Boston Neighborhoods Research Articles

Implementation of Neighborhood-Level Wastewater-Based Epidemiology to Measure and Mitigate Inequities in SARS-CoV-2 Infection in Boston, Massachusetts.

Starting October 2022, the Boston Public Health Commission implemented a neighborhood-level wastewater-based epidemiology program to inform strategies to reduce COVID-19 inequities. We collected samples twice weekly at 11 neighborhood sites, covering approximately 18% of Boston, Massachusetts's population. Results from the program's first year revealed inequities unobservable in regional wastewater data both between the City of Boston and the greater Boston area and between Boston neighborhoods. We report program results and neighborhood-specific recommendations and resources to help residents interpret and use our findings. (Am J Public Health. Published online ahead of print August 8, 2024:e1-e5. https://doi.org/10.2105/AJPH.2024.307749).

Associations between indoor fine particulate matter (PM2.5) and sleep-disordered breathing in an urban sample of school-aged children

ObjectivesEnvironmental risk factors may contribute to sleep-disordered breathing. We investigated the association between indoor particulate matter ≤2.5µm in aerodynamic diameter (PM2.5) and sleep-disordered breathing in children in an urban US community. MethodsThe sample consisted of children aged 6-12years living in predominantly low-income neighborhoods in Boston, Massachusetts. Indoor PM2.5 was measured in participants’ main living areas for 7days using the Environmental Multipollutant Monitoring Assembly device. High indoor PM2.5 exposure was defined as greater than the sample weekly average 80th percentile level (≥15.6 μg/m3). Sleep-disordered breathing was defined as an Apnea-Hypopnea-Index (AHI) or Oxygen-Desaturation-Index (ODI) (≥3% desaturation) of ≥5 events/hour. Habitual loud snoring was defined as caregiver-report of loud snoring (most or all the time each week) over the past 4weeks. We examined the associations of PM2.5 with sleep-disordered breathing or snoring using logistic regression adjusting for potential confounders. ResultsThe sample included 260 children (mean age 9.6years; 41% female), with 32% (n = 76) classified as having sleep-disordered breathing. In a logistic regression model adjusted for socioeconomics and seasonality, children exposed to high indoor PM2.5 levels (n = 53) had a 3.53-fold increased odds for sleep-disordered breathing (95%CI: 1.57, 8.11, p = .002) compared to those with lower indoor PM2.5. This association persisted after additional adjustments for physical activity, outdoor PM2.5, environmental tobacco smoke, and health characteristics. Similar associations were observed for snoring and indoor PM2.5. ConclusionsChildren with higher indoor PM2.5 exposure had greater odds of sleep-disordered breathing and habitual loud snoring, suggesting that indoor air quality contributes to sleep disparities.

"I don't think of it as a shelter. I say I'm going home": a qualitative evaluation of a low-threshold shelter for women who use drugs.

In 2021-2022, encampments in a downtown Boston neighborhood reached record heights, increasing the visibility of drug use and homelessness in the city. In response, the city planned a "sweep" (i.e., eradication of encampments) and requested support from social services and medical providers to pilot low-threshold shelters. Low-threshold shelters reduce barriers to staying in traditional congregate shelters with more flexible regulations, longer-term bed assignments, and secured storage for contraband (e.g., drugs, weapons) instead of forced disposal. One homeless service provider opened a harm reduction-focused shelter for women who use drugs. This report describes the low-threshold shelter design and program evaluation. This program evaluation had two primary aims: (1) to examine guests' beliefs about shelter policies and practices; and (2) to understand the staff's experiences working in a low-threshold model. We conducted semi-structured qualitative interviews with 16 guests and 12 staff members during the summer 2022. Interviews were thematically analyzed. Guests expressed overwhelming approval for the shelter's policies, which they stated supported their autonomy, dignity, and safety. They emphasized the staff's willingness to build relationships, thus demonstrating true commitment to the guests. Guests highlighted the value of daytime access to the shelter, as it granted them autonomy over their time, reduced their substance use, and helped them build relationships with staff and other guests. The co-directors and staff designed the shelter quickly and without US models for reference; they turned to international literature, local harm reduction health care providers, and women living in encampments for guidance on the shelter policies. The staff were passionate and committed to the health and stability of the guests. Most staff found value in the low-threshold model, though some were challenged by it, believing it enabled drug use and did not require the guests to "get better." This evaluation indicates the value of low-threshold, harm reduction shelters as alternatives to traditional models. While these shelters do not mitigate the need for overarching housing reform, they are important measures to meet the needs of women experiencing unsheltered homelessness who face intersectional oppression.

