High-poverty Neighborhoods Research Articles

Latino Enclaves and Healthcare Accessibility: An Ecologic Study Across Five States.

Hispanic or Latino populations (hereafter, "Latinos") are a rapidly expanding U.S. demographic and have documented inequities in preventable diseases and conditions. Many Latinos reside in ethnic enclaves, and understanding the context and healthcare accessibility within these places is critical. This study described the neighborhood social and built environment attributes of Latino enclaves and evaluated associations between enclaves and geographic healthcare accessibility. Cross-sectional ecologic analysis. Our unit of analysis was all neighborhoods (n ~ 20,000 census tracts) in California, Florida, New Jersey, New York, and Texas in years 2000 and 2010. The primary exposure of interest, "Latino enclaves," was defined using neighborhood-level data on the percentage of Latino residents, foreign-born Latinos, Spanish speakers with limited English proficiency, and linguistically isolated Spanish-speaking households. The primary outcome was a neighborhood-level measure of geographic healthcare accessibility of primary care physicians, which accounted for both the supply of physicians and population demand for healthcare (i.e., population size within driving distance). Approximately 30% of neighborhoods were classified as Latino enclaves, 87% of which were enclaves in both 2000 and 2010. Compared with non-enclaves, Latino enclaves had more markers of structural disadvantage including having higher proportions of poverty, uninsured individuals, crowded housing, and higher crime scores. Results from multivariable models suggest that more culturally distinct neighborhoods (i.e., higher enclave score) had lower healthcare accessibility, though when stratified, this association persisted only in high (≥ 20%) poverty neighborhoods. This study highlights several neighborhood structural disadvantages within Latino enclaves, including higher poverty, uninsured individuals, and crime compared to non-enclave neighborhoods. Moreover, our findings point to the need for interventions aimed at improving healthcare accessibility particularly within socioeconomically disadvantaged Latino enclaves. Addressing these inequities demands multifaceted approaches that consider both social and structural factors to ensure equitable healthcare access for Latino populations.

Structural inequality modifies midlife outcomes of a multisystemic early childhood program.

The role of structural inequalities in the long-term benefits of early childhood programs has not been assessed. Previous findings in the Chicago Longitudinal Study, an early childhood cohort investigation with low-income families, indicate that Child-Parent Center (CPC) participation beginning in preschool was associated with a variety of positive health behaviors. In this secondary analysis, we assessed if structural inequalities (neighborhood poverty, history of discrimination) modified the magnitude of associations between CPC and health and education outcomes (cardiovascular health, body mass index, educational attainment) 30 years later. The Chicago Longitudinal Study cohort of 1,539 children (93% Black, 7% Hispanic) grew up in high-poverty neighborhoods and attended CPCs or the usual district programs. At midlife (ages 32-37, M = 34.9 years, 2012-2017), 1,073 participants completed telephone interviews on structural inequalities, health, and education. Regression analyses were conducted with inverse propensity score weighting. After accounting for structural inequality, CPC participation was significantly associated with outcomes. Mean differences on Framingham risk scores, for example, were significant for CPC preschool at ages 3 and 4 (coefficient = -2.15, p = .004, standardized difference = -0.20). Neighborhood poverty moderated (reduced) the association between CPC and cardiovascular health. Neighborhood poverty and perceived discrimination had independent contributions with outcomes. Findings show that structural inequalities, especially poverty, directly influence and/or moderate long-term effects of CPC participation. Increasing neighborhood resources and socioeconomic status may help comprehensive programs sustain their impacts. Early childhood and sociostructural influences reflect the increasing importance of community contexts to health promotion. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Structural Equality and Support Index in Early Childhood Education

