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Espinoza Suarez NR, Loignon C, Dupere S, Dufour I, Shareck M, Apparicio P, Ouellet J, Pineault J, Amagnamoua S, Laferrière MC, Wilson I. Uncovering the state of knowledge about healthcare gentrification: a scoping review protocol. BMJ Open 2024; 14:e085375. [PMID: 39002957 PMCID: PMC11253761 DOI: 10.1136/bmjopen-2024-085375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/28/2024] [Indexed: 07/15/2024] Open
Abstract
INTRODUCTION Healthcare gentrification is the process in which the distribution of healthcare resources within a neighbourhood affects residents' access to healthcare services. To understand the complexity of healthcare access and to consider the socio-structural dimensions affecting equity in access to care, we aim to explore how healthcare gentrification has been described in the scientific literature and to document the reported relations between gentrification and healthcare access. METHODS AND ANALYSIS We will conduct a scoping review from data published from inception to September 2024 based on the methodology developed by Arksey and O'Malley (2005) and improved by Levac et al (2010). We will search the following databases: MEDLINE (OVID), Embase (embase.com), CINAHL Plus with Full Text (EBSCO), Web of Science and Geobase (Engineering Village). The review will be conducted from February 2024 to September 2024. The search strategy will be elaborated in conjunction with a professional librarian. Screening of titles and abstracts and full-text screening will be done in duplicates. A third reviewer will arbitrate discrepancies during the screening process. We will present our results narratively. ETHICS AND DISSEMINATION This scoping review does not require ethical approval since it will be collected from publicly available documents. The results of this scoping review will also be presented as a scientific article, scientific conferences, research webinars also in social media, workshops and conferences organised by healthcare organisations or academic institutions or on any appropriate platform.
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Affiliation(s)
| | - Christine Loignon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Sophie Dupere
- Faculty of Nursing, Laval University, Quebec, Quebec, Canada
| | - Isabelle Dufour
- Faculty of Nursing, Sherbrooke University, Sherbrooke, Quebec, canada
- Research Center on Aging, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Martine Shareck
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Philippe Apparicio
- Department of Applied Geomatics, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Julie Ouellet
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Justine Pineault
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Simone Amagnamoua
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Isabelle Wilson
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Pichardo MS, Pichardo CM, Talavera GA, Gallo LC, Kuo CC, Castañeda SF, Chambers EC, Daviglus ML, Pirzada A, Perreira KM, Sotres-Alvarez D, Peña Ortiz TY, Plascak JJ. Change in Neighborhood Socioeconomic Status and Adherence to the Cancer Prevention Lifestyle Guidelines in Hispanic/Latino Adults: Results from the HCHS/SOL Study. CANCER RESEARCH COMMUNICATIONS 2023; 3:1981-1991. [PMID: 37783658 PMCID: PMC10542571 DOI: 10.1158/2767-9764.crc-23-0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/03/2023] [Accepted: 09/05/2023] [Indexed: 10/04/2023]
Abstract
Neighborhood conditions are dynamic; the association of changing neighborhood socioeconomic factors with cancer preventive behaviors remains unclear. We examined associations of neighborhood socioeconomic deprivation, gentrification, and change in income inequality with adherence to the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention in The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The HCHS/SOL enrolled 16,415 adults, ages 18–74 years, at baseline (2008–2011), from communities in the Bronx, NY, Chicago, IL, Miami, FL, and San Diego, CA. Geocoded baseline addresses were linked to the 2000 decennial Census and 5-year American Community Survey (2005–2009 and 2012–2016) tracts to operationalize neighborhood deprivation index (NDI), gentrification, and income inequality. Complex survey multinominal logistic regression models estimated the relative risk ratio (RRR) with overall guideline adherence level (low, moderate, high) and by components—diet, physical activity, body mass index (BMI), and alcohol intake. Overall, 14%, 60%, and 26% of the population had low, moderate, and high ACS guideline adherence, respectively. NDI was negatively associated with risk of high (vs. low) guideline adherence [RRR = 0.87, 95% confidence interval (CI) = 0.78–0.98], although attenuated after controlling for individual socioeconomic status (SES; RRR = 0.89, 95% CI = 0.80–1.00), and associated with lower adherence to BMI recommendations (low vs. moderate RRR = 0.90, 95% CI = 0.84–0.97; high RRR = 0.86, 95% CI = 0.77–0.97). Gentrification was associated with higher likelihood of meeting the dietary recommendations (low vs. moderate RRR = 1.04, 95% CI = 1.01–1.07), but not with overall adherence or individual components. Change in income inequality was not associated with outcomes. Neighborhood deprivation may be negatively associated with ACS guideline adherence among Hispanic/Latino adults. SIGNIFICANCE This study provides new evidence on the link between neighborhood gentrification, changing income inequality and adoption and maintenance of cancer preventive behaviors in an understudied population in cancer research. We observed that while neighborhood deprivation may deter from healthy lifestyle behaviors, positive changes in neighborhood SES via the process of gentrification, may not influence lifestyle guideline adherence among Hispanic/Latino adults.
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Affiliation(s)
- Margaret S. Pichardo
- Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Catherine M. Pichardo
- South Bay Latino Research Center, Department of Psychology, San Diego State University, San Diego, California
| | | | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, California
| | - Charlene C. Kuo
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, Maryland
| | | | - Earle C. Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, New York
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois
| | - Krista M. Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Jesse J. Plascak
- Division of Cancer Prevention and Control, Ohio State University College of Medicine, Columbus, Ohio
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Gao C, Sanchez KM, Lovinsky-Desir S. Structural and Social Determinants of Inequitable Environmental Exposures in the United States. Clin Chest Med 2023; 44:451-467. [PMID: 37517826 DOI: 10.1016/j.ccm.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
American Indian (AI)/Alaskan Natives, African Americans, and Latino Americans have disproportionally high exposure to harmful environmental conditions as a consequence of unjust laws and policies, systemic racism, residential segregation, and discrimination. In this review, we draw connections between historical policies and social movements in the United States' history that have been rooted in racism and classism, leading to social isolation and marginalization of AIs, African Americans, and Latino Americans. We then discuss the structural factors that stem from the aforementioned inequities and that contribute to the inequitable distribution of environmental hazards.
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Affiliation(s)
- Courtney Gao
- Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, CHC 7-701, New York, NY, USA
| | - Kimberly M Sanchez
- Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, CHC 7-701, New York, NY, USA
| | - Stephanie Lovinsky-Desir
- Pulmonary Division, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, CHC 7-701, New York, NY 10032, USA.
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Shareck M, Aubé E, Sersli S. Neighborhood Physical and Social Environments and Social Inequalities in Health in Older Adolescents and Young Adults: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5474. [PMID: 37107756 PMCID: PMC10139110 DOI: 10.3390/ijerph20085474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
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.
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Affiliation(s)
- Martine Shareck
- Département des Sciences de la Santé Communautaire, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
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MEHDIPANAH ROSHANAK. Without Affordable, Accessible, and Adequate Housing, Health Has No Foundation. Milbank Q 2023; 101:419-443. [PMID: 37096623 PMCID: PMC10126970 DOI: 10.1111/1468-0009.12626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/30/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Today's housing disparities are rooted in the increasing commodification of housing that has taken precedence over the need for shelter, a basic human right. With rising housing costs across the country, more residents are finding their monthly income going to rent, mortgage payments, property taxes, and utilities, leaving little for food and medication. Housing is a determinant of health, and with increasing housing disparities, action must be taken to ensure no individual is displaced, communities remain intact, and cities continue to thrive.
