Low-income Neighborhoods Research Articles

Prevalence of dementia among people experiencing homelessness in Ontario, Canada: a population-based comparative analysis

BackgroundCognitive decline in people experiencing homelessness (PEH) is an increasingly recognized issue. We compared the prevalence of dementia among PEH to housed individuals in the general population and those living in low-income neighborhoods. ApproachA population-based cross-sectional comparative analysis using linked healthcare administrative data from Ontario, Canada. We included individuals ≥45 years on January 1, 2019 who visited hospital-based ambulatory care (eg, emergency department), were hospitalized, or visited a Community Health Centre in 2019; and identified PEH if they had one or more healthcare records with an indication of homelessness or unstable housing. Prevalence of dementia was ascertained using a validated case definition for Alzheimer’s disease and related dementia. Poisson models were used to generate estimates of prevalence. Findings12,863 PEH, 475,544 low-income comparators, and 2,273,068 general population comparators were assembled. Among these groups, dementia prevalence was 68.7, 62.6, and 51.0 per 1,000, respectively. Descriptively, prevalence ratios between PEH and the comparator groups were highest within the ages of 55-64 and 65-74 in both sexes, ranging from 2.98 to 5.00. After adjusting for age, sex, geographical location of residence, and health conditions associated with dementia, prevalence of dementia among PEH was found to be 1.71 (95% CI: 1.60–1.82) and 1.90 (1.79–2.03) times greater than the low-income and general population comparators, respectively. InterpretationPEH experience high burden of dementia compared to housed populations in Ontario. Findings suggest that PEH may experience dementia at younger ages and may benefit from the development of proactive screening and housing interventions.

Using Administrative Data to Identify Factors Associated with Healthy Development After Experiencing Household Challenge Adversity in Early Childhood

This study aimed to identify factors associated with healthy development after experiencing household challenge adversity in early childhood. A cohort of 42,505 children born in Manitoba, Canada was created using linkable health, social, and education administrative data. Children were divided into 5 groups according to whether they experienced adversity between birth and four years of age in the following categories: 1) having a parent diagnosed with a mental health disorder, 2) having a parent diagnosed with a substance use disorder, 3) having a parent who received income assistance for at least 2 months, 4) experiencing at least one of the 3 adversities, and 5) having none of the adversities listed. For each group, multiple linear regression models were computed to determine the association of the independent variables (age, sex, birth order, team parenting, neighbourhood-level socio-economic status, parent high school completion, being an established resident in Canada, not having a major illness, residential stability, program participation, and connectedness to health care services) on child development, represented by their Early Development Instrument scores. In each group, factors associated with healthy development included at minimum: older age, being female, being firstborn, team parenting, higher neighbourhood-level socio-economic status, parent high school completion, being an established resident in Canada, and not having a major illness. Several of these factors are associated with increased access to material resources. As such, policies that facilitate the delivery of resources to lower-income families and neighbourhoods with lower socioeconomic status could translate into improved developmental outcomes for children.

Long-Term Impact of Community Psychiatric Care on Quality of Life amongst People Living with Schizophrenia: A Systematic Review.

The review examines the long-term impact of community psychiatric care on improving the quality of life of people with schizophrenia. It addresses the global burden of this disorder and the need for effective community-based care strategies. A systematic literature search was conducted in databases such as CINAHL, Medline, Web of Science, Sage and ScienceDirect, with the search lasting until March 2024 and following the PRISMA guidelines. The inclusion criteria targeted studies that addressed the long-term effects of community mental health care for people aged 18 years and older with schizophrenia and included both quantitative and qualitative research designs. Studies unrelated to the research question or with significant methodological flaws were excluded. The risk of bias was assessed using GRADE and GRADECERqual, in addition to critical appraisal using the Joanna Briggs Institute (JBI) checklists. Independent screening and data extraction was performed, with results summarised by thematic analysis. In total, 11 studies met the inclusion criteria and included cross-sectional, cohort, qualitative and randomised controlled trial designs. The results showed that community psychiatric care significantly improves the quality of life, well-being and social integration of people with schizophrenia. Effective interventions identified include psychoeducation, cognitive behavioural therapy, social skills training and individualised care plans. However, challenges such as limited resources, labour shortages and social stigma, particularly in low-income neighbourhoods, were also identified. This study highlights the importance of continuous, personalised, multidisciplinary community-based care for sustainable mental health outcomes. Further research is recommended to investigate the long-term impact and strategies to overcome implementation challenges.

