Low-income Communities Of Color Research Articles

Scaling and sustaining COVID-19 vaccination through meaningful community engagement and care coordination for underserved communities: hybrid type 3 effectiveness-implementation sequential multiple assignment randomized trial

BackgroundCOVID-19 inequities are abundant in low-income communities of color. Addressing COVID-19 vaccine hesitancy to promote equitable and sustained vaccination for underserved communities requires a multi-level, scalable, and sustainable approach. It is also essential that efforts acknowledge the broader healthcare needs of these communities including engagement in preventive services.MethodsThis is a hybrid type 3 effectiveness-implementation study that will include a multi-level, longitudinal, mixed-methods data collection approach designed to assess the sustained impact of a co-created multicomponent strategy relying on bidirectional learning, shared decision-making, and expertise by all team members. The study capitalizes on a combination of implementation strategies including mHealth outreach with culturally appropriate messaging, care coordination to increase engagement in high priority preventive services, and the co-design of these strategies using community advisory boards led by Community Weavers. Community Weavers are individuals with lived experience as members of an underserved community serving as cultural brokers between communities, public health systems, and researchers to co-create community-driven, culturally sensitive public health solutions. The study will use an adaptive implementation approach operationalized in a sequential multiple assignment randomized trial design of 300 participants from three sites in a Federally Qualified Health Center in Southern California. This design will allow examining the impact of various implementation strategy components and deliver more intensive support to those who benefit from it most. The primary effectiveness outcomes are COVID-19 vaccine completion, engagement in preventive services, and vaccine confidence. The primary implementation outcomes are reach, adoption, implementation, and maintenance of the multicomponent strategy over a 12-month follow-up period. Mixed-effects logistic regression models will be used to examine program impacts and will be triangulated with qualitative data from participants and implementers.DiscussionThis study capitalizes on community engagement, implementation science, health equity and communication, infectious disease, and public health perspectives to co-create a multicomponent strategy to promote the uptake of COVID-19 vaccination and preventive services for underserved communities in San Diego. The study design emphasizes broad engagement of our community and clinic partners leading to culturally sensitive and acceptable strategies to produce lasting and sustainable increases in vaccine equity and preventive services engagement.Trial registrationClinicalTrials.gov Identifier: NCT05841810 May 3, 2023

Toxic Tides and Environmental Injustice: Social Vulnerability to Sea Level Rise and Flooding of Hazardous Sites in Coastal California.

Sea level rise (SLR) and heavy precipitation events are increasing the frequency and extent of coastal flooding, which can trigger releases of toxic chemicals from hazardous sites, many of which are in low-income communities of color. We used regression models to estimate the association between facility flood risk and social vulnerability indicators in low-lying block groups in California. We applied dasymetric mapping techniques to refine facility boundaries and population estimates and probabilistic SLR projections to estimate facilities' future flood risk. We estimate that 423 facilities are at risk of flooding in 2100 under a high emissions scenario (RCP 8.5). One unit standard deviation increases in nonvoters, poverty rate, renters, residents of color, and linguistically isolated households were associated with a 1.5-2.2 times higher odds of the presence of an at-risk site within 1 km (ORs [95% CIs]: 2.2 [1.8, 2.8], 1.9 [1.5, 2.3], 1.7 [1.4, 1.9], 1.5 [1.2, 1.9], and 1.5 [1.2, 1.9], respectively). Among block groups near at least one at-risk site, the number of sites increased with poverty, proportion of renters and residents of color, and lower voter turnout. These results underscore the need for further research and disaster planning that addresses the differential hazards and health risks of SLR.

Strengthening Doctor-Patient Relationships Through Hospital-Based Violence Interventions.