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O'Neill E, Cole HVS, García-Lamarca M, Anguelovski I, Gullón P, Triguero-Mas M. The right to the unhealthy deprived city: An exploration into the impacts of state-led redevelopment projects on the determinants of mental health. Soc Sci Med 2023; 318:115634. [PMID: 36621085 DOI: 10.1016/j.socscimed.2022.115634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 11/19/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022]
Abstract
Research shows mental health is impacted by poor-quality physical and social-environmental conditions. Subsequently state-led redevelopment/regeneration schemes focus on improving the physical environment, to provide better social-environmental conditions, addressing spatial and socioeconomic inequities thus improving residents' health. However, recent research suggests that redevelopment/regeneration schemes often trigger gentrification, resulting in new spatial and socioeconomic inequalities that may worsen health outcomes, including mental health, for long-term neighborhood residents. Using the right to the city and situating this within the framework of accumulation by dispossession and capitalist hegemony, this paper explores the potential mechanisms in which poor mental health outcomes may endure in neighborhoods despite the implementation of redevelopment/regeneration projects. To do so, we explored two neighborhoods in the city of Glasgow - North Glasgow and East End - and conducted a strong qualitative study based on 25 in-depth semi-structured interviews with key stakeholders. The results show that postindustrial vacant and derelict land spaces and socioeconomic deprivation in North and East Glasgow are potential mechanisms contributing to the poor mental health of its residents. Where redevelopment/regeneration projects prioritize economic goals, it is often at the expense of social(health) outcomes. Instead, economic investment instigates processes of gentrification, where long-term neighborhood residents are excluded from accessing collective urban life and its (health) benefits. Moreover, these residents are continually excluded from participation in decision-making and are unable to shape the urban environment. In summary, we found a number of potential mechanisms that may contribute to enduring poor mental health outcomes despite the existence of redevelopment/regeneration projects. Projects instead have negative consequences for the determinants of mental health, reinforcing existing inequalities, disempowering original long-term neighborhood residents and only providing the "right" to the unhealthy deprived city. We define this as the impossibility to benefit from material opportunities, public spaces, goods and services and the inability to shape city transformations.
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Affiliation(s)
- Ella O'Neill
- Universitat Autònoma de Barcelona (UAB), Institute for Environmental Science and Technology (ICTA), Edifici ICTA-ICP, Carrer de les Columnes s/n, Campus de la UAB, 08193, Cerdanyola del Vallès, Barcelona, Spain; Barcelona Laboratory for Urban Environmental Justice and Sustainability (BCNUEJ), Hospital del Mar Medical Research Institute (IMIM), 08003, Barcelona, Spain.
| | - Helen V S Cole
- Universitat Autònoma de Barcelona (UAB), Institute for Environmental Science and Technology (ICTA), Edifici ICTA-ICP, Carrer de les Columnes s/n, Campus de la UAB, 08193, Cerdanyola del Vallès, Barcelona, Spain; Barcelona Laboratory for Urban Environmental Justice and Sustainability (BCNUEJ), Hospital del Mar Medical Research Institute (IMIM), 08003, Barcelona, Spain.
| | - Melissa García-Lamarca
- Universitat Autònoma de Barcelona (UAB), Institute for Environmental Science and Technology (ICTA), Edifici ICTA-ICP, Carrer de les Columnes s/n, Campus de la UAB, 08193, Cerdanyola del Vallès, Barcelona, Spain; Barcelona Laboratory for Urban Environmental Justice and Sustainability (BCNUEJ), Hospital del Mar Medical Research Institute (IMIM), 08003, Barcelona, Spain.
| | - Isabelle Anguelovski
- Universitat Autònoma de Barcelona (UAB), Institute for Environmental Science and Technology (ICTA), Edifici ICTA-ICP, Carrer de les Columnes s/n, Campus de la UAB, 08193, Cerdanyola del Vallès, Barcelona, Spain; Barcelona Laboratory for Urban Environmental Justice and Sustainability (BCNUEJ), Hospital del Mar Medical Research Institute (IMIM), 08003, Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Spain.
| | - Pedro Gullón
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, 28871, Spain; Unidad Docente Medicina Preventiva y Salud Pública, National School of Public Health, Madrid, Spain.
| | - Margarita Triguero-Mas
- Universitat Autònoma de Barcelona (UAB), Institute for Environmental Science and Technology (ICTA), Edifici ICTA-ICP, Carrer de les Columnes s/n, Campus de la UAB, 08193, Cerdanyola del Vallès, Barcelona, Spain; Barcelona Laboratory for Urban Environmental Justice and Sustainability (BCNUEJ), Hospital del Mar Medical Research Institute (IMIM), 08003, Barcelona, Spain; Mariana Arcaya's Research Lab, Massachusetts Institute of Technology Department of Urban Studies and Planning, Cambridge, MA, USA.
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Mui Y, Headrick G, Chien J, Pollack C, Saleem HT. Revisiting revitalization: exploring how structural determinants moderate pathways between neighborhood change and health. Int J Equity Health 2022; 21:165. [DOI: 10.1186/s12939-022-01771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/16/2022] [Accepted: 09/27/2022] [Indexed: 11/19/2022] Open
Abstract
AbstractVacant housing can produce many issues that affect residents’ quality of life, especially in historically segregated communities of color. To address these challenges, local governments invest in strategic, place-based revitalization initiatives focused on the regeneration of vacant housing. Yet, the outcomes of these efforts remain contested. To maximize health benefits of revitalization investments, a more nuanced understanding of pathways between neighborhood changes and residents’ responses, adaptations, and ability to thrive is necessary, though, remains largely absent in the literature. Using the Vacants to Value initiative in Baltimore, MD as a case study, we explore (1) how health manifests among certain groups in the context of vacant housing revitalization; (2) how vacant housing and its regeneration engender social and cultural environmental change i.e., gentrification; and (3) what structural determinants (cultural norms, policies, institutions, and practices) contribute to the distribution of material resources and benefits of revitalization. Results suggest that vacant housing revitalization requires more than just physical remedies to maximize health. Our findings demonstrate how vacant housing revitalization influences the physical environment, social environment, and structural determinants of material resources and community engagement that can ultimately impact residents’ physical, mental, and social health. This study recommends that because housing disparities are rooted in structural inequalities, how policies, practices, and processes moderate pathways for residents to adapt and benefit from neighborhood changes is consequential for health and health equity. Establishing shared governance structures is a promising approach to foster equitable decision-making and outcomes. Going forward in urban regeneration, pathways to retain and strengthen the social environment while revitalizing the physical environment may be promising to achieve healthy communities.
