Flexible Resources Key to Neighborhood Resilience for Children: A Scoping Review

Neighborhoods have been the focus of health researchers seeking to develop upstream strategies to mitigate downstream disease development. In recent years, neighborhoods have become a primary target in efforts to promote health and resilience following deleterious social conditions such as the climate crisis, extreme weather events, the global pandemic, and supply chain disruptions. Children are often the most vulnerable populations after experiencing unexpected shocks. To examine and describe conceptually the construct of Neighborhood Resilience, we conducted a comprehensive scoping review using the terms (“resilience” or “resiliency” or “resilient”) AND (“neighborhood”), utilizing MEDLINE (through PubMed) and CINAHL (through EBSCOhost) databases, to assess overall neighborhood themes that impact resilience. A total of 57 articles were extracted that met inclusion criteria. Extracted characteristics included study purpose, country of origin, key findings, environmental protective/risk factors. The analysis revealed a positive relationship between neighborhood resource density, neighborhood resiliency, and individual resiliency. This study reports the finding for studies with a population focus of pre-school age and school age children (1.5–18 years of age). Broadly, we identified that the primary goals regarding neighborhood resilience for childhood can be conceptualized as all activities and resources that (a) prevent trauma during childhood development and/or (b) mitigate or heal childhood trauma once it has occurred. This goal conceptually encompasses antecedents that increase protective factors and reduces risk factors for children and their families. This comprehensive look at the literature showed that a neighborhood’s ability to build, promote, and maintain resiliency is often largely dependent on the flexible resources (i.e., knowledge, money, power, prestige, and beneficial social connections) that are available.


Introduction
Recent global events that have impacted the widespread childhood experience for children include the 2008 global financial crisis [1], COVID-19 pandemic [2], loss of land and ecosystems [3], increased vector-borne illnesses [4,5], and agricultural instability [6].Children and adolescents are especially vulnerable to these stressors for a variety of reasons [7,8].The ability of a child or adolescent to appropriately overcome the stressors surrounding them is in part dependent on the strength and ability of the systems in which they are a part [9].This includes neighborhoods.Social determinants of health and mental health may now include factors such as socioeconomic status and resource availability [10].For example, critical access to healthcare services is often limited in underserved or disadvantaged communities.Similarly, ecological determinants of health include clean water and food access, along with neighborhood and community abilities to overcome the consequences of natural disasters [11].
Children 2023, 10, 1791 2 of 26 Neighborhoods are a promising setting to promote health and resilience [12,13].Neighborhood disadvantages have been associated with an increased overall stress burden experienced by residents of those neighborhoods.Conversely, residence in affluent neighborhoods is associated with low to normal stress burdens [12].This is an especially important consideration when working with children and adolescents after exogenous shocks are experienced [14,15].The collective efficacy experienced at the neighborhood level may be key to building the resilience capacity of the children and families who live there [16].Despite the need to address upstream factors that impact health, prevention programs too often focus on individual-level health behaviors and risk factors [17,18].
This scoping review aims to develop a clear conceptual definition of resilience in the context of neighborhoods and children.The secondary aim of this study is to identify key risk and protective factors to be considered when developing neighborhood-level pediatric health promotion strategies.To address these aims, we comprehensively reviewed the literature on resilience in the neighborhood setting.

Materials and Methods
Scoping reviews are preferable to systematic reviews when study objectives relate to the clarification of key concepts and the identification of dimensions related to a concept [19].As such, due to the exploratory nature of this research inquiry, a scoping review was chosen as the methodology for synthesizing the literature.Utilizing the scoping review framework described by Arksey and O'Malley (2005), we (a) identified our research inquiry, (b) identified search parameters, (c) defined the study selection, (d) charted the data, and (e) collated, summarized, and reported the results [20].

