Urban Geographic Location Research Articles

Land Finance, Local Government Debt and Economic Green Transformation

As economic development continues to advance globally, countries are increasingly focused on the green transformation of their economies. This paper employs a data envelopment analysis (DEA) model and entropy weighting methodology to construct and assess an indicator system for economic green transformation, taking into account environmental pollution. The analysis is based on panel data from 215 prefecture-level cities in China between 2015 and 2019. The two-way fixed effects model and moderating effect model are employed to investigate the influence of land finance on economic green transformation and to ascertain the moderating effect mechanism of local government debt. The study’s conclusions are as follows: (1) Land finance impedes the transition to a green economy. (2) Local government debt is a major factor that restricts the influence of land finance on the transition to a green economy; as local government debt levels rise, land finance’s role in impeding the transition to a green economy rises, and a positive moderating effect occurs. (3) Depending on the urban geographic location, the size of the economy and other factors, the impact of local government debt and land finance on the economic green transition varies. This empirical study demonstrates that the more local government debt there is in an eastern region or city with a bigger economic output scale, the more of an inhibitory influence land finance has on the economic transition to a green economy. In light of this, the paper suggests that the land finance policy be updated at the appropriate time, that the land market be regulated, that the government’s reliance on land finance be gradually decreased, that the nature and amount of public debt be actively optimised, that the industrial infrastructure be enhanced to facilitate the transition towards a more environmentally sustainable economy, and that other suggestions be made.

Alcohol Use Amongst Rural Adolescents and Young Adults: A Brief Review of the Literature.

The sociodevelopmental periods of adolescence and young adulthood are rife with alcohol use. However, much of the literature demonstrating this comes from 'traditional' settings and college campuses (i.e., large suburban/urban campuses, or those containing their own infrastructure). Alcohol culture in rural areas has largely been understudied, which may be problematic given the unique stressors they face (e.g., economic hardship, lack of social activities, healthcare inequality). There has also been difficulty both within and across fields classifying rural versus urban geographical locations; no distinct system used broadly, making ittrea difficult to generalize and accurately collect data. The geographic categorizations are often viewed as homogenous identifiers; however, diversity occurs both within and outside of these classification systems. It appears that rurality may be a risk factor for increased drinking both earlier and later in life, but the research has failed to extend to the formative college years. This short review has two main focuses: attempting to disentangle the definition of rurality and reviewing the literature regarding alcohol use in rural areas, with a specific focus on adolescents and young adults. Identifying the mechanisms responsible for substance use in rural areas is a crucial component of prevention and treatment programs.

Socio-economic status predicts mathematics self-concept: A correlational study in OR Tambo Inland District

The current study explored the level to which socio-economic status predicts mathematics self-concept. A correlational and regression research designs were used. The study was carried out in OR Tambo Inland District in the Eastern Cape Province. The sample size comprised of 351 Grade 9 mathematics students, of which 171 were girls and 180 were boys. For generalizability purposes and fair distribution and representation of the sample across the population, both rural and urban geographical locations were represented by three schools each. The level of socio-economic status and mathematics self-concept was measured by use of a standardized questionnaire. The data collection tool was tested valid and reliable. Statistical Package for the Social Sciences (SPSS) was used to perform regression and correlation analysis. The research findings depict that mathematics self-concept was heavily influenced by socio-economic status of a parent. Furthermore, mathematics self-concept varied according to the socio-economic status and the variation was statistically significant. Recommendations were made to all implicated stakeholders to improvise strategies of improving mathematics self-concept despite the family’s economic hardships.

Digital inclusive finance, government intervention, and urban green technology innovation.