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Firth CL, Kestens Y, Winters M, Stanley K, Bell S, Thierry B, Phillips K, Poirier-Stephens Z, Fuller D. Using combined Global Position System and accelerometer data points to examine how built environments and gentrification are associated with physical activity in four Canadian cities. Int J Behav Nutr Phys Act 2022; 19:78. [PMID: 35799198 PMCID: PMC9261044 DOI: 10.1186/s12966-022-01306-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 06/01/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Built and social environments are associated with physical activity. Global Positioning Systems (GPS) and accelerometer data can capture how people move through their environments and provide promising tools to better understand associations between environmental characteristics and physical activity. The purpose of this study is to examine the associations between GPS-derived exposure to built environment and gentrification characteristics and accelerometer-measured physical activity in a sample of adults across four cities. METHODS We used wave 1 data from the Interventions, Research, and Action in Cities Team, a cohort of adults living in the Canadian cities of Victoria, Vancouver, Saskatoon, and Montreal. A subsample of participants wore a SenseDoc device for 10 days during May 2017-January 2019 to record GPS and accelerometry data. Two physical activity outcomes were derived from SenseDoc data: time spent in light, moderate, and vigorous physical activity; and time spent in moderate or vigorous physical activity. Using corresponding GPS coordinates, we summarized physical activity outcomes by dissemination area-a Canadian census geography that represents areas where 400 to 700 people live- and joined to built (active living space, proximity to amenities, and urban compactness) and gentrification measures. We examined the associations between environmental measures and physical activity outcomes using multi-level negative binomial regression models that were stratified by city and adjusted for covariates (weekday/weekend), home dissemination area, precipitation, temperature) and participant-level characteristics obtained from a survey (age, gender, income, race). RESULTS We found that adults spent more time being physically active near their homes, and in environments that were more walkable and near parks and less time in urban compact areas, regardless of where participants lived. Our analysis also highlighted how proximity to different amenities was linked to physical activity across different cities. CONCLUSIONS Our study provides insights into how built environment and gentrification characteristics are associated with the amount of time adults spend being physically active in four Canadian cities. These findings enhance our understanding of the influence that environments have on physical activity over time and space, and can support policies to increase physical activity.
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Affiliation(s)
- Caislin L. Firth
- University of Washington, 1959 NE Pacific St, Seattle, WA 98195 United States
| | - Yan Kestens
- Université de Montréal/Centre de Recherche du CHUM, Pavillon S, 850 rue St-Denis, Montréal, QC H2X 0A9 Canada
| | - Meghan Winters
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Kevin Stanley
- University of Saskatchewan, 105 Administration Place, Saskatoon, S7N 5A2 Canada
| | - Scott Bell
- University of Saskatchewan, 105 Administration Place, Saskatoon, S7N 5A2 Canada
| | - Benoit Thierry
- University of Saskatchewan, 105 Administration Place, Saskatoon, S7N 5A2 Canada
| | - Kole Phillips
- University of Saskatchewan, 105 Administration Place, Saskatoon, S7N 5A2 Canada
| | - Zoé Poirier-Stephens
- Université de Montréal/Centre de Recherche du CHUM, Pavillon S, 850 rue St-Denis, Montréal, QC H2X 0A9 Canada
| | - Daniel Fuller
- University of Saskatchewan, 105 Administration Place, Saskatoon, S7N 5A2 Canada
- Memorial University of Newfoundland, 230 Elizabeth Avenue, St. John’s Newfoundland, A1C 5S7 Canada
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Santos CJ, Paciência I, Ribeiro AI. Neighbourhood Socioeconomic Processes and Dynamics and Healthy Ageing: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116745. [PMID: 35682327 PMCID: PMC9180257 DOI: 10.3390/ijerph19116745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023]
Abstract
Elderly citizens are concentrated in urban areas and are particularly affected by the immediate residential environment. Cities are unequal and segregated places, where there is an intensification of urban change processes such as gentrification and displacement. We aimed to understand how neighbourhood socioeconomic processes and dynamics influence older people’s health. Three bibliographic databases—PubMed, Web of Science, and Scopus—were used to identify evidence of the influence of neighbourhood socioeconomic deprivation, socio-spatial segregation, urban renewal, and gentrification on healthy ageing. We followed the method of Arksey and O’Malley, Levac and colleagues, the Joanna Briggs Institute, and the PRISMA-ScR. The included studies (n = 122) were published between 2001 and 2021. Most evaluated neighbourhood deprivation (n = 114), followed by gentrification (n = 5), segregation (n = 2), and urban renewal (n = 1). Overall, older people living in deprived neighbourhoods had worse healthy ageing outcomes than their counterparts living in more advantaged neighbourhoods. Older adults pointed out more negative comments than positive ones for gentrification and urban renewal. As to segregation, the direction of the association was not entirely clear. In conclusion, the literature has not extensively analysed the effects of segregation, gentrification, and urban renewal on healthy ageing, and more quantitative and longitudinal studies should be conducted to draw better inferences.
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Affiliation(s)
- Cláudia Jardim Santos
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal;
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Correspondence: ; Tel.: +351-222-061-820
| | - Inês Paciência
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, P.O. Box 5000, 90570 Oulu, Finland;
- Biocenter Oulu, University of Oulu, P.O. Box 5000, 90570 Oulu, Finland
| | - Ana Isabel Ribeiro
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal;
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
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Dubowitz T, Haas A, Ghosh-Dastidar B, Collins RL, Beckman R, Brooks Holliday S, Richardson AS, Hale L, Buysse DJ, Buman MP, Troxel WM. Does investing in low-income urban neighborhoods improve sleep? Sleep 2021; 44:6071376. [PMID: 33417708 PMCID: PMC8193558 DOI: 10.1093/sleep/zsaa292] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/23/2020] [Indexed: 12/30/2022] Open
Abstract
STUDY OBJECTIVES Neighborhood disadvantage is associated with poor sleep, which may contribute to and exacerbate racial and socioeconomic health disparities. Most prior work has been cross-sectional and thus it has not been possible to estimate causal effects. METHODS We leveraged a natural experiment opportunity in two low-income, predominantly African American Pittsburgh, PA neighborhoods, following a randomly selected cohort of households (n = 676) between 2013 and 2016. One of the neighborhoods received substantial public and private investments (housing, commercial) over the study period, while the other socio-demographically similar neighborhood received far fewer investments. Primary analyses used a difference-in-difference analysis based on neighborhood, to examine changes in actigraphy-assessed sleep duration, efficiency, and wakefulness after sleep onset (WASO), and self-reported sleep quality. Secondary analyses examined whether residents' proximity to investments, regardless of neighborhood, was associated with changes in sleep outcomes. RESULTS Resident sleep worsened over time in both neighborhoods with no significant differences among residents between the two neighborhoods. Secondary analyses, including covariate adjustment and propensity score weighting to improve comparability, indicated that regardless of neighborhood, those who lived in closer proximity to investments (<0.1 mile) were significantly less likely to experience decreases in sleep duration, efficiency, and quality, or increases in WASO, compared to those who lived farther away. CONCLUSIONS While we did not observe sleep differences among residents between neighborhoods, living closer to a neighborhood investment was associated with better sleep outcomes. Findings have relevance for public health and policy efforts focused on investing in historically disinvested neighborhoods.
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Affiliation(s)
- Tamara Dubowitz
- RAND Corporation, Pittsburgh, PA
- Corresponding author. Tamara Dubowitz, RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213.
| | - Ann Haas
- RAND Corporation, Pittsburgh, PA
| | | | | | | | | | | | - Lauren Hale
- Department of Family, Population, and Preventive Medicine, Program in Public Health, Stony Brook University, Stony Brook, NY
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Matthew P Buman
- College of Health Solutions, Arizona State University, Phoenix, AZ
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Adapting the environmental risk transition theory for urban health inequities: An observational study examining complex environmental riskscapes in seven neighborhoods in Global North cities. Soc Sci Med 2021; 277:113907. [PMID: 33882438 DOI: 10.1016/j.socscimed.2021.113907] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/18/2020] [Accepted: 04/01/2021] [Indexed: 11/21/2022]
Abstract
Theories of epidemiologic transition analyze the shift in causes of mortality due to changes in risk factors over time, and through processes of urbanization and development by comparing risk factors between countries or over time. These theories do not account for health inequities such as those resulting from environmental injustice, in which minority and lower income residents are more likely to be exposed to environmental hazards or have less access to environmental goods. Neighborhoods with histories of environmental injustice are also at risk for gentrification as they undergo environmental improvements and new greening projects. We aimed to understand how environmental injustice, urban renewal and green gentrification could inform the understanding of epidemiologic risk transitions. We examined 7 case neighborhoods in cities in the United States and Western Europe which were representative in terms of city region and type, which 1) had experienced a history of environmental injustice and 2) exhibited evidence of recent processes of urban renewal and/or gentrification. In each city, we conducted semi-structured qualitative interviews (n = 172) with city representatives, activists, non-profits, developers and residents. Respondents reported health implications of traditional (heavy pollutants, poor social conditions), transitional (decontamination, new amenities), new (gentrification, access to amenities), and emerging (displacement, climate-related risks, re-emergence of traditional exposures) exposures. Respondents reported renewed, complexified and overlapping exposures leading to poor mental and physical health and to new patterns of health inequity. Our findings point to the need for theories of environmental and epidemiologic risk transitions to incorporate analysis of trends 1) on a city-scale, acknowledging that segregation and patterns of environmental injustice have created unequal conditions within cities and 2) over a shorter and more recent time period, taking into account worsening patterns of social inequity in cities.