Vulnerability and Colorectal screening during the pandemic

ObjectiveDisparities in colorectal cancer (CRC) screening prevalence across United States neighborhoods may reflect social inequities that create barriers to accessing and completing preventive health services. Our objective was to identify whether neighborhood social vulnerability was associated with a change in CRC screening prevalence in Boston neighborhoods during the COVID-19 pandemic. MethodsAdults ages 50–74 years due for CRC screening who received primary care at one of 35 primary care practices affiliated with Massachusetts General Hospital or Brigham and Women’s Hospital (Boston, MA), 3/1/2020 to 3/1/2022. The Social Vulnerability Index (SVI) is an aggregate measure of neighborhood social factors often used by public health authorities to examine neighborhood susceptibility to many health outcomes. ResultsIn 2020, 74.9 % of eligible individuals were up to date with CRC screening and this fell to 67.4 % in 2022 (p < 0.001). In 2020, 36.2 % of eligible patients lived in a neighborhood above the 80th percentile of SVI, consistent with high social vulnerability, while the same value was 35.1 % in 2022. There was no association between the change in screening prevalence and SVI: a decrease of 5.5 % screened in neighborhoods with SVI ≤ 80 compared to a decrease of 3.6 % in neighborhoods with SVI > 80 (p = 0.79). ConclusionsThe COVID-19 pandemic equalized the prevalence of CRC screening across Boston-area neighborhoods despite pre-existing geographic disparities in screening prevalence and SVI. Strategies to ensure equitable participation in CRC screening to promote health equity should be considered to promote equitable pandemic recovery.

Disparities in joint exposure to environmental and social stressors in urban households in Greater Boston

ObjectivesUnderstanding how environmental and social stressors cluster is critical to explaining and addressing health disparities. It remains unclear how these stressors cluster at fine spatial resolution in low to medium-income, urban households. We explored patterns of environmental and social exposures at the household-level and potential predictors of these joint exposures in two environmental justice communities in the Greater Boston area. MethodsWe recruited 150 households in Chelsea, MA and the Dorchester neighborhood of Boston, MA, between 2016 and 2019 and collected data on two domains: environmental and social stressor. For each domain, we fit Latent Class Analysis (LCA) models to exposure data to assess intra-domain variability, and cross-classified the resultant classes to identify joint exposure profiles. We compared differences in the distribution of these profiles by participants' demographic and household characteristics using χ2, Fisher's exact, Analysis of Variance, and Kruskal-Wallis tests. ResultsWe identified two latent classes in each domain: High environmental (n = 90; 60.4%), Low environmental (n = 59; 39.6%), High Social (n = 31; 20.8%), and Low Social (n = 118; 79.2%). Cross-classification yielded four joint exposure profiles: Both Low (n = 46, 30.9%); Both High (n = 18, 12.1%); High environmental-Low Social (n = 72, 48.3%); and Low environmental-High Social (n = 13, 8.7%). Significant group differences were found by housing type (e.g., single-family vs. multi-family) (Fisher's exact p = 0.0016), housing tenure (p = 0.0007), and study site (p < 0.0001). We also observed differences by race/ethnicity, income, and education: households that were Hispanic/Latinx, below the poverty level, and with lower education were more likely to be in the Both High group. ConclusionsOur analyses confirmed that environmental and social stressors cluster in socially disadvantaged households. Housing type, housing tenure, and location of the residence were also strong predictors of cluster membership, with renter and multi-family residents at risk of high exposures to environmental and social stressors.

Evaluating Neighborhood-Level Differences in Hair Product Safety by Environmental Working Group Ratings among Retailers in Boston, Massachusetts.

Personal care products are a notable source of exposure to endocrine-disrupting chemicals (EDCs). Racial/ethnic differences in the use of hair products containing EDCs are reported, with women and children of color more commonly using hair products that are hormonally active and contain EDCs than other racial/ethnic groups. There is limited research examining the neighborhood-level social and economic factors that may contribute to these reported disparities. We aimed to examine the safety of hair products across sociodemographically diverse neighborhoods in Boston, Massachusetts. Eight neighborhoods were identified based on indicators of race/ethnicity and socioeconomic status (SES). We randomly selected 50 stores and collected data on the hair products for sale and their corresponding Environmental Working Group (EWG) Skin Deep hazard score. The association between neighborhood and EWG hazard category (low, moderate, high) was examined using a multinomial logistic regression. A total of 14,019 hair products were identified in the eight neighborhoods. When considering products with EWG hazard scores, Roxbury, a lower income community of color, and Mission Hill, a lower income community, were reported to have a higher percentage of high-hazard hair products in comparison with Beacon Hill [12.2% (163/1,332), 11.4% (65/571) vs. 7.9% (30/382), respectively]. Differences between the safety of hair products were observed, with Roxbury and Mission Hill reporting more than a 2-fold higher risk ratio (RR) of finding hair products with high vs. low EWG scores in comparison with that of Beacon Hill [RR for Roxbury: 2.3, 95% confidence interval (CI): 1.1, 4.6; RR for Mission Hill: 2.3, 95% CI: 1.0, 5.4]. Other neighborhoods were also observed to have an increased RR in comparison with Beacon Hill, however, with 95% CIs that extended beyond the null. Retail stores in neighborhoods with a higher percentage of residents of color and lower SES were found to be more likely to sell products with high hazard scores than stores in a higher SES and predominately non-Hispanic White neighborhood. https://doi.org/10.1289/EHP10653.

Electronic data review, client reminders, and expanded clinic hours for improving cervical cancer screening rates after COVID-19 pandemic shutdowns: a multi-component quality improvement program.

To improve cervical cancer screening (CCS) rates, the East Boston Neighborhood Health Center (EBNHC) implemented a Quality Improvement (QI) initiative from March to August 2021. Staff training was provided. A 21-provider team validated overdue CCS indicated by electronic medical record data. To improve screening, CCS-only sessions were created during regular clinic hours (n=5) and weekends/evenings (n=8). Patients were surveyed on their experience. 6126 charts were reviewed. Of the list of overdue patients, outreach was performed to 1375 patients to schedule the 13 sessions. A total of 459 (33%) of patients completed screening, 622 (45%) could not be reached, and 203 (15%) canceled or missed appointments. The proportion of total active patients who were up to date with CCS increased from 68% in March to 73% in August 2021. Survey results indicated high patient satisfaction, and only 42% of patients would have scheduled CCS without outreach. The creation of a validated patient chart list and extra clinical sessions devoted entirely to CCS improved up-to-date CCS rates. However, high rates of unsuccessful outreach and cancelations limited sustainability. This information can be used by other community health centers to optimize clinical workflows for CCS. All funding was internal from EBNHC Adult Medicine, Family Medicine, and Women's Health Departments.

