Concentrated Investment for Health Disparities in Black Neighborhoods

Overseen By Evan Spencer, MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Pennsylvania

Disqualifiers: Moving, Unable to consent

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

The trial aims to address health disparities in Black neighborhoods in Philadelphia through community and financial support interventions. It will test whether improving neighborhood conditions, such as cleaning vacant lots and planting trees, along with providing financial counseling and tax assistance, can enhance overall health and wellbeing. Participants will join either the intervention group receiving these supports or a control group without them. Suitable candidates are permanent residents in the study area who can communicate via text and understand their household finances. As an unphased trial, this study offers a unique opportunity to contribute to community health improvements and potentially benefit from enhanced neighborhood conditions.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that these interventions are safe for participants?

Research has shown that improving financial well-being and enhancing neighborhoods are generally safe and well-received. These activities include providing better access to financial resources and cleaning up neighborhoods by removing trash and planting trees.

When people achieve more financial stability, they often experience better health because they can afford healthcare and other essential services. This strong connection between financial resources and health is well-supported by research.

Improving neighborhoods, known as place-based interventions, focuses on enhancing the physical environment. Studies indicate that cleaner and greener neighborhoods contribute to better physical and mental health. Activities like cleaning up and adding plants usually pose no risk to participants.

In summary, both improving financial stability and enhancing neighborhoods are linked to better health outcomes without major safety concerns. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these interventions because they offer a fresh approach to tackling health disparities in Black neighborhoods. Unlike traditional healthcare treatments that focus solely on medical interventions, this approach incorporates financial well-being and environmental improvements. By providing tax preparation assistance, access to public benefits, financial counseling, and microgrants, the intervention aims to empower individuals economically. Additionally, neighborhood enhancements like abandoned house remediation, trash cleanup, vacant lot greening, and tree planting address the broader social determinants of health. This holistic strategy not only targets individual financial stability but also enhances the living environment, which could lead to more sustainable health improvements.

What evidence suggests that this trial's interventions could be effective for reducing health disparities in Black neighborhoods?

This trial will compare the effects of financial well-being interventions and place-based interventions on health disparities in Black neighborhoods. Research has shown that improving financial well-being can enhance health. Participants in the intervention arm will receive services like tax help, access to benefits, and financial advice, which studies indicate can reduce stress and improve mental health. Early results suggest these efforts might lead to better overall health.

Additionally, community-based actions such as cleaning and greening empty lots will be implemented. These actions have shown promise in lowering crime and violence in neighborhoods, making areas safer and potentially boosting community health and well-being. These changes can help reduce health disparities in Black neighborhoods. ^{2 6 7 8 9}

Are You a Good Fit for This Trial?

This trial is for Black Americans at least 18 years old living in certain Philadelphia neighborhoods. Participants must be able to text, speak English, reside permanently in their homes, and understand their household finances. Those planning to move soon or unable to consent are excluded.

Inclusion Criteria

Have knowledge of their household finances

Have the ability to communicate via text messaging

Individuals comfortable communicating in English

Exclusion Criteria

Individuals who plan to move out of the study microcluster within 6 months

I am unable to fully understand or agree to the study on my own.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive place-based and financial well-being interventions, including tax preparation, access to public benefits, financial counseling, microgrants, abandoned house remediation, trash cleanup, vacant lot greening, and tree planting

24 months

Follow-up

Participants are monitored for changes in health and well-being, including overall health index, psychological distress, and participation in public benefit programs

12 months

What Are the Treatments Tested in This Trial?

Interventions

• Financial Well-being Interventions
• Place-based Interventions

Trial Overview The study tests a 'big push' intervention aimed at improving health by enhancing financial well-being and investing in neighborhood environments. It includes greening lots, fixing houses, planting trees, cleaning trash, financial counseling, tax help, and emergency cash aid.

How Is the Trial Designed?

Group I: Intervention Experimental Treatment 2 Interventions

At the individual level, participants in the intervention arm receive place-based and financial well-being interventions. These include, at the individual level: * Tax preparation * Access to public benefits * Financial counseling and microgrants At the neighborhood level: * Abandoned house remediation * Trash cleanup * Vacant lot greening * Tree planting

Group II: Control Active Control 1 Intervention

Participants in the control arm will not receive any of the listed interventions.

