Clinical trial NCT05541653: The IGNITE Study on Concentrated Investment in Black Neighborhoods
Official title: A Randomized Controlled Trial of Concentrated Investment in Black Neighborhoods to Address Structural Racism as a Fundamental Cause of Poor Health
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: NA
Conditions: Financial Stress
Economic Problems
Environmental Exposure
Health Behavior
Health, Subjective
Mental Health Wellness 1
Lead sponsor: University of Pennsylvania
Sponsor class: OTHER
First posted: 2022-09-15
Enrollment: 571
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

Brief summary: Black Americans in the US fare worse across nearly every health indicator compared to White individuals. In Philadelphia, the location of this study, these health disparities culminate in a stark longevity gap, with average life expectancies in poor, predominantly Black neighborhoods being 20 years lower than in nearby affluent, predominantly White neighborhoods. The investigators will conduct a cluster randomized controlled trial (RCT) of a suite of place-based and financial-wellbeing interventions at the community, organization, and individual/household levels that address the social determinants of racial health disparities. At the community level, the investigators address underinvestment in Black neighborhoods by implementing vacant lot greening, abandoned house remediation, tree planting, and trash cleanup. At the organization level, the investigators partner with community-based financial empowerment providers to develop cross-organizational infrastructure to increase reach and maximize efficiency. At the individual/household levels, the investigators increase access to public benefits, financial counseling and tax preparation services, and emergency cash assistance. The investigators will test this "big push" intervention in 60 Black neighborhood microclusters, with a total of 720 adults. The investigators hypothesize that this "big push" intervention will have significant impact on overall health and wellbeing.

Detailed description: Black individuals in the United States fare worse than White individuals across almost every social, economic, and health indicator. The Black health disadvantage starts at birth, reflecting the cumulative toll of racialized social stressors and healthcare discrimination on maternal health and resulting in higher rates of preterm birth and low birth weight. Black youth are disproportionately exposed to environmental toxins such as lead and adverse childhood events such as financial hardship and neighborhood violence. Black adults have higher rates of chronic disease, including diabetes, hypertension, as well as many cancers. These and other forces culminate in a stark racial longevity gap: in Philadelphia, the location of this study, life expectancy for people living in a poor, predominantly Black neighborhood is 20 years lower than for people living in a nearby affluent, predominantly White neighborhood.

The fundamental cause of these striking and pervasive disparities is structural racism - the confluence of deep historical, institutional, cultural, and ideological forces that unequally distribute resources and risks across racialized groups. Structural racism patterns health by affecting a range of interconnected, mutually reinforcing social determinants of health at the national, neighborhood, household, and individual levels. Most notably, longstanding, systematic disinvestment has resulted in highly segregated Black neighborhoods with dilapidated environmental conditions and severe economic insecurity within Black households, leading to a "feedback loop of concentrated racial disadvantage," all of which have been strongly tied to poor health.

Most interventions seeking to address racial health disparities focus on individual-level behaviors and outcomes, or individual channels by which structural racism harms health. However, by failing to address upstream social determinants, these interventions have had limited population level impact. A multi-level, multi-component intervention package focused on a range of social determinants of health is necessary to meaningfully address structural racism as a fundamental cause of racial health disparities.

Eligibility criteria: Inclusion Criteria:

* At least 18 years of age
* Have the ability to communicate via text messaging
* Individuals comfortable communicating in English
* A permanent resident of the home where they are to be enrolled
* Have knowledge of their household finances

Exclusion Criteria:

* Individuals who plan to move out of the study microcluster within 6 months
* Individuals who are unable to fully consent and participate based on recruitment team assessment

Primary outcomes:
measure: Overall Health Index
timeFrame: 24 months
measure: Psychological Distress
timeFrame: 24 months
Secondary outcomes:
measure: Overall health
timeFrame: 24 months
measure: Poor health
timeFrame: 24 months
measure: Change in overall health
timeFrame: 24 months
measure: Healthy days
timeFrame: 24 months
measure: Sleep duration
timeFrame: 24 months
measure: Short sleep
timeFrame: 24 months
measure: Healthcare access
timeFrame: 24 months
measure: Financial well-being
timeFrame: 24 months
measure: Food insecurity
timeFrame: 24 months
measure: Income tax filing
timeFrame: 24 months
measure: Home ownership
timeFrame: 24 months
measure: Owing on mortgage
timeFrame: 24 months
measure: Total debt
timeFrame: 24 months
measure: Participation in public medical benefit programs
timeFrame: 24 months
measure: Participation in public food benefit programs
timeFrame: 24 months
measure: Participation in public income support or cash benefit programs
timeFrame: 24 months
measure: Participation in public home ownership benefit programs
timeFrame: 24 months
measure: Frequency of greenspace engagment
timeFrame: 24 months
measure: Time spent in greenspace
timeFrame: 24 months
measure: Reasons for not spending time in greenspace
timeFrame: 24 months
measure: Perception of tree cover
timeFrame: 24 months
measure: Tree planting concerns
timeFrame: 24 months
measure: Perceived tree health benefits
timeFrame: 24 months
measure: Perceived stress
timeFrame: 24 months
measure: Time spent in neighborhood
timeFrame: 24 months
measure: Neighborhood social capital
timeFrame: 24 months
measure: Physical disorder
timeFrame: 24 months
measure: Neighborhood crime rates
timeFrame: Quarterly data from 24 months (8 quarters) prior to enrollment and 12 months (4 quarters) after intervention period complete
measure: Nuisance calls
timeFrame: Quarterly data from 24 months (8 quarters) prior to enrollment and 12 months (4 quarters) after intervention period complete
Other outcomes:
Locations:
city: Philadelphia
country: United States
facility: Philadelphia Neighborhoods
state: Pennsylvania
Study officials:
References: