The role of the built environment, food prices and neighborhood poverty in fruit and vegetable consumption: An instrumental variable analysis of the moving to opportunity experiment.

The food environment has been associated with fruit and vegetable consumption, however many studies utilize cross-sectional research designs. This study examined 3,473 participants in the Moving to Opportunity experiment, who were randomized into groups that affected where they lived. The relationship between the built environment, food prices and neighborhood poverty, assessed over four to seven years, on fruit or vegetable consumption was examined using instrumental variable analysis. Higher food prices and neighborhood poverty were associated with lower fruit or vegetable consumption. Policies and programs that address food prices should be implemented and evaluated for their effects on fruit and vegetable consumption.

Built Environment Exposures of Adults in the Moving to Opportunity Experiment.

This paper describes environmental exposures of adult participants in the Moving to Opportunity for Fair Housing (MTO) experiment over a four to seven year period from baseline to the interim evaluation. The MTO experiment randomized participants living in public housing or private assisted housing at baseline into experimental and control groups and provided a housing voucher for experimental group participants to move to neighborhoods with less than 10 percent of the population below the poverty line. However, few studies have examined how this move affected exposures to health promoting environments. We used data on residential locations of MTO participants and archival data on the built and food environment to construct environmental exposure variables. MTO participants in the experimental and Section 8 groups lived in neighborhoods with higher food prices, less high intensity development and more open space relative to the control group. The findings suggest that housing policies can have potential health consequences by altering health-related environmental exposures.

Why Does Child Maltreatment Occur? Caregiver Perspectives and Analyses of Neighborhood Structural Factors Across Twenty Years.

Research on caregivers' views of factors that contribute to child maltreatment and analyses of neighborhood structural factors offer opportunities for enhancing prevention and intervention efforts. This study compared explanations of the factors that contribute to child maltreatment in a neighborhood-based sample of adult caregivers at two-time points: 1995-1996 and 2014-2015 along with analyses of neighborhood structural conditions during the same period. The study sample consisted of two cross-sectional subsamples: 400 adult caregivers in 20 census tracts in Cleveland, Ohio from a 1995-1996 study, and 400 adult caregivers of the same 20 census tracts surveyed in 2014-2015. At each time point, residents were asked to rate how much each of 13 factors contributes to child abuse and neglect. Median regression analyses adjusted for individual and neighborhood characteristics showed that "lack of religion" decreased somewhat in importance over time, while that of "single parents" increased slightly. Otherwise, there was substantial consistency in caregivers' perceptions of factors contributing to maltreatment over the two study points. In terms of overall ranking, at each time point the most important contributors to child maltreatment were "drugs," "alcohol," and "psychological or emotional problems," while the least important were "divorce," "single parents," and "lack of religion." Differences in ratings of contributing factors were associated with individual and neighborhood characteristics, most consistently by participant race and age and by neighborhood maltreatment investigation rate. Despite these differences, for any maltreatment prevention or intervention effort using or planning to use maltreatment etiology in some way in its activities, etiology seems to represent a fairly stable platform for programming.

Two sides of the same neighborhood? Multilevel analysis of residents' and child-welfare workers' perspectives on neighborhood social disorder and collective efficacy.

Neighborhood processes have been shown to influence child maltreatment rates, and accordingly neighborhood-based strategies have been suggested as helpful in intervening in and preventing child maltreatment. Although child-welfare workers are at the forefront of child maltreatment work, little is known about the extent to which their perspectives on neighborhood processes related to child maltreatment align with those of neighborhood residents. The current study examined the views of neighborhood residents (n = 400) and neighborhood-based child-welfare workers (n = 260) on 2 neighborhood process measures: social disorder and collective efficacy. Because social disorder is viewed as a risk factor for child maltreatment and collective efficacy is viewed as a protective factor, child-welfare workers and residents of neighborhoods need to reach a common understanding of these factors in order to reach agreement on the safety of children in these neighborhoods. The samples of neighborhood residents and child-welfare workers were nested within 20 neighborhoods in Cleveland, Ohio. Multilevel modeling taking into account individual and neighborhood characteristics indicated that child-welfare workers consistently tended to perceive higher social disorder and lower collective efficacy compared to residents. Neighborhood characteristics were associated with residents' and child-welfare workers' perspectives on social disorder in different ways. Differences between residents and child-welfare workers concerning perceptions of neighborhood processes have implications for better understanding the context and improving the effectiveness of neighborhood-based interventions to prevent child maltreatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Contextual characteristics associated with the perceived neighbourhood scale in a cross-sectional study in a large urban centre in Brazil.

