Kansas City Metropolitan Area Research Articles

Summer Cancer Research Experience for High School Students from Historically Marginalized Populations in Kansas City.

The Accelerate Cancer Education (ACE) summer research program at The University of Kansas Cancer Center (KUCC) is a six-week, cancer-focused, summer research experience for high school students from historically marginalized populations in the Kansas City metropolitan area. Cancer affects all populations and continues to be the second leading cause of death in the United States, and a large number of disparities impact racial and ethnic minorities, including increased cancer incidence and mortality. Critically, strategies to bolster diversity, equity, inclusion, and accessibility are needed to address persistent cancer disparities. The ACE program offers an educational opportunity for a population of students who otherwise would not have easy access onto a medical center campus to make connections with cancer physicians and researchers and provides a vital response to the need for a more diverse and expansive oncology workforce. Students grow their technical, social, and professional skills and develop self-efficacy and long-lasting connections that help them matriculate and persist through post-secondary education. Developed in 2018, the ACE program has trained 37 high school junior and senior students. This article describes the need for and how we successfully developed and implemented the ACE program.

Impact of JayDoc Free Clinic on Emergency Department Usage in Kansas City

Introduction.JayDoc Free Clinic (JayDoc) serves medical needs of uninsured patients in the Kansas City metropolitan area. It is known that patients who have access to primary care are less likely to visit their local Emergency Department (ED) for non-emergent needs. However, it is not well described if JayDoc lowers usage of The University of Kansas Health System (TUKHS) ED. This is the first study to assess the patient referral process between TUKHS ED and JayDoc. Methods. The authors administered a voluntary survey to every patient triaged at JayDoc, even if they were ultimately not accepted for a visit. Items on the questionnaire included health insurance status, primary language, and access to a primary care physician. The authors included questions on the usage of TUKHS ED in the last 12 months. Results.Seventy-three patients completed the questionnaire. Approximately 10% of respondents reported they visited the ED in the last 12 months and received a referral to JayDoc from staff. However, authors observed no statistically significant difference in the proportion of new patients who used the ED in the last 12 months compared to that of returning patients. Conclusions.Results of this study demonstrated an existing referral system between JayDoc and TUKHS ED. However, the authors could not conclude that JayDoc reduces non-emergent ED visits among its patient population. Future initiatives will include further education to ED providers to increase the number of patients being referred to JayDoc.

Prenatal Care Utilization Challenges and Facilitators for a Growing Latino Community in the Midwest.

Latina women are less likely to start prenatal care in the first trimester and to attend the recommended amount of prenatal visits compared to their non-Latina white counterparts. This study aimed to assess challenges and facilitators to first-trimester prenatal care (FTPNC) and prenatal care utilization (PNCU) in a Midwestern urban area with a growing immigrant Latino community. This study used a mixed-method approach based on the Theoretical Domains Framework. Nine semi-structured interviews were conducted with healthcare professionals that worked in birth centers, clinics, or hospitals that provided prenatal care (PNC) services for Latina women. Eight focus groups and quantitative surveys were conducted with Latina women and their supporters in Kansas City metropolitan area. FTPNC was challenged by women's immigrant status, lack of healthcare coverage due to immigrant status, and complexity of Medicaid application. PNCU was challenged by the cost of PNC when diagnosed with gestational diabetes, lack of healthcare coverage, PNC literacy, late access to gynecologists/obstetricians, inadequate interpretation services, transportation, and mental health distress. Meanwhile, FTPNC was facilitated by social support and connectedness. PNCU was facilitated by Spanish-proficient providers and interpreters, effective nonverbal communication and education techniques, and pregnancy prevention access and education. Results from this study highlight important targets to improve PNC for Latina women. Participants called for various types of support to address identified challenges, ranging from information on social media about PNC services to broader efforts such as building trust from the community toward PNC providers and making PNC services affordable for women with gestational diabetes.

The Effects of COVID-19 Pandemic Policy on Social Needs Across the State of Kansas and Western Missouri: Paired Survey Response Testing.

