United States Cities Research Articles

ENERCA clinical recommendations for disease management and prevention of complications of sickle cell disease in children

Universal neonatal screening is performed in the United States, England, the Netherlands, and several cities in Belgium, with selective screening targeted on "high-risk" population in France (globally, one quarter of all the babies born in France are screened). Newborns diagnosed with a major sickle cell syndrome (SCD) should be referred to a designated pediatric sickle cell centre, and the parents are informed that their child has SCD; this may be in the sickle cell centre by an expert physician or in the community by an experienced nurse counsellor. The pediatric sickle cell centre should organize the care of the baby.

Risk Behavior Disclosure During HIV Test Counseling

Individualized risk assessments during HIV testing are an integral component of prevention counseling, a currently recommended behavioral intervention for patients in high-risk settings. Additionally, aggregate risk assessment data are the source of aggregate behavioral statistics that inform prevention programs and allocation of resources. Consequently, inaccurate or incomplete risk behavior disclosure during test counseling may impact the efficacy of the counseling intervention, as well as bias aggregate behavioral statistics. To quantify client-reported accuracy during the risk assessment and identify barriers and facilitators to risk behavior disclosure, we interviewed young men accessing HIV testing services in a southeastern United States city using mixed methodology. Data were collected from August 2007 to April 2008. Based on data collected via an audio and computer-assisted self-interview (n = 203), over 30% of men reported that they were not accurate during the risk assessment. Participants reported numerous interpersonal facilitators to complete disclosure. During qualitative interviews (n = 25), participants revealed that many did not understand the purpose of the risk assessment. Findings suggest that risk assessments completed during HIV test counseling may be incomplete. Modifications to the risk assessment process, including better explaining the role of the risk assessment in prevention counseling, may increase the validity of the data.

Fiducial inference on the largest mean of a multivariate normal distribution

Inference on the largest mean of a multivariate normal distribution is a surprisingly difficult and unexplored topic. Difficulties arise when two or more of the means are simultaneously the largest mean. Our proposed solution is based on an extension of R.A. Fisher’s fiducial inference methods termed generalized fiducial inference. We use a model selection technique along with the generalized fiducial distribution to allow for equal largest means and alleviate the overestimation that commonly occurs. Our proposed confidence intervals for the largest mean have asymptotically correct frequentist coverage and simulation results suggest that they possess promising small sample empirical properties. In addition to the theoretical calculations and simulations we also applied this approach to the air quality index of the four largest cities in the northeastern United States (Baltimore, Boston, New York, and Philadelphia).

City Structure and Congestion Costs

This paper presents a model and an automated methodology for decomposing congestion costs in cities. We model a city as a directed graph and define the planner’s problem of finding the subgraph minimizing the congestion costs (latency) of endogenously-routing traffic flowing through the subgraph. We show that the minimal total latency subnetwork displays congestion directly proportional to city population. By applying an automated search algorithm on a widely available Internet mapping application, and hence sampling from the empirically implemented subgraphs, the paper estimates the congestion-minimizing distortions of city transit networks in a large sample of United States and Italian cities.

Climate policy and action ‘underneath’ Kyoto and Copenhagen: China and the United States

AbstractThis contribution focuses on the role and promise of municipal‐government climate‐stabilization policies in the world's two largest greenhouse gases (GHG)‐emitting nations. The article compares emission‐mitigation authority, drivers, barriers, and activities at the city level in China and the United States. Recent municipal policy initiatives are analyzed within a policy context of climate‐driven and climate‐incidental municipal framings. For the most part, United States and Chinese cities have not yet adopted policy strategies that are intended to address GHG emissions directly and have not provided normative leadership in the interest of ecological justice. In both countries, however, increasingly independent and networked municipal governments are linking a diverse set of activities that focus on air‐quality, health‐promotion, and economic security to emissions reduction. These climate‐incidental municipal policies establish commitments that are beginning to exert an important global environmental impact. Although noteworthy and exemplary in a political context of national resistance to emission mandates, in the absence of a coordinated and strategically framed commitment among cities across both countries and/or policies and targets agreed upon at national and international levels that generate and reinforce local government initiatives, fragmented, uneven, and incomplete municipal‐government actions will continue to exert limited measurable and normative impact on global GHG emissions. Copyright © 2010 John Wiley & Sons, Ltd.This article is categorized under: Policy and Governance > Governing Climate Change in Communities, Cities, and Regions

