Boston Neighborhoods Research Articles

Abstract A26: Developing a community-based partnership to facilitate a multilevel community engaged study exploring barriers to cancer care and clinical trial participation among black Bostonians

Abstract In Boston, Massachusetts, disparities persist for Black residents across a myriad of chronic conditions including cancer. To assess perceptions in Boston's Black community about cancer and cancer care, the Lazarex-MGH Cancer Care Equity Program (CCEP) partnered with the Center for Community Health Education Research and Services, Inc. (CCHERS), a trusted community-based organization, to perform a specific cancer-focused community assessment. This exploratory community engaged research (CEnR) partnership set out to (1) determine the perceived barriers to participation in clinical trials and cancer care as perceived by diverse Black Bostonians; and (2) develop a grassroots interventional strategy designed to a) reduce barriers to cancer care and b) increase awareness of clinical trials. Communities are complex and comprise multiple layers. CEnR partnerships can facilitate the development of culturally relevant and community specific strategies to tackle disparities, while simultaneously empowering communities. CEnR is an asset-based research approach that emphasizes the importance of building on existing community knowledge, relationships, and resources to implement sustainable, community-relevant interventions. In addition, CEnR approaches can facilitate the dissemination of intervention results in a way that equally benefits providers, policy-makers, and participants at the local level. For this project, a multi-level approach is employed. Phase one of the study involved key informant interviews (n=20) with health care providers and patient advocates in community health centers, organizers from grassroots coalitions focused on health (namely cancer), and Black cancer survivors who may or may not have participated in clinical trials. Phase one (P1) data was coded thematically using a consensus coding strategy. Themes from P1 will be used used to develop a focus group script for Phase two (P2) of the study. In P2, a series of focus groups (n=9) will be held in three Boston neighborhoods with residents self-identifying as Black to explore 1) conceptualizations of clinical trials, 2) perceptions of barriers to clinical trial participation and general cancer care, and 3) potential strategies to reduce identified barriers. Coded data will then be presented in “town hall meeting format” to a broader group of community residents and stakeholders. Findings from P1 are consistent with the literature indicating generational differences in how barriers to cancer care and clinical trials are perceived. In addition, we identified disconnects in what religious leaders and oncologists view as barriers to care. Beyond medical mistrust the overall structure of care presented as barriers. By partnering with community stakeholders we were able to engage a “hard to research population” in exploratory cancer care research the results of which will be used to guide institutional planning. Citation Format: Karen Winkfield, Elizabeth Powell, Chidinma Osuagwa, Elmer Freeman, Linda Sprague-Martinez. Developing a community-based partnership to facilitate a multilevel community engaged study exploring barriers to cancer care and clinical trial participation among black Bostonians. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A26.

Geographic Disparities in Access to Agencies Providing Income-Related Social Services.

Geographic location is an important factor in understanding disparities in access to health-care and social services. The objective of this cross-sectional study is to evaluate disparities in the geographic distribution of income-related social service agencies relative to populations in need within Boston. Agency locations were obtained from a comprehensive database of social services in Boston. Geographic information systems mapped the spatial relationship of the agencies to the population using point density estimation and was compared to census population data. A multivariate logistic regression was conducted to evaluate factors associated with categories of income-related agency density. Median agency density within census block groups ranged from 0 to 8 agencies per square mile per 100 population below the federal poverty level (FPL). Thirty percent (n = 31,810) of persons living below the FPL have no access to income-related social services within 0.5 miles, and 77 % of persons living below FPL (n = 83,022) have access to 2 or fewer agencies. 27.0 % of Blacks, 30.1 % of Hispanics, and 41.0 % of non-Hispanic Whites with incomes below FPL have zero access. In conclusion, some neighborhoods in Boston with a high concentration of low-income populations have limited access to income-related social service agencies.