Studying patients' social needs is critical to the understanding of health conditions and disparities, and to inform strategies for improving health outcomes. Studies have shown that people of color, low-income families, and those with lower educational attainment experience greater hardships related to social needs. The COVID-19 pandemic represents an event that severely impacted people's social needs. This pandemic was declared by the World Health Organization on March 11, 2020, and contributed to food and housing insecurity, while highlighting weaknesses in the health care system surrounding access to care. To combat these issues, legislators implemented unique policies and procedures to help alleviate worsening social needs throughout the pandemic, which had not previously been exerted to this degree. We believe that improvements related to COVID-19 legislature and policy have positively impacted people's social needs in Kansas and Missouri, United States. In particular, Wyandotte County is of interest as it suffers greatly from issues related to social needs that many of these COVID-19-related policies aimed to improve. The research objective of this study was to evaluate the change in social needs before and after the COVID-19 pandemic declaration based on responses to a survey from The University of Kansas Health System (TUKHS). We further aimed to compare the social needs of respondents from Wyandotte County from those of respondents in other counties in the Kansas City metropolitan area. Social needs survey data from 2016 to 2022 were collected from a 12-question patient-administered survey distributed by TUKHS during a patient visit. This provided a longitudinal data set with 248,582 observations, which was narrowed down into a paired-response data set for 50,441 individuals who had provided at least one response before and after March 11, 2020. These data were then bucketed by county into Cass (Missouri), Clay (Missouri), Jackson (Missouri), Johnson (Kansas), Leavenworth (Kansas), Platte (Missouri), Wyandotte (Kansas), and Other counties, creating groupings with at least 1000 responses in each category. A pre-post composite score was calculated for each individual by adding their coded responses (yes=1, no=0) across the 12 questions. The Stuart-Maxwell marginal homogeneity test was used to compare the pre and post composite scores across all counties. Additionally, McNemar tests were performed to compare responses before and after March 11, 2020, for each of the 12 questions across all counties. Finally, McNemar tests were performed for questions 1, 7, 8, 9, and 10 for each of the bucketed counties. Significance was assessed at P<.05 for all tests. The Stuart-Maxwell test for marginal homogeneity was significant (P<.001), indicating that respondents were overall less likely to identify an unmet social need after the COVID-19 pandemic. McNemar tests for individual questions indicated that after the COVID-19 pandemic, respondents across all counties were less likely to identify unmet social needs related to food availability (odds ratio [OR]=0.4073, P<.001), home utilities (OR=0.4538, P<.001), housing (OR=0.7143, P<.001), safety among cohabitants (OR=0.6148, P<.001), safety in their residential location (OR=0.6172, P<.001), child care (OR=0.7410, P<0.01), health care access (OR=0.3895, P<.001), medication adherence (OR=0.5449, P<.001), health care adherence (OR=0.6378, P<.001), and health care literacy (0.8729, P=.02), and were also less likely to request help with these unmet needs (OR=0.7368, P<.001) compared with prepandemic responses. Responses from individual counties were consistent with the overall results for the most part. Notably, no individual county demonstrated a significant reduction in social needs relating to a lack of companionship. Post-COVID-19 responses showed improvement across almost all social needs-related questions, indicating that the federal policy response possibly had a positive impact on social needs across the populations of Kansas and western Missouri. Some counties were impacted more than others and positive outcomes were not limited to urban counties. The availability of resources, safety net services, access to health care, and educational opportunities could play a role in this change. Future research should focus on improving survey response rates from rural counties to increase their sample size, and to evaluate other explanatory variables such as food pantry access, educational status, employment opportunities, and access to community resources. Government policies should be an area of focused research as they may affect the social needs and health of the individuals considered in this analysis.

Outcomes of the KC life 360 intervention: Improving employment and housing for persons living with HIV.

Housing and employment are key factors in the health and wellbeing of persons living with HIV (PLWH) in the United States. Approximately 14% of low-income PLWH report housing instability or temporary housing, and up to 70% report being unemployed. The purpose of this study was to examine the outcomes of an intervention to improve housing and employment for PLWH in the Midwest. Participants (N = 87) were recruited from the Kansas City metropolitan area to participate in a one-year intervention to improve housing and employment. All individuals were living with HIV and were not stably housed, fully employed, nor fully engaged in HIV medical care. A series of generalized estimating equations were conducted using client-level longitudinal data to examine how housing, employment, viral load, and retention in care changed over time. Housing improved from baseline to follow-up, with more individuals reporting having stable housing (OR = 23.5; p < 0.001). Employment also improved from baseline to follow-up, with more individuals reporting full-time employment (OR = 1.9; p < 0.001). Viral suppression improved from baseline to follow-up, with more individuals being virally suppressed (OR = 1.6; p < 0.05). Retention in care did not change significantly from baseline to follow-up (OR = 0.820; p = 0.370). Client navigation seems to be a promising intervention to improve housing and employment for PLWH in the Midwest. Additional research is needed on the impact of service coordination on client-level outcomes. Future studies should be conducted on the scalability of client navigation interventions to improve the lives of low-income, underserved PLWH.

