Introduction
The geographic overlap of violence and poor health is a major public health concern.
To understand whether and how place-based interventions targeting micro-geographic
places can reduce this undesirable co-occurrence, the study addresses 2 important
questions. First, to what extent are deteriorated health conditions associated with
living at violent crime hot spots? Second, through what mechanisms can focused place-based
interventions break the association between living with violence and deteriorated
health?
Methods
This study used survey data from 2,724 respondents living on 328 street segments that
were categorized as violent crime hot spots (181 segments with 1,532 respondents)
versus non–hot spots (147 segments with 1,192 respondents) in 2013–2014 in Baltimore,
Maryland. Propensity score analysis assessed whether individuals living at violent
crime hot spots had lower general health perceptions than people living at non–hot
spots. Marginal structural models estimated the proportion of total effects mediated
by 3 theoretically informed intervening mechanisms. Analyses were conducted in 2019.
Results
Respondents living at violent crime hot spots had a lower level of self-rated general
health (b= −0.096, 95% CI= −0.176, −0.015) and higher levels of health limitations
(b=0.068, 95% CI=0.027, 0.109) and problems (OR=2.026, 95% CI=1.225, 3.349) than those
living at non–hot spots. Enhanced perceptions of safety, collective efficacy, and
police legitimacy may break the association between living in places with extremely
high levels of violence and deteriorated health.
Conclusions
Indicated or selective strategies are urgently needed to target micro-geographic locations
with known increased risks, supplementing universal strategies applied to a broader
community.
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Published online: February 12, 2020
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© 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
