Neighborhood Health Research Articles

A Qualitative Exploration of the Built Environment as a Key Mechanism of Safety and Social Cohesion for Youth in High-Violence Communities

The characteristics of a neighborhood’s built environment may influence health-promoting behaviors, interactions between neighbors, and perceptions of safety. Although some research has reported on how youth in high-violence communities navigate danger, less work has investigated how these youth perceive the built environment, their desires for these spaces, and how these desires relate to their conceptions of safety and perceptions of other residents. To fill this gap, this study used focus group data from 51 youth ages 13–24 living in New Orleans, Louisiana. Four themes were developed using reflexive thematic analysis: community violence is distressing and disruptive, youth use and want to enjoy their neighborhood, systemic failure contributes to negative outcomes, and resources and cooperation create safety. This analysis indicates that young people desire to interact with the built environment despite the threat of community violence. They further identified built environment assets that facilitate socialization and recreation, such as local parks, and social assets in the form of cooperation and neighbor-led civic engagement initiatives. In addition, the youth participants demonstrated awareness of structural inequities that influence neighborhood health and violence-related outcomes. This study contributes to efforts to understand how youth with high levels of community violence exposure understand and interact with the built and social environments.

The Neighbourhood–Health Nexus: Design, Behaviour and Futures

Over the last decade, and more recently with the coronavirus disease 2019 (COVID- 19) pandemic, increased attention has been given to the dynamic between health and urbanism. Features such as city design, the environment, and socioeconomic factors have been studied worldwide. Most studies have focused on a single element of the urban environment, making it difficult to understand the possible influence of related urban features. Furthermore, studies have addressed the issue of urbanism and health on different international, national, urban, and local scales, resulting in multiple inconsistencies. With the enhanced growth of cities, it is argued that the neighbourhood scale is the ideal scale to understand the built environmental–health nexus. More specifically, the paper reviews studies that focus on neighbourhood design and its influence on health, and studies that focus on residents' health-related behaviour. In addition, it maps the key developments in e-health and its expected influence on health services in neighbourhoods. Insights from these reviews are used to offer a preliminary conceptual framework for addressing health in neighbourhoods.

Does the neighborhood built and social environment reduce long-term care costs for Japanese older people? The JAGES2010-2019 cohort study

Japan's population has been aging steadily, evidenced by it spending JPY 11 trillion (USD 110 billion) on annual long-term care (LTC) costs in 2021. In this context, understanding the factors influencing LTC costs has become increasingly vital. Although studies have reported positive relationships between neighborhood environment and health outcomes, the connection between LTC costs and neighborhood environment remains unclear. To address this gap in the literature, this cohort study, conducted from 2010 to 2019 across seven Japanese municipalities and involving 34,982 older people, examined the relationship between eight neighborhood environment elements and the mean monthly cumulate costs (MMCC) of LTC. The results showed that older people who reported the presence of fresh food stores nearby and dangerous places for walking alone at night in the neighborhood had lower MMCC, by JPY 1,367.6 and 1,383.3 per month, respectively, than respondents who did not report the presence of these neighborhood elements. Meanwhile, older people whose neighborhoods had easily accessible facilities had higher MMCC of JPY 739.4. This study's key findings reveal significant relationships between neighborhood environment elements and LTC costs and can be used to support developments in urban design to support healthy aging and reduced LTC costs.

A natural experiment: The opening of a supermarket in a public housing community and impacts on children’s dietary patterns

