A Randomized Controlled Trial of Concentrated Investment in Black Neighborhoods to Address Structural Racism as a Fundamental Cause of Poor Health
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 571
- 试验地点
- 2
- 主要终点
- Psychological Distress
研究概览
简要总结
Black Americans in the US fare worse across nearly every health indicator compared to White individuals. In Philadelphia, the location of this study, these health disparities culminate 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 microclusters, with a total of 720 adults. The investigators hypothesize that this "big push" intervention will have significant impact on overall health and wellbeing.
详细描述
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 preterm 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 adults have higher rates of chronic disease, including diabetes, hypertension, as well as many cancers. These and other forces 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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- None
盲法说明
The investigators are not masked. Our recruitment team will be masked until cluster recruitment is complete. The outcomes assessor will be masked.
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •At least 18 years of age
- •Have the ability to communicate via text messaging
- •Individuals comfortable communicating in English
- •A permanent resident of the home where they are to be enrolled
- •Have knowledge of their household finances
排除标准
- •Individuals who plan to move out of the study microcluster within 6 months
- •Individuals who are unable to fully consent and participate based on recruitment team assessment
研究组 & 干预措施
Control
Participants in the control arm will not receive any of the listed interventions.
Intervention
At the individual level, participants in the intervention arm receive place-based and financial well-being interventions.
These 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
干预措施: Financial Well-being Interventions (Other)
Intervention
At the individual level, participants in the intervention arm receive place-based and financial well-being interventions.
These 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
干预措施: Place-based Interventions (Other)
结局指标
主要结局
Psychological Distress
时间窗: 24 months
Kessler-6 (answers scored 0-24 with higher scores indicating higher levels of psychological distress)
Overall Health Index
时间窗: 24 months
Composite index using method of Anderson (2008) based on three questions: rating of overall health (5-pt Likert ranging from poor to excellent); rating of how health has changed in last 6 months (better, same, worse); and number of days in the last 30 where physical or mental health precluded engagement in usual activities (self-care, work, recreation); (Oregon Health Insurance Experiment)
次要结局
- Poor health(24 months)
- Overall health(24 months)
- Change in overall health(24 months)
- Healthy days(24 months)
- Sleep duration(24 months)
- Short sleep(24 months)
- Healthcare access(24 months)
- Financial well-being(24 months)
- Food insecurity(24 months)
- Income tax filing(24 months)
- Home ownership(24 months)
- Owing on mortgage(24 months)
- Total debt(24 months)
- Participation in public medical benefit programs(24 months)
- Participation in public food benefit programs(24 months)
- Participation in public income support or cash benefit programs(24 months)
- Participation in public home ownership benefit programs(24 months)
- Frequency of greenspace engagment(24 months)
- Time spent in greenspace(24 months)
- Reasons for not spending time in greenspace(24 months)
- Perception of tree cover(24 months)
- Tree planting concerns(24 months)
- Perceived tree health benefits(24 months)
- Perceived stress(24 months)
- Time spent in neighborhood(24 months)
- Neighborhood social capital(24 months)
- Physical disorder(24 months)
- Neighborhood crime rates(Quarterly data from 24 months (8 quarters) prior to enrollment and 12 months (4 quarters) after intervention period complete)
- Nuisance calls(Quarterly data from 24 months (8 quarters) prior to enrollment and 12 months (4 quarters) after intervention period complete)
- Neighborhood crime rates(Quarterly data from 24 months (8 quarters) prior to enrollment and 12 months (4 quarters) post study completion)
- Nuisance calls(Quarterly data from 24 months (8 quarters) prior to enrollment and 12 months (4 quarters) post study completion)
- Hospitalizations(Quarterly/monthly data from 8 quarters/24 months prior to enrollment and at the completion of enrollment)
- Emergency department (ED) visits(Quarterly/monthly data from 8 quarters/24 months prior to enrollment and at the completion of enrollment)
- Ambulatory visits(Quarterly/monthly data from 8 quarters/24 months prior to enrollment and at the completion of enrollment)
研究者
Eugenia Garvin
Assistant Professor
University of Pennsylvania