Search Terms, Sources of Data, and Inclusion Criteria
On 5 July 2022, we conducted searches using the search terms [("resilience" or "resiliency" or "resilient") AND ("neighborhood")], utilizing MEDLINE (through PubMed) and CINAHL (through EBSCOhost) databases.Inclusion criteria included English language publication in a peer-reviewed journal and data collection involving human subjects.Although our search protocol focused on the general concept of neighborhood resilience, studies reported in this review were limited to those related to a pediatric population (preschool and school-age children, e.g., children aged 1.5-18 years old).Articles were included if pediatric population and resilience were addressed in the contexts of neighborhoods.No date range was defined for this study (all studies through 5 July 2022 were considered).
The concept of neighborhood was not predefined by the reviewer team.Of interest to us was how the construct of "neighborhood" was conceptualized by the authors of the reviewed articles and the populations being studied [21].Results were imported into Covidence™ [22], a software program that facilitates synthesis reviews.PROSPERO does not register scoping reviews; consequently, this study was not registered.All study procedures adhered to the PRISMA-ScR checklist for scoping reviews [23].
As part of our a priori protocol, we included any study that provided insight into the antecedents, attributes, or consequences of neighborhood resilience.Quality appraisal on each article was not conducted due to the exploratory conceptual focus.Study characteristics that were extracted included authors, year of publication, country in which the research was conducted, title, study design method, study purpose, population, sample size, and key findings.

Data Analysis Process
Two authors (SB and KD) independently reviewed the articles to assess if the inclusion criteria were met and were blinded to voting until all reviews had been conducted.Voting and evaluation interrater reliability for each decision stage was carried out in Covidence™.Cohen's Kappa was used to determine interrater reliability during the initial screening of title and abstract for inclusion/exclusion and full-text inclusion/exclusion phases.The authors reconciled any discrepancies in the inclusion and exclusion reviews through routine synchronous discussion via Zoom.Additionally, authors memo'ed and met routinely to discuss findings during the analysis and synthesis phase.Covidence™ software was used to standardize the extraction process conducted by SB, which was verified by KD and KWY.The results of the extraction process were exported for analysis and development (Table 1).The purpose of this study was to examine whether neighborhood factors predicted child resilience in the study population.

South African children N = 1238
Resilient children in the high prevalence (resilience) neighborhoods were more food secure and their mothers were less depressed.Children in the high prevalence neighborhoods also migrated to rural areas more often. N/A

Cross-sectional
The purpose of this study was to examine associations between positive childhood experiences (PCEs) and obesity among the study population.
Children N = 28,771 For children who experience trauma, PCEs may mitigate obesity.

Cohort study
The purpose of this study was to explore associations between the development of psychotic symptoms and polyvictimization in the study population.
Twin children

N = 2232
The following are protective factors that could mitigate childhood poly-victimization: Positive home atmosphere • Higher levels of neighborhood social cohesion.
Risk factors:

Qualitative data analysis
The purpose of this study was to explore urban youths' perspectives on neighborhood stressors.

Mexican American youth N = 32
Pervasive stress was consistent across all groups, but coping styles and psychological difficulties varied.
Themes related to stress include violence and poverty.
Protective factors:

Exploratory data analysis
The purpose of this study was to define and model the concept of asthma-related resilience for the study population.

Children and primary caregivers N = 31
After neighborhood disadvantage and asthma symptoms were held constant, higher levels of adaptability acted as a resource factor.For children living with higher levels of neighborhood disadvantage, higher adaptability was shown to be a protective factor for increasing asthma management behaviors.
Risk factors: Protective factors:

Cohort study
The purpose of this study was to examine associations between adolescent behavior, neighborhood cohesion, and housing insecurity.

Families N = 2425
Neighborhood cohesion in childhood is a protective factor for adolescent aggressive behaviors.Additionally, informal supports provide resilience for low-income families.
Protective factors:

Qualitative data Analysis
The purpose of this study was to explore academic failure and involvement in the criminal justice system for the study population.

Students N = 146
The protective factors trifecta confirms previous studies that indicate that resilience is not determined by individual traits of youth, but rather environmental exposures of youth.

