Public Health Commons^™

Cultural Context Index: A Geospatial Measure Of Social Determinants Of Health In The United States, Alaina M Beauchamp, Gordon C Shen, Syed H Hussain, Atif Adam, Linda Highfield, Kai Zhang

Journal Articles

Minority populations will continue to grow in the United States. Such pluralism necessitates iterative, geospatial measurements of cultural contexts. Our objective in this study was to create a measure of social determinants of health in geographic areas with varying ethnic, linguistic, and religious diversity in the United States. We extracted geographic information systems data based on community characteristics that have known associations with population health disparities from 2015 to 2019. We used principal component analysis to construct a Cultural Context Index (CCI). We created the CCI for 73,682 census tracts across 50 states and five inhabited territories. We identified hot …

The Development Of Health System Resiliency: How Kenya's Experience With Malaria Impacted Its Reaction To The Covid-19 Pandemic, Zoe A. Ward

Baker Scholar Projects

Public health scholars have recently focused on health system resiliency to explain how previous experiences dealing with public health crises impact the healthcare sector, public behavior, and policy response to novel crises. However, it is unclear how resiliency develops. This study contributes by testing whether a health system’s experience with a health emergency and significant interventions impacts the response to a novel crisis. This research asks, “How has Kenya’s experience with malaria impacted its response to COVID-19?” Using the United States Agency for International Development (USAID) Malaria Indicator Survey (MIS), I develop a malaria adherence score to measure county-level compliance …

Ballad Health: Understanding Appalachia’S Regional Healthcare Monopoly, Meredith A. Bailey

Baker Scholar Projects

The Ballad Health merger of 2018, which combined the now 21 hospitals in the region under one organization, has impacted the healthcare landscape in Northeast Tennessee and Southwest Virginia. Historically, Appalachia has had to persevere through primary physician shortages, a lack of specialty care, geographic obstacles to accessing healthcare, challenges related to substance abuse, and much more. Since the merger of Mountain States Health Alliance and Wellmont Health System, little research has been done to assess the perceived impact the aggregation of providers has had on the population it serves. This study utilizes an online survey to better understand the …

Ambulance Deserts: Geographic Disparities In The Provision Of Ambulance Services [Chartbook], Yvonne Jonk Phd, Carly Milkowski Mph, Zachariah Croll Mph, Karen Pearson Mlis, Ma

Emergency Medical Services (EMS)

This chartbook begins with a broad overview of ambulance services including common types of organizational structure(s) and workforce and reimbursement issues. The methods section provides our definition of ambulance deserts and describes how ambulance deserts are illustrated in the national and state maps. The results section begins with an overall description of the prevalence of ambulance deserts in rural and urban counties across the 41 states for which data were available at the time, and the variation in the percent of people living in ambulance deserts across the four census regions. States are ranked in terms of the percent of …

Epigenetics And Social Inequalities In Asthma And Allergy, Elizabeth S. Clausing, Cassidy J. Tomlinson, Amy L. Non

School of Global Integrative Studies: Faculty Publications

Respiratory illnesses, such as asthma and allergy disorders, are disproportionately more common among minority racial/ethnic groups and those of low socioeconomic status. In the United States, asthma prevalence and severity are highest among Puerto Ricans (19.2%), American Indians/Alaska Natives (13%), and Black Americans (12.7%) and higher in families living below the poverty threshold than among those living above it (11% vs 8%–9%).¹ Many studies of asthma/allergy inequalities assume that genetic differences underlie racial/ethnic differences in these disorders, pointing to genetic ancestry differences between races, but most genetic variants fail to explain racial/ethnic differences and are usually studied only in …

Participatory Mapping To Address Neighborhood Level Data Deficiencies For Food Security Assessment In Southeastern Virginia, Usa, Nicole S. Hutton, George Mcleod, Thomas R. Allen, Christopher Davis, Alexander Garnand, Heather Richter, Prachi P. Chaven, Leslie Hoglund, Jill Comess, Matthew Herman, Brian Martin, Cynthia Romero

Political Science & Geography Faculty Publications

Background: Food is not equitably available. Deficiencies and generalizations limit national datasets, food security assessments, and interventions. Additional neighborhood level studies are needed to develop a scalable and transferable process to complement national and internationally comparative data sets with timely, granular, nuanced data. Participatory geographic information systems (PGIS) offer a means to address these issues by digitizing local knowledge.