Self-Reported Willingness to Have Cancer Screening and the Effects of Sociodemographic Factors

BackgroundThe relative effects of race/ethnicity and other sociodemographic factors, compared to those of attitudes and beliefs on willingness to have cancer screening, are not well understood. MethodsWe conducted telephone interviews with 1148 adults (31% African American, 27% Puerto Rican American, 43% white) from 3 cities in mainland United States and Puerto Rico. Respondents reported their sociodemographic characteristics, attitudes about barriers and facilitators of cancer screening, and willingness to have cancer screening under 4 scenarios: when done in the community vs one's doctor's office, and whether or not one had symptoms. ResultsRacial/ethnic minority status, age, and lower income were frequently associated with increased willingness to have cancer screening, even after including attitudes and beliefs about screening. Having screening nearby was important for community screening, and anticipation of embarrassment from screening for when there were no cancer symptoms. Associations varied across 4 screening scenarios, with the fewest predictors for screening by one's doctor when there were symptoms. ConclusionsSociodemographic characteristics not only were related to willingness to have cancer screenings in almost all cases, but were generally much stronger factors than attitudinal barriers and facilitators. Cancer screening campaigns should affect attitudinal change where possible, but should also recognize that targeting screening to specific population groups may be necessary.

Cost Analysis of Impacts of Climate Change on Regional Air Quality

Climate change has been predicted to adversely impact regional air quality with resulting health effects. Here a regional air quality model and a technology analysis tool are used to assess the additional emission reductions required and associated costs to offset impacts of climate change on air quality. Analysis is done for six regions and five major cities in the continental United States. Future climate is taken from a global climate model simulation for 2049-2051 using the Intergovernmental Panel on Climate Change (IPCC) A1B emission scenario, and emission inventories are the same as current ones to assess impacts of climate change alone on air quality and control expenses. On the basis of the IPCC A1B emission scenario and current control technologies, least-cost sets of emission reductions for simultaneously offsetting impacts of climate change on regionally averaged 4th highest daily maximum 8-hr average ozone and yearly averaged PM2.5 (particulate matter [PM] with an aerodynamic diameter less than 2.5 μm) for the six regions examined are predicted to range from $36 million (1999$) yr-1 in the Southeast to $5.5 billion yr-1 in the Northeast. However, control costs to offset climate-related pollutant increases in urban areas can be greater than the regional costs because of the locally exacerbated ozone levels. An annual cost of $4.1 billion is required for offsetting climate-induced air quality impairment in 2049-2051 in the five cities alone. Overall, an annual cost of $9.3 billion is estimated for offsetting climate change impacts on air quality for the six regions and five cities examined. Much of the additional expense is to reduce increased levels of ozone. Additional control costs for offsetting the impacts everywhere in the United States could be larger than the estimates in this study. This study shows that additional emission controls and associated costs for offsetting climate impacts could significantly increase currently estimated control requirements and should be considered in developing control strategies for achieving air quality targets in the future.

Self-Reported Height, Calculated Height, and Derived Body Mass Index in Assessment of Older Adults

Body mass index (BMI) is frequently used as assessment of nutritional and health risk. Yet, there is no consensus regarding assessment of height and cutpoints for weight classification in older adults. We first investigated differences in height by self-report (SR-height) and height calculated from measured knee-height (KH-height) and derived BMI in a cross-sectional assessment of 145 older adults residing in a Midwestern United States city. We further compared the proportion of older adults classified as at risk by seven different BMI cutpoints for weight classification as reported in the literature. We found no substantive difference in SR-height and KH-height or derived BMI, but we did find significant differences in the proportions of participants classified as At Risk across different BMI cutpoints. In community and clinical practice, SR-height and KH-height, and BMI derived from these, can be used interchangeably, but the lack of consensus regarding BMI cutpoints could lead to misclassification of older adults at risk.

