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Neighborhood structural conditions influence police behavior, but few studies have addressed whether neighborhood conditions are associated with officers’ perceptions of residents in those communities. This is an important gap because officers’ perceptions of what they can expect from residents in disadvantaged communities may help explain differential treatment. Using data from the Project on Policing Neighborhoods, we examined neighborhood effects on officers’ perceptions of citizen cooperation. Officers working in beats with more concentrated disadvantage and higher homicide rates were less likely to believe that citizens would be willing to cooperate with law enforcement. We discuss this finding in relation to explaining differential police treatment across communities and what it means for the legitimacy dialogue that unfolds between the police and community.

Prior research has suggested that children living in a disadvantaged neighborhood have lower achievement test scores, but these studies typically have not estimated causal effects that account for neighborhood choice. Recent studies used propensity score methods to account for the endogeneity of neighborhood exposures, comparing disadvantaged and nondisadvantaged neighborhoods. We develop an alternative propensity function approach in which cumulative neighborhood effects are modeled as a continuous treatment variable. This approach offers several advantages. We use our approach to examine the cumulative effects of neighborhood disadvantage on reading and math test scores in Los Angeles. Our substantive results indicate that recency of exposure to disadvantaged neighborhoods may be more important than average exposure for children’s test scores. We conclude that studies of child development should consider both average cumulative neighborhood exposure and the timing of this exposure.

The geographic concentration of disadvantage is a key mechanism of inequity. In the United States, the spatial patterning of disadvantage renders it more than the sum of its individual parts and disproportionately harms economically and racially marginalized Americans. This article focuses specifically on the political effects of Medicaid beneficiaries being concentrated in particular locales. After offering a framework for conceptualizing the community-wide consequences of such policy concentration, I analyze aggregate multiyear data to examine the effect of Medicaid density on county-level voter turnout and local organizational strength. I find that, as the proportion of county residents enrolled in Medicaid increases, the prevalence of civic and political membership associations declines and aggregate rates of voting decrease. These results suggest that, if grassroots political action is to be part of a strategy to achieve health equity, policy makers and local organizations must make efforts to counteract the sometimes demobilizing “place-based” political effects of “people-based” policies such as Medicaid.

While black-white segregation has been consistently linked to detrimental health outcomes for blacks, whether segregation is necessarily a zero-sum arrangement in which some groups accrue health advantages at the expense of other groups and whether metropolitan segregation impacts the health of racial groups uniformly within the metropolitan area, remains unclear. Using nationally representative data from the 2008-2013 National Health Interview Survey linked to Census data, we investigate whether the association between metropolitan segregation and health is invariant within the metropolitan area or whether it is modified by neighborhood poverty for black and white Americans. In doing so, we assess the extent to which segregation involves direct health tradeoffs between blacks and whites. We conduct race-stratified multinomial and logistic regression models to assess the relationship between 1) segregation and level of neighborhood poverty and 2) segregation, neighborhood poverty, and poor health, respectively. We find that, for blacks, segregation was associated with a higher likelihood of residing in high poverty neighborhoods, net of individual-level socioeconomic characteristics. Segregation was positively associated with poor health for blacks in high poverty neighborhoods, but not for those in lower poverty neighborhoods. Hence, the self-rated health of blacks clearly suffers as a result of black-white segregation - both directly, and indirectly through exposure to high poverty neighborhoods. We do not find consistent evidence for a direct relationship between segregation and poor health for whites. However, we find some suggestive evidence that segregation may indirectly benefit whites through decreasing their exposure to high poverty environments. These findings underscore the critical role of concentrated disadvantage in the complex interconnection between metropolitan segregation and health. Weakening the link between racial segregation and concentrated poverty via local policy and planning has the potential for broad population-based health improvements and significant reductions in black-white health disparities.

Academic work on crime and punishment has focused mostly on urban centers, leaving rural communities understudied, except for acknowledgement that rural communities warehouse a large number of prisoners and that rural prisons provide jobs and economic development for some struggling communities. This study uses a novel dataset that includes information on the home addresses of all prisoners in Arkansas from 1993 to 2003 to document imprisonment rates and racial disparities in imprisonment rates across metropolitan and nonmetropolitan counties. We show how rural communities both receive and produce prisoners and that imprisonment and racial disparities in imprisonment vary more within different types of communities than across different types of communities. Further, we find that nonmetropolitan rates of imprisonment are higher than would be expected, based on observed local risk factors such as poverty rate. We close with a discussion of what these findings illustrate about concentrated disadvantage across the rural-urban interface.

An emergent body of literature has documented a relationship between the lead (Pb) pollution (a structural form of violence) and crime (including interpersonal forms of violence) at the aggregate level. This study contributes to the lead and crime literature by exploring the relationship between lead and youth violence at the community level. To explore this association, data on lead, concentrated disadvantage, residential mobility, racial and ethnic heterogeneity, percentage divorced, and youth violence were obtained across the city of Chicago’s Community Areas (n = 77). Results from hot spot analyses, Ordinary Least Squares regressions, and a Geographically Weighted Regression suggest that not only do lead and youth violence appear to concentrate in the same communities, but increases in community lead level are associated with corresponding increases in youth violence 10 years after exposure. This study concludes with a discussion of theoretical and policy implications.

