Possibilities for health-conscious assisted housing mobility

Thesis (M.C.P.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 2008."June 2008."Includes bibliographical references.Many poor, segregated, urban neighborhoods are rife with risks to health, which contributes to stark racial and geographic disparities in health. Fighting health disparities requires buy-in from non-health professionals whose work directly impacts the way cities are designed and governed. This thesis provides a case study of one non-health initiative, assisted housing mobility, with clear relevance to health disparities. Research suggests that moving from high- to lower-poverty neighborhoods may confer a range of health benefits on individuals; however, assisted housing mobility programs are, to date, relocation-only interventions. Could these programs more deliberately promote health, and should they do so? Through interviews and a review of counseling materials, I examine. how nine assisted housing mobility programs are linked to health, how health is understood by program staff, and how managers might offer more health-conscious programming. Based on a review of pathways between health and housing and neighborhoods, I identified five areas of intervention around which managers could build healthful programs: housing units, neighborhoods, health behavior and awareness, social connectedness, and access to health services. For each area of intervention, I detail possibilities for active versus passive approaches, and document relevant practices from the profiled programs. I then explore practitioner attitudes towards integrating health into mobility programs. Although most practitioners see their work as disconnected from health, their programs actually play a promising mediating role. Concerns about mandate, privacy, legality, liability, and capacity hinder programs from exploring health. So does limited understanding of how to incorporate health appropriately.(cont.) Yet, most staff members are encouraged that their work may improve client health, and many want to do more. I recommend steps programs could take to provide better health-related information and discuss health more openly throughout housing counseling so families can make deliberate choices. I provide a preliminary assessment of relative costs and benefits of each step. I note that program managers will require technical and collegial support in order to implement the suggested changes well. The Poverty & Race Research Action Council, which helped guide my research, could provide needed support.by Mariana Clair Arcaya.M.C.P

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

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

Health selection into neighborhoods among patients enrolled in a clinical trial

Health selection into neighborhoods may contribute to geographic health disparities. We demonstrate the potential for clinical trial data to help clarify the causal role of health on locational attainment. We used data from the 20-year United Kingdom Prospective Diabetes Study (UKPDS) to explore whether random assignment to intensive blood-glucose control therapy, which improved long-term health outcomes after median 10 years follow-up, subsequently affected what neighborhoods patients lived in. We extracted postcode-level deprivation indices for the 2710 surviving participants of UKPDS living in England at study end in 1996/1997. We observed small neighborhood advantages in the intensive versus conventional therapy group, although these differences were not statistically significant. This analysis failed to show conclusive evidence of health selection into neighborhoods, but data suggest the hypothesis may be worthy of exploration in other clinical trials or in a meta-analysis. Keywords: Neighborhoods, Self-selection, Health, Equity, Socioeconomic statu

Developing Core Capabilities for Local Health Departments to Engage in Land Use and Transportation Decision Making for Active Transportation

Objective: To develop a core set of capabilities and tasks for local health departments (LHDs) to engage in land use and transportation policy processes that promote active transportation. Design: We conducted a 3-phase modified Delphi study from 2015 to 2017. Setting: We recruited a multidisciplinary national expert panel for key informant interviews by telephone and completion of a 2-step online validation process. Participants: The panel consisted of 58 individuals with expertise in local transportation and policy processes, as well as experience in cross-sector collaboration with public health. Participants represented the disciplines of land use planning, transportation/public works, public health, municipal administration, and active transportation advocacy at the state and local levels. Main Outcome Measures: Key informant interviews elicited initial capabilities and tasks. An online survey solicited rankings of impact and feasibility for capabilities and ratings of importance for associated tasks. Feasibility rankings were used to categorize capabilities according to required resources. Results were presented via second online survey for final input. Results: Ten capabilities were categorized according to required resources. Fewest resources were as follows: (1) collaborate with public officials; (2) serve on land use or transportation board; and (3) review plans, policies, and projects. Moderate resources were as follows: (4) outreach to the community; (5) educate policy makers; (6) participate in plan and policy development; and (7) participate in project development and design review. Most resources were as follows: (8) participate in data and assessment activities; (9) fund dedicated staffing; and (10) provide funding support. Conclusions: These actionable capabilities can guide planning efforts for LHDs of all resource levels.Centers for Disease Control and Prevention (U.S.) (Agreement U48DP005031