Violence in Chicago has been persistently high in low-income communities of color. Recent attention has focused on how structural inequities weaken protective factors that help keep communities healthy and safe. Spikes in community violence seen in Chicago since the COVID-19 pandemic further expose the lack of social service, health care, economic, and political safety nets in low-income communities and the apparent dearth of faith in those systems. The authors contend that a comprehensive, collaborative approach to violence prevention that prioritizes treatment and community partnerships is needed to address social determinants of health and structural characteristics that often provide the context for interpersonal violence. One strategy to address decreasing faith in systems like hospitals is foregrounding frontline paraprofessional prevention workers who possess cultural capital based on their experiences navigating interpersonal and structural violence. Hospital-based violence intervention programs help professionalize these prevention workers by providing a framework for patient-centered crisis intervention and assertive case management. The authors describe how the Violence Recovery Program (VRP), a multidisciplinary hospital-based violence intervention model, leverages the cultural capital of credible messengers to use teachable moments to promote trauma-informed care to violently injured patients, assess their immediate risk for reinjury and retaliation, and connect them to wrap-around services to help aid comprehensive recovery. Violence recovery specialists have engaged over 6,000 victims of violence since the program's launch in 2018. Three-quarters of patients expressed social determinants of health needs. Over the past year, specialists have connected over one-third of engaged patients to mental health referrals and community-based social services. High violence rates in Chicago limited case management opportunities in the emergency room. In fall 2022, the VRP began to establish collaborative agreements with community-based street outreach programs and medical-legal partnerships to address structural determinants of health.

The ambivalence of independent mobility: Balancing perceived risks and expected benefits of walking to school in inner-city neighborhoods

Drawing on two Southern California neighborhoods, this paper assesses children’s perceptions of the risks of walking to school in urban and low-income communities of color, balanced against the expected benefits of child independent mobility. Quantitatively-estimated relationships between children’s travel modes and environmental observations show that those who walk to school – especially those who walk alone – exhibit heightened environmental perceptions at granular levels. They identify more negative aspects of the built environment (both social and physical) than those who are driven, suggesting they feel more vulnerable along their school routes. They also make more observations of the built environment in aggregate, suggesting that walking – an interactive mode of travel – confers greater spatial awareness. To maximize the psychological, cognitive, and social well-being benefits that child pedestrians can accrue from their experiences in inner-city settings, measures mitigating neighborhood risks are a necessary complement to existing traffic safety-oriented policies.

Making Architecture Relevant to Underserved Communities: Mapping Reconsidered

The COVID-19 pandemic and the death of George Floyd shed new light on longstanding disparities that exist in low-income communities of color and impact their overall well-being. Architectural educators and practitioners across the United States are engaging in public discourse to debate the role that architecture should play in promoting diversity, equity, and inclusion in education and the architectural profession. This trend has motivated us to ask: How can architecture be made more relevant to underserved communities? This article investigated that question via the construct of mapping. Mapping is a mechanism for reflection, rediscovery, and reexamination of the familiar and self-discovery of the less familiar. To further explore how mapping can help make architecture more relevant to disadvantaged populations, we used a mobile mapping station (MMS)—a practical, hands-on, community-based project conducted in Detroit. This article focused on MMSs, exploring how, when coupled with social justice values and equitable development principles, architecture can be made more accessible to broader populations.

The Effects of Cross-Age Peer Mentoring on Adolescent Mentors of Color Residing in Low Income, Urban Communities

The current study seeks to understand the potential benefits of culturally matched cross-age peer mentoring for Black and Latinx adolescent mentors residing in low-income, urban communities. Data for the study were derived from a 4-year longitudinal project examining the effectiveness of community-based cross-age mentoring. Data from the current sample ( N = 249, 60.6% female, M = 16.72 years) were analyzed using HLM. Findings indicated that the mentoring relationship bond rather than attendance predicted change on several positive outcomes. Adolescent mentors were found to experience improvements in several areas of positive youth development, ethnic identity, and GPA after the program was completed and at 9 to 12 months follow up. Researchers propose an adapted theoretical model of the impacts of youth cross-age mentoring in low-income communities of color. Findings from the current study offer key information on the value of facilitating empowering, person-focused services in concert with members of marginalized communities.

COMMUNITY-BASED AND RESTORATIVE-JUSTICE INTERVENTIONS TO REDUCE OVER-POLICING

COMMUNITY-BASED AND RESTORATIVE-JUSTICE INTERVENTIONS TO REDUCE OVER-POLICING

Local Measures to Curb Dollar Store Growth: A Policy Scan.