ObjectiveThe aim of the present study is to utilize a natural experiment and examine changes in dietary patterns of predominantly low-income, racial and ethnic minority children who live in a public housing community following the opening of a new supermarket. MethodsData comes from the Watts Neighborhood Health Study (WNHS), an ongoing study in South Los Angeles, United States, that follows residents of Jordan Downs, a public housing community undergoing redevelopment. Surveys were administered to children aged 9–17 years (n = 297), as well as an adult in the household. The second baseline data collection was conducted June-December 2019, and follow-up was conducted June 2020-April 2021, shortly after the introduction of the new supermarket in January 2020. ANCOVA linear regression models were estimated to examine the association between children’s proximity to the new supermarket with dietary outcomes at follow-up. Interactions with barriers to food access were also explored. ResultsLiving close to the new supermarket was not significantly associated with dietary outcomes at follow-up. However, for children who lived in households with no vehicle access, living close to the new supermarket was associated with increased fruit and vegetable consumption, compared to children in the comparison group. ConclusionProximity to the new supermarket was not associated with improved dietary outcomes among children unless they had transportation barriers. This adds to the growing body of literature that suggests that the effects of neighborhood food environments may be modified by individuals’ mobility, and that comprehensive interventions are needed.

Women, participation and development: an important relationship in the search for better health care conditions

This paper aims to discuss women, participation and development in the practices of health care. We analyze women and the participation process into health, especially in the Health Councils and Conferences. The methodological approach is inspired in the ethnography, which involves fieldwork, writing and data analysis that take into account the time spent in the research, the involvement of the researcher during the whole process, and the moments of thoughts about the implications, we have had with the experience. The main idea of this work is to study the fieldwork on participation process in the health care system. We attended the meetings of some local health councils, conducted some interviews and attended the Health Conferences in Sergipe. This work has been developed in a problematic context in which health care has suffering budget cuts, reflected in the everyday practices of people who needs the Unified Health System. The focus of this work relays on the discussion of the important role women have to play to search for better health care conditions, not only in their families, but also in their neighborhood and other health care dimensions. The research has shown that women have an interesting political commitment that we seek to analyze and connect to the everyday practices of health. In spite of women are minority in parties and elections, they are the majority in the participation process on health care and the quality of life in the environment.

Neighbourhood Health Inequalities between Ethnic Groups in England: An Application of Ecological Inference

Ecological inference has had primarily political science applications, but this study considers an application to assess variations in neighbourhood mental health between population sub-groups. The methodology used has particular utility when neighbourhood health data are available only in aggregate form, without disaggregation (e.g. by ethnic or socioeconomic group). The ecological inference approach is shown to provide insights into contextual effects, where neighbourhood features influence disease variations between sub-groups (e.g. the ethnic density effect on psychosis among non-white groups). The present study also highlights important issues raised by the data’s geographic framework, namely strong spatial clustering in the outcome, and compares spatial error and spatial lag methods to represent this spatial patterning appropriately. The study considers neighbourhood variations in psychosis between four ethnic groups, with a spatial framework provided by 32,844 small areas (Lower Super Output Areas, LSOAs) in England.

Association Between Neighborhood Opportunity, Allostatic Load, and All-Cause Mortality in Patients With Breast Cancer.

Adverse neighborhood contextual factors may affect breast cancer outcomes through environmental, psychosocial, and biological pathways. The objective of this study is to examine the relationship between allostatic load (AL), neighborhood opportunity, and all-cause mortality among patients with breast cancer. Women age 18 years and older with newly diagnosed stage I-III breast cancer who received surgical treatment between January 1, 2012, and December 31, 2020, at a National Cancer Institute Comprehensive Cancer Center were identified. Neighborhood opportunity was operationalized using the 2014-2018 Ohio Opportunity Index (OOI), a composite measure derived from neighborhood level transportation, education, employment, health, housing, crime, and environment. Logistic and Cox regression models tested associations between the OOI, AL, and all-cause mortality. The study cohort included 4,089 patients. Residence in neighborhoods with low OOI was associated with high AL (adjusted odds ratio, 1.21 [95% CI, 1.05 to 1.40]). On adjusted analysis, low OOI was associated with greater risk of all-cause mortality (adjusted hazard ratio [aHR], 1.45 [95% CI, 1.11 to 1.89]). Relative to the highest (99th percentile) level of opportunity, risk of all-cause mortality steeply increased up to the 70th percentile, at which point the rate of increase plateaued. There was no interaction between the composite OOI and AL on all-cause mortality (P = .12). However, there was a higher mortality risk among patients with high AL residing in lower-opportunity environments (aHR, 1.96), but not in higher-opportunity environments (aHR, 1.02; P interaction = .02). Lower neighborhood opportunity was associated with higher AL and greater risk of all-cause mortality among patients with breast cancer. Additionally, environmental factors and AL interacted to influence all-cause mortality. Future studies should focus on interventions at the neighborhood and individual level to address socioeconomically based disparities in breast cancer.