Whether early childhood education is associated with a wide range of adult outcomes above and beyond individual- and family-level outcomes is unknown. As a consequence of improving educational and career success, it is postulated that participation in high quality, comprehensive programs can promote residence in more supportive community contexts in adulthood. To investigate whether participation in high-quality early childhood programs (ECP) in high-poverty neighborhoods is associated with neighborhood-level social determinants of health (SDH) at midlife. This cohort study analyzed data from the Chicago Longitudinal Study, a prospective cohort investigation following-up 989 children aged 3 to 4 years attending the Child-Parent Center (CPC) preschool program between 1983 and 1985 and a comparison group of 550 children using a nonrandomized trial design. Participants from the original sample who completed a telephone interview on health and well-being between ages 32 and 37 years were included in this analysis. Data analysis was conducted from April to June 2024. Participation in a CPC program, which includes preschool (ages 3 to 4 years) and school-age (kindergarten through third grade), vs usual early education programs. The study used a new SDH measure (Index of Structural Equality and Support [I-SES]) based on the Healthy People 2030 framework. This 9-item index score included neighborhood-level assessment, measurement of the quality of education and health services, and assessment of racial discrimination in social and community contexts. Years of education by age 34 years was assessed as the key mediator of influence. A total of 1124 individuals (mean [SD] age at survey completion, 34.9 [1.4] years; 614 women [54.6%]; 1054 non-Hispanic Black [93.8%]; 69 Hispanic [6.2%]; 1 non-Hispanic White [<0.1%]) were included in the study, of whom 740 were in the CPC cohort and 384 were in the comparison cohort. After adjustment for baseline attributes and attrition, compared with no CPC preschool, CPC preschool was associated with significantly higher mean (SD) I-SES scores (5.93 vs 5.53; mean difference, 0.40; 95% CI, 0.16-0.65; standardized mean difference = 0.22). Compared with CPC participation for 0 to 3 years, CPC participation for 4 to 6 years showed a similar pattern of positive associations (adjusted mean I-SES score, 5.97 vs 5.69; mean difference, 0.28; 95% CI, 0.06-0.50; P = .01; SMD = 0.15). CPC participation had a larger-magnitude association with I-SES in married vs single-parent households. Years of education partially mediated the association of CPC with I-SES (up to 41%), especially among those growing up in the highest-poverty neighborhoods. This cohort study found that early childhood programming is associated with SDH in adulthood. These findings reinforce the importance of early childhood education in addressing health disparities and contributing to healthier, more equitable communities and suggest that educational attainment is a key mechanism for health promotion.

Racial and Ethnic Disparities in Health Care Usage and Death by Neighborhood Poverty Among Individuals With Congenital Heart Defects, 4 US Surveillance Sites, 2011 to 2013.

Socioeconomic factors may lead to a disproportionate impact on health care usage and death among individuals with congenital heart defects (CHD) by race, ethnicity, and socioeconomic factors. How neighborhood poverty affects racial and ethnic disparities in health care usage and death among individuals with CHD across the life span is not well described. Individuals aged 1 to 64 years, with at least 1 CHD-related International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code were identified from health care encounters between January 1, 2011, and December 31, 2013, from 4 US sites. Residence was classified into lower- or higher-poverty neighborhoods on the basis of zip code tabulation area from the 2014 American Community Survey 5-year estimates. Multivariable logistic regression models, adjusting for site, sex, CHD anatomic severity, and insurance-evaluated associations between race and ethnicity, and health care usage and death, stratified by neighborhood poverty. Of 31 542 individuals, 22.2% were non-Hispanic Black and 17.0% Hispanic. In high-poverty neighborhoods, non-Hispanic Black (44.4%) and Hispanic (47.7%) individuals, respectively, were more likely to be hospitalized (adjusted odds ratio [aOR], 1.2 [95% CI, 1.1-1.3]; and aOR, 1.3 [95% CI, 1.2-1.5]) and have emergency department visits (aOR, 1.3 [95% CI, 1.2-1.5] and aOR, 1.8 [95% CI, 1.5-2.0]) compared with non-Hispanic White individuals. In high poverty neighborhoods, non-Hispanic Black individuals with CHD had 1.7 times the odds of death compared with non-Hispanic White individuals in high-poverty neighborhoods (95% CI, 1.1-2.7). Racial and ethnic disparities in health care usage were similar in low-poverty neighborhoods, but disparities in death were attenuated (aOR for non-Hispanic Black, 1.2 [95% CI=0.9-1.7]). Racial and ethnic disparities in health care usage were found among individuals with CHD in low- and high-poverty neighborhoods, but mortality disparities were larger in high-poverty neighborhoods. Understanding individual- and community-level social determinants of health, including access to health care, may help address racial and ethnic inequities in health care usage and death among individuals with CHD.