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Breaking Down and Building Up: Gentrification, Its drivers, and Urban Health Inequality. Curr Environ Health Rep 2021; 8:157-166. [PMID: 33713334 PMCID: PMC7955692 DOI: 10.1007/s40572-021-00309-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 12/27/2022]
Abstract
Purpose of Review Many neighborhoods which have been unjustly impacted by histories of uneven urban development, resulting in socioeconomic and racial segregation, are now at risk for gentrification. As urban renewal projects lead to improvements in the long-neglected built environments of such neighborhoods, accompanying gentrification processes may lead to the displacement of or exclusion of underprivileged residents from benefiting from new amenities and improvements. In addition, gentrification processes may be instigated by various drivers. We aimed to discuss the implications of specific types of gentrification, by driver, for health equity. Recent Findings Several recent articles find differential effects of gentrification on the health of underprivileged residents of gentrifying neighborhoods compared to those with greater privilege (where sociodemographic dimensions such as race or socioeconomic status are used as a proxy for privilege). Generally, studies show that gentrification may be beneficial for the health of more privileged residents while harming or not benefiting the health of underprivileged residents. Very recent articles have begun to test hypothesized pathways by which urban renewal indicators, gentrification, and health equity are linked. Few public health articles to date are designed to detect distinct impacts of specific drivers of gentrification. Summary Using a case example, we hypothesize how distinct drivers of gentrification—specifically, retail gentrification, environmental gentrification, climate gentrification, studentification, tourism gentrification, and health care gentrification—may imply specific pathways toward reduced health equity. Finally, we discuss the challenges faced by researchers in assessing the health impacts of gentrification.
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13
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Towards the Healthy Community: Residents’ Perceptions of Integrating Urban Agriculture into the Old Community Micro-Transformation in Guangzhou, China. SUSTAINABILITY 2020. [DOI: 10.3390/su12208324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In the renewal of old communities, one of the development directions is to improve health and enhance well-being. A healthy community includes four aspects of health, namely, healthy production, healthy lifestyle, healthy environment and ecosystem, and healthy physical and mental states of residents living in the community. Urban agriculture (UA), as a form of the community garden, is a supplementary form for the lack of production function in the urban community. It also has the potential to contribute to sustainable and resilient urban communities. This study focuses on analysing the health benefits of UA and attempts to identify old community residents’ attitudes and perceptions towards UA and understand their confusion and worry. The purpose of this study is to promote the healthy and sustainable development of old communities by integrating UA into the micro-transformation of old communities and provide planning and design strategies and community development ideas for the micro-transformation. Surveys were conducted on 10 old communities in Yuexiu district, located in Guangzhou, China. Statistical analysis was conducted using IBM Statistical SPSS version 26 to obtain information on the factor structure of residents’ perceptions towards the health benefits of UA. The analysis results showed significant differences between gender groups and the status of children on old community residents’ perceptions towards general UA benefits. The main factors accounting for old community residents’ perceptions towards the health benefits of UA were environmental health benefits, physical and psychological health benefits, and community health benefits. When developing UA in old communities, co-construction and co-sharing mode, public participation mode, and promotion mode are three important development strategies. Construction location, design style, and seasonal design are also critical for the construction of UA in old communities.
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Firth CL, Fuller D, Wasfi R, Kestens Y, Winters M. Causally speaking: Challenges in measuring gentrification for population health research in the United States and Canada. Health Place 2020; 63:102350. [PMID: 32543436 DOI: 10.1016/j.healthplace.2020.102350] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/30/2022]
Abstract
The planet is rapidly urbanizing, the need for actionable evidence to guide the design of cities that help (not hinder) our health has never felt more urgent. One essential component of healthy city design is improving neighborhood conditions in previously disinvested areas. To ensure equitable city design, policy makers, city planners, health practitioners, and researchers are interested in understanding the complex relationship between urban change, gentrification, and population health. Yet, the causal link between gentrification and health outcomes remain unclear. Without clear and consistent gentrification measures, researchers struggle to identify populations who are exposed to gentrification, and to compare health outcomes between exposed and unexposed populations. To move the science forward, this paper summarizes the challenges related to gentrification measurement in the United States and Canada when aspiring to conduct studies to analyze causal relationships between gentrification and health. The paper concludes with a series of recommendations for studies aimed at examining both causes and consequences of gentrification and health.
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Affiliation(s)
- Caislin L Firth
- Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Daniel Fuller
- Memorial University of Newfoundland, 230 Elizabeth Avenue, St. John's Newfoundland, A1C 5S7, Canada.
| | - Rania Wasfi
- Université de Montréal/Centre de recherche du CHUM, Pavillon S, 850 rue St-Denis, Montréal, QC, H2X 0A9, Canada.
| | - Yan Kestens
- Université de Montréal/Centre de recherche du CHUM, Pavillon S, 850 rue St-Denis, Montréal, QC, H2X 0A9, Canada.
| | - Meghan Winters
- Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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15
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Cole HVS. A call to engage: considering the role of gentrification in public health research. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/23748834.2020.1760075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Helen V. S. Cole
- Institut de Ciѐncia I Tecnologia Ambientals, Universitat Autonoma de Barcelona, Barcelona, Spain
- Healthy Cities Research Group, Institut Hospital Del Mar D’Investigacions Mèdiques (IMIM), Barcelona, Spain
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16
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Schnake-Mahl AS, Jahn JL, Subramanian SV, Waters MC, Arcaya M. Gentrification, Neighborhood Change, and Population Health: a Systematic Review. J Urban Health 2020; 97:1-25. [PMID: 31938975 PMCID: PMC7010901 DOI: 10.1007/s11524-019-00400-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- Alina S Schnake-Mahl
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jaquelyn L Jahn
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
| | - Mary C Waters
- Department of Sociology, Harvard University, Cambridge, MA, USA
| | - Mariana Arcaya
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA, USA
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17
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Gentrification and Displacement in the San Francisco Bay Area: A Comparison of Measurement Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122246. [PMID: 31242684 PMCID: PMC6616964 DOI: 10.3390/ijerph16122246] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/28/2022]
Abstract
Gentrification may play an important role in influencing health outcomes, but few studies have examined these associations. One major barrier to producing empirical evidence to establish this link is that there is little consensus on how to measure gentrification. To address this barrier, we compared three gentrification classification methodologies in relation to their ability to identify neighborhood gentrification in nine San Francisco Bay Area counties: the Freeman method, the Landis method, and the Urban Displacement Project (UDP) Regional Early Warning System. In the 1580 census tracts, 43% of the population had a bachelor’s degree or higher. The average median household income was $79,671 in 2013. A comparison of gentrification methodologies revealed that the Landis and Freeman methodologies characterized the vast majority of census tracts as stable, and only 5.2% and 6.1% of tracts as gentrifying. UDP characterized 46.7% of tracts at risk, undergoing, or experiencing advanced stages of gentrification and displacement. There was substantial variation in the geographic location of tracts identified as gentrifying across methods. Given the variation in characterizations of gentrification across measures, studies evaluating associations between gentrification and health should consider using multiple measures of gentrification to examine the robustness of the study findings across measures.