Digital inclusive finance eases credit constraints on innovative small and medium-sized enterprises which contributes to urban green technology innovation in China. Government intervention plays an essential role in the development of digital inclusive finance. Based on the panel data of 243 cities in China from 2011 to 2019, this paper empirically examines the relationship between digital inclusive finance and urban green technology innovation as well as the intrinsic mechanism of government intervention. The findings show that, even after a series of robustness tests, digital inclusive finance can promote the quantity and quality of green technology innovation. In terms of its mechanism, digital inclusive finance can empower green technology innovation by complementing traditional financial development and stimulating green consumption, both in terms of supply and demand. At the same time, in the dynamic process of digital financial inclusion from low to high, the development of traditional finance and green consumption level on the marginal promotion of green technology innovation continues to strengthen. The nonlinear relationship test reveals that there is a significant double threshold effect on the positive impact of digital inclusive finance on urban green technology innovation with the evolution of government intervention. The innovation incentive effect of digital financial inclusion will be marginal decreasing with the increase of government intervention. Further considering the heterogeneity of urban geographic location and environmental regulation, it is found that digital financial inclusion promotes green technology innovation more in eastern and high-environmental regulation cities. Based on the above research conclusions, this paper argues that while developing digital inclusion finance, government support policies should be adjusted promptly to constantly stimulate the "Metcalfe's law" effect of digital inclusive finance enabling green technology innovation.

The Impact of China’s National Sustainable Development Experimental Zone Policy on Energy Transition

Energy transition plays a crucial role in supporting sustainable economic growth and the reduction in carbon emissions. In fact, China implemented the national sustainable development experimental zone policy to achieve sustainable development goals, including an energy transition. This paper divided the energy transition dimension into energy consumption and carbon dioxide emissions based on the perspectives of energy input and output. Furthermore, using panel data for 214 cities at the prefecture level in China from 2006 to 2019, the study measured the impact of the national sustainable development experimental zone policy on energy transitions by employing a difference-in-difference (DID) model and an intermediary effect model. The results showed that the national sustainable development experimental zone policy reduced energy consumption and carbon dioxide emissions and accelerated energy transition. The conclusions still held after a series of robustness tests. Additionally, the results of the heterogeneity analysis of different experimental zone types indicated that, compared with prefecture-level experimental zones, county experimental zones play a more obvious role in reducing energy consumption and carbon dioxide emissions. In addition, the results of the heterogeneity analysis of the urban geographical location showed that the national sustainable development experimental zone policy had different negative effects on urban energy consumption and carbon dioxide emissions in different regions, and the impact of policy on energy transition was experienced, in decreasing order, by the western, central, and eastern regions. The results of the mechanism verification indicated that the national sustainable development experimental zone policy can affect energy consumption and carbon dioxide emissions via technological progress and upgrading industrial structure, which had a relatively high aggregation order in the variables deployed.

A Machine-Learning-Based Classification Method for Meteorological Conditions of Ozone Pollution

Ozone pollution is harmful to human health and ecosystem, which occurs in ecosystems and has occurred frequently in China in recent years, especially during the warm seasons. Meteorological conditions are among the important factors affecting the occurrence of ozone pollution. In this study, a classification method for meteorological conditions of ozone pollution levels based on a back propagation (BP) neural network was proposed to reflect the impact of meteorological conditions on the occurrence of ozone pollution. Ozone pollution was divided into three levels according to surface hourly ozone (O3) concentrations and thus into three groups of meteorological conditions. The input physical parameters for the BP neural network were determined by evaluating the relationship between surface O3 concentrations and meteorological parameters and precursors, including relative humidity, temperature, mixing layer height, precipitation, and nitrogen dioxide (NO2) concentrations. The study area focused on 21 cities in Sichuan Province in southwestern China, which was divided into 12 BP classifiers according to the urban geographical location and sample number of each city, and a single BP classifier was trained for 21 cities. The classification results of the trained BP classifiers were verified by comparison to the observations. With 12 individual BP classifiers, the classification accuracy of all 21 cities was more than 60%, of which 18 cities were more than 70%, and 9 cities were more than 80%. With the single BP classifier, the classification accuracy of 20 cities was more than 60%, of which 18 cities were more than 70%, and 14 cities were more than 80%. Overall, the classification performance of the trained single model was better than trained 12 individual models. The classification method can comprehensively reflect the impact of meteorological conditions on the occurrence of ozone pollution.

Study on Tourism Spatial Structure of Urban Agglomeration in Central Region Based on Social Network Method

With the passage of time, China’s economic development, people’s life gradually pursue enjoyment, so the development of tourism has gradually become an important pillar of national economic development. According to the urban geographical location of the central region, combined with the existing tourism economic conclusions, this paper studies the urban tourism economic data of the central region by using the method of social network, so as to understand the economic development of tourism in the central region in 2019. Through the research, it can be concluded that the correlation of urban tourism economy in Central China is not high among cities, and the tourism economy of cities is relatively different. The strength and influence of tourism economy of central cities with better tourism economic development are much higher than those without tourism economic strength. The tourism economy of each adjacent city circle is relatively close and develops relatively evenly, which shows that the development of tourism economy is closely related to the tourism economic development of adjacent cities. In the urban agglomeration in the central region, there is a high connection between the tourism economy of the cities in the six urban circles. In addition, it can be seen from the tourism economic network diagram of the urban agglomeration in the central region that among the six sub urban agglomerations, the cities in the sub urban agglomerations are closely related to the tourism economy of the central cities in the sub urban agglomerations, but from the perspective of the overall tourism economy, the tourism economic relations among cities are layered, This paper puts forward some suggestions conducive to the integrated development of urban tourism economy in Central China.

Cultural constructions of the mentally ill in South Africa: A discourse analysis, part one

This article analyses Zulu constructions of mental illness, as according to Zulu Psychology Masters Students from universities in KwaZulu-Natal, South Africa, by means of Foucauldian Discourse analysis. Analysis of qualitative interviews highlighted the complexity surrounding mental illness and psychology within the Zulu culture in South Africa, and revealed various cultural constructions of the mentally ill and psychopathology that have not previously been researched. Elucidated cultural constructions of the mentally ill included constructions of the ill as a contagious diseased state; a threat to peace; a deviant; a vagrant; and a non-social being and non-functional. These constructions placed the mentally ill at the lowest strata level within society. Historically rooted discourses of the black South African’s fight to be resilient, and the philosophical idea of ‘Ubuntu’, intersect with these constructions of the mentally ill. Furthermore, the constructions of the mentally ill are impacted by rural and urban geographic location. Also explored is the discourse of the Zulu mentally ill’s oppressed subject position as the ‘mad’ and black. These elicited constructions and discourses of the mentally ill within Zulu communities, in South Africa, provide a basis for vital future research into the cultural relativity and nosologies of mental illness within the South African context, and wider African context.

Research on Machine Intelligent Perception of Urban Geographic Location Based on High Resolution Remote Sensing Images

Machine intelligent perception (MIP ) provides a novel way for human beings to recognize geographical locations automatically. MIP of geographical locations enables computers to describe locations automatically and quantitatively by extracting Earth's surface features and building relationships. The earth surface fingerprint is established here by mining the relationship between spatial objects with stable characteristics extracted from urban high-resolution remote sensing images, which realizes intelligent perception of geographical location innovatively. Mask Region-based Convolutional Neural Network is used to automatically extract the spatial objects such as playgrounds, crossroads, and bridges from the images. Then, the extracted spatial objects are encoded according to the landuse type, distance, and angle of 24 nearest objects to construct urban surface fingerprint database. The urban surface fingerprint database is used to match the geographical location of spatial objects in local images so that the matching algorithm can be used for machine recognition of the geographical location of specific objects in the target image. Taking the main cities in China as the experimental area, the success rate of location perception is 92%. We have made a useful exploration in the field of MIP of geographical location, hoping to promote the development of human cognition of geographical location.

Spatio-Temporal Coupling Characteristics and the Driving Mechanism of Population-Land-Industry Urbanization in the Yangtze River Economic Belt

