African Residents Research Articles

Variation in COVID-19 Diagnosis by Zip Code and Race and Ethnicity in Indiana.

Objectives: To describe variations in coronavirus disease 2019 (COVID-19) diagnosis by zip code race and ethnicity in Indiana.Methods: Cross-sectional evaluation of subjects with SARS-CoV-2 at Indiana University Health. We performed two separate analyses, first evaluating likelihood of COVID-19 diagnosis by race (Caucasian, African American, Asian, or other) and ethnicity (Hispanic vs. non-Hispanic) in the cohort encompassing the entire state of Indiana. Subsequently, patient data was geolocated with zip codes in Marion County and the immediate surrounding counties, and descriptive statistical analyses were used to calculate the number of COVID-19 cases per 10,000 persons for each of these zip codes.Results: Indiana had a total of 3,892 positive COVID-19 cases from January 1 to April 30, 2020. The odds of testing positive for COVID-19 were four-fold higher in African Americans than non-African Americans (OR 4.58, 95% CI 4.25–4.94, P < 0.0001). Increased COVID-19 cases per 10,000 persons were seen in zip codes with higher percentage of African American (median infection rate of 17.4 per 10,000 population in zip codes above median % African American compared to 6.7 per 10,000 population in zip codes below median % African American, with an overall median infection rate 9.9 per 10,000 population, P < 0.0001) or Hispanic residents (median infection rate of 15.9 per 10,000 population in zip codes above median % Hispanic compared to 7.0 per 10,000 population in zip codes below median % Hispanic, overall median infection rate 9.6 per 10,000 population, P < 0.0001).Conclusions: Individuals from zip codes with higher percentages of African American, Hispanic, foreign-born, and/or residents living in poverty are disproportionately affected by COVID-19. Urgent work is needed to understand and address the disproportionate burden of COVID-19 in minority communities and when economic disparities are present.

The future urban heat-wave challenge in Africa: Exploratory analysis

Urbanization and climate change are among the most important global trends affecting human well-being during the twenty-first century. One region expected to undergo enormous urbanization and be significantly affected by climate change is Africa. Studies already find increases in temperature and high temperature events for the region. How many people will be exposed to heat events in the future remains unclear. This paper attempts to provide a first estimate of the number of African urban residents exposed to very warm 15-day heat events (>42 °C). Using the Shared Socio-economic Pathways and Representative Concentration Pathways framework we estimate the numbers of exposed, sensitive (those younger than 5 and older than 64 years), and those in low-income nations, with gross national products of $4000 ($2005, purchasing power parity), from 2010 to 2100. We examine heat events both with and without urban heat island estimates. Our results suggest that at the low end of the range, under pathways defined as sustainable (SSP 1) and low relative levels of climate change (RCP 2.6) without including the urban heat island effect there will be large populations (>300 million) exposed to very warm heat wave by 2100. Alternatively, by 2100, the high end exposure level is approximately 2.0 billion for SSP 4 under RCP 4.5 where the urban heat island effect is included.

Scalar Claims, Worker Strategies, and ‘South Africa’s Labour Empire’ in Namibia, 1943–1979

This article seeks to place Namibia’s contract labour system, and those whose lives it shaped, in histories of labour migration and South African empire-building in southern Africa. In order to do so, it traces South African and South West African (SWA) officials’ attempts to re-scale a trans-colonial migrant labour system to fit nominally decolonised, national scales. Secondly, it examines how African contestations of state power on a municipal scale undermined officials’ scalar projects. In asserting a transnational zone of migrant labour recruitment that straddled the SWA–Angola boundary and articulated with the sprawling recruitment networks of the Witwatersrand Native Labour Association (WNLA), the SWA Native Labour Association (SWANLA) laid claim to the same scale of practice as recruiters for the Rand mines. Labour shortages in SWA and South Africa in the 1950s led then Minister of Native Affairs Hendrik Verwoerd to place the ‘controlled bringing in and sending away’ of foreign Africans at the centre of South Africa’s labour empire. In the 1960s, in response to African migration and international pressures, South African and SWA officials sought to replace SWANLA with a territory-wide labour bureau system, run partly out of bantustan governments, that would support claims of decolonisation through ‘separate development’. The article then examines African engagements with urban influx control infrastructures and practices on a small scale, in the port and fishing town of Walvis Bay. Whether leveraging house rental payments as a promise of secure urban tenure or using beer to escape infrastructural ties to the state, African Walvis Bay residents emphasised the importance of the urban scale in the colonial exercise of power. Since these contestations had African urbanisation at their core, they proved the lie of bantustans as the physical and political homes of essentially rural Africans.