Ferguson, Missouri, has been characterized as an archetype of structural inequality and segregation. Several questions guide this investigation of Ferguson and its surrounding region. How did policies, practices, and folkways help to create the conditions in Ferguson and the broader metropolitan region? The regional segregation regime’s history provides a background to better understand current conditions. What is the existing state of affairs for young persons and their families in the region? To address this question, social epidemiological methods and geospatial analysis inform the development of a set of visuals to determine if racial segregation, economic opportunity, health and developmental outcomes, and education-related outcomes are spatially arranged. The authors found that these indicators of well-being are spatially arranged and concentrated; thus, they raise another question: How does a politically fragmented region intervene to disrupt concentrated disadvantage? As Ferguson and the region seek social and education reform, the final section offers several recommendations to improve education outcomes through broader economic strategy and social policy.

Research on race and urban poverty views incarceration as a new and important aspect of social disadvantage in inner-city neighborhoods. However, in quantitative studies of the spatial distribution of imprisonment across neighborhoods, the pattern outside urban areas has not been examined. This paper offers a unique analysis of disaggregated prison admissions and investigates the spatial concentrations and levels of admissions for the entire state of Massachusetts. Spatial regressions estimate census tract-level prison admission rates in relation to racial demographics, social and economic disadvantage, arrest rates, and violent crime; an analysis of outlier neighborhoods examines the surprisingly high admission rates in small cities. Regression analysis yields three findings. First, incarceration is highly spatially concentrated: census tracts covering 15% of the state’s population account for half of all prison admissions. Second, across urban and non-urban areas, incarceration is strongly related to concentrated disadvantage and the share of the black population, even after controlling for arrest and crime rates. Third, the analysis shows admission rates in small urban satellite cities and suburbs comprise the highest rates in the sample and far exceed model predictions. Mass incarceration emerged not just to manage distinctively urban social problems but was characteristic of a broader mode of governance evident in communities often far-removed from deep inner-city poverty. These notably high levels and concentrations in small cities should be accounted for when developing theories of concentrated disadvantage or policies designed to ameliorate the impacts of mass incarceration on communities.

Objective While scholars treat neighborhoods as important contexts of inequality, few studies explore the social processes that create disparities in neighborhoods’ political capacities. How does neighborhood social organization affect rates of political participation? Methods We combine surveys from the U.S. Census and Boston Neighborhood Survey (BNS), and administrative data from the City of Boston. Accounting for spatial dependence, we fit a series of regression models investigating the relationship between neighborhood social structure and four forms of political engagement: community meeting attendance, contacting local government for services, and voter turnout in a local and a national midterm election. Results We find higher rates of political participation in more stable neighborhoods, and lower rates of participation in neighborhoods with higher concentrations of immigrants. The relationship between collective efficacy and rates of political participation is not statistically significant in our models. We find a positive association between concentrated disadvantage and city election turnout, but this association is nonlinear: beyond a certain threshold, increases in disadvantage are associated with decreasing rates of participation. Conclusion We argue that neighborhoods are indeed political places, and residential stability, immigrant concentration, and—to a lesser extent—concentrated disadvantage are important factors affecting the civic capacity of urban communities.

The relationship between victimization and subsequent maladaptive behaviors such as offending is well established. To a lesser degree, a contextual lens has been used to examine how neighborhood characteristics influence the overlap between victimization and offending. The existing literature has yet to explore how the neighborhood context moderates the victim–offender overlap among young women, specifically, or whether the type of force used during sexual victimization or offending matters. This study uses data from The National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine whether concentrated disadvantage moderates the impact of sexual victimization on subsequent offending for women. Results indicate that young women who experience sexual victimization are more likely to engage in general offending regardless of neighborhood type. However, closer examination reveals that, when taking into account the type of force used in sexual victimization (physical or coerced) and the type of offending (violent, property, drug use), the overlap does indeed vary across neighborhoods. Specifically, results indicate that only coerced sexual victimization significantly affects property offending in neighborhoods with high levels of concentrated disadvantage. Related to violent offending, physical sexual victimization has a strong positive impact in less disadvantaged neighborhoods. Finally, coerced sexual victimization is significantly associated with an increased likelihood for drug use, and this relationship is consistent across neighborhoods. The findings suggest that nuances in the nature of victimization and offending need to be taken into account to fully understand the victim–offender overlap across neighborhood context.

This study examines the significance of organizational founding and leadership by focusing on the minority founders of nine community-based–human service organizations in a neighborhood of concentrated disadvantage. It discusses founders’ motivations, barriers encountered, and strategies employed in establishing and operating such organizations. The paper draws on both institutional and resource dependence perspectives by paying particular attention to how minority founders seek to establish legitimacy and secure resources, but it also makes an important contribution to these perspectives by noting the distinct challenges and advantages for minority founders operating in a racialized context. Implications for research and practice are discussed.