Fostering diverse friendships: The role of beliefs about the value of diversity

Encouraging dialogue between people of differing social backgrounds and beliefs can reduce prejudice and lead to greater appreciation of diversity, which in turn fosters attitudinally diverse friendships. We investigated how beliefs about the value of diversity relate to attitudinal diversity within relationship dyads. In a field study of naturally occurring relationship pairs in two neighborhoods of Boston ( N = 89 dyads), participants completed measures of diversity beliefs and sociopolitical attitudes. People placed higher value on diversity in the Jamaica Plain neighborhood compared to people in the North End neighborhood, and relationship pairs were more attitudinally diverse in Jamaica Plain than in the North End. Attitudinal diversity within pairs was predicted by how highly the pair jointly valued diversity. Further, pairs’ greater valuing of diversity in Jamaica Plain mediated the effect of neighborhood on attitude diversity. These findings suggest that individual differences in appreciation for diversity are meaningful predictors of diverse relationships.

Safety and Solidarity After the Boston Marathon Bombing: A Comparison of Three Diverse Boston Neighborhoods

This article investigates the effect of the Boston Marathon Bombing on city residents— how the tragic incident changed, or did not change, how Bostonians live in and feel about their community and neighborhoods. Unlike prior research that began weeks or months after a terrorist attack and used retrospective reports, this study spans the focal event. An address‐based sample of residents from three neighborhoods, distinct in racial and economic makeup was surveyed by mail using a three‐contact protocol. About two‐thirds of respondents answered a survey of neighborhood sentiments, and health and well‐being in the days before the bombing (N = 581) and slightly over a third answered the survey after the bombing (N = 313).Assessments of safety, city and neighborhood satisfaction and solidarity, mental health, and other key measures vary greatly between the three neighborhoods, which are diverse in racial and economic composition, but also vary in proximity to the bomb site. Net of neighborhood differences, the bombing had a strong negative effect on neighborhood cohesion and reduced use of public transit. Strong interactions are also found between timing of survey completion (pre and post bombing) and neighborhood for assessments of neighborhood solidarity.

Heterogeneity in individually experienced temperatures (IETs) within an urban neighborhood: insights from a new approach to measuring heat exposure.

Urban environmental health hazards, including exposure to extreme heat, have become increasingly important to understand in light of ongoing climate change and urbanization. In cities, neighborhoods are often considered a homogenous and appropriate unit with which to assess heat risk. This manuscript presents results from a pilot study examining the variability of individually experienced temperatures (IETs) within a single urban neighborhood. In July 2013, 23 research participants were recruited from the South End neighborhood of Boston and equipped with Thermochron iButtons that measured the air temperatures surrounding individuals as they went about their daily lives. IETs were measured during a heat wave period (July 17-20), which included 2 days with excessive heat warnings and 1 day with a heat advisory, as well as a reference period (July 20-23) in which temperatures were below seasonal averages. IETs were not homogeneous during the heat wave period; mean IETs were significantly different between participants (p < 0.001). The majority of participants recorded IETs significantly lower than outdoor ambient temperatures (OATs), and on average, the mean IET was 3.7 °C below the mean OAT. Compared with IETs during the reference period, IETs during the heat wave period were 1.0 °C higher. More than half of participants did not experience statistically different temperatures between the two test periods, despite the fact that the mean OAT was 6.5 °C higher during the heat wave period. The IET data collected for this sample and study period suggest that (1) heterogeneity in individual heat exposure exists within this neighborhood and that (2) outdoor temperatures misrepresent the mean experienced temperatures during a heat wave period. Individual differences in attributes (gender, race, socioeconomic status, etc.), behaviors (schedules, preferences, lifestyle, etc.), and access to resources are overlooked determinants of heat exposure and should be better integrated with group- and neighborhood-level characteristics. Understanding IETs for the population at large may lead to innovative advances in heat-health intervention and mitigation strategies.

Tactical developments for achieving just and sustainable neighborhoods: the role of community-based coalitions and bottom-to-bottom networks in street, technical, and funder activism

Over the past two decades community activists in distressed urban neighborhoods have been organizing to improve environmental quality and livability for residents through parks, playgrounds, gardens, farms, or sports facilities, and this across political systems and contexts of urbanization. To date, however, limited research has been conducted on the development and intricacies of neighborhood activism for long-term environmental justice in marginalized neighborhoods, and little work has been done in a comparative manner and through a place-based approach. Through three historically marginalized neighborhoods in Boston, Barcelona, and Havana, I analyze how internal dynamics and external contexts shape community organization towards improved environmental quality and livability, and how mobilization unfolds over time and space. Findings reveal that activists tend to resort to similar tactical choices to achieve their objectives, including broad and flexible coalitions, and what I call bottom-to-bottom networks encompassing three forms of activism: street activism, technical activism, and funder activism.

