Low-income Urban Neighborhoods Research Articles

Telemedicine in diabetic eye care: A meta-analysis of its effectiveness in underserved populations

Telemedicine has emerged as a promising tool in diabetic eye care, particularly for underserved populations facing barriers to accessing traditional healthcare services. This meta-analysis aims to evaluate the effectiveness of telemedicine interventions in managing diabetic eye conditions within underserved communities. Through a systematic review of existing literature, encompassing diverse telemedicine approaches such as remote screening, teleconsultation, and telemonitoring. These studies were conducted across various regions with underserved populations, including rural areas, low-income urban neighborhoods, and underserved ethnic groups. The meta-analysis revealed significant improvements in several key outcome measures. Firstly, telemedicine interventions led to increased rates of early detection of diabetic retinopathy and other diabetic eye complications, facilitating timely intervention and preventing progression to more severe stages of the disease. Secondly, telemedicine facilitated better access to specialist care, overcoming geographical barriers and reducing the burden of travel for patients. Thirdly, telemedicine interventions were associated with improved patient compliance with follow-up appointments and treatment regimens, leading to better long-term management of diabetic eye conditions. Moreover, subgroup analyses revealed that telemedicine was particularly effective in reaching vulnerable populations such as elderly individuals, those with limited mobility, and ethnic minorities, thereby addressing disparities in healthcare access. Telemedicine holds great promise as an effective tool for diabetic eye care in underserved populations, offering a scalable and cost-effective approach to improving access to timely screening, diagnosis, and management of diabetic eye conditions. Further research and implementation efforts are warranted to optimize telemedicine interventions and ensure equitable access to quality eye care for all.

Hypertension care cascade in an urban resettlement colony and slum in Delhi, India: a cross-sectional survey

BackgroundHypertension care cascade in resource-limited settings is compromised with a majority of patients with hypertension remaining undiagnosed, untreated, non-adherent, and poorly controlled at every stage. However, there is paucity of information on care and management of hypertensive patients in community-based settings of low-income urban neighbourhoods in India.MethodsThis was a community-based cross-sectional study conducted in an urban resettlement colony and slum area in the Northeast District of Delhi. The adult population was screened for hypertension using standardized methods, and adherence to medications was assessed using the Morisky Green Levine scale. Binary logistic regression analysis was conducted to ascertain the sociodemographic predictors of the outcome (presence of hypertension, adherence to antihypertensive medication, blood pressure control). A p-value < 0.05 was considered statistically significant.ResultsWe included 8850 adult participants including 5295 females and 3555 males in this study. Nearly 29% of the participants were hypertensive, of which 61.77% were newly diagnosed cases. Furthermore, nearly 81% of the previously diagnosed cases had been initiated on antihypertensive medication, of which 57.54% were adherent to their medications while 36.12% attained controlled blood pressure levels. The odds of having hypertension were significantly higher among males (AOR = 1.87, 95% CI: 1.63 to 2.15), age ≥ 60 years (AOR = 9.15, 95% CI: 7.82 to 10.70), high waist circumference (AOR = 2.24, 95% CI: 1.86 to 2.70) and Body Mass Index of ≥ 25.00 (AOR = 2.55, 95% CI: 2.00 to 3.26). Furthermore, on adjusted analysis, patients of hypertension having diabetes (DM) comorbidity had significantly higher odds of being adherent to anti-hypertensive medications (AOR = 1.81, 95% CI: 1.31 to 2.51) compared to those without DM comorbidity, while tobacco users had significantly lower odds of being adherent to antihypertensive medication (AOR = 0.50, 95% CI: 0.31 to 0.82).ConclusionsHypertension care cascade in urban slum-resettlement colony setting revealed a high burden of undiagnosed hypertension, low rates of medication adherence, and poor blood pressure control. Strengthening community screening and primary care continuum of care is necessary to improve the hypertension care cascade from early diagnosis to effective management with optimal health outcomes to reduce patient complications and increase longevity.