Associations between the built and social environment and bike share, physical activity, and overall cycling among adults from Boston neighborhoods

IntroductionDespite research documenting associations between the built environment and both transport and recreational physical activity in adults, studies that simultaneously examine the social and built environment in relation to these behaviors are limited. MethodsThe Boston Panel Study (Beacon) is a probability-based panel survey of adult residents implemented in 2018. We tested independent and interactive cross-sectional relationships between GIS-derived built environment variables in 1-km and 2-km buffers, perceived social control and social cohesion, and bike share use, moderate-to-vigorous physical activity, and overall bicycling among 791 respondents. ResultsBike share station and population density had significant positive associations with bike share use and overall cycling in unadjusted regression models only. In models that adjusted for demographics, self-rated health, and social environmental factors, greenness and density of park space within 1-km and 2-km buffers were negatively associated with bike share use. Intersection, population, multi-use trail, bicycle lane, and bike station densities were all positively associated with minutes of physical activity (p < 0.05), whereas greenness showed a negative association (p < 0.05). Social control and social cohesion were not associated with bike share use, overall cycling, or physical activity, nor did they show significant interactions with the built environment. ConclusionsSeveral built environment variables had significant associations with bike share use and physical activity but not with overall bicycling. Social environmental factors were not related to either transport or recreational physical activity. Despite these findings the joint investigation of built and social environmental factors in relation to transport and recreational forms of physical activity warrants further research in diverse populations and settings. Consistent with a social ecological framework, more effective promotion of bike share, cycling, and overall physical activity may need to incorporate strategies targeting both the social and built environment.

Pilot studies of recruitment and feasibility of remote Tai Chi in racially diverse older adults with multisite pain

BackgroundMultisite musculoskeletal pain is highly prevalent among older adults yet undertreated. Studies support the promise of Tai Chi for managing pain and lowering fall risk. Since the COVID-19 pandemic, effective alternatives to classroom-based exercise programming are warranted. AimsTo recruit 100 racially diverse older adults with multisite pain and increased fall risk, who are interested in participating in a future Tai Chi clinical trial, and to evaluate the feasibility and acceptability of a short-term, remotely delivered home-based Tai Chi program. MethodsA random sample of adults aged 65 years or older living in diverse Boston neighborhoods were sent mailed invitations to participate in a telephone screening survey. Eligible adults were invited to join a 4-week Tai Chi program offered online via Zoom. Primary outcomes were class attendance, experience, and program safety. ResultsAmong 334 survey respondents, 105 were eligible for the intervention. Average age of eligible participants was 74 years, 75% were women, and 62% were Black. We assigned 32 participants to 4 Tai Chi or 2 light exercise groups conducted via Zoom; of these, 24 (75%) completed the program and 79% attended ≥6 of 8 classes. There were no adverse events reported. Two-thirds reported it was very easy to join the online classes and 88%, very easy to see the instructor. ConclusionMailed invitations were effective for recruiting a racially diverse sample. Remote exercise programming delivered online via live Zoom sessions is safe and feasible for diverse older adults who have multisite pain and risk of falls.

In Pursuit of Local Solutions for Climate Resilience: Sensing Microspatial Inequities in Heat and Air Pollution within Urban Neighborhoods in Boston, MA

Environmental hazards vary locally and even street to street resulting in microspatial inequities, necessitating climate resilience solutions that respond to specific hyperlocal conditions. This study uses remote sensing data to estimate two environmental hazards that are particularly relevant to community health: land surface temperature (LST; from LandSat) and air pollution (AP; from motor vehicle volume via cell phone records). These data are analyzed in conjunction with land use records in Boston, MA to test (1) the extent to which each hazard concentrates on specific streets within neighborhoods, (2) the infrastructural elements that drive variation in the hazards, and (3) how strongly hazards overlap in space. Though these data rely on proxies, they provide preliminary evidence. Substantial variations in LST and AP existed between streets in the same neighborhood (40% and 70–80% of variance, respectively). The former were driven by canopy, impervious surfaces, and albedo. The latter were associated with main streets and zoning with tall buildings. The correlation between LST and AP was moderate across census tracts (r = 0.4) but modest across streets within census tracts (r = 0.16). The combination of results confirms not only the presence of microspatial inequities for both hazards but also their limited coincidence, indicating that some streets suffer from both hazards, some from neither, and others from only one. There is a need for more precise, temporally-dynamic data tracking environmental hazards (e.g., from environmental sensor networks) and strategies for translating them into community-based solutions.

