A randomized trial of urban vacant lot stabilization and substance abuse outcomes

描述（由申请人提供）：环境决定因素与药物滥用行为、成瘾程度、过量风险、危险行为以及整体身心健康有关。对社区环境对健康和药物滥用行为的影响的新认识为开展基于地点的预防战略的创新随机试验创造了一个独特的机会。本研究的重点是稳定废弃的空地，作为公共物质滥用的潜在预防策略。研究小组的一项初步研究表明，空地稳定计划减少了犯罪，提高了选择的健康结果。稳定空置地段很重要，因为它们非常丰富，社区成员认为它们很重要，而且是高度可修改的，是社区一级的因素，可能以相对较少的成本带来持续、长期的健康和安全效益。1999年，宾夕法尼亚园艺协会（Pennsylvania Horticultural Society）启动了一项计划，以稳定和维护费城主要社区的空地。这个项目包括“清洁和绿化”废弃空地，通过清除碎片、分级土地、种草和树木来创造一个公园般的环境，并在其周边安装低围栏，以表明该地块得到了照顾，并阻止非法倾倒。本研究将测试该计划对公共物质使用及相关行为的影响。在费城的四个地理区域随机分配420个空地，将分为三个试验组：空地稳定（全面处理）、垃圾清理（垃圾控制）和不稳定或清理空地（不处理）。药物滥用和相关的健康和安全结果将在治疗前后的几年内进行测量。通过这样做，我们打算实现以下提议的具体目标：(1)与随机选择的只接收垃圾清理的空地和随机选择的不接收垃圾清理的空地相比，确定随机选择的空地的稳定是否会改变公众非法贩运和消费毒品的发生；(2)与随机选择的只进行垃圾清理的空地和不进行垃圾清理的空地相比，确定稳定随机选择的空地是否改变了公众非法饮酒的发生；(3)以每避免非法贩毒和吸食毒品以及在公共场所非法饮酒的情况下稳定空置地段的成本，确定稳定空置地段的增量成本效益估算。

DESCRIPTION (provided by applicant): Environmental determinants have been implicated in substance abuse behaviors, levels of addiction, risk of overdose, risky behaviors, and overall mental and physical health. An emerging understanding of the contribution of neighborhood environment to health and substance abuse behaviors has created a unique opportunity to develop an innovative randomized trial of a place-based prevention strategy. This study focuses on the stabilization of abandoned, vacant lots as a potential prevention strategy for public substance abuse. A preliminary study by the research team showed that the vacant lot stabilization program reduced crime and enhanced select health outcomes. The stabilization of vacant lots is important because they are in great abundance, singled out by community members as important, and are highly modifiable, community-level factors with potential for sustained, long-term health and safety benefits at relatively little cost. In 1999, the Pennsylvania Horticultural Society began a program to stabilize and maintain vacant lots in key Philadelphia neighborhoods. This program involves "cleaning and greening" abandoned vacant lots by removing debris, grading the land, planting grass and trees to create a park-like setting, and installing low fences around its perimeter to show that the lot is cared for and to deter illegal dumping. This study will test the impact of such a program on public substance use and related behaviors. The random assignment of 420 vacant lots stratified in four geographic sections of Philadelphia will be done in three trial arms: vacant lot stabilization (full treatment), trash clean-up only (trash control), and no vacant lot stabilization or clean-up (no treatment). Substance abuse and related health and safety outcomes on or near the lots will be measured in the years before and after treatment. Through this we intend to accomplish the following proposed specific aims: (1) To determine if the stabilization of randomly chosen vacant lots changes the public occurrence of illegal drug trafficking and consumption compared with vacant lots that have been randomly chosen to receive only trash clean-up and lots that have been randomly chosen to receive nothing; (2) To determine if the stabilization of randomly chosen vacant lots changes the public occurrence of illegal drunkenness and drinking compared with vacant lots that have been randomly chosen to receive only trash clean-up and lots that have been randomly chosen to receive nothing; (3) To determine incremental cost-effectiveness estimates of vacant lot stabilization in terms of the cost of vacant lot stabilization per instances of illegal drug trafficking and consumption and illegal public drunkenness and drinking avoided. PUBLIC HEALTH RELEVANCE: To the best of our knowledge, there have been no prior experimental trials of vacant lot stabilization and substance abuse-related outcomes, both alcohol and drug related. By remediating vacant lots across Philadelphia and then studying the effects of these remediations using a randomized trial, the proposed project's findings will contribute to municipal and national efforts to implement effective environmental modifications that can address public substance abuse behaviors and impact community health and well- being. The proposed study will produce scientific findings on the contribution of neighborhood environment to health, with a specific focus on public occurrence of alcohol and drug consumption and related illegal activities.