Patterns of participation in summer programming among United States’ elementary children from low-income urban households: Results from the project SWEAT study

Food insecurity increases among marginalized children during the summer when school is out of session. Summer programming that offers access to healthy meals and snacks may reduce the risk. There is a national call in the US for more research to assure equitable access to summer programming. The objective of this prospective observational study was to characterize patterns of participation in summer programming among elementary children from low-income urban neighborhoods of metropolitan[Blinded]. Summer programming was broadly defined (e.g., church, school, recreation center, community center). Caregivers(n = 100) received weekly text messages via TextIt during the summer (Jun-Aug 2017). They were asked: “How many days this week did [ChildName] attend a summer program? Please respond with a number from 0 to 5, where 0 – no days, 2 – 2 days, etc.” Weekly counts were summed.Stepwise logistic and linear regression models were conducted to examine differences in patterns of attendance according to key sociodemographic characteristics. Mean age was 7.03 ± 0.23. 52 % identified as female, 70 % were low-income, and 80.0 % identified as Black. 51 % attended summer programming at least once; 49 % never attended. Those who attended at least once vs. not at all were more likely to be male(p < 0.01); 62.75 % males vs. 37.25 % females attended summer programming at least once, whereas 67.35 % females compared to 32.65 % males never attended.Overall mean attendance was 10.40 ± 1.43 days(out of 50). Mean + SE attendance was lower for females (7.52 + 1.76) vs. males (13.52 + 2.21)(p < 0.05), and non-Black (4.30 + 1.97) vs. Black (11.93 + 1.67)(p = 0.01) children. Future research is needed to understand barriers to participation in summer programming.

Integrating trauma-informed services in out-of-school time programs to mitigate the impact of community gun violence on youth mental health

Community gun violence disproportionately impacts youth in low-income urban neighborhoods. Integrating trauma-informed mental health care in community-based out-of-school time (OST) programs is an innovative method of service delivery for these youth. This article provides justification for integrating evidence-based, trauma-informed services in OST programs within communities characterized by high rates of violent crime to minimize the impact of violence exposure on youth mental health. We describe the initial feasibility of a model program, the Violence Intervention and Prevention (VIP) Initiative, implemented in a small city in southeastern Pennsylvania. Within the first six months of the VIP Initiative, 95 community residents (90% under age 18; 51% Hispanic) received intervention services, primarily through single-session and short-term weekly group intervention in OST programs, and 80% of OST youth development staff participated in at least one trauma-informed professional development training. Recommendations to enhance and expand the delivery of trauma-informed services in the novel setting of OST programs are provided.

Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, Kenya.

Globally, 350 million under-5s do not have adequate childcare. This may damage their health and development and undermine societal and economic development. Rapid urbanization is changing patterns of work, social structures, and gender norms. Parents, mainly mothers, work long hours for insecure daily wages. To respond to increasing demand, childcare centers have sprung up in informal settlements. However, there is currently little or no support to ensure they provide safe, nurturing care accessible to low-income families. Here, we present the process of co-designing an intervention, delivered by local government community health teams to improve the quality of childcare centers and ultimately the health and development of under-5 children in informal settlements in Kenya. This mixed methods study started with a rapid mapping of the location and basic characteristics of all childcare centers in two informal settlements in Nairobi. Qualitative interviews were conducted with parents and grandparents (n = 44), childcare providers, and community health teams (n = 44). A series of 7 co-design workshops with representatives from government and non-governmental organizations (NGOs), community health teams, and childcare providers were held to design the intervention. Questionnaires to assess the knowledge, attitudes, and practices of community health volunteers (n = 22) and childcare center providers (n = 66) were conducted. In total, 129 childcare centers were identified -55 in Korogocho and 77 in Viwandani. School-based providers dominated in Korogocho (73%) while home-based centers were prevalent in Viwandani (53%). All centers reported minimal support from any organization (19% supported) and this was particularly low among home-based (9%) and center-based (14%) providers. Home-based center providers were the least likely to be trained in early childhood development (20%), hence the co-designed intervention focused on supporting these centers. All co-design stakeholders agreed that with further training, community health volunteers were well placed to support these informal centers. Findings showed that given the context of informal settlements, support for strengthening management within the centers in addition to the core domains of WHO's Nurturing Care Framework was required as a key component of the intervention. Implementing a co-design process embedded within existing community health systems and drawing on the lived experiences of childcare providers and parents in informal settlements facilitated the development of an intervention with the potential for scalability and sustainability. Such interventions are urgently needed as the number of home-based and small center-based informal childcare centers is growing rapidly to meet the demand; yet, they receive little support to improve quality and are largely unregulated. Childcare providers, and government and community health teams were able to co-design an intervention delivered within current public community health structures to support centers in improving nurturing care. Further research on the effectiveness and sustainability of support to private and informal childcare centers in the context of low-income urban neighborhoods is needed.

