Atlanta Region Research Articles

Abstract P381: Geographic Variation in Financial Strain and Food Insecurity After the COVID-19 Pandemic: Implications for Cardiovascular Health Equity

Reduced food security is associated with higher healthcare expenditures and increased risk of coronary heart disease, angina, heart attacks, and hypertension. State-level responses to the COVID-19 pandemic and support policies may contribute to regional differences in financial strain and food insecurity, which could have implications for cardiovascular outcomes. Hypothesis: We assessed the hypothesis that there is geographic variation in financial strain and food insecurity in the United States three years after the start of the pandemic. Methods: This study utilizes weighted data from the U. S. Census Bureau’s Household Pulse Survey Phase 3.10 conducted from August 23 - September 4, 2023. We organized data responses according to the Department of Health and Human Services regions - Boston, New York, Philadelphia, Atlanta, Chicago, Dallas, Kansas City, Denver, San Francisco, and Seattle. Food insecurity was measured using a single survey item about having sufficient food to eat in the last 7 days. Financial strain was defined as difficulty paying expenses in the last seven days. Results: There were 254,966,752 adults in the total sample population, (59%) reported difficulty with expenses due to the COVID-19 pandemic. The Atlanta region reported the most financial strain (13%), while the Denver region reported the least (2%), p-value=0.000. The rate of food insecurity was highest in the Atlanta region at 8% compared with 5% or less in other regions, p-value=0.000. Among the 8 states in the Atlanta region, Black individuals were disproportionately more likely to be food insecure, with the greatest difference for Kentucky, Florida, Tennessee, and South Carolina. All states in the Atlanta region had similar odds of food insecurity, but Mississippi residents were nearly twice as likely to experience food insecurity than residents of other states (OR 1.87, p =0.016). Conclusions: The Atlanta region (i.e., the “Deep South”) consists of the most populous states for non-Hispanic Black people and is experiencing the worst food insecurity and financial strain post-pandemic. The economic toll of the pandemic and post-pandemic inflation may contribute to worsening food insecurity and cardiovascular outcomes in a region that is already burdened by poor cardiovascular health. Multilevel intervention is needed to support full pandemic recovery and avoid exacerbating inequities in cardiovascular disease.

Tobacco in hotels: A study of smoke exposure and resident risk.

Extended-stay hotels (ESH) are a reliable and accessible housing option for low-income, minoritized renters, who are disproportionately exposed to secondhand and thirdhand cigarette smoke (SHS and THS). This study explores ESH residents' perceptions of their SHS and THS exposure, harms related to this exposure, their willingness to mitigate these harms, and the contextual factors associated with smoking in hotels. Eighty ESH renters from the metropolitan Atlanta region were recruited to complete a survey about the perceived harm and persistence of tobacco smoke, exposure experiences, knowledge, attitudes, self-efficacy, and intentions to protect oneself. Eleven of these participants completed semi-structured interviews, during which they discussed their daily SHS and THS exposure at their ESHs in greater detail. Of the survey respondents, 62% reported being bothered by their level of smoke exposure, and 77% said they believed smoke particulates remained in their rooms even after housekeeping cleaned them. Approximately half of survey respondents had attempted to stop smoking in the 3 months prior to the study, and 29 of these individuals were still on their smoking cessation journeys. Most interview participants agreed that SHS and THS exposure exacerbated their existing chronic illnesses and could possibly result in death in the long term. Participants agreed with the benefits of smoke-free policies, but also acknowledged other priorities for ESH living-affordability, safety, and proximity to the workplace-that overshadowed their desires for such policies. Overall, study findings suggest that ESH renters understand the dangers of smoking and SHS/THS and want to decrease their exposure, but the persistence of cultural and contextual factors prevents them from fully engaging with 100% smoke-free policies.

