Non-urban Settings Research Articles

Policy-relevant indicators for mapping the vulnerability of urban populations to extreme heat events: A case study of Philadelphia

The recent global increase in extreme heat events linked to climate change is projected to continue. The additive effect of urban heat islands from impervious surfaces and urban heat emissions (e.g., from transportation and building cooling) exacerbates extreme heat events in urban areas, exposing dense populations to extreme heat with implications for human health. Ground- and satellite-based data on urban and suburban temperatures and vegetation over a historical period can help identify temporal and geospatial trends in heat exposure. A set of indicators has been developed to map the exposure, social sensitivity, and vulnerability of urban populations to heat wave health impacts. Guided by an Advisory Group of local planners in the pilot city of Philadelphia, localized trends of increasing urban extreme heat events using MODIS Land Surface Temperature (LST) data, confirmed with urban and non-urban temperature monitor data were identified. For the Philadelphia study area, the number of heat-event days in the urban setting has increased from approximately 4 days in 1980 to almost 12 days in 2013, while the non-urban setting has consistently experienced 5 days of heat events per year across the time period. Warmer micro-climates with limited vegetative cooling and elevated LSTs were also identified. The exposure indicator was combined with areas of high social sensitivity (e.g., low-income and elderly) to create a vulnerability indicator, showing significant overlap between highly exposed and highly sensitive populations. As a measure of the adaptive capacity of local governments to reduce the urban heat island, evidence of targeted vegetation increases or reduced localized temperatures linked to urban greening and cooling programs were sought, though none were of a scale to be identified by the 1 km satellite data utilized. The indicators have helped local decision makers to understand patterns of vulnerability, and may be used in the future to target adaptation actions and measure results (LST reduction or vegetation increase) from existing adaptation actions.

Cancer-Directed Therapy and Hospice Care for Metastatic Cancer in American Indians and Alaska Natives.

Little has been reported regarding patterns of oncologic care in American Indian/Alaska Natives (AI/AN). Observed worse survival has been attributed to later-stage presentation. We aimed to evaluate racial differences in cancer-directed therapy and hospice care utilization in AI/ANs and non-Hispanic whites (NHW) with metastatic cancer. The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims database was accessed for AI/AN and NHW metastatic-cancer cases diagnosed between 2001 and 2007. Utilization of cancer-directed therapy (surgery, radiation, and/or chemotherapy) and/or hospice services was compared between AI/ANs and NHWs. Minimally adjusted (age, sex, diagnosis year) and fully-adjusted (also Klabunde comorbidity score, sociodemographic factors) regression models were used to estimate odds (OR) and hazard ratios (HR) for receipt of care. AI/ANs were younger, more likely to reside in the West, be unmarried, have lower income, and live in a nonurban setting than NHWs. Fewer AI/ANs received any cancer-directed therapy (57% vs. 61% NHWs) within 3 months of diagnosis; sociodemographic factors accounted for much of this difference [fully-adjusted HR, 0.94; 95% confidence interval (CI), 0.83-1.08]. We noted differences in hospice utilization between AI/ANs (52%) and NHWs (61%). A significant difference in hospice utilization remained after adjustment for sociodemographics (OR, 0.78; 95% CI, 0.61-0.99). Observed absolute differences in care for AI/ANs and NHWs with metastatic cancer were largely accounted for by adjusting for socioeconomics, comorbidities, and demographic factors. A significant association between race and hospice utilization was noted. Efforts to improve metastatic-cancer care should focus on socioeconomic barriers and investigate the observed disparity in receipt of hospice services.

Men Aged 15-44 in Need of Preconception Care.

