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While health care-associated financial burdens among uninsured individuals are well described, few studies have systematically characterized the array of financial and logistical complications faced by insured individuals with low household incomes. In this mixed methods paper, we conducted 6 focus groups with a total of 55 residents and analyzed programmatic administrative records to characterize the specific financial and logistic barriers faced by residents living in public housing in East and Central Harlem, New York City (NYC). Participants included individuals who enrolled in a municipal community health worker (CHW) program designed to close equity gaps in health and social outcomes. Dedicated health advocates (HAs) were explicitly paired with CHWs to provide health insurance and health care navigational assistance. We describe the needs of 150 residents with reported financial barriers to care, as well as the navigational and advocacy strategies taken by HAs to address them. Finally, we outline state-level policy recommendations to help ameliorate the problems experienced by participants. The model of paired CHW–HAs may be helpful in addressing financial barriers for insured populations with low household income and reducing health disparities in other communities.

Urban community gardens have been shown to have positive affects social capital, yet like many public spaces, are open to negative activities like crime. Contrary to this idea, most of the literature has indicated that urban green spaces are associated with a reduction in crime. This study utilized a mixed-methods research design to explore the hypothesis that areas around Seattle’s “P-Patch” community gardens are associated with a reduction in crime. We employed spatio-temporal GIS (Geographic Information Systems) analyses, statistical analyses, and qualitative interviews with gardeners. Yearly violent and property crime rates for 132 census tracts in Seattle, locations of 84 P-Patches were mapped, and changes in crime and garden establishment from 1996 to 2006 were observed. Correlations were conducted on socio-demographic, crime, and P-Patch variables. Interviews with four gardeners were conducted and qualitatively analyzed for common themes. Geographic visualization showed interesting patterns in crime and P-Patch establishment in South Seattle in particular, but outcomes of the correlation between P-Patch and crime variables were inconclusive. Qualitative interviews with gardeners provided a fuller account of the overall changes in Seattle crime, gardeners’ perceptions of neighborhood safety, and its relation to the development of urban community spaces such as P-Patches. Faculty Sponsor: Jin-Kyu Jung