Evapotranspiration From Developed Land and Urban Watersheds in a Humid Subtropical Climate

AbstractUrbanization introduces new and alters the existing hydrological processes. Projecting the direction and magnitude of change of evapotranspiration (ET), often a large existing process, in humid subtropical climates is difficult due to the lack of land‐cover specific estimates of ET. This research aims to improve our fundamental understanding of ET in urban areas by focusing on ET specific to land‐cover classes of the National Land Cover Database (NLCD). Using multiple physically based models along with ET from reference watersheds, this study estimates ET—within the Atlanta, GA, USA region—for NLCD classes. ET also is estimated for urban watersheds—both in the Atlanta region and in areas with humid subtropical climate types—for which published ET estimates exist. There are major differences in land cover among the four developed classes: high‐intensity developed land is 92% impervious surfaces, while open‐space developed land—the least intensively developed land—is only 8% impervious surfaces. Consequently, open‐space developed land has an ET total that is over four times that of high‐intensity developed land. Due to a high percentage of impervious cover and substantial evaporation of water from impervious surfaces throughout the year, there is little intra‐annual variation in ET for the high‐intensity developed class. The land‐cover ET totals aggregate to reliable estimates for urban watersheds. The largest source of uncertainty for ET estimates in urban areas is likely the evaporation magnitude associated with impervious surfaces; therefore, more work is needed in determining those magnitudes for humid subtropical climates.

Predicting Low-Level Childhood Lead Exposure in Metro Atlanta Using Ensemble Machine Learning of High-Resolution Raster Cells.

Low-level lead exposure in children is a major public health issue. Higher-resolution spatial targeting would significantly improve county and state-wide policies and programs for lead exposure prevention that generally intervene across large geographic areas. We use stack-ensemble machine learning, including an elastic net generalized linear model, gradient-boosted machine, and deep neural network, to predict the number of children with venous blood lead levels (BLLs) ≥2 to <5 µg/dL and ≥5 µg/dL in ~1 km2 raster cells in the metro Atlanta region using a sample of 92,792 children ≤5 years old screened between 2010 and 2018. Permutation-based predictor importance and partial dependence plots were used for interpretation. Maps of predicted vs. observed values were generated to compare model performance. According to the EPA Toxic Release Inventory for air-based toxic release facility density, the percentage of the population below the poverty threshold, crime, and road network density was positively associated with the number of children with low-level lead exposure, whereas the percentage of the white population was inversely associated. While predictions generally matched observed values, cells with high counts of lead exposure were underestimated. High-resolution geographic prediction of lead-exposed children using ensemble machine learning is a promising approach to enhance lead prevention efforts.

Breaking New Ground: Space Agencies and Epidemiologists Partner Up on Particulates

Breaking New Ground: Space Agencies and Epidemiologists Partner Up on Particulates

How much water is stolen by sewers? Estimating watershed-level inflow and infiltration throughout a metropolitan area

Human activities can have substantial impacts on watersheds, yet a major but understudied impact on many urban watersheds is the inflow and infiltration (I&I) of water into sewage infrastructure. I&I is important, because it is a major cause of sewer overflows, increases wastewater treatment plant costs, and reduces base flows of urban streams. Unfortunately, I&I information is deficient at the watershed scale. Therefore, this study uses a water-budget approach to quantify the magnitude of I&I for 90 watersheds in the Atlanta, Georgia USA region during 2013–2020. I&I for each watershed is calculated by subtracting outflows (i.e., stream discharge, water withdrawn by public water systems, and actual evapotranspiration (AET)) from inflows (i.e., precipitation, water-supply pipe leakage, and non-I&I effluent from wastewater treatment plants). Included in the AET estimates is irrigation water from public water systems and water withdrawals for agriculture. Results show that I&I is a major contributor to the total outflow in urban watersheds. The mean annual I&I total for the 15 most urbanized watersheds is 138 mm, constituting 25% of stream discharge. The mean annual I&I total from the watersheds with the five highest totals is 216 mm, which is 40% of stream discharge. These annual I&I totals align well with totals calculated for urban catchments in Europe, where most of the previous research has been conducted. Regression analyses show that the density of older housing, which is a proxy for deteriorating sewage infrastructure, is the most important predictor of I&I across the Atlanta region. Despite the uncertainties in estimating annual totals for all components, especially AET for urban watersheds, of the water budget, we conclude that estimating I&I using the water-budget approach is a useful initial approach to estimating I&I throughout a region.

