Research

Research interests

Historic redlining & place-based health inequities

Historic redlining associated with present-day health outcomes:

Redlining was a racialized zoning practice in the U.S. that blocked fair access to home loans, and recent research is illuminating health problems in the current residents of these historically redlined areas. In a systematic review and meta-analysis, published in Social Science & Medicine, we found that living in historically redlined neighborhoods was associated with worse health outcomes, including asthma, gun-related injuries, certain types of cancer, preterm births, self-rated health, heat-related outcomes, and other chronic conditions. For cause-specific mortality one study revealed no link between residential redlining and infant mortality rate, while one study on COVID-19 outcomes was inconclusive.

Residents living in historically redlined neighborhoods have worse cardiometabolic health outcomes:

In a nationwide study published in the Journal of the American College of Cardiology, we observed that residents living in historically redlined neighborhoods had an overall increase in the prevalence of cardiometabolic diseases, obesity, diabetes, hypertension and individuals who smoke. By contrast, we found that residents in non-redlined neighborhoods ("Best" or A-graded areas) had higher cholesterol screening, routine care visits, and health insurance coverage compared to residents in redlined neighborhoods ("Hazardous" or D-graded areas).

Spatial disparities in air pollution exposure & chronic diseases

Biorefineries and respiratory health:

Understanding potential health risks associated with biofuel production is critical to sustainably combat energy insecurity and climate change. However, the specific health impacts associated with biorefinery-related emissions have not been well characterized. In a study based on New York State (NYS), we found that respiratory ED visit rates were higher among residents living within 10 km of biorefineries than their control site counterparts. We also observed highest risks proximal to soybean and corn biorefinery facilities, followed by wood biorefinery facilities, and found substantial racial and socioeconomic disparities among all study participants when compared to the entire NYS.

Social deprivation, PM2.5 and cardiovascular mortality:

In a nationwide study, we found that social deprivation and PM2.5 exposures were independently associated with county level age-adjusted cardiovascular (CV) mortality. The associations between PM2.5 and CV mortality were stronger in counties with high vs low social deprivation. Social deprivation and PM2.5 represent potential targets to reduce CV mortality disparities and interventions to reduce PM2.5 exposure may be most impactful in communities of low socioeconomic status.

Communities in historically disinvested and marginalized neighborhoods face greater socioeconomic barriers & need for tailored-interventions

Community-level interventions reduced childhood asthma ED visits and hospitalization:

In a systematic review, we found that community interventions, such as care coordination, policy and environmental changes (e.g., smoke-free legislature, traffic reduction models, and green housing), home-based and community-based health services significantly reduced child asthma ED visits and hospitalizations and increased access to health care in low-income and marginalized communities. Increased caregiver self-efficacy, home environmental trigger reduction, and increased access to healthcare contributed to improved respiratory health outcomes.

Community health centers for reducing health inequities and emergency health care utilization:

Research shows that federally qualified health centers (FQHCs) improve access to care for important health services (e.g., preventive care), particularly among marginalized communities. However, whether spatial availability to FQHCs influences care-seeking behavior for medically underserved residents is unclear. In a study, we found that, having at least one FQHC site in medically underserved areas or areas with medically underserved populations* was associated with greater likelihood of patients seeking health services at FQHCs than areas with no FQHC sites available, varying across states. Relationships were stronger in zip codes with >5 FQHC sites, small towns, metropolitan areas and in redlined sections of urban areas (i.e., areas that have been historically denied access to health care).

*Medically underserved areas or areas with medically underserved populations (MUA/Ps) are defined by Health Resources & Services Administration (HRSA) as areas having too few primary care providers, high infant mortality rates, high poverty or a high elderly population.