Individuals living in socioeconomically disadvantaged neighborhoods have disproportionately high rates of obesity and related morbidity, including increased risk for diabetes and cardiovascular diseases (CVD). Although previous research has made significant contributions to our understanding of the health consequences associated with neighborhood disadvantage, causal relationships have been difficult to establish due to a reliance on cross-sectional designs, selection biases and limited data on potential mechanisms. Building on the existing research infrastructure developed by our team's previously funded, ongoing natural experiment studies, we have a unique opportunity to study whether changes to the built and social environment, stimulated by substantial ($160 million) economic investment in housing development and neighborhood revitalization, improves cardio-metabolic outcomes in the intervention neighborhood relative to the matched control neighborhood which is not undergoing such changes. The study includes a randomly selected cohort of 732 low-income, African American adults, from two urban neighborhoods (intervention and control communities). Our study will be the first natural experiment to examine the impact of a place-based natural experiment strategy (rather than residential mobility strategy) on clinically relevant cardio-metabolic outcomes (BMI, HbA1c, blood pressure, and lipids) in a high-risk, though understudied, African American population. We will leverage existing data from our previously funded studies on potential mediators, including measures of the built and social environment, and health behaviors including diet, physical activity and sleep (objective and subjective measures). In this proposal, we will add measured cardio-metabolic outcomes, including blood pressure, HbA1c, and lipids. The next stage of economic revitalization of the intervention neighborhood is focused on redevelopment of housing. Thus, in addition, the proposed study is optimally timed to add survey measures of perceptions of housing conditions, neighborhood-level audits of housing conditions, and compilation of secondary data from publically available resources on housing sales, vacancy rates, etc., before and after the housing changes occur. Understanding the impact and pattern of neighborhood revitalization as it unfolds over time is critical in the arsenal of policies to mitigte pervasive racial/ ethnic and socioeconomic disparities in obesity and cardio-metabolic health.
Individuals living in socioeconomically disadvantaged neighborhoods have significantly higher rates of obesity and obesity-related health problems, including cardiovascular diseases (CVD) and diabetes. Our study is the first of its kind to evaluate whether improvements in neighborhood conditions, spurred by substantial neighborhood-level revitalization in a predominantly African American (AA) neighborhood improves residents' cardio-metabolic risk factors (obesity, glycated hemoglobin, cholesterol, and, blood pressure) relative to a comparison neighborhood that is not undergoing such changes. Prior studies of similar redevelopment initiatives lack the comparative research design, and none, to our knowledge, have measured cardio-metabolic risk factors in a high-risk, yet understudied African American resident base. Findings from this longitudinal study would provide critical evidence concerning the causal impact of a major policy initiative to redevelop high-poverty neighborhoods on the cardiovascular health of the community.