In recent years, advocates have expressed concern about the exponential growth of dollar stores in low-income communities, given their limited stock of healthy foods, and several municipalities in the U.S. have passed novel policies to curb the proliferation of these stores. The purpose of this scan is to create a legal database to inform future healthy retail policies and programs. Legal mapping methods were used to identify local policies aimed at moderating dollar store proliferation. A search yielded 25 policies that met the inclusion criteria, all enacted between 2018 and 2020. Recent policies aiming to slow local dollar store growth were mostly passed in low-income communities of color. All identified policies were passed in either the Midwest or South. The majority of municipalities that passed the policies had populations where more than half of residents identified as non-Hispanic Black or Hispanic and where the poverty rate was greater than the national average. Twelve (48%) municipalities imposed temporary moratoria halting new dollar stores from opening, and ten (40%) banned new construction within a specified distance of an existing dollar store. Key themes identified from analysis of policies’ purpose statements included increasing healthy food availability, diversifying local businesses, and improving community safety. These findings may be useful to leaders in other communities seeking to potentially moderate the impact of dollar stores on community health, as well as researchers and policy makers seeking to evaluate the efficacy of existing policies.

United for health to improve urban food environments across five underserved communities: a cross-sector coalition approach

BackgroundCross-sector coalitions can be a powerful vehicle to promote adoption and implementation of evidence-based programs and policies across diverse racial/ethnic communities with a high chronic disease burden. Few studies have examined coalition composition, function, or capacity to promote learning among members.MethodsWe used a mixed methods approach to examine the United for Health coalition’s implementation of multiple food environment interventions across five low-income communities of color in Los Angeles, California (USA). At the coalition-level, key measures included the collaborative environment, membership characteristics, process and structure, communication, resources, strengths, challenges/barriers, and community impact. At the organizational- and individual-levels, we collected data on participation, leadership development, intraorganizational change, perceived benefits, and learning outcomes.FindingsOverall, the United for Health coalition produced five community gardens, three pop-up produce markets, and one farmers’ market; members also expanded Electronic Benefits Transfer (EBT) access at three existing farmers’ markets. Findings indicate early coalition strengths included having a mutual purpose, which was maintained throughout the study period. Coalition participation and engagement was consistently high, while coalition and inter-organizational communication improved over time. Strengths were membership diversity and the availability of learning opportunities. Benefits included leadership development and strategic alignment across organizations. Members demonstrated an increased awareness of the importance of culturally adapted interventions and knowledge of community health planning topics. Key implementation challenges were a lack of resources and social context barriers.ConclusionsExamining coalition function and maturation in a real-world context reveals important lessons for scholars and practitioners committed to addressing nutrition-related health disparities in marginalized and historically underserved communities. Future work should investigate the sustainability of externally funded cross-sector coalitions after funding ceases.

Contextual Considerations of Green Stormwater Infrastructure Siting

Green infrastructure increasingly is used to ameliorate water quality and quantity problems caused by runoff in cities. Studies show how the spatial distribution of these Green Stormwater Infrastructure (GSI) sites are unevenly distributed relative to socioeconomic and demographic groups. Often this is described as an indicator of perpetuated environment injustice, given the purported social and environmental benefits of GSI. To assess equity, researchers often examine either who gets what with respect to environmental ‘goods’ such as tree canopy and other green infrastructures, or investigate the procedures, decision making processes, and power structures pertaining to planning processes. This paper uses both spatial analyses to examine where GSI is located and who lives nearby in New Haven, CT, and illuminates the processes by which those locations were determined. An environmental injustice pattern was not observed: most GSI were located in low-income communities of color. However, the process that led to the siting had very little to do with who was living where. Instead, GSI siting decisions were determined by funding opportunities and their site selection criteria, flooding, combined sewer infrastructure, and avoiding infrastructure conflicts on a street segment. Future spatial analyses could consider the implicit or explicit baselines for equity in light of the processes and constraints that determine how and where GSI gets installed, and better incorporate the process of green infrastructure allocation in the chosen analytical metrics. By examining the process (ie the “how”) and the outcomes (ie the “what went where”) this study broadens the spatial analyses to include embedded knowledge from those who actually make the decisions that ultimately determine the location of GSI.