Urban mosquito distributions are modulated by socioeconomic status and environmental traits in the USA.

The distribution of mosquitoes and associated vector diseases (e.g., West Nile, dengue, and Zika viruses) is likely to be a function of environmental conditions in the landscape. Urban environments are highly heterogeneous in the amount of vegetation, standing water, and concrete structures covering the land at a given time, each having the capacity to influence mosquito abundance and disease transmission. Previous research suggests that socioeconomic status is correlated with the ecology of the landscape, with lower-income neighborhoods generally having more concrete structures and standing water via residential abandonment, garbage dumps, and inadequate sewage. Whether these socioecological factors affect mosquito distributions across urban environments in the USA remains unclear. Here, we present a meta-analysis of 42 paired observations from 18 articles testing how socioeconomic status relates to the overall mosquito burden in urban landscapes in the USA. We also analyzed how socioecological covariates (e.g., abandoned buildings, vegetation, education, and garbage containers) varied across socioeconomic status in the same mosquito studies. The meta-analysis revealed that lower-income neighborhoods (regions with median household incomes <US$50,000 per household per year) are exposed to 63% greater mosquito densities and mosquito-borne illnesses compared with higher-income neighborhoods (≥US$50,000 per household per year). One common species of urban mosquito (Aedes aegypti) showed the strongest relationship with socioeconomic status, with Ae. aegypti being 126% higher in low-income than high-income neighborhoods. We also found that certain socioecological covariates correlated with median household income. Garbage, trash, and plastic containers were found to be 67% higher in low-income neighborhoods, whereas high-income neighborhoods tended to have higher levels of education. Together, these results indicate that socioecological factors can lead to disproportionate impacts of mosquitoes on humans in urban landscapes. Thus, concerted efforts to manage mosquito populations in low-income urban neighborhoods are required to reduce mosquito burden for the communities most vulnerable to human disease.

Why Don’t Scientists Follow the Water Footprint Assessment Manual? Example of One Study

A recently published study by Parra-Orobio et al. looked at a water footprint assessment in low-income urban neighborhoods from developing countries; specifically, this is a case study of the Fátima site in the municipality of Gamarra, Colombia. However, that study deviates significantly from the water footprint methodology described in the Water Footprint Assessment Manual. Therefore, the results of the study cannot be compared with similar studies. In this Letter to the Editors, different parts of the application of the water footprint methodology used in the mentioned study are analyzed and several main deviations from the standard water footprint methodology are pointed out. It is, therefore, suggested that the authors of the article “Assessment of the Water Footprint in Low-Income Urban Neighborhoods from Developing Countries: Case Study Fátima (Gamarra, Colombia)” should expand or modify this article to clarify any deviations from the standard water footprint methodology.