Investigating the potential for cool roofs to mitigate urban heat in the Kansas City metropolitan area

Investigating the potential for cool roofs to mitigate urban heat in the Kansas City metropolitan area

PrEP patient attitudes, beliefs and perceived barriers surrounding HPV vaccination: a qualitative study of semistructured interviews with PrEP patients in primary care clinics in Kansas and Missouri

ObjectivesMen who have sex with men who use pre-exposure prophylaxis (PrEP) have not traditionally been targets for human papillomavirus (HPV) vaccine programmes, despite their high risk for HPV-related cancers and...

A novel echocardiographic approach for assessing coronary artery origins.

Anomalous aortic origin of a coronary artery (AAOCA) is a potential etiology of sudden cardiac death (SCD) in physically active individuals. Identification of coronary artery origins is an essential part of comprehensive pre-participation athletic screening. Although echocardiography is an established method for identifying AAOCA, current imaging protocols are time intensive and readers frequently have low confidence in coronary artery identification. Echocardiographic images from a sample of 110 patients from a database of competitive athletes ages 13-22years from the Kansas City metropolitan area were reviewed by six echocardiographers of varying experience. Coronary artery images were provided to the readers in the conventional single plane for all the patients; then biplane images of the same patients were presented to the readers. While reviewing the images, readers recorded perceived confidence level of identifying the coronary artery from 1 (least confident) to 5 (most confident). Ratings and differences between ratings were summarized descriptively by means and standard deviations across all readings as well as by individual reader. The mean confidence level of echocardiogram readers in identifying coronary artery origins increased by 0.4 points (P=.05) on a five-point confidence scale when using biplane imaging rather than single plane imaging. When assessing the variability of confidence of readers on the same patient, the between-reader variability improved from 25.9% to 10.3%. Biplane echocardiographic imaging increases the confidence of readers in identifying coronary artery origins.

Modeling potential air temperature reductions yielded by cool roofs and urban irrigation in the Kansas City Metropolitan Area

We evaluate two mitigation strategies for urban heat island (UHI) in the Kansas City Metropolitan Area (KCMA). Using the Weather Research and Forecasting (WRF) model, we assess the potential benefits of reflective "cool" roofs and urban irrigation on air temperature in typical summer conditions between 2011 and 2015, and during six of the strongest historical heat waves from 2005 to 2016. Under the typical summer conditions, we simulate 2-m air temperature for 10 summer weeks, finding average daytime (07:00–19:00 local time) temperature reductions of 0.08 and 0.28 °C for cool roofs and urban irrigation, respectively. During the six heat-wave episodes, we find daytime temperature reductions of 0.02 and 0.26 °C for the two scenarios, similar to those under typical summer conditions. Our results suggest that urban irrigation can be more efficient than cool roofs in mitigating UHI in metropolitan regions where the majority of the land cover is comprised of areas with low urban (i.e., non-vegetated) fractions. Finally, we find the alteration of surface conditions due to enhanced roof albedos influences precipitation within the WRF simulation, in particular during the heat waves. Further research would be necessary to determine the robustness of this last finding.

Hospital Collaboration in Response to the COVID-19 Pandemic in Kansas City Metropolitan Region

IntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2, aka COVID-19) virus has evolved into a World Health Organization-declared pandemic which has strained our regional critical care and hospital resources.MethodsA Critical Care Task Force was established between Kansas City area intensive care units to allow for preparedness for potential surges by sharing of bed capacity both in the ICU and hospital, and ventilator capacity as well as weekly web-based meetings to share resource concerns and best practice. This Task Force also collected patient information to understand the dynamics of community impact and resource needs better. This effort allowed for compilation and dissemination of information regarding data that describe characteristics of patients with COVID-19 compared to a random sample of medical ICU patients with conditions other than COVID-19.Demographic and therapeutic factors affecting patients admitted to medical intensive care units in the Kansas City metro area are reported from May 5, 2020 until June 2, 2020 using a retrospective case-control study examining gender, race, and therapeutic options including modes of ventilation, vasopressor requirements, renal-replacement therapy, and disposition.ResultsDuring data collection, patients being treated for COVID-19 in intensive care units in the Kansas City metropolitan area were more likely to be older, less likely to be white, and less likely to be immunosuppressed as compared to those being treated for non-COVID illnesses. They were more likely to require non-invasive ventilation and undergo prone positioning but were equally likely to require invasive ventilation and other organ supportive therapy.ConclusionsHospitalized patients being treated for COVID-19 in the Kansas City metropolitan area have similar demographics to those being reported in the U.S. including age and race. Additionally, establishing a Critical Care Task Force in response to the pandemic allowed for preparation for a potential surge, establishing capacity, and disseminating timely information to policy makers and critical care workers on the front line.

