those who are from racialized communities, the 2SLGBTQI+ community, who are refugees or immigrants, and/or who have a disability, may experience a unique set of challenges accessing virtual models of care. The objective of this qualitative study was to describe the experiences of patients from equity-deserving communities and their family members who received care from a Virtual Emergency Department (ED) in Toronto, Canada. Forty-three participants (36 patients and 7 family caregivers) with different and intersecting identities who used the Virtual ED participated in the study. Semi-structured interviews were conducted to explore reasons for accessing the Virtual ED, barriers to access, and how the Virtual ED met their care needs and expectations, including ways their experience could have been improved. Thematic analysis was used to identify themes from the data. Patients from equity-deserving populations described negative past experiences with ED in-person care, which included recounts of discrimination or culturally insensitive care while waiting to see the ED physician or nurse. Conversely, participants found the Virtual ED to be a socially and culturally safe space since they could now by-pass the waiting room experience. However, virtual care could not replace in-person care for certain issues (e.g., physical exam), and there was a need for greater promotion of the service to specific communities that might benefit from having access to the Virtual ED. Targeted outreach to help raise awareness of the service to equity-deserving communities is an important future direction.

The embodiment of exclusionary displacement pressure: Intersections of housing insecurity and mental health in a Hispanic/Latinx immigrant neighborhood

Gentrification, growing income inequality, urban development, and the affordable housing crisis necessitate understanding the impact of the concern of displacement on health - prior to or even in the absence of a displacement event. In this paper, I use the term "exclusionary displacement pressure" to unify the literature on exclusionary displacement and displacement pressure, highlighting the disproportionate and inequitable impacts of displacement pressure among communities of color. Through following 35 residents over 2.5-years (2019-2022) in one predominantly low-income Hispanic/Latinx immigrant neighborhood in Denver, Colorado, I examine how exclusionary displacement pressure shapes their health and wellbeing over time. Through paying attention to how participants' lived experience is shaped by structural vulnerability (e.g. lack of documentation status, inadequate work, limited access to safety net systems), I identify how exclusionary displacement pressure is constantly internalized and responded to as a unique embodied health experience, wearing on individuals over time and reproducing population health inequities. The framework of embodied health experiences captures the wide range of health-related impacts, from diagnosable health conditions to idioms of distress, using participant's own language of suffering to express how they were feeling, battling, and enduring the pressure. Theorizing on structural vulnerability within specific subpopulations with intersecting identities, such as low-income immigrant Hispanic/Latinx communities, provides a bottom-up refinement to existing theories of embodied health. Understanding the place-health experiences of individuals in changing neighborhoods over time is also critically important to define time points at which context-specific supports and interventions are appropriate.

Contextualizing black emerging adults' perceptions of neighborhood quality

The ways in which Black emerging adults perceive and evaluate their neighborhoods may be impacted by a host of social and political factors that interplay with their social identities, the social identities of other urban residents, and their time in the area. Early literature on Black emerging adults' perceived neighborhood quality (PNQ) tended to make comparisons to White people and to focus disproportionately on the perceptions of low-income Black people residing in predominately racial/ethnic minority and underresourced communities. Subsequent work on subjective neighborhood assessment has considered specific features of neighborhoods, such as safety or disorder, but a general sense of the quality of one's neighborhood features is still underexplored. The current study adapts Connerly and Marans' (1985) PNQ model to explore the relations between social identities and locations, neighborhood sociostructural features, time in the area, and PNQ among Black urban-residing emerging adults. Block-wise regression results suggest that education and partner status were associated with PNQ. Perceptions of the percentage of Black neighbors and Census Bureau proportions of residents in the zip code who are poor were also associated with PNQ. Length of residence in the neighborhood was marginally associated with PNQ while length of residence in the city/town was not significantly associated with PNQ. For young Black women, combined household income was marginally associated with PNQ, but neighborhood sociostructural features were the strongest contributors to PNQ. In contrast, education was the only significant contributor to PNQ for young Black men. We discuss the ways that the social positions of young Black residents and their neighbors may impact their experiences and evaluations of urban areas.

Can changing neighborhoods influence mental health? An ecological analysis of gentrification and neighborhood-level serious psychological distress-New York City, 2002-2015