Census-based urban building energy modeling to evaluate the effectiveness of retrofit programs

Housing retrofits are essential for meeting societal decarbonization goals, alongside addressing energy insecurity, improving public health, and creating new jobs. Yet, despite their multiple benefits and comprehensive government efforts to incentivize retrofits, adoption rates across the world remain low, usually less than 1% per year. Barriers to adoption among homeowners include lack of knowledge of what combination of energy retrofitting upgrades are most cost effective for their situation given available incentive programs. Similarly, cities lack urban-level analysis tools to optimize uptake of and predict carbon emissions reduction from existing incentive programs. To address the latter gap, we present a census-based Urban Building Energy Modeling framework that combines a technical energy saving potential analysis with a socioeconomic model that includes occupant demographics, local building regulations, and incentive eligibility criteria. We use the framework to evaluate the effectiveness of retrofit programs in two Boston neighborhoods with median incomes of $110,00 and $42,000. Results reveal that for the higher income, neighborhood predicted and actual adoption rates between 2014 and 2017 are comparable. In the lower income neighborhood, the proportion of households that would financially benefit from incentive offerings is higher. However, current participation rates do not reflect this difference suggesting that many viable projects do not happen for reasons that are not yet captured by the model. Urban planners, energy policy designers, and community advocates seeking to plan and evaluate energy incentive programs can use this framework to understand the breakdown of opportunities and barriers for different socio-demographic groups and geographic locations.

Pandemic transit: examining transit use changes and equity implications in Boston, Houston, and Los Angeles

While the COVID-19 pandemic upended many aspects of life as we knew it, its effects on U.S. public transit were especially dramatic. Many former transit commuters began to work from home or switched to traveling via private vehicles. But for those who continued to work outside the home and could not drive—who were more likely low-income and Black or Hispanic—transit remained an important means of mobility. However, most transit agencies reduced service during the first year of the pandemic, reflecting reduced ridership demand, increasing costs, and uncertain budgets. To analyze the effects of the pandemic on transit systems and their users, we examine bus ridership changes by neighborhood in Boston, Houston, and Los Angeles from 2019 to 2020. Combining aggregated stop-level boarding data, passenger surveys, and census data, we identify associations between shifting travel patterns and neighborhoods. We find that early in the pandemic, neighborhoods with more poor and non-white households lost proportionally fewer riders; however, this gap between high- and low-ridership-loss neighborhoods shrank as the pandemic wore on. We also model ridership change controlling for multiple factors. Ridership in Houston and LA generally outperformed Boston, with built environment and demographic factors accounting for some of the observed differences. Neighborhoods with high shares of Hispanic and African American residents retained more riders in the pandemic, while those with higher levels of auto access and with more workers able to work from home lost more riders, all else equal. We conclude that transit’s social service role elevated during the pandemic, and that serving travelers in disadvantaged neighborhoods will likely remain paramount emerging from it.

Evaluating equity in community-based naloxone access among racial/ethnic groups in Massachusetts