Factors associated with glycemic control among South African adult residents of Mkhondo municipality living with diabetes mellitus.

This study examines the rate and the influencing factors of glycemic control among adult residents living with DM in Mkhondo Municipality of South Africa.In this cross-sectional study, 157 individuals attending care for DM were recruited. Glycemic control status was categorized as poor if glycated hemoglobin (HbA1c) > 7% and very poor if HbA1c ≥ 9%. Multivariate regression analysis was used to identify the significant determinants of poor and very poor glycemic control.The majority of the study participants were females (84.71%) and above 45 years old (88.55%). The overall prevalence of poor glycemic control was 77.71% (n = 122), while very poor glycemic control occurred in 50.6% (n = 80) of the study cohort. In the multivariate logistic regression model analysis, African traditional [AOR = 0.15; 95% confidence interval (95% CI) 0.04–0.57], fast food consumption (AOR = 5.89; 95% CI 2.09–16.81), elevated total cholesterol (TC) [odds ratio (OR) = 2.33; 95% CI 1.50–5.17], elevated low-density lipoprotein cholesterol (LDL-C) (AOR = 5.28; 95% CI 1.89–14.69), and triglyceride (TG) (AOR = 4.39; 95% CI 1.48–13.00) were the independent and significant determinants of poor glycemic control. Age (AOR = 0.46; 95% CI 0.23–0.92) was the only independent and significant determinant of very poor glycemic control.We found a high rate of poor glycemic control (77.71%) possibly attributed to religious affiliation, fast food consumption, and dyslipidemia. On the contrary, about half of the study sample had very poor glycemic control (HbA1c ≥9%), which was predominant among younger cohort with diabetes mellitus. Interventions aimed at improving glycemic control in this population must also target religious practice, dietary patterns and dyslipidemia as well as tailored-approach for young people.

Frederick Douglass

Frederick Douglass, Black abolitionist, author, and statesman, was born into chattel slavery in the United States in 1818. Douglass’s antislavery activism inspired his sons to fight in the Civil War to end slavery in the nation (1861–1865). It also enabled him to meet other U.S. abolitionists such as James McCune Smith, the first Black American graduate in medicine (Glasgow University, 1837), as well as John Brown and Abraham Lincoln. Douglass arrived in Scotland in 1846, where he gave many lectures on the evils of chattel slavery and was aware of the roles politicians and the church played in maintaining this institution. He argued that if the Free Church of Scotland refused to help to abolish slavery in the United States, it should “Send Back The Money” that it acquired from slaveholding investors. A commemorative plaque to Frederick Douglass was unveiled in Edinburgh in November 2018. This article reflects on Frederick Douglass’s activism in Scotland and what it means for Scotland’s African diasporic residents.

The impact of the South African antiretroviral treatment programme on the age-standardised incidence rate of Kaposi sarcoma, 1999–2016: An interrupted time series analysis

ObjectiveThe objective of this study was to quantify the impact of the South African antiretroviral treatment programme on the age-standardised incidence rate of Kaposi sarcoma among black South African residents of all ages. MethodsWe performed an interrupted time series analysis using routinely collected, histologically confirmed surveillance data from the South African National Cancer Registry for the years 1999 to 2016. The analysis was performed using R statistical software. The total number of cases was 29,623 (12,475 females and 17,166 males). The background antiretroviral treatment coverage was less than 1% at the time that the antiretroviral programme was introduced and increased to over 50% in 2016. ResultsIn 1999, the age-standardised rates were 1.48 and 2.82 cases per 100,000 per year for black females and males, respectively. These rates increased to 5.52 and 7.46 in 2008 before declining. The antiretroviral treatment programme was started in 2004. Five years after 2008 (nine years after the antiretroviral programme was introduced), the predicted standardised rates were 58.3% and 50.3% lower for females and males, respectively, than what they would have been without the treatment programme. ConclusionIntroduction of the antiretroviral treatment programme was associated with a decrease of over 50% in the predicted age-standardised incidence rates of Kaposi sarcoma.