Sexual harassment is a pervasive problem predominantly perpetrated by men. Creating cultural shifts to prevent men’s sexual harassment perpetration requires attention to community as well as individual factors. Study data were collected from a cohort of 768 youth and young adult males ages 10–18 at baseline (2013), with follow-up 3 years later. Multivariable regression was applied to assess the role of neighborhood characteristics, including crime rates, gender equality, and concentrated disadvantage, adjusting for individual sociodemographics and views on traditional gender stereotypes. The self-reported prevalence of sexual harassment perpetration was 8.8%. In neighborhoods characterized by greater concentrated disadvantage, the likelihood of male sexual harassment perpetration was significantly lower than in neighborhoods characterized by greater advantages. Relative neighborhood advantage was associated with sexual harassment perpetration even controlling for the significant positive association between espousing traditional gender stereotypes and perpetration of sexual harassment. The relative rates of neighborhood crime and gender equality did not predict young males’ sexual harassment perpetration. In sum, young men’s perpetration of sexual harassment behaviors is more common in more advantaged communities, underscoring the importance of awareness that, beyond individual attitudes, there is a collective social influence on individual behavior.

This study contributes to previous research by advancing a &ldquo, racialized structural vulnerability&rdquo, framework and presenting a new empirical analysis of the relationship between neighborhood Asian, Black, and Latinx composition, extrinsic and intrinsic vulnerability, and PM2.5 exposures in California with secondary data from 2004&ndash, 2014. Principal component analyses revealed that tract Latinx composition was highly correlated with extrinsic vulnerability (economic disadvantage and limited English-speaking ability), and that tract Black composition was highly correlated with intrinsic vulnerability (elevated prevalence of asthma-related emergency department visits and low birth weight). Spatial lag regression models tested hypotheses regarding the association between Asian, Black, and Latinx population vulnerability factors and the 2009&ndash, 2011 annual average PM2.5 percentile rankings, net of emissions and spatial covariates. Results indicated that the percent Latinx population, followed by the regional clustering of PM2.5, and the percent of non-Latinx Black and non-Latinx Asian population were the strongest positive multivariable correlates of PM2.5 percentile rankings, net of other factors. Additional analyses suggested that despite shifting demographic and spatial correlates of 2012&ndash, 2014 PM2.5 exposures, the tracts&rsquo, Black and Latinx composition and location in the San Joaquin Valley remain important vulnerability factors with implications for future research and policy.

Triple Negative Breast Cancer (TNBC) is an aggressive, heterogeneous subtype of breast cancer, which is more frequently diagnosed in African American (AA) women than in European American (EA) women. The purpose of this study is to investigate the role of social determinants in racial disparities in TNBC. Data on Louisiana TNBC patients diagnosed in 2010–2012 were collected and geocoded to census tract of residence at diagnosis by the Louisiana Tumor Registry. Using multilevel statistical models, we analyzed the role of neighborhood concentrated disadvantage index (CDI), a robust measure of physical and social environment, in racial disparities in TNBC incidence, stage at diagnosis, and stage-specific survival for the study population. Controlling for age, we found that AA women had a 2.21 times the incidence of TNBC incidence compared to EA women. Interestingly, the incidence of TNBC was independent of neighborhood CDI and adjusting for neighborhood environment did not impact the observed racial disparity. AA women were more likely to be diagnosed at later stages and CDI was associated with more advanced stages of TNBC at diagnosis. CDI was also significantly associated with poorer stage-specific survival. Overall, our results suggest that neighborhood disadvantage contributes to racial disparities in stage at diagnosis and survival among TNBC patients, but not to disparities in incidence of the disease. Further research is needed to determine the mechanisms through which social determinants affect the promotion and progression of this disease and guide efforts to improve overall survival.

Police practices evolve and are often shaped by technological innovation, such as the adoption of body-worn cameras (BWCs). While initial research on their impact is evergrowing, researchers have neglected to examine if their use is influenced by neighborhood characteristics. This study examines the influence of a BWC implementation on police activity and enforcement practices across neighborhoods, using minority threat hypothesis and place theory to explain the relationship. We used pre- and postimplementation enforcement data to examine the influence of BWCs and community characteristics on the actions taken by Louisville Metro Police Department officers. Ten ordinary least squares models were used to analyze the enforcement changes including self-initiated activity, total enforcement, felony arrests, low-level arrests, and low-level citations. Our findings indicate BWCs implementation was associated with a decrease in low-level citations; however, self-initiated activity and felony and low-level arrests were unaffected. Also, concentrated disadvantage was associated with a decrease in self-initiated activity. We also examined the moderating effects between BWCs and neighborhood characteristics and found BWCs were correlated with a decrease in low-level citations. The implications of the findings are discussed.

Research indicates that victims who make changes to their risky behavioral routines are better able to avoid being victimized again in the future. Nevertheless, some victims’ abilities to change their behaviors may be limited by what Hindelang et al. in Victims of personal crime: an empirical foundation for a theory of personal victimization. Ballinger, Cambridge (1978) referred to as “structural constraints.” To assess this issue, we determine: (1) whether victims who reside in communities characterized by structural constraints (e.g., concentrated disadvantage) are more likely to continue engaging in risky behaviors (e.g., offending, illicit drug use, and getting drunk) after being victimized; and (2) whether victims who continue to engage in risky lifestyles have an increased likelihood of repeat victimization. Ten waves of data (spanning nearly 7 years) from the Pathways to Desistance Study are used, and multilevel models are estimated to examine changes to risky lifestyles and repeat victimization among a subsample of victims. Findings indicate that community-level structural constraints impose limits on the changes that victims make to their risky lifestyles, and that these changes influence repeat victimization. We conclude that, in the context of repeat victimization, structural constraints are both real and consequential, and that future theory and research should continue to explore how context shapes and influences victims’ behavioral routines.