The purpose of this paper is to probe into the coupled coordination of urbanization in population, land, and industry to improve urbanization quality. A coupled coordination degree model, spatial analysis method and spatial metering model are employed. The study area is 110 prefecture-level cities in the Yangtze River Economic Belt. The study shows that: (1) the coupling degree of the population-land-industry urbanization grew very slowly between 2006 and 2016. On the whole, the three-dimensional urbanization is in a running-in period, and land-based urbanization dominates, while population-based urbanization and industry-based urbanization are relatively lagging behind. (2) The three major urban agglomerations, the Chengdu-Chongqing, the middle reaches of the Yangtze River and the Yangtze River Delta, are parallel to the whole area in terms of the coupling degree of the three dimensional urbanization with a well-ordered structure, especially in the central cities of the three major urban agglomerations. (3) There is significant spatial correlation in the coupling degree and coordination degree of the three-dimensional urbanization. The high value of coupling degree and coordination degree are clustered continuously in developed cities, provincial capitals, and central cities of the downstream reaches of the Yangtze River. (4) The coordinated degree has significant positive spatial autocorrelation, showing obvious spatial agglomeration characteristics: H-H agglomeration areas are concentrated in the downstream developed areas such as Jiangsu, Zhejiang, and Shanghai. L-L agglomeration areas are mainly concentrated in upstream undeveloped areas, but the number of their cities shows a decreasing trend. (5) The coordination degree of the three-dimensional urbanization is the result of the comprehensive effect of economic development level, the government’s decision-making behavior, and urban location. Among them, the economic development level, urbanization investment, traffic condition, and urban geographical location play a decisive role. This paper contributes to the existing literatures by exploring urbanization quality, spatial correlation and influencing factors from the perspectives of the three-dimensional urbanization in the Yangtze River Economic Belt. The conclusion might be helpful to promote the coupling and coordinated development of urbanization in population-land-industry, and ultimately to improve urbanization quality in the Yangtze River Economic Belt.

A socio-cognitive impact of class-skipping syndrome on learners communicative and linguistic competence among private school students in Lagos state, Nigeria.

A significant number of parents are always in a rush that their children or wards should finish secondary at an age that learners have not attained cognitive maturity. The negative impact of unhealthy curriculum and class skipping syndrome has enormous effect on the educational system, cognitive and linguistic competence and the social and academic wellbeing of learners. The study examined parental perception towards unhealthy curriculum and class skipping syndrome among private schools in Lagos State, Nigeria. Two research questions and two hypotheses were raised to guide the study. A Questionnaire on Perceptions towards Unhealthy Curriculum and Class Skipping Syndrome was used to collect the data. The instrument was validated through face and construct validity while the Test Re-test method was used to obtain a reliability correlation co-efficient of 0.72. The instrument was administered on 120 parents randomly selected from six private schools on the basis of rural and urban geographical locations. The results showed a significant relationship between class skipping syndrome and student’s social communicative and linguistic competence on academic wellbeing. Likewise, there is a significant relationship between unhealthy curriculum and student’s academic, communicative, linguistic and social wellbeing among private schools in Lagos State. So, it was concluded from this study that unhealthy curriculum and class skipping syndrome when excessively applied on students may negatively affect student’s wellbeing and there is a strong relationship between academic stress and reduced academic performance. It is recommended that parents, teachers, policy makers, educational administrators, career and counseling centers should put in place mechanisms that can lessen the negative impacts of unhealthy curriculum and class skipping syndrome on the students. Structures and infrastructures needed for proper implementation of Nigerian educational policy should be put in place.

Symptom Burden in Transplant Ineligible Patients with Newly Diagnosed Multiple Myeloma: A Population-Based Study of Patient-Reported Outcomes

Introduction Multiple myeloma (MM) is an incurable malignant plasma cell disease with a median age at diagnosis of 70 years, making it a disease of older patients. Although there has been much progress made in the therapeutics of MM, there is a paucity of data with regards to the symptoms experienced by these patients. Patient reported outcomes (PROS) represent an opportunity to both understand the magnitude as well as the temporal trend of this symptom burden. In 2007, routine prospective collection of patient-reported Edmonton Symptoms Assessment System (ESAS) scores during all outpatient cancer clinic visits was initiated in Ontario, Canada. The ESAS is a validated and reliable tool that assesses the severity of nine common symptoms: well-being, pain, tiredness, anxiety, depression, drowsiness, lack of appetite, nausea and shortness of breath. The study of longitudinal data from an administrative data base provides a unique opportunity to understand the symptom burden experienced by MM patients in the 'real-world' at a population level. Methods We conducted a retrospective population-based study using administrative data from the Institute of Clinical Evaluative Sciences (ICES), which maintains a central database of health records for all patients in the publicly funded health care system for the province of Ontario, Canada. All patients with newly diagnosed multiple identified using the ICD-O-3 code 9732 (Multiple Myeloma), who received treatment, but no transplant in the first year, between the years Jan 2007-Dec 2018, were identified. The main outcome of interest was an ESAS score of ≥4 which has been shown to represent clinically significant moderate to severe symptom burden, within the first 12 months following MM diagnosis. Logistic regression was used to assess the association between baseline factors identified a priori and moderate to severe symptoms for each domain. Results A total of 4611 transplant ineligible patients with newly diagnosed myeloma were identified between the years 2007-2018. Of these, 2876 (62.3%) with at least one ESAS score following diagnosis were included in this analysis. This represented 27,701 unique ESAS assessments recorded during the first year, which were used to form the cohort. Baseline characteristics for transplant ineligible patients with one or more ESAS are shown in Table I. Trajectory for moderate to severe symptoms in each month following diagnosis is shown in Figure 1. A high proportion of the cohort reported moderate to severe symptoms at diagnosis, with tiredness (64%) and impaired well-being (60%) being among the most prevalent and nausea being the least prevalent (13%). Most symptoms decreased over the first year, with the largest decline happening in the first 3 months. One year following diagnosis, there continued to be a substantial burden of symptoms, with over 25% of the cohort reporting at least one or more of the following moderate-severe symptoms: tiredness, pain, impaired well-being, drowsiness or loss of appetite. Self-reported depression rates marginally decreased over time; however, at the end of one year, 18% of cohort still reported moderate to severe depression. On multivariable analysis, younger age, female sex, urban geographic location, poor socioeconomic status, an earlier diagnosis year, myeloma defining end-organ damage and non-teaching hospital were associated with a higher odds of reporting moderate to severe symptoms. Conclusion Our results demonstrate that there is considerable symptom burden during the first year following MM diagnosis, with tiredness, impaired well-being and pain being the most common. Although symptoms improve over time, a significant proportion of patients continue to experience moderate to severe symptoms one-year post diagnosis. This study represents the largest population-based cohort study done to date in symptom burden among patients with MM. Future studies aimed at targeted intervention are needed early in the disease course in order to alleviate symptoms burden for at-risk patient groups. Disclosures Mian: Takeda: Consultancy, Honoraria; Celgene: Consultancy; Janssen: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Sanofi: Consultancy. Pond:Roche Canada: Other; Astra Zeneca: Consultancy; Takeda: Honoraria. Wildes:Janssen: Research Funding; Seattle Genetics: Consultancy; Carevive Systems: Consultancy.

Capsules TCN Network for Urban Computing and Intelligence in Urban Traffic Prediction

Predicting urban traffic is of great importance to smart city systems and public security; however, it is a very challenging task because of several dynamic and complex factors, such as patterns of urban geographical location, weather, seasons, and holidays. To tackle these challenges, we are stimulated by the deep-learning method proposed to unlock the power of knowledge from urban computing and proposed a deep-learning model based on neural network, entitled Capsules TCN Network, to predict the traffic flow in local areas of the city at once. Capsules TCN Network employs a Capsules Network and Temporal Convolutional Network as the basic unit to learn the spatial dependence, time dependence, and external factors of traffic flow prediction. In specific, we consider some particular scenarios that require accurate traffic flow prediction (e.g., smart transportation, business circle analysis, and traffic flow assessment) and propose a GAN-based superresolution reconstruction model. Extensive experiments were conducted based on real-world datasets to demonstrate the superiority of Capsules TCN Network beyond several state-of-the-art methods. Compared with HA, ARIMA, RNN, and LSTM classic methods, respectively, the method proposed in the paper achieved better results in the experimental verification.

The relationship between mental health literacy regarding schizophrenia and psychiatric stigma in the Republic of Ireland

Background: There is an unclear relationship between mental health literacy (MHL) and psychiatric stigma. MHL is associated with both positive and negative attitudes to mental illness. To our knowledge, no published peer reviewed study has examined this relationship in the Republic of Ireland.Aims: This study was conducted to assess MHL regarding schizophrenia and the degree of psychiatric stigma displayed by the general public in the Republic of Ireland.Method: A face-to-face in-home omnibus survey was conducted with a representative sample of residents of the Republic of Ireland. Participants (N = 1001) were presented with a vignette depicting schizophrenia and were asked questions to determine their ability to recognise the condition and to ascertain their attitudes towards schizophrenia and mental illness.Results: Among the participants, 34.1% correctly identified schizophrenia. Higher age, higher socioeconomic status, and an urban geographic location predicted identification. Those who did not correctly identify schizophrenia were significantly more optimistic about recovery and perceived people with schizophrenia as less dangerous. However, only the relationship with perceived dangerousness was considered robust.Conclusions: Participants with higher MHL displayed more negative attitudes to mental illness. Findings have implications internationally for MHL and anti-stigma campaigns.