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18
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Bilal U, Glass TA, Del Cura-Gonzalez I, Sanchez-Perruca L, Celentano DD, Franco M. Neighborhood social and economic change and diabetes incidence: The HeartHealthyHoods study. Health Place 2019; 58:102149. [PMID: 31220800 DOI: 10.1016/j.healthplace.2019.102149] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 05/09/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
We studied the association between neighborhood social and economic change and type 2 diabetes incidence in the city of Madrid (Spain). We followed 199,621 individuals living in 393 census tracts for diabetes incidence for 6 years using electronic health records, starting in 2009. We measured neighborhood social and economic change from 2005 to 2009 using a finite mixture model with 16 indicators that resulted in four types of neighborhood change. Adjusted results showed an association between neighborhood change and diabetes incidence: compared to those living in Aging/Stable areas, people living in Declining SES, New Housing and Improving SES areas have an 8% (HR = 0.92, 95% CI 0.87 to 0.99), 9% (HR = 0.91, 95% CI 0.81 to 1.01) and 11% (HR = 0.89, 95% CI 0.81 to 0.98) decrease in diabetes incidence. This evidence can help guide policies for diabetes prevention by focusing efforts on specific urban areas.
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Affiliation(s)
- Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Social and Cardiovascular Research Group, Universidad de Alcala, Alcala de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Thomas A Glass
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Isabel Del Cura-Gonzalez
- Primary Care Research Unit, Gerencia de Atención Primaria, Madrid, Spain; Department Preventive Medicine and Public Health, University Rey Juan Carlos, Madrid, Spain; Red de Investigación en Servicios de Salud y Enfermedades Crónicas (REDISSEC) ISCIII, Madrid, Spain
| | - Luis Sanchez-Perruca
- Primary Care Research Unit, Gerencia de Atención Primaria, Madrid, Spain; Red de Investigación en Servicios de Salud y Enfermedades Crónicas (REDISSEC) ISCIII, Madrid, Spain
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Manuel Franco
- Social and Cardiovascular Research Group, Universidad de Alcala, Alcala de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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19
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O'Brien R, Buston K, Wight D, McGee E, White J, Henderson M. A realist process evaluation of Enhanced Triple P for Baby and Mellow Bumps, within a Trial of Healthy Relationship Initiatives for the Very Early years (THRIVE): study protocol for a randomized controlled trial. Trials 2019; 20:351. [PMID: 31196169 PMCID: PMC6567913 DOI: 10.1186/s13063-019-3395-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 05/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background THRIVE is a three-arm randomised controlled trial (RCT) that aims to evaluate whether antenatal and early postnatal interventions, Enhanced Triple B for Baby (ETPB) plus care as usual (CAU) or Mellow Bumps (MB) plus CAU (versus CAU alone), can: 1) improve the mental health and well-being of pregnant women with complex health and social care needs; 2) improve mother-infant bonding and interaction; 3) reduce child maltreatment; and 4) improve child language acquisition. This paper focuses on THRIVE’s realist process evaluation, which is carefully monitoring what is happening in the RCT. Methods Realistic evaluation provides the theoretical rationale for the process evaluation. We question: 1) how faithfully are MB and ETPB implemented? 2) What are the mechanisms by which they work, if they do, and who do they work for and how? 3) What contextual factors are necessary for the programmes to function, or might prevent them functioning? The mixed-methods design includes quantitative measures, which are pre- and post-training/intervention questionnaires for facilitators and mothers-to-be, and post-session evaluation forms. Qualitative data collection methods include participant observation of facilitator training and the delivery of a series of antenatal sessions in selected intervention groups (n = 3 for ETPB and n = 3 for MB), semi-structured interviews with facilitators, pregnant women, partners, and referring facilitators, and telephone interviews examining the content of the postnatal components of ETPB and MB. Discussion The findings of this process evaluation will help researchers and decision makers interpret the outcomes of THRIVE. It will provide a greater understanding of: how the interventions work (if they do); the extent and quality of their implementation; contextual factors facilitating and constraining intervention functioning; variations in response within and between subgroups of vulnerable parents; and benefits or unintended consequences of either intervention. Few studies to date have published detailed research protocols illustrating how realist process evaluation is designed and conducted as an integral part of a randomised controlled trial. Trial registration ISRCTN, ISRCTN21656568. Registered on 8 November 2013. Electronic supplementary material The online version of this article (10.1186/s13063-019-3395-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rosaleen O'Brien
- Glasgow Caledonian University, Psychology, Social Work and Allied Health Professionals, School of Health and Life Sciences, 4th Floor, George Moore Building, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Katie Buston
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, UK
| | - Daniel Wight
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, UK
| | - Elizabeth McGee
- Glasgow Caledonian University, Psychology, Social Work and Allied Health Professionals, School of Health and Life Sciences, 4th Floor, George Moore Building, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Jane White
- Public Health Sciences, NHS Health Scotland, Gyle Square, 1 Gyle Crescent, Edinburgh, EH12 9EB, UK
| | - Marion Henderson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, UK.
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20
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Morrison J, Osrin D, Alcock G, Azad K, Bamjan J, Budhathoki B, Kuddus A, Mala MA, Manandhar D, Nkhata A, Pathak S, Phiri T, Rath S, Tripathy P, Costello A, Houweling TAJ. Exploring the equity impact of a maternal and newborn health intervention: a qualitative study of participatory women's groups in rural South Asia and Africa. Int J Equity Health 2019; 18:55. [PMID: 30971254 PMCID: PMC6458781 DOI: 10.1186/s12939-019-0957-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A consensus is developing on interventions to improve newborn survival, but little is known about how to reduce socioeconomic inequalities in newborn mortality in low- and middle-income countries. Participatory learning and action (PLA) through women's groups can improve newborn survival and home care practices equitably across socioeconomic strata, as shown in cluster randomised controlled trials. We conducted a qualitative study to understand the mechanisms that led to the equitable impact of the PLA approach across socioeconomic strata in four trial sites in India, Nepal, Bangladesh, and Malawi. METHODS We conducted 42 focus group discussions (FGDs) with women who had attended groups and women who had not attended, in poor and better-off communities. We also interviewed six better-off women and nine poor women who had delivered babies during the trials and had demonstrated recommended behaviours. We conducted 12 key informant interviews and five FGDs with women's group facilitators and fieldworkers. RESULTS Women's groups addressed a knowledge deficit in poor and better-off women. Women were engaged through visual learning and participatory tools, and learned from the facilitator and each other. Facilitators enabled inclusion of all socioeconomic strata, ensuring that strategies were low-cost and that discussions and advice were relevant. Groups provided a social support network that addressed some financial barriers to care and gave women the confidence to promote behaviour change. Information was disseminated through home visits and other strategies. The social process of learning and action, which led to increased knowledge, confidence to act, and acceptability of recommended practices, was key to ensuring behaviour change across social strata. These equitable effects were enabled by the accessibility, relevance, and engaging format of the intervention. CONCLUSIONS Participatory learning and action led to increased knowledge, confidence to act, and acceptability of recommended practices. The equitable behavioural effects were facilitated by the accessibility, relevance, and engaging format of the intervention across socioeconomic groups, and by reaching-out to parts of the population usually not accessed. A PLA approach improved health behaviours across socioeconomic strata in rural communities, around issues for which there was a knowledge deficit and where simple changes could be made at home.