Objectives: Examine how neighborhoods vary in the degree to which they experience repeat/near repeat crime patterns and whether theoretical constructs representing neighborhood-level context, including social ecology and structural attributes, can explain variation in single incidents and those linked in space and time. Methods: Examine social, structural, and environmental design covariates from the American Community Survey to assess the context of near repeat burglary at the block group level. Spatially lagged negative binomial regression models were estimated to assess the relative contribution of these covariates on single and repeat/near repeat burglary counts. Results: Positive and consistent association between concentrated disadvantage and racial heterogeneity and all types of burglaries was evident, although the effects for other indicators, including residential instability, family disruption, and population density, varied across classifications of single and repeat/near repeat burglaries. Conclusions: Repeat/near repeat burglary patterns are conditional on the overall level and specific dimensions of disorganization, holding implications for offender-focused as well as community-focused explanations. This study contributes greater integration between the study of empirically observed patterns of repeats and community-based theories of crime, including collective efficacy.

Objectives:Neighborhood characteristics predict burglary targets, but target attractiveness may be colored by the conditions in which a potential offender resides. We test whether relative differences in concentrated disadvantage, racial/ethnic composition, and ethnic heterogeneity influence where burglars offend, controlling for distance. From a relative deprivation perspective, economically advantaged areas make more attractive targets to burglars residing in disadvantage neighborhoods, but a social disorganization perspective predicts areas lower in social cohesion are most attractive, which may be neighborhoods with greater disadvantage.Methods:Drawing upon a unique sample of cleared burglaries in the City of Tampa, Florida from 2000 to 2012, we utilize discrete choice modeling to predict burglar offense destination.Results:Offenders target neighborhoods that are geographically proximate or ecologically similar to their own. When accounting for relative differences, burglars from all neighborhood type...

Quantitative segregation research focuses almost exclusively on the spatial sorting of demographic groups. This research largely ignores the structural characteristics of neighborhoods – such as crime, job accessibility, and school quality – that likely help determine important household outcomes. This paper summarizes the research on segregation, neighborhood effects, and concentrated disadvantage, and argues that we should pay more attention to neighborhood structural characteristics, and that the data increasingly exist to include measures of spatial segregation and neighborhood opportunity. The paper concludes with a brief empirical justification for the inclusion of data on neighborhood violence and a discussion on policy applications.

Few studies have examined multilevel effects of neighborhood context on childhood maltreatment. Less work has analyzed these effects with juvenile offenders, and no prior work has examined context effects of childhood maltreatment through the Adverse Childhood Experiences (ACEs) framework. ACEs include 10 indictors: emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, domestic violence toward the youth’s mother, household substance abuse, household mental illness, parental separation/divorce, and household member with a history of jail/imprisonment. Effects of concentrated disadvantage and affluence on ACE scores are examined in a statewide sample of more than 59,000 juvenile offenders, controlling for salient individual (including family and parenting) measures and demographics. Both disadvantage and affluence affect ACE exposure. Implications for research and policy are discussed.

Context Childhood lead exposure has been associated with criminal behavior later in life. The current study aimed to analyze the association between elevated blood lead levels (n=59,645) and crime occurrence (n=90,433) across census tracts within St. Louis, Missouri. Design Longitudinal ecological study. Setting Saint Louis, Missouri. Exposure measure Blood lead levels. Main outcome measure Violent, Non-violent, and total crime at the census tract level. Results Spatial statistical models were used to account for the spatial autocorrelation of the data. Greater lead exposure at the census-tract level was associated with increased violent, non-violent, and total crime. In addition, we examined whether non-additive effects existed in the data by testing for an interaction between lead exposure and concentrated disadvantage. Some evidence of a negative interaction emerged, however, it failed to reach traditional levels of statistical significance (supplementary models, however, revealed a similar negative interaction that was significant). Conclusions More precise measurements of lead exposure in the aggregate, produced additional evidence that lead is a potent predictor of criminal outcomes.

Background and purpose Previous studies report that foster care placement is associated with an increased risk of delinquency. Yet it remains unclear which aspects of the placement experience increase the risk of delinquency. The current study addresses this knowledge gap. This study investigates the relationship between geographic neighborhood change and the risk of delinquency for adolescents in foster care settings. Based on findings from the neighborhood effects literatures, we hypothesize that moving to a neighborhood characterized by concentrated disadvantage and residential instability is associated with increased risk of delinquency. Methods The design for the current study is longitudinal. The sample is comprised of 145 foster youth from two birth cohorts, one born in 1983 and one in 1984, in Chicago, Illinois. The sample was 92% African American and 52% male. Overall, 11% had an official juvenile arrest. We used data from multiple sources, including the 1990 census data and administrative data from the Illinois Department of Children and Family Services and the Cook County Juvenile Court. To measure neighborhood change, we calculated a difference between children's home and placement neighborhoods on ten census variables: percentages of households in a given neighborhood that were below the poverty line, neighborhood households on public assistance, female-headed households, unemployed population, and persons Results The results indicate that moving to a neighborhood with high residential instability significantly increases an individual's risk of juvenile delinquency. In addition, two subgroups—male foster youth; and all foster youth with an experience of neglect—are significantly more likely to be associated with a formal delinquency petition. Conclusions and implications The current study is unique and builds the knowledge base with regard to the placement of children and adolescents in substitute care settings. The findings indicate that the neighborhoods in which children are placed do matter in terms of their outcomes, and thus they should be considered in the placement decision process. This finding is consistent with the “person-in-environment” concept advanced by social work professionals.