INTRODUCTION: Health outcomes have been associated with physical and social characteristics of neighbourhoods, but little is known about the relationship between contextual factors and perceived neighbourhood scale. OBJECTIVE: To identify the contextual factors associated with self-perceived neighbourhood scale. METHODS: We analysed data from a cross-sectional population-based study in Belo Horizonte, Brazil, that took place in 2008-2009. The dependent variable was perceived neighbourhood, encoded as an ordinal scale based on a brief description of the concept of the neighbourhood, and two independent scales relating distance, expressed in terms of geography and time. Street connectivity, demographic density and residents' perceptions of the neighbourhoods' physical and social environment were used as contextual predictors. Individual characteristics were used as covariates. Multilevel ordinal logistic regression models estimated the association between perceived neighbourhood scale and contextual characteristics. RESULTS: Residents that perceive better walkability (OR 2.96; 95% CI 1.29 to 3.82) and high amounts of violence (OR 1.35; 95% CI 1.12 to 1.62) perceived their neighbourhoods to be larger, even after adjusting for individual characteristics. CONCLUSION: There are contextual factors that are associated with self-perceived neighbourhood scale. Careful definition of neighbourhood scale is a key factor in improving the results of eco-epidemiological studies. Although these findings must be further explored in other studies, these results can contribute to a better understanding of an appropriate choice of neighbourhood scale, especially for cities in Latin America.

Understanding trends in neighborhood child maltreatment rates: A three-wave panel study 1990-2010.

This study examines how changes in the social and economic structure of neighborhoods relate to changes in child maltreatment report rates over an extended period. The panel study design allows us to partition the changes in child maltreatment report rates into a portion associated with how the levels of socio-economic risk factors have changed over time, and a portion related to how the relative importance of those factors in explaining maltreatment report rates has changed over time. Through the application of fixed effects panel models, the analysis is also able to control for unmeasured time-invariant characteristics of neighborhoods that may be a source of bias in cross-sectional studies. The study finds that increases in vacant housing, single parent families and unemployment rates are strongly associated with increases in child maltreatment report rates. Changes in racial/ethnic composition did not produce changes in maltreatment report rates except when they reached extreme levels of segregation. Although poverty rates were predictive of cross-sectional variation in child maltreatment, increases in neighborhood poverty became less associated with increases in child maltreatment report rates over time.

Change and consistency in descriptions of child maltreatment: A comparison of caregivers' perspectives 20 years apart.

Although approximately one-fifth of child maltreatment reports originate with family members, friends, neighbors, or community members, their efforts to identify and report child maltreatment are still not well understood. Nor is it well understood how these individuals' perceptions of what constitutes maltreatment may change over time. This study examined descriptions of behavior perceived as maltreatment by caregivers of minors in Cleveland, Ohio, USA neighborhoods. Data were obtained from two neighborhood-based cross-sectional surveys of caregivers of minors: one conducted in 1995-1996 and the other in 2014-2015. The sample consisted of 400 caregivers living in 20 census tracts with varying profiles of maltreatment risk in the 1995-1996 study, and 400 caregivers living in the same 20 census tracts surveyed in 2014-2015. Each time point, participants were asked to provide three examples of behaviors they considered to be child abuse and neglect. All responses were categorized using the 1995-1996 coding scheme. Logistic regression analyses including all 800 participants, adjusted for individual and neighborhood characteristics, and accounting for residential clustering in neighborhoods, showed that participating in the 2014-2015 survey was associated with 51% increased odds of mentioning an act of neglect and a 39% decreased odds of mentioning an act of physical abuse. No significant temporal changes were observed for inadequate supervision, emotional or verbal abuse, sexual abuse, and parental misbehavior. Associations between specific types of maltreatment and individual and neighborhood characteristics were observed. Potential practice implications and future research directions include seeking greater familiarity with caregivers' perceptions of maltreating behaviors to better understand how these perceptions might "translate" into child maltreatment reports and investigations.