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Affiliation(s)
- Joanna Morrison
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH UK
| | - David Osrin
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH UK
| | - Glyn Alcock
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH UK
| | - Kishwar Azad
- BADAS, Room No-390, BIRDEM Building 122,Kazi Nazrul Islam Avenue,Shahbagh, Dhaka, 1000 Bangladesh
| | | | | | - Abdul Kuddus
- BADAS, Room No-390, BIRDEM Building 122,Kazi Nazrul Islam Avenue,Shahbagh, Dhaka, 1000 Bangladesh
| | | | | | | | | | | | | | | | - Anthony Costello
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH UK
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21
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Mehdipanah R, Novoa AM, León-Gómez BB, López MJ, Palència L, Vasquez H, Díez È, Borrell C, Pérez K. Effects of Superblocks on health and health inequities: a proposed evaluation framework. J Epidemiol Community Health 2019; 73:585-588. [PMID: 30936190 DOI: 10.1136/jech-2018-211738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/22/2019] [Accepted: 03/12/2019] [Indexed: 11/04/2022]
Abstract
The following essay outlines the intervention and presents a framework that will serve as a guide in the evaluation of the different effects of the Superblocks. Superblocks consist of amalgamations of blocks throughout the city, with the goal of improving the habitability of public spaces, advancing sustainable mobility, increasing urban green, and promoting residents' participation and coresponsibility, while ultimately influencing residents' health and health inequities. The evaluation framework considers the following aspects: the interventions implemented in the Superblock strategy, the changes that occur at neighbourhood and individual level and the population turnover as intermediate factors and finally the health outcomes. Inequity dimensions are also considered.
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Affiliation(s)
- Roshanak Mehdipanah
- Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Ana M Novoa
- Agència Salut Pública de Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain
| | | | - Maria José López
- Agència Salut Pública de Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Laia Palència
- Agència Salut Pública de Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Hugo Vasquez
- Agència Salut Pública de Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain.,Departamento de Salud Pública, Universidad de La Frontera, Temuco, Chile
| | - Èlia Díez
- Agència Salut Pública de Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carme Borrell
- Agència Salut Pública de Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Katherine Pérez
- Agència Salut Pública de Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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22
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Matheson A. Reducing social inequalities in obesity: complexity and power relationships. J Public Health (Oxf) 2018; 38:826-829. [PMID: 28158692 DOI: 10.1093/pubmed/fdv197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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23
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Moore THM, Kesten JM, López-López JA, Ijaz S, McAleenan A, Richards A, Gray S, Savović J, Audrey S. The effects of changes to the built environment on the mental health and well-being of adults: Systematic review. Health Place 2018; 53:237-257. [PMID: 30196042 DOI: 10.1016/j.healthplace.2018.07.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 06/01/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
There is increasing interest in the influence of place on health, and the need to distinguish between environmental and individual level factors. For environmental-level factors, current evidence tends to show associations through cross-sectional and uncontrolled longitudinal analyses rather than through more robust study designs that can provide stronger causal evidence. We restricted this systematic review to randomised (or cluster) randomised controlled trials and controlled before-and-after studies of changes to the built environment. Date of search was December 2016. We identified 14 studies. No evidence was found of an effect on mental health from 'urban regeneration' and 'improving green infrastructure' studies. Beneficial effects on quality-of-life outcomes from 'improving green infrastructure' were found in two studies. One 'improving green infrastructure' study reported an improvement in social isolation. Risk-of-bias assessment indicated robust data from only four studies. Overall, evidence for the impact of built environment interventions on mental health and quality-of-life is weak. Future research requires more robust study designs and interdisciplinary research involving public health, planning and urban design experts.
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Affiliation(s)
- T H M Moore
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK.
| | - J M Kesten
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, Bristol Medical School, University of Bristol, UK
| | - J A López-López
- Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - S Ijaz
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - A McAleenan
- Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - A Richards
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK
| | - S Gray
- Department of Health and Applied Social Science, University of the West of England, Bristol BS16 1QY, UK
| | - J Savović
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - S Audrey
- Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
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Adlbrecht L, Bartholomeyczik S, Mayer H. Entwicklung einer Programmtheorie als Grundlage für die Evaluation einer Demenzstation. Pflege 2018; 31:125-134. [DOI: 10.1024/1012-5302/a000610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Zusammenfassung. Hintergrund: Ein bestehendes Konzept einer Demenzstation soll evaluiert werden. Damit die Evaluation gut aufgesetzt werden kann, bedarf es eines theoretischen Verständnisses für die implementierte Intervention, welches bisher nicht explizit formuliert ist. Eine Möglichkeit dafür ist die Entwicklung einer Programmtheorie. Ziel: Ziel ist es, eine Methode vorzustellen, wie eine Programmtheorie für das bestehende Wohn- und Betreuungskonzept einer Demenzstation entwickelt wird, die im Rahmen eines grösseren Projekts dazu dienen soll, dieses Konzept theoriegeleitet zu evaluieren. Methode: Die Evaluation wurde in den Strukturrahmen von van Belle et al. (2010) eingebettet und ein Action Model und ein Change Model nach Chen (2015) erstellt. Die Contribution Analysis ( Mayne, 2011 ) dient der Konkretisierung des Change Models. Es wurden Workshops mit den Entwicklern / Entwicklerinnen und den Pflegenden der Demenzstation sowie eine Literaturrecherche zu den Interventionen und Outcomes durchgeführt. Die Ergebnisse wurden in einem Konsensworkshop zusammengeführt. Ergebnisse: Das Action Model beschreibt die Interventionen der Demenzstation, die Implementierer / Implementiererinnen, die Organisation und den Kontext. Im Change Model wird dargelegt, mit welchen Mechanismen die Intervention Outcomes verändert. Schlussfolgerung: Die Ergebnisse der Programmtheorie können für die Wahl der Datenerhebungsmethoden und Instrumente der Evaluation genutzt werden. Anhand der Ergebnisse der Evaluation kann in weiterer Folge die Programmtheorie verfeinert und adaptiert werden.
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Affiliation(s)
| | | | - Hanna Mayer
- Institut für Pflegewissenschaft, Universität Wien
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Impact of Housing and Community Conditions on Multidimensional Health among Middle- and Low-Income Groups in Hong Kong. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061132. [PMID: 29857544 PMCID: PMC6025217 DOI: 10.3390/ijerph15061132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/27/2018] [Accepted: 05/29/2018] [Indexed: 12/23/2022]
Abstract
With decades of urbanization, housing and community problems (e.g., poor ventilation and lack of open public spaces) have become important social determinants of health that require increasing attention worldwide. Knowledge regarding the link between health and these problems can provide crucial evidence for building healthy communities. However, this link has heretofore not been identified in Hong Kong, and few studies have compared the health impact of housing and community conditions across different income groups. To overcome this gap, we hypothesize that the health impact of housing and community problems may vary across income groups and across health dimensions. We tested these hypotheses using cross-sectional survey data from Hong Kong. Several health outcomes, e.g., chronic diseases and the SF-12 v. 2 mental component summary scores, were correlated with a few types of housing and community problems, while other outcomes, such as the DASS-21⁻Stress scores, were sensitive to a broader range of problems. The middle- and low-income group was more severely affected by poor built environments. These results can be used to identify significant problems in the local built environment, especially amongst the middle- and low-income group.