NYC’s Overdose Prevention Centers: Data from the First Year of Supervised Consumption Services

Unintentional drug overdose deaths are a critical public health concern nationally and locally; New York City (NYC) reported 3,026 overdose fatalities in 2022, the highest number of overdose deaths citywide since reporting began in 2000. The burden of overdose deaths is highly unequal: older New Yorkers, Black and Latino/a New Yorkers, people experiencing homelessness, and residents of high-poverty neighborhoods continue to experience the highest rates of fatal overdose citywide. The rise in overdose deaths is driven by the proliferation of fentanyl, which was present in 81% of overdose deaths in NYC in 2022. Overdose prevention centers (OPCs), also known as supervised consumption spaces, have demonstrated international success in reducing overdose deaths and associated harms. OPCs provide hygienic spaces where people can use previously acquired substances under the supervision of trained staff. These OPCs, which opened in NYC on November 30, 2021, are recognized as the first OPCs with supervised use of illicit substances to be formally supported by a governmental entity in the United States. The OPCs are operated by the nonprofit organization OnPoint NYC; the City of New York provides monetary support for many services at the OPCs except direct supervised consumption, as well technical assistance and programmatic oversight by the NYC Department of Health & Mental Hygiene. This report summarizes the first year of operations of these two centers in NYC. From November 30, 2021, to November 30, 2022, 2,841 individuals visited the two OPCs 48,533 times and staff intervened during 636 visits (1.3%) to prevent overdose-related injury and death. During this period, emergency medical services (EMS) were called only 23 times, and no overdose deaths occurred in the OPCs. Results suggest that the OPCs diverted up to 39,000 instances of public drug use and played a critical role in connecting participants to care, with 75% of participants accessing other harm-reduction, social, and medical services through OnPoint NYC. Despite these early successes, these and other OPCs face challenges sustaining operations in uncertain legal and law enforcement, legislative, and funding environments. Additional research exploring the needs of participants, patterns of OPC service utilization, and the long-term impacts of OPC use on health outcomes is needed to expand the body of evidence supporting OPCs in the United States.

Association between neighborhood poverty and ovarian reserve: the ovarian aging study.

This study aimed to examine the association between neighborhood poverty and ovarian reserve. Among 1,019 healthy premenopausal women in the Ovarian Aging Study, aggregate exposure to neighborhood poverty was examined in relation to biomarkers of ovarian reserve, antimüllerian hormone (AMH) and antral follicle count (AFC). Specifically, the interaction of age-x-neighborhood poverty was assessed cross-sectionally to determine whether AMH and AFC declines across women may be greater in women exposed to more neighborhood poverty. Neighborhood poverty was assessed by geocoding and linking women's residential addresses in adulthood to US Census data. Independent of covariates, a significant interaction term showed the association between age and AMH varied by degree of exposure to neighborhood poverty in adulthood ( b = -0.001, P < 0.05). AMH declines increased progressively across women exposed to low, medium, and high levels of neighborhood poverty. In addition, main effects showed that higher neighborhood poverty was related to higher AMH in the younger women only ( b = 0.022, P < 0.01). Results related to AFC were all nonsignificant ( P > 0.05). Across women, greater aggregate exposure to neighborhood poverty in adulthood was related to lower ovarian reserve, indexed by AMH. In addition, there was a positive association between neighborhood poverty and AMH in younger women that attenuated in the older women. Together, results suggest that neighborhood disadvantage may have detrimental impacts that manifest as initially higher AMH, resulting in greater ovarian follicle loss over time. However, it remains unclear whether these results examining differences across women may replicate when AMH declines by neighborhood poverty are examined longitudinally.

Education for Environmental Justice: The Fordham Regional Environmental Sensor for Healthy Air

In urban environments, the nonuniform distribution of pollution contributes to disproportionate exposure to harmful pollutants in low-income and high-poverty neighborhoods. Particulate matter, especially of the class PM2.5, results from combustion processes which are a main driver for human-caused global warming and climate change. A resulting impact on socio-economically disadvantaged communities like the Bronx, NY is the high incidence of asthma, other respiratory diseases, and cardiovascular disease. This disparity is an environmental justice concern. Project FRESH Air is educating the community through STEM outreach with sensors for monitoring particulate matter, student projects, curriculum development, and wider community engagement in order to educate for environmental justice.