Remote sensing of the urban heat island effect across biomes in the continental USA

Impervious surface area (ISA) from the Landsat TM-based NLCD 2001 dataset and land surface temperature (LST) from MODIS averaged over three annual cycles (2003–2005) are used in a spatial analysis to assess the urban heat island (UHI) skin temperature amplitude and its relationship to development intensity, size, and ecological setting for 38 of the most populous cities in the continental United States. Development intensity zones based on %ISA are defined for each urban area emanating outward from the urban core to the non-urban rural areas nearby and used to stratify sampling for land surface temperatures and NDVI. Sampling is further constrained by biome and elevation to insure objective intercomparisons between zones and between cities in different biomes permitting the definition of hierarchically ordered zones that are consistent across urban areas in different ecological setting and across scales. We find that ecological context significantly influences the amplitude of summer daytime UHI (urban–rural temperature difference) the largest (8 °C average) observed for cities built in biomes dominated by temperate broadleaf and mixed forest. For all cities combined, ISA is the primary driver for increase in temperature explaining 70% of the total variance in LST. On a yearly average, urban areas are substantially warmer than the non-urban fringe by 2.9 °C, except for urban areas in biomes with arid and semiarid climates. The average amplitude of the UHI is remarkably asymmetric with a 4.3 °C temperature difference in summer and only 1.3 °C in winter. In desert environments, the LST's response to ISA presents an uncharacteristic “U-shaped” horizontal gradient decreasing from the urban core to the outskirts of the city and then increasing again in the suburban to the rural zones. UHI's calculated for these cities point to a possible heat sink effect. These observational results show that the urban heat island amplitude both increases with city size and is seasonally asymmetric for a large number of cities across most biomes. The implications are that for urban areas developed within forested ecosystems the summertime UHI can be quite high relative to the wintertime UHI suggesting that the residential energy consumption required for summer cooling is likely to increase with urban growth within those biomes.

Organophosphorus and pyrethroid insecticide urinary metabolite concentrations in young children living in a southeastern United States city

Pesticide metabolites are routinely measured in the urine of children in the United States. Although the sources of these metabolites are believed to include residues in food from agricultural applications and residues from applications in everyday environments (e.g., homes), few studies have been able to demonstrate an association between indoor residential pesticide applications and pesticide metabolite concentrations. To better quantify the effects of potential risk factors related to demographics, household characteristics, occupation, and pesticide use practices on urinary biomarker levels, we performed a study in a city (Jacksonville, Florida) previously determined to have elevated rates of pesticide use. We enrolled a convenience sample of 203 children ranging in age from 4 to 6 years; their caregivers completed a questionnaire and the children provided a urine sample, which was analyzed for a series of organophosphorus and pyrethroid insecticide metabolites. The questionnaire responses substantiated much higher pesticide use for the study participants as compared to other studies. Urinary metabolite concentrations were approximately an order of magnitude higher than concentrations reported for young children in other studies. Few statistically significant differences (at the p < 0.05 level) were observed, however, several trends are worth noting. In general, mean urinary pesticide metabolite concentrations were higher for males, Caucasians, and those children living in homes with an indoor pesticide application occurring within the past four weeks. Comparing the urinary pesticide metabolite concentrations in this study to those reported in the NHANES and GerES studies showed that the children living in Jacksonville had substantially higher pyrethroid pesticide exposures than the general populations of the United States and Germany. Further research is needed in communities where routine pesticide use has been documented to obtain information on the most important routes and pathways of exposure and to develop the most effective strategies for reducing pesticide exposures for children.

Self injurious behavior among homeless young adults: A social stress analysis

Although self-mutilation has been studied from medical and individual perspectives, it has rarely been examined within a social stress context. As such, we use a social stress framework to examine risk factors for self-mutilation to determine whether status strains that are often associated with poorer health outcomes in the general population are also associated with self-mutilation among a sample of young adults in the United States who have a history of homelessness. Data are drawn from the Homeless Young Adult Project which involved interviews with 199 young adults in 3 Midwestern United States cities. The results of our path analyses revealed that numerous stressors including running away, substance use, sexual victimization, and illegal subsistence strategies were associated with more self-mutilation. In addition, we found that certain social statuses exacerbate the risk for self-mutilation beyond the respondents' current situation of homelessness. We discuss the implications of our findings for the social stress framework and offer suggestions for studying this unique population within this context.