Heterogeneity in COVID-19 vaccine uptake within low-income minority communities: evidence from the watts neighborhood health study

BackgroundThe literature on disparities in COVID-19 vaccine uptake focuses primarily on the differences between White versus non-White individuals or differences by socioeconomic status. Much less is known about disparities in vaccine uptake within low-income, minority communities and its correlates.MethodsThis study investigates disparities in COVID-19 vaccination uptake within racial and ethnic minoritized communities with similar socioeconomic backgrounds and built environments, specifically focusing on Black-Hispanic disparities and disparities within the Hispanic community by country of origin. Data are analyzed from the fourth wave (June 2021- May 2022) of the Watts Neighborhood Health Study, a cohort study of public housing residents in south Los Angeles, CA. Linear probability models estimated the association between vaccine uptake and participants’ race/ethnicity, sequentially adding controls for sociodemographic characteristics, health care access and insurance, prior infection, and attitudes towards COVID-19 vaccines. Differences in reasons for vaccination status by race/ethnicity were also tested.ResultsMexican Hispanic and non-Mexican Hispanic participants were 31% points (95% CI: 0.21, 0.41, p < 0.001) and 44% points (95% CI: 0.32, 0.56, p < 0.001) more likely to be vaccinated than non-Hispanic Black participants, respectively. The disparity between Black and Hispanic participants was reduced by about 40% after controlling for attitudes towards COVID-19 vaccines. Among Hispanic participants, non-Mexican participants were 13% points (95% CI: 0.03, 0.24, p = 0.01) more likely to be vaccinated than Mexican participants, however, these differences were no longer significant after controlling for individual and household characteristics (β = 0.04, 95% CI: -0.07, 0.15, p = 0.44).ConclusionThere are sizeable racial and ethnic COVID-19 vaccination disparities even within low-income and minoritized communities. Accounting for this heterogeneity and its correlates can be critically important for public health efforts to ensure vaccine equity.

The neighbourhood effect on mental well-being in the Global South

ABSTRACT Although individual mental health is a growing concern for the Global South, the southern literature on health and planning has paid limited attention to space-sensitive neighbourhood studies on addressing the crisis. This paper highlights the importance of a holistic neighbourhood environment in shaping the mental well-being of citizens. Through a cross-sectional study of 14,222 households in 272 neighbourhoods of 13 cities across seven countries, the paper claims that there is a place effect on the mental well-being of citizens in rapidly urbanising Asian and African cities. This study demonstrates that the diverse physical and social attributes of neighbourhoods influence mental well-being. Better coverage of neighbourhood services, improved waste disposal services, quality neighbourhood health facilities and educational opportunities, high family solvency, safety, trust in neighbours, dwelling satisfaction, and habits of exercise are found to be the most influential attributes for good mental well-being. However, institutional attributes, like political leadership for neighbourhood management and neighbourhood-level associations, are less likely to be associated with good mental well-being. As the significance of influential attributes varies among neighbourhood wealth categories, cities and countries, a shift towards a place- and context-specific neighbourhood approach for policymaking can best address the mental well-being in rapidly urbanising cities in the Global South.

A greening theory of change: How neighborhood greening impacts adolescent health disparities.

