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Fernandez CC, Maddock J, Patalay P, Fett AK, Pitman A, Vaughan L, Krenz K. Proximity to high streets, social isolation and social support in British adolescents: A longitudinal analysis of sociospatial influences on social connectedness using geospatial data. Health Place 2024; 88:103260. [PMID: 38735152 DOI: 10.1016/j.healthplace.2024.103260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
High streets have been shown to be central to socio-economic activity, given their diverse residential, leisure, and commercial activities. This study explores the link between adolescent social isolation and proximity to, and land use mix in, high streets. Hypothesising that greater distance from high streets might increase social isolation, measured via social activities, friend contact frequency, and social support, we used multilevel modelling with data from the Millennium Cohort Study. We did not observe a relationship between proximity to high streets and these social isolation indicators, suggesting that high streets may either not significantly influence adolescent social engagement or that young people are willing to travel greater distances.
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Affiliation(s)
| | - Jane Maddock
- MRC Unit for Lifelong Health and Ageing, UCL, London, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing, UCL, London, UK; Centre for Longitudinal Studies, Social Research Institute, UCL, London, UK
| | - Anne-Kathrin Fett
- Department of Psychology, City, University of London, London, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Laura Vaughan
- The Space Syntax Lab, Bartlett School of Architecture, UCL, London, UK
| | - Kimon Krenz
- The Space Syntax Lab, Bartlett School of Architecture, UCL, London, UK
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Kelty CE, Dickinson MG, Leacche M, Jani M, Shrestha NK, Lee S, Acharya D, Rajapreyar I, Sadler RC, McNeely E, Loyaga-Rendon RY. Increased disparities in waitlist and post-heart transplantation outcomes according to socioeconomic status with the new heart transplant allocation system. J Heart Lung Transplant 2024; 43:134-147. [PMID: 37643656 PMCID: PMC11152116 DOI: 10.1016/j.healun.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/31/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The study objective was to assess disparities in outcomes in the waitlist and post-heart transplantation (HT) according to socioeconomic status (SES) in the old and new U.S. HT allocation systems. METHODS Adult HT candidates in the United Network for Organ Sharing database from 2014 through 2021 were included. Old or new system classification was according to listing before or after October 18, 2018. SES was stratified by patient ZIP code and median household income via U.S. Census Bureau and classified into terciles. Competing waitlist outcomes and post-transplantation survival were compared between systems. RESULTS In total, 26,450 patients were included. Waitlisted candidates with low SES were more frequently younger, female, African American, and with higher body mass index. Reduced cumulative incidence (CI) of HT in the old system occurred in low SES (53.5%) compared to middle (55.7%, p = 0.046), and high (57.9%, p < 0.001). In the new system, the CI of HT was 65.3% in the low SES vs middle (67.6%, p = 0.002) and high (70.2%, p < 0.001), and SES remained significant in the adjusted analysis. In the old system, CI of death/delisting was similar across SES. In the new system, low SES had increased CI of death/delisting (7.4%) vs middle (6%, p = 0.012) and high (5.4%, p = 0.002). The old system showed similar 1-year survival across SES. In the new system, recipients with low SES had decreased 1-year survival (p = 0.041). CONCLUSIONS SES affects waitlist and post-transplant outcomes. In the new system, all SES had increased access to HT; however, low SES had increased death/delisting due to worsening clinical status and decreased post-transplant survival.
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Sadler RC, Larsen K. Mapping the Way to Good Health: The Interdisciplinary Challenges of Geographers in Medical Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12419. [PMID: 36231725 PMCID: PMC9564750 DOI: 10.3390/ijerph191912419] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Geography has an important role to play in shaping the direction of medical research. In particular, its tools and theory provide essential understanding to the impacts of place on health behaviors and outcomes. Understanding some of its evolution-particularly into the subfield of medical geography-is therefore useful both for geographers and medical researchers. In this paper, we present some of the debates that geographers have grappled with, the growth of GIS (particularly in the context of medical research), some important methodological considerations that geographers help center, and some recommendations for future work at this nexus. Throughout, we speak from the perspective of geographers who have worked nearly exclusively in the health sciences since obtaining our PhDs.
