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Inequities in urban greenspace have been identified, though patterns by race and socioeconomic status vary across US settings. We estimated the magnitude of the relationship between a broad mixture of neighborhood-level factors and residential greenspace using weighted quantile sum (WQS) regression, and compared predictive models of greenspace using only neighborhood-level, only individual-level, or multi-level predictors. Greenspace measures included the Normalized Difference Vegetation Index (NDVI), tree canopy, and proximity of the nearest park, for residential locations in Shelby County, Tennessee of children in the CANDLE cohort. Neighborhood measures include socioeconomic and education resources, as well as racial composition and racial residential segregation. In this sample of 1012 mother-child dyads, neighborhood factors were associated with higher NDVI and tree canopy (0.021 unit higher NDVI [95% CI: 0.014, 0.028] per quintile increase in WQS index); homeownership rate, proximity of and enrollment at early childhood education centers, and racial composition, were highly weighted in the WQS index. In models constrained in the opposite direction (0.028 unit lower NDVI [95% CI: - 0.036, - 0.020]), high school graduation rate and teacher experience were highly weighted. In prediction models, adding individual-level predictors to the suite of neighborhood characteristics did not meaningfully improve prediction accuracy for greenspace measures. Our findings highlight disparities in greenspace for families by neighborhood socioeconomic and early education factors, and by race, suggesting several neighborhood indicators for consideration both as potential confounders in studies of greenspace and pediatric health as well as in the development of policies and programs to improve equity in greenspace access.

Racial residential segregation has been deemed a fundamental cause of health inequities. It is a result of historical and contemporary policies such as redlining that have created a geographic separation of races and corresponds with an inequitable distribution of health-promoting resources. Redlining and racial residential segregation may have contributed to racial inequities in COVID-19 vaccine administration in the early stages of public accessibility. We use data from the National Archives (historical redlining), Home Mortgage Disclosure Act (contemporary redlining), American Community Survey from 1940 (historical racial residential segregation) and 2015–2019 (contemporary racial residential segregation), and Washington D.C. government (COVID-19 vaccination administration) to assess the relationships between redlining, racial residential segregation, and COVID-19 vaccine administration during the early stages of vaccine distribution when a tiered system was in place due to limited supply. Pearson correlation was used to assess whether redlining and racial segregation, measured both historically and contemporarily, were correlated with each other in Washington D.C. Subsequently, linear regression was used to assess whether each of these measures associate with COVID-19 vaccine administration. In both historical and contemporary analyses, there was a positive correlation between redlining and racial residential segregation. Further, redlining and racial residential segregation were each positively associated with administration of the novel COVID-19 vaccine. This study highlights the ongoing ways in which redlining and segregation contribute to racial health inequities. Eliminating racial health inequities in American society requires addressing the root causes that affect access to health-promoting resources. [ABSTRACT FROM AUTHOR]

Background Residential segregation, a geospatial manifestation of structural racism, is a fundamental driver of racial and ethnic health inequities, and longitudinal studies examining segregation's influence on cardiovascular health are limited. This study investigates the impact of segregation on hypertension in a multiracial and multiethnic cohort and explores whether neighborhood environment modifies this association. Methods and Results Leveraging data from a diverse cohort of adults recruited from 6 sites in the United States with 2 decades of follow-up, we used race- and ethnicity-stratified Cox models to examine the association between time-varying segregation with incident hypertension in 1937 adults free of hypertension at baseline. Participants were categorized as residing in segregated and nonsegregated neighborhoods using a spatial-weighted measure. We used a robust covariance matrix estimator to account for clustering within neighborhoods and assessed effect measure modification by neighborhood social or physical environment. Over an average follow-up of 7.35 years, 65.5% non-Hispanic Black, 48.1% Chinese, and 53.7% Hispanic participants developed hypertension. Net of confounders, Black and Hispanic residents in segregated neighborhoods were more likely to develop hypertension relative to residents in nonsegregated neighborhoods (Black residents: hazard ratio [HR], 1.33; 95% CI, 1.09-1.62; Hispanic residents: HR, 1.33; 95% CI, 1.04-1.70). Results were similar but not significant among Chinese residents (HR, 1.20; 95% CI, 0.83-1.73). Among Black residents, neighborhood social environment significantly modified this association such that better social environment was associated with less pronounced impact of segregation on hypertension. Conclusions This study underscores the importance of continued investigations of groups affected by the health consequences of racial residential segregation while taking contextual neighborhood factors, such as social environment, into account.

The Great Migration was a movement of roughly eight million Black Southerners relocating to the North and West from 1910 to 1980. Despite being one of the most significant mass internal migrations during the twentieth century, little is known about the health outcomes resulting from migration and whether migrators' destination choices were potential mechanisms. This study measured the association between destination county disadvantage and odds of low birth weight during the last decade of the Great Migration. We used the US Census from 1970 as well as the birth records of first-time Black mothers who migrated from the South collected through the National Center of Health Statistics from 1973 to 1980 (n = 154,145). We examined three measures of area-based opportunity: Black male high school graduation rate, Black poverty rate, and racialized economic residential segregation. We used multilevel logistic regression, where mothers were nested within US counties, to quantify the relationship between county disadvantage and low birth weight. After adjusting for individual risk and protective factors for infant health, there was no relationship between county opportunity measures and low birth weight among migrators. Although high socioeconomic opportunity is typically associated with protection of low birth weight, we did not see these outcomes in this study. These results may support that persistent racial discrimination encountered in the North inhibited infant health even as migrators experienced higher economic opportunity relative to the South. [ABSTRACT FROM AUTHOR]

Abstract Background Foundational literature demonstrates that racial residential segregation results in poorer health outcomes for Black people than white people due to a variety of social determinants of health. COVID-19 vaccine uptake is important for better health outcomes, regardless of race. The COVID-19 pandemic has elevated concerns about racial health disparities but with little discussion of racial residential segregation as a predictor of disparate health outcomes. This paper investigates the relationship between racial residential segregation and COVID-19 vaccine uptake using county level data from the State of Georgia (USA). Methods Using publicly available data, regression analysis is conducted for 138 of the 159 counties in Georgia USA, using a dissimilarity index that describes county level differences in racial residential segregation. The primary independent variable is Black-white differences in vaccine uptake at the county level. The analytic methods focus on a spatial analysis to support information for county level health departments as the basis for health policy and resource allocation. Results Constructing a variable of the difference in vaccination rates between Black and white residents we find that Black-white differences in COVID-19 vaccination are most notable in the 69 most segregated of the 159 counties in Georgia. A ten-point lower segregation index is associated with an improvement in the Black-white vaccination gap of 1.5 percentage points (95% CI -0.31, -0.00). Income inequality and access to health care resources, such as access to a primary care physician, also predict Black-white differences in vaccination rates at the county level. Suggested mapping approaches of publicly available data at a state county level, provides a resource for local policy makers to address future challenges for epidemic and pandemic situations. Conclusion County level and geospatial data analysis can inform policy makers addressing the impact of racial residential segregation on local health outcomes, even for pandemic and epidemic issues.

This study investigates the impact of racial residential segregation on COVID-19 mortality during the first year of the US epidemic. Data comes from the Center for Disease Control and Prevention (CDC), and the Robert Wood Johnson Foundation's and the University of Wisconsin's joint county health rankings project. The observation includes a record of 8,670,781 individuals in 1488 counties. We regressed COVID-19 deaths, using hierarchical logistic regression models, on individual and county-level predictors. We found that as racial residential segregation increased, mortality rates increased. Controlling for segregation, Blacks and Asians had a greater risk of mortality, while Hispanics and other racial groups had a lower risk of mortality, compared to Whites. The impact of racial residential segregation on COVID-19 mortality did not vary by racial group. [ABSTRACT FROM AUTHOR]

In the late 1990s, the predominantly white community of Morningside, North Carolina, prevented annexation into the larger majority-minority city of Greensboro, citing their desire to "preserve their way of life." This case demonstrates how a white, affluent town incorporated, resisting annexation, and with it, centralized water service connections. More than twenty years later, many residents in Morningside continue to reject centralized water and sewerage, fearing it will facilitate in-migration and erode the town's "community character." These decades-long dynamics maintain the high degree of racial residential segregation between Morningside and neighboring Greensboro. Morningside stands in stark contrast to many Black communities in North Carolina, which are underbounded and excluded from municipal water and sanitation. This case contributes to environmental injustice and water security scholarship in three ways. First, we enrich the meaning ascribed to water infrastructure and the purposes that it serves—as a connection (an improvement) and as an intrusion. Second, by situating these current contests within a larger historical context, we highlight the social constructedness of water. In this dialectical relationship, water is both the outward mechanism to marginalize, hiding the actors behind the process, and the object of corruption for people who are marginalized. Third, we demonstrate how water infrastructure advances exclusionary futures that rely on erasure and discursive coding. Overall, we caution how the depoliticization of centralized water infrastructure can enable the persistence of racial residential segregation in the United States. [ABSTRACT FROM AUTHOR]

To address racial residential segregation, considered a reflection of structural racism, and its relative importance to social determinant of health (SDOH) pathways to health disparities, we analyze self-reported health, a known predictor of health outcomes. We use County Health Rankings, a public dataset provided by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. Using a panel dataset (2016 to 2019) with multilevel modelling techniques, we compare racial residential segregation at the county level to other health-outcome related county level characteristics considered pathways to disparate health outcomes. Consistent with prior research we find that higher racial residential segregation is associated with greater reporting of fair or poor health. However, the effects of education and economic stability measures of SDOH are more important for predicting fair/poor health outcomes than segregation. Our research highlights the need for more multi-level analysis and a better understanding of the complex nature of SDOH in a structural racism approach to inform where, when, how, and for whom policies are developed, funded, and implemented at the local level. [ABSTRACT FROM AUTHOR]