Public Access Defibrillation.

In the United States, 250,000 people die from a cardiac arrest every year. Despite a well established emergency medical response system, survival from out-of-hospital cardiac arrest remains poor in United States cities. Paramount to achieving successful resuscitation of a cardiac arrest victim is provision of early defibrillation. Among patients that arrest due to a ventricular fibrillation, the likelihood of survival decreases by 10% for every minute of delay in defibrillation. In 1995, the American Heart Association challenged the medical industry to develop a defibrillator that could be placed in public settings, used safely by lay responders, and provide earlier defibrillation to cardiac arrest victims. Over the last decade, there have been significant technological advancements in automated external defibrillators (AEDs), and clinical studies have demonstrated their benefits and limitations in various public locations. This article discusses the technologic features of the modern AED and the current data available on the use of AEDs in public settings.

Enteric illness risks before and after water treatment improvements

This study evaluated whether occurrence of acute gastrointestinal illnesses declined after filtration and ozonation were added to a previously unfiltered, chlorinated high-quality surface water source in a northwest United States city. Enteric and other illnesses were recorded for two 6-month periods for control and intervention sites in the same city. During phase 1, chlorinated, unfiltered drinking water for both sites was obtained from protected watersheds. During phase 2, the intervention site received chlorinated, filtered and ozonated drinking water. The water was not altered in the control site. No overall differences were found in the risk of any of the illnesses after the new water treatment plant was completed. There was a significantly increased risk of diarrhoea and highly credible gastrointestinal illness in participants with three or more episodes of the same type of illness during phase 1.

Confident Commitment Is a Key Factor for Sustained Breastfeeding

The characteristics that distinguish women who breastfeed successfully from those who do not are just beginning to be identified in breastfeeding literature. The objective of this study was to identify the processes contributing to breastfeeding decisions among Caucasian and African American women. Data were initially collected through 24 focus groups consisting of separate groups of African American and Caucasian pregnant women, and breastfeeding and formula-feeding mothers from three major United States cities. The focus group study was initiated by the U.S. Department of Health and Human Services to obtain data on salient messages that would inform a national campaign to promote breastfeeding. This study was a secondary analysis of those data using a modified grounded theory approach. The process that emerged associated with successful breastfeeding was labeled "confident commitment." This process included several components: a) confidence in the process of breastfeeding, b) confidence in their ability to breastfeed, and c) commitment to making breastfeeding work despite obstacles. Contrary to popular conceptions, breastfeeding appears to be a learned skill. If mothers achieved a level of "confident commitment" before the birth, they were able to withstand lack of support by significant others and common challenges that occurred as they initiated breastfeeding. Without the element of "confident commitment," a decision to breastfeed appeared to fall apart once challenged.

Tree Care and Topping Beliefs, Knowledge, and Practices in Six Western U.S. Cities

A survey of households was conducted in six cities in the interior western United States to determine homeowners’ knowledge of tree biology and tree care and their knowledge and practice of topping. Tree biology and tree care knowledge was low, depending on the specific subject, and few respondents had any formal training in tree care. Respondents’ topping knowledge was moderate to poor if they had topped trees before, regardless of whether they received a topping-related educational brochure. Those who had not previously topped trees were fairly knowledgeable and the brochure increased knowledge in some cases. Topping was fairly commonly practiced, even by those who cared about trees, and often was done for safety and to improve tree appearance and tree health. Amongst those who had topped trees, the survey explored who performed the topping, why it was done, and their satisfaction with the practice. Examples of ways the tree care industry and others may be contributing to misunderstanding, such as inconsistent practices, are discussed. Recommendations are made for changing knowledge and attitudes about tree care as well.

Reproductive Decisions for Women With HIV: Motherhood's Role in Envisioning a Future

Cultural influences might exert more influence on HIV-positive women's reproductive choices than HIV-related conditions. In this article we report on grounded theory research on how women with HIV made reproductive decisions during a time of transition from HIV as potentially fatal to mothers and newborns to its current status as an often controllable chronic illness. Eighty HIV-positive women of childbearing age in three United States cities were interviewed, and the interviews were analyzed using grounded theory techniques. The core concept of the findings was that women's decisions were based on their judgment of the relative weight of positive aspects of motherhood versus the often negative pressures of social and public opinion. These findings have relevance for future research as well as for program development and policy.