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Borrell C, Malmusi D, Muntaner C. Introduction to the "Evaluating the Impact of Structural Policies on Health Inequalities and Their Social Determinants and Fostering Change" (SOPHIE) Project. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2017; 47:10-17. [PMID: 27956577 DOI: 10.1177/0020731416681891] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The SOPHIE Project (acronym for Structural Policies for Health Inequalities Evaluation) has focused on evaluating the impact of structural policies on health equity, considering as such all those policies that exert a powerful influence on the structural determinants of health (e.g., patterns of social stratification, living and working conditions) and thus on health-related exposures through intermediary determinants. In these sections of the International Journal of Health Services, we present some of the main findings of the SOPHIE Project. We include both articles that summarize all the evidence already published in the project on a thematic area (such as labor market, gender, or housing) and articles that present new, unpublished evidence on a specific health inequality or policy.
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Affiliation(s)
- Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | | | - Carles Muntaner
- Dalla Lana School of Public Health, Bloomberg Faculty of Nursing, Dept. of Psychiatry and Center for Research in Inner City Health, St Mike's Hospital University of Toronto Toronto, Canada
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Smith M, Hosking J, Woodward A, Witten K, MacMillan A, Field A, Baas P, Mackie H. Systematic literature review of built environment effects on physical activity and active transport - an update and new findings on health equity. Int J Behav Nutr Phys Act 2017; 14:158. [PMID: 29145884 PMCID: PMC5693449 DOI: 10.1186/s12966-017-0613-9] [Citation(s) in RCA: 368] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence is mounting to suggest a causal relationship between the built environment and people's physical activity behaviours, particularly active transport. The evidence base has been hindered to date by restricted consideration of cost and economic factors associated with built environment interventions, investigation of socioeconomic or ethnic differences in intervention effects, and an inability to isolate the effect of the built environment from other intervention types. The aims of this systematic review were to identify which environmental interventions increase physical activity in residents at the local level, and to build on the evidence base by considering intervention cost, and the differential effects of interventions by ethnicity and socioeconomic status. METHODS A systematic database search was conducted in June 2015. Articles were eligible if they reported a quantitative empirical study (natural experiment or a prospective, retrospective, experimental, or longitudinal research) investigating the relationship between objectively measured built environment feature(s) and physical activity and/or travel behaviours in children or adults. Quality assessment was conducted and data on intervention cost and whether the effect of the built environment differed by ethnicity or socioeconomic status were extracted. RESULTS Twenty-eight studies were included in the review. Findings showed a positive effect of walkability components, provision of quality parks and playgrounds, and installation of or improvements in active transport infrastructure on active transport, physical activity, and visits or use of settings. There was some indication that infrastructure improvements may predominantly benefit socioeconomically advantaged groups. Studies were commonly limited by selection bias and insufficient controlling for confounders. Heterogeneity in study design and reporting limited comparability across studies or any clear conclusions to be made regarding intervention cost. CONCLUSIONS Improving neighbourhood walkability, quality of parks and playgrounds, and providing adequate active transport infrastructure is likely to generate positive impacts on activity in children and adults. The possibility that the benefits of infrastructure improvements may be inequitably distributed requires further investigation. Opportunities to improve the quality of evidence exist, including strategies to improve response rates and representativeness, use of valid and reliable measurement tools, cost-benefit analyses, and adequate controlling for confounders.
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Affiliation(s)
- Melody Smith
- School of Nursing, The University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Jamie Hosking
- School of Population Health, The University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Alistair Woodward
- School of Population Health, The University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Karen Witten
- SHORE and Whāriki Research Centre, School of Public Health, Massey University, Box 6137, Wellesley Street, Auckland, PO New Zealand
| | - Alexandra MacMillan
- Dunedin School of Medicine, University of Otago, Box 56, Dunedin, PO 9054 New Zealand
| | - Adrian Field
- Dovetail Consulting Ltd, Box 78-146, Grey Lynn, Auckland, PO 1245 New Zealand
| | - Peter Baas
- Transport Engineering Research New Zealand Limited, Box 11029, Auckland, PO 1542 New Zealand
| | - Hamish Mackie
- Mackie Consulting Limited, Box 106525, Auckland, PO 1143 New Zealand
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Mehdipanah R, Marra G, Melis G, Gelormino E. Urban renewal, gentrification and health equity: a realist perspective. Eur J Public Health 2017; 28:243-248. [DOI: 10.1093/eurpub/ckx202] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Roshanak Mehdipanah
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Giulia Marra
- SiTI – Istituto Superiore sui Sistemi Territoriali per l’Innovazione, Turin, Italy
- Polytechnic University of Turin, Turin, Italy
| | - Giulia Melis
- SiTI – Istituto Superiore sui Sistemi Territoriali per l’Innovazione, Turin, Italy
| | - Elena Gelormino
- Department of Public Health, Local Health Authority TO5, Turin, Italy
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Zapata Moya AR, Navarro Yáñez CJ. Impact of area regeneration policies: performing integral interventions, changing opportunity structures and reducing health inequalities. J Epidemiol Community Health 2016; 71:239-247. [DOI: 10.1136/jech-2015-207080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 06/17/2016] [Accepted: 07/27/2016] [Indexed: 12/22/2022]
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Berghs M, Atkin K, Graham H, Hatton C, Thomas C. Implications for public health research of models and theories of disability: a scoping study and evidence synthesis. PUBLIC HEALTH RESEARCH 2016. [DOI: 10.3310/phr04080] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BackgroundPublic health interventions that are effective in the general population are often assumed to apply to people with impairments. However, the evidence to support this is limited and hence there is a need for public health research to take a more explicit account of disability and the perspectives of people with impairments.Objectives(1) To examine the literature on theories and models of disability; (2) to assess whether or not, and how, intervention studies of effectiveness could incorporate more inclusive approaches that are consistent with these theories and models; and (3) to use the findings to draw out implications for improving evaluative study designs and evidence-based practice.Review methodsThe project is a scoping review of the literature. The first stage examines theories and models of disability and reflects on possible connections between theories of disability and public health paradigms. This discussion is used to develop an ethical–empirical decision aid/checklist, informed by a human rights approach to disability and ecological approaches to public health. We apply this decision aid in the second stage of the review to evaluate the extent to which the 30 generic public health reviews of interventions and the 30 disability-specific public health interventions include the diverse experiences of disability. Five deliberation panels were also organised to further refine the decision aid: one with health-care professionals and four with politically and socially active disabled people.ResultsThe evidence from the review indicated that there has been limited public health engagement with theories and models of disability. Outcome measures were often insensitive to the experiences of disability. Even when disabled people were included, studies rarely engaged with their experiences in any meaningful way. More inclusive research should reflect how people live and ‘flourish’ with disability.LimitationsThe scoping review provides a broad appraisal of a particular field. It generates ideas for future practice rather than a definite framework for action.ConclusionsOur ethical–empirical decision aid offers a critical framework with which to evaluate current research practice. It also offers a resource for promoting more ethical and evidence-based public health research that is methodologically robust while being sensitive to the experiences of disability.Future workDeveloping more inclusive research and interventions that avoid conceptualising disability as either a ‘burden’ or ‘problem’ is an important starting point. This includes exploring ways of refining and validating current common outcome measures to ensure that they capture a diverse range of disabling experiences, as well as generating evidence on meaningful ways of engaging a broad range of disabled children and adults in the research process.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Maria Berghs
- Department of Health Sciences, University of York, York, UK
| | - Karl Atkin
- Department of Health Sciences, University of York, York, UK
| | - Hilary Graham
- Department of Health Sciences, University of York, York, UK
| | - Chris Hatton
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
| | - Carol Thomas
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
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Rodríguez-Sanz M, Gotsens M, Marí-Dell'Olmo M, Mehdipanah R, Borrell C. Twenty years of socioeconomic inequalities in premature mortality in Barcelona: The influence of population and neighbourhood changes. Health Place 2016; 39:142-52. [PMID: 27105035 DOI: 10.1016/j.healthplace.2016.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 02/18/2016] [Accepted: 03/04/2016] [Indexed: 11/30/2022]
Abstract
The objective of this study was to analyse trends in socioeconomic inequalities in premature mortality in Barcelona from 1992 to 2011, accounting for population changes. We conducted a repeated cross-sectional study of the Barcelona population (25-64 years) using generalized linear mixed models for trend analysis, and found that socioeconomic inequalities in premature mortality persisted between neighbourhoods, but tended to diminish. However, the reduction in inequality was related to an increase in the number of foreign-born individuals mainly in socioeconomic disadvantaged neighbourhoods, in which the decrease in premature mortality was more marked. To study trends in geographical inequalities in mortality, it is essential to understand demographic changes occurred in different places related to local levels of deprivation.
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Affiliation(s)
- Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Pompeu Fabra, Barcelona, Spain.
| | - Mercè Gotsens
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Marc Marí-Dell'Olmo
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Roshanak Mehdipanah
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Department of Health Behavior & Health Education, University of Michigan School of Public Health, USA
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Pompeu Fabra, Barcelona, Spain
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Jongeneel-Grimen B, Droomers M, Kramer D, Bruggink JW, van Oers H, Kunst AE, Stronks K. Impact of a Dutch urban regeneration programme on mental health trends: a quasi-experimental study. J Epidemiol Community Health 2016; 70:967-73. [PMID: 27053684 DOI: 10.1136/jech-2015-207016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 03/15/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Birthe Jongeneel-Grimen
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariël Droomers
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniëlle Kramer
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Hans van Oers
- Centre for Public Health Status and Forecasting, National Institute for Public Health and the Environment, Bilthoven, The Netherlands Faculty of Social Sciences, Academic Collaborative Centre for Public Health Brabant, Tranzo, Tilburg University, Tilburg, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Egan M, Kearns A, Katikireddi SV, Curl A, Lawson K, Tannahill C. Proportionate universalism in practice? A quasi-experimental study (GoWell) of a UK neighbourhood renewal programme's impact on health inequalities. Soc Sci Med 2016; 152:41-9. [PMID: 26829008 DOI: 10.1016/j.socscimed.2016.01.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/17/2015] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
Recommendations to reduce health inequalities frequently emphasise improvements to socio-environmental determinants of health. Proponents of 'proportionate universalism' argue that such improvements should be allocated proportionally to population need. We tested whether city-wide investment in urban renewal in Glasgow (UK) was allocated to 'need' and whether this reduced health inequalities. We identified a longitudinal cohort (n = 1006) through data linkage across surveys conducted in 2006 and 2011 in 14 differentially disadvantaged neighbourhoods. Each neighbourhood received renewal investment during that time, allocated on the basis of housing need. We grouped neighbourhoods into those receiving 'higher', 'medium' or 'lower' levels of investment. We compared residents' self-reported physical and mental health between these three groups over time using the SF-12 version 2 instrument. Multiple linear regression adjusted for baseline gender, age, education, household structure, housing tenure, building type, country of birth and clustering. Areas receiving higher investment tended to be most disadvantaged in terms of baseline health, income deprivation and markers of social disadvantage. After five years, mean mental health scores improved in 'higher investment' areas relative to 'lower investment' areas (b = 4.26; 95% CI = 0.29, 8.22; P = 0.036). Similarly, mean physical health scores declined less in high investment compared to low investment areas (b = 3.86; 95% CI = 1.96, 5.76; P < 0.001). Relative improvements for medium investment (compared to lower investment) areas were not statistically significant. Findings suggest that investment in housing-led renewal was allocated according to population need and this led to modest reductions in area-based inequalities in health after five years. Study limitations include a risk of selection bias. This study demonstrates how non-health interventions can, and we believe should, be evaluated to better understand if and how health inequalities can be reduced through strategies of allocating investment in social determinants of health according to need.
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Affiliation(s)
- Matt Egan
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK.
| | - Ade Kearns
- Urban Studies, University of Glasgow, Glasgow, UK.
| | - Srinivasa V Katikireddi
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Angela Curl
- Urban Studies, University of Glasgow, Glasgow, UK.
| | - Kenny Lawson
- College of Public Health, Medical & Vet Sciences, James Cook University, Queensland, Australia.
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Whittle HJ, Palar K, Hufstedler LL, Seligman HK, Frongillo EA, Weiser SD. Food insecurity, chronic illness, and gentrification in the San Francisco Bay Area: An example of structural violence in United States public policy. Soc Sci Med 2015; 143:154-61. [PMID: 26356827 DOI: 10.1016/j.socscimed.2015.08.027] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/11/2015] [Accepted: 08/14/2015] [Indexed: 12/22/2022]
Abstract
Food insecurity continues to be a major challenge in the United States, affecting 49 million individuals. Quantitative studies show that food insecurity has serious negative health impacts among individuals suffering from chronic illnesses, including people living with HIV/AIDS (PLHIV). Formulating effective interventions and policies to combat these health effects requires an in-depth understanding of the lived experience and structural drivers of food insecurity. Few studies, however, have elucidated these phenomena among people living with chronic illnesses in resource-rich settings, including in the United States. Here we sought to explore the experiences and structural determinants of food insecurity among a group of low-income PLHIV in the San Francisco Bay Area. Thirty-four semi-structured in-depth interviews were conducted with low-income PLHIV receiving food assistance from a local non-profit in San Francisco and Alameda County, California, between April and June 2014. Interview transcripts were coded and analysed according to content analysis methods following an inductive-deductive approach. The lived experience of food insecurity among participants included periods of insufficient quantity of food and resultant hunger, as well as long-term struggles with quality of food that led to concerns about the poor health effects of a cheap diet. Participants also reported procuring food using personally and socially unacceptable strategies, including long-term dependence on friends, family, and charity; stealing food; exchanging sex for food; and selling controlled substances. Food insecurity often arose from the need to pay high rents exacerbated by gentrification while receiving limited disability income--a situation resulting in large part from the convergence of long-standing urban policies amenable to gentrification and an outdated disability policy that constrains financial viability. The experiences of food insecurity described by participants in this study can be understood as a form of structural violence, motivating the need for structural interventions at the policy level that extend beyond food-specific solutions.
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Affiliation(s)
- Henry J Whittle
- Global Health Sciences, University of California, San Francisco (UCSF), Mission Hall/Global Health and Clinical Sciences Building, 550 16th Street, 3rd Floor, San Francisco, CA 94158-2549, United States.
| | - Kartika Palar
- Division of HIV/AIDS, Department of Medicine, UCSF, United States
| | | | - Hilary K Seligman
- Center for Vulnerable Populations at San Francisco General Hospital, Division of General Internal Medicine, UCSF, United States
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, United States
| | - Sheri D Weiser
- Global Health Sciences, University of California, San Francisco (UCSF), Mission Hall/Global Health and Clinical Sciences Building, 550 16th Street, 3rd Floor, San Francisco, CA 94158-2549, United States; Division of HIV/AIDS, Department of Medicine, UCSF, United States; Center for AIDS Prevention Studies, UCSF, United States
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