Metropolitan Residents Research Articles

Regional disparities in the associations of cardiometabolic risk factors and healthy dietary factors in Korean adults.

BACKGROUND/OBJECTIVESRegional disparities in dietary factors might be related to regional disparities in cardiometabolic health. Therefore, this study investigated the associations of cardiometabolic risk factors and dietary factors with regional types in Korean adults.SUBJECTS/METHODSBased on data from the 2007–2017 Korea National Health and Nutrition Examination Survey, the study included 39,781 adults aged ≥ 19 years who completed the dietary survey and a health examination. Healthy and unhealthy dietary factors (fat, sodium, fruit, and vegetable intakes) were evaluated using 1-day 24-h dietary recall method, as well as the use of nutrition labels with a questionnaire.RESULTSOf the participants, 48.7%, 36.0%, and 15.2% lived in metropolitan, urban, and rural areas, respectively. Adults living in urban and rural had higher odds ratios (ORs) for obesity (OR for urban, 1.07; 95% confidence interval (CI), 1.01–1.14; OR for rural, 1.14; 95% CI, 1.05–1.24) than adults living in metropolitan areas; these associations were significantly observed in middle-aged adults. Compared to metropolitan residents, rural residents had lower ORs for hypertension in middle-aged (OR, 0.86; 95% CI, 0.76–0.96) and metabolic syndrome in older adults (OR, 0.78; 95% CI, 0.67–0.91). Regarding urban residents, a lower OR for diabetes in middle-aged adults (OR, 0.85; 95% CI, 0.74–0.97) and a higher OR for hypertension in older adults (OR, 1.19; 95% CI, 1.02–1.39) were observed. Overall rural residents had higher ORs of excessive carbohydrate, low fruit, and high salted-vegetable intakes than metropolitan residents. Low fruit intake was positively associated with obesity, metabolic syndrome, and hypertension, after adjustment for regional type and other confounders in total participants.CONCLUSIONSThese findings indicate that cardiometabolic risk and unhealthy dietary factors differ among regional types and age groups within Korea. Nutritional policy and interventions should consider regional types for prevention and management of cardiometabolic risk factors.

Tokyo Listening: Sound and Sense in a Contemporary City by Lorraine Plourde

Reviewed by: Tokyo Listening: Sound and Sense in a Contemporary City by Lorraine Plourde Po-Hsien Chu TOKYO LISTENING: SOUND AND SENSE IN A CONTEMPORARY CITY. By Lorraine Plourde. Middletown, CT: Wesleyan University Press, 2019. 220 pp. Paperback, $25. In 1973, Canadian music composer and environmental activist Murray Schafer, in a groundbreaking project named The Vancouver Soundscape, employed the concept of soundscape as a theoretical lens to explore the critical role of auditory experience in the formation of an urban landscape. Schafer's experimental research has become a monumental work for academic scholars and sound designers enthralled by the [End Page 598] interplay between acoustic effect and city landscape. Lorraine Plourde's Tokyo Listening: Sound and Sense in a Contemporary City provides new insights in this field as the author engages in an interdisciplinary study of Tokyo's urban landscape using ethnomusicology, anthropology, cultural and performance studies. In the introductory chapter, Plourde succinctly posits that the aim of Tokyo Listening is to investigate "a range of distinct listening cultures that all reveal something about how listeners attune themselves to the sounds and noises of the city" (p. 2). Traditionally the study of sound is often understood as something highly abstract or theoretical; the essence of sound is materially intangible and visually unrecognizable. However, in the twenty-first century, most urban spaces where people work, live, or relax are all filled with different sonic elements designed to be part of the city atmospheres. Therefore, sound as a form of immaterial presence in urban space should not be overlooked as it engenders an embodied mode of sensory experience which constitutes the metropolitan residents' quotidian behaviors and "orients people's movements, affect, labor practices, and consumption" (p. 132). Framing her analysis of listening practices within the context of Tokyo's urban auditory cultures, Plourde meticulously examines four sites of semipublic and public space—experimental music venues, music cafés, white-collar offices, and commercial spaces like department stores and shopping centers—in which a set of orchestrated "music programming" (muzak in Japanese) informs the listeners of their embodied contact with the metropolitan center of Japan. Muzak, translated as "Background Music" (BGM) in English, is precisely the focal point of the author's analysis since it "bring[s] together two different types of listening spaces in the same frame of reference: spaces people go to specifically for the music, and places where the music comes to them" (p. 11, emphasis original). In the first chapter, Plourde discusses how the architectural design of an experimental music venue called Off Site creates a sensory fusion of live music and the quotidian sounds of Tokyo. Situated within a residential neighborhood, Off Site offers independent musicians and composers a space to experiment with sound. The experimental music genre, known as "onkyo" in Japanese refers to an improvised performance of electronic music emphasizing "sound texture, gaps, and silences rather than melody or rhythm" (p. 15). Experimenting with the rupture of music notes and the discontinuation of auditory harmony, the onkyo performance at Off Site constantly distracts the audience as unexpected moments of silence inside the performance venue paradoxically amplify the non-intentional urban sounds leaking into the enclosed space from the outside. The coexistence of instrumental sounds and urban noises (the BGM of [End Page 599] Tokyo) at Off Site blurs the boundary between intentional and non-intentional sounds. The second chapter contextualizes the city's café culture in light with the author's ethnographic research. Plourde conducted fieldwork by visiting various music café shops and interviewing the owners and patrons. Plourde claims the listening culture of Tokyo's music cafés remains understudied because the consumer population is relatively small compared to those who favor chain coffee shops (e.g., Starbucks). Grounded in a nostalgic atmosphere, Tokyo'smusic cafés establish an exquisite mode of listening culture by requiring their patrons to follow a set of rules. For instance, prohibiting a customer from conversing with other people inside the café explicitly constitutes a form of social etiquette governed by the restraint of acoustic volume. This measure of auditory control directs the patron's attention to the ubiquitous analog sounds, non-digital music players, and old-fashioned acoustic devices...