Analysis of Uveal Melanoma 5-Year Survival Rates by Medicaid Status: A Nationwide Analysis

ABSTRACT Purpose The survival outcomes of patients with primary uveal melanomas based on Medicaid status have not been previously discussed in the literature. Methods The Surveillance, Epidemiology, and End Results Medicaid database were utilized to identify patients with primary uveal melanomas diagnosed between 2006 and 2013. The Kaplan–Meier method was utilized to construct 5-year survival curves in adult, non-elderly patients. Log-rank testing was used to determine differences in survival rates, and multivariate Cox proportional hazards modeling was utilized to perform adjusted survival analysis. Results A total of 1,765 patients were included (Medicaid: 81, non-Medicaid: 1684). A total of 1683 (95.4%) were White. The average age was 51.75 years (SD = 9.5 years). Medicaid patients were more likely to be unmarried, live in a high poverty neighborhood, and live in a rural area (all p < .001). We observed no significant difference in 5-year survival rates between those enrolled in Medicaid (86.6%, 95% CI: 79.1%1–94.7%) and those not enrolled in Medicaid (85.5, 95% CI: 83.8%–87.2%) (p = .80). After controlling for socioeconomic and clinical factors, Medicaid enrollment was not associated with an increased risk of mortality compared to non-Medicaid enrollment. Age (aHR: 1.04, 95% CI: 1.02–1.06, p < .001) and tumor size >10 mm (aHR: 3.04, 95% CI: 1.49–6.21, p = .002) were associated with an increased risk of mortality. Conclusion Medicaid enrollment was not associated with worse cancer-specific 5-year survival. Further research needs to be elicited to better understand the role of Medicaid enrollment in patients with primary uveal melanoma.

Disparities in Primary Spinal Osseous Malignant Bone Tumor Survival by Medicaid Status: A National Population-Based Risk Analysis

The impact of Medicaid status on survival outcomes of patients with spinal primary malignant bone tumors (sPMBT) has not been investigated. Using the SEER-Medicaid database, adults diagnosed between 2006 and 2013 with sPMBT including chordoma, osteosarcoma, chondrosarcoma, Ewing sarcoma, or malignant giant cell tumor (GCT) were studied. Five-year survival analysis was performed using the Kaplan-Meier method. Adjusted survival analysis was performed using Cox proportional-hazards regression controlling for age, sex, marital status, cancer stage, poverty level, vertebral versus sacral location, geography, rurality, tumor diameter, tumor grade, tumor histology, and therapy. A total of 572 patients with sPMBT (Medicaid: 59, non-Medicaid: 513) were identified. Medicaid patients were more likely to be younger (P < 0.001), Black (P < 0.001), live in high poverty neighborhoods (P= 0.006), have distant metastases at diagnosis (P < 0.001), and less likely to receive surgery (P= 0.006). The 5-year survival rate was 65.7% (chondrosarcoma: 70.0%, chordoma: 91.5%, Ewing sarcoma: 44.6%, GCT: 90.0%, osteosarcoma: 34.2%). Medicaid patients had significantly worse 5-year survival than non-Medicaid patients (52.0% vs. 67.2%, P= 0.02). Minority individuals on Medicaid were associated with an increased risk of cancer-specific mortality compared with White non-Medicaid patients (adjusted hazard ratio [aHR]= 2.51, [95% CI 1.18-5.35], P= 0.017). Among Medicaid patients, those who received surgery had significantly better survival than those who did not (64.5% vs. 30.6%, P= 0.001). For all patients, not receiving surgery (aHR= 1.90 [1.23-2.95], P= 0.004) and tumor diameter >50 mm (aHR=1.89 [1.10-3.25], P= 0.023) were associated with an increased risk of mortality. Medicaid patients may be less likely to receive surgery and suffer from poorer survival. These disparities may be especially prominent among minorities.

Short-term impact of a neighbourhood-based intervention on mental health and self-rated health in Hamilton, Ontario, Canada.