Cross-sectional
The purpose of this study was to identify whether youths' engagement in coping behaviors was related to profile membership.

African-American youth N = 733
The four neighborhood profiles identified:

Cross-sectional
The purpose of this study was to test the association between risk factors and stress and coping methods in the study population.

African-American adolescents N = 202
High calamity fears diminished the anger response of the study population.
Protective factor process:Kinship social support -> anger suppression for youth in high-risk environments Long-term neighborhood effects on adolescent outcomes: mediated through adverse childhood experiences and parenting stress

Cohort study
The purpose of this study was to examine childhood experiences and adolescent anxiety.

Male children and mothers N = 4898
Significant mediators:

Results
The initial search returned 422 articles with 90 duplications (Figure 1).Two authors independently screened the title and abstract of 332 articles and reviewed the full text of 247 articles.For the larger general search, which beyond the scope of reporting in this manuscript, 170 articles met the inclusion criteria and were extracted for analysis.Included articles were published between 1994 and 2022.The primary reasons for excluding articles during the full-text review phase were because they did not focus on neighborhoods (N = 47) or resilience (N = 18).Articles were excluded if they were not a study (N = 10) or published in English (N = 2).All 170 articles were extracted for our larger neighborhood resilience analysis.

Results
The initial search returned 422 articles with 90 duplications (Figure 1).Two authors independently screened the title and abstract of 332 articles and reviewed the full text of 247 articles.For the larger general search, which is beyond the scope of reporting in this manuscript, 170 articles met the inclusion criteria and were extracted for analysis.Included articles were published between 1994 and 2022.The primary reasons for excluding articles during the full-text review phase were because they did not focus on neighborhoods (N = 47) or resilience (N = 18).Articles were excluded if they were not a study (N = 10) or published in English (N = 2).All 170 articles were extracted for our larger neighborhood resilience analysis.
To narrow the articles being reported for this manuscript, only 57 studies were retained for the narrowed inclusion criteria focusing on the pediatric population and preschool age and school-age children (ages 1.5-18 years old).[("resilience" or "resiliency" or "resilient") AND ("neighborhood")].

Broad Themes
There was fair agreement between the reviewers for the title/abstract screening phase (Cohen's κ = 0.39) and moderate agreement for the full-text reviews (κ = 0.47) between independent raters [81].Broadly, the results suggest that neighborhood resilience for [("resilience" or "resiliency" or "resilient") AND ("neighborhood")].
To narrow the articles being reported for this manuscript, only 57 studies were retained for the narrowed inclusion criteria focusing on the pediatric population and pre-school age and school-age children (ages 1.5-18 years old).

Broad Themes
There was fair agreement between the reviewers for the title/abstract screening phase (Cohen's κ = 0.39) and moderate agreement for the full-text reviews (κ = 0.47) between independent raters [81].Broadly, the results suggest that neighborhood resilience for childhood can be conceptualized as all activities and attributes that (a) prevent trauma during childhood development and/or (b) mitigate or heal childhood trauma once it has occurred.This conceptually encompasses antecedents that increase protective factors and reduce risk factors for children and their families.
Authors of articles included in this study describe "skin-deep" resilience as the againstall-odds ability to rise above the traumas one has experienced in childhood [33].Skin-deep resilience speaks to the phenomena where children of disadvantaged neighborhoods, through individual attributes such as conscientiousness and hard work, achieve external success such as high educational attainment or upward social economic mobility [82,83].The individual attributes of high conscientiousness and productivity in work are correlated with less substance use and increased outward achievement, but these children also experience a higher prevalence of health conditions associated with cumulative "weathering" stress.Brody and Chen's work is primarily focused on African-American youth.However, the weathering effect has also been noted in children who have experienced adverse childhood experiences (ACEs) [84].
We contrasted skin-deep resilience that is based on the attributes of an individual child and the potential of a deeper-rooted resilience that is supported across all the nested systems of a neighborhood.Two studies focused on environments that promote flourishing beyond the baseline and where access to flexible resources across all levels is crucial [28,58].In these studies, the protective resilience that is provided through positive childhood experiences such as having a mentor, family resiliency, and networked community connections is discussed.Creating protective resilience was central to Breton's (2001) work on neighborhood resilience.Breton posited that what makes a neighborhood resilient is social and physical resources that improve one's ability to adapt.Initial resource availability and a state of equilibrium must be present, such that when disequilibrium occurs, whether by a disaster or similar event, resources may be tapped into to reinstate the equilibrium of the neighborhood [85].Breton argues that this ability is dependent on resources and infrastructure and that policies that increase these resources must be protected.
After a review of the literature, we define the construct of neighborhood resilience as "the protective capacity of a neighborhood to restore itself, and promote adaption among citizens, after experiencing an adverse exogenous shock" [26,85].The conceptualization of resilience and level of resilience addressed by reviewed articles can be found in Supplementary Table S1.
To aide conceptual exploration and refinement, notes on risk and protective factors are reported in Table 1.The findings can be thematically categorized into two groups: neighborhood advantages that exhibit a positive association with resilience and neighborhood disadvantages that demonstrate a negative association with resilience.

