Neighborhood Access Research Articles

Neighborhood environments and intrinsic capacity interact to affect the health-related quality of life of older people in New Zealand

ObjectivesFollowing the WHO 2015 policy framework, we tested the effects of older people’s intrinsic capacity and their perceptions of their neighborhood environments on mental and physical health-related quality of life (QoL) outcomes across two years. Study designParticipants (mean age = 66) were drawn from two waves of a longitudinal study of aging (n = 2910) in 2016 and 2018. Regression analyses tested the main and interaction effects of intrinsic capacity and neighborhood factors on health-related QoL at T2 (controlling for T1). Main outcome measuresIntrinsic capacity was assessed with number of chronic conditions. Neighborhood perceptions was assessed with measures of housing suitability, neighborhood satisfaction, and neighborhood social cohesion. Health-related QoL was assessed with SF12 physical and mental health component scores. ResultsPerceptions of greater neighborhood accessibility and more trust among neighbours were associated with better mental health-related QoL two years later, but not to changes in physical health-related QoL. A significant interaction between intrinsic capacity and neighborhood access to facilities on physical health-related QoL over time showed that those reporting lower neighborhood access experienced a stronger impact of intrinsic capacity on physical health-related QoL. ConclusionsThe neighborhood environment is important to the wellbeing of older people and is amenable to policy interventions. We need more work on the aspects of the immediate environment that support QoL in older age. This study points to the need for accessible facilities and cohesive neighborhoods to support health.

Abstract P283: Where You Shop and Neighborhood Access to Fruit and Vegetables are Associated With Self-rated and Cardiometabolic Health

Introduction: The food environment, including food retail venues, has been shown to be associated with diet, and many disadvantaged neighborhoods lack access to high quality and affordable healthy foods. Research has sought to understand whether and how the food retail environment influences diet, and it is possible that shopping at different types of stores (e.g. full-service vs discount grocery store) influences diet and self-reported health outcomes. There is limited understanding of whether factors of the food environment and primary shopping location impact cardiometabolic health (blood pressure, HbA1c, cholesterol) and self-rated health. Methods: We report on 459 individuals who participated in a blood draw in 2018 as part of the Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health, a longitudinal natural-experiment study among African American adults from two socioeconomically similar neighborhoods. Participants reported their perceived access to fruit and vegetables within their neighborhood and where they did their primary food shopping. Outcomes include measured height, weight, blood pressure, cholesterol (HDL, Total), HbA1c, and participant’s self-rated health. We employed logistic regression to examine associations between 1) perceived fruit and vegetable availability, quality, and price and 2) primary food shopping store type and reason for shopping there, with cardiometabolic and self-rated health outcomes. Covariates were neighborhood, years lived in neighborhood, age, race, income, education, and marital status. Results: Participants were on average, 60.7 years old (SD=13.9); 81.7% (375 of 459) female; 80.4% (369 of 459) overweight/obese. After covariate adjustment, both more perceived accessibility of purchasing (OR: 0.47, 95% CI: 0.28, 0.79) and pricing of fruits and vegetables (OR: 0.59, 95% CI: 0.36, 0.96) within one’s neighborhood were associated with lower odds of high blood pressure. More accessible purchasing (OR: 0.59, 95% CI: 0.39, 0.90), pricing (OR: 0.62, 95% CI: 0.41, 0.94), and higher quality of fruits and vegetables (OR: 0.64, 95% CI: 0.42, 0.97) within one’s neighborhood were associated with lower odds of poor self-rated health. Doing one’s primary food shopping at a discount grocery store compared to a full-service grocery store was associated with lower odds of being overweight (OR: 0.51, 95% CI: 0.26, 0.99). Choosing a primary food store based on price rather than quality of food was associated with increased odds of high cholesterol (OR: 2.02, 95% CI: 1.19, 3.45). Conclusion: These results suggest that higher perceptions of access to fruits and vegetables in one’s neighborhood and choice of primary food shopping store are important correlates of cardiometabolic health. Further research should look towards understanding how direct food choices made at stores impact cardiometabolic outcomes within this population.