The Hamilton Neighbourhoods Study aimed to measure the short-term impact of a neighbourhood-based intervention known as the City of Hamilton's Neighbourhood Action Strategy on health and neighbourhood outcomes. A quasi-experimental study with 881 intervention participants across six targeted neighbourhoods and 173 control participants was conducted to investigate changes in self-rated health and mental health from baseline to follow-up. There was evidence of small improvements in mental health in two neighbourhoods, but there was no change in self-rated health. Place-based interventions aimed at high poverty neighbourhoods may have only modest impacts on health in the short-term.

Decomposing Neighbourhood (In)Stability: The Structural Determinants of Turnover and Implications for Neighbourhood Crime

Abstract While the human ecological model views neighbourhood instability as a function of household-level decisions, the present study draws on a political economy of place perspective to highlight how the profit-seeking interests of outside actors shapes instability, with consequences for neighbourhood crime. Using data on neighbourhoods in Los Angeles County from 2007 to 2013, I decompose levels of stability according to housing dynamics (displacement, development, changing rents, sales, low-income units), and assess their direct and indirect association with violent and property crime. I find that, over a 7-year period, poorer neighbourhoods are more vulnerable to these exchange-value pressures, stability is more consequential to crime in high-poverty neighbourhoods, and certain housing dynamics are associated with increasing crime through their detrimental effect on renter stability.

Choosing Alone? Peer Continuity Disparities in Choice-Based Enrollment Systems

We provide novel evidence on the broader impacts of school choice systems by quantifying disparities in peer continuity from middle to high school in New York City. We find that Black and Hispanic students and those in high-poverty neighborhoods attend high school with a much smaller fraction of their middle school or neighborhood peers than their White, Asian, and low-poverty neighborhood counterparts. Disparities also emerge in peer isolation: 27% and 20% of Black and Hispanic students transitioned with no other student from their middle school, while only 7% to 8% of White and Asian students did. Group differences in choice similarity, which in part reflects systematic variation in the number of local school options, drive this result.

Health insurance and neighborhood poverty as mediators of racial disparities in advanced disease stage at diagnosis and nonreceipt of surgery for women with breast cancer.

In our recent study, advanced disease stage and nonreceipt of surgery were the most important mediators of the racial disparity in breast cancer survival. The purpose of this study was to quantify the racial disparity in these two intermediate outcomes and investigate mediation by the more proximal mediators of insurance status and neighborhood poverty. This was a cross-sectional study of non-Hispanic Black and non-Hispanic White women diagnosed with first primary invasive breast cancer in Florida between 2004 and 2015. Log-binomial regression was used to obtain prevalence ratios (PR) with 95% confidence intervals (CIs). Multiple mediation analysis was used to assess the role of having Medicaid/being uninsured and living in high-poverty neighborhoods on the race effect. There were 101,872 women in the study (87.0% White, 13.0% Black). Black women were 55% more likely to be diagnosed with advanced disease stage at diagnosis (PR, 1.55; 95% CI, 1.50-1.60) and nearly twofold more likely to not receive surgery (PR, 1.97; 95% CI, 1.90-2.04). Insurance status and neighborhood poverty explained 17.6% and 5.3% of the racial disparity in advanced disease stage at diagnosis, respectively; 64.3% remained unexplained. For nonreceipt of surgery, insurance status explained 6.8% while neighborhood poverty explained 3.2%; 52.1% was unexplained. Insurance status and neighborhood poverty were significant mediators of the racial disparity in advanced disease stage at diagnosis with a smaller impact on nonreceipt of surgery. However, interventions designed to improve breast cancer screening and receipt of high-quality cancer treatment must address additional barriers for Black women with breast cancer.