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Affiliation(s)
- Richard Casey Sadler
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI 48502, USA
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Kristian Larsen
- CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Department of Geography and Planning, University of Toronto, Toronto, ON M5G 1G6, Canada
- Department of Geography and Environmental Studies, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
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Drahota A, Sadler R, Hippensteel C, Ingersoll B, Bishop L. Service deserts and service oases: Utilizing geographic information systems to evaluate service availability for individuals with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2008-2020. [PMID: 32564619 DOI: 10.1177/1362361320931265] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
LAY ABSTRACT Autism spectrum disorder and co-occurring symptoms often require lifelong services. However, access to autism spectrum disorder services is hindered by a lack of available autism spectrum disorder providers. We utilized geographic information systems methods to map autism spectrum disorder provider locations in Michigan. We hypothesized that (1) fewer providers would be located in less versus more populated areas; (2) neighborhoods with low versus high socioeconomic status would have fewer autism spectrum disorder providers; and (3) an interaction would be found between population and socioeconomic status such that neighborhoods with low socioeconomic status and high population would have few available autism spectrum disorder providers. We compiled a list of autism spectrum disorder providers in Michigan, geocoded the location of providers, and used network analysis to assess autism spectrum disorder service availability in relation to population distribution, socioeconomic disadvantage, urbanicity, and immobility. Individuals in rural neighborhoods had fewer available autism spectrum disorder providers than individuals in suburban and urban neighborhoods. In addition, neighborhoods with greater socioeconomic status disadvantage had fewer autism spectrum disorder providers available. Finally, wealthier suburbs had good provider availability while few providers were available in poorer, urban neighborhoods. Knowing autism spectrum disorder providers' availability, and neighborhoods that are particularly poorly serviced, presents the opportunity to utilize evidence-based dissemination and implementation strategies that promote increased autism spectrum disorder providers for underserved individuals.
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Affiliation(s)
- Amy Drahota
- Michigan State University, USA.,Child and Adolescent Services Research Center, USA
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Trangenstein PJ, Sadler R, Morrison CN, Jernigan DH. Looking Back and Moving Forward: The Evolution and Potential Opportunities for the Future of Alcohol Outlet Density Measurement. ADDICTION RESEARCH & THEORY 2020; 29:117-128. [PMID: 33883975 PMCID: PMC8054780 DOI: 10.1080/16066359.2020.1751128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 05/29/2023]
Abstract
The literature consistently finds that areas with greater density of alcohol outlets (places that sell alcohol) tend to have higher levels of public health harms. However, conflicting findings arise when researchers drill down to identify the type(s) of alcohol outlets with the strongest associations with harms and the mechanisms that explain these associations. These disagreements could be a result of the outdated methods commonly used to quantify the alcohol environment: counts of the number of outlets in an area. This manuscript reviews the events and ideas that shaped the literature on the physical alcohol environment. It then defines the three main methods used to measure alcohol outlet density, conducts an exploratory factor analysis to explore the constructs underlying each method, and presents a novel conceptual framework that summarizes the three methods, their respective underlying constructs, and the setting(s) in which each may be most appropriate. The framework proposes that counts of alcohol outlets measure availability, proximity to the nearest outlet measures accessibility, and spatial access measures measure access, which comprises both availability and accessibility. We argue that researchers should consider using proximity and spatial access measures when possible and outline how doing so may present opportunities to advance theory and the design and implementation of alcohol outlet zoning regulations. Finally, this manuscript draws on research from other areas of the built environment to suggest opportunities to use novel methods to overcome common hurdles (e.g., separating subtypes of outlets, ecologic designs) and a new challenge on the horizon: home delivery.