Through Jean Anyon’s “Screen Door”: The Differentially Racialized Incursion of the Neoliberal State in Milwaukee and Detroit Schools

Background/Context: Research has documented educational neoliberalization as a disrupter of “failing” urban schools and a driver of the remaking of urban space for development interests, through the dislocation of low-income communities of color. Such research draws upon Jean Anyon’s work on cities, schools, race, and inequality, yet undertheorizes the nexus of race and political economy by positing their interplay as straightforward and unvariegated. Purpose/Objective: This article documents differential racialization in neoliberal education reform across two urban contexts—Milwaukee and Detroit—and therewith seeks to build theory aligned with Jean Anyon’s final wish to complicate her work in urban educational political economy with more rich accounts of the intersection of race and political economy. Research Design: This comparative study utilizes discourse analysis of key educational policy documents and ethnographic work with educational policy actors in both contexts. Findings/Results: Market-based educational reform agendas in the two cities’ school systems proceeded from differing assemblages of political actors and regional particularities, and had as primary demonstrative objective different neoliberal outcomes. While in Milwaukee neoliberals capitalized upon Black disaffection from public schools to demonstrate the political viability of diverting public educational funds to the private sector, the imposition of such reform in Detroit buttressed the spatial reorganization of a shrinking city for the purpose of accumulation by dispossession rooted in the real estate market. Conclusions/Recommendations: Drawing upon these findings, the study recommends a more refined critical racial lens to augment Jean Anyon’s political economy, arguing for a more nuanced and practicable understanding of racialized neoliberal urbanism and its contestation.

Procedural Vulnerability and Its Effects on Equitable Post-Disaster Recovery in Low-Income Communities

Problem, research strategy, and findings Equity is a major goal in post-disaster recovery and reconstruction. However, although extensive research demonstrates the connections between race/class and heightened vulnerability to disasters, few examine or name the mechanisms responsible for this correlation. Such mechanisms are referred to as procedural vulnerabilities or historical and ongoing power relations that lead to inequitable outcomes. We interrogate the role of procedural vulnerabilities in generating inequitable recovery by analyzing LUPE et al. v. FEMA (B:08-cv-487 [2008]). This legal case emerged from the experiences of colonia residents in the Río Grande Valley of South Texas following Hurricane Dolly in 2008. From this case, we found that, first, the Federal Emergency Management Agency’s (FEMA’s) unclear definitions of deferred maintenance and insufficient damages negatively affected low-income households. Second, even with clear definitions, post-disaster recovery and reconstruction outcomes would remain inequitable due to historic patterns of disinvestment in the colonias. Takeaway for practice From this case, two key implications for planners emerge. First, planners must acknowledge the historic concerns facing low-income communities of color that lead to inequitable outcomes in FEMA funding. Unincorporated communities of color are less likely to be able to access strong environmental planning, placing them at higher risk of disaster. Second, local stigma surrounding communities can greatly influence the efficacy of post-disaster reconstruction and recovery by predetermining who is or is not “deserving” of assistance. Engaging local histories of racism and prejudice is key to addressing and redressing these inequities.

Mutual Deference Between Hospitals and Courts

This Article explores the phenomenon of “mutual deference” between the medical and legal systems to show that placing mandated reporting responsibilities on clinicians results in lasting harm for families. On the medical side, clinicians are obligated to defer any “reasonable suspicion” that a child may be at risk to the legal system; their concern may be mild or severe, medical or nonmedical in nature. But the legal system, comprised of lay-people in the field of medicine, is illequipped to evaluate a medical concern, and so defers back to the clinician’s report when making critical decisions around family integrity. Thisdeference often functions to elevate a clinician’s “reasonable suspicion” to a finding of “imminent risk,” justifying needless and prolonged separation of families. More systemically, mutual deference creates and reinforces medical and legal associations between low-income communities of color and notions of child maltreatment. Mutual deference insulates the medical reporter and the legal system from liability while imposing tremendous harm on the families caught in the middle. That mandated reporting laws discourage clinicians from considering this harm when deciding whether to report a family reflects the extent to which the family regulation system has prioritized prosecution over supporting families. Efforts to re-envision how society’s support for and protection of families can move away from state-sanctioned violence and towards strengthening families within their communities must begin with removing mandated reporter responsibilities from medical providers.