An empirical Bayes approach to quantifying the impact of transportation network companies (TNCs) operations on travel demand

Assessing the impacts of new and disruptive technologies on the transportation system is crucial for planners and policymakers. This study offers an innovative method for estimating the impact of transportation network company (TNC, e.g., Uber and Lyft) operations on travel demand. Among various measures of travel demand, vehicle‐miles traveled (VMT) is tested due to its broad applications in evaluating changes in transportation policy. The evaluation is based on counterfactual theory, which compares VMT estimates after the TNCs introduction to a region to what the VMT would have been without the TNCs. The latter of the two is a counterfactual, and this study develops and demonstrates the empirical Bayes (EB) approach for obtaining counterfactual VMT estimates. The EB approach is widely used to estimate crash frequency after a particular traffic safety treatment is applied to a roadway location. We reinterpret the traffic safety treatment as being akin to the introduction of TNCs in the Atlanta region and the estimation of crash frequency as analogous to the resulting change in VMT. Since the crash experience of a roadway site may be affected by several factors, like the VMT of a region, a robust counterfactual estimate is necessary for conducting a before-after study. A counterfactual VMT estimate is obtained by combining two VMT estimates from 1) the cross‐sectional analysis for Atlanta and its regional peers and 2) the time-series analysis based on the longitudinal trend from the Atlanta region. We measure the difference between the counterfactual VMT estimate and the reported VMT estimate as an indicator of TNC impact. We find that the VMT estimates in a counterfactual scenario without TNCs are lower than the actual VMT estimates between 2012 and 2018. We estimate that the TNCs may be accounting for extra 0.6 percent average annual growth in VMT. The findings may support future TNC-related planning and policymaking. We expect the approach to be useful in estimating the effects of other disruptions, such as connected and autonomous vehicles (CAVs) introduction and lasting impact of the pandemic, on VMT.

The COVID-19 pandemic and male sex workers who have sex with men: associations between age and race and advertising for work in 2019–2021

Despite government-mandated restrictions on business and social activities worldwide, some sex workers continued to see clients in person throughout the COVID-19 pandemic. To better understand this behaviour, we compiled publicly available data from Internet advertisements posted on a popular website before and during the pandemic by male sex workers providing services to men. We first collected data in March 2019 from 172 advertisements – the complete number available at that time – posted by male sex workers advertising services in the Atlanta region. We then assessed whether these same sex workers continued to advertise their availability at three subsequent points during the COVID-19 pandemic: April 2020, January 2021 and February 2021. We also determined whether age and race were associated with advertising presence at each time point. While advertising rates declined among sex workers in all race categories (Black, White and ‘other’), results from our mixed effects logistic regression model show that the odds of older male sex workers continuing to advertise were greater than the odds for their younger counterparts. Further, the predicted probability of continued advertising was highest for White male sex workers. Our findings provide additional insights into male sex work during a global pandemic.

COVID-19 Vaccine Hesitancy Among Health Care Workers in Four Health Care Systems in Atlanta.

Coronavirus disease 2019 (COVID-19) vaccine hesitancy among health care workers (HCWs) undermines community vaccine confidence. Predictors and reasons for HCW hesitancy in the Atlanta region were evaluated using a survey between May and June 2021. Vaccine hesitancy was highest in younger and less educated HCWs. Interventions to address vaccine hesitancy in HCWs are necessary.