아동의 동네 안전(Neighborhood Safety) 경험에 관한 포토보이스 연구

This paper was undertaken to investigate holistic-understanding on the experiences of children of neighborhood safety and to provide practical implications and design social policy related to their safety. In children’s perspective, this paper may provide some implications to alternative on safe support for children through analyzing their existential experiences. Using photo-voice method, this paper is based on group interview method with six individuals who file ages between 4th to 6th grade of elementary school. They have lived in Seoul City and Kyung-gi District. For reflecting the characteristics of community, research participants come from low-income, middle class and new urban neighborhood of community. As a result, four topics and 25 sub-topics are as follows. First topic is ‘discovering topos-philia, familiar living places’. Children have felt safety at familiar places. Second thing is ‘socially arranged safety devices and facilities’. Children have perceived socially arranged safety devices and facilities in their neighborhood as a safety area. Third topic is ‘being neighbors to protect’. Children had safety experiences when they were with neighbors. Last thing is ‘seeking self-preservation’. Children always have tried to protect self according to one’s own standards. The first thing(‘discovering topos-philia, familiar living places’) and third thing(‘being neighbors to protect’) and last thing(‘seeking self-preservation’) among above topics are new findings. Three findings give some meaningful implications to design social policy and program on neighborhood safety for children. Based on these results, some practical suggestions, research on neighborhood safety for children, developing safety program based on topos-philia, using those who has social networks, extending radius of their life and safety devices within their neighbors, are provided for neighborhood safety for children. In this context, this paper would be established to research, program and social policy for neighborhood safety for children.

On the causes and consequences of the free-roaming dog problem in southern Chile

Free-roaming dogs are an important concern for public health, livestock production and the environment. Human behaviors—such as allowing pets to roam, abandoning dogs, or feeding stray animals—could influence free-roaming dog abundance and the frequency of occurrence of dog-caused problems. Here we aim to determine patterns of free-roaming dog abundance in urban and rural areas, to reveal spatial variation in human behaviors underlying the free-roaming dog problem, and to test for associations between free-roaming dog abundance and related problems. We conducted our study in Chile, where dogs are a major environmental issue. In Chile, as in many other Global South countries, many people leave their dogs to roam, partly due to norms and to lax enforcement of dog control laws. To address our objectives, we counted dogs in 213 transects in urban and rural areas to model dog abundance using N-mixture models. Then we conducted interviews in 553 properties around the transects to determine people's dog management, their behavior towards free-roaming dogs and the prevalence of dog-caused problems. Dog abundance was higher in transects where a higher number of owned dogs was allowed to roam, as well as in lower-income neighborhoods (based on property tax valuation). Meanwhile, rural citizens were more likely to let their dogs' roam. Dog abandonment was reported more frequently in lower-income urban neighborhoods and rural areas. Not surprisingly, we found that several problems—such as dog bites—were more frequent where we detected more free-roaming dogs. Our results highlight that the owned dog population is a central component of the free-roaming dog problem, and that human behavior is the key driver underlying the problem. Dog management programs should promote responsible dog-ownership, with a strong message focused on keeping dogs inside properties and preventing abandonment.

Neighborhood Income Mobility and Risk of Neonatal and Maternal Morbidity

Residing in a low-income neighborhood is generally associated with worse pregnancy outcomes. It is not known if moving from a low- to higher-income area between 2 pregnancies alters the risk of adverse birth outcomes in the subsequent birth compared with women who remain in low-income areas for both births. To compare the risk of adverse maternal and newborn outcomes among women who achieved upward area-level income mobility vs those who did not. This population-based cohort study was completed in Ontario, Canada, from 2002 to 2019, where there is universal health care. Included were all nulliparous women with a first-time singleton birth at 20 to 42 weeks' gestation, each residing in a low-income urban neighborhood at the time of the first birth. All women were then assessed at their second birth. Statistical analysis was conducted from August 2022 to April 2023. Movement from a lowest-income quintile (Q1) neighborhood to any higher-income quintile neighborhood (Q2-Q5) between the first and second birth. The maternal outcome was severe maternal morbidity or mortality (SMM-M) at the second birth hospitalization or up to 42 days post partum. The primary perinatal outcome was severe neonatal morbidity or mortality (SNM-M) within 27 days of the second birth. Relative risks (aRR) and absolute risk differences (aARD) were estimated by adjusting for maternal and infant characteristics. A total of 42 208 (44.1%) women (mean [SD] age at second birth, 30.0 [5.2] years) experienced upward area-level income mobility, and 53 409 (55.9%) women (age at second birth, 29.0 [5.4] years) remained in income Q1 between births. Relative to women who remained in income Q1 between births, those with upward mobility had a lower associated risk of SMM-M (12.0 vs 13.3 per 1000 births), with an aRR of 0.86 (95% CI, 0.78 to 0.93) and aARD of -2.09 per 1000 (95% CI, -3.1 to -0.9 per 1000 ). Likewise, their newborns experienced lower respective rates of SNM-M (48.0 vs 50.9 per 1000 live births), with an aRR of 0.91 (95% CI, 0.87 to 0.95) and aARD of -4.7 per 1000 (95% CI, -6.8 to -2.6 per 1000). In this cohort study of nulliparous women living in low-income areas, those who moved to a higher-income area between births experienced less morbidity and death in their second pregnancy, as did their newborns, compared with those who remained in low-income areas between births. Research is needed to determine whether financial incentives or enhancement of neighborhood factors can reduce adverse maternal and perinatal outcomes.

