JMIR Publications

ABSTRACT

Background:

Neighborhood revitalization is a process through which land use rezoning and capital investment can spur new resources such as access to healthful food and amenities for physical activity. While revitalization efforts may promote cardiovascular health, their benefits may not be distributed equally across socio-demographic groups.

Objective:

The objective of the study is to apply a social-ecological framework that uses a multi-method approach incorporating quantitative data (longitudinal electronic health record (EHR) and cross-sectional survey) and qualitative data (longitudinal “walk-a-long” interviews) to examine the short-term effect of neighborhood land use rezoning and revitalization effort on cardiovascular disease (CVD), CVD-related health behaviors, and engagement in health care. Systems science methods, namely microsimulation modeling and system dynamics modeling (SDM), will be used to assess long-term land use rezoning policy and revitalization effort effects on cardiovascular health and ways to sustain priority health equity goals in revitalized neighborhoods.

Methods:

We leverage a land use rezoning initiative in the Bronx, NY, where a largely commercial area is being rezoned along with capital investments to expand healthful neighborhood resources. Using electronic health records from a single hospital system, we will follow cohorts of mid-life and older adults (≥50 years) residing in both the rezoned area and a comparison area. We will assess clinically measured incident CVD and other CVD risk factors to evaluate changes in cardiovascular health over time. In parallel, we will conduct a cross-sectional survey and a purposive sampling of patients for in-person “walk-a-long” qualitative interviews to understand how residents perceive neighborhood access to healthful resources after land use rezoning. To estimate long-term effects, we will use a validated microsimulation model to project CVD outcomes and costs. Lastly, we will use system dynamics modeling to integrate quantitative and qualitative findings to inform future revitalization and public health strategies.

Results:

Mid-life and older adult patients in the intervention area and the comparison area will be followed approximately 7-years following land use rezoning and revitalization effort to compare CVD risk between neighborhoods. The cross-sectional survey and qualitative assessment will increase understanding of perceptions of access to healthful resources and related health behaviors among residents. System science approaches will estimate long-term CVD risk and related costs associated with revitalization efforts.

Conclusions:

This study uses a socio-ecological framework to provide a novel, transferable method for evaluating the impact of neighborhood revitalization efforts on cardiovascular health by combining methods to examine short and long-term effects across individual, neighborhood, and structural (systems) levels over time. Findings will inform policies aimed at reducing CVD through equitable urban revitalization.