Where we eat is who we are: a survey of food-related travel patterns to Singapore’s hawker centers, food courts and coffee shops

Background The development of empirically-grounded policies to change the obesogenic nature of urban environment has been impeded by limited, inconclusive evidence of the link between food environments, dietary behaviors, and health-related outcomes, in part due to inconsistent methods of classifying and analyzing food environments. This study explores how individual and built environment characteristics may be associated with how far and long people travel to food venues,that can serve as a starting point for further policy-oriented research to develop a more nuanced, context-specific delineations of ‘food environments’ in an urban Asian context. Methods Five hundred twenty nine diners in eight different neighborhoods in Singapore were surveyed about how far and long they travelled to their meal venues, and by what mode. We then examined how respondents’ food-related travel differed by socioeconomic characteristics, as well as objectively-measured built environment characteristics at travel origin and destination, using linear regression models. Results Low-income individuals expended more time traveling to meal destinations than high-income individuals, largely because they utilized slower modes like walking rather than driving. Those travelling from areas with high food outlet density travelled shorter distances and times than those from food-sparse areas, while those seeking meals away from their home and work anchor points had lower thresholds for travel. Respondents also travelled longer distances to food-dense locations, compared to food-sparse locations. Conclusion Those seeking to improve food environments of poor individuals should consider studying an intervention radius pegged to typical walking distances, or ways to improve their transport options as a starting point. Policy-focused research on food environments should also be sensitive to locational characteristics, such as food outlet densities and land use

Using Health Impact Assessment as an Interdisciplinary Teaching Tool

Health Impact Assessment (HIA) courses are teaching public health and urban planning students how to assess the likely health effects of proposed policies, plans, and projects. We suggest that public health and urban planning have complimentary frameworks for training practitioners to address the living conditions that affect health. Planning perspectives emphasize practical skills for impacting community change, while public health stresses professional purpose and ethics. Frameworks from both disciplines can enhance the HIA learning experience by helping students tackle questions related to community impact, engagement, social justice, and ethics. We also propose that HIA community engagement processes can be enriched through an empathetic practice that focuses on greater personal introspection. View Full-Text Keywords: health impact assessment; social determinants of health; public health; urban planningMassachusetts Institute of Technology. Libraries (Open Access Article Publication Subvention Fund

Using Internal Migration to Estimate the Causal Effect of Neighborhood Socioeconomic Context on Health: A Longitudinal Analysis, England, 1995–2008

There is long-standing evidence for the existence of geographical inequalities in health. Multiple conceptual frameworks have been proposed to explain why such patterns persist. The methodological design for these studies is often not appropriate for identifying causal effects of neighborhood context, however. It is possible that findings that show the importance of neighborhoods could be subject to confounding of individual-level factors, neighborhood sorting effects (i.e., health-selective migration), or both. We present an approach to investigating neighborhood-level factors that provides a stronger examination for causal effects, as well as addressing issues of confounding and sorting. We use individual-level data from the British Household Panel Survey (1995–2008). Individuals were grouped into quintiles based on the median house price of an individual's lower super output area as our measure of neighborhood socioeconomic context. Multivariate propensity scores were used to match individuals to control for confounding factors, and logistic regression models were used to estimate the association between destination of migration and risk of poor health (up to ten years following migration). Initially, we found some evidence that poorer neighborhoods were associated with an increased risk of poor health. Following controlling for an individual's health status prior to migration, the influence of neighborhood socioeconomic context was statistically nonsignificant. Our findings suggest that health-selective migration might help to explain the association between neighborhood-level factors and individual-level health. Our study design appears useful for both identifying causal effects of neighborhoods and accounting for health-selective migration

Eviction Moratoria Expiration and COVID-19 Infection Risk Across Strata of Health and Socioeconomic Status in the United States