Teachers Learning to Implement Equitable Classroom Talk

Language in education for children and youth from low-income communities of color, including those learning English as an additional language, has been fraught for decades with ideological entanglements, conceptual ambiguities, and empirical limitations. Meanwhile, the teacher learning challenge to implement equitable teaching practices remains largely unresolved. With an eye toward improving equitable classroom talk (ECT)—that is, meaningful participation in disciplinary practices through communal and connected language interactions—for all students from minoritized communities, we integrate research on additional language development, disciplinary practices, sociocultural classroom interactions, and teacher learning. We recommend researcher-educator collaborations (a) develop indicators of ECT, (b) use lesson videos to make ECT visible, and (c) develop and test materials to support and scale teacher learning to enact ECT.

The cumulative risk of jail incarceration

Research on incarceration has focused on prisons, but jail detention is far more common than imprisonment. Jails are local institutions that detain people before trial or incarcerate them for short sentences for low-level offenses. Research from the 1970s and 1980s viewed jails as "managing the rabble," a small and deeply disadvantaged segment of urban populations that struggled with problems of addiction, mental illness, and homelessness. The 1990s and 2000s marked a period of mass criminalization in which new styles of policing and court processing produced large numbers of criminal cases for minor crimes, concentrated in low-income communities of color. In a period of widespread criminal justice contact for minor offenses, how common is jail incarceration for minority men, particularly in poor neighborhoods? We estimate cumulative risks of jail incarceration with an administrative data file that records all jail admissions and discharges in New York City from 2008 to 2017. Although New York has a low jail incarceration rate, we find that 26.8% of Black men and 16.2% of Latino men, in contrast to only 3% of White men, in New York have been jailed by age 38 y. We also find evidence of high rates of repeated incarceration among Black men and high incarceration risks in high-poverty neighborhoods. Despite the jail's great reach in New York, we also find that the incarcerated population declined in the study period, producing a large reduction in the prevalence of jail incarceration for Black and Latino men.

Recruitment and Retention Strategies for Community-Based Longitudinal Studies in Diverse Urban Neighborhoods.

Longitudinal, natural experiments provide an ideal evaluation approach to better understand the impact of built environment interventions on community health outcomes, particularly health disparities. As there are many participant engagement challenges inherent in the design of large-scale community-based studies, adaptive and iterative participant engagement strategies are critical. This paper shares practical lessons learned from the Physical Activity and Redesigned Community Spaces (PARCS) study, which is an evaluation of the impact of a citywide park renovation initiative on physical activity, psychosocial health, and community well-being. The PARCS study, although ongoing, has developed several approaches to improve participant engagement: building trust with communities, adapting the study protocol to meet participants’ needs and to reflect their capacity for participation, operational flexibility, and developing tracking systems. These strategies may help researchers anticipate and respond to participant engagement challenges in community-based studies, particularly in low-income communities of color.

How health-conscious urban gardeners aim to increase vegetable consumption in their community while simultaneously supporting Black entrepreneurship

While the food justice movement was initially asso¬ciated with increasing availability of fresh produce in low-income communities of color through insti¬tutions such as farmers markets, scholars have cri¬tiqued this as imposing a right way of eating. Food justice scholarship has moved away from a focus on healthy eating toward a focus on community economic development, as food enterprises can stimulate job creation. This paper investigates the dual goals of the food justice movement through a case study in San Diego. While food justice has moved beyond promoting a love of produce and is increasingly oriented toward good jobs, for the urban gardeners in this study, the movement is still a lot about vegetables. They see food as medicine, and note the health benefits of moving toward a plant-based diet. Yet, they are reluctant to push this way of eating on others, as they do not want to come across as elitist. Instead, they spread aware¬ness that plant-based diets are an African tradition that should not just be associated with rich white folks. Rather than leading with nutrition, they lead with tradition, taste, and buying Black. To encour¬age consumption of vegetables, they aim to in¬crease the supply of prepared food options in the community, and to market dishes as delicious rather than healthy, all the while supporting Black food entrepreneurs. When selling produce direct to the consumer through farmers markets does not achieve their vision of promoting health or sup¬porting livelihoods, they re-imagine a strategy of promoting food justice through a neighborhood food supply chain.