Background The national impact of racial residential segregation on out‐of‐hospital cardiac arrest outcomes after initial resuscitation remains poorly understood. We sought to characterize the association between measures of racial and economic residential segregation at the ZIP code level and long‐term survival and readmissions after out‐of‐hospital cardiac arrest among Medicare beneficiaries. Methods and Results In this retrospective cohort study, using Medicare claims data, our primary predictor was the index of concentration at the extremes, a measure of racial and economic segregation. The primary outcomes were death up to 3 years and readmissions. We estimated hazard ratios (HRs) across all 3 types of index of concentration at the extremes measures for each outcome while adjusting for beneficiary demographics, treating hospital characteristics, and index hospital procedures. In fully adjusted models for long‐term survival, we found a decreased hazard of death and risk of readmission for beneficiaries residing in the more segregated White communities and higher‐income ZIP codes compared with the more segregated Black communities and lower‐income ZIP codes across all 3 indices of concentration at the extremes measures (race: HR, 0.87 [95% CI, 0.81–0.93]; income: HR, 0.75 [95% CI, 0.69–0.78]; and race+income: HR, 0.77 [95% CI, 0.72–0.82]). Conclusions We found a decreased hazard of death and risk for readmission for those residing in the more segregated White communities and higher‐income ZIP codes compared with the more segregated Black communities and lower‐income ZIP codes when using validated measures of racial and economic segregation. Although causal pathways and mechanisms remain unclear, disparities in outcomes after out‐of‐hospital cardiac arrest are associated with the structural components of race and wealth and persist up to 3 years after discharge.

Background: Foundational literature demonstrates that racial residential segregation results in poorer health outcomes for Black people than white people due to a variety of social determinants of health. COVID-19 vaccine uptake is important for better health outcomes, regardless of race. The COVID-19 pandemic has elevated concerns about racial health disparities but with little discussion of racial residential segregation as a predictor of disparate health outcomes. This paper investigates the relationship between racial residential segregation and COVID-19 vaccine uptake using county level data from the State of Georgia (USA). Methods: Using publicly available data, regression analysis is conducted for 138 of the 159 counties in Georgia USA, using a dissimilarity index that describes county level differences in racial residential segregation. The primary independent variable is Black-white differences in vaccine uptake at the county level. The analytic methods focus on a spatial analysis to support information for county level health departments as the basis for health policy and resource allocation. Results: Constructing a variable of the difference in vaccination rates between Black and white residents we find that Black-white differences in COVID-19 vaccination are most notable in the 69 most segregated of the 159 counties in Georgia. A ten-point lower segregation index is associated with an improvement in the Black-white vaccination gap of 1.5 percentage points (95% CI -0.31, -0.00). Income inequality and access to health care resources, such as access to a primary care physician, also predict Black-white differences in vaccination rates at the county level. Suggested mapping approaches of publicly available data at a state county level, provides a resource for local policy makers to address future challenges for epidemic and pandemic situations. Conclusion: County level and geospatial data analysis can inform policy makers addressing the impact of racial residential segregation on local health outcomes, even for pandemic and epidemic issues. [ABSTRACT FROM AUTHOR]

Neighborhood disadvantage erodes residents' mental and physical health. But whether rapid reductions in disadvantage spurred by gentrification attenuate or exacerbate these effects remains unknown due to mixed theoretical expectations and empirical results. To help clarify these dynamics, I propose a novel hypothesis that casts gentrification as a carcinogen. As neighborhoods receive inflows of affluent, White residents, influxes of private vehicles may come with them. In turn, stationary residents become exposed to higher vehicular emissions, and their risk of cancer—especially lung cancer—climbs. As an initial empirical test of these theoretical possibilities, I link Urban Displacement Project data identifying Los Angeles County neighborhoods that gentrified during the 2000s to tract-level data on vehicle ownership and cancer risk profiles—the latter from the Environmental Protection Agency's National Air Toxics Assessment. Descriptive regressions that include a lagged dependent variable and municipal fixed effects suggest gentrifying tracts' levels of cancer risk factors increased by ∼0.5 standard deviations more than those of disadvantaged neighborhoods that did not gentrify. Sobel tests of mediation indicate nearly half of this association may be explained by a pathway related to increasing vehicle density. The study thus motivates future research leveraging individual-level data and quasi-experimental methods to solidify whether gentrification is indeed a carcinogen. [ABSTRACT FROM AUTHOR]

Racial and racialized economic residential segregation has been empirically associated with outcomes across multiple health conditions but not yet explored in relation to out-of-hospital cardiac arrest (OHCA). We sought to examine if measures of racial and economic residential segregation are associated with differences in survival to discharge after OHCA for Black and White Medicare beneficiaries. Utilizing age-eligible Medicare fee-for-service claims data from 2013 to 2015, we identified OHCA claims and determined survival to discharge. The primary predictor, residential segregation, was calculated using the index of concentration at the extremes (ICE) for the beneficiary residential ZIP code. Multilevel modified Poisson regression models were used to determine the association of OHCA outcomes and ZIP code level ICE measures. In total, 194,263 OHCA cases were identified among beneficiaries residing in 75% of US ZIP codes. Black beneficiaries exhibited 12.1% survival to discharge, compared with 12.5% of White beneficiaries. In fully adjusted models of the three ICE measures accounting for differences in treating hospital characteristics, there was as high as a 28% (RR 1.28, CI 1.23–1.26) higher relative likelihood of survival to discharge in the most segregated White ZIP codes (Q5) as compared to the most segregated Black ZIP codes (Q1). Racial residential segregation is independently associated with disparities in OHCA outcomes; among Medicare beneficiaries who generated a claim after suffering an OHCA, ICE measures of racial segregation are associated with a lower likelihood of survival to discharge for those living in the most segregated Black and lower income quintiles compared to higher quintiles. [ABSTRACT FROM AUTHOR]

