RESUMO
INTRODUCTION: The geographic overlap of violence and poor health is a major public health concern. To understand whether and how place-based interventions targeting micro-geographic places can reduce this undesirable co-occurrence, the study addresses 2 important questions. First, to what extent are deteriorated health conditions associated with living at violent crime hot spots? Second, through what mechanisms can focused place-based interventions break the association between living with violence and deteriorated health? METHODS: This study used survey data from 2,724 respondents living on 328 street segments that were categorized as violent crime hot spots (181 segments with 1,532 respondents) versus non-hot spots (147 segments with 1,192 respondents) in 2013-2014 in Baltimore, Maryland. Propensity score analysis assessed whether individuals living at violent crime hot spots had lower general health perceptions than people living at non-hot spots. Marginal structural models estimated the proportion of total effects mediated by 3 theoretically informed intervening mechanisms. Analyses were conducted in 2019. RESULTS: Respondents living at violent crime hot spots had a lower level of self-rated general health (b= -0.096, 95% CI= -0.176, -0.015) and higher levels of health limitations (b=0.068, 95% CI=0.027, 0.109) and problems (OR=2.026, 95% CI=1.225, 3.349) than those living at non-hot spots. Enhanced perceptions of safety, collective efficacy, and police legitimacy may break the association between living in places with extremely high levels of violence and deteriorated health. CONCLUSIONS: Indicated or selective strategies are urgently needed to target micro-geographic locations with known increased risks, supplementing universal strategies applied to a broader community.