Urban Runoff Simulation: How Do Land Use/Cover Change Patterning and Geospatial Data Quality Impact Model Outcome?

With the increase in global urbanization, satellite imagery and other types of geospatial data have been extensively used in urban landscape change research, which includes environmental modeling in order to assess the change impact on urban watersheds. For urban hydrological modeling, as a focus of this study, several related research questions are raised: (1) How sensitive are runoff simulation to land use and land cover change patterning? (2) How will input data quality impact the simulation outcome? (3) How effective is integrating and synthesizing various forms of geospatial data for runoff modeling? These issues were not fully or adequately addressed in previous related studies. With the aim of answering these questions as research objectives, we conducted a spatial land use and land cover (LULC) change analysis and an urban runoff simulation in the Blue River watershed in the Kansas City metropolitan area between 2003 and 2017. In this study, approaches were developed to incorporate the Hydrologic Engineering Center Hydrologic Modeling System (HEC-HMS) model with remote sensing, geographic information systems (GIS), and radar rainfall data. The impact of data quality on the model simulation outcome was also analyzed. The results indicate that there are no significant differences between simulated runoff responses in the two study years (2003 and 2017) due to spatial and temporal heterogeneity of urbanization processes in the region. While the metropolitan area has been experiencing remarkable urban development in the past few decades, the gain in built-up land in the study watershed during the study period is insignificant. On the other hand, the gain in vegetated land caused by forestation activities is offset by a decrease in farmland and grassland. The results show that increasing spatial data resolution does not necessarily or noticeably improve the HEC-HMS model performance or outcomes. Under these conditions, using Next Generation Weather Radar (NEXRAD) rainfall data in the simulation provides a satisfactory fit in hydrographs’ shapes, peak discharge amounts and time after calibration efforts, while they may overestimate the amount of rainfall as compared with gauge data. This study shows that the developed approach of synthesizing satellite, GIS, and radar rainfall data in hydrological modeling is effective and useful for incorporating urban landscape and precipitation change data in dynamic flood risk assessment at a watershed level.

Tuthill opens pump manufacturing facility in Kansas

Tuthill Corp has invested in a new US manufacturing site for Fill-Rite fuel transfer pumps and products in the Kansas City metropolitan area.

A Tale of Two Borders: Use‐Value Assessment, Land Development, and Irrigation Investment

Since 1960, all 50 states in the US have adopted some form of preferential tax treatment for farmland. These provisions often take the form of use‐value assessment, where farmland is taxed on the basis of its value in agricultural production, as opposed to its full market value. While the main goal of use‐value assessment is to slow the conversion of farmland to non‐agricultural uses, other channels of influence are also possible, such as those stemming from reinvestment of foregone tax expenses. Despite its widespread nature, there is little empirical evidence pertaining to the influence of use‐value assessment on land‐use or investment decisions. Using a postmatching difference‐in‐differences framework, we exploit the temporal and spatial discontinuities surrounding the adoption of use‐value assessment in Kansas in 1989 to measure how use‐value assessment affected plot‐level land development and irrigation investment decisions. The results of our analysis indicate that, as intended, the use‐value assessment policy curtailed development in the Kansas City metropolitan area. Evidence regarding the potential investment‐spurring effects of use‐value assessment is more mixed, suggesting that farmers may have increased irrigation in some areas because of use‐value assessment‐induced tax savings.

