Midwest City Research Articles

Timing of emergency medical services activations for falls

ObjectiveFalls are a major challenge to public health, particularly among older adults. Understanding factors that influence fall risk is pivotal in the prevention of falls and fall-related injuries. This study evaluated the timing of emergency medical service (EMS) activations for falls and transport patterns for adults age ≥65. MethodsA patient care report system at a single fire-based emergency medical service agency in a suburban, Midwest city was retrospectively reviewed. Type of call (lift assist/fall), time of injury (time, day, and month), and demographics (sex, age) were collected for residents age ≥65 who activated 9–1–1 for a lift assist or fall. Results1169 calls met inclusion criteria. Mornings and afternoons were the time of day associated with falls (33 % and 36 % of EMS activations, respectively, vs. 21 % and 10 % for evenings and nights, respectively; p = 0.002) while day of the week and month were not associated with falls or lift assists. More males requested lift assists than females (256 vs. 238) and more females called for falls than males (408 vs. 267; p < 0.001). Falls were more likely to be associated with transport to the hospital than lift assists (78% vs. 7 %). Female sex was associated with increased risk for transport to the hospital (60 % of females vs. 40 % of males; p < 0.001). ConclusionsMornings and afternoons were associated with increased risk for falls and sex (female) with increased risk for transport to the hospital.

Girls Rule Art!

Abstract Arts-based programs can provide space for forcibly displaced youth to process pre-migration and resettlement experiences creatively. While these programs can facilitate growth and healing, limited research addresses forcibly displaced girls’ perceived benefits of engaging in arts-based programs. Through in-depth interviews with 20 high school girls who resettled in a Midwest City in the United States, I explore this group's motivation to engage in arts-based activities like dance, drama, and theater. My findings suggest that participants engaged in arts-based programs to explore their artistic interests, connect with other girls with similar cultural identities, and manage feelings of homesickness and loss. I discuss how schools and community organizations can tailor arts-based programs to help forcibly displaced girls manage socio-emotional and educational needs.

Charisma, Gender and ‘Glocality’: Catholic Charismatic Women in the 1970s

This article addresses the role of women in Catholic charismatic renewal, with reference to the movement in both the United States and England. It examines the renewal in relation to a wider mid-century context in which the role of Catholic women was being re-evaluated. It looks closely at the role of women in Catholic prayer groups, showing how while a ‘rediscovery’ of the Spirit contributed, broadly, to a democratising tendency where the laity were concerned, the place of women was contested. It shows how the dominant approach to gender to emerge in the United States – a patriarchal model linked to high profile charismatic ‘covenant communities’ in the upper Midwest cities of South Bend and Ann Arbor – did not have the same influence in England, where a more egalitarian approach tended to develop. This study of gender in the Catholic charismatic renewal is therefore also a case study of the ‘glocality’ of the Catholic charismatic movement.

Kindergarteners' peer relationships and early school absenteeism

This study used a short-term longitudinal design to examine the extent to which kindergartners': (a) peer relationships are associated with their school absenteeism; and (b) development of positive peer relationships vary as a function of their time spent in school. To address these aims, data were drawn from 801 kindergartners across 64 classrooms and 15 schools in a Midwest city in the United States. Results from covariate-adjusted regression models revealed that kindergartners' relational bonds were not predictive of their time away from school, and that their relationships with classmates were generally unaffected by absenteeism. There was, however, some indication that children's relationships with their classmates were more strongly predicted by their absenteeism for children from less educated households relative to children from more educated households.

