A randomized trial of abandoned housing remediation, substance abuse and violence

 描述（由申请人提供）：一项关于废弃住房补救、药物滥用和暴力的随机试验。在美国，废弃住房构成了一个主要的健康负担，在过去几十年中显著增加。作为一个典型的美国城市，费城有大约4万处空置房产，其中相当一部分是废弃的住宅建筑或结构。包括我们自己在内的研究表明，空置和废弃的房产与药物依赖、枪支暴力、压力、性传播疾病和过早死亡有关。我们之前的研究还表明，城市居民每天在上班或上学的路上都会看到废弃的建筑物，并将这些不受欢迎的建筑物描述为最重要的，对社区健康的高度可见的诋毁者，降低社区凝聚力，创造垃圾，啮齿动物，犯罪，恐惧，压力，以及临时工，吸毒和性工作的避风港。多种理论认为，可见的环境障碍，如废弃的建筑物，通过发出社区无人照顾的信号，导致社区衰落，不文明是可以容忍的，居民参与社会共同期望的能力， 对邻里问题的控制受到侵蚀。因此，居民无法从事积极的健康行为，而不健康的行为，如药物滥用和暴力，成为庇护和更普遍。因此，对废弃住房的直接补救可能是中断长期药物滥用和暴力的有力干预措施。拟议的研究小组已经进行了几项初步/试点研究，证明其有能力完成拟议的研究：（1）一项已发表的、全市范围的准实验性研究，研究源自2011年《费城门窗条例》的一项新的废弃建筑补救方案对健康和安全的影响;（2）多项已发表的关于废弃和空置物业整治对健康和安全影响的试点随机对照试验（RCT）;和（3）一个大型的，全市范围的空地绿化RCT，涉及超过600,000平方英尺的土地和5波，随机抽样调查超过600费城人。目前还没有随机对照试验来测试废弃房屋修复对健康和安全的影响。这项提案的广泛目标是通过在全市范围内开展一项关于废弃住房补救对药物滥用结果（包括酒精和毒品相关结果）和暴力结果（特别是枪支暴力）影响的随机对照试验，解决这一知识差距。共320个随机选择的废弃房屋，分层为费城的四个地理区域，将被随机分配到四个试验组：完全废弃房屋修复（n=80，完全治疗），涂鸦和垃圾清理（n=80，涂鸦治疗），垃圾清理（n=80，接触对照），没有房屋修复或清理（n=80，没有治疗）。将在治疗前后的18个月内测量废弃房屋及其附近的纵向结果。将采用定量和定性相结合的方法来实现拟议的具体目标，以确定废弃住房补救是否是解决药物滥用和枪支暴力问题的一种具有成本效益的方法。

 DESCRIPTION (provided by applicant): A randomized trial of abandoned housing remediation, substance abuse and violence Housing abandonment poses a major health burden that has grown significantly over the past several decades in the US. As a typical US city, Philadelphia has some 40,000 vacant properties, a significant number with abandoned residential buildings or structures. Research, including our own, has shown that vacant and abandoned properties are associated with drug- dependence, firearm violence, stress, sexually transmitted diseases, and premature mortality. Our prior research also shows that urban residents see abandoned buildings every day on their way to work or school and describe these undesirable structures as foremost, hypervisible detractors to community health, reducing community cohesion and creating trash, rodents, crime, fear, stress, and havens for transients, drug use, and sex work. Multiple theories posit that visible, environmental disorders, such as abandoned buildings, lead to community decline by signaling that a community is uncared-for, incivilities are tolerated, and the ability of residents to engage in shared expectations of social control over neighborhood problems is eroded. As a result, residents are prevented from engaging in positive health behaviors while unhealthy behaviors, such as substance abuse and violence, become sheltered and more prevalent. Direct remediation of abandoned housing could thus be a potent intervention to interrupt longstanding substance abuse and violence. The proposed research team has produced several preliminary/pilot studies that demonstrate its capacity to complete the proposed study: (1) a published, citywide quasi-experimental study of the health and safety effects of a novel abandoned building remediation protocol stemming from the 2011 Philadelphia Doors and Windows Ordinance; (2) multiple published pilot randomized controlled trials (RCTs) of the effects of abandoned and vacant property remediation on health and safety; and (3) a large, citywide RCT of vacant lot greening involving over 600,000 ft2 of land and a 5-wave, random sample survey of over 600 Philadelphians. There have been no RCTs that test the health and safety effects of abandoned housing remediation. The broad objective of this proposal addressed this gap in knowledge by conducting a citywide RCT of the effects of abandoned housing remediation on substance abuse outcomes, both alcohol and drug related, and violence outcomes, particularly firearm violence. A total of 320 randomly selected abandoned houses, stratified into four geographic sections of Philadelphia, will be randomly assigned to four trial arms: full abandoned housing remediation (n=80, full treatment), graffiti and trash clean-up only (n=80, graffiti treatment), trash clean-up only (n=80, contact control), and no housing remediation or clean-up (n=80, no treatment). Longitudinal outcomes on and near the abandoned houses will be measured in the 18 months before and after treatment. Mixed, quantitative and qualitative methods, will be used to achieve the proposed specific aims in determining if abandoned housing remediation is a cost-effective approach to substance abuse and firearm violence.