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Neighborhoods influence children’s health, so it is important to have measures of children’s neighborhood environments. Using the Child Opportunity Index 2.0, a composite metric of the neighborhood...

Lead is well known for its adverse health effects on children, particularly when exposure occurs at earlier ages. The primary source of lead hazards among young children is paint used in buildings built before 1978. Despite being 100% preventable, some children remain exposed and state and local policies often remain reactive. This study presents a methodology for planners and public health practitioners to proactively address lead risks among young children. Using geospatial analyses, this study examines neighborhood level measurement of lead paint hazard in homes and childcare facilities and the concentration of children aged 0–5. Results highlight areas of potential lead paint hazard hotspots within a county in the Midwestern state studied, which coincides with higher concentration of non-white children. This places lead paint hazard in the context of social determinants of health, where existing disparity in distribution of social and economic resources reinforces health inequity. In addition to being proactive, lead poisoning intervention efforts need to be multi-dimensional and coordinated among multiple parties involved. Identifying children in higher lead paint hazard areas, screening and treating them, and repairing their homes and childcare facilities will require close collaboration of healthcare professionals, local housing and planning authorities, and community members.

Introduction Experiences of racial discrimination in the medical setting are common among Black patients and may be linked to mistrust in medical recommendations and poorer clinical outcomes. However, little is known about the prevalence of experiences of racial mistreatment by healthcare workers among Black patients seeking addiction treatment, or how these experiences might influence Black patients' medical mistrust or expectations of care. Methods Participants were 143 Black adults recruited consecutively from two university addiction treatment facilities in Columbus, Ohio. All participants completed validated surveys assessing perceptions of prior racial discrimination in the medical setting and group-based medical mistrust. Participants were also asked a series of questions about their expectations of care with regard to racial discrimination and addiction treatment. Descriptive analyses were used to characterize the sample with regard to demographics, perceived racial discrimination and medical mistrust. Kendall tau-b correlations assessed relationships between racial discrimination, mistrust and expectations of care. Results Seventy-nine percent (n = 113) of participants reported prior experiences of racial discrimination during healthcare. Racial discrimination in the medical setting was associated with greater mistrust in the medical system and worse expectations regarding racial discrimination in addiction treatment including delays in care-seeking due to concern for discrimination, projected non-adherence and fears of discrimination-precipitated relapse. Conclusions Black patients seeking addiction treatment commonly report experiencing racial discrimination by healthcare workers which may be associated with mistrust in the medical system and expectations of care. Strategies to eliminate and mitigate experiences of racial discrimination may improve addiction treatment receptivity and engagement.

Neighborhoods influence children's health, so it is important to have measures of children's neighborhood environments. Using the Child Opportunity Index 2.0, a composite metric of the neighborhood conditions that children experience today across the US, we present new evidence of vast geographic and racial/ethnic inequities in neighborhood conditions in the 100 largest metropolitan areas in the US. Child Opportunity Scores range from 20 in Fresno, California, to 83 in Madison, Wisconsin. However, more than 90 percent of the variation in neighborhood opportunity happens within metropolitan areas. In 35 percent of these areas the Child Opportunity Gap (the difference between Child Opportunity Scores in very low- and very high-opportunity neighborhoods) is higher than across the entire national neighborhood distribution. Nationally, the Child Opportunity Score for White children (73) is much higher than for Black (24) and Hispanic (33) children. To improve children's health and well-being, the health sector must move beyond a focus on treating disease or modifying individual behavior to a broader focus on neighborhood conditions. This will require the health sector to both implement place-based interventions and collaborate with other sectors such as housing to execute mobility-based interventions.