Accuracy of Cardiovascular Risk Prediction Varies by Neighborhood Socioeconomic Position: A Retrospective Cohort Study.

BACKGROUND: Inequality in health outcomes in relation to Americans' socioeconomic position is rising. OBJECTIVE: First, to evaluate the spatial relationship between neighborhood disadvantage and major atherosclerotic cardiovascular disease (ASCVD)-related events; second, to evaluate the relative extent to which neighborhood disadvantage and physiologic risk account for neighborhood-level variation in ASCVD event rates. DESIGN: Observational cohort analysis of geocoded longitudinal electronic health records. SETTING: A single academic health center and surrounding neighborhoods in northeastern Ohio. PATIENTS: 109 793 patients from the Cleveland Clinic Health System (CCHS) who had an outpatient lipid panel drawn between 2007 and 2010. The date of the first qualifying lipid panel served as the study baseline. MEASUREMENTS: Time from baseline to the first occurrence of a major ASCVD event (myocardial infarction, stroke, or cardiovascular death) within 5 years, modeled as a function of a locally derived neighborhood disadvantage index (NDI) and the predicted 5-year ASCVD event rate from the Pooled Cohort Equations Risk Model (PCERM) of the American College of Cardiology and American Heart Association. Outcome data were censored if no CCHS encounters occurred for 2 consecutive years or when state death data were no longer available (that is, from 2014 onward). RESULTS: The PCERM systematically underpredicted ASCVD event risk among patients from disadvantaged communities. Model discrimination was poorer among these patients (concordance index [C], 0.70 [95% CI, 0.67 to 0.74]) than those from the most affluent communities (C, 0.80 [CI, 0.78 to 0.81]). The NDI alone accounted for 32.0% of census tract-level variation in ASCVD event rates, compared with 10.0% accounted for by the PCERM. LIMITATIONS: Patients from affluent communities were overrepresented. Outcomes of patients who received treatment for cardiovascular disease at Cleveland Clinic were assumed to be independent of whether the patients came from a disadvantaged or an affluent neighborhood. CONCLUSION: Neighborhood disadvantage may be a powerful regulator of ASCVD event risk. In addition to supplemental risk models and clinical screening criteria, population-based solutions are needed to ameliorate the deleterious effects of neighborhood disadvantage on health outcomes. PRIMARY FUNDING SOURCE: The Clinical and Translational Science Collaborative of Cleveland and National Institutes of Health.

Adolescent self-defined neighborhoods and activity spaces: spatial overlap and relations to physical activity and obesity.

Defining the proper geographic scale for built environment exposures continues to present challenges. In this study, size attributes and exposure calculations from two commonly used neighborhood boundaries were compared to those from neighborhoods that were self-defined by a sample of 145 urban minority adolescents living in subsidized housing estates. Associations between five built environment exposures and physical activity, overweight and obesity were also examined across the three neighborhood definitions. Limited spatial overlap was observed across the various neighborhood definitions. Further, many places where adolescents were active were not within the participants׳ neighborhoods. No statistically significant associations were found between counts of facilities and the outcomes based on exposure calculations using the self-defined boundaries; however, a few associations were evident for exposures using the 0.75mile network buffer and census tract boundaries. Future investigation of the relationship between the built environment, physical activity and obesity will require practical and theoretically-based methods for capturing salient environmental exposures.

How big is my neighborhood? Individual and contextual effects on perceptions of neighborhood scale.