BackgroundRacial/ethnic minorities have experienced disproportionate opioid-related overdose death rates in recent years. In this context, we examined inequities in community-based naloxone access across racial/ethnic groups in Massachusetts. MethodsWe used data from: the Massachusetts Department of Public Health on community-based overdose education and naloxone distribution (OEND) programs; the Massachusetts Office of the Chief Medical Examiner on opioid-related overdose deaths, and; the United States Census American Community Survey for regional demographic/socioeconomic details to estimate community populations by race/ethnicity and racial segregation between African American/Black and white residents. Race/ethnicity groups included in the analysis were African American/Black (non-Hispanic), Hispanic, white (non-Hispanic), and “other” (non-Hispanic). We evaluated racial/ethnic differences in naloxone distribution across regions in Massachusetts and neighborhoods in Boston descriptively and spatially, plotting the race/ethnicity-specific number of kits per opioid-related overdose death per jurisdiction. Lastly, we constructed generalized estimating equations models with a negative binomial distribution to compare the race/ethnicity-specific naloxone distribution rate by OEND programs. ResultsFrom 2016–2019, the median annual rate of naloxone kits received from OEND programs in Massachusetts per racial/ethnicity group ranged between 160 and 447 per 100,000. In a multivariable analysis, we found that the naloxone distribution rates for racial/ethnic minorities were lower than the rate for white residents. We also found naloxone was more likely to be distributed in racially segregated communities than non-segregated communities. ConclusionWe identified racial/ethnic inequities in naloxone receipt by individuals in Massachusetts. Additional resources focused on designing and implementing OEND programs for racial/ethnic minorities are warranted to ensure equitable access to naloxone.

Street efficacy, daily activities and youth perceptions of neighborhood safety

ABSTRACT The central objective of the present study is to contextualize youths’ perception of neighborhood safety from a youth-centered perspective of native born and immigrant youth living in a police-defined ‘hot spot’ neighborhood in Boston, U.S.A. Using the concept of street efficacy and lifestyles-routine activities theories, focus groups were conducted with teens, and photovoice was used to elaborate on perceptions. Youth described neighborhood offenders, capable guardians, and steps they took to reduce themselves as targets, consistent with lifestyles-routine activities theories. Results showed that although youth were aware of violence and victimization in their neighborhood, they displayed high street efficacy, or confidence, in the way they discussed their daily routines and navigated their lives. Youth generally felt they had the power to stay safe, but there were cultural dimensions to safety. Youth also described a nuanced relationship with police depending on situational context as well as personal and vicarious experiences. Study findings point to the need to address system-level barriers to safety, improve relationships among residents, youth, and police and to further investigate the cultural dimensions of youth perceptions of neighborhood safety.

Effect of clinician information sessions on diagnostic testing for Chagas disease.

BackgroundChagas disease is a potentially life-threatening neglected disease of poverty that is endemic in continental Latin America. Caused by Trypanosoma cruzi (T. cruzi), it is one of six parasitic diseases in the United States targeted by the Centers for Disease Control as a public health problem in need of action. An estimated 300,000 people are infected with T. cruzi in the United States (US). Although its morbidity, mortality and economic burden are high, awareness of Chagas disease is lacking among many healthcare providers in the US. The purpose of this analysis is to determine if the number of diagnostic tests performed at a community health center serving an at-risk population for Chagas disease increased after information sessions. A secondary aim was to determine if there was a difference by provider type, i.e., nurse practitioner vs. physician, or by specialty in the number of patients screened.Methodology/Principal findingsWe conducted a retrospective data analysis of the number of Chagas serology tests performed at a community health center before and after information sessions for clinicians. A time series analysis was conducted focusing on the Adult and Family Medicine Departments at East Boston Neighborhood Health Center (EBNHC). Across all departments there were 1,957 T. cruzi tests performed before the sessions vs. 2,623 after the sessions. Interrupted time series analysis across departments indicated that testing volume was stable over time prior to the sessions (pre-period slope = +4.1 per month; p = 0.12), followed by an immediate shift after the session (+51.6; p = 0.03), while testing volume remained stable over time after the session (post-period slope = -6.0 per month; p = 0.11).Conclusion/SignificanceIn this study, Chagas testing increased after information sessions. Clinicians who began testing their patients for Chagas disease after learning of the importance of this intervention added an extra, potentially time-consuming task to their already busy workdays without external incentives or recognition.

