Association of a Park-Based Violence Prevention and Mental Health Promotion After-School Program With Youth Arrest Rates | Adolescent Medicine | JAMA Network Open | JAMA Network
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Table 1.  Preprogram Implementation Summary Statistics for 36 Zip Codes With and Without the After-School Program in Miami-Dade County, Florida, 2013-2015
Preprogram Implementation Summary Statistics for 36 Zip Codes With and Without the After-School Program in Miami-Dade County, Florida, 2013-2015
Table 2.  Adjusted Difference-in-Differences Poisson Regression Estimates of the Association of Program Implementation With Youth Arrest Rates Within 36 Zip Codes in Miami-Dade County, Floridaa
Adjusted Difference-in-Differences Poisson Regression Estimates of the Association of Program Implementation With Youth Arrest Rates Within 36 Zip Codes in Miami-Dade County, Floridaa
1.
David-Ferdon  C, Vivole-Kantor  AM, Dahlberg  LL, Marshall  KJ, Rainford  N, Hall  JE. A comprehensive technical package for the prevention of youth violence and associated risk behaviors. https://www.cdc.gov/violenceprevention/pdf/yv-technicalpackage.pdf. Updated 2016. Accessed April 11, 2018.
2.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Preventing youth violence. https://www.cdc.gov/violenceprevention/pdf/yv-factsheet508.pdf. Updated 2019. Accessed October 22, 2019.
3.
D’Agostino  EM, Frazier  SL, Hansen  E,  et al.  Two-year changes in neighborhood juvenile arrests after implementation of a park-based afterschool mental health promotion program in Miami-Dade County, Florida, 2015-2017.  Am J Public Health. 2019;109(S3):S214-S220. doi:10.2105/AJPH.2019.305050PubMedGoogle ScholarCrossref
4.
Ferguson  CJ, San Miguel  C, Hartley  RD.  A multivariate analysis of youth violence and aggression: the influence of family, peers, depression, and media violence.  J Pediatr. 2009;155(6):904-908.e3. doi:10.1016/j.jpeds.2009.06.021PubMedGoogle ScholarCrossref
5.
Sallis  JF, Cain  KL, Conway  TL,  et al.  Is your neighborhood designed to support physical activity? a brief streetscape audit tool.  Prev Chronic Dis. 2015;12:E141. doi:10.5888/pcd12.150098PubMedGoogle Scholar
6.
Maller  C, Townsend  M, Pryor  A, Brown  P, St Leger  L.  Healthy nature healthy people: ‘contact with nature’ as an upstream health promotion intervention for populations.  Health Promot Int. 2006;21(1):45-54. doi:10.1093/heapro/dai032PubMedGoogle ScholarCrossref
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    Research Letter
    Pediatrics
    January 29, 2020

    Association of a Park-Based Violence Prevention and Mental Health Promotion After-School Program With Youth Arrest Rates

    Author Affiliations
    • 1Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
    • 2Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, Florida
    • 3Clinical Science Program in Child and Adolescent Psychology, Florida International University, Miami
    • 4Miller School of Medicine, Department of Pediatrics, University of Miami, Miami, Florida
    • 5Center for Pediatric Population Health, University of Texas Health Science Center School of Public Health, Dallas
    JAMA Netw Open. 2020;3(1):e1919996. doi:10.1001/jamanetworkopen.2019.19996
    Introduction

    Violence is the leading cause of death and nonfatal injuries in US youth ages 10 to 24 years1 and a primary focus of the Centers for Disease Control and Prevention.2 Leveraging existing community resources to reduce youth violence in high-crime, low-resource neighborhoods needs to be rigorously tested.

    Methods

    Fit2Lead is a park-based violence prevention and mental health promotion after-school program in Miami-Dade County, Florida, developed through extensive cross-agency collaboration for youth ages 12 to 17 years residing in high-crime, low-resource neighborhoods.3 The program has been described in depth elsewhere.3 This study was approved by the Sterling Institutional Review Board and followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. Written informed assent or consent was obtained from study participants and guardians.

    This prospective cohort study used difference-in-differences models to estimate the association between program implementation and youth arrest rates. The primary factor evaluated was presence or absence of this program (vs other after-school programs) in areas matched by (1) park serving the zip code and (2) baseline youth arrest rates and sociodemographic characteristics (aggregated) drawn from the American Community Survey. The main outcome was change in arrest rates (all offenses) per year among youth ages 12 to 17 years across matched zip codes for 3 years before and after program implementation (2013-2018). Arrest rates were used as a proxy for youth engagement in violent behaviors, consistent with prior literature.3,4 Potential confounding variables included area-level sex, age, race/ethnicity, single-parent households, low-income households, and youth perceptions of park safety (binary variable) representing at and above vs below grand mean–centered zip code–level scores using the Teen Environment Neighborhood measure,5 Barriers to Activity in Your Neighborhood subscale.

    Descriptive statistics were computed for all park area–level sociodemographic characteristics and youth baseline arrest rates across matched zip codes. Preimplementation parallel trends were examined graphically, and potential for reverse causality was tested using crude and adjusted repeated-measures generalized linear models with random intercepts to ensure program site selection was not driven by preimplementation arrests. Differences in youth arrests by zip code before and after implementation were assessed using crude and adjusted repeated-measures Poisson regression models with random intercepts. Statistical significance was set at 2-tailed P < .05, and SAS software version 9.4 (SAS Institute Inc) was used for all analyses.