Identifying Racial Disparities in Utilization and Clinical Outcomes of Ambulatory Hip Arthroscopy: Analysis of Temporal Trends and Causal Inference via Machine Learning.

Arthroscopic diagnosis and treatment of femoroacetabular pathology has experienced significant growth in the last 30 years; nevertheless, reduced utilization of orthopaedic procedures has been observed among the underrepresented population. The purpose of this study was to examine racial differences in case incidence rates, outcomes, and complications in patients undergoing hip arthroscopy. It was hypothesized that racial and ethnic minority patients would undergo hip arthroscopy at a decreased rate compared with their White counterparts but that there would be no differences in clinical outcomes. Cross-sectional study. The State Ambulatory Surgery and Services Database and the State Emergency Department Database of New York were queried for patients undergoing hip arthroscopy between 2011 and 2017. Patients were stratified into White and racial and ethnic minority races, and intergroup comparisons were performed for utilization over time, total charges billed per encounter, 90-day emergency department (ED) visits, and revision hip arthroscopy. Temporal trends in the utilization of hip arthroscopy were identified, and racial differences in secondary outcomes were analyzed with a semiparametric method known as targeted maximum likelihood estimation (TMLE) backed by a library of machine learning algorithms. A total of 9745 patients underwent hip arthroscopy during the study period, with 1081 patients of minority race (11.1%). White patients underwent hip arthroscopy at 5.68 (95% CI, 4.98-6.48) times the incidence rate of racial and ethnic minority patients; these incidence rates grew annually at a ratio of 1.11 in White patients compared with 1.03 in racial and ethnic minority patients (P < .001). Based on the TMLE, racial and ethnic minority patients were significantly more likely to incur higher costs (P < .001) and visit the ED within 90 days (P = .049) but had negligible differences in reoperation rates at a 2-year follow-up (P = .53). Subgroup analysis identified that higher likelihood for 90-day ED admissions among racial and ethnic minority patients compared with White patients was associated with Medicare insurance (P = .002), median income in the lowest quartile (P = .012), and residence in low-income neighborhoods (P = .006). Irrespective of insurance status, racial and ethnic minority patients undergo hip arthroscopy at a lower incidence and incur higher costs per surgical encounter.

Exploration of auditory statistical learning, socioeconomic status, and language outcomes in Bangladeshi children: A functional near-infrared spectroscopy study.

Auditory statistical learning, or the ability to detect statistical regularities in continuously presented stimuli, is thought to be one element that underlies language acquisition. Prior studies have uncovered behavioral and neural correlates of statistical learning, yet additional work is needed from low- and middle-income countries to explore whether statistical learning varies across cultures or underlies associations often found between socioeconomic status (SES) and language outcomes. In the present study, we explored the feasibility of using functional near-infrared spectroscopy (fNIRS) to explore auditory statistical learning in Bangladesh, a lower-middle-income country. Participants were 102 2-year-old (M = 25.72 months, SD = 2.07 months) and 125 5-year-old children (M = 62.35 months, SD = 2.46 months) living in a low-income urban neighborhood of Dhaka (average family income of 28,145.13 Bangladeshi Takas or 260.06 U.S. dollars per month). We also collected measures of SES and language outcomes. Brain responses during the statistical learning paradigm could be detected with fNIRS in both two- and 5-year-olds, with 2-year-olds exhibiting a higher response to predictable sequences and 5-year-olds exhibiting higher responses to unpredictable sequences. fNIRS correlates of statistical learning were not related to language outcomes but were associated with SES in the 5-year-old cohort. This study demonstrates the utility of employing fNIRS to study the neural correlates of statistical learning in low- and middle-income countries and the feasibility of expanding the representativeness of the existing literature. These findings also highlight potential areas for inquiry into how SES may relate to individual differences in statistical learning responses. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Clinical Profile of Neurodevelopmental Disorders in Children at a Tertiary Care Center.