Preconception care for men focuses on prevention strategies implemented prior to conception of a first or subsequent pregnancy to improve pregnancy and infant outcomes. Little is known about U.S. men in need of preconception care. This analysis describes the proportion of men in need of preconception care and associations of these needs by background characteristics, related health conditions, access to care and receipt of services. Data from men aged 15-44 in the National Survey of Family Growth 2006-2010 were analyzed to describe men in need of preconception care, based on future childbearing intentions and self and partner fecundity status (among sexually experienced only), and associated factors with these needs using weighted bivariate analyses. About 60 % of men are in need of preconception care. Higher prevalence of being in need was observed among men aged 15-29 than older; living in urban than non-urban settings; in school than not in school regardless of working status; not in a coresidential union than married or cohabiting; who were recent immigrants than U.S. born; and reporting never having had a child than ≥1 child(ren). Men in need were overweight/obese (56 %), ever binge drank in the last year (58 %), and have high STI risk (21 %). The majority of men in need reported access to care in the last year (>70 %), but few reported receipt of services including STD/HIV testing (<20 %) or counseling (<11 %). Findings from this analysis have implications for promoting preconception care among U.S. men.

Syndemic Theory and Male Same Sex Intimate Partner Violence: An Urban/Non-Urban Comparison

Background: The majority of research with gay men has been conducted in urban populations, with minimal work on partner violence in non-urban (suburban and rural) settings. Syndemic theory, the concept that negative health outcomes are increased with the addition of each new deleterious health variable, has been used to understand partner violence. The aim of the study was to determine differences in prevalence and associated factors of male same-sex intimate partner violence (MSSIPV) among gay men residing in urban versus non-urban settings. Methods: A cross-sectional survey was conducted with gay men in the state of California. Variables were identified from syndemic theory and included exposure to intimate partner violence, depression, sexual compulsivity, poly-drug use, and childhood sexual abuse. Results: Demographic differences were evident between urban and non-urban dwelling gay men. Rates of lifetime victimization and perpetration of MSSIPV between urban and non-urban gay men were not significant. In regard to syndemic variables, only childhood sexual abuse (CSA) showed any significant differences between the two populations. Being a victim of CSA increased the odds of being a lifetime victim of MSSIPV by a factor of five for non-urban participants and increased the odds of being a victim by a factor of three for all subjects. Moreover, being a victim of CSA increased the odds of being a lifetime perpetrator of MSSIPV by a factor of three for non-urban participants. Conclusion: This appears to be the first of its kind study differentiating between urban and non-urban MSM. More research is needed to verify our findings of demographic and syndemic differences between these two populations in order to fully understand and address the needs of all members of the Lesbian, Gay, Bisexual, and Transgender (LGBT) community.

Qualitative GIS: A Mixed Methods Approach

Qualitative GIS: A Mixed Methods Approach Meghan Cope and Sarah Elwood (Editors) Sage Publications, Los Angeles, CA, 2009 x + 182 Pp. $64.00 Paperback Reviewed by Rudo KemperQualitative GIS - isn't that kind of an oxymoron? This comment from a colleague with years of experi- ence working with GIS echoes the title of an edito- rial from an edition of Environment and Planning dedicated to the topic (Kwan and Knigge: 2006), and voices lingering concerns about the limitations of GIS. Qualitative GIS: A Mixed Methods Approach serves as an invitation to scholars in fields like cultural anthropology and human geography to take seriously how GIS can serve as a productive and genuinely qualitative research framework, unshackled from the rigid, Cartesian understandings of space that con- temporary scholarship with a qualitative orientation tends to reject. From the very first sentence, the edi- tors, both with longstanding and extensive academic engagements with GIS, anticipate the resistance that scholars might have to the idea of qualitative GIS. Indeed, the text very much reads as a response to the understanding that GIS is an inherently quantitative research framework. A significant part of this rebut- tal targets the well-known critiques of GIS from the mid-1990s, which depicted GIS as being rooted in positivism and therefore mostly, if not exclusively, suited for quantitative spatial techniques which lend themselves to such a perspective. Each author aims to move beyond these critical polemics of the 1990s. They do so by thinking through the creative possibili- ties of a 'post-positivistic' GIS, capable of visualizing multiple (or partial) representations unhinged from any particular spatial epistemology.At the time this book review is being written, Quali- tative GIS is already four years old. Since the volume's publication, qualGIS methods have started to make an appearance in a number of articles and confer- ence presentations. Most of these cite Qualitative GIS as an important source, and seek to build upon the advances made by the authors contributing to the volume. For example, Boschmann and Cubbon (2013) revisit sketch maps and argue that their use to focus on spatial experiences and knowledge of interview participants achieves the postpositivist goals of qualGIS. Jones and Evans (2012) describe an innovative technique they call spatial transcripts, in which participants' spoken words are automati- cally georeferenced through GPS location tracking by means of a mobile device. This allows the location of an interviewee's comments to be recorded dynami- cally, and therefore produces a much richer, spatially referenced range of data that not only expedites the note taking process but can bring new analytical perspectives to light. Interestingly, both of these stud- ies focus on the urban landscape like much of the extant qualGIS literature, although the methods are directly applicable to research in non-urban settings. These and other recently published papers helpfully show how qualGIS can contribute an indispensible spatial dimension to existing qualitative methods like ethnography, in practice.Qualitative GIS remains the sole book about qualGIS itself, and continues to be worth reading as a wel- come meditation on the imaginative possibilities of qualGIS. On the whole, it is a concise manifesto for a counter-intuitive, yet bona fide qualitative research method. The volume achieves a fine balance between brevity and detail, and it can therefore serve as an excellent introduction to the pursuit of qualGIS for advanced undergraduate and graduate courses on qualitative research methods or anthropological GIS. Although the volume is not written as a research methods guide, it could also be used as a source of ideas for researchers seeking to incorporate qualGIS approaches to supplement other qualitative method- ologies such as ethnography.The book is composed of ten chapters, two of which serve as introductory preludes to make the reader comfortable with the idea of qualitative GIS (hereafter qualGIS). …