A public health approach to violence prevention involves the empirical identification of groups and communities at the highest risk for violence to inform targeted interventions. We demonstrate the utility of complete incident-level crime data toward this end. Data for 32,056 unique incidents involving homicide, aggravated assault, and robbery were extracted from the 2013 Michigan Incident Crime Reporting system, a statewide National Incident-Based Reporting System (NIBRS) data system. Differential victimization rates were calculated across demographic subgroups and jurisdictions to identify patterns in risk. Two-stage least squares regression models were estimated to examine correlates of variation in excess risk. Analyses identified young Black males and females at relatively high risk for violent victimization, and that this risk was amplified within cities with disproportionately high crime rates. Multivariate models suggested concentrated disadvantage as the most stable correlate of variation in excess risk across Michigan cities and towns. The results highlight the importance of expanding NIBRS adoption and the deployment of focused interventions involving both short-term enforcement and long-term social reinvestment.

Several recent spatial analyses conclude the strong positive association typically found between neighborhood concentrated disadvantage and crime in cross–sectional studies significantly differs across neighborhoods. It is possible this spatial variation is due to within–neighborhood dynamics of continuity and change, as suggested by ecological theories of neighborhood crime. Using ordinary least–squares and geographically weighted regression models, I explore the role of within–neighborhood change on the disadvantage–homicide relationship across Chicago neighborhoods and find that controlling for historical changes in disadvantage within neighborhoods reduces—but does not eliminate—spatial variation in the cross–sectional relationship. Within–neighborhood changes in concentrated disadvantage from 1970 to 2000 are positively related to homicide rates, net of the level of disadvantage in 2000. This suggests the relationship is influenced to some degree by temporal continuity or change in the neighborhood ecological structure, consistent with the dynamic conceptualization of neighborhoods inherent to ecological theories of crime like social disorganization.

Background Racial variation in the relationship between blood glucose and hemoglobin A1c (HbA1c) complicates diabetes diagnosis and management in racially mixed populations. Understanding why HbA1c is persistently higher in blacks than whites could help reduce racial disparity in diabetes outcomes. Objective Test the hypothesis that neighborhood disadvantage is associated with inflammation and poor metabolic control in a racially mixed population of pediatric type 1 diabetes patients. Methods Patients (n = 86, 53 white, 33 black) were recruited from diabetes clinics. Self-monitored mean blood glucose (MBG) was downloaded from patient glucose meters. Blood was collected for analysis of HbA1c and C-reactive protein (CRP). Patient addresses and census data were used to calculate a concentrated disadvantage index (CDI). High CDI reflects characteristics of disadvantaged neighborhoods. Results HbA1c and MBG were higher (p < 0.0001) in blacks [10.4% (90.3 mmol/mol), 255 mg/dL] than whites [8.9% (73.9 mmol/mol), 198 mg/dL). CDI was higher in blacks (p < 0.0001) and positively correlated with HbA1c (r = 0.40, p = 0.0002) and MBG (r = 0.35, p = 0.0011) unless controlled for race. CDI was positively associated with CRP by linear regression within racial groups. CRP was not different between racial groups, and was not correlated with MBG, but was positively correlated with HbA1c when controlled for race (p = 0.04). Conclusions Neighborhood disadvantage was associated with inflammation and poor metabolic control in pediatric type 1 diabetes patients. Marked racial differences in potential confounding factors precluded differentiation between genetic and environmental effects. Future studies should recruit patients matched for neighborhood characteristics and treatment regimen to more comprehensively assess racial variation in HbA1c.

Recent evidence has shown that Hispanics/Latinos in the United States have disproportionately good health outcomes even in the face of economic hardship, a phenomenon known as the Hispanic/Latino Health Paradox. This study used both a spatial typology of neighborhoods and a hierarchical modeling approach to test the idea of spatially segmented cultural adaptation as a framework for unraveling the spatial and cultural differences in health outcomes across Hispanic/Latino neighborhood contexts and how this theory relates to changes in bonding social capital as a mechanism for explaining the loss of the health benefit. Data included the Los Angeles Family and Neighborhood Survey, a longitudinal study of families in Los Angeles County focusing on the effects of neighborhood-level stressors on health for adults. Spatial analyses revealed a strong spatial relationship between concentrated disadvantage and immigrant concentration across Hispanic/Latino communities, resulting in a four-level neighborhood typology including the gateway, the barrio, the enclave, and the ethnoburb. Multilevel modeling revealed a significant association between neighborhood type and morbidity, with individuals in the most acculturated neighborhoods (the ethnoburbs) showing the highest illness scores, and those in the least acculturated neighborhoods (the gateways) showing the lowest scores.