Discourses on Well-Being

In the current South African socio-political framework children have been afforded the highest priority within government, via affirmation of their rights. Not only have the rights and needs of children been entrenched in the development strategies of the government, but children themselves have been guaranteed socio-economic rights and protection from abuse, exploitation, and neglect. Subsequently, knowledge and information on the well-being of children have become important pursuits. It has also become increasingly important to obtain an understanding of what children regard as essential to their well-being. The current study explores children’s subjective perceptions of well-being, with a specific focus on elucidating the discourses that children use to assign meaning to well-being. A qualitative study was conducted using a series of focus group discussions with 56 children between the ages of 13 and 15 from rural and urban geographical locations. A discourse analysis reveals a complex interplay between the social environment and the children’s sense of well-being. Three key thematic domains were identified, namely, personal safety, infrastructural deficiencies, and psycho-social functioning. Central discourses to emerge from these thematic domains were closely interrelated and mutually influencing and focussed on, personal safety, the social environment and a stable self as ‘non-negotiables’ of well-being, helplessness and vulnerability, desensitisation, marginalisation, (non)acknowledgement and (dis)respect. A notable finding emerging from the study was the extent to which the participants’ discursive constructions of well-being were ideologically configured. The findings raise important considerations for educational and intervention programmes and policies aimed at children and youth.

Race Has Always Mattered: An Intergeneration Look at Race, Space, Place, and Educational Experiences of Blacks

Within school settings race continues to be one of the most formidable obstacles for Black children in the United States (US) school system. This paper expands the discussions of race in education by exploring how the social links among race, space, and place provide a lens for understanding the persistence of racism in the educational experiences of Black children. This paper examines how differences in a rural versus urban geographical location influence a student’s experience with race, racism, and racial identity across four generations of Black people in the context of school and community. Implications for research and practice are discussed.

Access to medicines for acute illness in middle income countries in Central America

OBJECTIVETo analyze the main predictors of access to medicines for persons who experienced acute health conditions.METHODSThis was a cross-sectional analytic study, based on data from household surveys. We examined the predictors of: (1) seeking care for acute illness in the formal health care system and (2) obtaining all medicines sought for the acute condition.RESULTSThe significant predictors of seeking health care for acute illnesses were urban geographic location, head of household with secondary school education or above, age under 15, severity of illness perceived by the respondent, and having health insurance. The most important predictor of obtaining full access to medicines was seeking care in the formal health care system. People who sought care in the formal system were three times more likely to receive all the medicines sought (OR 3.0, 95%CI 2.3;4.0). For those who sought care in the formal health system, the strongest predictors of full access to medicines were seeking care in the private sector, having secondary school education or above, and positive perceptions of quality of health care and medicines in public sector health facilities. For patients who did not seek care in the formal health system, full access to medicines was more likely in Honduras or Nicaragua than in Guatemala. Urban geographic location, higher economic status, and male gender were also significant predictors.CONCLUSIONSA substantial part of the population in these three countries sought and obtained medicines outside of the formal health care system, which may compromise quality of care and pose a risk to patients. Determinants of full access to medicines inside and outside the formal health care system differ, and thus may require different strategies to improve access to medicines.

Access to medicines for acute illness in middle income countries in Central America

OBJECTIVE : To analyze the main predictors of access to medicines for persons who experienced acute health conditions. METHODS : This was a cross-sectional analytic study, based on data from household surveys. We examined the predictors of: (1) seeking care for acute illness in the formal health care system and (2) obtaining all medicines sought for the acute condition. RESULTS : The significant predictors of seeking health care for acute illnesses were urban geographic location, head of household with secondary school education or above, age under 15, severity of illness perceived by the respondent, and having health insurance. The most important predictor of obtaining full access to medicines was seeking care in the formal health care system. People who sought care in the formal system were three times more likely to receive all the medicines sought (OR 3.0, 95%CI 2.3;4.0). For those who sought care in the formal health system, the strongest predictors of full access to medicines were seeking care in the private sector, having secondary school education or above, and positive perceptions of quality of health care and medicines in public sector health facilities. For patients who did not seek care in the formal health system, full access to medicines was more likely in Honduras or Nicaragua than in Guatemala. Urban geographic location, higher economic status, and male gender were also significant predictors. CONCLUSIONS : A substantial part of the population in these three countries sought and obtained medicines outside of the formal health care system, which may compromise quality of care and pose a risk to patients. Determinants of full access to medicines inside and outside the formal health care system differ, and thus may require different strategies to improve access to medicines.

Cross-validation of the factorial structure of the Neighborhood Environment Walkability Scale (NEWS) and its abbreviated form (NEWS-A)

BackgroundThe Neighborhood Environment Walkability Scale (NEWS) and its abbreviated form (NEWS-A) assess perceived environmental attributes believed to influence physical activity. A multilevel confirmatory factor analysis (MCFA) conducted on a sample from Seattle, WA showed that, at the respondent level, the factor-analyzable items of the NEWS and NEWS-A measured 11 and 10 constructs of perceived neighborhood environment, respectively. At the census blockgroup (used by the US Census Bureau as a subunit of census tracts) level, the MCFA yielded five factors for both NEWS and NEWS-A. The aim of this study was to cross-validate the individual- and blockgroup-level measurement models of the NEWS and NEWS-A in a geographical location and population different from those used in the original validation study.MethodsA sample of 912 adults was recruited from 16 selected neighborhoods (116 census blockgroups) in the Baltimore, MD region. Neighborhoods were stratified according to their socio-economic status and transport-related walkability level measured using Geographic Information Systems. Participants self-completed the NEWS. MCFA was used to cross-validate the individual- and blockgroup-level measurement models of the NEWS and NEWS-A.ResultsThe data provided sufficient support for the factorial validity of the original individual-level measurement models, which consisted of 11 (NEWS) and 10 (NEWS-A) correlated factors. The original blockgroup-level measurement model of the NEWS and NEWS-A showed poor fit to the data and required substantial modifications. These included the combining of aspects of building aesthetics with safety from crime into one factor; the separation of natural aesthetics and building aesthetics into two factors; and for the NEWS-A, the separation of presence of sidewalks/walking routes from other infrastructure for walking.ConclusionThis study provided support for the generalizability of the individual-level measurement models of the NEWS and NEWS-A to different urban geographical locations in the USA. It is recommended that the NEWS and NEWS-A be scored according to their individual-level measurement models, which are relatively stable and correspond to constructs commonly used in the urban planning and transportation fields. However, prior to using these instruments in international and multi-cultural studies, further validation work across diverse non-English speaking countries and populations is needed.

Feast or famine? Supplemental food programs and their impacts on two American Indian communities in California

This article examines the use of supplemental food programs by two Native American populations and assesses some of the health and cultural impacts of these programs. A cross-sectional survey of 80 American Indian families, 40 families residing on the Round Valley Indian Reservation and 40 in Sacramento, California was conducted to determine access, use and appropriateness of supplemental feeding programs. Respondents at both the rural and urban geographic location showed considerable familiarity with available supplemental feeding programs. USDA Food Commodities were utilized most at Round Valley, raising the concern that provided staples which were highly processed and contained significant amounts of sodium, sucrose, and fat, could contribute to the problems of obesity and diabetes. Native Americans in Sacramento used food banks and food closets as their primary source of supplemental foods, and some expressed concern that the foods provided were highly sweetened and high in fat. While some nutrition advising was available at both geographical localities, access was inadequate. The study found that the foods provided by the supplemental food programs varied considerably in their nutritional quality and healthier foods such as fresh fruits, vegetables, and meats were either completely lacking or in short supply. In addition, culturally sensitive nutritional counseling and the development of education modules to instruct program recipients in the preparation of healthy meals and how to manage obesity and diabetes were needed and requested within the California Native American communities surveyed.