Developing air pollution concentration fields for health studies using multiple methods: Cross-comparison and evaluation

Past air pollution epidemiological studies have used a wide range of methods to develop concentration fields for health analyses. The fields developed differ considerably among these methods. The reasons for these differences and comparisons of their strengths, as well as the limitations for estimating exposures, remains under-investigated. Here, we applied nine methods to develop fields of eight pollutants (carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), fine particulate matter (PM2.5), and three speciated PM2.5 constituents including elemental carbon (EC), organic carbon (OC), and sulfate (SO4)) for the metropolitan Atlanta region for five years. The nine methods are Central Monitor (CM), Site Average (SA), Inverse Distance Weighting (IDW), Kriging (KRIG), Land Use Regression (LUR), satellite Aerosol Optical Depth (AOD), CMAQ model, CMAQ with kriging adjustment (CMAQ-KRIG), and CMAQ based data fusion (CMAQ-DF). Additionally, we applied an increasingly popular method, Random Forest (RF), and compared its results for NO2 and PM2.5 with other methods. For statistical evaluation, we focused our discussion on the temporal coefficient of determination, although other metrics are also calculated. Raw output from the CMAQ model contains modeling biases and errors, which are partially mitigated by fusing observational data in the CMAQ-KRIG and CMAQ-DF methods. Based on analyses that simulated model responses to more limited input data, the RF model is more robust and outperforms LUR for PM2.5. These results suggest RF may have potential in air pollution health studies, especially when limited measurement data are available. The RF method has several important weaknesses, including a relatively poor performance for NO2, diagnostic challenges, and computational intensiveness. The results of this study will help to improve our understanding of the strengths and weaknesses of different methods for estimating air pollutant exposures in epidemiological studies.

Tactical Design of Same-Day Delivery Systems

We study tactical models for the design of same-day delivery (SDD) systems. Same-day fulfillment in e-commerce has seen substantial growth in recent years, and the underlying management of such services is complex. Although the literature includes operational models to study SDD, they tend to be detailed, complex, and computationally difficult to solve, and thus may not provide any insight into tactical SDD design variables and their impact on the average performance of the system. We propose a simplified vehicle-dispatching model that captures the “average” behavior of an SDD system from a single stocking location by utilizing continuous approximation techniques. We analyze the structure of optimal vehicle-dispatching policies given our model for two important instance families—the single-vehicle case and the case in which the delivery fleet is large—and develop techniques to find these policies that require only simple computations. We also leverage these results to analyze the case of a finite fleet, proposing a heuristic policy with a worst-case approximation guarantee. We then demonstrate with several example problem settings how this model and these policies can help answer various tactical design questions, including how to select a fleet size, determine an order cutoff time, and combine SDD and overnight order delivery operations. We validate model predictions empirically against a detailed operational model in a computational case study using geographic and Census data for the northeastern metro Atlanta region, and we demonstrate that our model predicts the average number of orders served and dispatch time to within 1%. This paper was accepted by Jay Swaminathan, operations management.

The relationship between older adult migration and destination characteristics in Georgia

Older adult migration patterns are shaped by distinct sets of factors for intrastate versus interstate and younger (65–74) versus aged (75+) older migrants. Moving decisions relate to individual factors and the destination's characteristics, including the climate, amenity, and cost of living. Previous studies have rarely integrated destination characteristics such as long-term care (LTC) facilities, affordable housing, or geriatricians. This study addresses this gap by examining older adult migration by age group and migration type. We proposed a variable structure describing six living environment categories of destination counties and further investigated the relationship between migrants and destination characteristics. We identified geographical patterns of migration and used linear regression and decision tree models to analyze migrants' destination variables. Results indicated four subgroups of older migrants have different high-high clusters in or near the Atlanta region and low-low clusters in South Georgia. Linear regression models quantified the relationship and indicated variables such as LTC facility bed and affordable housing availability should be considered in older adult migration analysis. Decision tree models revealed that different variables are associated with certain county groups, such as core Atlanta and rural counties. Our findings highlighted the variety of variables shaping the migration of older adult subgroups.