A Ground-Based Method of Assessing Urban Forest Structure and Ecosystem Services

To properly manage urban forests, it is essential to have data on this important resource. An efficient means to obtain this information is to randomly sample urban areas. To help assess the urban forest structure (e.g., number of trees, species composition, tree sizes, health) and several functions (e.g., air pollution removal, carbon storage and sequestration), the Urban Forest Effects (UFORE) model was developed. Data collection variables and model methods are detailed and urban forest structure results are compared among 14 United States cities with average tree density ranging between 22.5 trees/ha (9.1 trees/ac) in Casper, Wyoming, U.S. to 275.8 trees/ha (111.6 trees/ac) in Atlanta, Georgia, U.S. Advantages and disadvantages of this ground-based method of assessing urban forest structure, functions, and values are discussed.

Spatial equity and transportation hazard along cross‐border trade corridors: The case of Ambos Nogales

Using a spatial perspective, this article explores the equity dimension of the North American Free Trade Agreement (NAFTA) in Nogales, Sonora and Nogales, Arizona, two of the U.S.‐Mexico border communities most impacted by trade after the implementation of the agreement in 1994. Ambos Nogales (Both Nogales) is a major hub within the cross‐border transportation corridor connecting northwestern Mexico with the United States and Canada and both cities are subject to intense trade‐related traffic, including the movement of hazardous materials and toxic waste generated by export‐oriented industries in Mexico. As a first step in this analysis, we classify and map residential areas in Ambos Nogales applying an index of socio‐environmental vulnerability. We then define the boundaries of existing hazard zones and their overlay with these areas in both cities. Finally, we contrast residential areas within the hazard zones with those outside to probe for patterns of social inequity both locally and across the border.

Marginalization of Midwives in the United States: New Responses to an Old Story

This column addresses issues raised by an intensive study of the circumstances and actions that resulted in the closure of two long-standing, successful nurse-midwifery services in a large United States city in 2003. Dr. Steffie Goodman of the School of Nursing, University of Colorado Health Science Center in Denver, USA, conducted 52 in-depth interviews with midwives, nurses, administrators, childbirth educators, policymakers, and physicians in an effort to understand how and why these two services were closed and what their closures revealed about the general underutilization of midwives in contemporary U.S. health care. Goodman concluded that economics, power, and authority converge in a way that allows persons in positions of institutional power and authority to make self-serving decisions that diminish access to midwifery services and that they can do so without any public accountability for their actions.

Current and Future Linked Responses of Ozone and PM2.5 to Emission Controls

Responses of ozone and PM2.5 to emission changes are coupled because of interactions between their precursors. Here we show the interdependencies of ozone and PM2.5 responses to emission changes in 2001 and 2050, with the future case accounting for both currently planned emission controls and climate change. Current responses of ozone and PM2.5 to emissions are quantified and linked on a daily basis for five cities in the continental United States: Atlanta, Chicago, Houston, Los Angeles, and NewYork. Reductions in anthropogenic NO(x) emissions decrease 24-h average PM2.5 levels but may either increase or decrease daily maximum 8-h average ozone levels. Regional ozone maxima for all the cities are more sensitive to NO(x) reductions than at the city center, particularly in New York and Chicago. Planned controls of anthropogenic NO(x) emissions lead to more positive responses to NO(x) reductions in the future. Sensitivities of ozone and PM2.5 to anthropogenic VOC emissions are predicted to decrease between 2001 and 2050. Ammonium nitrate formation is predicted to be less ammonia-sensitive in 2050 than 2001 while the opposite is true for ammonium sulfate. Sensitivity of PM2.5 to SO2 and NO(x) emissions changes little between 2001 and 2050. Both ammonium sulfate and ammonium nitrate are predicted to decrease in sensitivity to SO2 and NO(x) emissions between 2001 and 2050. The complexities, linkages, and daily changes in the pollutant responses to emission changes suggest that strategies developed to meet specific air quality standards should consider other air quality impacts as well.