Neighborhoods are one of the key determinants of health disparities among young people in the United States. While neighborhood deprivation can exacerbate health disparities, amenities such as quality parks and greenspace can support adolescent health. Existing conceptual frameworks of greening-health largely focus on greenspace exposures, rather than greening interventions. In this paper, we develop and propose a Greening Theory of Change that explains how greening initiatives might affect adolescent health in deprived neighborhoods. The theory situates greening activities and possible mechanisms of change in the context of their ability to modify distal social determinants of health factors, stemming from macrostructural and historical processes that lead to resource inequalities, affecting both the social and built environment in which adolescents live and develop. The framework illustrates both short- and long-term health, economic, and security effects of greening. We also describe how the theory informed the development of Project VITAL (Vacant lot Improvement to Transform Adolescent Lives) in Baltimore, MD, which aims to (1) build a citywide sharable database on vacant lot restoration activities, (2) evaluate the impact of greening initiatives on adolescent health outcomes, (3) conduct cost-effectiveness analyses, and (4) develop best practices for greening programs for improved adolescent health.

Assessment of Slaughter Slabs Waste Management on Meat, Environment and Public Health in Khartoum State

Stratified random sampling was adopted for this study to detect and interprets the impacts of three slaughter slabs’ waste on the public and environmental health. While hazard analysis critical control points (HACCP) prerequisite programs (PRPs) in the investigated slaughter slabs were assessed by administering structured checklist. Verification for these PRPs by microbiological quality of meat was determined using both Aerobic Plate Count (APC) and Total Coliform Count (TCC). In addition, the assessment of the awareness of neighborhood residence pertaining public health and environmental hazards implications of the slaughter slabs waste was done by administering two semi-structured questionnaires; the first of which targeted 50 respondents of neighborhood residence and the other targeted 10 hospitals located at the vicinity of the slaughter slabs and contained questions pertaining to medical staff perceptions and medical records of cases diagnosed as public health diseases. The result revealed that the three slaughter slabs failed to attain compliance with FAO requirements. This was reflected in the higher microbial content of meat samples with mean total bacteria count (TBC) 16. 7× 10 5; 16. 6 × 105 and 13.9 × 105 in slaughter slabs A, B and C, respectively. A highly statistically significant difference was found in the TBC between the three slaughter slabs with P &lt; 0.05. These values were higher than the standard permissible limit (1× 105). Moreover, the mean total coliform count using (MPN) in the three slabs were 263, 418 and 361 in slaughter slab A, B and C, respectively with a higher significant difference in the TCC compared to the standard permissible limit (1×102) of MPN. The results also showed that 90% of the respondents agreed that there were public and environmental hazards of slaughter slab waste to residential neighborhoods. The findings also disclosed that 100% of the investigated physicians in charge of hospitals in the vicinity of slaughter slabs confirmed that there was association between slaughter slab waste and infectious diseases, gastro-intestinal infections as well as spread of respiratory infection. It could be concluded that slaughter slabs’ waste had negatively impacted both public and environmental health of the residential neighborhoods.

Uncovering the determinants of health in deprived urban neighborhoods in Accra, Ghana: a qualitative and participatory reconnaissance study.

Delivering primary care services within the context of rapid urbanization and a changing disease burden is a major challenge in sub-Saharan Africa. Rural models of primary care, including the "Community-based Health Planning and Services" (CHPS) programme in Ghana, have shown improved health outcomes. However, adapting these to the urban context has proved problematic. Differences in the determinants of health found in these settings may help to explain the challenges of delivering CHPS in poor urban neighborhoods in Accra. To inform the redesign of CHPS for the urban context, we aimed to understand the determinants driving health and engagement with health services in three informal settlements in Accra. This study formed a reconnaissance phase for a subsequent participatory action research study. We used qualitative and participatory methods to explore the influence of wider and proximal determinants on health and the use and perceptions of CHPS. Three transect walks with community leaders across the study settings informed interview guides and the recruitment of suitable participants for key informant and focus group interviews. Using a Framework Approach, we analysed transcripts and reports from these activities and developed themes and sub-themes in participants' experiences accessing healthcare. Our findings highlight the importance of wider and proximal determinants of health including physical environment, gender and other social stratifiers including age, ethnicity, religion and disability, on health, health seeking behavior and personal behaviors such as substance misuse, tobacco use and alcohol. Utilization of CHPS was low and seen primarily as a service for maternal and child health. Private providers, ranging from informal drug stores to private clinics, were used most commonly. Community leaders and groups were active, but engagement was limited by opportunity costs for members. Traditional service delivery packages need to be adapted to include non-communicable diseases driven by risk behaviors such as tobacco, unhealthy diet, alcohol and substance abuse. Assets such as volunteerism and nurses embedded within communities are challenging to attain in complex urban settings, yet other assets exist including occupational associations and a range of informal and private providers that could support delivery of preventive and promotive health care with equitable reach.