Analysis of blood plasma cytokine profile in healthy residents of the Republic of Guinea

The cytokine system is a large group of humoral factors produced by immune cells and involved in the pathogenesis of most human diseases. To assess the significance of changes in cytokines/chemokines under pathological conditions, appropriate reference values are required for healthy people. As known from existing literature, most studies of various cytokine/chemokine concentrations in blood plasma were performed in healthy subjects from Western Europe and North America. Certain inter-population differences are known, with respect to production of distinct cytokines in different racial and national groups. Only single studies concern normal levels of distinct cytokines in blood plasma of healthy African residents. The purpose of this study was to determine the blood plasma cytokine profile in healthy residents of the Republic of Guinea (RG), and to establish normal cytokine values.We have examined 24 healthy RG residents and 23 residents of St. Petersburg. Concentrations of 40 cytokines/chemokines were determined in blood plasma. The study was performed using multiplex analysis by xMAP technology.The following cytokine/chemokine levels were significantly increased in the blood plasma of the RG residents: IFNγ, IL-2, IL-4, IL-6, IL-10, TNFα, CCL1/I-309, CCL3/MIP-1α, CCL7/MCP-3, CCL17/ TARC, CCL19/MIP-3β, CCL20/MIP-3α, CCL21/6Ckine, CXCL2/Gro-β, CXCL5/ENA-78, CXCL6/ GCP-2, CXCL9/MiG, CX3CL1/Fractalkine (р &lt; 0.001). For the CCL8/MCP-2, CCL22/MDC, CXCL1/ Gro-α and CXCL12/SDF-1α+β chemokines a trend for increased concentration was revealed, in comparison with residents of St. Petersburg (р &lt; 0.05). Moreover, the levels of CCL23/MPIF-1 and MIF were significantly lower (р &lt; 0.0001) in the RG residents. There was a tendency for decreased levels (р &lt; 0.05) for CCL2/MCP-1 and CCL24/Eotaxin-2 chemokines in blood plasma taken from RG residents. There were no differences in levels of cytokines/chemokines for the studied groups: GM-CSF, IL-1β, IL-16, CCL11/Eotaxin, CCL13/MCP-4, CCL15/Leukotactin-1, CCL25/TECK, CCL26/Eotaxin-3, CCL27/CTACK, CXCL8/IL-8, CXCL10/IP-10, CXCL11/I-TAC, CXCL13/BCA, and CXCL16/SCYB16. Hence, this study has presented for the first time the normal limits for a wide range of cytokines/chemokines in blood plasma of the African inhabitants. Interpopulation differences were found, including those for constitutive chemokines. Different levels of CCL19/ MIP-3β and CCL21/6Ckine chemokines (the CCR7 receptor ligands) for the two populations may indirectly indicate the physiological features of T-cell maturation. Increased levels of CXCR2 receptor ligands in the blood plasma of Guineans, i.e., CXCL2/Gro-β, CXCL5/ENA-78 and CXCL6/GCP-2, may be due to additional function of these chemokines as ligands for atypical DARC chemokine receptor, which neutralizes chemokines from the blood flow, whereas 95% of West Africans have mutations in the DARC gene and do not express this receptor. Increased levels of proinflammatory IL-6 and TNFα cytokines, and chemokine CCL20/MIP-3α in blood plasma from RG residents may suggest inflammatory processes in the liver, since 100% of the examined Guineans had antibodies against the hepatitis A virus, 48% had antibodies to hepatitis B virus (anti-HBs), and 12% had antibodies against hepatitis C virus. In summary, the differences in cytokine/chemokine level may be related to specific environment, circulation of infectious diseases, composition of intestinal, skin and mucosal microbiota, as well as distinct genetic features.