Access to Higher Education in New Mexico: Racial, Ethnic and Geographic Disparities

This chapter, written for a collected volume on Race in Rural America, assesses the intersections of race and ethnicity with rurality in relation to higher education access and attainment in the State of New Mexico. New Mexico is one of the nation’s most rural states and is home to a distinct population in terms of race and ethnicity: the greatest percentage Latinx/Hispanic population—right at half and growing fast—and the third smallest population of non-Hispanic whites among all states. Further, more than a tenth of New Mexicans identify as American Indian, the second greatest percentage among the states. The fifth most sparsely populated state in the nation, New Mexico struggles chronically with a lagging economy, high poverty and child poverty rates, and low educational attainment. Against that demographic and economic backdrop, the analysis in this chapter reveals disappointing educational attainment among Hispanic and American Indian students as measured against these groups’ proportion of the state’s broader population, but particularly in relation to New Mexico’s college-aged population. In other words, young Hispanics’ status as a majority does not appear to be a protective factor—or at least not a sufficiently protective one—when it comes to higher educational attainment. American Indian students struggle to an even greater degree, falling far behind both their non-Hispanic white and Hispanic counterparts. While rural residents’ education level consistently falls behind that of metropolitan residents, it is impossible to determine the extent to which this is due to a rural brain drain—the phenomenon of young people raised in rural areas who migrate to urban areas to obtain their college degrees and then stay, often because of better economic opportunities. Indeed, the data suggest bleak higher education outcomes for all low-income and rural residents, regardless of race or ethnicity. We attribute this in part to inadequate state funding of public higher education and to a mismatch between how that funding is currently spent, e.g., four-year institutions, merit-based student aid, and how it could be better spent to promote access and attainment for the most vulnerable students. We close the chapter with recommendations for policy makers seeking to achieve equity in education and thus also foster a brighter economic future for the entire state. We emphasize the need for the collection of more nuanced data so that the State of New Mexico can better understand trends and shift resources in ways that will make education access more equitable across race, ethnicity and geography.