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Affiliation(s)
- PJ. Trangenstein
- University of North Carolina at Chapel Hill Gillings
School of Global Public Health, Department of Health Behavior, Chapel Hill, NC
29599
- Boston University School of Public Health, Department of
Health Law, Policy, and Management, Boston, MA 02118
| | - R. Sadler
- Michigan State University College of Human Medicine
Department of Family Medicine/Division of Public Health Flint, MI 48502
| | - CN. Morrison
- Columbia University Mailman School of Public Health,
Department of Epidemiology, New York, NY 10032
- Monash University School of Public Health and Preventive
Medicine, Department of Epidemiology and Preventive Medicine, Melbourne, VIC 3000,
Australia
| | - DH. Jernigan
- Boston University School of Public Health, Department of
Health Law, Policy, and Management, Boston, MA 02118
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Sadler RC, Hippensteel C, Nelson V, Greene-Moton E, Furr-Holden CD. Community-engaged development of a GIS-based healthfulness index to shape health equity solutions. Soc Sci Med 2019; 227:63-75. [PMID: 30037592 PMCID: PMC6339605 DOI: 10.1016/j.socscimed.2018.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/14/2018] [Accepted: 07/18/2018] [Indexed: 12/20/2022]
Abstract
Addressing health disparities requires both community engagement and an understanding of the social determinants of health. Although elements of the built environment can influence behavior change in public health interventions, such determinants have not been explicitly teased out via participatory mapping. An opportunity exists to integrate community voice in the development of such metrics. To fill this gap and inform the deployment of public health interventions in the Flint (USA) Center for Health Equity Solutions (FCHES), we created a means of assessing spatially-varying community needs and assets in a geographic information system (GIS), what we refer to as a healthfulness index. We engaged community and academic partners in their expert opinions on features of Flint's built environment that may promote or inhibit healthy behaviors via a multiple-criteria decision analysis framework. Experts selected from and ranked 29 variables in 6 categories (including amenities, environment, greenspace, housing, infrastructure, and social issues) using the analytic hierarchy process. The resulting matrices of expert opinions were aggregated and appended as weights for each variable's corresponding map layer. When combined through map algebra, composite scores yield spatially-varying healthfulness indices which signal any neighborhood's relative health promoting qualities (along a 0-100 scale). Results varied substantially across Flint, with the middle belt scoring highest and older neighborhoods in the northeast and north center of the city scoring lowest. Scores were aggregated to 38 Flint neighborhoods; for each of two project-specific indices, these ranged from lows of 38.7 (Hilborn Park) and 41.8 (Columbia Heights) to highs of 52.9 (College Cultural) and 58.0 (University Ave Corridor). We hypothesize that-even when controlling for individual-level factors-we will measure better and more sustained behavior change among participants living in neighborhoods with high healthfulness scores. Future work will examine this hypothesis and determine the importance of such indices in other similar communities.
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Sadler RC. Misalignment Between ZIP Codes and Municipal Boundaries: A Problem for Public Health. CITYSCAPE (WASHINGTON, D.C.) 2019; 21:335-340. [PMID: 34306299 PMCID: PMC8301226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
While useful for mail delivery, ZIP Codes are flawed as a geographic metric for public health research. This paper quantifies the magnitude of potential error inherent in using ZIP Codes as a unit of analysis in the state of Michigan. ZIP Codes are intersected with municipality boundaries in ArcGIS to determine the degree of misclassification. Results showed that 49 percent of the population had their municipality misclassified by their ZIP Code. This creates potentially huge errors when ZIP Code is the only geographic identifier, because actual exposure may vary from the exposure to which an individual is assigned based on ZIP Code. The Flint, Michigan, Water Crisis is a prime example of this error and the need to consider finer units of analysis whenever possible. Collaboration with experts in geographic information science is therefore essential for any public health research project where location is a factor.
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