Speed up random walk by leveraging community affiliation information

Large online networks are most massive and opulent data sources these days. The inherent growing demands of analyses related data fetching conflict greatly with network providers’ efforts to protect their digital assets as well as users’ increasing awareness of privacy. Restrictions on web interfaces of online networks prevent third party researchers from gathering sufficient data and further global images of these networks are also hidden. Under such circumstances, only techniques like random walk approaches that can run under local neighborhood access will be adopted to fulfill large online network sampling tasks. Meanwhile, the presence of highly clustered community like structure in large networks leads to random walk’s poor conductance, causing intolerable and hard-to-foresee long mixing time before useful samples can be collected. With lack of techniques incorporate online network topology features being the context, in this paper we focus on taking use of community affiliation information that possibly comes with metadata when querying objects in online networks, and proposed a speeded version of random walk by raising the probability of inter-community edges being selected. Assuming the community structure is well established as promised, the community speeded random walk expects better conductance and faster convergence. Our method forces the sampler to travel rapidly among different communities that conquers the bottlenecks and thus the samples being collected are of higher quality. We also consider the scenario when community affiliation is not directly available, where we apply feature selection algorithms to select features as community.

Neighborhood green spaces, facilities and population density as predictors of activity participation among 8-year-olds: a cross-sectional GIS study based on the Norwegian mother and child cohort study

BackgroundA rapidly growing body of research suggests that qualities of the built environment can promote active living among children and youth. Nevertheless, shortcomings in the current evidence for understanding which built environment characteristics provide opportunities for taking part in activities in childhood remain. This study aimed to examine whether population density, green spaces, and facilities/amenities are associated with participation in leisure-time physical activity (PA), organized activities, and social activities with friends and peers in Norwegian 8-year-olds.MethodsData from a sample of 23,043 children from the Norwegian Mother and Child Cohort Study (MoBa) were linked with geospatial data about the built environment. The questionnaire data reported by mothers provided information on the children’s leisure activities. We computed exposure to neighborhood population density and access to green spaces and facilities/amenities within 800- and 5000-m radii of the participants’ home addresses using geographic information systems. Associations were estimated using logistic regression models.ResultsWe found beneficial associations between having a park within 800-m and more leisure-time PA during the summer. Furthermore, children living in neighborhoods with higher proportions of green space participated in more PA during the winter. More densely populated areas and access to facilities were associated with participation in organized and social activities. Specifically, we observed that more playgrounds/sport fields in the neighborhood were the strongest and most consistent correlate of activity participation in Norwegian 8-year-olds by being related to more socialization with friends and peers.ConclusionThis population-based study underscores the importance of access to a variety of venues and opportunities for different activities in the immediate neighborhood surroundings and in the greater community to support participation in physical activity and organized and social activities in childhood.

Neighborhood Influences on Women's Parenting Practices for Adolescents' Outdoor Play: A Qualitative Study.

Understanding factors that influence parenting decisions for outdoor play is necessary to promote physical activity during critical years for adolescent adjustment. This study explored physical and social environmental influences on parenting decisions and rules for their child’s outdoor play using semistructured in-depth interviews with parents (n = 30, 29 of whom were mothers) of adolescents. Mothers from low- (n = 16) and high-disadvantage (n = 13) neighborhood environments were recruited to identify environmental factors that resulted in parenting decisions that either promoted or hindered outdoor play and identify differences across neighborhood types. Data were analyzed using a grounded theory approach. Mothers limit their child’s independent play, as well as the location and time of outdoor play, due to both social and physical aspects of their neighborhood. Seven themes (safety, social norms, sense of control, social cohesion and neighborhood composition, walkability, and access to safe places for activity) were identified as influencers of parenting practices. Mothers in high-disadvantage neighborhoods reported facing greater neighborhood barriers to letting their child play outside without supervision. Physical and social neighborhood factors interact and differ in low- and high-disadvantage neighborhoods to influence parenting practices for adolescent’s outdoor play. Community-level interventions should target both physical and social environmental factors and be tailored to the neighborhood and target population, in order to attenuate parental constraints on safe outdoor play and ultimately increase physical activity and facilitate adolescent adjustment among developing youth.