Cross-sectional study of prevalence and determinants of uncontrolled hypertension among South African adult residents of Mkhondo municipality

BackgroundAchieving the blood pressure treatment target in individuals with hypertension is a serious global health challenge. Furthermore, the actual burden of uncontrolled hypertension is poorly understood, especially in the developing countries. Therefore, this study comprehensively examined the prevalence and factors associated with uncontrolled hypertension in individuals receiving care at the primary healthcare facilities in the rural areas of Mkhondo Municipality in the Mpumalanga Province, South Africa.MethodsIn this cross-sectional study, 329 individuals attending care for hypertension were recruited from January 2019 to June 2019 at three primary healthcare centres, namely, Piet Retief hospital, Mkhondo town clinic and Thandukukhanya community health centre. Uncontrolled hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg in accordance with the South African Hypertension Society guideline (2014). Multiple logistic regression (Forward LR method) analysis was used to identify the significant determinants of uncontrolled hypertension.ResultsThe majority of the participants were 55 years old and above (69.0%), Zulus (81.2%), non-smokers (84.19%) and had been diagnosed with hypertension for more than a year prior to the study (72.64%). The overall prevalence of uncontrolled hypertension was 56.83% (n = 187) with no significant difference between sexes, 57.38% male versus 56.88% female, respectively. In the multiple logistic regression model analysis after adjusting for confounding variables, obesity (AOR = 2.90; 95% CI 1.66–5.05), physical activity (AOR = 4.79; 95% CI 2.15–10.65) and HDL-C (AOR = 5.66; 95% CI 3.33–9.60) were the significant and independent determinants of uncontrolled hypertension in the cohort.ConclusionThe high prevalence of uncontrolled hypertension in the study setting can be largely attributed to obesity, physical activity and dyslipidaemia. Treatment will require the collaborative efforts of individuals, clinicians and health authorities. All these determinants should be addressed decisively so as to achieve the treatment blood pressure targets in the study population.

Green Apartheid: Urban green infrastructure remains unequally distributed across income and race geographies in South Africa

Urban green infrastructure provides ecosystem services that are essential to human wellbeing. A dearth of national-scale assessments in the Global South has precluded the ability to explore how political regimes, such as the forced racial segregation in South Africa during and after Apartheid, have influenced the extent of and access to green infrastructure over time. We investigate whether there are disparities in green infrastructure distributions across race and income geographies in urban South Africa. Using open-source satellite imagery and geographic information, along with national census statistics, we find that public and private green infrastructure is more abundant, accessible, greener and more treed in high-income relative to low-income areas, and in areas where previously advantaged racial groups (i.e. White citizens) reside. Areas with White residents report 6-fold higher income, have 11.7% greater tree cover, 8.9% higher vegetation greenness and live 700 m closer to a public park than areas with predominantly Black African, Indian, and Coloured residents. The inequity in neighborhood greenness levels has been maintained (for Indian and Coloured areas) and further entrenched (for Black African areas) since the end of Apartheid in 1994 across the country. We also find that these spatial inequities are mirrored in both private (gardens) and public (street verges, parks, green belts) spaces, hinting at the failure of governance structures to plan for and implement urban greening initiatives. By leveraging open-access satellite data and methods presented here, there is scope for civil society to monitor urban green infrastructure over time and thereby hold governments accountable to addressing environmental justice imperatives in the future. Interact with the data here: green-apartheid.zsv.co.za.

Letter to the Editor “COVID-19 and Neurosurgical Education in Africa: Making Lemonade from Lemons”

Never in history has the fabric of African neurosurgery been challenged as it is today with the advent of the novel coronavirus identified in 2019 (COVID-19). Even the most robust and resilient neurosurgical educational systems in the continent have been brought to their knees with neurosurgical trainees and young neurosurgeons bearing the brunt. In the face of this new reality, and in order to limit the impact of the current COVID-19 pandemic, multiple programs have implemented physical distancing to reduce in-person interactions. In some cases, residents have been asked to stay home at least until they are instructed otherwise. This unfortunate event presents an innovative opportunity for neurosurgical education in Africa. Herein, we detail the framework of an online neurosurgical education initiative to advance the education of African residents and young neurosurgeons during and after the COVID-19 pandemic.