Assessment of the Water Footprint in Low-Income Urban Neighborhoods from Developing Countries: Case Study Fátima (Gamarra, Colombia)

The increasing pressure on water resources due to population growth and high water consumption, especially in urban areas from tropical developing countries, has led to a rise in water stress. The sustainability analysis of the Total Water Footprint (WFtotal) and the Environmental Sustainability Index (SIblue) are holistic water management tools that allow for establishing pressures over water resources. This study assessed the WFtotal and their components (Blue, Green, and Gray) in the households of a low-income tropical neighborhood in Colombia with sanitation deficiencies. The activities associated with intra-household water use and higher environmental impact were identified, considering socioeconomic conditions and the water quality in the receiving water body, a wetland, through the application of surveys in a sample of households. The results showed that 86.7% of the WF was the WFgreen, followed by the WFgray (13.2%), and finally, the WFblue (0.2%). The high value of the WFgreen was related to food consumption patterns, which varied according to socioeconomic level. Likewise, the SIblue shows that the Baquero wetland presented scarcity scenarios regarding water quality and sedimentation, threatening the environmental service provision from this strategic ecosystem. Finally, tools such as the WFtotal and SIblue help identify strategies that could be implemented to reduce the pressure on the water resources and the water quality degradation in ecosystems relevant to global sustainability as wetlands.

Morbidity and mortality of newborns born to immigrant and nonimmigrant females residing in low-income neighbourhoods.

Living in low-income neighbourhoods and being an immigrant are each independently associated with adverse neonatal outcomes, but it is unknown if disparities exist in the neonatal period for children of immigrant and nonimmigrant females living in low-income areas. We sought to compare the risk of severe neonatal morbidity and mortality (SNMM) between newborns of immigrant and nonimmigrant mothers who resided in low-income neighbourhoods. This population-based cohort study used administrative data for females residing in low-income urban neighbourhoods in Ontario, who had an in-hospital, singleton live birth at 20-42 weeks' gestation, from 2002 to 2019. We defined immigrant status as nonrefugee immigrant or nonimmigrant, further detailed by country of birth and duration of residence in Ontario. The primary outcome was a SNMM composite (with 16 diagnoses, including neonatal death and 7 neonatal procedures as indicators), arising within 0-27 days after birth. We estimated relative risks (RRs) and 95% confidence intervals (CIs) using modified Poisson regression with generalized estimating equations. Our cohort included 148 050 and 266 191 live births among immigrant and nonimmigrant mothers, respectively. Compared with newborns of non-immigrant females, SNMM was less frequent among newborns of immigrant females (49.7 v. 65.6 per 1000 live births), with an adjusted RR of 0.76 (95% CI 0.74 to 0.79). The most frequent SNMM indicator was receipt of ventilatory support. Relative to neonates of nonimmigrant females, the risk of SNMM was highest among those of immigrants from Jamaica (adjusted RR 1.14, 95% CI 1.05 to 1.23) and Ghana (adjusted RR 1.20, 95% CI 1.05 to 1.38), and lowest among those of immigrants from China (adjusted RR 0.44, 95% CI 0.40 to 0.48). Among immigrants, the risk of SNMM declined with shorter duration of residence before the index birth. Within low-income urban areas, newborns of immigrant females had an overall lower risk of SNMM than those of nonimmigrant females, with considerable variation by maternal birthplace and duration of residence. Initiatives should focus on improving preconception health and perinatal care within subgroups of females residing in low-income neighbourhoods.