The Effectiveness of an After-school Sport Sampling Intervention on Urban Middle School Youth in the Midwest: Posttest-Only Study

Effective and scalable interventions are needed to combat chronic low levels of youth physical activity. After-school sport sampling programs may be vital interventions for teaching sports and increasing physical literacy and physical activity, which result in healthy lifelong habits that are maintained into adulthood. The purpose of this study was to test the effectiveness of an after-school sport sampling intervention among underserved youth in the Midwest. Youth (n=81) in 3 middle schools within a large Midwest city participated in an 8-month, after-school physical activity intervention that aimed to increase moderate- and vigorous-intensity physical activity, improve physical literacy, and decrease BMI. Difference scores for this 2-group, posttest-only design were calculated. A series of 2-tailed t tests were conducted to assess between-group differences. The intervention group had significantly better physical literacy (t115=7.57; P=.004) and engaged in more moderate- and vigorous-intensity physical activity minutes per week (t115=4.28; P=.04) and steps per day (t115=4.29; P=.03). An after-school sport sampling program may be an effective solution for combating youth physical inactivity. Future research should assess the scalability of this intervention with larger populations and in different areas. RR2-10.2196/37126.

Physical Literacy of Marginalized Middle School Adolescents in Kansas City Public Schools.

Physical inactivity among adolescents in the United States continues to be a pervasive and growing problem, especially among low income and adolescents of color. Physical literacy is important for adolescents to engage in physical activity. However, few studies have assessed physical literacy among marginalized populations. The purpose of this study is to describe levels of physical literacy among marginalized adolescents in a Midwest City. Data were collected from 169 participants (85 adolescents and 84 parents). Adolescents included in the study were from 4 Kansas City (Missouri) public schools. Univariate statistics were calculated for 3 physical literacy domains (PLAYinventory, PLAYself, and PLAYparent). To assess for differences among groups, the authors conducted a single-factor analysis of variance (1-way analysis of variance). The sample (N = 169) was primarily Hispanic (48.2% adolescents and 42.9% parents). Sedentary behaviors were self-reported as the highest overall activities adolescents participated in within the past 12months. The mean physical literacy score for this sample was 71.9 among adolescent reported and 72.7 among parent reported. Analysis of variance of racial and ethnic groups for PLAYself and PLAYparent assessments showed no significant difference in values. Compared with other subscales of both the PLAYparent and PLAYself instrument, parents and adolescents showed a lack of confidence in adolescent's ability to be active in the 4 environments (land, water, ice, and snow). Physical literacy is shown to be important in maintaining physical activity throughout life; given this, it is important to understand how to increase confidence of seasonal specific skills in marginalized adolescents.

Nature-centered interiority as an urban social-spatial ecology

This essay proposes a conceptual framework to understand how urban, nature-centered interiority can create more social-spatial ecologies to support well-being, access, and delight. The approach expands on established research and strategies to filter design decisions for nature-spatial integration in urban environments that are dynamic, ecologically meaningful, and express human values. The narrative investigates the juxtaposition of natural and artificial, wild and controlled, open versus closed, and interior versus exterior within a Midwest city’s downtown as a case study. By speculating on nature interiority as a spatial system for human discovery and interaction through shared values, the series of illustrations expresses the possibility of augmenting urban interiority with nature to shape dialogue, participation, and access for further integration with culture and place within the surrounding environments.

Sexually Transmitted Infections Diagnosed Among Sexual and Gender Minority Communities During the First 11 Months of the COVID-19 Pandemic in Midwest and Southern Cities in the United States.

The COVID-19 pandemic adversely affected sexual health services. Given the burden of sexually transmitted infections (STIs) on sexual and gender minorities (SGMs), we estimated incidence of self-reported STI diagnoses and factors associated with STI diagnoses among SGMs during the pandemic's first year. A cohort of 426 SGM persons, 25 years or older, recruited in Chicago, Milwaukee, Detroit, Minneapolis, and Houston completed 5 online surveys from April 2020 to February 2021. Persons self-reported on each survey all health care provider STI diagnoses. Kaplan-Meier was used to estimate the cumulative risk of STI diagnoses, stratified by human immunodeficiency virus (HIV) status. Factors associated with STI diagnoses were assessed with a longitudinal negative binomial regression. Median age was 37 years, and 27.0% were persons living with HIV (PLH). Participants reported 63 STIs for a cumulative incidence for PLH and HIV-negative persons of 0.19 (95% confidence interval [CI], 0.13-0.29) and 0.12 (95% CI, 0.09-0.17), respectively. Regardless of HIV, a younger age and changes in health care use were associated with STI diagnoses. Among HIV-negative persons, the rate of STI diagnoses was higher in Houston than the Midwest cities (adjusted relative risk, 2.37; 95% CI, 1.08-5.20). Among PLH, a decrease in health care use was also associated with STI diagnoses (adjusted relative risk, 3.53; 95% CI, 1.01-12.32 vs no change in health care services), as was Hispanic ethnicity and using a dating app to meet a sex partner. Factors associated with STI diagnoses during the COVID-19 pandemic generally reflected factors associated with STI incidence before the pandemic like geography, HIV, age, and ethnicity.