A River in the City of Fountains: An Environmental History of Kansas City and the Missouri River by Amahia K. Mallea

Reviewed by: A River in the City of Fountains: An Environmental History of Kansas City and the Missouri River by Amahia K. Mallea Brian Frehner (bio) A River in the City of Fountains: An Environmental History of Kansas City and the Missouri River By Amahia K. Mallea. Lawrence: University Press of Kansas, 2018. Pp. 358. The story of Kansas City's growth and its need for water have often been a story about racial and class inequality. The connection between water and inequality is so embedded in the city's history that public officials are, at this very moment, meeting to rename a fountain that serves as the centerpiece of a popular commercial district known as "the Plaza." The J. C. Nichols Memorial Fountain commemorates the man who built the district as the country's first automobile-friendly shopping mall and as the centerpiece of the suburban neighborhood sprawling southward where many white residents fled urbanization and Black Americans. Nichols is also widely known for creating stark racial divides in the city by instituting real estate covenants for the houses he built that effectively "redlined" neighborhoods, excluding Black Americans and Jews. In recent weeks, protestors have gathered next to Nichols Fountain to protest the death of a Black American man, George Floyd, at the hands of Minneapolis police and to call for racial equality. Under its current name, the fountain has come to symbolize both the racist legacy of urban infrastructure and how inequality has marked the control of water in Kansas City, an idea at the center of this book. [End Page 1245] According to the author, Amahia Mallea, A River in the City of Fountains is about the "long-term intimate relationship" between Kansas City and the Missouri River and "about how intertwined the city and river" have been (p. 2). Although "intertwined," the Missouri River curiously "became invisible to Kansas Citians" even though it supplied water for drinking, fountains, and sewers (p. 1). Mallea never entirely elucidates the reasons for the river's invisibility, which would have made the book's central ideas clearer and easier to discern. Instead, she argues "what we have is a complex relationship in which the social matrix is constantly and inseparably interacting with the ecological system, and together they make the urban environment" (p. 2). Thus, it is the relationship between Kansas City and the Missouri River the author seeks to capture, much as Richard White has done in his book The Organic Machine. White explains that it is "the history of the relationship itself" around which he organizes his ideas, and Mallea strives to emulate this approach. The book's title does not fully express the broad scope of material covered, as the subject matter extends far beyond Kansas City and the Missouri River. Those who have never visited the Kansas City metropolitan area might not know that there are actually two urban centers named "Kansas City." The two cities are adjacent. One is in the state of Kansas and the other is in Missouri. The Kansas-Missouri state line divides the cities, as does a portion of the Missouri River. The Kaw River runs just south of Kansas City in Kansas and empties into the Missouri River near the state line where the two cities meet. Mallea's book is partly an exploration of how these political and geographical markers have complicated the broader metropolitan area's relationship with water over time, resulting in disparities among those who rely on these rivers. The book's ten chapters are grouped into three parts and cover a chronological timeframe running roughly from the late nineteenth century to the 1970s. Part I examines the relationship between city and river in terms of flooding, drinking water, and sewage. Part II surveys the diverse constituents who relied on the Missouri River as well as the Kaw River in neighboring Kansas City, Kansas. Part III recounts efforts to manage the Missouri River as part of a broader regional plan, the 1951 flood, and public health values that increasingly informed the river's management. The book concludes with a chapter on recent efforts to remediate the river and some personal reflections by the author on her...

Greenspace Pattern and the Surface Urban Heat Island: A Biophysically-Based Approach to Investigating the Effects of Urban Landscape Configuration

Surface urban heat islands (SUHIs) are influenced by the spatial distribution of green space, which in turn can be influenced by urban planning. When studying the relationship between structure and function it is critical that the scale of observation reflects the scale of the phenomenon being measured. To investigate the relationship between green space pattern and the SUHI in the Kansas City metropolitan area, we conducted a multi-resolution wavelet analysis of land surface temperature (LST) to determine the dominant length scales of LST production. We used these scales as extents for calculating landscape metrics on a high-resolution land cover map. We built regression models to investigate whether–controlling for the percent vegetated area–patch size, fragmentation, shape, complexity, and/or proximity can mitigate SUHIs. We found that while some of the relationships between landscape metrics and LST are significant, their explanatory power would be of little use in planning for green infrastructure. We also found that the relationships often reported between landscape metrics and LST are artifacts of the relationship between the percent of vegetation and LST. By using the dominant length scales of LST we provide a methodology for robust biophysically-based analysis of urban landscape pattern and demonstrate that the contributions of green space configuration to the SUHI are negligible. The simple result that increasing green space can lower LST regardless of configuration allows the prioritization of resources towards benefiting neighborhoods most vulnerable to the negative impacts of urban heat.