Incidence of Gonorrhea and Chlamydia in Urban Settings: The Case for Neighborhood Level Analysis in Boston

The sexually transmitted infections (STIs) gonorrhea and chlamydia are known to disproportionately affect impoverished communities and communities of color, especially in urban areas. Moreover, socioeconomic and demographic factors such as poverty and race/ethnicity may contribute to a difference in treatment setting choice as well as a delay in care seeking. In an urban metropolitan area such as Boston, the overall gonorrhea and chlamydia rates are higher than national rates, and such differences are even more marked in certain neighborhoods with greater proportions of individuals who are impoverished, young, and of color. Using a retrospective analysis of city wide data, we highlight the effects of socioeconomic and demographic variables on urban STI prevalence. High poverty rates, race/ethnicity and younger adult populations are linked to disproportionately high STI rates. Interestingly, STI rates do not appear to be influenced by the universal health care coverage offered to the whole Massachusetts’ resident populations. We examine the effects of these variables in Boston neighborhoods in conjunction to STI rates and hypothesize that the observed rates are underestimates of the true prevalence of infection. Future studies will investigate how these same socioeconomic and demographic factors influence which treatment settings are chosen and subsequently lead to a delay in treatment.

Mapping carbon storage in urban trees with multi-source remote sensing data: Relationships between biomass, land use, and demographics in Boston neighborhoods

High resolution maps of urban vegetation and biomass are powerful tools for policy-makers and community groups seeking to reduce rates of urban runoff, moderate urban heat island effects, and mitigate the effects of greenhouse gas emissions. We developed a very high resolution map of urban tree biomass, assessed the scale sensitivities in biomass estimation, compared our results with lower resolution estimates, and explored the demographic relationships in biomass distribution across the City of Boston. We integrated remote sensing data (including LiDAR-based tree height estimates) and field-based observations to map canopy cover and aboveground tree carbon storage at ~1m spatial scale. Mean tree canopy cover was estimated to be 25.5±1.5% and carbon storage was 355Gg (28.8MgCha−1) for the City of Boston. Tree biomass was highest in forest patches (110.7MgCha−1), but residential (32.8MgCha−1) and developed open (23.5MgCha−1) land uses also contained relatively high carbon stocks. In contrast with previous studies, we did not find significant correlations between tree biomass and the demographic characteristics of Boston neighborhoods, including income, education, race, or population density. The proportion of households that rent was negatively correlated with urban tree biomass (R2=0.26, p=0.04) and correlated with Priority Planting Index values (R2=0.55, p=0.001), potentially reflecting differences in land management among rented and owner-occupied residential properties. We compared our very high resolution biomass map to lower resolution biomass products from other sources and found that those products consistently underestimated biomass within urban areas. This underestimation became more severe as spatial resolution decreased. This research demonstrates that 1) urban areas contain considerable tree carbon stocks; 2) canopy cover and biomass may not be related to the demographic characteristics of Boston neighborhoods; and 3) that recent advances in high resolution remote sensing have the potential to improve the characterization and management of urban vegetation.

Oxidative stress and systemic inflammation as modifiers of cardiac autonomic responses to particulate air pollution