Neighborhood Advantages
Neighborhood advantages are all the protective factors that increase resilience for the citizens who live there.Within the context of promoting resilience among children, community connections emerged as a significant neighborhood advantage.Constructs such as neighborhood cohesion, collective efficacy, and neighborhood connectedness were identified as key factors.Neighborhood cohesion is defined as the degree to which neighbors are interconnected and supportive [64].In neighborhoods with high collective efficacy, residents are more likely to take collective action on behalf of each other and the neighbor- hood as a whole [86,87].Furthermore, neighborhood connectedness encompasses both the quality and quantity of relationships maintained among neighbors.
Predictably, neighborhoods that demonstrate collective efforts to increase resilience capacity and proactively prepare for the unforeseen serve as protective environments for children and families residing within them.Planning activities include assessing neighborhood resources and the availability of neighborhood services [88].Other studies focused on developing a community understanding of resilience and how communities can prepare for future disasters [35,89] or hasten recovery post-disaster [90].

Neighborhood Disadvantages
Neighborhood disadvantages were conceptualized in this analysis as all risk factors that decreased the capacity for resilience and exhausted any banked capacity among citizens.The presence of disorder and perceived senses of being unsafe within a neighborhood are strongly associated with a decreased capacity for resilience.A primary goal in promoting resilience across the life-course is the prevention of childhood trauma.Neighborhood disorder and incivilities experienced in neighborhood spaces are clearly identified risk factors.Studies have consistently demonstrated that exposure to neighborhood violence [24] and perceived neighborhood disorder are associated with a decreased resilience capacity [48,69].Similarly, perceived neighborhood incivilities decrease a neighborhood's capacity for resilience.These incivilities include nuisance crimes [45,46].

Discussion
This study cataloged the multi-layered aspects of what makes a neighborhood resilient and how that resiliency can affect outcomes in children and adolescents.The analyzed studies highlight the effects of neighborhood stability and resource availability on individual health, wherein increased exposure to stressors and instability are linked to increased cumulative stress and chronic disease development.Given the significant influence of neighborhoods on health and wellness, it is imperative that neighborhood citizens recognize that an erosion of social capital occurs as resource availability is diminished [91].Yet there are many neighborhood-level actions that can be taken that are not resource intensive but rather rely upon social capital and connectedness.Simple activities that engage neighbors in building social supports for each other and particularly for the children of the neighborhood will likely improve a sense of connectedness.One potential neighborhood action would be to collectively identify the risk factors and protective factors in their neighborhood.Once a consensus is built around identification, engaging in the superordinate goal of increasing the protective factors (flexible resources) in the neighborhood or mitigating risk would likely increase neighborhood resilience.
As a midrange theory, fundamental cause theory could explain this relationship between higher socioeconomic status neighborhoods wherein increased resources allowed for more resiliency [92].In contrast, individuals residing in lower socioeconomic status neighborhoods face a disadvantage due to limited access to these flexible resources [93,94].If basic needs are not being met for neighborhood citizens, no amount of creativity will convert absolute deprivation into flexible resources.However, building the capacity for resilience within a neighborhood could come in the form of creatively increasing the flexibility of the limited resources that are present.As such, neighborhoods with highly connected citizens will have an increased resilience capacity.Conversely, disadvantaged neighborhoods are more at risk for destabilization, possibly due to a lack of built social capital [95].
Children and adolescents are psychologically vulnerable.Developmental psychopathology frameworks explain that various stressors, including environmental, neurobiological, and emotional stressors, can increase the prevalence of adverse mental health outcomes based on developmental staging [96].This review reinforces the positive relationship between increased access to flexible resources such as beneficial social connections, knowledge, money, power, and prestige, and increased neighborhood adaptive capacity.Favorable social conditions with flexible resources promote increased adaption to unforeseen events of all types [97].