Background: Non-Hispanic Black (NHB) and Hispanic patients with Acute Myeloid Leukemia (AML) have higher mortality rates than non-Hispanic white (NHW) patients despite lower incidence, more favorable genetics, and a younger age at presentation (Darbinyan, Blood Adv. 2017). We performed a multilevel analysis of disparities in AML patients to investigate the contribution of structural violence, specifically neighborhood SES, on racial/ethnic differences in leukemia-specific survival. Methods: Adult AML (non-APL) patients diagnosed between 2012 and 2018 at six academic cancer centers in the Chicago area were included. Census tract data was collected using the FFIEC Geocoding/Mapping System and computed tract disadvantage and tract affluence scores were categorized into distribution tertiles (low, moderate, high). Time to relapse and death from leukemia were examined, adjusting for age, gender and race/ethnicity (baseline models), and for potential mediators of racial disparities including distal (Charlson Comorbidity Index (CCI), obesity, concentrated disadvantage and affluence, health insurance status), and proximal mediators (somatic mutations, and European Leukemia Network (ELN) prognostic score categories). Results Patient characteristics are shown in Table 1 (n = 822). Significant heterogeneity in age and comorbidities at diagnosis was observed, with Hispanic patients being the youngest and with the lowest CCI. Morbid obesity was more prevalent in NHB and Hispanic (23% and 20%, respectively) compared with NHW (11%) patients. Payer source also differed significantly; private insurance was twice as frequent among NHW than NHB (51% vs. 25%) patients, while the largest uninsured population was Hispanic. ELN adverse risk disease was most prevalent in NHW subjects, NPM1 mutations were least prevalent in Hispanic patients, and p53 mutations more prevalent in NHB (26%) compared to NHW (12%) and Hispanics (9%) although due to low numbers this did not reach significance (p=0.10). NHB and Hispanic patients tended to reside in more disadvantaged and less affluent areas. Treatment data was available for 764 patients (Table 2); 75% received intensive induction therapy and choice of first-line treatment did not differ by race or tract disadvantage. Allogeneic transplant rates however differed by race, age, insurance status, tract disadvantage, and ELN score. Treatment complications of induction chemotherapy, as reflected by ICU admissions during induction, were significantly lower in NHW (25%) compared to NHB (39%) and Hispanic (42%) patients. ICU admission rates were significantly higher in patients with morbid obesity and low tract affluence. Minority (vs. NHW) ethnicity was associated with a 42% increased hazard of death from leukemia (HR=1.42, 95% CI: 1.09, 1.85), and a 36% increased hazard of death from all causes (HR=1.36, 95% CI: 1.07, 1.72), each after controlling for age, gender and study site. Adjustment for continuous tract disadvantage and affluence and their interaction lowered both the hazard of leukemia and all cause death to 1.18 (95% CI: 0.88, 1.60) and 1.14 (95% CI: 0.88, 1.49), respectively. In formal mediation analysis, neighborhood SES accounted for 37% (p=0.09) and 50% (p=0.02) of the racial disparity in death from leukemia and all causes, respectively. Discussion: This study is the first to integrate data at the individual patient level with neighborhood characteristics, using census tract level variables to examine their contribution to AML patient outcomes. To date, formal mediation methods had not been employed to disentangle race/ethnic disparities in adult AML survival. Notably, our mediation analysis shows that census tract level SES explains a substantial proportion of the disparity in hazard of leukemia death. In addition, the observed disparities in treatment complications of induction chemotherapy, as reflected by ICU admissions, and the continued disparity in allogeneic transplant utilization all warrant further study. These results draw attention to the need for deeper investigation into the social and economic barriers to successful treatment outcomes for leukemia patients and represent an important first step toward designing strategies to mitigate these persistent health inequities. Disclosures Altman: Janssen: Consultancy; Syros: Consultancy; Genentech: Research Funding; Novartis: Consultancy; Amphivena: Research Funding; Amgen: Research Funding; Aprea: Research Funding; ImmunoGen: Research Funding; Celgene: Research Funding; Boehringer Ingelheim: Research Funding; Fujifilm: Research Funding; Kartos: Research Funding; AbbVie: Other: advisory board, Research Funding; Kura Oncology: Other: Scientific Advisory Board - no payment accepted, Research Funding; BioSight: Other: No payment but was reimbursed for travel , Research Funding; Daiichi Sankyo: Other: Advisory Board - no payment but was reimbursed for travel; Agios: Other: advisory board, Research Funding; Glycomimetics: Other: Data safety and monitoring committee; Astellas: Other: Advisory Board, Speaker (no payment), Steering Committee (no payment), Research Funding; Theradex: Other: Advisory Board; Immune Pharmaceuticals: Consultancy; Bristol-Myers Squibb: Consultancy; France Foundation: Consultancy; PeerView: Consultancy; PrIME Oncology: Consultancy; ASH: Consultancy; Cancer Expert Now: Consultancy. Stock:Research to Practice: Honoraria; UpToDate: Honoraria; Adaptive Biotechnologies: Consultancy, Membership on an entity's Board of Directors or advisory committees; American Society of Hematology: Honoraria; Leukemia and Lymphoma Society: Research Funding; Novartis: Research Funding; Abbvie: Honoraria, Research Funding; Morphosys: Consultancy, Membership on an entity's Board of Directors or advisory committees; Agios: Consultancy, Membership on an entity's Board of Directors or advisory committees; Kite: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; Servier: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Quigley:Alnylam: Speakers Bureau; Agios: Speakers Bureau; Amgen: Other: Advisory board. Khan:Celgene: Consultancy; Incyte: Honoraria; Takeda: Research Funding; Amgen: Consultancy.