Rural–Urban Differences in Access to Primary Care: Beyond the Usual Source of Care Provider

In the U.S., rural residents have poorer health than urban residents and this disadvantage is growing. Therefore, it is important to understand rural-urban differences in access to medical care. This study compared the percentage of individuals with a usual source of care and characteristics of usual source of care providers across 3 urban-rural categories. This study identified 51,920 adults from the 2014-2016 Medical Expenditure Panel Survey and estimated the percentage with a usual source of care across the rural-urban categories. Then, differences in a variety of provider characteristics were examined. Estimates were weighted to be representative of the U.S. non-institutionalized population and adjusted for age, race/ethnicity, self-rated health, and presence of chronic conditions. Analysis was conducted in 2018 and 2019. Compared with metropolitan county residents, residents of the most rural counties were 7 percentage points more likely to have a usual source of care (81% vs 74%), but their providers were 13 percentage points less likely to be physicians (22% vs 35%). Despite having to travel longer to reach their usual source of care providers, residents of the most rural counties were 18 percentage points less likely than metropolitan residents to have usual source of care providers with office hours on nights and weekends (27% vs 39%). Rural-urban differences in access to care are complex; there is a rural disadvantage on some dimensions of access but not others. To understand rural-urban disparities in healthcare access, research should move beyond the usual source of care provider as an overall indicator and instead investigate disparities using multiple indicators of access based on theoretically distinct domains.

FALLS AND NUTRITIONAL RISK AMONG RURAL STATE RESIDENTS

Vermont continues to have one of the nation’s highest fall rates and its rurality may be a contributing factor. The purpose of our study was to compare fall history and nutritional risk (a fall risk factor also associated with rurality) in participants from rural and metropolitan areas. We collected data at statewide community-based fall risk screenings. During the events, nutritional data was collected using the DETERMINE Your Nutritional Health Screening Tool Questionnaire. We used descriptive statistics (chi2) to examine the relationship between fall history, nutritional risk, and rurality. From 123 subjects, 67% were classified as rural residents. There was no relationship between fall history and nutritional risk (p=0.6). Compared to rural residents, a significantly higher percentage of those living in metropolitan areas reported falls (54% versus 35% p=0.05). However, metropolitan residents were not at higher nutritional risk (49% versus 54%, p=0.61). National nutritional risk rates are lacking, but food insecurity is associated with nutritional risk. Our overall reported high nutritional risk (20%) is higher than the prevalence of food insecurity, both nationally (11%) and in Vermont (9%). In conclusion, we did not identify a relationship between fall history and nutritional risk. We did find a higher percentage of metropolitan residents reporting falls. Furthermore, we identified that DETERMINE is a feasible nutritional screening tool to use at fall risk screenings. It can be used to identify community-dwelling older adults at nutritional risk, but it may not have the sensitivity to identify an association between nutritional risk and falls.

Trends in prescription opioid use and dose trajectories before opioid use disorder or overdose in US adults from 2006 to 2016: A cross-sectional study.

BackgroundWith governments’ increasing efforts to curb opioid prescription use and limit dose below the Centers for Disease Control and Prevention (CDC)-recommended threshold of 90 morphine milligram equivalents per day, little is known about prescription opioid patterns preceding opioid use disorder (OUD) or overdose. This study aimed to determine prescribed opioid fills and dose trajectories in the year before an incident OUD or overdose diagnosis using a 2005–2016 commercial healthcare database.Methods and findingsThis cross-sectional study identified individuals aged 18 to 64 years with incident OUD or overdose in the United States. We measured the prevalence of opioid prescription fills and trajectories of opioid morphine equivalent dose (MED) prescribed during the 12-month period before the diagnosis. Of 227,038 adults with incident OUD or overdose, 33.1% were aged 18 to 30 years, 52.9% were males, and 85.0% were metropolitan residents. Half (50.5%) of the patients had a diagnosis of chronic pain, 32.7% had depression, and 20.3% had anxiety. Overall, 79,747 (35.1%) patients filled no opioid prescription in the 12 months before OUD or overdose diagnosis, with the proportion significantly increasing between 2006 and 2016 (adjusted prevalence ratio, 1.86; 95% CI 1.79–1.93; P < 0.001). Patients without (versus with) prescribed opioids tended to be younger males and metropolitan and Northeast US residents. Of 145,609 patients who filled opioid prescriptions, 5 distinct prescribed daily dose trajectories preceding diagnosis emerged: consistent low dose (<3 mg MED, 34.6%), consistent moderate dose (20 mg MED, 27.3%), consistent high dose (150 mg MED, 15.0%), escalating dose (from <3 to 20 mg MED, 13.7%), and de-escalating dose (from 20 to <3mg MED, 9.4%). Overall, over two-thirds of patients with OUD or overdose with prescription opioids were prescribed a mean daily dose below 90 mg MED before diagnosis. Major limitations include the limited generalizability of the study findings and lack of information on out-of-pocket drug spending, race/ethnicity, and socioeconomic status of participants, which prevents analyses addressing these characteristics.ConclusionsIn this study, we found that absence of opioid prescription fills in the year before incident OUD or overdose diagnosis was prevalent, and the majority of the patients received prescription opioid doses below the risk threshold of 90 mg MED. An increasing proportion of high-risk patients could be missed by current programs solely based on opioid prescribing and dispensing information in this new era of limited access to prescription opioids.

