About this poster

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Panel information
Panel 1. Context: Cross-Cultural, Neighborhood, and Social

Abstract

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There is a large body of research showing deleterious associations between poor neighborhood conditions and adverse health outcomes, yet the types of questions researchers are seeking to answer remains unclear. The questions asked in research play a critical role in shaping narratives about health and who should act to improve it (e.g., lawmakers vs. individual action). For instance, research that focuses on individuals (beginning with individual determinants of health and ending with individual health outcomes) or on determinants of health rather than determinants of health inequities, may result in a moral solely placing the burden to act on health on individuals (e.g., people should engage in health promotive behaviors or participate in medical interventions) or a moral advocating for interventions focused solely on health, which may exacerbate health inequities. Alternatively, research that focuses on how broader contextual factors lead to differential exposure to risk that then influence health and health inequities may encourage a different narrative - one that recognizes the role of laws, policies, and social hierarchies in shaping health and health inequities and shifts the burden of health away from being solely on the individual. Thus, this scoping review evaluated the types of research questions included in neighborhoods and health research published over the past five years by mapping them onto a modified version of the World Health Organization’s conceptual framework on Social Determinants of Health and Health Inequities (SDoH; see Figure 1).

In this pre-registered review, we searched Ovid Medline and PsycInfo for quantitative articles that included a measure of both neighborhood characteristics and health as a measure of interest (i.e., not a covariate) that were focused on U.S. youth (i.e., participants < 18). After removing duplicates, 5,501 articles were double screened for eligibility in two phases: a title/abstract phase and a full text phase, with a Cohen’s kappa of .83 at the title/abstract screening and .86 at the full text screening. A total of 474 articles were eligible for inclusion. To determine the research narrative(s) dominating this body of research, we coded: the SDoH category that aligned with each variable in the research goal and the role of each in the research design (see Table 1). From this information, we coded whether the research plot of each article aligned with the WHO framework (i.e., SDoH was the predictor, moderator, or mediator and intermediary determinants or health was the outcome).

Our findings indicate that only 20% of articles included a structural determinant of health or health inequities, with fewer than 1% of studies including measures of the socioeconomic and political context (i.e., laws, policies, societal values). Race/ethnicity and gender/sex/LGBTQIA+ status were the most commonly included structural determinants. Over half of the research goals included only predictor(s) and outcome(s), rather than examining for whom associations vary and potential pathways. Only approximately 20% of articles had research goals that aligned with the WHO framework, with others focusing solely on intermediary determinants of health and health outcomes.

The systemic inequalities that lead to disproportionate exposure to adverse neighborhoods by certain groups highlight the need for research that incorporates the socioeconomic and political context and structural determinants of health inequities that are upstream from neighborhood conditions. It is time to question the dominant narrative that the burden of health falls on individuals or that interventions solely focused on health will ameliorate health inequities and question how broader societal forces shape the neighborhoods we live in to subsequently impact health and health inequities. We need to move beyond establishing basic associations between myriad neighborhood characteristics and health. It is time to think more critically about whether, how, and for whom neighborhoods shape health.

Author information

Author	Role
Bria Gresham, University of Minnesota - Twin Cities	Presenting author
Canan Karatekin, University of Minnesota - Twin Cities, United States	Non-presenting author

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