Teachers at the Center: Place and Education Displacement in Southwest Atlanta

In Southwest Atlanta, urban education reform and gentrification have intersected to create the perfect collision of housing and educational displacement of Black students, Black families, and Black teachers. While Black communities are dealing with the impacts of gentrification, Black schools are simultaneously witnessing shifts that uproot students and their teachers. As a teacher participatory action research (PAR) collective, we share our personal experiences of housing displacement and how it has impacted our students, our communities, and our ability to maintain our positions as community-centered teachers. In this article, we acclimate readers to Atlanta, Georgia, and the Southwest Atlanta region in which we serve. We also illustrate how we have confronted the displacement of our students and ourselves. Finally, we highlight the significance of community-centered teachers operating within a Critical Studyin’ for Human Freedom praxis in the struggle against systemic inequities that persistently plague our students and communities.

Homeownership and Community Involvement: Results From the 2019 Metro Atlanta Speaks Survey

ABSTRACT While the relationship between homeownership and community involvement is mixed and unclear, this study aims to contribute to this debate by further examining the relationship between these two. Using data from the 2019 Metro Atlanta Speaks survey, we find that homeowners and residents with longer community tenure have higher odds of being involved in the community compared with renters in the metro Atlanta region of the U.S. state of Georgia. Among various community activities examined, homeowners are associated with higher odds of participating in parent–teacher association meetings, neighborhood association meetings, and public meetings held by local governments. Because housing needs of and challenges faced by residents are different, a balanced and comprehensive housing policy ensuring safe, decent, and affordable housing options—rental housing and homeownership opportunities—is crucial in stabilizing homeownership rates and in keeping residents in their communities longer.

Implementation of a community grant program to address community-driven environmental health concerns

ABSTRACT Community-engaged approaches to research can increase trust, enhance the relevance and use of research, address issues of equity and justice, and increase community knowledge and capacity. The HERCULES Exposome Research Center sought to engage local Atlanta communities to learn about and address their self-identified environmental health concerns. To do this, HERCULES and their stakeholder partners collaboratively developed a community grant programme. The programme was evaluated using mixed qualitative methods that included document review and semi-structured interviews. This paper presents the development, implementation, and evaluation of the grant programme. HERCULES awarded one-year grants of $2,500 to 12 organisations within the Atlanta region, for a total 13 grants and $32,500 in funding. Grantees reported accomplishments related to community knowledge, awareness, and engagement in addition to material accomplishments. All grantees planned to sustain their programmes, and some received additional funding to do so. Some grantees remained actively involved with HERCULES beyond the grant programme. The HERCULES Community Grant Program was able to increase awareness of HERCULES among applicant communities, establish or enhance relationships with community-based organisations, and identify local environmental health concerns while providing tangible results for grantees and the communities they serve. Mini-grant programmes are a feasible approach to address community environmental health and establish new relationships. This model may benefit others who aim to establish community-academic relationships while addressing community health concerns.

‘I just wanted them to see me’: Intersectional stigma and the health consequences of segregating Black, HIV+ transwomen in prison in the US state of Georgia

This paper mobilizes the findings generated from in depth, in person interviews conducted with ten Black, HIV+ transgender women who had previously served time in local jails and prisons in the Atlanta region of the state of Georgia, USA. The paper explores how intersectional stigma emerges in the carceral environment in relation to the women’s multiple identity locations and the ways that HIV and transgender stigma in particular are linked to two harmful correctional practices. First, participants revealed that the ‘layering’ of these different forms of stigma resulted in institutional coercion to suppress their gender identity and to the inappropriate use of solitary confinement, both of which led to increased mental and emotional distress during their period of incarceration as well as after they were released from jail or prison. Second, participants were also frequently denied access to or had irregular access to their HIV medication and hormone replacement therapies (HRT), which can have significant mental and physical side effects. In carceral environments, the manifestation of intersectional stigma influences how individuals are treated by staff, where they were housed and how their institutional time is managed; in other words, it contributes to mapping their carceral experience.

