Mixed Effects of Neighborhood Revitalization on Residents’ Cardiometabolic Health


      Despite the growing recognition of the importance of neighborhood conditions for cardiometabolic health, causal relationships have been difficult to establish owing to a reliance on cross-sectional designs and selection bias. This is the first natural experiment to examine the impact of neighborhood revitalization on cardiometabolic outcomes in residents from 2 predominantly African American neighborhoods, one of which has experienced significant revitalization (intervention), whereas the other has not (comparison).


      The sample included 532 adults (95% African American, 80% female, mean age=58.9 years) from 2 sociodemographically similar, low-income neighborhoods in Pittsburgh, PA, with preintervention and postintervention measures (2016 and 2018) of BMI, diastolic and systolic blood pressure, HbA1c, and high-density lipoprotein cholesterol and covariates. Data were collected in 2016 and 2018 and analyzed in 2020.


      Difference-in-difference analyses showed significant improvement in high-density lipoprotein cholesterol in intervention residents relative to that in the comparison neighborhood (β=3.88, 95% CI=0.47, 7.29). There was also a significant difference-in-difference estimate in diastolic blood pressure (β=3.00, 95% CI=0.57, 5.43), with residents of the intervention neighborhood showing a greater increase in diastolic blood pressure than those in the comparison neighborhood. No statistically significant differences were found for other outcomes.


      Investing in disadvantaged neighborhoods has been suggested as a strategy to reduce health disparities. Using a natural experiment, findings suggest that improving neighborhood conditions may have a mixed impact on certain aspects of cardiometabolic health. Findings underscore the importance of examining the upstream causes of health disparities using rigorous designs and longer follow-up periods that provide more powerful tests of causality.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Agardh E
        • Allebeck P
        • Hallqvist J
        • Moradi T
        • Sidorchuk A.
        Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis.
        Int J Epidemiol. 2011; 40: 804-818
        • Carnethon MR
        • Pu J
        • Howard G
        • et al.
        Cardiovascular health in African Americans: a scientific statement from the American Heart Association.
        Circulation. 2017; 136: e393-e423
        • Agardh EE
        • Sidorchuk A
        • Hallqvist J
        • et al.
        Burden of type 2 diabetes attributed to lower educational levels in Sweden.
        Popul Health Metr. 2011; 9: 60
        • Golden SH
        • Brown A
        • Cauley JA
        • et al.
        Health disparities in endocrine disorders: biological, clinical, and nonclinical factors–an Endocrine Society scientific statement.
        J Clin Endocrinol Metab. 2012; 97: E1579-E1639
        • Gary-Webb TL
        • Suglia SF
        • Tehranifar P.
        Social epidemiology of diabetes and associated conditions.
        Curr Diab Rep. 2013; 13: 850-859
        • Auchincloss AH
        • Diez Roux AV
        • Mujahid MS
        • Shen M
        • Bertoni AG
        • Carnethon MR
        Neighborhood resources for physical activity and healthy foods and incidence of type 2 diabetes mellitus: the Multi-Ethnic study of Atherosclerosis.
        Arch Intern Med. 2009; 169: 1698-1704
        • Auchincloss AH
        • Mujahid MS
        • Shen M
        • Michos ED
        • Whitt-Glover MC
        • Diez Roux AV
        Neighborhood health-promoting resources and obesity risk (the multi-ethnic study of atherosclerosis).
        Obesity (Silver Spring). 2013; 21: 621-628
        • Diez Roux AV
        • Mair C.
        Neighborhoods and health.
        Ann N Y Acad Sci. 2010; 1186 ( 125-145
        • Ding D
        • Gebel K.
        Built environment, physical activity, and obesity: what have we learned from reviewing the literature?.
        Health Place. 2012; 18: 100-105
        • Churchwell K
        • Elkind MSV
        • Benjamin RM
        • et al.
        Call to action: structural racism as a fundamental driver of health disparities: a presidential advisory from the American Heart Association.
        Circulation. 2020; 142: e454-e468
        • Dwyer-Lindgren L
        • Bertozzi-Villa A
        • Stubbs RW
        • et al.
        Inequalities in life expectancy among U.S. counties, 1980 to 2014: temporal trends and key drivers.
        JAMA Intern Med. 2017; 177: 1003-1011
        • Williams DR
        • Collins C.
        Racial residential segregation: a fundamental cause of racial disparities in health.
        Public Health Rep. 2001; 116: 404-416
        • Sims M
        • Kershaw KN
        • Breathett K
        • et al.
        Importance of housing and cardiovascular health and well-being: a scientific statement from the American Heart Association.
        Circ Cardiovasc Qual Outcomes. 2020; 13e000089
        • Chandrabose M
        • Rachele JN
        • Gunn L
        • et al.
        Built environment and cardio-metabolic health: systematic review and meta-analysis of longitudinal studies.
        Obes Rev. 2019; 20: 41-54
        • Arcaya M
        • James P
        • Rhodes JE
        • Waters MC
        • Subramanian SV.
        Urban sprawl and body mass index among displaced Hurricane Katrina survivors.
        Prev Med. 2014; 65: 40-46
        • Ludwig J
        • Sanbonmatsu L
        • Gennetian L
        • et al.
        Neighborhoods, obesity, and diabetes–a randomized social experiment.
        N Engl J Med. 2011; 365: 1509-1519
      1. About HOPE VI. U.S. Department of Housing and Urban Development. Accessed March 16, 2021.