Connecting to Community: A Social Identity Approach to Neighborhood Mental Health

Academic Integrative theorizing is needed to advance our understanding of the relationship between where a person lives and their mental health. To this end, we introduce a social identity model that provides an integrated explanation of the ways in which social-psychological processes mediate and moderate the links between neighborhood and mental health. In developing this model, we first review existing models that are derived primarily from a resource-availability perspective informed by research in social epidemiology, health geography, and urban sociology. Building on these, the social identity model implicates neighborhood identification in four key pathways between residents’ local environment and their mental health. We review a wealth of recent research that supports this model and which speaks to its capacity to integrate and extend insights from established models. We also explore the implications of the social identity approach for policy and intervention. Public We need to understand the connection between where people live and their mental health better than we do. This article helps us do this by presenting an integrated model of the way that social and psychological factors affect the relationship between someone’s neighborhood and their mental health. This model builds on insights from social epidemiology, health geography, and urban sociology. Its distinct and novel contribution is to point to the importance of four pathways through which neighborhood identification shapes residents’ mental health. A large body of recent research supports this model and highlights its potential to integrate and expand upon existing theories. We also discuss how our model can inform policies and interventions that seek to improve mental health outcomes in communities.

NEIGHBORHOOD DISADVANTAGE AND PHYSICAL FUNCTIONING: EXPLORING GENDER-SPECIFIC MECHANISMS

Abstract The relationship between poverty status and functional limitation among late middle age and older adults is well-established. However, the contextual effect of neighborhood disadvantage on physical functioning is less clear. First, the potential pathways linking the two are largely unexplored. Extant evidence shows that perceived neighborhood safety and order are significant predictors of physical functioning. Moreover, stress eating is a common coping strategy for stressful life events and contexts. These three explanations potentially mediate the relationship between poverty rate and physical functioning. Second, even though existing evidence finds stark gender difference in physical functioning, the explanations for the gender difference remains largely unknown. We propose that gender-specific mechanisms can explain the gender difference in physical functioning. The goal of the study was to test the gender-specific mechanism thesis based on a nationally representative sample of adults 55 to 93 years of age in the MIDUS 2 and 3 data (N = 2099). We employed Multilevel Generalized Structural Equation Modeling to test the gender-specific mediating roles of the three mediators. Results showed that county-level poverty rate is significantly associated with instrumental activities of daily living (IADL) among women and men. In contrast, perceived neighborhood safety and stress eating significantly mediate the relationship between poverty rate and physical functioning among women but not men. Furthermore, the indirect effect among women is significantly larger than among men. The important findings support gender-specific mechanisms linking neighborhood disadvantage and health and highlight the role of subjective neighborhood indicators among older women.

NEIGHBORHOOD CHARACTERISTICS AND SLEEP PROBLEMS: MEDIATING ROLES OF HEALTH BEHAVIORS AND MENTAL HEALTH

Abstract Existing studies have well-documented the relationship between the neighborhood environment and health among older adults. Yet very few have focused on how the neighborhood environment predicts late-life sleep quality. Using longitudinal data (Rounds 7-9) from the National Health and Aging Trends Study, this study examined the cross-sectional and longitudinal associations between neighborhood characteristics (physical disorder and social cohesion) and sleep problems among Americans aged 65 or older, as well as whether health behaviors and mental health mediated these associations. The analytical sample included 4,029 adults aged 65 or older. Logistic regressions with a lagged dependent variable were adopted to test longitudinal associations. Longitudinal mediation analyses were also used to examine the mediation effects of health behaviors and mental health. The results suggested that neighborhood physical disorder was a significant predictor of sleep problems cross-sectionally, whereas social cohesion was both cross-sectionally and longitudinally associated with sleep problems. Moreover, mediation analysis revealed that health behaviors and mental health significantly mediated the longitudinal relationship between social cohesion and sleep problems, though the strength of the indirect effect diminished over time. These findings suggest that neighborhood physical disorder and social cohesion are significant predictors of late-life sleep problems among older Americans. The study also highlighted older adults’ resilience and adaptability to adverse neighborhood environments and the long-term health benefits of social cohesion in late-life sleep quality. Therefore, community health interventions that facilitate older adults’ physical and social activity, along with mental health programs, may help community-dwelling older adults improve their sleep quality.

NEIGHBORHOOD HEALTH CARE FACILITIES AND INCIDENT DEMENTIA: RESULTS FROM THE EINSTEIN AGING STUDY

Abstract Though access to health care is associated with improved chronic health outcomes, data on dementia risk are limited. From the Ecological Model of Aging, limited access to health care facilities may be associated with increased likelihood of developing dementia through poor management of comorbidities. The current study aims to investigate the association between the density of neighborhood health care facilities and incident dementia. Participants were community-dwelling older adults, systematically recruited from Bronx, NY (N=1,461, mean age=78.4; mean follow-ups=4.6 years; 68% non-Hispanic White, 26% non-Hispanic Black). Density of health care facilities in each participant’s Census Tract was derived from the National Establishment Time-Series data. We used Cox proportional hazards models using age as the time scale and adjusted for sex, race, education, income, and neighborhood deprivation. Incident dementia developed in 10% of the sample. Older adults living in the areas with lower density of health care facilities, compared to those living areas with a higher density of health care facilities, were at increased risk for incident dementia (HR=1.79, 95% CI=[1.12, 2.87] for lowest vs. highest tertile; HR=1.65, 95% CI=[1.02, 2.66] for intermediate vs. highest tertile). Further controlling for cardiovascular and other comorbidities did not change the pattern of results. The current results suggest that unequal distribution of health care facilities across geographic locations may help account for cognitive health disparities among older adults. Future studies will need to identify behavioral and individual-level mechanisms (e.g., healthcare use, better treatment before disease occurs) in the association between neighborhood health care facilities and dementia.

Neighborhood effects on the health of elderly persons: evidence from China

BackgroundPresently, global aging has become increasingly serious, whereas the health concerns brought by aging have become a public issue that warrants an urgent solution from all countries across the world. Therefore, this research paper discusses the influence of neighborhood health on elderly individuals’ health, and extending a realistic basis for the other economies to improve the neighborhood environment and promote the health of the elderly.MethodsBased on the data of CHARLS2018, this research paper adopts the samples that fulfill the study requirements (N = 7326). we constructed a comprehensive research framework integrating oprobit regression model, heterogeneity analysis, conditional mixed process(CMP)robustness testing, Furthermore, the KHB decomposition method is implemented to ascertain the influential mechanism of NMH and NPH on the mental- and physical health of elderly persons.ResultsThe oprobit regression model analysis indicates that NMH 0.434 and NPH 0.550 exert positive influences on the elderly’s mental- and physical health. Meanwhile, the effects of conditional mixed process on NMH and NPH stand at 0.381 and4.372, which are different from the oprobit regression results; thereby, indicating the existence of endogeneity. Afterward, KHB mediating effect confirms that Internet use, gift reciprocity, and charity activity contribute 30.21% and 16.83% to mental- and physical health, respectively.ConclusionsFirstly, the NMH and NPH demonstrate a positive influence on the mental- and physical health of the elder population. However, there exist heterogeneous differences. Secondly, the conditional mixed process deals with the endogeneity of NMH and NPH. Thirdly, social integration, social interaction, and social engagement serve as significant transmission mechanisms for the influences of NMH and NPH on the health of elderly persons.

GIS-Based Assessments of Neighborhood Food Environments and Chronic Conditions: An Overview of Methodologies.