Multi-omic association study identifies DNA methylation-mediated genotype and smoking exposure effects on lung function in children living in urban settings.

Impaired lung function in early life is associated with the subsequent development of chronic respiratory disease. Most genetic associations with lung function have been identified in adults of European descent and therefore may not represent those most relevant to pediatric populations and populations of different ancestries. In this study, we performed genome-wide association analyses of lung function in a multiethnic cohort of children (n = 1,035) living in low-income urban neighborhoods. We identified one novel locus at the TDRD9 gene in chromosome 14q32.33 associated with percent predicted forced expiratory volume in one second (FEV1) (p = 2.4x10-9; βz = -0.31, 95% CI = -0.41- -0.21). Mendelian randomization and mediation analyses revealed that this genetic effect on FEV1 was partially mediated by DNA methylation levels at this locus in airway epithelial cells, which were also associated with environmental tobacco smoke exposure (p = 0.015). Promoter-enhancer interactions in airway epithelial cells revealed chromatin interaction loops between FEV1-associated variants in TDRD9 and the promoter region of the PPP1R13B gene, a stimulator of p53-mediated apoptosis. Expression of PPP1R13B in airway epithelial cells was significantly associated the FEV1 risk alleles (p = 1.3x10-5; β = 0.12, 95% CI = 0.06-0.17). These combined results highlight a potential novel mechanism for reduced lung function in urban youth resulting from both genetics and smoking exposure.

Urban community gardens in Cape Town, South Africa: navigating land access and land tenure security.

Land tenure security continues to pose a significant challenge to the sustainability of urban community gardens in global South cities. However, a few studies have explored the mechanisms thaturban gardeners employ to facilitate land access and variations in land tenure security arrangements made with land owners in South African cities. This paper employs a mixed-methods research approach involving quantitative and qualitative techniques to examine how urban community gardens access land and land tenure security arrangements thereof. The study is based on questionnaires, semi-structured interviews, and observations from 34 urban community food gardensin Cape Town selected through a combination of purposive and snowball sampling methods across selected low-income urban neighbourhoods. The findings reveal that although formalised land tenure security poses a sustainability threat to community gardens, perceived and de facto tenure present equally crucial forms of tenure which could be supported by state actors to promote urban agriculture. Reflecting on past efforts to formalise land tenure security, the article concludes that these efforts have failed due to poor coordination among government departments, and the complex and unclear processes of acquiring land. The paper recommends that while formalising land tenure arrangements may prove to be an effective solution, supporting institutions need to adopt a bottom-up approach to understand the gardener's needs and build on perceived and de facto land tenure security options to promote the sustainability of community gardening projects.

Small Business Support Is Associated with the Quantity, Quality, and Usage of Youth Physical Activity Opportunities in Urban, Low-Income, African American Neighborhoods.

Evidence suggests small businesses could play a significant role in bringing quality youth physical activity opportunities (YPAOs) to urban areas. Knowing more about their involvement with YPAOs in African American neighborhoods would be of significant value given the relatively low PA rates of African American youth. The current study examined associations between small businesses and YPAOs in low-income, African American urban neighborhoods. Surveys were conducted with 46.4% (n = 223) of eligible small business owners/managers and 44.2% (n = 38) of eligible YPAO providers in 20 low-income, African American urban neighborhoods to ascertain business and YPAO characteristics. Audits were conducted at the YPAOs and parks (n = 28) in the study areas to obtain counts of users and data on amenities/incivilities. Analyses included multiple linear regression. Only 33.6% of all businesses were currently supporting YPAOs. The percentage of businesses supporting only local YPAOs (YPAOs near the business) was significantly associated with the number of YPAOs in the area, number of YPAO amenities, youth participants, teams, amenity quality, and the severity of incivilities after controlling for neighborhood demographics. Businesses supporting only local YPAOs were at their location longer, and their owners were more likely to have a sports background, children, and believe small businesses should support YPAOs than business not supporting local YPAOs. This study provides evidence that YPAOs in low-income, African American urban neighborhoods are improved by support from small businesses. Efforts to enhance PA among African American youth living in low-income urban neighborhoods could benefit from involving small businesses.