We recruited women (primarily non-Hispanic White) from 14 rural, segregated counties in a Northeastern US state for an explanatory sequential study: 100 women (ages 50–65 years) completed a survey, and 16 women participated in focus groups. We sought to identify personal (e.g., healthcare mistrust) and environmental (e.g., travel time to healthcare providers) factors related to colorectal and cervical cancer screening. Quantitatively, 89% of participants were up-to-date for cervical screening, and 65% for colorectal screening. Factors interacted such that compounding barriers were associated with lower odds of screening (e.g., insurance status and healthcare mistrust: interaction p =.02 for cervical; interaction p =.05 for colorectal). Qualitatively, three themes emerged regarding barriers to screening: privacy concerns, logistical barriers, and lack of trust in adequacy of healthcare services. While cancer screening was common in rural, segregated counties, women who reported both environmental and personal barriers to screening had lower uptake. Future interventions to promote screening can target these barriers. [ABSTRACT FROM AUTHOR]

Racial/ethnic disparities in academic performance may result from a confluence of adverse exposures that arise from structural racism and accrue to specific subpopulations. This study investigates childhood lead exposure, racial residential segregation, and early educational outcomes. Geocoded North Carolina birth data is linked to blood lead surveillance data and fourth-grade standardized test scores (n = 25,699). We constructed a census tract-level measure of racial isolation (RI) of the non-Hispanic Black (NHB) population. We fit generalized additive models of reading and mathematics test scores regressed on individual-level blood lead level (BLL) and neighborhood RI of NHB (RINHB). Models included an interaction term between BLL and RINHB. BLL and RINHB were associated with lower reading scores; among NHB children, an interaction was observed between BLL and RINHB. Reading scores for NHB children with BLLs of 1 to 3 µg/dL were similar across the range of RINHB values. For NHB children with BLLs of 4 µg/dL, reading scores were similar to those of NHB children with BLLs of 1 to 3 µg/dL at lower RINHB values (less racial isolation/segregation). At higher RINHB levels (greater racial isolation/segregation), children with BLLs of 4 µg/dL had lower reading scores than children with BLLs of 1 to 3 µg/dL. This pattern becomes more marked at higher BLLs. Higher BLL was associated with lower mathematics test scores among NHB and non-Hispanic White (NHW) children, but there was no evidence of an interaction. In conclusion, NHB children with high BLLs residing in high RINHB neighborhoods had worse reading scores. [ABSTRACT FROM AUTHOR]

Worldwide, migrant agricultural workers face poor housing conditions and related health challenges. A growing body of research has documented the substandard housing often occupied by this largely racialized population. Yet limited health research has examined mechanisms of structural racism that determine this group’s poor housing and health. Drawing on interviews with 151 migrant farmworkers in Ontario and British Columbia, Canada, we documented the housing experiences faced by migrant agricultural workers and examined the role of structural racism in determining housing and health inequities. Our analysis identified four overlapping mechanisms by which migrants’ housing and health were determined by structural racism: (1) scarcity, (2) segregation, (3) sacrifice, and (4) stagnation. These mechanisms both reinforced and normalized housing hardships, making it difficult for migrants to escape unsafe or inadequate housing. Our findings point to the need for immediate action to improve housing conditions for this population and to interrogate the racist design that keeps migrant workers at the margins of society. [ABSTRACT FROM AUTHOR]

Racialized health inequities in substance use-related harms might emerge from differential access to syringe service programs (SSPs). To explore this, we examined the association between county-level racialized environments, other factors, and (1) SSP presence, and (2) per capita syringe and (3) naloxone distribution. 2021 US National Survey of SSP data (n=295/412;72 % response rate) was used to identify SSP presence and the sum of syringes and naloxone doses distributed in 2020 by county. Study measures included racial residential segregation (RRS; i.e., divergence and dissimilarity indexes for Black:Non-Hispanic White & Hispanic:Non-Hispanic White) and covariates (i.e., demographic proportions, urban/suburban/rural classifications, 2020 US presidential Republican vote share, and overdose mortality from 2019). We used logit Generalized Estimating Equations to determine factors associated with county-level SSP presence, and zero inflated negative binomial regression models to determine factors associated with per capita syringe and naloxone distribution. SSPs were reported in 9 % (283/3106) of US counties. SSP presence was associated with higher divergence and dissimilarity indexes, urban and suburban counties, higher opioid overdose mortality, and lower 2020 Republican presidential vote share. Per capita syringes distributed was associated with lower RRS (divergence and Hispanic:White dissimilarity), lower racially minoritized population proportions and rural counties, while per capita naloxone distribution was associated with lower Hispanic and "other" population proportions, and rural counties. Racialized environments are associated with SSP presence but not the scope of those programs. Preventing HIV and HCV outbreaks, and overdose deaths requires addressing community level factors that influence SSP implementation and accessibility. • Racialized inequities in substance use-related harms persist. • Harm reduction services are critical to addressing overdose mortality. • Diverse county-level factors contribute to harm reduction services availability. • Racial residential segregation is associated with harm reduction services availability. • Political health determinants must be addressed to optimize harm reduction services. [ABSTRACT FROM AUTHOR]