Increasing HIV/AIDS knowledge among urban ethnic minority youth: Findings from a community-based prevention intervention program

HIV (Human Immunodeficiency Virus)/AIDs (Acquired immunodeficiency syndrome) prevention and research are imperative. Prevention-intervention programming is minimal in low-income communities of color. Additional research is needed that uncovers points of support and prevention to increase HIV knowledge and awareness and limit new HIV infections among adolescents of color. This study presents preliminary findings from a community-based HIV/AIDS, substance abuse, and viral hepatitis (VH) prevention education intervention for ethnic minority youth in a northeastern urban community. We evaluated HIV/AIDS knowledge and factors associated with knowledge. Participants (N = 599) completed a baseline survey followed by an exit survey measuring HIV/AIDS knowledge. Exit survey findings indicated that there was an increase in HIV/AIDs knowledge. Multivariate regression analyses showed that change scores in VH knowledge accuracy, sexual negotiation skills, risk perception, and ethnic identity were positively associated with change in HIV/AIDs knowledge score. The development and implementation of HIV/AIDS knowledge interventions can be crucial in alleviating new infections in the U.S.

Exploring the Psychosocial Impact of a Mindfulness Workforce Development Program on Instructors of Color: A Qualitative Descriptive Study.

A growing body of literature supports the use of mindfulness-based practices to increase resilience and reduce emotional and behavioral problems of low-income youth of color who are exposed to chronic trauma. The current study, the first of its kind, addresses existing gaps in the literature by examining the social and emotional effects of mindfulness on instructors of color, a largely understudied population. All trainees (n = 25) in a year-long, mindfulness-based workforce development program in Baltimore were invited to participate in this qualitative descriptive study that involved semistructured interviews regarding the personal emotional impact of participating in the program, as well as possible changes in the subjects' perceptions of yoga and the potential role of yoga in their communities. We applied a transcript-based analysis approach to the data from the individual interviews and derived themes using the constant comparative method. Twenty-one trainees (84%) participated in semistructured interviews. Participants were between the ages of 18 and 29 and were predominantly male (71.4%) and African-American (85.7%). We identified four key themes related to participating in the program: (1) changes in emotional functioning and self-perception, (2) changes in interactions with others, (3) changes in perception of yoga and mindfulness, and (4) perceived real-world application of yoga and mindfulness. The current study adds to the literature by exploring the public health implications of mindfulness, particularly in addressing effects of chronic trauma in low-income communities of color. The workforce development program also merits further evaluation as a potential model for enabling local and national nonprofit organizations to offer low-income youth and youth of color employment options that enhance resources in trauma-affected communities.

Student Housing Choices and Neighborhood Change: Brown University 1937–1987

The formal ambitions and societal expectations of anchor institutions have shifted over time. Many universities have evolved from walled-off enclaves, to self-interested urban redevelopers, to mutual gain negotiators. Detailed accounts exist of universities, as anchor institutions, directly displacing low-income communities of color by utilizing the higher education provisions of urban renewal. This case study of Brown University in Providence, Rhode Island, adds to this history by documenting the university’s contribution to the diminution of a working-class neighborhood of color specifically through student residency philosophies and policies, enrollment expansion, and real-estate decisions, during 1937–1987. Brown University’s choices played out in a neighborhood already scarred by interstate highway construction and urban renewal. Drawing from primary source materials on institutional decision-making this work examines the transformation of Brown University’s models of student housing amidst evolving community concerns about the demolition of historic properties and push back around increasing displacement pressures. Several issues and research directions for the new era of equity centered anchor work emerge from this historical recounting of an anchor institution’s student housing choices.