Who Is Running the Clinical Trial?

University of Pennsylvania

Lead Sponsor

Trials

2,118

Recruited

45,270,000+

Published Research Related to This Trial

Cardiometabolic diseases, such as diabetes and heart disease, lead to significant health disparities among Black adults in the U.S., with 12 million years of life lost annually, particularly in low socio-economic neighborhoods.

Interventions targeting social determinants of health, including access to medical care and adherence to treatment, are essential to improve cardiometabolic health equity and reduce the higher prevalence of diseases and complications in Black communities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Social and Medical Determinants of Cardiometabolic Health: The Big Picture. Puckrein, GA., Egan, BM., Howard, G.[2022]

Medical-Financial Partnerships (MFPs) are innovative collaborations between healthcare systems and financial organizations aimed at reducing financial stress in low-income families, which can lead to improved health outcomes.

MFPs provide a range of financial services, such as coaching and tax preparation, and have shown promise in enhancing both financial stability and health, addressing the link between financial circumstances and health in marginalized communities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Medical-Financial Partnerships: Cross-Sector Collaborations Between Medical and Financial Services to Improve Health. Bell, ON., Hole, MK., Johnson, K., et al.[2023]

Patients with low financial status (7467 individuals) reported 10% to 30% lower satisfaction with healthcare services and collaborative care compared to those with adequate financial status (43,701 individuals).

Markers of disease management and prevention were also significantly lower (7% to 18%) in patients with low financial status, highlighting that financial disparities negatively impact health outcomes and access to quality care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Postscript: health disparity and collaborative care. Wasson, JH., Benjamin, R.[2019]

Citations

1. reporter.nih.gov reporter.nih.gov/project-details/10929515

Clinical Studies - NIH RePORTER The fundamental cause of these racial health disparities is structural racism, which operates via interconnected, mutually reinforcing social and economic ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT05541653

The IGNITE Study on Concentrated Investment in Black ... A randomized controlled trial of concentrated investment in Black neighborhoods to address structural racism as a fundamental cause of poor health conditions.

3. healthaffairs.org healthaffairs.org/doi/10.1377/hlthaff.2023.01037

Interventions At The Neighborhood Level Could Help ... This article is a critical review of the relationship between neighborhoods and health. We discuss inequality among US neighborhoods and the roots of that ...

4. clinicaltrials.gov clinicaltrials.gov/ProvidedDocs/01/NCT05760001/Prot_SAP_000.pdf

IGNITE A Randomized Controlled Trial of Concentrated ... The objective is to develop and test a concentrated suite of place-based and financial well-being interventions at the community, organization, and individual ...

5. researchgate.net researchgate.net/publication/375317171_A_guaranteed_income_intervention_to_improve_the_health_and_financial_well-being_of_low-income_black_emerging_adults_study_protocol_for_the_Black_Economic_Equity_Movement_randomized_controlled_crossove

A guaranteed income intervention to improve the health ... Primary outcomes include: (a) financial well-being (investing in education/training); (b) mental health status (depressive symptoms); and (c) ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10527840/

Race, Healthcare, and Health Disparities: A Critical Review ... An overwhelming body of evidence points to an inextricable link between race and health disparities in the United States.

7. kff.org kff.org/racial-equity-and-health-policy/key-data-on-health-and-health-care-by-race-and-ethnicity/

Key Data on Health and Health Care by Race and Ethnicity Using data to identify disparities and the factors that drive them is important for developing interventions and directing resources to address ...

8. sciencedirect.com sciencedirect.com/science/article/pii/S2352827325000060

What role does wealth play in the racial health gap ... Wealth is a crucial factor in the racial health gap in the United States (USA), as it influences access to resources, healthcare and other social services.

9. cdn.clinicaltrials.gov cdn.clinicaltrials.gov/large-docs/53/NCT05541653/Prot_SAP_001.pdf

ignite The objective is to develop and test a concentrated suite of place-based and financial well-being interventions at the community, organization, and individual ...