Neighborhood conditions influence people's health; sustaining healthy neighborhoods is a New York City (NYC) Health Department priority. Gentrification is characterized by rapid development in historically disinvested neighborhoods. The gentrification burden, including increased living expenses, and disrupted social networks, disproportionally impacts certain residents. To ultimately target health promotion interventions, we examined serious psychological distress time trends in gentrifying NYC neighborhoods to describe the association of gentrification and mental health overall and stratified by race and ethnicity. We categorized NYC neighborhoods as hypergentrifying, gentrifying, and not-gentrifying using a modified New York University Furman Center index. Neighborhoods with ≥100% rent growth were hypergentrifying; neighborhoods with greater than median and <100% rent growth were gentrifying; and neighborhoods with less than median rent growth were not-gentrifying. To temporally align neighborhood categorization closely with neighborhood-level measurement of serious psychological distress, data during 2000-2017 were used to classify neighborhood type. We calculated serious psychological distress prevalence among adult populations using data from 10 NYC Community Health Surveys during 2002-2015. Using joinpoint and survey-weighted logistic regression, we analyzed serious psychological distress prevalence time trends during 2002-2015 by gentrification level, stratified by race/ethnicity. Among 42 neighborhoods, 7 were hypergentrifying, 7 were gentrifying, and 28 were not gentrifying. In hypergentrifying neighborhoods, serious psychological distress prevalence decreased among White populations (8.1% to 2.3%, β = -0.77, P = 0.02) and was stable among Black (4.6% to 6.9%, β = -0.01, P = 0.95) and Latino populations (11.9% to 10.4%, β = -0.16, P = 0.31). As neighborhoods gentrified, different populations were affected differently. Serious psychological distress decreased among White populations in hypergentrifying neighborhoods, no similar reductions were observed among Black and Latino populations. This analysis highlights potential unequal mental health impacts that can be associated with gentrification-related neighborhood changes. Our findings will be used to target health promotion activities to strengthen community resilience and to ultimately guide urban development policies.

Identifying drivers of increasing opioid overdose deaths among black individuals: a qualitative model drawing on experience of peers and community health workers

BACKGROUND

Black individuals in the USA face disproportionate increases in rates of fatal opioid overdose despite federal efforts to mitigate the opioid crisis. The aim of this study was to examine what drives increases in opioid overdose death among Black Americans based on the experience of key stakeholders.

METHODS

Focus groups were conducted with stakeholders providing substance use prevention services in Black communities in St. Louis, MO (n = 14). One focus group included peer advocates and volunteers conducting outreach-based services and one included active community health workers. Focus groups were held at community partner organizations familiar to participants. Data collection was facilitated by an interview guide with open-ended prompts. Focus groups were audio recorded and professionally transcribed. Transcripts were analyzed using grounded theory to abstract line-by-line codes into higher order themes and interpret their associations.

RESULTS

A core theme was identified from participants' narratives suggesting that opioid overdose death among Black individuals is driven by unmet needs for safety, security, stability, and survival (The 4Ss). A lack of The 4Ss was reflective of structural disinvestment and healthcare and social service barriers perpetuated by systemic racism. Participants unmet 4S needs are associated with health and social consequences that perpetuate overdose and detrimentally impact recovery efforts. Participants identified cultural and relationship-based strategies that may address The 4Ss and mitigate overdose in Black communities.

CONCLUSIONS

Key stakeholders working in local communities to address racial inequities in opioid overdose highlighted the importance of upstream interventions that promote basic socioeconomic needs. Local outreach efforts utilizing peer services can provide culturally congruent interventions and promote harm reduction in Black communities traditionally underserved by US health and social systems.

Building health equity through housing policies: critical reflections and future directions for research

Housing may be at once the most powerful and underused tool at our disposal to improve population health. Using examples from the USA, we argue that current levels of housing insecurity are the result of clear and inequitable policy choices, leading to the entrenchment of health inequities-particularly, across race and class. Solutions to housing insecurity must, therefore, be structural. The COVID-19 pandemic has opened a window of opportunity for these structural housing policy reforms. Through justice- and action-oriented research, health researchers can inform the development and implementation of housing policies that advance health equity. We offer a series of recommendations to better position our field to achieve this goal.

Aligning Physical Literacy With Critical Positive Youth Development and Student-Centered Pedagogy: Implications for Today's Youth

The purpose of this article is three-fold: (1) revisit the concept of life skills to position physical literacy as a social justice life skill; (2) make the argument that physical literacy is particularly relevant within a critical positive youth development perspective; and (3) propose a novel critical praxis for developing physical literacy amongst youth. When considering emergent social issues, youth programming has the potential to integrate concepts from a range of theoretical frameworks, which may help youth transform into social change activists and competent movers. Such critical perspectives may guide sport and physical education programming as contemporary society poses numerous challenges concerning youths' diverse emotional, mental, physical, and social needs. In order to advance knowledge and practice, we urge researchers and practitioners to rethink the way sport and physical education has been traditionally conceptualized. Ultimately, we propose that educating individuals to recognize and then confront neoliberal values within a post-pandemic landscape is critical. These notions may help researchers (re)frame their positionality and readiness to tackle physical literacy through broader theoretical lenses which-as alluded to in this article-may equip practitioners and researchers to meaningfully advance social justice.

The dynamics of indiscriminate/ illegal dumping of waste in Fisantekraal, Cape Town, South Africa

Indiscriminate dumping may be considered a 'wicked problem', as it is regarded as a complex, intractable, open-ended problem and it includes rights-based and justice issues. An understanding of the dynamics of indiscriminate dumping may assist with improving the management of indiscriminate dumping. The results show that indiscriminate dumping in Fisantekraal is a serious threat. From the first round of data collection to the last, no dumpsite disappeared despite the efforts of the community to clean up each month. Rather, the formation of new dumpsites and the extension of a few existing ones were evident. The morphology composition of the waste suggests that the main dumpers are the households and spaza shop owners. Conversations and collaboration between the authorities and community are encouraged in order to explore solutions to indiscriminate dumping.

Rising home values and Covid-19 case rates in Massachusetts

We explore whether housing displacement pressure could help explain place-based disparities in Massachusetts COVID-19 prevalence. We use qualitative data from the Healthy Neighborhoods Study to illustrate how rising and unaffordable housing costs are experienced by residents in municipalities disproportionately affected by COVID-19. We then predict municipal-level COVID-19 case rates as a function of home value increases and housing cost burden prevalence among low-income households, controlling for previously identified community-level risk factors. We find that housing value increase predicts higher COVID-19 case rates, but that associations are ameliorated in areas with higher home values. Qualitative data highlight crowding, "doubling up," homelessness, and employment responses as mechanisms that might link housing displacement pressure to COVID-19 prevalence.

Evidence-Informed strategies for promoting equitability in brownfields redevelopment

Brownfields redevelopment creates opportunities for enhanced environmental conditions, improved physical and mental health, community cohesion, and economic prosperity. However, brownfields cleanup and recycling projects sometimes fail due to a lack of community engagement. Recent research suggests that such failures can stem from a lack of equitability in the planning process, especially when it comes to decision making. This paper examines issues of equitability in a recent brownfields redevelopment project in Tampa, Florida funded by the U.S. Environmental Protection Agency. The project focused on an underserved and under-resourced community with long-term environmental burdens and health disparities. Our ethnographic research shows that, while the project engaged in multiple and intersecting efforts to include a diversity of community voices in the decision-making process, ultimately structural and organizational power imbalances in sustainability transitions influenced participation in redevelopment initiatives. This study suggests that attending to issues of power articulated through expressions of local and authoritative knowledge about environmental cleanup and redevelopment can lead to deeper levels of community engagement.

Gentrification, Neighborhood Change, and Population Health: a Systematic Review

Despite a proliferation of research on neighborhood effects on health, how neighborhood economic development, in the form of gentrification, affects health and well-being in the USA is poorly understood, and no systematic assessment of the potential health impacts has been conducted. Further, we know little about whether health impacts differ for residents of neighborhoods undergoing gentrification versus urban development, or other forms of neighborhood socioeconomic ascent. We followed current guidelines for systematic reviews and present data on the study characteristics of the 22 empirical articles that met our inclusion criteria and were published on associations between gentrification, and similar but differently termed processes (e.g., urban regeneration, urban development, neighborhood upgrading), and health published between 2000 and 2018. Our results show that impacts on health vary by outcome assessed, exposure measurement, the larger context-specific determinants of neighborhood change, and analysis decisions including which reference and treatment groups to examine. Studies of the health impacts of gentrification, urban development, and urban regeneration describe similar processes, and synthesis and comparison of their results helps bridge differing theoretical approaches to this emerging research. Our article helps to inform the debate on the impacts of gentrification and urban development for health and suggests that these neighborhood change processes likely have both detrimental and beneficial effects on health. Given the influence of place on health and the trend of increasing gentrification and urban development in many American cities, we discuss how future research can approach understanding and researching the impacts of these processes for population health.

Effects of gentrification on health status after Hurricane Katrina

Despite substantial debate about the impacts of gentrification on cities, neighborhoods, and their residents, there is limited evidence to demonstrate the implications of gentrification for health. We examine the impacts of gentrification on several health measures using a unique individual-level longitudinal data set. We employ data from the Resilience in Survivors of Hurricane Katrina (RISK) project, a study of low-income parents, predominantly non-Hispanic Black single mothers, who participated in a New Orleans-based study before and after Hurricane Katrina. After Katrina, all participants were displaced, at least temporarily, from New Orleans, and had little or no control over neighborhood placement immediately following the storm. This near-random displacement after Katrina created a natural experiment. We employ a quasi-experimental intent to treat design to assess the causal effects of gentrification on health in the RISK population. We do not find evidence of significant main effects of being displaced to a gentrified neighborhood on BMI, self-rated health, or psychological distress. The analysis employs a quasi-experimental design and has several additional unique features--homogeneous population, limited selection bias, and longitudinal data collection-- that improve our ability to draw causal conclusions about the relationship between gentrification and health. However, the unique context of displacement by natural disaster may limit the generalizability of our findings to other circumstances or residents experiencing gentrification.

Designing and Facilitating Collaborative Research Design and Data Analysis Workshops: Lessons Learned in the Healthy Neighborhoods Study

One impediment to expanding the prevalence and quality of community-engaged research is a shortage of instructive resources for collaboratively designing research instruments and analyzing data with community members. This article describes how a consortium of community residents, grassroots community organizations, and academic and public institutions implemented collaborative research design and data analysis processes as part of a participatory action research (PAR) study investigating the relationship between neighborhoods and health in the greater Boston area. We report how nine different groups of community residents were engaged in developing a multi-dimensional survey instrument, generating and testing hypotheses, and interpreting descriptive statistics and preliminary findings. We conclude by reflecting on the importance of balancing planned strategies for building and sustaining resident engagement with improvisational facilitation that is responsive to residents’ characteristics, interests and needs in the design and execution of collaborative research design and data analysis processes.