The urban exposome framework and a proof-of-concept study

PDS 71: Exposome, Johan Friso Foyer, Floor 1, August 27, 2019, 4:30 PM - 5:30 PM Cities face rapid changes including increasing inequalities and public health issues. Therefore, urban centers should become more resilient, monitor and address all emerging issues with cost-effectively. Using the city and inter-city areas as measurement units, the urban exposome can be defined as the continuous spatiotemporal monitoring of environmental and health indicators with an interdisciplinary approach that combines qualitative and quantitative methods. The urban exposome framework was applied in a proof-of-concept study in Limassol, Cyprus combining: a mixed-methods study on stakeholders’ perceptions, a systematic assessment of secondary data from the cancer, birth and death registries, and a population health and biomonitoring survey. Data collection was conducted in summer 2017. The first results on drinking water and quality of life were described and combined with an agnostic environment-wide association analysis (EWAS). Water quality parameters and participants’ opinions on city life (i.e. neighborhood life, health care and green space access) were mapped using small administrative areas as the reference unit. In the exploratory EWAS analysis, all variables were used (questionnaire responses and water quality metrics) to describe correlations. Overall, urban drinking-water quality using chemical (disinfection byproducts-trihalomethanes) and microbial (coliforms, E. coli, and Enterococci) quality indicators did not raise concerns. General health and having a chronic disease were significantly (FDR-corrected p-value<0.1) associated with different health conditions e.g. hypertension and asthma, as well as having financial issues in access to dental care. Additionally, correlations between water trihalomethanes and participant behaviors (e.g. household cleaning, drinking water habits) were documented. This proof-of-concept study showed the potential of using integrative approaches to develop urban exposome profiles to prospectively identifying within-city differences in environmental and health indicators. The continuous monitoring of the urban exposome will allow stakeholders to timely identify and develop targeted to the city interventions to tackle urban health challenges.

A review of social determinants of prostate cancer risk, stage, and survival.

Social determinants of health that have been examined in relation to prostate cancer incidence, stage at diagnosis, and survival include socioeconomic status (income, education), neighborhood disadvantage, immigration status, social support, and social network. Other social determinants of health include geographic factors such as neighborhood access to health services. Socioeconomic factors influence risk of prostate cancer. Prostate cancer incidence rates tend to be positively associated with socioeconomic status. On the other hand, low socioeconomic status is associated with increased risk of poorer survival. There are well-documented disparities in prostate cancer survival by socioeconomic status, race, education, and census tract–level poverty. The results of this review indicate that social determinants such as poverty, lack of education, immigration status, lack of social support, and social isolation play an important role in prostate cancer stage at diagnosis and survival. To address these social determinants and eliminate cancer disparities, effective interventions that account for the social and environmental contexts in which patients with cancer live and are treated are needed.

Predicting physical activity levels in individuals with schizophrenia through integrated global positioning system and accelerometer data

Research has documented that individuals with schizophrenia spend a significant amount of time in sedentary activity and often do not meet physical activity (PA) guidelines (Stubbs et al., 2016). Environmental factors have long been studied as facilitators or barriers to PA. Among individuals with schizophrenia, environmental factors are known to predict walking and moderate to vigorous PA (Vancampfort et al., 2013). Additionally, environmental characteristics explain 16.8% of sitting time of individuals with schizophrenia (Vancampfort et al., 2014), with factors such as neighborhood infrastructure (e.g., sidewalks or parks) or access to fitness equipment in the home reducing time spent in sedentary behavior. Consistent with Barker’s Behavior Settings Theory (Schoggen, 1989) this study is predicated on the expectation that certain locations are associated with behaviors that involve more or less PA. Thus, there is a need to study current PA levels associated with certain locations in the community, which could lead to development of ecological interventions that are personalized to a person’s time and location preference to maximize PA performance. To address this need, we propose a new methodology called Personalized PA level estimation for specific Locations over time (PerPAL) to better predict PA levels by location. The development of the personalized models involves identifying recurring locations (Townley et al., 2018) for an individual and using their baseline PA data, location, and time-window to predict future PA levels for specific locations (Brusilovskiy et al., 2016) and time-windows.