The industrial revolution and urbanization fundamentally restructured populations' living circumstances, often with poor impacts on health. As an example, unhealthy food establishments may concentrate in some neighborhoods and, mediated by social and commercial drivers, increase local health risks. To understand the connections between neighborhood food environments and public health, researchers often use geographic information systems (GIS) and spatial statistics to analyze place-based evidence, but such tools require careful application and interpretation. In this article, we summarize the factors shaping neighborhood health in relation to local food environments and outline the use of GIS methodologies to assess associations between the two. We provide an overview of available data sources, analytical approaches, and their strengths and weaknesses. We postulate next steps in GIS integration with forecasting, prediction, and simulation measures to frame implications for local health policies.

Austerity, Health and Public Safety in Low-Income Neighborhoods: Grassroots Responses to the Decline of Local Services in Southeast England

This article uses ethnographic and qualitative research to explore the health implications and social responses of a low-income neighborhood in Southeast England, to more than a decade of austerity policies and declining institutional and welfare support. Findings examine how cuts to public services and welfare programs alongside changes to the area’s social structure shape resident’s perceptions of health risks and threats. Residents pointed to poor levels of mental health that were exacerbated by financial insecurity, the closure of community facilities and difficulties accessing support and professional help. An increase in social disorder and sense of danger within the vicinity were attributed to changes in the area’s social composition and a reduction of policing in the neighborhood, which were an additional cause of anxiety for residents. Many people felt their neighborhood was treated inequitably with regard to law-and-order, health provision and other services designed to address health problems and risks and dangers in their social environment. This institutional vacuum generates unmet health needs facilitating informal practices and methods for managing health, such as through self-provision or using alternative, and more readily available, sources of medical advice and treatment. The demise of older forms of social control and surveillance that ran parallel with closure of the area’s communal spaces had been partly compensated by social media usage, while informal methods of policing were a growing presence in the neighborhood in reaction to rising lawlessness and the ineffectiveness of police and local authorities.

1854. Legionnaires’ Disease Case Exposure Classification Differs by Race and Ethnicity and Neighborhood Health — California, 2011–2021

Abstract Background Legionnaires’ disease (LD) is a severe pneumonia caused by Legionella bacteria transmitted by inhalation of contaminated water droplets found in poorly maintained water systems. During 2012–2020, 53% of California LD patients were white and 14% were black; however, these groups account for only 39% and 6% of the population, respectively. Healthy Places Index (HPI) measures census tract health, which can affect risk for LD, by combining 23 indicators of social and environmental conditions. We assessed associations between race/ethnicity and neighborhood health, with LD case exposure classifications to establish priorities for decreasing LD disparities in California. Methods Using all California LD cases reported during 2011–2021 and six, individual modified Poisson regression models, we estimated incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for associations between race/ethnicity and neighborhood health (using HPI quartile) with three LD case exposure classifications (sporadic, healthcare-associated, or travel-associated). The most advantaged HPI quartile and non-Hispanic white race/ethnicity were the referent groups. All models controlled for birth sex, age, and year. Results Among 4,373 people with LD, 47% were white, 22% were Hispanic, 12% were black, and 22%–28% fell in each HPI quartile. Among cases, 78% were sporadic, 16% were travel-associated, and 5% were healthcare-associated. Black (IRR: 0.69; 95% CI: 0.55, 0.87) and Hispanic (IRR: 0.64; 95% CI: 0.52, 0.77) race/ethnicity were associated with decreased rates of travel-associated LD. Black (IRR: 1.06; 95% CI: 1.01, 1.11) and Hispanic (IRR: 1.11; 95% CI: 1.07, 1.16) race/ethnicity, and living in the least advantaged quartile (IRR: 1.05; 95% CI: 1.01, 1.10) were associated with increased rates of sporadic LD. Healthcare-associated LD was not associated with race/ethnicity or HPI. Conclusion We found evidence of racial and neighborhood disparities in sporadic LD, racial disparities in travel-associated LD, and no evidence of disparities in healthcare-associated LD. Efforts to increase uptake of water management programs in buildings in disadvantaged neighborhoods and travel accommodations might lessen LD burden and disparities in California. Disclosures All Authors: No reported disclosures