Background Neurodevelopmental disorders (NDDs) encompass intricate interactions among genetic, brain, cognitive, emotional, and behavioral processes. These disorders, which are influenced by hereditary and environmental factors, impair personal, social, intellectual, or occupational functioning. Typically emerging early in life, NDDs include conditions such as attention deficit hyperactivity disorder (ADHD), intellectual disability, autism spectrum disorders (ASDs), vision and hearing impairments, motor disorders, and specific learning disabilities. Children from impoverished and low-income neighborhoods are particularly vulnerable. The lack of comprehensive health data and public awareness about these conditions results in limited information regarding the prevalence of neurological illnesses in developing countries. India, with its large and ethnically diverse population, exemplifies this gap. Methods It is a prospective study to detect the prevalence and risk factors of neurodevelopmental disorders in children aged six months to nine years at a tertiary care center. Patient details, clinical findings, and relevant history were recorded on a pre-designed pro forma and analyzed statistically. Results Among the 1000 children in the study, 91 (9.1%) tested positive for NDDs. Among the 91 children who tested positive for NDD, the highest frequency is in the three to four years age group (17.6%), males were found to be in a higher ratio with 75.82%, with the male: female ratio being 3:1. Among the 91 children with NDD, intellectual disability was the most common disorder (20.9%), followed by ADHD (17.6%) and vision impairment (14.3%). Autism spectrum disorders, including autism and Asperger syndrome, and communication disorders, including stuttering and speech disorders, accounted for 13.2% each. Hearing loss was seen in 9.9% of children and multiple disorders were seen in 8.8% of the children from among 91 children. Conclusion Neurodevelopmental disorders are common and often coexist with other conditions. Children from low-income backgrounds are more affected. This study provides valuable insights into the prevalence and characteristics of NDDs in a specific population.

Improving the Expansion of Electricity Services Considering Affordability Issues: A Case Study in Brazilian Low-Income Households

The assurance of universal access to electricity refers to not only physical access to electricity, heating, and/or cooling services but also making them affordable to families. This is the case in Brazil, where physical electricity access reaches more than 99% of the urban population, but a high proportion of households are disconnected due to lack of payment. Affordability is a key factor in planning the expansion and maintenance of the electricity grid. In this paper, therefore, we propose the development of a strategy, called the Payment Capability Indicator (PCI), that provides new information about the relationship between energy cost and family income. The classic indicator, the Ten Percent Rule (TPR), was the base, and empirical research was conducted in two low-income neighborhoods in Paraná state, southern Brazil. The results consider variables that add new information to guide local public policies, combining interventions to improve affordability, energy efficiency, alternatives to energy services and consumer behavioral changes.

The great equalizer? Mixed effects of social infrastructure on diverse encounters in cities

Casual encounters with diverse groups of people in urban spaces have been shown to foster social capital and trust, leading to higher quality of life, civic participation, and community resilience to hazards. To promote such diverse encounters and cultivate social ties, policymakers develop social infrastructure sites, such as community centers, parks, and plazas. However, their effects on the diversity of encounters, compared to baseline sites (e.g., grocery stores), have not been fully understood. In this study, we use a large-scale, privacy-enhanced mobility dataset of >120 K anonymized mobile phone users in the Boston area to evaluate the effects of social infrastructure sites on the observed frequencies of inter-income and inter-race encounters. Contrary to our intuition that all social infrastructure sites promote diverse encounters, we find the effects to be mixed and more nuanced. Overall, parks and social businesses promote more inter-income encounters, while community spaces promote more same-income encounters, but each produces opposite effects for inter-race encounters. Parks and community spaces located in low-income neighborhoods were shown to result in higher inter-income and inter-race encounters compared to ordinary sites, respectively, however, their associations were insignificant in high-income areas. These empirical results suggest that the type of social infrastructure and neighborhood traits may alter levels of diverse encounters.

Exposing Freeway Inequalities in the Suburbs: The Cases of Pasadena and Pacoima

U.S. freeways have come under scrutiny for their adverse impacts on low-income neighborhoods of color, primarily in urban centers. This article offers a comparative historical analysis of the impact of freeways on two communities in Southern California, which were ethnically diverse suburbs. Planning authorities in Pasadena and Pacoima chose freeway routes that displaced a greater share of households of color than the proposed alternatives. Meanwhile, neighboring white, wealthier communities successfully influenced routing decisions in consequential ways. Beyond the visible and immediate effects of the freeways, social inequity and environmental degradation persist in both neighborhoods today.