Social determinants of breast cancer risk, stage, and survival.

Social determinants of health that have been examined in relation to breast cancer incidence, stage at diagnosis, and survival include socioeconomic status (income, education), neighborhood disadvantage, unemployment, racial discrimination, social support, and social network. Other social determinants of health include medical distrust, immigration, status, inadequate housing, food insecurity, and geographic factors such as neighborhood access to health services. Socioeconomic factors influence risk of breast cancer. For all racial/ethnic groups, breast cancer incidence rates tend to be positively associated with socioeconomic status. On the other hand, low socioeconomic status is associated with increased risk of aggressive premenopausal breast cancers as well as late stage of diagnosis and poorer survival. There are well-documented disparities in breast cancer survival by socioeconomic status, race, education, census-tract-level poverty, and access to health insurance and preventive care. Poverty is associated with other factors related to late stage at breast cancer diagnosis and poorer survival such as inadequate health insurance, lack of a primary care physician and poor access to health care. The results of this review indicate that social determinants such as poverty, lack of education, neighborhood disadvantage, residential segregation by race, racial discrimination, lack of social support, and social isolation play an important role in breast cancer stage at diagnosis and survival. To address these social determinants and eliminate cancer disparities, effective interventions are needed that account for the social and environmental contexts in which cancer patients live and are treated.

Spatial accessibility to pediatric primary care in Philadelphia: an area-level cross sectional analysis

BackgroundPediatric primary care visits are a foundational element in the health maintenance of children. Differential access may be a driver of racial inequities in health. We hypothesized that pediatric primary care accessibility would be lowest in neighborhoods with higher proportion of non-Hispanic Black residents.MethodsAnnual ratios (2008–2016) of providers to pediatric population were calculated by census tract in Philadelphia, Pennsylvania. Marginal logistic regression was used to estimate the independent association between neighborhood racial composition and access to pediatric primary care controlling for confounders.ResultsIn general, low access to care was associated with greater neighborhood disadvantage (e.g., SES, % poverty, % public insurance). After controlling for neighborhood indicators of disadvantage, risk of being in the lowest quintile of access significantly increased as the percent of non-Hispanic Black residents increased.ConclusionA new measure of pediatric primary care accessibility demonstrates a persistent disparity in primary care access for predominantly non-Hispanic Black neighborhoods.

Mapping inequality: Childhood asthma and environmental injustice, a case study of St. Louis, Missouri

As a geographic continuum of poverty and affluence has emerged, so too has a geographic continuum of good and poor health. Asthma is currently one of the most prevalent chronic childhood diseases. Over the past three decades, the greatest increases in asthma rates have been in urban areas and have disproportionately affected youth in poverty and those in racial and ethnic minority groups. Neighborhoods serve as a mechanism fostering environmental injustice and perpetuating these disparities in health outcomes and life opportunity for our most vulnerable populations. Using Geographic Information Systems (GIS) methods in a case study of St. Louis Missouri, this study examines local environmental risk by identifying ‘hotspots,’ or statistically significant spatial clustering of high or low levels of childhood asthma, and associations with neighborhood characteristics, socio-demographic characteristics, and access to healthcare resources within these hotspots. Results revealed statistically significant clustering of high asthma rates in areas with more non-White and poor residents, higher rates of public housing, deteriorating housing, and violent crime. High asthma hotspots were also located in areas with limited physical access to healthcare resources, such as physicians and medication, and lower school attendance rates. Residents of these high asthma hotspots experience greater environmental risk, and significant disparities in health and education outcomes, physical and financial healthcare resources, and overall well-being. This study demonstrates these place-based inequalities and presents clear evidence of environmental injustice, supporting the need for investments and interventions to improve the environments, health, and economic resources of our most vulnerable youth.