‘Marginalised formalisation’: an analysis of the in/formal binary through shifting policy and everyday experiences of ‘poor’ housing in South Africa

This paper contributes to global debates over the in/formal binary through an analysis of the South African state’s provision of formal housing to residents previously living informally or insecurely. Focusing on cases within the cities of eThekwini and Msunduzi, it uses a mix of empirical data from housing beneficiaries and government officials alongside an analysis of documents to examine the processes and experiences of housing formalisation. The paper makes two key contributions. The first is to argue for a stronger focus on the processes of dichotomisation of the in/formal binary. It illustrates the significance of a processual analysis by examining shifts in South African housing policy and residents’ expectations of housing gain, noting a situation of hyperbole, where informal housing is regarded as unacceptable, to one of waning, where policy statements acknowledge a greater role for informality. The second contribution is to direct analysis to the idea of formal housing and processes of formalisation, as these have arguably received less attention in wider debates. The paper proposes the concept of marginalised formalisation to articulate both the shortcomings experienced by residents living in formal housing and also the misrepresentation of housing policy and government rhetoric of the benefits of formalisation. Marginalised formalisation is contextualised within ongoing urban poverty which frames this reality.

Impact of Catholicism on the Attitude Toward the Donation of Organs Among African Residents in Spain

IntroductionThe African population is one of the largest immigrant groups in Europe. Religious beliefs are deeply rooted in most African societies and condition their attitude toward organ donation. ObjectiveWe sought to analyze the influence of Catholicism in the attitude toward organ donation among Africans residing in Spain. Materials and methodsStudy participants were born in Africa and were residents in Spain. Data were obtained from the database of the International Donor Collaborative Project, which includes a sample of the population for 15 years, stratified by those who were born in Africa, as well as age and sex. The instrument used was a validated attitude questionnaire toward living kidney donation (PCID-DTO-Ríos). ResultsOf the population under study, 13% are Catholics (n = 475) and 80% (n = 2896) are Muslims. The favorable attitude toward the donation of cadaver organs is 53.7% (n = 255) among Catholics compared with 25.6% (n = 742) among Muslims (P < .001). On the contrary, 17.7% of Catholics have an unfavorable opinion (n = 84), while 45.5% (n = 1280) of Muslims have an unfavorable opinion; 28.6% of Catholics and 29.2% of Muslims are undecided.In addition, among Catholics who believe that their doctrine accepts organ donation and transplantation, 70.6% (n = 132) are in favor of donating a corpse compared to those who believe that Catholic doctrine is against (P < .001 ), with only 35% (n = 7) in favor of the donation. ConclusionsAfricans who have converted to Catholicism have a more favorable attitude toward donating their own organs than those who continue in Islam.

Differences in hypertension phenotypes between Africans and Europeans: role of environment.

Hypertension phenotypes differ between Africans and Europeans, with a greater prevalence of low renin salt-sensitive hypertension and greater predisposition to adverse cardiac remodelling in Africans. To elucidate the roles of inheritance and environment in determining hypertension phenotypes in sub-Saharan Africans and white-Europeans, we compared phenotypes in white individuals in the UK (n = 132) and in African individuals in the UK (n = 158) and Nigeria (n = 179). Biochemistry, blood pressure, left ventricular structure (echocardiography) and 24-h urinary collections of sodium and potassium were measured. Twenty-four-hour urinary sodium/potassium ratio was lower in individuals living in Europe (both African and white: 2.32 ± 0.15 and 2.28 ± 0.17) than in individuals in Nigeria (4.09 ± 0.26, both P < 0.001) reflecting proportionately higher potassium intake in Europeans (African or white) than African residents. Plasma renin was lower in Africans irrespective of residency than white Europeans, but aldosterone was higher in Africans in Europe than those in Africa (466.15 ± 32.95 vs. 258.60 ± 17.42 pmol/l, P < 0.001). Left ventricular mass index adjusted for blood pressure and other confounders was greatest in Africans in Europe (103.27 ± 2.32 g/m) compared with those in Africa (89.28 ± 1.98 g/m) or white Europeans (86.77 ± 2.63 g/m, both P < 0.001). Despite a similar low renin state in African origin individuals living in Europe and Africa, a higher aldosterone level, possibly related to higher potassium intake or other environmental factors, may contribute to greater cardiac remodelling in Africans in Europe.

Education and employment following apartheid protests

Demonstrations, rallies, boycotts, and other forms of protest were common under apartheid in South Africa. Using a compilation of more than 150 geocoded protests between 1948 and 1990, this paper compares people affected and unaffected by protests at every age throughout childhood. Exposure to protests before age 14 was associated with 2.7 percent fewer years of completed schooling. This difference was larger following violent protests, and for African residents of South Africa. On the other hand, people who experienced protests as children were up to 6.9 percent more likely to be employed as adults. The paper considers social solidarity as a possible channel connecting protests to changes in education and employment, and finds that places that had more protests during apartheid had lower reported levels of trust and physical safety in the years after apartheid ended.