Despite the long history of racial hostility, African Americans after 1990 began moving from the city of Detroit to the surrounding suburbs in large numbers. After World War II, metropolitan Detroit ranked with Chicago, Cleveland, and Milwaukee for having the highest levels of racial residential segregation in the United States. Detroit's suburbs apparently led the country in their strident opposition to integration. Today, segregation scores are moderate to low for Detroit's entire suburban ring and for the larger suburbs. Suburban public schools are not highly segregated by race. This essay describes how this change has occurred and seeks to explain why there is a trend toward residential integration in the nation's quintessential American Apartheid metropolis. [ABSTRACT FROM AUTHOR]

Mortality from cervical and colorectal cancers can be reduced through routine screening, which can often be accessed through primary care. However, uptake of screening in the US remains suboptimal, with disparities observed across geographic characteristics, such as metropolitan status or level of racial residential segregation. Little is known about the interaction of metropolitan status and segregation in their relationship with cancer screening. We conducted a quantitative survey of 474 women aged 45–65 in central Pennsylvania. The survey collected county-level characteristics and participant-level demographics, beliefs, cancer screening barriers, and cervical and colorectal cancer screening. We used bivariate and multivariable logistic regression to analyze relationships between metropolitan status and segregation with screening. For cervical cancer screening, 82.8% of participants were up-to-date, which did not differ by county type in the final analysis. Higher healthcare trust, higher cancer fatalism, and reporting cost as a barrier were associated with cervical cancer screening. For colorectal cancer screening, 55.4% of participants were up-to-date, which differed by county type. In metropolitan counties, segregation was not associated with colorectal cancer screening, but in non-metropolitan counties, segregation was associated with greater colorectal cancer screening. The relationship between metropolitan status and being up-to-date with colorectal, but not cervical, cancer screening varied by segregation. Other important beliefs and barriers to screening varied by county type. This research can guide future cancer screening interventions in primary care settings in underserved communities. [ABSTRACT FROM AUTHOR]

Racial residential segregation is interconnected with several other phenomena such as income inequalities, property values inequalities, and racial disparities in health and education. Furthermore, recent literature suggests the phenomenon of gentrification as a cause of perpetuation or increase of racial residential segregation in some American cities. In this paper, we analyze the dynamics of racial residential segregation for white, black, Asian, and Hispanic citizens in New York City in 1990, 2000, and 2010. It was possible to observe that segregation between white and Hispanic citizens and between white and Asian ones has grown, while segregation between white and black is relatively stable. Furthermore, we analyzed the per capita income and the Gini coefficient in each segregated zone, showing that the highest inequalities occur in the zones where there is an overlap of high-density zones of pair of races. Focusing on the changing of the density of population across the city during these 20 years, and by analyzing white and black people’s segregation, our analysis reveals that a positive flux of white (black) people is associated with a substantial increase (decrease) of the property values, as compared with the city mean. Furthermore, by clustering the region with the higher density of black citizens, we measured the variation of area and displacement of the four most significant clusters from 1990 to 2010. The large displacements (≈1.6km) observed for two of these clusters, namely, one in the neighborhood of Harlem and the other inside the borough of Brooklyn, led to the emergence of typically gentrified regions.

Background Residential segregation, a geospatial manifestation of structural racism, is a fundamental driver of racial and ethnic health inequities, and longitudinal studies examining segregation’s influence on cardiovascular health are limited. This study investigates the impact of segregation on hypertension in a multiracial and multiethnic cohort and explores whether neighborhood environment modifies this association. Methods and Results Leveraging data from a diverse cohort of adults recruited from 6 sites in the United States with 2 decades of follow‐up, we used race‐ and ethnicity‐stratified Cox models to examine the association between time‐varying segregation with incident hypertension in 1937 adults free of hypertension at baseline. Participants were categorized as residing in segregated and nonsegregated neighborhoods using a spatial‐weighted measure. We used a robust covariance matrix estimator to account for clustering within neighborhoods and assessed effect measure modification by neighborhood social or physical environment. Over an average follow‐up of 7.35 years, 65.5% non‐Hispanic Black, 48.1% Chinese, and 53.7% Hispanic participants developed hypertension. Net of confounders, Black and Hispanic residents in segregated neighborhoods were more likely to develop hypertension relative to residents in nonsegregated neighborhoods (Black residents: hazard ratio [HR], 1.33; 95% CI, 1.09–1.62; Hispanic residents: HR, 1.33; 95% CI, 1.04–1.70). Results were similar but not significant among Chinese residents (HR, 1.20; 95% CI, 0.83–1.73). Among Black residents, neighborhood social environment significantly modified this association such that better social environment was associated with less pronounced impact of segregation on hypertension. Conclusions This study underscores the importance of continued investigations of groups affected by the health consequences of racial residential segregation while taking contextual neighborhood factors, such as social environment, into account.