Residential Care in Los Angeles: evaluating the spatial distribution of facilities and neighbourhood access to care among older adults

ABSTRACTResidential care has increased in number of facilities and has grown in density in urban areas, yet it is disproportionately dispersed in cities and only beginning to meet the current long-term care need of older adults as an alternative to institutional and in-home care. California State Department of Social Services residential care facility data were linked with Los Angeles County census tract data to examine the spatial distribution of facilities through hot spot analysis of clusters of small and large facilities and zero-inflated negative binomial regression of census tract facility counts on older age and race groups, older disabled adults, and older adults in poverty in the area. The results show clusters of large facilities west of downtown Los Angeles and clusters of small facilities in the northern suburbs of the city in the San Fernando Valley. Increases in pre- and early-retired adults and older Hispanics in census tracts are associated with the greatest decreases in facility tract capacity in the area, whereas increases in the oldest old and older disabled adults are associated with the greatest increases. Understanding spatial disparities in residential care can help local agencies and developers plan and partner in more intentional and equitable development of facilities. The greatest opportunity for such development may lie in institutional tools for eldercare facility development such as the eldercare facility ordinance of Los Angeles and development of board and care facilities in residential zones of Los Angeles and other cities.

Highlights of This Issue

Previous studies suggested inflammation increases risk for ovarian cancer while aspirin use decreases risk, though the mechanisms are unknown. Hada and colleagues evaluated prediagnostic circulating levels of 31 lipid molecules, including arachidonic, linoleic, and alpha-linoleic acid metabolites. Metabolites in the linoleic acid pathway, precursors of inflammatory markers, were associated with increased risk of ovarian cancer, supporting a pro-inflammatory mechanism. Further, prostaglandins/thromboxane derived from arachidonic acid via COX pathway were not associated with risk. The identification of novel, risk-related fatty acid metabolites provides mechanistic insights into the etiology of ovarian cancer and supports future research of these pathways.Since the influential contribution by McCormack and dos Santos Silva (CEBP, 2006), no comprehensive meta-analysis of the association between mammographic density and breast cancer has been published. At the same time, the literature has expanded substantially. This article by Bond-Smith and Stone fills this gap and provides guidance on the impact of using different mammographic density measurement and analysis strategies as a risk marker for breast cancer. The authors specifically discuss methodological challenges for meta-analyses with small and noisy data where appropriate estimation of heterogeneity is critical (and frequently neglected) for obtaining reliable and robust clinical findings.Conceptualization, data collection, and analysis at multiple levels can help identify determinants of health disparities that are often systemic. In a study of non-Hispanic white, non-Hispanic black, and Hispanic newly diagnosed female breast cancer patients (N=989), Warnecke and colleagues examined patient resources, neighborhood primary care access, and screening and diagnostic facility characteristics as potential determinants of disparities in stage at diagnosis. The authors found that racial/ethnic differences in mode of breast cancer detection (through screening or symptoms), and differences in the characteristics of facilities where patients are diagnosed, accounted for much of the disparity in later stage at diagnosis.Up to 40% of cancer cases are thought to be attributable to lifestyle factors. Usher-Smith and colleagues developed lifestyle-based models for the five cancers for which the most cases are potentially preventable through lifestyle change in the UK using estimates of relative risk from meta-analyses of observational studies. They assessed the performance of the models in a UK-based cohort and found that the discrimination and calibration of the models are both reasonable. These models could be used to demonstrate the potential impact of lifestyle change on risk of cancer to promote behaviour change.

Do Neighborhoods Matter? A Systematic Review of Modifiable Risk Factors for Obesity among Low Socio-Economic Status Black and Hispanic Children.