Wetter climates select for higher immune gene diversity in resident, but not migratory, songbirds.

Pathogen communities can vary substantially between geographical regions due to different environmental conditions. However, little is known about how host immune systems respond to environmental variation across macro-ecological and evolutionary scales. Here, we select 37 species of songbird that inhabit diverse environments, including African and Palaearctic residents and Afro-Palaearctic migrants, to address how climate and habitat have influenced the evolution of key immune genes, the major histocompatibility complex class I (MHC-I). Resident species living in wetter regions, especially in Africa, had higher MHC-I diversity than species living in drier regions, irrespective of the habitats they occupy. By contrast, no relationship was found between MHC-I diversity and precipitation in migrants. Our results suggest that the immune system of birds has evolved greater pathogen recognition in wetter tropical regions. Furthermore, evolving transcontinental migration appears to have enabled species to escape wet, pathogen-rich areas at key periods of the year, relaxing selection for diversity in immune genes and potentially reducing immune system costs.

Mental health literacy: conceptions of mental illness among African residents of Sisonke District in KwaZulu-Natal, South Africa

The prevalence of mental illness is on the rise, and there are many people with chronic or severe mental disorders who are unaware that they have a diagnosable disorder. It is plausible that this is largely because of the public’s non-alignment with biomedical understandings of mental illness which may imply a lack of mental health literacy. This study investigated conceptions and aetiological beliefs about mental illness among 787 randomly selected African residents of Sisonke District using a survey. The results show that participants did not use standard psychological nomenclature to describe mental illness, but instead used very broad, over-encompassing terms which may be indicative of their worldview. Of the three disorders investigated, depression was mainly conceptualised using psychological and medical terms, and schizophrenia and alcohol dependency were conceptualised in psychological and social terms. In addition, only schizophrenia, among the three disorders investigated, was conceptualised using supernatural descriptions such as bewitchment and ukuthwasa. The findings of this study highlight the importance of awareness campaigns that take into consideration and respect the cultural differences of the people as well as collaboration between traditional and medical practitioners.

Risk factors of low back pain and the relationship with sagittal vertebral alignment in Tanzania

BackgroundLBP is a common and serious problem affecting vast populations of the world. However, only few studies on LBP in sub-Saharan Africa have been conducted. Studies report that LBP and pelvic angle are interrelated, and African residents have a high pelvic tilt. The strategy to prevent LBP should focus on activities that promote holistic health. For that purpose, it is important to grasp the state of LBP and how it affects people’s lifestyle in Tanzania to clarify the direction of implementation of physiotherapy treatment and reduce the incidences of LBP among adults. This study aimed to investigate the prevalence and presentation of low back pain (LBP) and the relationship between anthropometric measurements and LBP among people in Moshi city, Kilimanjaro region Tanzania.MethodsFollowing signing consent forms, participants were given questionnaires regarding LBP and then grouped accordingly into either asymptomatic or symptomatic cohorts. Anthropometric measurements of participants’ height, weight, curvature of the spine, and pelvic angle were obtained.ResultsA Mann-Whitney U test analysis showed a significant difference in pelvic angle, body mass index (BMI), and thoracic kyphosis angle between the asymptomatic group and the symptomatic group. No significant differences in lumbar lordosis angle or abdominal muscle strength were found between the two groups.ConclusionsA person with symptomatic LBP in Tanzania has a large anteversion of the pelvic tilt and a thoracic kyphotic posture. This study shows a relationship between sagittal spinal alignment and LBP in Tanzania, which could allow for prospective identification of subjects prone to developing LBP in the future.