Importance: Housing insecurity induced by evictions may increase the risk of contracting COVID-19. Objective: To estimate the association of lifting state-level eviction moratoria, which increased housing insecurity during the COVID-19 pandemic, with the risk of being diagnosed with COVID-19. Design, Setting, and Participants:This retrospective cohort study included individuals with commercial insurance or Medicare Advantage who lived in a state that issued an eviction moratorium and were diagnosed with COVID-19 as well as a control group comprising an equal number of randomly selected individuals in these states who were not diagnosed with COVID-19. Data were collected from OptumLabs Data Warehouse, a database of deidentified administrative claims. The study used a difference-in-differences analysis among states that implemented an eviction moratorium between March 13, 2020, and September 4, 2020. Exposures: Time since state-level eviction moratoria were lifted. Main Outcomes and Measures: The primary outcome measure was a binary variable indicating whether an individual was diagnosed with COVID-19 for the first time in a given week with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code U07.1. The study analyzed changes in COVID-19 diagnosis before vs after a state lifted its moratorium compared with changes in states that did not lift it. For sensitivity analyses, models were reestimated on a 2% random sample of all individuals in the claims database during this period in these states. Results: The cohort consisted of 509 694 individuals (254 847 [50.0%] diagnosed with COVID-19; mean [SD] age, 47.0 [23.6] years; 239 056 [53.3%] men). During the study period, 43 states and the District of Columbia implemented an eviction moratorium and 7 did not. Among the states that implemented a moratorium, 26 (59.1%) lifted their moratorium before the US Centers for Disease Control and Prevention issued their national moratorium, while 18 (40.1%) maintained theirs. In a Cox difference-in-differences regression model, individuals living in a state that lifted its eviction moratorium experienced higher hazards of a COVID-19 diagnosis beginning 5 weeks after the moratorium was lifted (hazard ratio [HR], 1.39; 95% CI, 1.11-1.76; P = .004), reaching an HR of 1.83 (95% CI, 1.36-2.46; P < .001) 12 weeks after. Hazards increased in magnitude among individuals with preexisting comorbidities and those living in nonaffluent and rent-burdened areas. Individuals with a Charlson Comorbidity Index score of 3 or greater had an HR of 2.37 (95% CI, 1.67-3.36; P < .001) at the end of the study period. Those living in nonaffluent areas had an HR of 2.14 (95% CI, 1.51-3.05; P < .001), while those living in areas with a high rent burden had an HR of 2.31 (95% CI, 1.64-3.26; P < .001). Conclusions and Relevance:The findings of this difference-in-differences analysis suggest that eviction-led housing insecurity may have exacerbated the COVID-19 pandemic

A public health perspective on small business development: a review of the literature

Federal spending on non-health entitlement programs, including the Earned Income Tax Credit and SNAP, has decreased as a percent of GDP since 2011, putting social safety net and community and economic development funding at risk. As an important component of community development, small business support programs are also at risk under social spending cuts. While theory suggests that a strong small business sector could protect health by improving socioeconomic conditions and reducing unemployment, the public health implications of reduced support for small business has not been explored. We conducted a scoping literature review of studies indexed by Pubmed, Cochrane Review, Google Scholar, and Academic Search Premier. The literature suggests that small businesses may provide social and economic benefits to communities that likely protect health, especially in economically deprived communities. These health impacts should be considered when policy-makers weigh decisions that affect small businesses and funding for community and economic development.Robert Wood Johnson FoundationPew Charitable Trust

Health perception and commuting choice: a survey experiment measuring behavioral trade-offs between physical activity benefits and pollution exposure risks

Previous literature suggests that active commuting has substantial health benefits. Yet, in polluted regions, it can also cause additional health risks by increasing riders' pollution exposure and raising their inhalation rate. We examine the effect of perceived air pollution on stated commuting choices using an on-site survey experiment for 2285 non-automobile commuters in Zhengzhou, a heavily polluted city in central China. We integrate a sequential randomized controlled trial in a survey where individuals in the treatment group received tailored information on their commuting-related pollution exposure, based on our 2 week peak-hour pollution monitoring campaign across transportation modes in the city. We find that travelers in Zhengzhou have already adopted pollution prevention actions by favoring indoor commuting modes on polluted days. Individuals receiving personalized pollution exposure information by mode further decrease active commuting by 8.4 percentage points (95% CI: 5.1, 11.6), accompanied by a 14.7 percentage points (95% CI: 10.7, 18.3) increase in automobile commuting. Travellers make sub-optimal, overly risk averse choices by reducing active commuting even for trips where epidemiological research suggests the exercise benefits outweigh pollution exposure risks. This pollution avoidance tendency significantly attenuates the effect of policies encouraging active commuting. Our findings show the intricately intertwined relationships between the public health targets of promoting active lifestyles and reducing pollution exposure, and between individual pollution avoidance and societal pollution mitigation