0233 Racial/ethnic Residential Segregation - a Component of Structural Racism - and Sleep Health by Neighborhood-level Poverty

Abstract Introduction Racial/ethnic residential segregation may contribute to sleep disparities by concentrating poverty and impairing sleep among minoritized groups. Yet, due to racism, equitable access to sleep-promoting resources may not occur in integrated neighborhoods. Further, social/cultural factors within ethnic enclaves could be protective. Methods To investigate whether relationships between racial/ethnic residential segregation and sleep vary by census tract-level poverty among US adults, we linked nationally-representative National Health Interview Survey data (2011-2017) to 2012 and 2017 American Community Survey census tract-level data. We used the local Getis-Ord Gi* statistic to categorize residential segregation (high, medium, low [reference]), considering differences between racial/ethnic composition within a census tract to the surrounding county. Survey-weighted, Poisson regressions with robust variance estimation were stratified by race/ethnicity and approximate census tract-level poverty tertile (high [&amp;gt;16.9% of residents below poverty level], medium [&amp;gt;7.9%-16.9%], low [0%-7.9%]) to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for self-reported sleep health measures. Results Among 126,539 participants (mean age±SE=46±0.1 years), non-Hispanic (NH)-Black and Latino adults were most likely to report short sleep (41%) and non-restorative sleep (37%), respectively. Racial/ethnic residential segregation was most common among NH-Black (38%), followed by non-Mexican Latino (34%) and NH-Asian adults (34%), and was least prevalent among NH-White adults (17%) but was not associated with sleep among Mexican, non-Mexican Latino, or NH-Black adults. Among NH-Asian adults, high segregation was marginally associated with a higher prevalence of short sleep (&amp;lt; 7-hours vs. recommended [7-9 hours]) in low-poverty neighborhoods (PR=1.17 [95% CI:0.97-1.42]) but was associated with recommended sleep in medium-poverty neighborhoods (PRshort sleep=0.79 [0.63-0.99]). Among NH-White adults, high residential segregation was associated with more restorative sleep only in high-poverty (PR=1.13 [1.06-1.20]) and low-poverty (PR=1.03 [1.00-1.07]) neighborhoods. Conclusion Associations between racial/ethnic residential segregation and sleep health varied by neighborhood-level poverty among NH-Asian and NH-White adults. The lack of differences among most minoritized groups may be related to the close proximity of higher-income and lower-income neighborhoods due to structural racism. Future studies including spatial analyses are warranted. The findings/conclusions in this research are those of the authors and do not necessarily represent the views of the Research Data Center, National Center for Health Statistics, or CDC. Support (if any)

The Prevalence, Profitability, and Risks of Milking Among Low-End Small Rental Properties

Low-cost but unsubsidized one- to four-unit rental properties provide a critical source of housing for millions of low- and moderate-income renters. These properties are disproportionately in high-poverty neighborhoods and, until recently, studies of these low-end small rental properties (SRPs) primarily focused on their financial viability. Scholars found that, in general, these properties were marginally profitable at best and carried serious financial risks. Recently, however, studies have found that low-end SRPs may be as profitable as or even more profitable than properties in lower-poverty neighborhoods, and have suggested that these profits are driven by exploitative management. I surveyed the owners and managers of SRPs to understand whether low-end properties were more likely to be profitable and whether the owners who did achieve profits at the low end used “milking” strategies. I found that SRPs in high-poverty neighborhoods are about as likely to be profitable as the rest of the market, but are also financially riskier. I found no compelling evidence of a link between profit and more exploitative management practices at the low end of the market. These findings call for a change in policymakers’ understanding of profit and exploitative management among low-end SRPs.

“I Thought This Was a Ghost Neighborhood”: How Youth Respond to Neighborhood Change

Abstract Relatively little scholarship centers the experiences of Black youth to understand how young people interact with their neighborhood contexts, evaluate the differences between neighborhoods, and adapt to new neighborhoods. Using interviews with 120 Black youth whose families moved from high-poverty central city neighborhoods into lower-poverty, more racially diverse suburban neighborhoods with the Baltimore Housing Mobility Program, we find that Black youth describe tradeoffs that come with living in both city and suburban neighborhoods. While youth viewed their suburban neighborhoods as safer, the young people encountered new repertoires of socializing and space use after moving to the suburbs, with fewer opportunities to spontaneously hang out with peers. This made it challenging to establish new social ties. In response, youth adopted varied strategies, some aligned with new patterns of socializing, others stayed inside, and some returned to the city to reconnect with friends, even if this involved returning to neighborhoods they perceived as less safe. Our work underscores the idea that neighborhoods do not impose culture on youth in enduring or inflexible ways; rather they offer strategies of action that youth can decide to take up. How youth perceive the qualities of their neighborhoods shapes where and how they choose to spend their time.