What lies beyond the built environment? Exploring “walkability” across the Detroit region

Despite a long history of research on the influence of the built environment on travel, studies on urban form and pedestrian activity in neighborhoods characterized by rapid decline, as evident across U.S. Midwest cities, remain under-represented in the literature. Moreover, detailed exploration of travel inequities experienced by the socioeconomically disadvantaged is even rare. In examining travel, this research measures precise variations in the built environment—with the use of Road Network Buffers—across Detroit (Michigan) region neighborhoods, including in those experiencing severe disinvestment. This study reconfirms that compact urban form promotes non-automobile travel, and reaffirms the importance of a more balanced residential, retail and commercial land use mix in encouraging pedestrian activity, although it also identifies caveats for those neighborhoods experiencing decline. The research also contributes to expanding our understanding of travel behaviors within the context of amenity disparities and abandonment in neighborhoods experiencing severe disinvestment and extreme income divergence. Intersecting the sociodemographic dimensions and the built environment allows a deeper understanding of much disregarded nuance of travel amongst lower-income, racial minorities in highly segregated urban neighborhoods.

City-Wide Firearm Violence Spikes in Minneapolis following the Murder of George Floyd: A Comparative Time-Series Analysis of Three Cities

This study investigates the aftermath of a high-profile violent police incident as it relates to city-wide firearm violence. Utilizing two Midwest cities (Kansas City, Missouri and Omaha, Nebraska) as comparison cities, we assess whether violent firearm incidents increased in Minneapolis after the murder of George Floyd. Multiple interrupted time-series analyses showed statistically significant increases in weekly firearm incidents in Minneapolis (AME = 10.63, p &lt; 0.05) and Omaha (AME = 1.47, p &lt; 0.5) following the murder of George Floyd. No significant results were found in Kansas City. Similar relationships were found when examining monthly firearm incidents. The firearm spike in Minneapolis thus represents an approximate 10-fold increase in weekly firearm incidents relative to that observed in Omaha. We conclude, therefore, that the murder of George Floyd was associated with a substantially greater increase in firearm violence in Minneapolis than in the two comparison cities. Police training to reduce police violence and public health approaches to reduce urban firearm violence will alleviate the social and economic impacts of violence on federal and state governments.

Mapping recovery: A qualitative node map approach to understanding factors proximal to relapse among adolescents in a recovery high school

IntroductionDespite data suggesting that recovery high schools are largely effective in reducing substance use, relapse in these settings is common. The goal of the current study was to characterize factors proximal to relapse among adolescents in a local recovery high school. MethodData for this study were 200 de-identified node maps (i.e., graphical break downs of a relapse event; randomly chosen from 600 available node maps) from the charts of students at a local recovery high school in a large Midwest city (Mean Age = 16.8 ± 1.9 years, 64.1% male, 89.1% White). A four-phase process of qualitative data sorting examined features most frequently described in relapse episodes. ResultsThe most common elements reported were using with others (n = 153, 76.5%), away from home (n = 156, 78.0%), and in response to negative affect (n = 93, 48.4%). Six relapse pathways emerged: coping (n = 30), acting out (n = 15), unexpected temptation (n = 30), planned lapse (n = 19), resistant to recovery (n = 27), and passive agency (n = 30). The pathways identified represent three critical failures in the recovery system: failure to cope, failure to guard against temptation, and failure of belief. Identifying these system failures can contribute to increased rapport and engagement, as well as planning for detailed and specific factors proximal for relapse for any given individual, both on the individual and system levels. ConclusionThe use of node maps aligned with previous work, showed good face and content validity, can be used to reduce blame and increase engagement in substance use treatment among adolescents, and produced novel micro-frames with new vocabulary to accurately understand common factors associated with relapse among adolescents.