Examining the link between emotional childhood abuse and social relationships in midlife: The moderating role of the oxytocin receptor gene

BackgroundA single nucleotide polymorphism (SNP), rs53576, of the oxytocin receptor gene (OXTR) has been associated with fundamental aspects of social processes and behaviors. Compared to A carriers, GG individuals have enhanced social competencies and tend to elicit more positive responses from social partners. However, the G allele of the OXTR rs53576 has also been associated with greater social sensitivity. ObjectiveThe current study examined the unique influence of emotional childhood abuse on positive and negative aspects of different types of social relationships (e.g., family, spouse/partner, and friends) in midlife and whether genetic variations of OXTR rs53576 moderated these associations.Participants and Setting: A total of 614 participants in midlife (aged 40–65), recruited for a large-scale study of Phoenix metropolitan residents (AS U Live Project), answered self-report questionnaires and provided blood samples for DNA genotyping. MethodsHierarchical multiple regression analyses tested whether emotional childhood abuse predicted social support and strain for each relationship type and whether these potential linkages differed by OXTR genotype (GG versus AA/AG). ResultsOverall, individuals with a history of emotional childhood abuse had less supportive and more strained relationships in midlife. For supportive family relationships, the effect of emotional childhood abuse was moderated by OXTR rs53576 (p < .001). Under conditions of experiencing more emotional abuse in childhood, GG individuals had more supportive family relationships in midlife compared to A carriers. ConclusionsOverall, genetic variations of OXTR rs53576 may be an important candidate in understanding the development of social functioning within the context of emotional childhood abuse.

Sleep disorders in metropolitan residents

Every second patient has sleep disorder. Outcomes of decreased quality of sleep lead to serious medical and socioeconomic value. Population studies identify the main causes of sleep problems: stress, poor sleep hygiene, somatic disorders. The effect of stress on sleep is noted by 75% of responders. The most frequently sleep disorders are insomnia, obstructive sleep apnea and restless legs. Treatment of insomnia based on current standards for the management of patients with insomnia. The main methods for the treatment of chronic insomnia are cognitive behavioral therapy, short-term hypnotic pharmacotherapy or a combination of both. Z-hypnotics, benzodiazepine receptors agonists, melatonine and melatonine receptors agonists, antihistamines, antidepressants, neuroleptics, herbal and antiepileptic drugs are recommended for the treatment of chronic insomnia. Most of them are in tablet form. Cases of gradual cancellation of hypnotics, an increase in half-life of the drug and refusal of hypnotic drug for fear of lack of hypnotic side effects control, require individual selection of the dosage. Liquid form (in drops) of doxilamine from antihistamines group -Valocardine®-Doxilamine (Krewel Meuselbach GmbH, Germany) enables convenient dosing with addition potentiation of the effect due to combination with ethanol and mint oil.