Paternal incarceration leads to educational disparities among children who are innocent of their fathers' crimes. The scale and concentration of mass paternal incarceration thus harms millions of innocent American children. Current individuallevel analyses neglect the contribution of macro-level variation in responses of punitive state regimes to this social problem. We hypothesize that state as well as individual level investment in exclusionary paternal incarceration diminishes the educational attainment of children, although state inclusionary investment in welfare and education can offset some - and could potentially offset more - of this harm. Understanding intergenerational educational attainment therefore requires individual- and contextuallevel analyses. We use Hierarchical Generalized Linear Models to analyze the National Longitudinal Survey of Adolescent to Adult Health. Disparities in postsecondary educational outcomes are especially detrimental for children of incarcerated fathers located in state regimes with high levels of paternal incarceration and concentrated disadvantage. This has important implications for intergenerational occupational and status attainment.

Purpose Research on juvenile reoffending has experienced an ecological turn, marked by an impressive expansion of studies that test the relation between elements of residential context and reoffending. Yet, to date, little consensus exists regarding what ecological factors matter, how they affect reoffending, and for whom they matter most. To address this gap, this study takes stock of research that tests the relationship between ecological factors and reoffending among youth. Methods A systematic review, in accordance with PRISMA-P guidelines, of quantitative studies (k = 27) was conducted. Evidence was synthesized quantitatively (i.e., meta-analytically, tabularly) and qualitatively (i.e., narratively). Results A variety of ecological factors have been tested, but results are inconsistent and reflect relatively few contexts and samples. The most frequently tested factor, concentrated disadvantage (k = 15), is a predictor of re-arrest (pooled OR = 1.09, p = .01). Inconsistent findings regarding other factors seem to reflect sample and study characteristics. Conclusions Research to date does not indicate summarily rejecting or accepting ecological factors as risk factors for reoffending. To further clarify the ecology-reoffending relationship and inform recidivism reduction interventions, future research should sample from unexamined contexts and test theoretically meaningful relationships via approaches that strengthen causal inference.

Purpose: Over the past three decades, Hepatocellular Carcinoma (HCC) is one of few cancers for which incidence has increased in the United States (US). It is likely social determinants at the population level are driving this increase. We designed a population-based study to explore whether social determinants at the neighborhood level are geographically associated with HCC incidence in Louisiana by examining the association of HCC incidence with neighborhood concentrated disadvantage. Methods: Primary HCC cases diagnosed from 2008 to 2012 identified from the Louisiana Tumor Registry were geocoded to census tract of residence at the time of diagnosis. Neighborhood concentrated disadvantage index (CDI) for each census tract was calculated according to the PhenX Toolkit data protocol based on population and socioeconomic measures from the US Census. The incidence of HCC was modeled using multilevel binomial regression with individuals nested within neighborhoods. Results: The study included 1,418 HCC cases. Incidence of HCC was greater among males than females and among black than white. In multilevel models controlling for age, race, and sex, neighborhood CDI was positively associated with the incidence of HCC. A one standard deviation increase in CDI was associated with a 22% increase in HCC risk [Risk Ratio (RR) = 1.22; 95% CI (1.15, 1.31)]. Adjusting for contextual effects of an individual's neighborhood reduced the disparity in HCC incidence. Conclusion: Neighborhood concentrated disadvantage, a robust measure of an adverse social environment, was found to be a geographically associated with HCC incidence. Differential exposure to neighborhoods characterized by concentrated disadvantage partially explained the racial disparity in HCC for Louisiana. Our results suggest that increasing rates of HCC, and existing racial disparities for the disease, are partially explained by measures of an adverse social environment.

Background Childhood lead exposure is linked to numerous adverse health effects and exposure in the United States is highest among people living in substandard housing, which is disproportionately inhabited by socioeconomically disadvantaged individuals. In this paper, we compared the Vox lead exposure risk score and concentrated disadvantage based on principal component analysis (PCA) to weighted quantile sum (WQS) regression to determine which method was best able to explain variation in elevated blood lead levels (EBLLs). Methods We constructed indices for census tracts in Minnesota and used them in Poisson regression models to identify the best socioeconomic measure for explaining EBLL risk. Results All indices had a significant association with EBLL in separate models. The WQS index had the best goodness-of-fit, followed next by the Vox index, and then the concentrated disadvantage index. Among the most important variables in the WQS index were percent of houses built before 1940, percent renter occupied housing, percent unemployed, and percent African American population. Conclusions The WQS approach was best able to explain variation in EBLL risk and identify census tracts where targeted interventions should be focused to reduce lead exposure.

