Abstract for: Causal loop diagramming for synthesizing results in a multi-method, multi-level assessment of revitalization in two large urban catchment areas

Demonstrating the benefits of neighborhood revitalization initiatives on long-term health outcomes like cardiovascular disease (CVD) is challenging, as CVD risk is complex and varied among subpopulations, particularly among older adults. A single methodological approach is insufficient to capture how these changes affect CVD risk over time. The current study uses a social-ecological framework that recognizes the individual and community-level determinants of cardiovascular health. A purposive baseline sample of N=36 older residents participated in walk-along interviews exploring perceptions of neighborhood change, health behaviors, and social dynamics. Interview transcripts were analyzed using a two-stage coding process combining deductive and inductive approaches. Emerging themes were translated into conceptual variables and systematically compared with the original CLD. Relevant concepts were incorporated as mediating variables to expand our qualitative system dynamics model. Qualitative findings revealed several mechanisms not fully captured in the original CLD, including environmental stressors, quality of public infrastructure, and sense of neighborhood safety as key mediators linking revitalization policies to everyday environmental conditions; sense of community as an important mechanism influencing social cohesion, use of public spaces, and physical activity; and mental and physical health as a central mediator connecting health care access and social isolation with CVD morbidity. Integrating these variables generated a more comprehensive CLD capturing the multi-level pathways through which revitalization policies interact with neighborhood environments, social dynamics, and health outcomes. The expanded definition of the dynamics of long-term health outcomes attributable to neighborhood revitalization provides a practical, evidence-based framework for planned system dynamics simulation analyses.