Urban Expansion and the Loss of Prairie and Agricultural Lands: A Satellite Remote-Sensing-Based Analysis at a Sub-Watershed Scale

Prairies or grasslands together with areas designated as agricultural lands are one of the largest types of land cover and land use that exist today. While prairies provide habitat to a wide variety of animals and organisms, and agricultural lands support human populations, these lands, especially those in the immediate vicinities of large urban areas, are giving way to urbanization at alarming rates. In particular, prairies are often viewed as wastelands because their benefit to the effective functioning of the urban ecosystem is often not fully understood. On the other hand, many agricultural lands are being converted for several urban uses because of the high economic returns from their sale. In this study, we classified SPOT (Satellite Pour l’Observation de la Terre) satellite data of the study area using the supervised maximum likelihood classification approach in order to investigate the loss of prairies and agricultural lands due to urban expansion in six sub-watersheds in the Kansas City metropolitan area of the States of Kansas and Missouri in the U.S. Based on the classified maps, we computed the magnitude and rate of urban expansion, and the proportion of loss in prairies and agricultural lands that was a result of urban expansion. Results from the 22-year study revealed that in all six sub-watersheds, agricultural lands and grassland were depleted at alarming rates with no sustainable effort to conserve them. These results provide baseline information that can support a data-driven and sustainable path for urban expansion in the examined sub-watersheds.

Bitcoin’s Not-So-Carbon-Friendly Footprint

New research finds that verifying cryptocurrency produces about the same amount of carbon emissions as the Kansas City metropolitan area.

Data deluge or data trickle? Difficulties in acquiring public data for telecommunications policy analysis

There is a paucity of granular, high-resolution broadband data in the United States, which limits the prospects of informed telecommunications policy debates. In the absence of regulation requiring telecommunication providers to accurately report service footprints, pricing, and service quality data, providers refuse to disclose this information, routinely citing competition as the primary reason for keeping network and pricing data obfuscated. In addition, many secondary datasets needed for broadband planning and policy research, such as parcel or address point data, are equally challenging to gather. These datasets are often controlled by county governments, with no overarching access policy, resulting in neighboring counties with widely divergent policies for the release of these important data. In this article we explore the challenges of open data and its impacts on telecommunication policy development. A recent project which explored the spatial provision of Google Fiber in the Kansas City metropolitan area helps to highlight these difficulties. Basic strategies for mitigating information asymmetries and the lack of data transparency for telecommunication policy analysis are discussed.

Pediatric Emergency Department Visits and Pollen Trends in the Kansas City Metropolitan Area 2013-2017

Pediatric Emergency Department Visits and Pollen Trends in the Kansas City Metropolitan Area 2013-2017

Evaluation of EPT macroinvertebrate metrics in small streams located within the non-connected stormwater management region of Kansas City, Missouri, USA

AbstractDuring 2012-2014, we evaluated macroinvertebrate communities in streams draining the non-connected stormwater management region (Municipal Separate Storm Sewer System, or MS4) within the Kansas City metropolitan area utilizing the Missouri bioassessment protocols. Trends in aquatic life impairment status based on Missouri's Macroinvertebrate Stream Condition Index (MSCI), as well as richness and abundance of EPT indicator metrics (Ephemeroptera, Plecoptera, Trichoptera), were compared between rural control sites and both transitional and urban stream sites representing varying stages of land use conversion. As compared to non-urban control sites, EPT taxa richness was significantly lower at MS4 urban sites during all three years (p = 0.007 – 0.013) and MS4 transitional sites during one of three years (p=0.48). EPT abundance (%) was significantly lower at MS4 urban sites during all years (p = 0.008 – 0.013) and MS4 transitional sites during one of three years (p=0.34). Mean EPT abundances ranged between 0.6% - 10.3% at urban MS4 sites, and always exceeded 18% at control sites. Both EPT richness and abundance were lower at the MS4 control site but means for EPT and other core metrics at this site were most often similar to non-urban control sites based on analysis of variance (ANOVA). MS4 transitional sites with active development in their watersheds were partially-supporting in their impairment status, and EPT metrics had lower means and generally more variability than control sites. Temporal trends indicate non-urban control and MS4 control sites consistently meet fully-supporting impairment status based on overall MSCI scores, but no study sites currently meet regional expectations (as defined by state reference streams) for either of the EPT metrics. Results indicate that Missouri and Kansas biocriteria for both EPT metrics are not consistently being met at any stream sites in the Kansas City metro area, including fully-supporting control sites and MS4 streams that receive stormwater runoff in watersheds with urban development that is well-established or currently transitioning to urban or suburban land uses.