BackgroundThe role of oxidative stress and systemic inflammation on the association between personal exposures to ambient fine particulate matter ≤2.5μm in diameter (PM2.5) and cardiac autonomic dysfunction, indicated by reduction in heart rate variability (HRV), has not been examined. MethodsWe performed a repeated measures study on community adults in a densely populated inner city neighborhood in Boston, Massachusetts. Continuous ambulatory electrocardiogram (ECG) monitoring and personal exposure to PM2.5 were measured for up to two consecutive days. Peripheral blood and spot urine samples were collected at 12-hour intervals for the measurements of markers of inflammation including C-reactive protein (CRP), fibrinogen, white blood cell (WBC) and platelet counts as well as for the analysis of urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG), a marker of oxidative DNA damage. ResultsAfter adjusting for confounders, we found a pronounced decrease in nighttime standard deviation of normal-to normal intervals (SDNN): an interquartile range (IQR) increase in PM2.5 (13.6μg/m3) was associated with an 8.4% decrease in SDNN (95% CI: −11.3 to −5.5). Compared with the lower eightieth percentile, significantly greater PM2.5 associated nighttime SDNN reductions were observed among subjects in the upper twentieth percentile of 8-OHdG by −25.3%, CRP by −24.9%, fibrinogen by −28.7%, WBC by −23.4%, and platelet counts by −24.0% (all P<0.0001; all Pinteraction<0.01). ConclusionsThese data suggest that oxidative stress and systemic inflammation exacerbate the adverse effects of PM2.5 on the cardiac autonomic function even at ambient levels of exposure.

An empirical analysis of White privilege, social position and health

Accumulated evidence has demonstrated that social position matters for health. Those with greater socioeconomic resources and greater perceived standing in the social hierarchy have better health than those with fewer resources and lower perceived standing. Race is another salient axis by which health is stratified in the U.S., but few studies have examined the benefit of White privilege. In this paper, we investigated how perceptions of inequality and subjective and objective social status affected the health and well-being of N = 630 White residents in three Boston neighborhoods lying on a social gradient differentiated by race, ethnicity, income and prestige. Outcomes were self-rated health, dental health, and happiness. Results suggested that: neighborhood residence was not associated with health after controlling for individual level factors (e.g., positive ratings of the neighborhood, education level); objective measures of socioeconomic status were associated with better self-reported and dental health, but subjective assessments of social position were more strongly associated; and White residents living in the two wealthiest neighborhoods, and who perceived Black families as welcome in their neighborhoods enjoyed better health than those who believed them to be less welcome. However, those who lived in the least wealthy and most diverse neighborhood fared worse when reporting Black families to be welcome. These results suggest that White privilege and relative social position interact to shape health outcomes.

A spatially explicit approach to the study of socio-demographic inequality in the spatial distribution of trees across Boston neighborhoods.

The racial/ethnic and income composition of neighborhoods often influences local amenities, including the potential spatial distribution of trees, which are important for population health and community wellbeing, particularly in urban areas. This ecological study used spatial analytical methods to assess the relationship between neighborhood socio-demographic characteristics (i.e. minority racial/ethnic composition and poverty) and tree density at the census tact level in Boston, Massachusetts (US). We examined spatial autocorrelation with the Global Moran's I for all study variables and in the ordinary least squares (OLS) regression residuals as well as computed Spearman correlations non-adjusted and adjusted for spatial autocorrelation between socio-demographic characteristics and tree density. Next, we fit traditional regressions (i.e. OLS regression models) and spatial regressions (i.e. spatial simultaneous autoregressive models), as appropriate. We found significant positive spatial autocorrelation for all neighborhood socio-demographic characteristics (Global Moran's I range from 0.24 to 0.86, all P=0.001), for tree density (Global Moran's I=0.452, P=0.001), and in the OLS regression residuals (Global Moran's I range from 0.32 to 0.38, all P<0.001). Therefore, we fit the spatial simultaneous autoregressive models. There was a negative correlation between neighborhood percent non-Hispanic Black and tree density (rS=-0.19; conventional P-value=0.016; spatially adjusted P-value=0.299) as well as a negative correlation between predominantly non-Hispanic Black (over 60% Black) neighborhoods and tree density (rS=-0.18; conventional P-value=0.019; spatially adjusted P-value=0.180). While the conventional OLS regression model found a marginally significant inverse relationship between Black neighborhoods and tree density, we found no statistically significant relationship between neighborhood socio-demographic composition and tree density in the spatial regression models. Methodologically, our study suggests the need to take into account spatial autocorrelation as findings/conclusions can change when the spatial autocorrelation is ignored. Substantively, our findings suggest no need for policy intervention vis-à-vis trees in Boston, though we hasten to add that replication studies, and more nuanced data on tree quality, age and diversity are needed.