Background: Studies investigating the impact of racial segregation on health have reported mixed findings and tended to focus on the racial composition of neighborhoods. These studies use varying racial composition measures, such as census data or investigator-adapted questions, which are currently limited to assessing one dimension of neighborhood racial composition., Objective: This study aims to develop and validate a novel racial segregation measure, the Pictorial Racial Composition Measure (PRCM)., Methods: The PRCM is a 10-item questionnaire of pictures representing social environments across adolescence and adulthood: neighborhoods and blocks (adolescent and current), schools and classrooms (junior high and high school), workplace, and place of worship. Cognitive interviews (n=13) and surveys (N=549) were administered to medically underserved patients at a primary care clinic at the Barnes-Jewish Hospital. Development of the PRCM occurred across pilot and main phases. For each social environment and survey phase (pilot and main), we computed positive versus negative pairwise comparisons: mostly Black versus all other categories, half Black versus all other categories, and mostly White versus all other categories. We calculated the following validity metrics for each pairwise comparison: sensitivity, specificity, correct classification rate, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, false positive rate, and false negative rate., Results: For each social environment, the mostly Black and mostly White dichotomizations generated better validity metrics relative to the half Black dichotomization. Across all 10 social environments in the pilot and main phases, mostly Black and mostly White dichotomizations exhibited a moderate-to-high sensitivity, specificity, correct classification rate, positive predictive value, and negative predictive value. The positive likelihood ratio values were >1, and the negative likelihood ratio values were close to 0. The false positive and negative rates were low to moderate., Conclusions: These findings support that using either the mostly Black versus other categories or the mostly White versus other categories dichotomizations may provide accurate and reliable measures of racial composition across the 10 social environments. The PRCM can serve as a uniform measure across disciplines, capture multiple social environments over the life course, and be administered during one study visit. The PRCM also provides an added window into understanding how structural racism has impacted minoritized communities and may inform equitable intervention and prevention efforts to improve lives., (©Jemar R Bather, Kimberly A Kaphingst, Melody S Goodman. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 08.08.2024.)

Prior research has found that a high level of residential racial segregation, or the degree to which racial/ethnic groups are isolated from one another, is associated with worsened infant health outcomes, particularly among non-Hispanic (NH) Black infant populations. However, because exposure to segregation is non-random, it is unclear whether and to what extent segregation is causally linked to infant health. To overcome this empirical limitation, we leverage exogenous variation in the placement of railroad tracks in the 19th century to predict contemporary segregation, an approach first introduced by Ananat (2011). In alignment with prior literature, we find that residential segregation has statistically significant associations with negative birth outcomes among Black infant populations in the area. Using OLS methods underestimates the negative impacts of segregation on infant health. We fail to detect comparable effects on health outcomes among NH White infant populations. Further, we identify several key mechanisms by which residential segregation could influence health outcomes among Black infant populations, including lower access to prenatal care during the first trimester, higher levels of anti-Black prejudice, greater transportation barriers, and increased food insecurity. Given that poor birth outcomes have adverse effects on adults' health and well-being, the findings suggest that in-utero exposure to residential segregation could have important implications for Black–White inequality over the life course. [ABSTRACT FROM AUTHOR]

Research on asthma prevalence and neighborhood effects shows how health disparities may be linked to neighborhood racial composition and local exposure to toxic air, but it often leaves aside how neighborhoods are spatially interconnected. Informed by urban studies and environmental justice research, this study suggests that analyses of asthma disparities can adopt a complementary spatial framework that highlights how social outcomes are patterned across geographic space. Using data from more than 4,000 census tracts in the US South, spatial models examine the direct and indirect effects of racial composition and air pollution on asthma prevalence within neighborhoods. Findings show that presence in neighborhoods with more Black residents and with greater air pollution are associated with higher asthma prevalence, and that contiguous areas sharing these characteristics also were positively associated with higher asthma rates. The effect for proportion of Black residents is much greater than air pollution. Implications center on how spatial modeling, environmental justice, and urban social science can contribute to our understanding of how urban asthma disparities come to be. Las investigaciones sobre la prevalencia del asma incluyen datos sobre los efectos del vecindario y cómo las disparidades de salud pueden estar vinculadas a la composición racial del vecindario y la exposición local al aire tóxico, pero a menudo deja de lado cómo los vecindarios están interconectados espacialmente. Este estudio, informado por estudios urbanos e investigaciones sobre justicia ambiental, sugiere que los análisis de las disparidades de asma pueden adoptar un marco espacial complementario que resalta cómo se modelan los resultados sociales en el espacio geográfico. Utilizando datos de más de 4,000 secciones censales en el sur de EE. UU. Los modelos espaciales examinan los efectos directos e indirectos de la composición racial y la contaminación del aire sobre la prevalencia del asma dentro de los vecindarios. Los resultados muestran que la presencia en los vecindarios con más residentes afroamericanos y con mayor contaminación del aire se asocian con una mayor prevalencia de asma, y que las áreas contiguas que comparten estas características también se asociaron positivamente con mayores tasas del asma. El efecto para la proporción de residentes afroamericanos es mucho mayor que la contaminación del aire. Las implicaciones se centran en cómo el modelado espacial, la justicia ambiental y las ciencias sociales urbanas pueden contribuir a nuestra comprensión de cómo surgen las disparidades en el asma urbano. [ABSTRACT FROM AUTHOR]