Childhood obesity increases the risk of obesity and harmful comorbidities later in life. It is influenced by characteristics of a child's neighborhood, particularly among underserved groups. Our objective was to systematically review the evidence relating neighborhood environment and obesity risk among urban, low socioeconomic status (SES) Black and Hispanic children. We included studies published from 1993 through early 2017 from PubMed, SCOPUS, Web of Science, and Sociological Abstracts databases investigating relationships between empirically measured neighborhood characteristics and obesity risk factors in the populations of interest. Databases were last searched on May 8, 2018. Initial analysis took place during 2014 and was completed during 2017. We extracted data on study population, design, and associations between neighborhood characteristics and obesity risk factors. We identified 2011 unique studies; 24 were included. Few studies demonstrated consistent patterns of association. Most neighborhood characteristics were not examined across multiple studies. BMI may be related to living in a lower-income neighborhood or convenience store access. This review found that the body of evidence relating neighborhood exposures and obesity risk factors among urban, low SES Black (also commonly referred to in the literature as "non-Hispanic Black" or African American) and Hispanic children is limited. Given the high risk of obesity and cardiovascular disease among these populations throughout the life course, research on neighborhood determinants of obesity should specifically include these populations, ensuring adequate power and methodological rigor to detect differences.

Do patients’ SEP influence therapeutic strategy in acute myeloid leukaemia: Results from a French longitudinal observational study

Introduction Several studies highlight the influence of socioeconomic position (SEP) on cancer survival, especially through treatment choice. However, data on hemopathy are scarce. Specific studies on acute myeloid leukaemia (AML) found an association between educational level and access to transplantation, SEP and survival or neighborhood SEP and access to chemotherapy and transplantation. However, these studies were done in countries with heath systems that are not the same as in France. In this study, we investigate the influence of SEP on the treatment received among patients of at least 60 y with AML using data from France, i.e. in settings of tax-supported Health Care System and policy aiming at harmonizing the quality of care as the National ‘cancer plans’. Methods We used data from an observational cohort representative of AML patients of at least 60y treated in MP. This represented 697 patients with an AML diagnosed between 1st January 2009 to 31st December 2014, excluding AML 3 - promyelocytic - subtypes. We built a theoretical model of clinical decision process in which we distinguished 2 steps: access to chemotherapy (first step), and access to an alternative to best supportive care among patients who were not eligible for intensive chemotherapy (second step). Logistic models were used to test, independently for each step, the effect of PSE on treatment received, first without adjustment, and then, after successive adjustment for confounders identified with bivariate analyses (a = 0.2). We measured PSE by the French version of the European Deprivation Index (EDI), an ecological deprivation index already used in several studies addressing social inequalities in cancer management and outcome. Results Analyses on complete data (n = 593 - 85% of included patients) show that, in the first step, disadvantaged patients had a lower probability to be treated by intensive chemotherapy compared to most advantaged patients. However, this association did not persist after adjusting for ‘initial status’, i.e. whether it was an AML de novo or a post-affection AML. No statistically significant association was found between SEP and treatment choice in the second step among patients who was not eligible to intensive chemotherapy. Consistent results were found in sensitivity analyses using alternative coding of EDI and after dealing with missing data using multiple imputation. Conclusion No direct influence of PSE on treatment choice was found in our study among a sample representative of patients of at least 60 y treated for AML in the Midi-Pyrenees region. These results might be seen as an evidence of the efficacy of the regional organization in care network to provide homogeneous quality of care in the territory. Nevertheless, further studies are needed to explore the influence of SEP on the initial status, i.e. AML de novo or AML post-affection.

Differences in the Neighborhood Retail Food Environment and Obesity Among US Children and Adolescents by SNAP Participation