Midwest Ecological Study Outlined the Neighbourhood Literacy Environment and the Inequitable Access Children Have to Books in Public Library Branches

A Review of: Crosh, C., Hutton, J., Szumlas, G., Xu, Y., Beck, A., &amp; Riley, C. (2022). Inequities in public library branch access and children’s book circulation in a Midwestern American city. The International Journal of Information, Diversity, &amp; Inclusion (IJIDI), 6(3), 68-81. https://doi.org/10.33137/ijidi.v6i4.38127 Objective – To explore the impact of the neighbourhood literacy environment (NLE) by examining associations between public library locations, book circulation rates, and neighbourhood racial composition. Design – An ecological study using aggregated data sources. Setting – Forty selected neighbourhood public libraries in the state of Ohio, United States of America. Subjects – Analysis of (1) existing circulation statistics from January 2014 to December 2018 for the neighbourhoods of Cincinnati and Hamilton Public Libraries; and (2) the American Community Survey (ACS) data from 2018. Methods – Among the key components studied for the population was the NLE, which the authors defined as access to literacy materials in a neighbourhood. The data the authors examined for the targeted populations were race, age, poverty level, and library location. The two groups of variables computed were: (1) the connection between circulation rates of children’s books and child poverty; (2) the connection between circulation statistics and the proportion of people who self-identify as Black in the neighbourhood. Additionally, the researchers used the Spearman’s rank order correlation coefficient (rs) to measure the relationships between the correlating variables within each neighbourhood library branch – number of books circulated per child; the census data of children who self-identified as Black; and the children who were designated as 20% below the federal poverty level (FPL). The Chi-square test was used to calculate associations between access to a library branch and child poverty in each neighborhood. In this study, the researchers only looked at the associations between variables at an aggregate level. The authors defined the terms they used in the study: (1) children were ages 0-18 years; (2) children’s books were literature intended for an audience from 0-18 years old; (3) the definition of poverty was taken from the U.S. Census and classified as neighborhoods with 20% of children below the FPL. Main Results – There were 40 library branches that served 81 neighbourhoods, of which there was only a 38% distribution in the high-poverty areas, compared with 58% for the low. Approximately 24 million books were circulated during the 5-year period of 2014 -2018. The median circulation rate per child at the neighbourhood level was 22 books. The results showed steep variations in circulation rates per child across branch locations; the numbers range from 3 to 98 books per child across neighborhoods. The authors indicated that the increases and decreases in the circulation rates were tied to branch location and the area’s socioeconomic status. The primary finding of the data analyzed was a negative correlation between the population identified as Black/African American and lower circulation rates in poorer neighbourhoods. Limitations identified by the authors were (1) the allocation of literacy resources per branch was unknown; (2) the in-library book user statistics in high-poverty neighbourhoods may not be accurately documented; (3) the precise allocations for literacy funds and the use of in-library resources for developing literacy skills need further study. Conclusion – The authors noted that race, economic status, and proximity to public libraries were pertinent factors in understanding inequitable access to books for children in the neighbourhoods studied. The NLE was an important dynamic beyond the home; the availability of books and engagement with them were contributing factors to the development of literacy skills. The associations observed between the variables indicated that improving the NLE matters and libraries must mindfully work to alleviate the disproportionately lower levels of access to books and their unfavorable outcome for children in low-income areas.

A Missed Opportunity? The 4% Low-Income Housing Tax Credit Program

The Low-Income Housing Tax Credit program is the largest housing production subsidy in the U.S. Two types of credit, known as the 9% credit and the 4% credit, are subject to different allocation criteria. The 4% program has been flying under the radar of policymakers, housing advocates, and researchers since its inception. Whereas newly constructed 9% units are increasingly sited in lower poverty neighborhoods, 4% investment is made in high-poverty and low-opportunity neighborhoods. This paper reveals that states have not actively influenced the locational outcomes of 4% projects credit until recently. Policy levers have a more substantial impact on the outcomes of the 9% program. However, the results indicate that increased competition and strong policy levers have enabled some states to influence the siting outcomes of 4% projects. As states have significant power over tax credit allocations and additional financing required to enable the 4% credit, they could consider explicitly using this credit to further fair housing goals and help low-income households reach opportunities. However, careful consideration is needed to balance these goals with neighborhood revitalization.