Beyond individual and visible acts of violence: A framework to examine the lives of women in low-income neighborhoods

Synopsis Low-income minority women are among the most disadvantaged in terms of social location, which exposes them to various forms of violence that perpetuate their poverty. Previous research has focused on individual explanations of actions that affect them. We seek to redirect our understandings away from individual explanations to focus on the broader contexts and inequalities that lie at the root of multiple and interconnected forms of violence in the lives of women in vulnerable positions. This approach facilitates recognition of violent structures often unrecognized or misrecognized as such. Our framework includes structural, interpersonal, and symbolic forms of violence, which we apply to examine the lives of a subsample of minority-status women gathered ethnographically in low-income neighborhoods in Boston, Los Angeles and New York through the Three City Study of Moving to Opportunity. In this exercise, we highlight the broader contexts that create conditions for individuals to harm one another.

Does neighborhood collective efficacy for families change over time? The Boston Neighborhood Survey.

There is an increased interest in how neighborhood social processes, such as collective efficacy, may protect mental health. Yet little is known about how stable these neighborhood processes are over time, or how to change them to influence other downstream factors. We used a population-based, repeat cross-sectional study of adults (n=5135) to assess stability of collective efficacy for families in 38 Boston neighborhoods across 4 years (2006, 2008, 2010) (the Boston Neighborhood Survey). We test temporal stability of collective efficacy for families across and within neighborhoods using 2-level random effects linear regression, fixed effects linear regression, T-tests, and Wilcoxon rank tests. Across the different methods, neighborhood collective efficacy for families remained stable across 4 years, after adjustment for neighborhood composition. If neighborhood collective efficacy is measured within 4 years of the exposure period of interest, assuming temporal stability may be valid.

Organizational Parochialism: “Placing” Interorganizational Network Ties

Are interorganizational network ties “placeless” or “placed”? The study of organizations, particularly the study of interorganizational network ties, has reemerged in urban sociology, yet the urban literature on place and the organizations literatures on organizational network activity are not fully integrated. This article bridges these theories through an investigation of the social and spatial underpinnings of interorganizational network ties. Quantitative analysis of data from 152 interviews with nonprofit organizations serving youth across 12 contiguous neighborhoods in Boston reveals a propensity for organizations to share resources within the local neighborhood, controlling for proximity to other organizations, organizational characteristics, and various network properties. Qualitative data suggest a multilevel social process underlying the parochial network structure, illustrating the context for collaboration, restrictions on extra–local exchange, and incentives guiding a local focus. Based on this evidence, I propose a theory of organizational parochialism, extending research on organizations, networks, and urban social processes.

The Spatial Accessibility of Fast food Restaurants and Convenience Stores in Relation to Neighborhood Schools

Differences in the local food environment are hypothesized to contribute to neighborhood disparities in obesity prevalence. We examined the density of and proximity to fast food restaurants and convenience stores according to levels of neighborhood median incomes in the city of Boston. We also examined the distribution of food stores in relation to Boston city schools. We used Geographic Information System to geocode fast food restaurant and convenience store addresses. Regression analyses were performed to test the association between Census tract and block-group median household income and food store distances and densities. All fast food restaurants and 98 % of convenience stores were geocoded successfully to a street address. Higher income neighborhoods had lower fast food restaurant density. Compared to schools in lower income neighborhoods, schools in higher income neighborhoods had fewer fast food restaurants and were further away from fast food restaurants and convenience stores. Fast food restaurants are more concentrated in lower income neighborhoods and near schools in lower income neighborhoods in Boston. Spatial inequities in food access have major policy and health implications, specifically related to lower income neighborhoods and schools. The close proximity of fast food restaurants and convenience stores to lower income schools expose children to unhealthy food options that may contribute to unhealthy eating and obesity in economically disadvantaged neighborhoods.