Neighborhood is a social and geographic concept that plays an increasingly important role in research and practice that address disparities in health and well-being of populations. However, most studies of neighborhoods, as well as community initiatives geared toward neighborhood improvement, make simplifying assumptions about boundaries, often relying on census geography to operationalize the neighborhood units. This study used geographic information system (GIS) tools to gather and analyze neighborhood maps drawn by residents of low-income communities in 10 cities. The median resident map size was approximately 30 percent smaller than the median census tract, but 25 percent of residents viewed their neighborhood as quite small (less than one-fifth of the typical census tract). Multi-level modeling showed significant within context variation in perceived neighborhood scale. Longer term residents with higher education and income and who were more engaged in the neighborhood held more expansive views. But there were also contextual influences with higher density and mixed use areas associated with smaller perceived neighborhoods, and higher collective efficacy associated with larger neighborhood sizes. Artificially imposed neighborhood units may misrepresent resident experience, but GIS tools can be used to craft more authentic neighborhood definitions for research and practice.

Utilization and physical activity levels at renovated and unrenovated school playgrounds.

OBJECTIVE: This study examined utilization and physical activity levels at renovated compared to unrenovated school playgrounds. METHODS: Ten unrenovated and ten renovated school playgrounds (renovated at least a year prior) in Cleveland, OH were matched on school and neighborhood characteristics. Using direct observation (SOPLAY), the number of persons attending each playground and their physical activity levels were recorded using separate counts for girls, boys, men and women. Each school was observed ten times for 90 min each time outside of school hours in 2005. Paired t-tests, Wilcoxon Signed Ranks tests, and regression analyses were completed to examine differences across school pairs. RESULTS: More persons overall including adults and children utilized the renovated playgrounds compared to the unrenovated playgrounds. The proportion moderately-to-vigorously active was not different between renovated and unrenovated playgrounds although the proportion of children, in particular boys, who were vigorously active was greater at the renovated playgrounds. Although utilization was higher at the renovated playgrounds, absolute utilization was low across all playgrounds. CONCLUSIONS: This study suggests that playgrounds renovations may have the potential to increase the number of children utilizing the playground outside of school hours and may increase the proportion of children, especially boys, who are vigorously active.

The benefits of life table analysis for describing disproportionality.

This article reviews how life table analysis can improve on cross-sectional analysis of disproportionality by comparing African American and Caucasian children's risk of being investigated for child maltreatment or being placed in foster care before their 10th birthday. We then highlight the application of life table results in advocacy. Newspaper commentaries and presentations for community groups using these results raised awareness with policymakers and in turn helped to increase funding and programming that addresses disproportionality. Life table results point to the role of age and geography in understanding why disproportionality occurs. We conclude by describing how one community is using these results to develop interventions and reform strategies based on addressing these age and geography factors.

How neighborhoods influence child maltreatment: a review of the literature and alternative pathways.

OBJECTIVE: To review the literature on the relationships between neighborhoods and child maltreatment and identify future directions for research in this area. METHOD: A search of electronic databases and a survey of experts yielded a list of 25 studies on the influence of geographically defined neighborhoods on child maltreatment. These studies were then critically reviewed by an interdisciplinary research team. RESULTS: Numerous studies demonstrate that child maltreatment cases are concentrated in disadvantaged areas. A number of socio-economic characteristics of neighborhoods have been shown to correlate with child maltreatment rates as measured by official reports to child protective service agencies. Only a few studies examine direct measures of parenting behaviors associated with maltreatment, and these show a weaker relationship with neighborhood disadvantage. Moreover, the processes that link neighborhood conditions to either maltreatment reports or parenting behaviors are not yet confirmed by the research literature. Selection bias, neighborhood definitions and spatial influences are largely uncontrolled in the existing research. CONCLUSIONS: We propose a framework for pursuing further study of neighborhoods and child maltreatment that addresses the gaps in the current literature. Neighborhood-based strategies to prevent and reduce child maltreatment will be enhanced by research that provides a better understanding of how neighborhood conditions act as stressors or supports for families at risk of child maltreatment.

Building community capacity for violence prevention.

The capacity of communities to prevent violence is examined from three perspectives: youth violence, child maltreatment, and intimate partner violence. The analysis suggests that community social control and collective efficacy are significant protective factors for all three types of violence, but these need to be further distinguished for their relationships to private, parochial, and state controls. It is argued that strong interpersonal ties are not the only contributor to collective efficacy and violence prevention. Weak ties, including those outside the community, and organizational ties are also seen as necessary. Violence prevention programs should be structured in ways that contribute to the communities' own capacity to prevent violence.