A Randomized Controlled Trial of Concentrated Investment in Black Neighborhoods to Address Structural Racism as a Fundamental Cause of Poor Child Health
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- University of Pennsylvania
- Enrollment
- 221
- Locations
- 1
- Primary Endpoint
- Child Health Questionnaire Parent Form 28 (CHQ-PF28) Composite Score
Study Overview
Brief Summary
Black children and adults in the United States fare worse across nearly every health indicator compared to White individuals. In Philadelphia, the location of this study, these health disparities result in a stark longevity gap, with average life expectancies in poor, predominantly Black neighborhoods being 20 years lower than in nearby affluent, predominantly White neighborhoods. The investigators will conduct a cluster randomized controlled trial (RCT) of a suite of place- based and financial-wellbeing interventions at the community, organization, and individual/household levels that address the social determinants of racial health disparities. At the community level, the investigators address underinvestment in Black neighborhoods by implementing vacant lot greening, abandoned house remediation, tree planting, and trash cleanup. At the organization level, the investigators partner with community-based financial empowerment providers to develop cross-organizational infrastructure to increase reach and maximize efficiency. At the individual/household levels, the investigators increase access to public benefits, financial counseling and tax preparation services, and emergency cash assistance. The investigators will test this "big push" intervention in 60 Black neighborhood micro-clusters, with a total of 480 children. The investigators hypothesize that this "big push" intervention will have significant impact on children's health and wellbeing.
Detailed Description
Black individuals in the United States fare worse than White individuals across almost every social, economic, and health indicator. The Black health disadvantage starts at birth, reflecting the cumulative toll of racialized social stressors and healthcare discrimination on maternal health and resulting in higher rates of pre-term birth and low birth weight. Black youth are disproportionately exposed to environmental toxins such as lead and adverse childhood events such as financial hardship and neighborhood violence. Black children also have higher rates of chronic disease, including asthma and diabetes. These and other forces result in inequities in child health and well-being and can also impact children's educational and earning potential. Furthermore, these inequities culminate in a stark racial longevity gap: in Philadelphia, the location of this study, life expectancy for people living in a poor, predominantly Black neighborhood is 20 years lower than for people living in a nearby affluent, predominantly White neighborhood.
The fundamental cause of these striking and pervasive disparities is structural racism - the confluence of deep historical, institutional, cultural, and ideological forces that unequally distribute resources and risks across racialized groups. Structural racism patterns health by affecting a range of interconnected, mutually reinforcing social determinants of health at the national, neighborhood, household, and individual levels. Most notably, longstanding, systematic disinvestment has resulted in highly segregated Black neighborhoods with dilapidated environmental conditions and severe economic insecurity within Black households, leading to a "feedback loop of concentrated racial disadvantage," all of which have been strongly tied to poor health.
Most interventions seeking to address racial health disparities focus on individual-level behaviors and outcomes, or individual channels by which structural racism harms health. However, by failing to address upstream social determinants, these interventions have had limited population level impact. A multi-level, multi-component intervention package focused on a range of social determinants of health is necessary to meaningfully address structural racism as a fundamental cause of racial health disparities. In this trial, we aim to implement such a multi-level, multi-component intervention and then evaluate its impact on child health and well-being.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Other
- Masking
- None
Masking Description
The investigators are not masked. Our recruitment team will be masked until cluster recruitment is complete. The outcomes assessor will be masked.
Eligibility Criteria
- Ages
- 3 Years to 19 Years (Child, Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Child is between the ages of 3 and 17 years at the start of the trial (between the ages of 5 and 19 years at the end of the trial)
- •Parent/caregiver is at least 18 years of age
- •Parent/caregiver has the ability to communicate via text messaging
- •Parent/caregiver is comfortable communicating in English
- •Child is a permanent resident of the home where they are to be enrolled
- •Parent/caregiver has knowledge of their household finances
Exclusion Criteria
- •Children who plan to move out of the study microcluster within 6 months
- •Children whose caregivers are unable to fully consent and participate based on CC team assessment
Arms & Interventions
Control Arm
Participants in the control arm will not receive any of the listed interventions
Intervention Arm
At the individual level, participants in the intervention arm will receive place-based and financial well-being interventions.
These will include, at the individual level:
- Tax preparation
- Access to public benefits
- Financial counseling and microgrants
At the neighborhood level:
- Abandoned house remediation
- Trash cleanup
- Vacant lot greening
- Tree planting
Intervention: Assigned Interventions (Other)
Outcomes
Primary Outcomes
Child Health Questionnaire Parent Form 28 (CHQ-PF28) Composite Score
Time Frame: 24 months
Composite index using CHQ-28 scoring method, based on a series of 28 questions focused on overall child health, activity limitation, emotional/behavioral difficulties, mood, relationships, and family cohesion. (Child Health Questionnaire)
Secondary Outcomes
- Caregiver-reported child health care utilization, sick clinic visits(24 months)
- Parent-reported child health(24 months)
- Parenting: Anger with child(24 months)
- Caregiver-reported child health care utilization, well child visits(24 months)
- Caregiver-reported child health care utilization, hospitalization(24 months)
- Difficulty paying medical bills(24 months)
- Average sleep duration(24 months)
- Time spent playing outdoors, weekdays(24 months)
- Screen time(24 months)
- Perceived neighborhood cohesion(24 months)
- Parenting: Difficulty caring for child(24 months)
- School attendance(24 months)
- Health care utilization: emergency room visits(24 months)
- Time spent playing outdoors, weekends(24 months)
- Uninsurance or gaps in insurance(24 months)
- Parenting: Child bothers parent(24 months)
- Parenting: Handling the day-to-day demands of raising children(24 months)
- Rate of low birthweight(24 months)
- Caregiver-reported child health care utilization, emergency room visits(24 months)
- Usual source of care(24 months)
- Forgone health care(24 months)
- Health care utilization: hospitalizations(24 months)
- Perceived safety of child in neighborhood(24 months)
- School performance(24 months)
- Rate of preterm birth(24 months)