The Effectiveness of an Intergenerational Technology Program for Older Adults: A Pilot Study

Medical residents need training to assess social determinants of health (SDOH) related to chronic conditions. We created a checklist to identify SDOH affecting residency clinic patients’ ability to manage chronic conditions. The tool: 1) involves resident training; 2) provides decision support checklist; 3) influences patient activation; and 4) increases provider and patient communication through shared decision making. Action Planning Guide checklist (APG) includes questions pertaining to SDOH preventing patients from managing their chronic conditions and actions patients will take. Areas identified are discussed between patient and resident, increasing patient activation. The clinic’s nurse care facilitator guides referrals to community-based resources. Fifty-two patients were enrolled, with 75% of patients responding they would like to be better managers of their chronic conditions. This information is used to develop patient’s goals of care. Over 90% of patients said their conditions affect their lives and discussed ways better to care for themselves. Over 80% discussed medication management, health goals to improve their quality of life, and made a plan that maps out ways to reach their goals. All of these are essential for achieving positive health outcomes for older patients with chronic conditions. These attributes promote effective patient/provider partnerships. Seventy referrals were made; food through 2-1-1 (47%); monthly commodity food program (30%); utility payments (11%), and transportation (9%). Twenty-seven referrals were made to agencies serving older adults; 25 to the local AAA information and assistance services, and 2 to Senior Project Fresh Voucher Program.

Vulnerability of Street Trees in Upper Midwest Cities to Climate Change

Urban trees play an important role in helping cities adapt to climate change, but also are vulnerable to changes in climate themselves. We developed an approach for assessing vulnerability of urban tree species and cultivars commonly planted in cities in the United States Upper Midwest to current and projected climate change through the end of the 21st century. One hundred seventy-eight tree species were evaluated for their adaptive capacity to a suite of current and future-projected climate and urban stressors using a weighted scoring system based on an extensive literature review. These scores were then evaluated and adjusted by leading experts in arboriculture in the region. Each species or cultivar’s USDA Hardiness Zone and American Horticultural Society Heat Zone tolerance was compared to current and future heat and hardiness zones for 14 municipalities across Michigan, Wisconsin, and Minnesota using statistically downscaled climate data. Species adaptive capacity and zone tolerance was combined to assign each species one of five vulnerability categories for each location. We determined the number of species and trees in each category based on the most recent municipal street tree data for each location. Under a scenario of less climate change (RCP 4.5), fewer than 2% of trees in each municipality were considered highly vulnerable across all 14 municipalities. Under a scenario of greater change (RCP 8.5), upward of 25% of trees were considered highly vulnerable in some locations. However, the number of vulnerable trees varied greatly by location, primarily because of differences in projected summer high temperatures rather than differences in species composition. Urban foresters can use this information as a complement to other more traditional considerations used when selecting trees for planting.

A Mixed Method Examination of Sleep Patterns and Barriers to Sleep in Hispanic Women.

Research on Hispanic sleep (1) remains far behind research on non-Hispanic White sleep, and (2) seldom focuses solely on Hispanic women. A convergent parallel mixed-methods study design was used to examine (1) sleep quantity, quality, and habits; (2) the association of sleep and health; and (3) perceived barriers to healthy sleep in middle-aged Hispanic women living in [a large Midwest city]. A total of 78 Hispanic women were surveyed, and 27 of these Hispanic women participated in focus groups. Participants had: poor sleep quantity, quality, and sleep hygiene. In focus groups, participants identified three barriers to healthy sleep: poor sleep hygiene, responsibilities and related stress, and additional mental health concerns. While poor sleep quantity and quality have serious health consequences for Hispanic women, sleep disorders in Hispanic women have been understudied. This study underscores barriers to healthy sleep and the associations between sleep and health in Hispanic women.