Disparities in public transport accessibility in London from 2011 to 2021

Addressing urban inequalities has become a pressing concern on both the global sustainable development agenda and for local policy. Improving public transport services is seen as an important area where local governments can exert influence and potentially help reduce inequalities. Existing measures of accessibility used to inform decision-making for public transport infrastructure in London show spatial disparities, yet there is a gap in understanding how these disparities vary across demographic groups and how they evolve over time—whether they are improving or worsening. In this study, we investigate the distribution of public transport accessibility based on ethnicity and income deprivation in London over the past decade. We used data from the Census 2011 and 2021 for area-level ethnicity characteristics, English Indices of Deprivation for income deprivation in 2011 and 2019, and public transport accessibility metrics from Transport for London for 2010 and 2023, all at the small area level using lower super output areas (LSOAs) in Greater London. We found that, on average, public transport accessibility in London has increased over the past decade, with 78% of LSOAs experiencing improvements. Public transport accessibility in London showed an unequal distribution in cross-sectional analyses. Lower income neighbourhoods had poorer accessibility to public transportation in 2011 and 2023 after controlling for car-ownership and population density. These disparities were particularly pronounced for underground accessibility. Temporal analyses revealed that existing inequalities with respect to income deprivation and ethnicity are generally not improving. While wealthier groups benefited most from London Underground service improvements; lower income groups benefited more from bus service improvements. We also found that car ownership levels declined in areas with substantial increases to public transport accessibility and major housing developments, but not in those with moderate improvements.

The 15-minute city dilemma? Balancing local accessibility and gentrification in Gothenburg, Sweden

This article explores the relationships between gentrification and the realization of the 15-minute city vision in the city of Gothenburg, Sweden. Using unique Swedish registry micro-data, we track changes in local accessibility to urban social functions from 2011 to 2017 in neighborhoods experiencing different gentrification processes. Findings reveal a positive association between gentrification and improved local accessibility in low-income neighborhoods experiencing classic gentrification. The findings emphasize the need to balance socio-spatial polarization and 15-minute city planning, particularly in neighborhoods undergoing classic gentrification. Future studies should delve in more detail into potential displacement effects when gentrification and 15-minute city goals intersect.

Synanthropic rodents and urbanization processes: understanding the spatiotemporal pattern of rodent activity during urbanization works in a low-income neighborhood

Synanthropic rodents and urbanization processes: understanding the spatiotemporal pattern of rodent activity during urbanization works in a low-income neighborhood

Low-Income Homeownership and Safety Nets: The Role of Radical Community Practices

ABSTRACT Nonprofit networks that oversee housing accessibility within urban neighbourhoods emerge as crucial arenas for inducing transformative shifts in policy and practice in the United States. However, civil society actors are subject to considerable critique in the discourse on radical planning theory. They are often alleged to be hand in glove with state and market actors in enabling displacement and dispossession of marginalised groups. This study challenges some of these entrenched positions and provides important counter-narratives on the transformative roles of civil society. Delving into the roles of various institutions that facilitate low-income homeownership, community building, and neighbourhood stabilisation, the study reveals that civil society actors present opportunities for subaltern expression, disruptive activism, and structural transformation in power relationalities. Their strategies respond to wealth-building pathways through housing and address intersectional challenges related to identity, citizenship, and access, thus reaffirming their transformative potential in the urban planning discourse.

‘Can we Mec the Municipality?’ Emerging voices of young people in a segregated urban landscape

This article details the failure and success of an action research project that experiments with foregrounding young people’s perspectives in visions of future, sustainable, urban landscapes in Malmö, Sweden. In a range of future-creation workshops, the author, an assistant, and 34 young people aged 15–20 from two low-income neighbourhoods developed analyses, visions, and concrete change proposals for meaningful interventions in Malmö’s urban environment. The primary contribution is the young participants’ analyses of the subjective experience of a segregated urban landscape, the facilitation and contextualisation offered by the action researcher, and the integrative visions and actions that arose. The open-ended approach allowed participants to accentuate both diverse experiences and gathering points (such as a shared metaphor). The article highlights the discursive limits encountered by participatory processes related to urban landscape planning, as well as the methodological openings offered by critical utopian action research to experiment with overcoming these limits.