Exposure to Neighborhood Green Space and Mental Health: Evidence from the Survey of the Health of Wisconsin

Green space is now widely viewed as a health-promoting characteristic of residential environments, and has been linked to mental health benefits such as recovery from mental fatigue and reduced stress, particularly through experimental work in environmental psychology. Few population level studies have examined the relationships between green space and mental health. Further, few studies have considered the role of green space in non-urban settings. This study contributes a population-level perspective from the United States to examine the relationship between environmental green space and mental health outcomes in a study area that includes a spectrum of urban to rural environments. Multivariate survey regression analyses examine the association between green space and mental health using the unique, population-based Survey of the Health of Wisconsin database. Analyses were adjusted for length of residence in the neighborhood to reduce the impact of neighborhood selection bias. Higher levels of neighborhood green space were associated with significantly lower levels of symptomology for depression, anxiety and stress, after controlling for a wide range of confounding factors. Results suggest that “greening” could be a potential population mental health improvement strategy in the United States.

Seasonal comparisons of daily activity budgets of gray squirrels (Sciurus carolinensis) in urban areas

Gray squirrels (Sciurus carolinensis) use trees for various resource needs in urban and nonurban settings; particularly, mast producing trees which are the preferred and supplemental foods for the species. During periods of abundant mast availability, less time will be invested in foraging because of the higher success rate stemming from the increased ability to locate food items. Conversely, in periods of reduced mast availability, more time will be invested in foraging. However, correlations between food availability and foraging effort are only supported under the assumption that gray squirrels rely significantly on mast as a preferred or supplemental food source (Nixon et al, J Wildl Manag 39:1–25, 1975). Therefore, given the seasonal variation in the availability of mast, there should also be correlating seasonal variations in foraging effort. In this paper, we will examine daily and seasonal time-activity budgets of gray squirrels in urban areas. We studied the time-activity budgets of gray squirrels in six urban parks in Baltimore, MD. Seasonal frequencies of activities were expressed as percent occurrence and seasonal differences in activities were analyzed using a Tukey Studentized multiple range test for significance. We found that the activity with highest percent occurrence was forage (2003, summer: 23.8 %, fall: 25.9 %; 2004, summer: 23.1 %, fall: 25.2 %), followed by feed and store, all activities associated with food. Results of the Tukey Studentized multiple range test for seasonal differences of activities yielded significant results (P < 0.05) for rest: fall 2003 and summer 2004 (P = 0.003); fall 2003 and fall 2004 (P = 0.048).

A small-area analysis of inequalities in chronic disease prevalence across urban and non-urban communities in the Province of Nova Scotia, Canada, 2007–2011

BackgroundSmall-area studies of health inequalities often have an urban focus, and may be limited in their translatability to non-urban settings. Using small-area units representing communities, this study assessed the influence...

Testing the key assumption of heritability estimates based on genome-wide genetic relatedness

Comparing genetic and phenotypic similarity among unrelated individuals seems a promising way to quantify the genetic component of traits while avoiding the problematic assumptions plaguing twin- and other kin-based estimates of heritability. One approach uses a Genetic Relatedness Estimation through Maximum Likelihood (GREML) model for individuals who are related at less than 0.025 to predict their phenotypic similarity by their genetic similarity. Here we test the key underlying assumption of this approach: that genetic relatedness is orthogonal to environmental similarity. Using data from the Health and Retirement Study (and two other surveys), we show two unrelated individuals may be more likely to have been reared in a similar environment (urban versus nonurban setting) if they are genetically similar. This effect is not eliminated by controls for population structure. However, when we include this environmental confound in GREML models, heritabilities do not change substantially and thus potential bias in estimates of most biological phenotypes is probably minimal.

Exposure to Neighborhood Green Space and Mental Health: Evidence from the Survey of the Health of Wisconsin

Green space is now widely viewed as a health-promoting characteristic of residential environments, and has been linked to mental health benefits such as recovery from mental fatigue and reduced stress, particularly through experimental work in environmental psychology. Few population level studies have examined the relationships between green space and mental health. Further, few studies have considered the role of green space in non-urban settings. This study contributes a population-level perspective from the United States to examine the relationship between environmental green space and mental health outcomes in a study area that includes a spectrum of urban to rural environments. Multivariate survey regression analyses examine the association between green space and mental health using the unique, population-based Survey of the Health of Wisconsin database. Analyses were adjusted for length of residence in the neighborhood to reduce the impact of neighborhood selection bias. Higher levels of neighborhood green space were associated with significantly lower levels of symptomology for depression, anxiety and stress, after controlling for a wide range of confounding factors. Results suggest that “greening” could be a potential population mental health improvement strategy in the United States.

Theorizing Alternative Pathways Through Adulthood: Unequal Social Arrangements in the Lives of Young Disadvantaged Men

This chapter introduces the innovative field-based studies on disadvantaged men that are featured in this volume. Together, these studies of disadvantaged men from diverse racial and ethnic backgrounds and both urban and nonurban settings complement and extend recent discussions of emerging adulthood, which typically conceptualizes the transition to adulthood as a normative and linear process. The authors offer that the research presented here provides a more accurate rendering of the transition to adulthood for young disadvantaged men. For disadvantaged young men, the transition to adulthood is often complex and nonlinear, and features a diversity of pathways that are often overlooked in contemporary research on transitions to adulthood. The chapter ends with a call for research and theory that better reflects the precarious nature of pathways to adulthood for disadvantaged men in urban and nonurban settings. Researchers are encouraged to draw on findings from field-based studies to inform policies and practices directed at minimizing the marginalization of disadvantaged men from mainstream society.

Latent Class Analysis of Job and Life Satisfaction Among School Counselors: A National Survey

We surveyed 1,293 employees working in the Ministry of National Education using a sociodemographic questionnaire, the Minnesota Satisfaction Questionnaire, and the Satisfaction with Life Scale. Of these, 680 participants were school counselors (52.59 %), 371 were office staff (28.69 %), and 242 were administrators (18.72 %). Data were analyzed using latent class analysis. A four-class solution was fitted to the current data. Results revealed that 58.93 % of the respondents were satisfied and very satisfied with their current job and life. Among the school counselors, 66.47 % fell into the satisfied and very satisfied latent classes. School counselors reported greater levels of job and life satisfaction compared to other groups of employees. Working in a school and in non-urban settings were significant predictors of job and life satisfaction. Participants with higher levels of education reported higher scores on job and life satisfaction.

How Wild Do We Want It? “Wiley” Coyote Versus Fluffy

Abstract Human relationships with companion animals (cats) and nondomestic, wilder animals (coyotes) are explored in terms of domestic and nondomestic spaces in urban and nonurban settings. What companion animals contribute to and mean to human well-being is considered alongside the perceived need to protect companion animals from wilder animals while allowing them to live naturally, a contested category. Questions related to companion animal/human relationships are explored: do humans romanticize their relationships with their companion animals? Is that to the detriment of other animals’ well-being?

Correlates of Job Burnout among Human Services Workers: Implications for Workforce Retention

Job burnout has impacted workers and negatively transformed the social agency and its clients. This study examined the correlates of job burnout among human service workers in a non-urban setting in Central California. Using a convenience sample, researchers collected responses from 288 participants on a 13 item burnout scale. Findings indicated that workers experienced moderate to high levels of job burnout. Several scale items, including caseload size, age, gender, education, and experience, were significantly correlated with burnout. In addition, regression analyses revealed that caseload size was the most significant predictor of job burnout among human service workers. Implications for workforce retention and policy practice are discussed.

Barriers and facilitators of hepatitis C screening among people who inject drugs: a multi-city, mixed-methods study

BackgroundPeople who inject drugs (PWID) are at high risk of contracting and transmitting and hepatitis C virus (HCV). While accurate screening tests and effective treatment are increasingly available, prior research indicates that many PWID are unaware of their HCV status.MethodsWe examined characteristics associated with HCV screening among 553 PWID utilizing a free, multi-site syringe exchange program (SEP) in 7 cities throughout Wisconsin. All participants completed an 88-item, computerized survey assessing past experiences with HCV testing, HCV transmission risk behaviors, and drug use patterns. A subset of 362 clients responded to a series of open-ended questions eliciting their perceptions of barriers and facilitators to screening for HCV. Transcripts of these responses were analyzed qualitatively using thematic analysis.ResultsMost respondents (88%) reported receiving a HCV test in the past, and most of these (74%) were tested during the preceding 12 months. Despite the availability of free HCV screening at the SEP, fewer than 20% of respondents had ever received a test at a syringe exchange site. Clients were more likely to receive HCV screening in the past year if they had a primary care provider, higher educational attainment, lived in a large metropolitan area, and a prior history of opioid overdose. Themes identified through qualitative analysis suggested important roles of access to medical care and prevention services, and nonjudgmental providers.ConclusionsOur results suggest that drug-injecting individuals who reside in non-urban settings, who have poor access to primary care, or who have less education may encounter significant barriers to routine HCV screening. Expanded access to primary health care and prevention services, especially in non-urban areas, could address an unmet need for individuals at high risk for HCV.

Cost-Effectiveness Analysis of Breast Cancer Control Interventions in Peru

ObjectivesIn Peru, a country with constrained health resources, breast cancer control is characterized by late stage treatment and poor survival. To support breast cancer control in Peru, this study aims to determine the cost-effectiveness of different breast cancer control interventions relevant for the Peruvian context. MethodsWe performed a cost-effectiveness analysis (CEA) according to WHO-CHOICE guidelines, from a healthcare perspective. Different screening, early detection, palliative, and treatment interventions were evaluated using mathematical modeling. Effectiveness estimates were based on observational studies, modeling, and on information from Instituto Nacional de Enfermedades Neoplásicas (INEN). Resource utilizations and unit costs were based on estimates from INEN and observational studies. Cost-effectiveness estimates are in 2012 United States dollars (US$) per disability adjusted life year (DALY) averted.ResultsThe current breast cancer program in Peru ($8,426 per DALY averted) could be improved through implementing triennial or biennial screening strategies. These strategies seem the most cost-effective in Peru, particularly when mobile mammography is applied (from $4,125 per DALY averted), or when both CBE screening and mammography screening are combined (from $4,239 per DALY averted). Triennially, these interventions costs between $63 million and $72 million per year. Late stage treatment, trastuzumab therapy and annual screening strategies are the least cost-effective. ConclusionsOur analysis suggests that breast cancer control in Peru should be oriented towards early detection through combining fixed and mobile mammography screening (age 45-69) triennially. However, a phased introduction of triennial CBE screening (age 40-69) with upfront FNA in non-urban settings, and both CBE (age 40-49) and fixed mammography screening (age 50-69) in urban settings, seems a more feasible option and is also cost-effective. The implementation of this intervention is only meaningful if awareness raising, diagnostic, referral, treatment and basic palliative services are simultaneously improved, and if financial and organizational barriers to these services are reduced.