      2. Hill CDC Developers. Accessed March 16, 2021.

        • Dubowitz T
        • Ghosh Dastidar M
        • Richardson AS
        • et al.
        Results from a natural experiment: initial neighbourhood investments do not change objectively-assessed physical activity, psychological distress or perceptions of the neighbourhood.
        Int J Behav Nutr Phys Act. 2019; 16: 29
      3. Brooks Holliday S, Troxel W, Haas A, et al. Do investments in low-income neighborhoods produce objective change in health-related neighborhood conditions? Health Place. 2020;64:102361.

        • Dubowitz T
        • Ghosh-Dastidar M
        • Cohen DA
        • et al.
        Diet and perceptions change with supermarket introduction in a food desert, but not because of supermarket use [published correction appears in Health Aff (Millwood). 2015;34(12):2205].
        Health Aff (Millwood). 2015; 34: 1858-1868
        • Richardson AS
        • Ghosh-Dastidar M
        • Beckman R
        • et al.
        Can the introduction of a full-service supermarket in a food desert improve residents’ economic status and health?.
        Ann Epidemiol. 2017; 27: 771-776
        • Gary-Webb TL
        • Egnot NS
        • Nugroho A
        • Dubowitz T
        • Troxel WM.
        Changes in perceptions of neighborhood environment and cardiometabolic outcomes in two predominantly African American neighborhoods.
        BMC Public Health. 2020; 20: 52
        • Troxel WM
        • DeSantis A
        • Richardson AS
        • et al.
        Neighborhood disadvantage is associated with actigraphy-assessed sleep continuity and short sleep duration.
        Sleep. 2019; 42: zsy140
      4. U.S. Census Bureau 2005-2009 American Community Survey 5-year estimates, 2010, Accessed February 5, 2020.

      5. U.S. Census Bureau 2010-2014 American Community Survey 5-year estimates, 2015, Accessed February 5, 2020.

      6. U.S. Census Bureau 2014-2018 American Community Survey 5-year estimates, 2018, Accessed February 5, 2020.

        • Dubowitz T
        • Ncube C
        • Leuschner K
        • Tharp-Gilliam S.
        A natural experiment opportunity in two low-income urban food desert communities: research design, community engagement methods, and baseline results.
        Health Educ Behav. 2015; 42 (1): 87S-96S
        • Dubowitz T
        • Zenk SN
        • Ghosh-Dastidar B
        • et al.
        Healthy food access for urban food desert residents: examination of the food environment, food purchasing practices, diet and BMI.
        Public Health Nutr. 2015; 18: 2220-2230
        • DeSantis A
        • Troxel WM
        • Beckman R
        • et al.
        Is the association between neighborhood characteristics and sleep quality mediated by psychological distress? An analysis of perceived and objective measures of 2 Pittsburgh neighborhoods.
        Sleep Health. 2016; 2: 277-282
      7. Version 9.4 of the SAS System for Windows; 2020. SAS Software. Accessed September 18, 2020.

      8. The R Project for Statistical Computing. R Core Team. Accessed September 18, 2020.

        • Chen H
        • Cohen P
        • Chen S.
        How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies.
        Commun Stat Simul Comput. 2010; 39: 860-864
        • Devi S
        Getting to the root of America's racial health inequalities.
        Lancet. 2012; 380: 1043
        • Malambo P
        • Kengne AP
        • De Villiers A
        • Lambert EV
        • Puoane T.
        Built environment, selected risk factors and major cardiovascular disease outcomes: a systematic review.
        PLoS One. 2016; 11e0166846
        • Braun LM
        • Rodriguez DA
        • Song Y
        • et al.
        Changes in walking, body mass index, and cardiometabolic risk factors following residential relocation: longitudinal results from the CARDIA study.
        J Transp Health. 2016; 3: 426-439
        • Braun LM
        • Rodríguez DA
        • Evenson KR
        • Hirsch JA
        • Moore KA
        Diez Roux AV. Walkability and cardiometabolic risk factors: cross-sectional and longitudinal associations from the multi-ethnic study of atherosclerosis.
        Health Place. 2016; 39: 9-17
        • Berke EM
        • Vernez-Moudon A.
        Built environment change: a framework to support health-enhancing behaviour through environmental policy and health research.
        J Epidemiol Community Health. 2014; 68: 586-590
        • Frank LD
        • Iroz-Elardo N
        • MacLeod KE
        • Hong A.
        Pathways from built environment to health: a conceptual framework linking behavior and exposure-based impacts.
        J Transp Health. 2019; 12: 319-335
        • Paquet C
        • Coffee NT
        • Haren MT
        • et al.
        Food environment, walkability, and public open spaces are associated with incident development of cardio-metabolic risk factors in a biomedical cohort.
        Health Place. 2014; 28: 173-176
        • Diez Roux AV
        • Merkin SS
        • Arnett D
        • et al.
        Neighborhood of residence and incidence of coronary heart disease.
        N Engl J Med. 2001; 345: 99-106
        • Baird MD
        • Schwartz H
        • Hunter GP
        • et al.
        Does large-scale neighborhood reinvestment work? Effects of public–private real estate investment on local sales prices, rental prices, and crime rates.
        Hous Policy Debate. 2020; 30: 164-190
        • Nordestgaard BG
        • Langsted A
        • Freiberg JJ.
        Nonfasting hyperlipidemia and cardiovascular disease.
        Curr Drug Targets. 2009; 10: 328-335