Strengths and Limitations
A limitation of this study was the variability of independent reviewer voting as manifested by fair to moderate interrater reliability scores.This scoping review was exploratory by nature.Achieving an eventual consensus between two independent reviewers through memo'ing and discussion clarified the conclusions drawn.
An additional limitation was that we did not conduct quality appraisals on each article.We established an a priori protocol for our study and mitigated potential bias originating from our study.However, inclusion criteria for this study were based on the potential conceptual value and not the rigor of the reviewed study.Although all the included studies had conceptual value for the discourse of neighborhood resilience, not all reviewed studies were of quality or designed to, on their own, inform practice changes.
A strength of this scoping review is the comprehensiveness of the literature reviewed.Our specific objective was to review articles that contribute to the conceptual understanding of neighborhood resilience across all contexts found in the literature.As a result of the broad exploration undertaken by this study, the findings are presented in a concise and condensed manner, with greater emphasis on the wide breadth of literature than on detailed analysis.It is important to note that the intention of scoping reviews is to provide a broad assessment of the literature on a given topic and inform next steps, which we have effectively accomplished in this study.

Conclusions
With this study, we reviewed 28 years of literature and cataloged the risk factors and, perhaps more importantly, the protective factors of neighborhood resiliency.We have established the foundation on which our Extension community resource publications can be built upon.This scoping review contributes to the growing body of evidence regarding how neighborhood environmental factors influence the resilience of groups and individuals.This scoping review presents a foundation of how neighborhoods influence childhood resilience.Implications of this knowledge can help inform neighborhood health promotion strategies intended to build protective and resilient environments for children.
We recommend the next steps of this synthesized knowledge to be the future conceptual modeling of the core constructs of resilience in the neighborhood context.This scoping review can also contribute to discourse regarding the planning and policy development that directly affect resource availability in neighborhoods and, by proxy, promote positive health outcomes for youth.

Author Contributions:
Conceptualization, S.B. and K.D.; methodology, S.B. and K.D.; software, S.B. and K.D.; validation, S.B., K.D. and K.W.-Y.; formal analysis, S.B., K.D. and K.W.-Y.; investigation, S.B. and K.D.; data curation, S.B.; writing-original draft preparation, S.B.; writing-review and editing, S.B., K.D., K.W.-Y., J.P. and J.M.G.; visualization, S.B.; supervision, J.P. and J.M.G.; project administration, S.B.; funding acquisition, S.B.All authors have read and agreed to the published version of the manuscript.Funding: The research reported in this publication was supported in part by the National Institute of Environmental Health Sciences of the National Institutes of Health under award number R25ES033452.The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.Shawna Beese received additional support for this study from the Lukins Scott & Betty Graduate Fellowship through the Thomas S. Foley Institute for Public Policy & Public Service at Washington State University.

Table 1 .
Study characteristics for full-text reviews from database search conducted on 5 July 2022 using the search terms [("resilience" or "resiliency" or "resilient") AND ("neighborhood")].