A remote Tai Chi program for diverse older adults with multisite pain during the COVID-19 pandemic

The goal of this study was to evaluate feasibility and acceptability of a remote Tai Chi program in diverse older adults with multisite pain and risk for falls during the COVID-19 pandemic. Adults aged ≥65y living in diverse Boston neighborhoods were invited through mailed letters to participate in a recruitment and screening survey. Eligible adults were re-contacted to join a 4-week Tai Chi or light exercise program offered online twice weekly. We conducted pre- and post-interviews to assess pain characteristics, fall risk, computer use, and satisfaction with the program. Primary outcomes were class attendance, experience, and program safety. Among 335 survey respondents, 105 (31%) were eligible based on multisite pain and fall history or cane/walker use. Of the eligible respondents, average age was 74y, 75% were women, 62% were Black, and 31% had high school education or less. We assigned 32 participants to 4 Tai Chi (Yang-style Tai Chi tailored to older adults with pain) or 2 light exercise (stretching and strength exercise) groups conducted via zoom; of these, 24 (75%) completed the program. Overall, 79% attended ≥6 of 8 classes. There were no adverse events reported. Regarding experiences with remote exercise, 67% reported it was very easy to join, 88%, very easy to see the instructor and 83%, very easy to participate. For future planning, 29% prefer remote classes, 33% prefer in-person classes, and 38% could do either. In conclusion, remote exercise programming is safe and feasible for diverse older adults who have multisite pain and risk of falls.

570. Prioritized Access to COVID-19 Vaccines Among Vulnerable Communities Increases Vaccination Rates

BackgroundBased on national recommendations,1 Beth Israel Lahey Health (BILH) in Eastern Massachusetts (MA) prioritized vulnerable communities in our distribution of COVID-19 vaccines. We hypothesized that creating prioritized access to appointments for patients in these communities would increase the likelihood vaccination.MethodsThe BILH health system sent vaccine invitations first to patients of two clinics in vulnerable neighborhoods in Boston (Wave 1), followed by other patients from vulnerable communities (Wave 2) up to 1 day later, and then by all other patients (Wave 3) after up to 1 more day later. To identify whether early access/prioritization increased the likelihood of receipt of vaccine at any site or a vaccine at a BILH clinic, we compared patients in Wave 1 in a single community with high cumulative incidence of COVID-19 (Dorchester) to patients in Wave 2 during a period of limited vaccine access, 1/27/21-2/24/21. Each wave was modeled using logistic regression, adjusted for language and race. By taking the difference between these two differences, we are left with the impact of early vaccination invitation in Wave 1 for a subset of our most vulnerable patients (termed difference-in-differences; Stata SE 16.0). ResultsIn our study of Waves 1 and 2, we offered vaccinations to 24,410 patients. Of those, 6,712 (27.5%) scheduled the vaccine at BILH (Table 1). Patients in Wave 1 were much more likely to be vaccinated at BILH than patients in Wave 2. Patients offered the vaccine in Wave 1 and living in Dorchester were 1.7 percentage points more likely to be vaccinated at all (p=0.445) and 9.4 percentage points more likely to be vaccinated at BILH than another site in MA (p-value = 0.001), relative to patients living outside of Dorchester and offered the vaccine in Wave 2 (Table 2). The coefficient of interest is on Wave1*Dorchester, 0.094. This indicates that residents of Dorchester who were offered the vaccine in Wave 1 were 9.4 percentage points more likely to receive the vaccine at BILH, given that they were vaccinated, relative to patients living outside of Dorchester and offered the vaccine in Wave 2.ConclusionPatients residing in an urban community given prioritized access to vaccination had a higher likelihood of vaccination at our health system, given that they were vaccinated, than patients in other urban communities without prioritized access. We provide an example of a successful effort to move towards equity in access to COVID-19- vaccines, in contrast to larger national trends.2,3 Health systems can use a prioritization approach to improve vaccination equity. Disclosures All Authors: No reported disclosures

