Natural Experiment of Neighborhood Revitalization and Cardiometabolic Health

 描述(由申请人提供)：居住在社会经济条件较差社区的个人肥胖率和相关发病率高得不成比例，包括糖尿病和心血管疾病(CVD)的风险增加。尽管以前的研究对我们理解邻里劣势对健康的影响做出了重大贡献，但由于依赖于横断面设计、选择偏差和关于潜在机制的有限数据，因果关系一直很难建立。在我们团队之前资助的、正在进行的自然实验研究开发的现有研究基础设施的基础上，我们有一个独特的机会来研究，在住房开发和社区振兴方面的大量(1.6亿美元)经济投资刺激下，建筑和社会环境的变化是否相对于没有经历这种变化的匹配的“对照”社区改善了心脏代谢结果。这项研究包括从两个城市社区(干预社区和对照社区)随机选择的732名低收入非裔美国成年人的队列。我们的研究将是第一个自然实验，考察以地点为基础的自然实验策略(而不是居住流动性策略)对非裔美国人高危人群临床相关心脏代谢结果(BMI、HbA1c、血压和血脂)的影响，尽管研究不足。我们将利用我们之前资助的关于潜在介体的研究的现有数据，包括对建筑和社会环境的测量，以及包括饮食、体力活动和睡眠在内的健康行为(客观和主观测量)。在这项提案中，我们将添加测量的心脏代谢结果，包括血压、糖化血红蛋白和血脂。干预社区的下一阶段经济振兴将集中在住房的重新开发上。因此，此外，拟议研究的最佳时机是增加对住房条件的看法的调查措施、对住房条件的邻里一级审计以及汇编关于住房销售、空置率等公共可用资源的二级数据， 住房发生变化前后。随着时间的推移，了解社区振兴的影响和模式，对于缓解肥胖和心脏代谢健康方面普遍存在的种族/民族和社会经济差异的政策来说至关重要。

 DESCRIPTION (provided by applicant): 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.