Evidence of High Rates of Undiagnosed Asthma in Central Ohio Elementary Schoolchildren

In Ohio, 14.5% of 5- to 9-year-olds and 17.3% of 10- to 17-year-olds have asthma. Moreover, there is concern that these numbers may underestimate the true disease burden. We sought to evaluate variability in asthma rates and respiratory symptoms among central Ohio fourth graders as a means to assess potential undiagnosed and undertreated asthma and its determinants. We recruited 13 central Ohio elementary schools representing a broad range of nonurban settings and surveyed fourth graders to estimate school-level physician-diagnosed asthma (PDA), respiratory morbidity, and home exposures to smoking and pets. We used generalized linear mixed models with random intercept for school to examine relationships among exposures, respiratory symptoms, and PDA. Across the 13 schools, 94% of students participated in the survey, and the estimated asthma prevalence rate was 10.2% (N = 101 of 987). An additional 41% reported not having PDA but then went on to report symptoms consistent with asthma potentially suggestive of undiagnosed asthma. Of students with PDA, 21% reported symptoms suggestive of poorly controlled asthma. High levels of secondhand smoke (SHS) exposure were associated both with PDA (p = .05) and with respiratory symptoms (p < .0001). Students who owned a cat or a bird were more likely to report respiratory symptoms (p = .02 and p = .04, respectively). We provide evidence that the already high childhood asthma public health burden in central Ohio may be underreported. Schools may be an ideal location to conduct screenings and implement environmental interventions oriented toward SHS and household pets that will yield respiratory morbidity benefits.

Hepatitis C Virus Serosorting in People Who Inject Drugs: Sorting Out the Details

Hepatitis C Virus Serosorting in People Who Inject Drugs: Sorting Out the Details

Risk factors for developing congenital nasolacrimal duct obstruction

ObjectiveTo identify potential risk factors for developing congenital nasolacrimal duct obstruction (CNLDO). Study design and methodsA cross-sectional study. A quantitative questionnaire was distributed to a sample of mothers attending the Pediatrics Clinic at King Khalid University Hospital, Riyadh, Saudi Arabia. ResultsA total of 756 mothers responded to our questionnaire. Of the 756 filled questionnaires, 389 (51.67%) were male children. 5.3% of the mothers lived in non-urban settings. CNLDO was reported in the children attending the clinic by 17.1% (129/756) of their mothers. Average age (±SD) of infants when persistent tearing was noticed was 3.2±2.7months, while average age (±SD) of resolution was 9.6±3.7months. Of the children with CNLDO, 37.2% (48/129) still have persistent tearing at the time of distributing the questionnaire. Among the group with CNLDO, 17% (22/129) of their mothers have experienced an infection during pregnancy (p=0.022). Within the same group, 14.7% (19/129) of the affected children were reported by their mothers to have other children with CNLDO which was statistically significant (p=<0.001). ConclusionCNLDO could have a genetic predisposition and maternal infection is a possible risk factor for developing CNLDO. Surgical management awareness should be emphasized to relieve children from this relatively common and benign condition.

ICD9 Coding of Hyperkalemia Greatly Underestimates Incidence of Lab-Defined Hyperkalemia in Veterans with Heart Failure

to distance away from tertiary care services. Conclusion: Measurement of LVEF in incident heart failure patients is suboptimal and highly variable. Patients outside of hospitals with tertiary services are at a disadvantage as are those with generalist attending MD. Efforts to better identify and address barriers to appropriate measurement of LVEF, with a special focus upon non-urban settings are needed.