Spatial and sociodemographic determinants of community loudness perception

Urban noise is an increasingly important public health concern, but few studies have characterized drivers of community loudness perception rather than objective measures of sound, which may be an important element of the associated health effects. In this study, we used survey responses from the 2015–2016 Greater Boston Neighborhood Noise Survey (n = 898) to determine the key geospatial determinants of community loudness perception at both the street and neighborhood level. We gathered numerous land use and sociodemographic covariates and used an elastic net selection approach to determine the subset to include in final prediction models. Individual noise sensitivity and proximity to bus stops (<150 m) was associated with perceived loudness at the street and neighborhood level. In addition, at the street level, the restaurant and transportation infrastructure within close proximity (<200 m) of the residence were predictive of perceived loudness. At the neighborhood level, there was a larger and more complex set of predictors in the final prediction model, including multiple commercial/business sources at larger distances (500–1000 m buffers) from the residence. In general, these predictors overlapped with those in existing models predicting objective sound across multiple frequencies (A-weighted sound. low-frequency sound, mid-frequency sound, and high frequency sound), especially for transportation sources, although some predictors of noise perception differed from those for sound measurements. These results emphasize the importance of characterizing both perceived noise and objective sound, with the combined insights helping to develop soundscape maps and determine which urban areas require intervention to improve community public health.

Airbnb and neighborhood crime: The incursion of tourists or the erosion of local social dynamics?

The proliferation of internet-based home-sharing platforms like Airbnb has raised heated debates, with many in the general public believing that the presence of Airbnb listings can lead to an increase in crime and disorder in residential neighborhoods. Despite the importance of this debate to residents, policymakers, and other stakeholders, few studies have examined the causal linkage between Airbnb listings and crime in neighborhoods. We conduct the first such empirical test in Boston neighborhoods, focusing on two potential mechanisms: (1) the inflow of tourists might generate or attract crime; and (2) the creation of transient properties undermines local social dynamics. Corresponding to these mechanisms, we examine whether the number of tourists (approximated with reviews) or the prevalence of listings predict more incidents of private conflict, social disorder, and violence both concurrently and in the following year. We find evidence that increases in Airbnb listings–but not reviews–led to more violence in neighborhoods in later years. This result supports the notion that the prevalence of Airbnb listings erodes the natural ability of a neighborhood to prevent crime, but does not support the interpretation that elevated numbers of tourists bring crime with them.

Food Shopping Experiences Among Dollar Store Shoppers in Fresno and Boston During the COVID-19 Pandemic

ObjectivesIn this qualitative study, we examined the impact of the COVID-19 pandemic on motivations, decision-making, and food shopping among dollar store shoppers in Fresno, CA and Boston, MA. Eligible participants were ≥18 years old, lived in Boston or Fresno, spoke English or Spanish, and shopped at a dollar store within the past month.MethodsUsing convenience sampling, participants were recruited via flyers at 10 dollar stores in low-income neighborhoods in Fresno and Boston and posts in community Facebook groups. Interviews in Boston (n = 25) and Fresno (n = 26) were conducted remotely from August-December 2020.ResultsOur participants were primarily low-income, English-speaking women who shopped at dollar stores about once perweek. Preliminary qualitative content analysis shows that key shopper motivations included low prices, product variety, and convenience. Shelf-stable foods and snacks were frequently purchased, especially for children. Shoppers in Fresno relied more on dollar stores for groceries and fresh produce, while Boston shoppers primarily purchased shelf-stable foods or snacks. Shoppers in both cities desired increased availability of fresh foods. Shoppers reported fear of shopping, limited stock, financial stress, and fewer trips early in the pandemic. Shopping increased by summer. Shoppers with children reported increased food expenditures during the pandemic, including at dollar stores, as closed schools meant that children consumed meals at home.ConclusionsDollar stores continue to be an important food resource despite challenges related to the pandemic. Considering frequent use, food purchases, and desire for more fresh foods among shoppers, dollar stores chains may find a receptive audience for increasing their fresh food stock.Funding SourcesEthical approval was provided by the Tufts University Social, Behavioral & Educational Research Institutional Review Board. Funding was provided by the Bergstrom Foundation and Tufts Friedman School of Nutrition Science and Policy.