The Sistah Powah Structured Writing Intervention: A Feasibility Study for Aging, Low-Income, HIV-Positive Black Women

The purpose of this study was to test the feasibility and assess outcomes of health care adherence based on whether participants engage in particular risky behaviors relevant to general health or living with human immunodeficiency virus (HIV) infection and the frequency of these adherent behaviors. Health adherent behaviors include both self-advocacy and decreased stigma as underlying key components. A randomized control trial comparing peer-led attention control support and intervention groups. Community-based women's drop-in center in an urban, black neighborhood of Boston, Massachusetts. Aging, low-income, black women living with HIV infection. Peer-led, small-group, structured writing using film clips from Women's Voices Women's Lives as a writing prompt. Demographic and outcome data that included adherence, self-advocacy, and stigma; collected at baseline, 6 weeks, and 6 months. Repeated-measures analysis of variance scores were examined between groups and waves. Paired-sample t-tests were used to examine mean differences across time. Sample included 110 women (intervention, n = 56; comparison, n = 54). Retention was 85.5%. Repeated-measures analysis indicated intervention group condom use (n = 69, F = 8.02, df = 1, p < .01) and safe sex (n = 71, F = 13.02, df = 1, p < .01) was higher than that of comparison group. A time effect was also found in the Silencing the Self Scale (n = 91, Pillai's trace = 7.21, df = 2, p < .01). This study demonstrates the feasibility of a tailored, peer-led, and culturally relevant interventions and tentative efficacy in populations affected by health disparities. Key limitations include no comparison intervention format with women who can't write and the need to test generalizability.

Mobile monitoring of traffic-related ultrafine particles in near-highway neighborhoods in Boston, Massachusetts (USA)

Background: Intensive mobile monitoring data are needed for development of models for exposure assessment of ultrafine particles (UFP) and other traffic-related air pollutants in near-highway urban...

Participation in Context: Neighborhood Diversity and Organizational Involvement in Boston

We use unique data from the Boston Non–Profit Organizations Study, an innovative survey containing rich information on organizational participation across seven social domains in two Boston neighborhoods, to examine the relationship between ethnic diversity and participation in local organizations. In particular, we identify neighborhood–based social ties as a key mechanism mediating the initial negative association between diversity and participation. In contrast to previous work, we measure participation using both the domain–based and group–based approach, with the former approach uncovering a wider range of organizational connections that are often missed in the latter approach. We also investigate the relationship between interpersonal ties and organizational ties, documenting how primary involvement with an organization facilitates the development of further interpersonal ties and secondary forms of organizational involvement. We then discuss implications of our findings for urban poverty research.

From Environmental Trauma to Safe Haven: Place Attachment and Place Remaking in Three Marginalized Neighborhoods of Barcelona, Boston, and Havana

In recent years, local activists in the Global North and South have been organizing to improve degraded and abandoned spaces in marginalized neighborhoods by creating parks, playgrounds, urban farms, or community gardens. This paper integrates existing knowledge on urban place attachment and sense of community with scholarship on environmental justice in order to understand the role of place attachment in environmental mobilization in distressed neighborhoods across political systems and urbanization contexts. It examines the different forms of connections that activists develop and express toward neighborhoods with long–time substandard environmental conditions and how their experience of the neighborhood shapes their engagement in environmental revitalization projects. This comparison of three neighborhoods in Barcelona, Boston, and Havana shows that activists in all three places intend for their environmental endeavors to express grief at the loss of community, fears of erasure, and emotional connection and feelings of responsibility to place. To address environmental trauma, they aim to construct nurturing, soothing, “safe havens,” recreate rootedness, and remake place for residents.

Safely active mobility for urban baby boomers: The role of neighborhood design

Many urban designers and researchers argue that walkable urban environments can encourage older residents’ walking activities that benefit their physical health. However, walking also exposes older adults to safety risks, including due to traffic accidents. This study seeks to reveal the interactions between urban form and safety affecting urban baby boomers’ walking behavior. Spatial analysis reveals traffic collision patterns in urban Boston neighborhoods, detecting hotspots around activity centers. Structural equation modeling, estimated on individual data collected from a mail-back survey and utilizing numerous measures of neighborhood urban form and accessibility, then attempts to reveal the causal, interacting relationships between neighborhood-level urban form, traffic crashes, and baby boomers’ walking behavior. The analysis identifies significant effects of walkable urban forms (e.g., mixed use, well-connected streets, and good access to potential destinations) on older adults’ walking. Yet, accessibility to retail, as well as traffic speed and volume, are positively associated with the traffic collision frequency. The results suggest more cautious approaches may be necessary for designing urban spaces for walkability and also call into question prescriptions based on the “safety in numbers” hypothesis.