Although racial residential segregation and colorism, independently, strongly shape the lives of Latinas, previous studies rarely bridged both lines of research directly. This paper begins to fill this gap by examining within-group differences in perceived unfair treatment and preferences for housing segregation across Latinas of varying skin tones. Using the National Politics Survey (N = 222) and the Chicago Area Study (CAS; N = 152), cross-sectional analyses investigated the association of Latinas' skin tones with different forms of unfair treatment. The CAS also examined preferences for Latinx in-group versus White neighbors. Findings suggested that medium-skinned Latinas perceived elevated levels of particular types of discrimination. In the CAS sample, lighter skinned Latinas were more likely to reside in predominantly White neighborhoods, while darker Latinas resided in mainly mixed-race neighborhoods. Darker Latinas also ideally preferred more Latinx in-group neighbors while lighter skinned Latinas preferred more White neighbors. Experiences of discrimination interacted with anti-Latinx sentiments (i.e., internalized racism) to predict preferences to reside near Latinx neighbors. Results implied that darker Latinas may be more motivated to remain in segregated regions while lighter Latinas may move to predominantly White neighborhoods. Implications for theory, policy, and health are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND Racial residential segregation is associated with higher rates of chronic hypertension, as well as greater risk of preterm birth and low birthweight. However, few studies have examined associations between segregation and hypertensive disorder of pregnancy (HDP). METHODS Electronic health records from 4,748 singleton births among non-Hispanic black women at Prentice Women's Hospital in Chicago, IL (2009–2013) were geocoded to the census tract level. Residential segregation was measured using the Gi* statistic, a z -score measuring the extent to which each individual's neighborhood composition deviates from the composition of the larger surrounding area. Segregation was categorized as low (z < 0), medium (z = 0–1.96) or high (z > 1.96). We estimated cross-sectional associations of segregation with HDP using multilevel logistic regression models with census tract random intercepts. Models adjusted for neighborhood poverty and maternal characteristics. We also examined effect modification by neighborhood poverty. RESULTS Overall, 27.2% of women lived in high segregation, high-poverty neighborhoods. Racial residential segregation was not associated as a main effect with HDP in models adjusting for neighborhood poverty and maternal characteristics. However, at higher levels of neighborhood poverty (>20%), women living in high- and medium-segregated neighborhoods had greater odds of HDP relative to those in low-segregation neighborhoods (P interaction: 0.002). CONCLUSIONS In this sample of non-Hispanic black women in Chicago, racial residential segregation was associated with greater prevalence of HDP among those living in higher poverty neighborhoods. Understanding sources of heterogeneity in the relationship between segregation and health will help refine targeted intervention efforts to reduce disparities. [ABSTRACT FROM AUTHOR]

The military has long been seen as an avenue for increasing racial equality for minorities, especially black Americans. In this article, we examine to what extent military veterans also experience residential integration by looking at neighborhood residential outcomes for black and white men utilizing the popular Veterans Affairs (VA) loan program to purchase a home. We draw on data from the Home Mortgage Disclosure Act (HMDA) to examine residential integration among white and black veteran homebuyers compared to homebuyers utilizing conventional loans over three major lending eras: 1990s, 2000-2007, and 2008-2015. By 2015, a quarter of all home purchase mortgages loans to black men were VA loans even though veterans made up only a tenth of the adult black male population. In our multivariate analyses, we uncover a sizeable combined swing toward neighborhood minority-white integration, 14.4% points, among black and white veterans who use VA loans. Compared to those with conventional loans, black veterans live in neighborhoods with 10% points fewer minorities and, white veterans, 4.4% points fewer whites. Our results illustrate how racial integration in the US military has the potential to foster lasting housing integration among veterans. [ABSTRACT FROM AUTHOR]

We examined whether current and/or persistent racial residential segregation is associated with black-white stillbirth disparities among 49,969 black and 71,785 white births from the Consortium on Safe Labor (2002-2008). Black-white segregation was measured using the dissimilarity index and the isolation index, categorized into population-based tertiles. Using hierarchical logistic models, we found low and decreasing levels of segregation were associated with decreased odds of stillbirth, with blacks benefitting more than whites. Decreasing segregation may prevent approximately 900 stillbirths annually among U.S. blacks. Reducing structural racism, segregation in particular, could help reduce black-white stillbirth disparities. [ABSTRACT FROM AUTHOR]

Trends in concentrated neighborhood poverty in the United States have been volatile over the past several decades. Using data from the 1980 to 2000 decennial census and the 2010–2014 American Community Survey, we examine the association between concentrated poverty across metropolitan areas in the United States and key proximate factors, including overall changes in poverty, racial residential segregation, and income segregation. One of our unique contributions is assessing the relative contribution of each of these to long-term trends in such poverty using a decomposition analysis. We find that changes in the segregation of the poor explained the largest share of the change in concentrated poverty over most of the time period, with the exception of the 1990s, where the plunge in both black and white poverty rates had the largest role in explaining the considerable decline in concentrated poverty in that decade for both groups. The association between racial segregation and black concentrated poverty is positive but weaker, indicating that without declines in black segregation, concentrated poverty would have been higher. Overall, growing income segregation, along with weak economic performance in recent years, have put more poor people at risk for living in high-poverty communities. [ABSTRACT FROM AUTHOR]

Several perspectives dominate as explanations for neighborhood preferences: pure race, racial proxy, race-based neighborhood stereotyping, and race-associated neighborhood factors. This analysis extends and supports the pure race and race-associated neighborhood factors arguments by showing that these theories are applied differently depending on respondents' social class, race and ethnicity, and whether they are talking about white, black, or Latino neighborhoods. Race-associated factors are emphasized for white and black neighborhoods, but pure race serves as a better theoretical framework for understanding people's preferences for Latino neighborhoods. I analyze qualitative interview data, using maps of real neighborhoods and hypothetical neighborhood show cards, to examine the neighborhood preferences of 65 white, black, and Latino residents in Ogden, Utah, and Buffalo, New York. [ABSTRACT FROM AUTHOR]