Leveraging local knowledge for landslide disaster risk reduction in an urban informal settlement in Manado, Indonesia

Disaster preparedness and response, including for landslides, increasingly involves local knowledge. Incorporating contextual, dynamic and experience-based local knowledge leads to greater awareness of the interconnectedness of geological, natural, and social processes. Still, technical literature on urban landslide risk is mainly based on geological and natural dynamics and, to a lesser extent, physical infrastructure. Moreover, although local knowledge is recognized as important in principle for all aspects of disaster risk management, it is not frequently taken as a starting point for identifying contextually specific landslide risk factors in practice. To gain insights into local knowledge on factors contributing to landslide risk, we conducted a qualitative case study within a landslide-prone informal settlement in Manado, Indonesia. The study comprised qualitative household interviews, transect walks, and ethnographic observation. Our findings indicate that anthropogenic factors specific to informal settlements, particularly inadequate solid waste management, may serve as an overlooked risk factor for urban landslides. This is especially problematic in low-income or informal neighborhoods, where detrimental effects of poor solid waste management frequently intersect with heightened vulnerability to various hazards. We therefore advocate systematically incorporating anthropogenic factors into studies of contributing factors to urban landslides. Additionally, we encourage further research into the interactions between inadequate solid waste management and landslide risk. Finally, we call for leveraging local knowledge to enhance policy, planning, and research efforts, with the ultimate goal of fostering safer urban environments for all.

Income differences in time to colon cancer diagnosis.

People with low income have worse outcomes throughout the cancer care continuum; however, little is known about income and the diagnostic interval. We described diagnostic pathways by neighborhood income and investigated the association between income and the diagnostic interval. This was a retrospective cohort study of colon cancer patients diagnosed 2007-2019 in Ontario using routinely collected data. The diagnostic interval was defined as the number of days from the first colon cancer encounter to diagnosis. Asymptomatic pathways were defined as first encounter with a colonoscopy or guaiac fecal occult blood test not occurring in the emergency department and were examined separately from symptomatic pathways. Quantile regression was used to determine the association between neighborhood income quintile and the conditional 50th and 90th percentile diagnostic interval controlling for age, sex, rural residence, and year of diagnosis. A total of 64,303 colon cancer patients were included. Patients residing in the lowest income neighborhoods were more likely to be diagnosed through symptomatic pathways and in the emergency department. Living in low-income neighborhoods was associated with longer 50th and 90th-percentile symptomatic diagnostic intervals compared to patients living in the highest income neighborhoods. For example, the 90th percentile diagnostic interval was 15 days (95% CI 6-23) longer in patients living in the lowest income neighborhoods compared to the highest. These findings reveal income inequities during the diagnostic phase of colon cancer. Future work should determine pathways to reducing inequalities along the diagnostic interval and evaluate screening and diagnostic assessment programs from an equity perspective.

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

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

Stressful Life Events and Depression in Adolescents from Low-Income Neighborhoods: An Investigation of the Role of Working Memory Capacity and Distress Intolerance

Stressful Life Events and Depression in Adolescents from Low-Income Neighborhoods: An Investigation of the Role of Working Memory Capacity and Distress Intolerance

Age Melancholy of Older Mizrahi Women Residing in Tel Aviv as a Social Loss: Exploring Intersections of Health and Social Support in an Ethnographic Study.

Inspired by Freud's "Mourning and Melancholia" and expanding upon his notions within the social context, this article proposes an innovative concept called "age melancholy" to describe the multifaceted elements of social loss experienced by empty nest older adults. While most studies emphasize a psychological-individualist approach to this phenomenon, age melancholy frames older age as a process marked by a loss of social engagements. The findings are grounded in anthropological fieldwork conducted from 2010 to 2013 in a lower-income neighborhood of Tel Aviv. They are based on deductive comprehension of social melancholy, combined with inductive qualitative analyses of 29 meetings within a designated narrative group of older Mizrahi women-Jewish immigrants from Islamic countries. The results reveal that empty nest older adults perceive their loneliness, fragile health, and approaching death as interrelated aspects of social detachment, leading to melancholy. However, whereas their emotional experiences are tainted by age melancholy, it is temporal and contextual and may be mitigated through social support.

Walking cities that are (un)walkable: exploring everyday lived realities in low-income neighbourhoods in Accra

Walking cities that are (un)walkable: exploring everyday lived realities in low-income neighbourhoods in Accra