ObjectivesWe studied the impact of a Housing First (HF) intervention on housing, contact with the justice system, healthcare usage and health outcomes among At Home/Chez Soi randomised trial participants in Toronto, a city with an extensive service network for social and health services for individuals who are experiencing homelessness and mental illness.MethodsParticipants identified as high needs were randomised to receive either the intervention which provided them with housing and supports by an assertive community treatment team (HF+ACT) or treatment as usual (TAU). Participants (N=197) had in-person interviews every 3 months for 2 years.ResultsThe HF+ACT group spent more time stably housed compared to the TAU group with the mean difference between the groups of 45.8% (95% CI 37.1% to 54.4%, p<0.0001). Accounting for baseline differences, HF+ACT group showed significant improvements over TAU group for community functioning, selected quality-of-life subscales and arrests at some time points during follow-up. No differences between HF+ACT and TAU groups over the follow-up were observed for health service usage, community integration and substance use.ConclusionsHF for individuals with high levels of need increased housing stability and selected health and justice outcomes over 2 years in a city with many social and health services.Trial registration numberISRCTN42520374.

BackgroundPrior research examining neighbourhood effects on cardiovascular diseases (CVDs) has focused on the impact of neighbourhood socio-economic status or a few selected environmental variables. No studies of cardiovascular disease outcomes have investigated a broad range of urban planning related environmental factors. This is the first study to combine multiple neighbourhood influences in an integrated approach to understanding the association between the built and social environment and CVDs. By modeling multiple neighbourhood level social and environmental variables simultaneously, the study improved the estimation of effects by accounting for potential contextual confounders.MethodsData were collected using a cross-sectional survey (n = 2411) across 87 census tracts (CT) in Toronto, Canada, and commercial and census data were accessed to characterize the residential environment. Multilevel regressions were used to estimate the associations of neighbourhood factors on the risk of CVD.ResultsExposure to violent crimes, environmental noise, and proximity to a major road were independently associated with increased odds of CVDs (p < 0.05) in the fully adjusted model. While reduced access to food stores, parks/recreation, and increased access to fast food restaurants were associated with increased odds of CVDs in partially adjusted models (p < 0.05), these associations were fully attenuated after adjusting for BMI and physical activity. Housing disrepair was not associated with CVD risk.ConclusionsThese findings illustrate the importance of measuring and modeling a broad range of neighborhood factors— exposure to violent crimes, environmental noise, and traffic, and access to food stores, fast food, parks/recreation areas— to identify specific stressors in relation to adverse health outcomes. Further research to investigate the temporal order of events is needed to better understand the direction of causation for the observed associations.

Gentrification, a process of transforming working-class areas into middle-class use, is a pervasive process in many cities around the world. Although researchers recognize the dangers of displacement in this process, the magnitude of dislocation is highly contested. Literature on gentrification offers little guidance with regard to understanding the timing of displacement in a gentrifying neighborhood. Moreover, evictions have been neglected as a form of gentrification-led displacement, which may have led to underestimating displacement effects. This study sheds light on the geography of displacement through an analysis of 59,415 eviction applications in the City of Toronto from 1999 to 2001, which are compared with the timing of gentrification at the census tract level (n = 502). The study finds that evictions are positively associated with (1) neighborhoods in early stages of gentrification, and (2) "pre-gentrified neighborhoods" that are beginning to be marked by changes in social composition, that is, an increasing number of artists and people with higher education, but no significant increase yet in aggregate income or the number of owner-occupied dwellings. By illuminating the timing and magnitude of displacement in gentrifying neighborhoods, this study fosters a better understanding of gentrification outcomes that may inform policies to ameliorate its negative impacts.