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、成瘾水平、过量风险、危险行为以及整体身心健康有关。邻里环境对健康和药物滥用行为的贡献的新认识创造了一个独特的机会，以开发一个创新的随机试验的地方为基础的预防策略。 这项研究的重点是稳定废弃的，空置的地段作为一个潜在的预防战略，公共药物滥用。研究小组的一项初步研究表明，空地稳定计划减少了犯罪，并提高了选定的健康结果。稳定空置土地很重要，因为这些土地非常丰富，社区成员认为这些土地非常重要，而且是高度可变的社区一级因素，有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开始了一项计划，以稳定和维护费城主要社区的空地。该计划包括“清洁和绿化”废弃的空地，清除垃圾，平整土地，种植草和树木，创造一个公园般的环境，并在周边安装低围栏，以表明该地段得到了照顾，并阻止非法倾倒。这项研究将测试这样一个计划对公众物质使用和相关行为的影响。将在费城四个地理区域分层的420块空地随机分配到三个试验组中：空地稳定化（完全处理），仅垃圾清理（垃圾控制）和无空地稳定化或清理（无处理）。药物滥用和相关的健康和安全结果或附近的批次将在治疗前后的几年内进行测量。通过这一点，我们打算实现以下拟议的具体目标：（1）确定与随机选择只接受垃圾清理的空地和随机选择不接受任何东西的空地相比，随机选择的空地的稳定性是否改变了非法毒品贩运和消费的公开发生;（2）确定与随机选择只接受垃圾清理的空地和随机选择什么也不接受的空地相比，随机选择的空地的稳定性是否改变了非法醉酒和饮酒的公共发生率;（3）根据每宗非法贩毒和吸毒以及避免非法公众酗酒和饮酒的情况下的空地稳定成本，确定空地稳定的增量成本效益估计数。 公共卫生相关性：据我们所知，之前没有关于空地稳定和药物滥用相关结果的实验性试验，包括酒精和药物相关结果。通过补救费城的空地，然后使用随机试验研究这些补救措施的效果，拟议项目的研究结果将有助于市政和国家努力实施有效的环境改造，以解决公共药物滥用行为并影响社区健康和福祉。拟议的研究将产生关于邻里环境对健康的贡献的科学发现，特别关注公众发生的酒精和毒品消费以及相关的非法活动。

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.