ObjectiveTo understand the association between children’s neighborhood food access and overweight/obesity in a national sample of U.S. households, and whether it differs by Supplemental Nutrition Assistance Program (SNAP) participation or household purchases.MethodsData were from the National Household Food Acquisition and Purchase Survey (2012–2013; n=3,748 children ages 2–18). We used logistic regression to examine associations between neighborhood retail food access (<1-mile from home), food purchases (including sugary beverages), and overweight/obesity, stratified by SNAP status (1,720 participants, 453 eligible non-participants, 1,575 SNAP ineligible). Store types included: supermarkets/grocery, combination grocery/other (independent drug, dollar, and general stores), convenience, fast food, and non-fast food restaurants.ResultsOdds of childhood overweight/obesity (OR [95% CI]) were higher with greater access to combination grocery/other stores overall (1.10 [1.03, 1.17]) and for children in SNAP (1.14 [1.05, 1.24]). Eligible non-SNAP children had higher odds of overweight/obesity with greater access to convenience stores (1.11 [1.04, 1.18]). The average child lived in a household with 6.3% of total spending at food outlets on sugary beverages (SNAP: 8.3%, eligible non-SNAP: 7.7%, SNAP ineligible: 5.5%).ConclusionsGreater neighborhood access to combination grocery/other stores is associated with higher obesity prevalence for children overall and those in SNAP.

Race and Location: The Role Neighborhoods Play in Family Wealth and Well‐Being

AbstractA household’s wealth provides an important form of economic security for a family, as well as enabling parents to invest in children to help them realize their aspirations. Yet in the United States, wealth inequality between white families and families of color who are earning the same incomes has reached startling levels. The racial wealth gap, which reduces the opportunities available to African American families, has proved to be a pernicious and enduring phenomenon since it was first identified in 1990. This article identifies and explores the role of neighborhoods in creating and perpetuating the ongoing racial wealth gap. Wealth available to a family influences the neighborhood a family is able to afford to live in: through wealth available to purchase a home or wealth available to put down a deposit on an apartment. This article makes the case that the neighborhood a family lives in not only influences social outcomes, but also influences how much wealth a family can build over the years, either as a homeowner or a renter. It also discusses the key wealth mechanisms that influence neighborhood access as well as how a household’s neighborhood location influences wealth accumulation. Historical government policies created an inequitable landscape of neighborhoods across the United States. Government policies must seek to address this historical injustice.

Neighborhood crime and access to health-enabling resources in Chicago.

Neighborhood crime may be an important social determinant of health in many high-poverty, urban communities, yet little is known about its relationship with access to health-enabling resources. We recruited an address-based probability sample of 267 participants (ages ≥35 years) on Chicago's South Side between 2012 and 2013. Participants were queried about their perceptions of neighborhood safety and prior experiences of neighborhood crime. Survey data were paired to a comprehensive, directly-observed census of the built environment on the South Side of Chicago. Multivariable logistic regression models were used to examine access to health-enabling resources (potential and realized access) as a function of neighborhood crime (self-reported neighborhood safety and prior experience of theft or property crime), adjusting for sociodemographic characteristics and self-reported health status. Low potential access was defined as a resident having nearest resources >1 mile from home; poor realized access was defined as bypassing nearby potential resources to use resources >1 mile from home. Poor neighborhood safety was associated with low potential access to large grocery stores (AOR = 1.73, 95% CI = 1.04, 2.87), pharmacies (AOR = 2.24, 95% CI = 1.33, 3.77), and fitness resources (AOR = 1.93, 95% CI = 1.15, 3.24), but not small grocery stores. Any prior experience of neighborhood crime was associated with higher adjusted odds of bypassing nearby pharmacies (AOR = 3.78, 95% CI = 1.11, 12.87). Neighborhood crime may be associated with important barriers to accessing health-enabling resources in urban communities with high rates of crime.

Introduction

Introduction

Sanitation and externalities: evidence from early childhood health in rural India

This paper estimates two sources of benefits related to sanitation infrastructure access: a direct benefit households receive when they have access to sanitation infrastructure, and an external benefit produced by the neighborhood's access to sanitation infrastructure. Using a sample of children under age four from rural areas of India in the Third Round of District Level Household Survey 2007–08, the study demonstrates evidence of positive direct benefits and a concave positive externality for improved sanitation and fixed-point defecation. The paper finds that a child who moves from a household without improved sanitation and a low ratio of village access to a household with improved sanitation and a high ratio of village access enjoys a reduction in diarrhea prevalence of 47 percent. From this, one-fourth of this benefit is due to the direct benefit, leaving the rest to external gains. These results hold under several robustness checks.