Rates of organ donor registration range from 20% to 60% throughout the United States. The purpose of this study was to examine sociogeographic differences in organ donor registration rates throughout Missouri to identify varying patterns The organ donor registration rate from each Department of Motor Vehicle office in Missouri was extracted from the National Organ Registration database, office locations were geocoded, and census tract level sociodemographic characteristics were extracted. Spatial regression analyses were conducted to identify relationships between location of DMV offices and census tract-level concentrated disadvantage. Census tract-level concentrated disadvantage (education attainment, poverty, single-headed households) had a significant negative relationship with organ donor registration rates. Yet, census tract-level African American/Black resident concentration was not significantly related to organ donor registration rates. These findings suggest that race-based interventions to recruit organ donors may no longer be necessary. Yet, identifying how characteristics of concentrated disadvantage may be more influential in determining organ donor registration. Gaining a better understanding of how individual decisions are made is integral in the context of increased life expectancy in conjunction with the complex management of chronic conditions.

Living in a disadvantaged neighborhood is associated with heightened risk for poor school readiness and health outcomes in early childhood, and the home environment is thought to be a primary mechanism by which neighborhood context impacts preschoolers. This study examined the effects of neighborhood concentrated disadvantage and neighborhood residential instability on the home physical environment and home learning environment for preschoolers in economically disadvantaged families (N = 187). Using structural equation modeling, mothers' perceived neighborhood disorder and depressive symptoms were examined as mechanisms by which neighborhood context "comes through the door." Mothers' neighborhood social embeddedness was also explored as a protective factor. Results showed that concentrated disadvantage was negatively associated with the quality of the home physical environment, and residential instability was negatively associated with the quality of the home learning environment. Concentrated disadvantage had an indirect effect on the home learning environment through mothers' perceived neighborhood disorder and depressive symptoms. The effects of concentrated disadvantage on the home environment were buffered by mothers' neighborhood social embeddedness. Study findings advance understanding of socioeconomic- and place-based disparities in developmental outcomes and identify potential targets for interventions aimed at lessening effects of neighborhood disadvantage on families with young children.

Most studies of social disorganization theory focus on urban communities. In addition, these studies largely ignore more intimate crimes, such as intimate partner violence. Yet, results from extant studies are often generalized to explain all types of crime in all types of communities, thus potentially ignoring the dynamics surrounding intimate crimes and rurality. The current study expands on previous research in two ways. First, this study examines whether characteristics of social disorganization can predict assault across various victim–offender relationships. Second, this study applies social disorganization predictors to both metropolitan (or urban) and nonmetropolitan (or rural) counties. The sample consisted of 690 counties located across 13 different states. Results from the Poisson regression models indicate higher levels of ethnic heterogeneity and concentrated disadvantage were associated with increased rates of assault across various victim–offender relationships. Furthermore, the measures of social disorganization functioned in the expected direction in both metropolitan and nonmetropolitan counties. These results highlight the importance of controlling for community structures when examining rates of violence, including intimate partner violence. Programs and policies designed to reduce intimate partner violence should include neighborhood components as these affect rates of violence within a community.

Focusing on shopkeepers in Latino/a neighborhoods in Los Angeles, Dolores Trevizo and Mary Lopez reveal how neighborhood poverty relative to other stratification variables (including racial segregation and gender) affects the business performance of Mexican immigrant entrepreneurs. Their survey of Mexican shopkeepers in 20 immigrant neighborhoods demonstrates that less poor and more multiethnic communities offer better business opportunities than do the highly impoverished and racially segregated Mexican neighborhoods of Los Angeles. Their findings not only contribute to the scholarship of concentrated disadvantage that emphasizes the long-term consequences of neighborhood deprivation, but reveal previously overlooked aspects of microclass, as well as “legal capital,” advantages. The authors argue that even poor Mexican immigrants whose class backgrounds in Mexico imparted an entrepreneurial disposition can achieve a modicum of business success in the right (US) neighborhood context, and the more quickly they build legal capital, the better their outcomes. While they show that the local place characteristics of neighborhoods both reflect and reproduce class and racial inequalities, they also demonstrate that the diversity of experiences among Mexican immigrants living within the spatial boundaries of these communities also matters to their economic mobility. In sum, race, gender, legal status, and poverty affect individuals, but do so according to the ways that they are nested in space and time.

The small population problem arises in analysis of rare events such as homicides when rates are often unreliable and sensitive to missing data and other data errors in arbitrarily delineated areal units (e.g., census tracts) of low population. This article uses two geographic information systems (GIS) automated regionalization methods, namely regionally constrained agglomerative clustering and partitioning (REDCAP) and mixed-level regionalization (MLR), to mitigate the problem by constructing larger geographic areas with a sufficient threshold population for homicide rate estimate. The case study applies the method to examining the homicide pattern in New Orleans, Louisiana. Analysis of homicide rates in the original census tracts shows a wide variation of unreliable homicide rates and an insignificant relationship between concentrated disadvantage and homicide rates in the study area. Based on the newly constructed geographic areas by either the REDCAP or MLR method, the variability of homicide rates is ...