Abstract P359: Long-Term Exposure to Neighborhood Poverty Throughout Midlife and Subclinical Cardiovascular Disease Burden in Subsequent Years: The Study of Women's Health Across the Nation

Purpose: To examine whether longitudinal exposure to neighborhood poverty throughout midlife influences the degree of subclinical CVD (SCVD) burden experienced in early old age in a racially and ethnically-diverse cohort of women transitioning through menopause. Methods: We used longitudinal data on 1,212 women (aged 42-52 at baseline) from The Study of Women’s Health Across the Nation . Residential address histories were collected annually for eleven years across midlife (1996-2007). The following carotid ultrasound SCVD measures were collected during a subsequent follow-up visit (2009-2013): intima media thickness (CIMT), inter-adventitial diameter (IAD), and plaque presence. Values &gt;75th percentile of each were considered high (CIMT &gt; 0.79 mm; IAD &gt; 7.21 mm; plaque index &gt;=2) and were summed together to create our composite SCVD index (range: 0-3). We used longitudinal latent class analysis to identify distinct patterns of exposure to high neighborhood poverty among women across midlife, and used ordinal logistic regression models to determine if a woman’s neighborhood poverty class throughout midlife was associated with her future SCVD burden. Results: We identified five longitudinal neighborhood poverty classes across midlife: consistent low (72% of total), decreasing (6.4%), early-increasing (7.3%), late-increasing (5.5%), and consistent high (8.4%). In age and site-adjusted models, the odds of having greater SCVD burden were 70% higher among women living in consistently high poverty neighborhoods (OR=1.70, 95% CI: 1.14-2.54), 52% higher among women experiencing early increases in neighborhood poverty (OR=1.52, 95% CI: 0.97-2.38), and 69% higher among women experiencing late increases in neighborhood poverty (OR=1.69, 95% CI: 1.04-2.74), compared to women living in consistent low poverty throughout midlife. Controlling for social, behavioral, and menopause-associated factors reduced the magnitude and significance of the estimated effects towards the null. Adjusting for baseline age, race/ethnicity, site, education, marital status, employment, alcohol use, smoking, depressive symptoms, physical activity, menopausal status, hypertension, diabetes, and obesity, the estimated odds of greater SCVD burden were 6% higher among women living in consistently high poverty neighborhoods (95% CI: 0.69-1.63), 10% higher among women experiencing early increases in poverty (95% CI: 0.68-1.76), and 17% higher among women experiencing late increases in poverty (95% CI: 0.70-1.94), relative to women living in consistent low poverty neighborhoods across midlife. Conclusions: Women living in neighborhoods with higher levels of poverty throughout midlife had greater SCVD burden in early old age. Associations between neighborhood poverty trajectories and SCVD burden were largely accounted for by individual-level social, behavioral, and biomedical confounders.

Marketing Sustainability Analysis of Stores Participating in a Healthier Retail Food Program

ObjectivesTo examine how food retailers completing Shop Healthy NYC, a healthy food retail program, (1) changed availability, placement, and promotion of healthier food immediately after participation and (2) sustained changes 1-year postintervention. MethodsFrom 2014 to 2017, stores in 2 high-poverty New York City neighborhoods participated in a low-intensity intervention focused on in-store advertising or a high-intensity intervention to meet 7 criteria related to availability, placement, and promotion of healthy items. Stores were assessed preintervention (Pre), 1-month postintervention (Post 1), and 12–16 months postintervention (Post 2). Analyses were restricted to stores that completed the intervention and were assessed at all time points (n = 64). Changes were compared across time points. ResultsAcross stores participating in the low-intensity intervention, the ratio of unhealthy-to-healthy ads decreased from Pre to Post 1, and by Post 2 remained improved over baseline. Among stores participating in the high-intensity intervention, the median number of healthy criteria met increased from 3.5 to 6 from Pre to Post 1 and decreased to 5 at Post 2. ConclusionsImprovements in the marketing and availability, placement, and promotion of healthy products are feasible but may require reinforcement and additional support over time.