    Results

    The program was offered in areas with a population that was 48% male, 60% Hispanic, and 29% non-Hispanic black. In all, 33% of households were single parent and 33% were low income. The program served a mean (SD) of 501 (37) youths per year. Table 1 shows preimplementation youth arrest rates and sociodemographic characteristics. Analyses of preimplementation arrest rate trends showed constant correlation across zip code comparison groups and no evidence of reverse causality (b = 0.02; 95% CI, −0.05 to 0.10; P = .23 [crude]; and b = 0.24; 95% CI, −0.08 to 0.56; P = .14 [adjusted]). Sociodemographic variables were included in adjusted models to account for residual differences across matched zip codes. Adjusted difference-in-differences coefficient estimates (Table 2), represented as incident rate ratios, showed a 19.3% greater reduction in youth arrest rates in zip codes where the program was offered (b = −0.21 [95% CI, −0.27 to −0.16]) compared with those where it was not. Findings indicated 252 fewer arrests per 10 000 population aged 12 to 17 years over the 3-year intervention period in zip codes where the program was vs was not offered.

    Discussion

    This prospective cohort study found that adjusted youth arrest rate estimates were lower in areas where a park-based violence prevention and mental health promotion after-school program was offered compared with areas hosting other after-school programs. Results suggest that park-based settings can foster positive mental health among youth confronting adversities common to living in high-crime, low-resource neighborhoods6 and support growing evidence that leveraging community-based settings through cross-agency collaboration promotes population-level health and resilience.1,3,6 Study limitations include residual differences across matched zip codes, although changes in arrest rates (vs counts) were tested, and models were adjusted for multiple area-level factors to control for group differences. In addition, we did not account for spillover effects and concurrent violence-prevention programs. Parks are abundant in many high-crime settings in the United States. Future analyses could allow continued monitoring of outcomes associated with the program to inform potential for scalability in other high-need settings.

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    Article Information

    Accepted for Publication: December 2, 2019.

    Published: January 29, 2020. doi:10.1001/jamanetworkopen.2019.19996

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 D’Agostino E et al. JAMA Network Open.

    Corresponding Author: Emily D'Agostino, DrPH, MS, MEd, MA, Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W Main St, Ste 600, Durham, NC 27710 (emily.m.dagostino@duke.edu).

    Author Contributions: Dr D’Agostino had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: All authors.

    Acquisition, analysis, or interpretation of data: D'Agostino, Messiah.

    Drafting of the manuscript: D'Agostino, Messiah.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: D'Agostino, Messiah.

    Obtained funding: All authors.

    Administrative, technical, or material support: Hansen, Messiah.

    Supervision: Nardi, Messiah.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: This work was supported in part by a grant from The Children’s Trust and initiated as part of the Miami-Dade County Mayor’s Roundtable on Youth Community Safety.

    Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Additional Contributions: We thank the Miami-Dade County Juvenile Services Department, Miami-Dade County Police Department, Miami-Dade County Public Schools, University of Miami, and Florida International University for their valued collaboration on designing and implementing the Fit2Lead program.

    References
    1.
    David-Ferdon  C, Vivole-Kantor  AM, Dahlberg  LL, Marshall  KJ, Rainford  N, Hall  JE. A comprehensive technical package for the prevention of youth violence and associated risk behaviors. https://www.cdc.gov/violenceprevention/pdf/yv-technicalpackage.pdf. Updated 2016. Accessed April 11, 2018.
    2.
    Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Preventing youth violence. https://www.cdc.gov/violenceprevention/pdf/yv-factsheet508.pdf. Updated 2019. Accessed October 22, 2019.
    3.
    D’Agostino  EM, Frazier  SL, Hansen  E,  et al.  Two-year changes in neighborhood juvenile arrests after implementation of a park-based afterschool mental health promotion program in Miami-Dade County, Florida, 2015-2017.  Am J Public Health. 2019;109(S3):S214-S220. doi:10.2105/AJPH.2019.305050PubMedGoogle ScholarCrossref
    4.
    Ferguson  CJ, San Miguel  C, Hartley  RD.  A multivariate analysis of youth violence and aggression: the influence of family, peers, depression, and media violence.  J Pediatr. 2009;155(6):904-908.e3. doi:10.1016/j.jpeds.2009.06.021PubMedGoogle ScholarCrossref
    5.
    Sallis  JF, Cain  KL, Conway  TL,  et al.  Is your neighborhood designed to support physical activity? a brief streetscape audit tool.  Prev Chronic Dis. 2015;12:E141. doi:10.5888/pcd12.150098PubMedGoogle Scholar
    6.
    Maller  C, Townsend  M, Pryor  A, Brown  P, St Leger  L.  Healthy nature healthy people: ‘contact with nature’ as an upstream health promotion intervention for populations.  Health Promot Int. 2006;21(1):45-54. doi:10.1093/heapro/dai032PubMedGoogle ScholarCrossref
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