The high rate of obesity among black women in the USA is a significant public health problem. However, there is limited research on the relationship between racial residential segregation and disparities in obesity, and the existing evidence is limited and results are mixed. This study examines the relationship between racial residential segregation and obesity among black and white women. We conducted this cross-sectional study by joining data from the 1999-2004 National Health and Nutrition Examination Survey with data from the 2000 US Census. Multilevel logistic regression models found that for every one-point increase in the black isolation index, there was a 1.06 (95 % confidence interval (CI) = 1.01, 1.11) times higher odds of obesity for black women. In order to address the disparately high rates of obesity among black women, health policies need to address the economic, political, and social forces that produce racially segregated neighborhoods. [ABSTRACT FROM AUTHOR]

We argue that the relative persistence of racial segregation is due, at least in part, to the process of residential search and the perceptions upon which those searches are based—a critical but often-ignored component of the residential sorting process. We examine where Chicago-area residents would “seriously consider” and “never consider” living, finding that community attraction and avoidance are highly racialized. Race most clearly shapes the residential perceptions and preferences of whites, and matters the least to blacks. Latinos would seriously consider moving to numerous neighborhoods, but controls for demographics and distance from the respondents’ home make Latino preferences much like those of whites. Critically, the geography of existing segregation begets further segregation: distance from current community significantly affects perceptions of the communities into which respondents might move. While neighborhood perception may cause persistent segregation, it may also offer hope for integration with appropriate policy interventions. [ABSTRACT FROM PUBLISHER]

Since the formal dismantling of apartheid in the early 1990s, the South African government has placed much emphasis on redressing the social imbalances caused by apartheid, including overcoming patterns of segregation inherent in the apartheid city. The National Development Plan, in specifying its principles for the spatial development of South African settlements, outlines the principle of spatial justice: that apartheid's policy of confining particular groups to limited spaces must be reversed. In order to inform the future success of the National Development Plan's goal of social cohesion, research into residential segregation can provide one indication of how socially integrated South African society is. The purpose of this article is to measure racial residential segregation at different geographic scales for the South African cities of Cape Town and Johannesburg, and to measure how residential segregation has changed over time using data from the population censuses of 1991, 1996, 2001 and 2011. Theil's entropy index of segregation, applied to grid squares of varying spatial sizes, is used to calculate both racial diversity and racial segregation for both cities. The results show that from 1991 to 2011, segregation levels decreased at all geographic scales in both cities. However, despite this decrease, both cities remain highly segregated. If the census enumeration area or small area is used as the base from which to calculate segregation, Cape Town as a whole is more racially segregated than Johannesburg. However, Johannesburg is more racially segregated than Cape Town at larger geographic scales. [ABSTRACT FROM PUBLISHER]

Abstract: Background: Food store availability may determine the quality of food consumed by residents. Neighborhood racial residential segregation, poverty, and urbanicity independently affect food store availability, but the interactions among them have not been studied. Purpose: To examine availability of supermarkets, grocery stores, and convenience stores in US census tracts according to neighborhood racial/ethnic composition, poverty, and urbanicity. Methods: Data from 2000 US Census and 2001 InfoUSA food store data were combined and multivariate negative binomial regression models employed. Results: As neighborhood poverty increased, supermarket availability decreased and grocery and convenience stores increased, regardless of race/ethnicity. At equal levels of poverty, Black census tracts had the fewest supermarkets, White tracts had the most, and integrated tracts were intermediate. Hispanic census tracts had the most grocery stores at all levels of poverty. In rural census tracts, neither racial composition nor level of poverty predicted supermarket availability. Conclusions: Neighborhood racial composition and neighborhood poverty are independently associated with food store availability. Poor predominantly Black neighborhoods face a double jeopardy with the most limited access to quality food and should be prioritized for interventions. These associations are not seen in rural areas which suggest that interventions should not be universal but developed locally. [Copyright &y& Elsevier]

Research on racial residential segregation and health typically uses multilevel, population-based, slice-in-time data. Although research using this approach, including that by Kershaw et al. (Am J Epidemiol. 2013;177(4):299–309), has been valuable, I argue that to advance our understanding of how residential segregation influences health and health disparities, it is critical to incorporate a life-course perspective and integrate social theory. Applying a life-course perspective would entail modeling transitions, cumulative risk, and developmental and dynamic processes and mechanisms, as well as recognizing the contingency of contextual effects on different social groups. I discuss the need for analytic methods appropriate for modeling health effects of distal causes experienced across the life course, such as segregation, that operate through multiple levels and sequences of mediators, potentially across decades. Sociological theories of neighborhood attainment (e.g., segmented assimilation, ethnic resurgence, and place stratification theories) can guide effect-modification tests to help illuminate health effects resulting from intersections of residential processes, race/ethnicity, immigration, and other social determinants of health. For example, nativity and immigration history may crucially shape residential processes and exposures, but these have received limited attention in prior segregation-health literature. [ABSTRACT FROM PUBLISHER]