Using Technology to Persuade: Visual Representation Technologies and Consensus Seeking in Virtual Teams

How do virtual teams reach consensus when there is disagreement among team members and the consequences of making the wrong decision are high? To answer this question, the authors examine the daily chat room discussions and decisions of a virtual team responsible for air quality forecasting for the 5-million-person Atlanta region in the United States. They show that team members increase their use of visual representation technologies (VRTs), such as weather maps, during chat room discussions when the initial team consensus is low and the team is deciding whether to issue a smog alert that has large economic and health consequences. More use of VRTs in team discussions is associated with bigger shifts in the initial to final consensus forecasts of the team and greater likelihood that the team changes its forecast to issue a smog alert. Greater use of VRTs is not associated with greater forecast accuracy. Increased VRT use is also associated with greater imagery processing and increased group cohesion. For managers these results show that, in virtual team settings, some information technologies are associated with more persuasion than others and that training teams on the advantages and disadvantages of persuasive technologies is important.

Envisioning a New City Center: Time, Displacement, and Atlanta’s Suburban Futures

AbstractIn the fast‐growing, gentrifying metro Atlanta region, poor people and immigrants are simultaneously being priced out of inner city neighborhoods and displaced by suburban revitalization initiatives. Affordable housing activists struggle to adapt their strategies to the place and pace of redevelopment. In this context, focusing on time becomes increasingly crucial to understanding people’s varying experiences and responses to these phenomena. I develop this insight by attending to an often‐overlooked site of gentrification: a majority‐white, conservative, but rapidly diversifying suburb of Atlanta, Georgia. In 2012, this suburban municipality launched an ambitious plan to transform its sprawling, car‐centric landscape into a brand‐new “city center.” The project, inspired by the principles of new urbanism, was only the first step toward a broader redevelopment vision targeting the city’s most diverse neighborhoods. By analyzing planning documents alongside ethnographic data, I examine how affluent homeowners, renters, activists, and institutional actors differentially engaged with and endured the temporalities of redevelopment. I focus in particular on working poor Latinx families, who were first to be affected by these plans. Unlike nonresident activists, these people did not engage in overt forms of contestation, nor did they try to influence local planning decisions. Instead, they deployed various time‐tricking (Bear 2016) and place making tactics in an effort to build a life in the leftover spaces and “meantime” of redevelopment. Through creative uses of time and the re‐purposing of disinvested landscapes, Latinx residents endured the regime of temporal uncertainty and residential mobility (re)produced by redevelopment.

Sharon Pappas, PhD, RN, NEA-BC, FAAN

Sharon Pappas, PhD, RN, NEA-BC, FAAN (seated, center), is chief of the Nurse Executive Team for Emory Healthcare in Atlanta, Georgia.

Analysis of Production System Components of Container-grown Chrysanthemum for Their Impact on Carbon Footprint and Variable Costs Using Life Cycle Assessment

Life cycle assessment (LCA) was used to analyze the production system components of a 20-cm Chrysanthemum grown for the fall market in the north Atlanta region of the United States. The model system consisted of 2 weeks of mist in a greenhouse followed by 9 weeks on an outdoor gravel bed equipped with drip irrigation. The carbon footprint, or global warming potential (GWP), was calculated as 0.555 kg CO2e and the variable costs incurred during the modeled production system (from rooting purchased cuttings to loading the truck for shipment) totaled $0.846. Use of plastics was important in terms of GWP and variable costs with the container contributing 26.7% of the GWP of the product and 12.2% of the variable costs. The substrate accounted for 44.8% of the GWP in this model but only 12.1% of the variable costs. Consumptive water use during misting was determined to be 3.9 L per plant whereas water use during outdoor production was 34.8 L. Because propagation is handled in various ways by Chrysanthemum growers, the potential impact of alternative propagation scenarios on GWP and variable costs, including the purchase of plugs, was also examined.