The patterns and places of counterurbanization: A ‘macro’ perspective from Newfoundland and Labrador, Canada

Abstract Counterurbanization scholarship in Canada is dominated by micro-scale case studies, most recently conducted in the province of Newfoundland and Labrador (NL). In this article, a macro perspective is used to paint a broader picture of this downward migration stream. It seeks to determine the relative importance of counterurbanization in NL, compared to other Canadian provinces and territories; to uncover its dominant form (population decentralization or deconcentration); and to determine if counterurbanites are contributing to population growth in productivist or post-productivist municipalities. To undertake this research, migration, population, and labour force data are extracted from the 2016 census. Analysis reveals that counterurbanization is a substream movement at the sub-national scale, but a mainstream flow to small settlement areas in NL, as it is across the country. It more often involves the decentralization of metropolitan residents to urban adjacent municipalities, although in all regions, including NL, interprovincial deconcentration to isolated census subdivisions is also apparent. In-migrants are attracted to nine of ten potential destination types in NL, differentiated by the relative size of the labour force in productivist industries (agriculture, forestry, fishing, hunting, mining, utilities, quarrying, oil/gas extraction, and manufacturing), and post-productivist sectors (arts, entertainment, recreation, accommodation and food services). Counterurbanites are more numerous in post-productivist settlement types and often contribute to population growth; fewer reside in productivist settlements, which typically are experiencing population decline. This cooccurrence of productivist and post-productivist destinations is not typical of an advanced economy, but one more often found in developing states. These findings enrich Canadian counterurbanization scholarship and demonstrate the application of a counterurbanite-destination typology that can be customized for use in international settings.

Identifying typologies among persons admitted to hospital for non-fatal intentional self-harm in Victoria, Australia

PurposeThe aim of this study was to determine whether people who have been hospitalised as the result of non-fatal self-harm form meaningful groups based on mechanism of injury, and demographic and mental health-related factors.MethodsA retrospective analysis of 18,103 hospital admissions for self-harm in Victoria, Australia over the 3-year period 2014/2015–2016/2017 recorded on the Victorian Admitted Episodes Dataset (VAED). The VAED records all hospital admissions in public and private hospitals in Victoria. The primary analysis used a two-step method of cluster analysis. Initial analysis determined two distinct groups, one composed of individuals who had a recorded mental illness diagnosis and one composed of individuals with no recorded mental illness diagnosis. Subsequent cluster analysis identified four subgroups within each of the initial two groups.ResultsWithin the diagnosed mental illness subgroups, each subgroup was characterised by a particular mental disorder or a combination of disorders. Within the no diagnosis of mental illness groups, the youngest group was also the most homogenous (all females who self-poisoned), the oldest group had a high proportion of rural/regional residents, the group with the highest proportion of males also had the highest proportion of people who used cutting as the method of self-harm, and the group with the highest proportion of metropolitan residents also had the highest proportion of people who were married.ConclusionsPreventative interventions need to take into account that those who are admitted to hospital for self-harm are a heterogeneous group.

Introducing autonomous buses and taxis: Quantifying the potential benefits in Japanese transportation systems

The introduction of autonomous buses and taxis is expected to generate such benefits as cost reductions—and particularly for regional bus operations with a substantial deficit—as well as enhancing public transit accessibility through decreased trip costs. The purpose of this paper is to provide an overview of the impacts of introducing autonomous buses and taxis on metropolitan transportation systems by quantifying the costs of travel in Japan, and to discuss the potential benefits. First, this study sets the assumptions on autonomous driving technology, including its impacts on vehicle costs, the decreased labor costs for driving and safety monitoring in buses and taxis, and decreased driving stress for private car users. Next, operating costs are computed for autonomous buses and taxis in Japanese metropolitan areas. The costs of travel, or the sum of monetary and time costs, are then computed with and without vehicle automation for different trip types in high- and low-density metropolitan areas. The results highlight that the costs of public transit trips that currently have a smaller share of time costs in overall trip costs could decrease considerably due to vehicle automation. For instance, costs for 10–20-km trip lengths could decrease by 44–61% for taxi trips and 13–37% for rail/bus trips with taxi access, followed by a decrease of 6–11% for bus trips and 1–11% for rail trips with bus access. Further, private car trip costs could decrease by 11–16%. More substantial cost reductions in rail/bus trips with taxi access could occur in the case of smaller trip distances and/or in residential areas far from stations; larger reductions in rail trips with bus access could occur in low-density metropolitan areas. Finally, it is expected that vehicle automation in more fixed modes of public road transit could primarily benefit the transit industry and government, with such effects as improved labor productivity and reduced subsidies, while vehicle automation in more flexible modes could benefit metropolitan residents as well as the transit industry. This further suggests that a deficit of regional bus operations could be recovered during the transition to the full performance of autonomous buses.