Caregiver-infant and toddler interactions during diapering: Caregiver responsiveness and child well-being and involvement.

The findings of this empirical research provide new information about the importance of caregiver interactions during care routines, specifically diaper changing, in supporting infant and toddler involvement and well-being. This correlational study involved observations of 144 separate diapering cycles by 31 caregivers with 74 infants and toddlers in 30 infant and toddler classrooms in a U.S. Midwest city. Based on these observations, caregiver responsiveness was found to be significantly related to both child involvement and child well-being. Another feature of caregivers' behavior, caregiver encouragement, was significantly associated with child well-being, but not child involvement. The study results suggest that caregivers' behaviors, specifically responsiveness and encouragement, during diapering are vital proximal processes in the moment-to-moment interactions between a caregiver and child. Thus, responsiveness and encouragement in care routines should be emphasized in infant care settings and be a focus for caregiver professional development, including pre- and in-service training. Although training related to diapering is often restricted to health concerns, the findings suggest that specific caregiver-child interactions during this care routine may support or hinder children's well-being and involvement in the moment. Caregiver responsiveness to children's cues in this context may enhance children's opportunities to practice involvement in bidirectional relationships and support children's well-being.

At the forefront of racial tolerance?: African-Americans and high school football in Iowa in the 1930s

ABSTRACT In the upper Midwest, at least until the late 1930s, there was a modest presence of black athletes in American football and track and field in particular, with a smaller number in basketball and other sports. We know a great deal about how the post-war desegregation in professional baseball and football began to slowly change the landscape of elite American sports. But despite this overarching national narrative of small numbers of black athletes in integrated sports in the north and segregated structures in the south, we still know very little about specific contexts, especially at the high school level where the vast majority of organized sporting competition is held in the USA Key questions remain: was there a qualitative difference between the treatment of African-American athletes in different regions of the United States during the first four decades of the twentieth century? Was there a difference in racial attitudes in places where African-Americans were resident in small numbers such as in the towns and medium sized cities of the upper Midwest? Indeed, Iowa was regarded as relatively welcoming of African-American athletes by the 1930s whether that reputation was fully deserved or not. In this article we examine this question from a case study point of view.

Predicting nursing baccalaureate program graduates using machine learning models: A quantitative research study

BackgroundDespite powerful efforts to maximize nursing school enrollment, schools and colleges of nursing are faced with high rates of attrition and low rates of completion. Early identification of at-risk students and the factors associated with graduation outcomes are the main foci for the studies that have addressed attrition and completion rates in nursing programs. Machine learning has been shown to perform better in prediction tasks than traditional statistical methods. ObjectivesThe purpose of this study was to identify adequate models that predict, early in a students career, if an undergraduate nursing student will graduate within six college years. In addition, factors related to successful graduation were to be identified using several of the algorithms. DesignPredictions were made at five time points: the beginning of the first, second, third, fourth years, and the end of the sixth year. Fourteen scenarios were built for each machine learning algorithm through the combinations of different variable sections and time points. SettingsCollege of Nursing in a private university in an urban Midwest city, USA. ParticipantsSeven hundred and seventy-three full time, first time, and degree-seeking students who enrolled from 2004 through 2012 in a traditional 4-year baccalaureate nursing program. MethodsEight popular machine learning algorithms were chosen for model construction and comparison. In addition, a stacked ensemble method was introduced in the study to boost the accuracy and reduce the variance of prediction. ResultsUsing one year of college academic performance, the graduation outcome can be correctly predicted for over 80% of the students. The prediction accuracy can reach 90% after the second college year and 99% after the third year. Among all the variables, cumulative grade points average (GPA) and nursing course GPA are the most influential factors for predicting graduation. ConclusionsThis study provides a potential mode of data-based tracking system for nursing students during their entire baccalaureate program. This tracking system can serve a large number of students automatically to provide customized evaluation on the dropout risk students and enhance the ability of a school or college to more strategically design school-based prevention and interventional services.

