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Primary Submission Category: Health equity
A Randomized Controlled Trial of Concentrated Investment in Black Neighborhoods to Address Structural Racism as a Fundamental Cause of Poor Health
Authors: Evan Spencer, Eugenia South, Atheendar Venkataramani, Hilena Addis, Rikley Costa Paixao, Helena Jeudin, Craig Terry, Ashley Tryba, Aditi Vasan,
Presenting Author: Evan Spencer*
Significance: Black individuals in the United States fare worse than White individuals across almost every social, economic, and health indicator, including chronic disease, chronic stress, and exposure to violent crime. Most interventions seeking to address racial health disparities focus on individual-level behaviors and outcomes, which may have limited impact. In this randomized controlled trial of concentrated investment in Black neighborhoods, we delivered a suite of evidenced-based environmental and economic interventions. Methods: We enrolled 571 participants from 58 predominantly Black, low-socioeconomic neighborhood clusters (~4×4 blocks each) in Philadelphia, PA from 9/29/22-11/3/23 through door-to-door recruitment by a team of community coordinators who represented the lived experiences of our population. Environmental interventions (vacant lot greening, tree planting, litter removal) were implemented across the intervention clusters. Our team connected participants living in intervention clusters to community organizations leading the economic interventions (financial counseling, connection to public benefits, tax preparation, and $400 microgrant) using a warm-handoff approach. Follow-up data collection was conducted from 9/30/24-1/30/26. For our secondary outcome of police reported crime, we used a two-stage difference-in-difference design to account for staggered enrollment. Results: Our population was 87.6% Black, 50.8% Female, and 58.7% had a household income < $45K yearly. In interventions clusters, 66 vacant lots were remediated, 6,500 bags of trash were collected, and 300 trees were planted. 75% of the intervention group received cash grants and financial counseling. Results for our primary health outcomes will be completed before the conference. Analysis of crime data showed a statistically significant decrease in crimes committed in intervention vs control neighborhoods during the study. Over 1200 crimes were averted due to study interventions.