South African township residents describe the liminal potentialities of tourism

The townships of South Africa are peri-urban neighbourhoods defined by racial segregation, economic disparity, and geographic isolation. A product of the racist policies of apartheid, these spaces exist as exclusively black or ‘coloured’ neighbourhoods that present limited opportunities for mobility for residents. Since the end of apartheid, townships have increasingly come up under the tourists’ gaze as sites/sights of resistance, difference, and, urban adventure. While much of tourism scholarship on liminality to date has focused on tourism landscapes creating liminal opportunities for tourists, this paper details how tourism encounters may also become liminal opportunities for tourism hosts under certain conditions. While the tourism encounters take place in the familiar landscape that is home, they become liminal occasions in which to come face-to-face with the previously inaccessible Other and transform one’s relationship with them, with themselves, and with their home space. In conducting a critical discourse analysis with the texts of interviews with 16 township residents, a number of liminal moments were identified in participants’ descriptions of tourism encounters. Themes identified in this research include: (1) Pertaining to a change in social standing, economic state, relationships to/with the other; (2) Desire for engagement, transformation through encounter; (3) Transformation of one’s understanding of the physical landscape, and; (4) Transformation of one’s understanding of self. These themes are elucidated through the use of creative analytic practice (CAP) and demonstrate that while tourism encounters in the spaces of home do not involve a physical relocation, they can have a transformative effect in people for whom such encounters with the Other were previously forbidden.

Temporal Aspects of Wellbeing in Later Life: Gardening among Older African Americans in Detroit.

Gardening has well-established physical, social, and emotional benefits for older adults in varied circumstances. In Detroit, Michigan (United States of America), as in many cities, policymakers, funders, researchers, community organizations, and residents regard gardening as a means of transforming bodies, persons, communities, cities, and broader polities. We draw on ethnographic research conducted during one gardening season with 27 older African Americans in Detroit to foreground the social dimensions of wellbeing in later life and thus develop a more robust and nuanced understanding of gardening's benefits for older adults. Based on anthropological understandings of personhood and kinship, this article expands concepts of wellbeing to include social relations across multiple scales (individual, interpersonal, community, state) and temporalities (of the activity itself, experiences of ageing, city life). Even when performed alone, gardening fosters connections with the past, as gardeners are reminded of deceased loved ones through practices and the plants themselves, and with the future, through engagement with youth and community. Elucidating intimate connections and everyday activities of older African American long-term city residents counters anti-black discourses of "revitalization." An expansive concept of wellbeing has implications for understanding the generative potential of meaningful social relations in later life and the vitality contributed by older adults living in contexts of structural inequality.

Fruit and Vegetable Prescriptions for Pediatric Patients in Flint, Michigan: Program Development, Methods, and Baseline Characteristics (FS02-05-19)

ObjectivesTo address food access and affordability challenges among low-income children and adolescents, some health care providers are prescribing fresh fruits and vegetables. However, the evaluation of these programs is limited as are descriptions of study designs and needs of the population they serve. Our objectives were to describe the development of a fruit and vegetable prescription program for pediatric patients, baseline characteristics of the study population, child dietary patterns, and household food security. MethodsResearchers partnered with pediatricians in Flint, Michigan to offer one $15 prescription for fresh fruits and vegetables to children at every office visit. Participating vendors included the downtown farmers’ market as well as a local mobile market, which accepts on-line or telephone orders for fruit and vegetable boxes delivered to homes. Following receipt of the prescription, patients (7–18 years of age) were invited to participate in the current study with one caregiver. Researchers restricted enrollment to one child per family. Caregiver-child dyads completed evaluation instruments with a trained research assistant during their pediatric office visit. In addition to completing a demographic survey, caregivers and children responded to questions about dietary patterns, food security, and food access. Results320 caregiver-child dyads enrolled in the study. Most of the children (mean age 12.7 ± 2.9) were African American (68%) and residents of Flint (73%). The majority of caregivers (mean age 39.7 ± 9.7) were female (91%), African American (65%), and receiving SNAP benefits (54%). Of the 277 children who completed the food screener, average intake of vegetables (0.71 cups ± 0.73) and dairy (1.3 cups ± 1.1) as well as whole grains (0.48 ounces ± 0.47) were well below current recommendations. Moreover, nearly half of caregivers who enrolled in the study (47%) reported low or very low household food security. ConclusionsResults confirm and continue to raise deep concerns about dietary behaviors and food insecurity among children in Flint, many of whom continue to face an ongoing drinking water crisis. By addressing both access to fresh produce and food insecurity, the prescription program has the potential to improve fruit and vegetable intake. Funding SourcesThis study was supported by a grant from Michigan Health Endowment Fund.