Conceptual replication and validation of the PACER survey in the multi-ethnic study of atherosclerosis (MESA)

Objective: The Perceptions About Changes in Environments and Residents (PACER) survey was developed to measure individual experiences of health-related neighborhood gentrification. Initial validation in Philadelphia and Montreal supported its reliability and validity, but generalizability remained limited by geographic and demographic constraints. We conducted a multi-site replication study within the Multi-Ethnic Study of Atherosclerosis (MESA), a diverse cohort of older adults across six U.S. cities. Methods: Participants completed the 21-item PACER instrument during MESA Exam 7 (2022-2024). We used confirmatory factor analysis (CFA) to assess internal consistency, factor stability across subgroups, and criterion-related validity. We assessed differences by sociodemographic characteristics. Results: CFA largely supported the hypothesized four subscales: Feelings, Built Environment, Social Environment, and Affordability. The factor structure was stable by age and hours in neighborhood, but varied modestly by site. Subscale correlations and expected associations with perceived amount and pace of change supported criterion validity. Lower socioeconomic status and Black or Hispanic respondents reported more affordability concerns and perceived more neighborhood change. Conclusions: This study affirms PACER's validity in a large, geographically and demographically diverse U.S. cohort. PACER provides a resident-centered tool for measuring the lived experience of neighborhood change and its health implications across different residential contexts.