The mountains are calling! An extended TPB model for understanding metropolitan residents' intentions to visit nearby alpine destinations in summer

This study investigated the suitability of an extended Theory of Planned Behaviour (TPB) to research the travel intention of metropolitan citizens to nearby destinations. The consideration of heat waves in this context is a novel approach. The survey data was collected from 877 Viennese respondents. Structural equation modelling shows a very good fit of the final model to the data; model extensions yield a strong increase of explained variance. The results suggest that heat-related change of intention is influenced by the strength of heat stress perceived during past heat waves. Nevertheless, subjective and social norm are the strongest determinants of intention, whereas attitude is a very weak predictor. Additional significant predictors are outdoor sports as a travel motive, media coverage, and past behaviour. The first application of an extended TPB model to summer tourism in the context of climate change yields important insights as to how climate change affects the destination choice of summer tourists. The results provide valuable starting points for attracting heat stressed metropolitan visitors.

A mediation analysis of the effect of practical training on the relationship between demographic factors, and bystanders' self-efficacy in CPR performance.

This study examined the mediation effect of practical training on the relationship of demographic characteristics with bystander self-efficacy in cardiopulmonary resuscitation (CPR) performance. We used nationwide, cross-sectional data from the Korea Community Health Survey and analyzed 25,082 Korean adults who participated in CPR training within the last 2 years. A mediation model was applied to explore the pathway from demographic characteristics via CPR practical training to self-efficacy in CPR performance. A multiple logistic regression analysis was performed to examine each path in the mediation model. Of the 25,082 respondents recently trained, 19,168 (76.8%) practiced on a manikin. In the unadjusted CPR practical training model, the demographic characteristics associated with high self-efficacy in CPR performance were male gender (odds ratio [OR] = 2.54); 50s age group (OR = 1.30); college or more (OR = 1.39) and high school education (OR = 1.32); white collar (OR = 1.24) and soldier (OR = 2.98) occupational statuses. The characteristics associated with low self-efficacy were 30s age group (OR = 0.69) and capital (OR = 0.79) and metropolitan (OR = 0.84) areas of residence (p < 0.05). In the adjusted CPR practical training model, the significance of the relationship between demographics and self-efficacy in CPR performance decreased in male gender, 30s age group, college or more and high school education, and soldier occupational status (i.e., partial mediation), and disappeared in metropolitan residents (i.e., complete mediation). The degree of the mediating effect of CPR practical training on self-efficacy differed for each demographic characteristic. Thus, individualized educational strategies considering recipient demographics are needed for effective practice-based CPR training and improving bystander CPR performance.

Patient Characteristics and Causes of Facial Fractures in the State of California

Each year, more than 400,000 emergency department (ED) visits in the United States are due to facial fractures. To inform targeted interventions to prevent facial fractures, the purpose of this study was to identify patient characteristics associated with causes of facial fractures in California. The 2005 to 2011 California State Emergency Department Database was used for this cross-sectional study. The study population was composed of all ED visits for facial fractures. The primary outcome was cause of injury: fall, firearm injury, motor vehicle traffic accident, pedal cycle accident, pedestrian accident, transport accident, and assault. Predictor variables included patient characteristics, such as age, gender, insurance type, and race and ethnicity. Multivariable logistic regression models were used. There were 198,870 ED visits for facial fractures from 2005 to 2011. The patients' average age was 35.7years. Most ED visits were by male patients (71%), privately insured patients (35%), and white patients (52%). Approximately 65% of visits were on weekdays and 93% were routinely discharged. Closed fractures of nasal bones, other facial bones, orbital floor, malar and maxillary bones, and mandible were the most prevalent (91%) facial fractures. Assaults (44%), falls (24%), and motor vehicle traffic crashes (6%) were the top 3 causes of facial fractures. Elderly patients (odds ratio [OR]=6.17), female patients (OR=2.25), and Medicare enrollees (OR=1.51) were statistically more likely to have fall-related fractures than patients 45 to 64years old, male patients, and privately insured patients. Blacks (OR=0.46) and micropolitan residents (OR=0.76) were statistically less likely to have fall-related fractures than whites and metropolitan residents. Violence among youth and falls among the elderly are predominant causes of facial fractures. The uninsured contribute to more than one fourth of ED visits for facial fractures. Interventions targeted at these population groups can curb the prevalence of these fractures.

