Communities Designed to Support Cardiovascular Health for Older Adults

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7. Project Summary Abstract Retail-focused built environment work in public health has informed governmental actions (restrictions, zoning changes, and incentive programs) that favor certain establishment types (such as supermarkets versus fast food restaurants). With the growth of e-commerce, demand for several traditional uses of retail space has declined, especially following the 2008 housing crisis and more recently during the 2020 COVID-19 pandemic. Fortunately, across the US communities are innovating, including by temporarily or permanently re-purposing vacant commercial spaces. Our renewal is designed to be responsive to the emerging questions about neighborhood change, and to meet current information needs on how the built environment affects behavioral and stress pathways to chronic disease. This renewal will (1) collect questionnaire data on neighborhood change perceptions and update neighborhood characterization throughout the contiguous US among participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (ongoing follow-up of 11,205 adults age 45+ recruited in 2003-2007) and (2) convene public deliberation events engaging residents from neighborhoods in New York City; NY, Philadelphia, PA; and Birmingham, AL experiencing ongoing or upcoming change to use of commercial space, about which values and community preferences could inform action. This combination of longitudinal analyses within a large cohort study and local engagement to inform built environment change will help to identify aspects of GIS-based neighborhood dynamics (e.g., urbanization, gentrification, greening, retail instability) associated with perceptions by residents about their neighborhoods and behavioral and stress pathways affecting resident health. We will draw on and contribute to the literature linking longitudinal neighborhood characteristics to population health, while also fostering collective decision-making capacity that draws on a broader range of perspectives and values. To accomplish the proposed activities, we have assembled an experienced investigative team spanning Drexel University, University of Alabama Birmingham, Columbia University, and New York Academy of Medicine. While building on the productive collaboration in the original funding period, this team has been configured for alignment with the proposed questionnaire data collection, geographic linkage, longitudinal analysis, and community-engagement activities. Support in maximizing the relevance of this work to multiple settings and audiences will come from an advisory committee spanning disciplines, sectors, and stakeholders in each setting.