Aggregate-level Lead Exposure and Child Maltreatment.

The purpose of this study was to examine the possible ecological association between aggregate blood lead levels (BLL) and rates of child maltreatment. To this end, we employed an ecologic study design, analyzing results from 59,645 child BLL tests between the years 1996 and 2007, and 6,640 substantiated maltreatment investigations from 2006 to 2016 in a large Midwest city. Separate Bayesian spatial Poisson conditional autoregressive (CAR) and Bayesian spatial zero-inflated Poisson CAR models were used to predict the occurrence of maltreatment.Bivariate results showed that aggregate rates of maltreatment increased as aggregate BLL increased. Multivariate results showed that medium-exposure BLL census tracts (OR = 1.38) and high-exposure BLL tracts (OR = 1.38) had increased odds of substantiated investigations for any maltreatment compared to low BLL census tracts even after controlling for crime rates, age of the housing stock, and concentrated disadvantage. Our findings, considered with prior research, continue to reveal a confluence of deleterious outcomes in areas where exposure to lead seems elevated. In this case, child maltreatment also appears to represent a macro-level correlate of aggregate lead exposure. Yet our results preclude any causal inference, and further research on the intersection of child maltreatment with environmental toxins is needed to determine if contaminant abatement should be considered as a possible maltreatment prevention strategy.

Consumo alimentar e saúde bucal em escolares de um município da Região Meio Oeste de Santa Catarina

Introdução: A cárie dental é uma doença crônica multifatorial que apesar do seu declínio nos últimos anos, considera-se um problema de saúde pública. Objetivo: Analisar os hábitos alimentares e a relação com a saúde bucal em escolares. Metodologia: Trata-se de um estudo transversal, realizado no período de outubro a novembro de 2017, em uma cidade da Região Meio Oeste de Santa Catarina. Os dados foram obtidos através de um questionário semiestruturado e prontuário eletrônico. A análise estatística foi realizada através do GraphPad Prism 6®. Resultados: A amostra constitui-se por 51 crianças, idade média 10,4 anos, prevalência do sexo feminino (66,7%). Os maiores índices de escolares com diagnóstico de cárie dental (25,5%) residiam na zona rural, menor renda mensal, menor escolaridade dos pais e maior frequência de consumo de alimentos cariogênicos. Conclusão: Hábitos alimentares associados às características sociodemográficas possuem relação direta refletindo na saúde bucal dos escolares, tornando-se evidente a importância da educação em saúde como medida preventiva. Palavras chave: Educação em saúde. Alimentos cariogênicos. Alimentos cariostáticos. Cárie dental. Saúde bucal.

Examining Criminogenic Risk Levels Among People with Mental Illness Incarcerated in US Jails and Prisons.

This study examines criminogenic risk levels of individuals with serious mental illness (SMI) involved in the justice system compared to justice-involved individuals without mental illness. The sample (N= 436) consisted of ninety-three individuals with SMI incarcerated in a county jail in a mid-size Midwest city, 217 individuals with SMI incarcerated in a state prison in the US Northeast, and 126 individuals without mental illness incarcerated in a state prison in the US Southwest. Results indicated that people with SMI incarcerated in jail and prison had higher overall criminal risk levels than prison inmates without mental illness. Results further demonstrated that, on average, higher percentages of persons with SMI had high/very high criminogenic risk scores. Finally, we noted that persons with SMI scored higher on most of the eight criminogenic risk domains measured by the Level of Service Inventory. These findings are possibly the most compelling to date in the growing body of literature demonstrating that justice-involved people with SMI have elevated criminogenic risk comparable to or greater than their non-mentally ill peers involved in the justice system. Consequently, treatment programs and interventions for justice-involved individuals with SMI need to explicitly target criminogenic needs into treatment efforts.