Impact of a sanitation intervention on quality of life and mental well-being in low-income urban neighbourhoods of Maputo, Mozambique: an observational study

ObjectivesToilet users often report valuing outcomes such as privacy and safety more highly than reduced disease, but effects of urban sanitation interventions on such outcomes have never been assessed quantitatively....

How ‘smart’ are we with smart technology: comparison of water ATMs in Nairobi and Delhi

Abstract New forms of decentralized water infrastructure with digital projects driven by private investment are being introduced in low-income urban neighborhoods in the global south with the aim of increasing the coverage of affordable and safe water. These ‘smart’ water-vending machines are gaining popularity to meet water demand in growing cities as they are low-cost, transparent, revenue generating and replicable. However, field evidence from Nairobi and Delhi shows that similar technologies implemented to solve similar problems in different geographical and social settings can have completely different outcomes. Smart technologies can offer better outcomes when the implementing agencies and policy makers make smart choices about implementation, setting aside utopian hype.

Providing Post-Disaster Affordable Housing: Lessons from Housing Strategies in Low-Income Urban Neighbourhoods

Providing Post-Disaster Affordable Housing: Lessons from Housing Strategies in Low-Income Urban Neighbourhoods

Clinic navigation and home visits to improve asthma care in low income adults with poorly controlled asthma: Before and during the pandemic

Asthma-related deaths, hospitalizations, and emergency visits are more numerous among low-income patients, yet management guidelines do not address this high-risk group's special needs. We recently demonstrated feasibility, acceptability, and preliminary evidence of effectiveness of two interventions to improve access to care, patient-provider communication, and asthma outcomes: 1) Clinic Intervention (CI): study staff facilitated patient preparations for office visits, attended visits, and afterwards confirmed patient understanding of physician recommendations, and 2) Home Visit (HV) by community health workers for care coordination and informing clinicians of home barriers to managing asthma. The current project, denominated “HAP3,” combines these interventions for greater effectiveness, delivery of guideline-based asthma care, and asthma control for low-income patients recruited from 6 primary care and 3 asthma specialty practices. We assess whether patients of clinicians receiving guideline-relevant, real-time feedback on patient health and home status have better asthma outcomes.In a pragmatic factorial longitudinal trial, HAP3 enrolls 400 adults with uncontrolled asthma living in low-income urban neighborhoods. 100 participants will be randomized to each of four interventions: (1) CI, (2) CI with HVs, (3) CI and real-time feedback to asthma clinician of guideline-relevant elements of patients' current care, or (4) both (2) and (3). The outcomes are asthma control, quality of life, ED visits, hospitalizations, prednisone bursts, and intervention costs. The COVID-19 pandemic struck 6.5 months into recruitment. We describe study development, design, methodology, planned analysis, baseline findings and adaptions to achieve the original aims of improving patient-clinician communication and asthma outcomes despite the markedly changed pandemic environment.

Touristification, commercial gentrification, and experiences of displacement in a disadvantaged neighborhood in Busan, South Korea

ABSTRACT One of the most prominent topics in scholarship on touristification and gentrification is displacement, including not only direct physical displacement, but also the emotional and social impacts associated with indirect displacement. Although research on touristification and gentrification has begun to examine the experiences and perceptions of residents undergoing displacement in low-income urban neighborhoods, it has paid less attention to the spatial characteristics of indirect displacement and the distinctive characteristics of displacement associated specifically with tourism. In Gamcheon Culture Village (GCV) in Busan, South Korea, touristification and commercial gentrification have generated limited direct physical displacement of residents and business owners spatially concentrated in areas adjacent to the main tourist thoroughfare. However, indirect displacement in the sense of displacement pressure and un-homing has a more widespread and complex presence within the community, depending in part on residents’ proximity to tourist activity. In addition, tourism-induced displacement can create dimensions of un-homing less common in typical gentrifying neighborhoods. Our findings suggest a need both for more comparative empirical research on indirect displacement and for urban policies attentive to un-homing associated with touristification and gentrification.