Factors contributing to COPD hospitalisations from 2010 to 2015: Variation among rural and metropolitan Australians.

Rural and remote populations experience the greatest burden of chronic obstructive pulmonary disease (COPD), the fifth leading cause of death in Australia. Currently there is a need to prioritise health services to improve health outcomes among those at higher risk of COPD. To investigate the differences in COPD hospitalisation between rural and urban populations and determine predictive factors contributing to COPD hospitalisation. Statewide hospitalisation data from 2010 to 2015 were obtained through the Victorian Admitted Episodes Dataset and other key data sets. The rates of hospitalisation were analysed using hierarchical multiple regression to examine the association between COPD hospitalisations and a number of predictor variables. The highest COPD incidence occurred in metropolitan males aged 85years of age and older (35.092 hospitalisations per 1000 population). Among metropolitan residents, smoking, population density and household income had a significant association with COPD hospitalisations for both sexes. Among rural males, smoking rates, household income and rural land use (farming) were significant predictors of COPD hospitalisations. There was an overall stability in statewide COPD hospitalisation over the 5 years to 2015, P=0.420. This investigation highlights many rural and regional areas have much lower COPD hospitalisation rates than metropolitan areas. Between males and females, there are heterogenetic factors that contribute to the significant variation associated with COPD hospitalisation in metropolitan and rural areas, such as rural land use among rural males. This indicates that risk factor assessments, beyond smoking alone, need to be individualised and prioritised in practice to optimise care.

“Can you take me higher?”: Normative thresholds for air quality in the Salt Lake City Metropolitan area

Urban-proximate protected areas provide metropolitan residents with a variety of benefits. We explored the pursuit of clean air by winter outdoor recreationists who live in the Salt Lake City metropolitan area of northern Utah, a region that experiences seasonal air pollution events. To better understand how air quality in the Salt Lake Valley affects winter outdoor recreation in the nearby Uinta-Wasatch-Cache National Forest (UWCNF), we employed qualitative interviews (n = 14) and a norms-based thresholds questionnaire (n = 380). Results suggest that degraded metropolitan air quality serves as an impetus for winter outdoor recreation in the UWCNF and, at the same time, disproportionately displaces certain recreationists from outdoor pursuits. Participants’ normative transit behaviors are discussed, as are the effects of existing air quality conditions on self-reports. These results help illustrate air quality is a viable indicator of overall outdoor recreation quality in the UWCNF and likely in other urban-proximate protected areas.

Privileging the preventive medicine physician: A solution in search of a problem?

While home foreclosure can lead to mental and physical health declines in persons experiencing the foreclosure, whether neighborhood foreclosures can affect the health of other residents is debatable. Using a racially/ethnically diverse sample of Chicago metropolitan area residents linked to foreclosure data from 2008 to 2014, we assessed whether exposure to neighborhood foreclosure fillings was associated with changes in objectively measured body mass index (BMI) over time. Using a retrospective longitudinal design, we employed fixed-effects regression models that controlled for individual- and neighborhood-level covariates to test the association of neighborhood foreclosures and BMI in >60,000 individuals and for individuals who did not move during the follow-up period. We also adjusted for the non-linear association of age and BMI and comorbidities and employed a series of sensitivity analysis to test for robustness. In fully adjusted models, a standard-deviation increase in neighborhood foreclosure filings within 500 m was associated with increases in BMI for individuals who did not move (nonmovers) (mean = 0.03 BMI units, 95% confidence interval: 0.01, 0.06). Neighborhood foreclosure rates were not associated with changes in BMI for the full sample. Given the potential deleterious effects of neighborhood foreclosure on individuals with longer exposure to the local vicinity, clarifying the potential health effects of neighborhood foreclosures would help policymakers when planning actions to prevent home losses, predatory home loans, and that aim to more efficiently return foreclosure properties to productive uses.

