Black children and adults in the United States fare worse across nearly every health indicator compared to White individuals. In Philadelphia, the location of this study, these health disparities result in a stark longevity gap, with average life expectancies in poor, predominantly Black neighborhoods being 20 years lower than in nearby affluent, predominantly White neighborhoods. The investigators will conduct a cluster randomized controlled trial (RCT) of a suite of place- based and financial-wellbeing interventions at the community, organization, and individual/household levels that address the social determinants of racial health disparities. At the community level, the investigators address underinvestment in Black neighborhoods by implementing vacant lot greening, abandoned house remediation, tree planting, and trash cleanup. At the organization level, the investigators partner with community-based financial empowerment providers to develop cross-organizational infrastructure to increase reach and maximize efficiency. At the individual/household levels, the investigators increase access to public benefits, financial counseling and tax preparation services, and emergency cash assistance. The investigators will test this "big push" intervention in 60 Black neighborhood micro-clusters, with a total of 480 children. The investigators hypothesize that this "big push" intervention will have significant impact on children's health and wellbeing.
Black individuals in the United States fare worse than White individuals across almost every social, economic, and health indicator. The Black health disadvantage starts at birth, reflecting the cumulative toll of racialized social stressors and healthcare discrimination on maternal health and resulting in higher rates of pre-term birth and low birth weight. Black youth are disproportionately exposed to environmental toxins such as lead and adverse childhood events such as financial hardship and neighborhood violence. Black children also have higher rates of chronic disease, including asthma and diabetes. These and other forces result in inequities in child health and well-being and can also impact children's educational and earning potential. Furthermore, these inequities culminate in a stark racial longevity gap: in Philadelphia, the location of this study, life expectancy for people living in a poor, predominantly Black neighborhood is 20 years lower than for people living in a nearby affluent, predominantly White neighborhood. The fundamental cause of these striking and pervasive disparities is structural racism - the confluence of deep historical, institutional, cultural, and ideological forces that unequally distribute resources and risks across racialized groups. Structural racism patterns health by affecting a range of interconnected, mutually reinforcing social determinants of health at the national, neighborhood, household, and individual levels. Most notably, longstanding, systematic disinvestment has resulted in highly segregated Black neighborhoods with dilapidated environmental conditions and severe economic insecurity within Black households, leading to a "feedback loop of concentrated racial disadvantage," all of which have been strongly tied to poor health. Most interventions seeking to address racial health disparities focus on individual-level behaviors and outcomes, or individual channels by which structural racism harms health. However, by failing to address upstream social determinants, these interventions have had limited population level impact. A multi-level, multi-component intervention package focused on a range of social determinants of health is necessary to meaningfully address structural racism as a fundamental cause of racial health disparities. In this trial, we aim to implement such a multi-level, multi-component intervention and then evaluate its impact on child health and well-being.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
221
Financial well-being interventions: • Tax preparation; access to public benefits; financial counseling and microgrants Place-based interventions: • Vacant lot greening; abandoned house remediation; trash cleanup; tree planting
University of Pennsylvania
Philadelphia, Pennsylvania, United States
Child Health Questionnaire Parent Form 28 (CHQ-PF28) Composite Score
Composite index using CHQ-28 scoring method, based on a series of 28 questions focused on overall child health, activity limitation, emotional/behavioral difficulties, mood, relationships, and family cohesion. (Child Health Questionnaire)
Time frame: 24 months
Parent-reported child health
(5-pt Likert ranging from poor to excellent) (Child Health Questionnaire)
Time frame: 24 months
Caregiver-reported child health care utilization, well child visits
Well child visits in previous 12 months (National Survey of Children's Health)
Time frame: 24 months
Caregiver-reported child health care utilization, sick clinic visits
Sick clinic visits in previous 12 months (National Survey of Children's Health)
Time frame: 24 months
Caregiver-reported child health care utilization, emergency room visits
Emergency room visits in previous 12 months (National Survey of Children's Health)
Time frame: 24 months
Caregiver-reported child health care utilization, hospitalization
Hospitalizations in previous 12 months (National Survey of Children's Health)
Time frame: 24 months
Usual source of care
Whether a child has a usual source of care when they are ill or when a parent/caregiver needs advice about their health (National Survey of Children's Health)
Time frame: 24 months
Forgone health care
Caregiver report of whether the child needed but did not receive medical, mental health, dental, or vision care in the previous 12 months (National Survey of Children's Health)
Time frame: 24 months
Difficulty paying medical bills
Difficulty paying medical bills in the previous 12 months (National Survey of Children's Health)
Time frame: 24 months
Uninsurance or gaps in insurance
Uninsurance or gaps in insurance in the previous 12 months (National Survey of Children's Health)
Time frame: 24 months
Average sleep duration
Average sleep duration in the previous week (National Survey of Children's Health)
Time frame: 24 months
Time spent playing outdoors, weekdays
Time spent playing outdoors on weekdays (National Survey of Children's Health)
Time frame: 24 months
Time spent playing outdoors, weekends
Time spent playing outdoors on weekends (National Survey of Children's Health)
Time frame: 24 months
Screen time
Screen time (National Survey of Children's Health)
Time frame: 24 months
Perceived neighborhood cohesion
Perceived neighborhood cohesion (National Survey of Children's Health)
Time frame: 24 months
Perceived safety of child in neighborhood
Perceived safety of child in neighborhood (National Survey of Children's Health)
Time frame: 24 months
Parenting: Difficulty caring for child
Parenting: Difficulty caring for child (National Survey of Children's Health)
Time frame: 24 months
Parenting: Child bothers parent
Parenting: Child bothers parent (National Survey of Children's Health)
Time frame: 24 months
Parenting: Anger with child
Parenting: Anger with child (National Survey of Children's Health)
Time frame: 24 months
Parenting: Handling the day-to-day demands of raising children
Parenting: Handling the day-to-day demands of raising children (National Survey of Children's Health)
Time frame: 24 months
School attendance
School attendance, based on Philadelphia school district data (Proportion of school days attended, internally developed)
Time frame: 24 months
School performance
School performance, based on Philadelphia school district data (Grade point average over previous 12 months, internally developed)
Time frame: 24 months
Rate of preterm birth
Rate of preterm birth (birth \< 37 weeks of gestation age), based on Pennsylvania birth certificate data
Time frame: 24 months
Rate of low birthweight
Rate of low birthweight (birthweight \<2000 grams), based on Pennsylvania birth certificate data
Time frame: 24 months
Health care utilization: emergency room visits
Health care utilization: emergency room visits in the previous we months, based on Children's Hospital of Philadelphia EHR data
Time frame: 24 months
Health care utilization: hospitalizations
Health care utilization: hospitalizations in the previous 12 months, based on Children's Hospital of Philadelphia EHR data
Time frame: 24 months
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