Patterns and correlates of urban trail use: Evidence from the Cincinnati metropolitan area

Transportation, parks, and health organizations are collaborating to develop multiuse trail networks that meet the needs of metropolitan residents for utilitarian travel, recreation, and fitness. This paper describes how trails are used and explores correlates of trail use in the Greater Cincinnati region. Drawing on a systematic survey of users, we use ordinary probit and spatial models to explore the effects of socio-demographics, trip characteristics, attitudes, and the built environment, on recreational and utilitarian use. Most (89%) respondents report using trails for recreation; just 8.8% say they use trails for utilitarian purposes. Ordinary probit models show that users reporting recreational use are significantly more likely to be female, have incomes greater than $120,000, and travel longer distances on trails, but less likely to bike or walk to access trails. Transit connectivity is negatively correlated with recreational use. Trail users reporting utilitarian purposes are disproportionately male, significantly less likely to have incomes greater than $120,000, and more likely to take short trips on trails and to access trails by cycling or walking. They say they would commute more by cycling if connectivity were improved. Spatial probit model indicates negative spatial relationships among recreational users, implying the absence of a spatially-based common culture of trail use. Trail planners in this region can use these findings to strengthen the planning and design of trail networks and to meet the needs of different users. Given the finding most trail use is for recreational purposes, additional studies of the needs of utilitarian users are warranted.

Differences in Characteristics and Exposure to Stressors Between Persons With and Without Diagnosed Mental Illness Who Died by Suicide in Victoria, Australia

Background: Mental illness is an established risk factor for suicide. To develop effective prevention interventions and strategies, the demographic characteristics and stressors (other than, or in addition to, mental illness) that can influence a person's decision to die by suicide need to be identified. Aim: To examine cases of suicide by the presence or absence of a diagnosed mental illness (mental illness status) to identify differences in factors associated with suicide in the groups. Method: Logistic regression analyses were used to investigate mental illness status and exposure to stressors among 2,839 persons who died by suicide in Victoria, Australia (2009-2013), using the Victorian Suicide Register. Results: Females, metropolitan residents, persons treated for physical illness/injury, those exposed to stressors related to isolation, family, work, education, and substance use and those who had made a previous suicide attempt had increased odds of having a diagnosed mental illness. Employed persons had decreased odds of having a diagnosed mental illness. Limitations: The retrospectivity of data collection as well as the validity and reliability of some of the data may be questionable owing to the potential for recall bias. Conclusion: The point of intervention for suicide prevention cannot always be a mental health professional; some people who die by suicide either do not have a mental illness or have not sought help.

Community organizations and mental health after the 2013 Boston Marathon bombings

ObjectiveDisasters are place-based traumatic events, yet contemporary understandings of disaster recovery often do not consider the role of community organizations. We examine organization type and proximity as they relate to post-disaster mental health in a longitudinal study following the 2013 Boston Marathon bombings. MethodResidents of metropolitan Boston (N = 846) were recruited via a probability-based sampling strategy within weeks of the bombings and were surveyed several times over a two-year period. Residents of metropolitan New York (N = 941) were recruited and surveyed at the same time and used for comparison due to similarities in community demographics, geography, and disaster histories. We identified six different organization types nearby resident: safety-based organizations, religious organizations, educational organizations, child- and family-promoting organizations, health-based organizations, and voluntary community organizations. With possible environmental detriments (crowds and noise) or benefits of organizations amplified in areas closest to the resident, the concentration of these local organization types was examined at different distance-based boundaries. Contextual data for both communities came from the U.S. Census, Google Places API, and Guidestar. ResultsFor Boston metropolitan area residents, having more safety-based organizations within a half-mile to one-mile area in the aftermath of the bombings was associated with poorer functioning six to seven months later and greater psychological distress two years later. However, the presence of more safety-based organizations in the one to three mile area was associated with decreased psychological distress two years later. More health-based and voluntary community organizations in the half-mile to one-mile area were also associated with fewer fears and worries about future adversity two years post-bombing. Exposure to the bombings and other community traumas moderated this relationship among Boston area participants. ConclusionResults suggest that local community organizations are not merely buildings or structures but ecological sources of support to those in need after a disaster.