Methods: The objectives of this study were two-fold: (i) identify granular locations missing from food source and risk datasets and (ii) examine the relation between the spatial, socio-economic, and agency contributors to food security. Twenty-nine subject matter experts from three cities …

The Politics Of The Self: Psychedelic Assemblages, Psilocybin, And Subjectivity In The Anthropocene, Joshua Falcon

FIU Electronic Theses and Dissertations

This dissertation examines how psychedelic substances become drawn into particular sociohistorical and political arrangements, and how psychedelic experiences with psilocybin ‘magic mushrooms’ are used as tools of subjectivation. Guided by literatures in philosophy, critical theory, and the social sciences that focus on subjectivity, assemblage theory, and critical posthumanism, I argue that psychedelics are drawn into variegated assemblages, each of which conceptualizes the nature of psychedelics in highly specific ways that reflect implicit conceptions of the world and the self. In developing the concept of psychedelic assemblages, this research provides a window onto the politics of the self in the Anthropocene. …

The Value Of Education: School Policy Decisions During The Covid-19 Pandemic, Elika W. Somani

Individually Designed Interdepartmental Major Honors Project

During the COVID-19 pandemic, lacking national U.S. policies, wide variation and conflict over chosen public school policy decisions emerged. What factors and guidelines informed the decision-making process in K-12 public schools during the COVID-19 pandemic and who were the key stakeholders? This study examines three school district types – a large city, medium city, and small-town – across Minnesota as case studies to unpack how policy decisions were made during the pandemic. Stakeholder interviews uncovered that the school decision-making process was a) connected to a district's political opinions, b) made by the superintendent and school board, c) primarily influenced by …

Rural Resiliency: The Cause And Effect Of Minnesota's Maternal Health Crisis, Annabel Traudie Gregg

Geography Honors Projects

The United States is experiencing a maternal health crisis that disproportionately affects those who give birth in rural communities. Rural birthing people have higher maternal mortality rates, increased risk of postpartum hemorrhage, non-indicated cesarean sections, and other adverse health outcomes. Despite the enhanced risks of rural birth, rural communities are losing access to hospital-based obstetric care at an unprecedented rate. Minnesota has vast rural territory, with one-fourth of its population living outside the urban sphere ­– making it a strategic area of study. As of July, 2021, 31% of Minnesota’s 91 rural hospitals were at risk of closing. The repercussions …

Geographic Determinants Of Colorectal Cancer In Louisiana, Denise Danos, Claudia Leonardi, Xiao Cheng Wu

School of Public Health Faculty Publications

Purpose: Currently, rural residents in the United States (US) experience a greater cancer burden for tobacco-related cancers and cancers that can be prevented by screening. We aim to characterize geographic determinants of colorectal cancer (CRC) incidence in Louisiana due to rural residence and other known geographic risk factors, area socioeconomic status (SES), and cultural region (Acadian or French-speaking). Methods: Primary colorectal cancer diagnosed among adults 30 years and older in 2008–2017 were obtained from the Louisiana Tumor Registry. Population and social and economic data were obtained from US Census American Community Survey. Rural areas were defined using US Department of …

Detroit Food Metrics Report 2020 (With 2021 Update), Alex B. Hill, Amy Kuras

Urban Studies and Planning Faculty Research Publications

This report provides a snapshot of data and information on Detroit’s food system as well as trends over time. The report includes a broad range of programs and initiatives that local organizations, the Detroit Food Policy Council, and the City of Detroit are undertaking to address food insecurity, increase healthy food access and awareness, and support a more sustainable and just food system.

Evaluating Urban Parks Accessibility And Equity: A Case Study Of Hartford, Ct And New Haven, Ct, Natalie Roach, Mara Tu

Honors Scholar Theses

Public parks provide cities with environmental benefits, positive health effects, recreational opportunities, community building, educational spaces, and public amenities. However, certain populations have been systematically denied their fair share of these benefits because of unjust practices in the creation and maintenance of urban parks. With a lens of environmental justice, the goal of this research was to assess park quality and accessibility of two Connecticut cities, Hartford and New Haven, by gathering publicly available information as well as using GIS tools.

The Trust for Public Land (TPL) has an existing ParkScore rating system that evaluates the quality of a city’s …

Pulling The Food System Up By The Roots: How Do We Build An Equitable Food System In The Twin Cities?, Aubrey A. Hagen

Geography Honors Projects

Prior to 2020, food insecurity was already a pervasive problem in the United States, with limited access to adequate, nutritious foods being linked to numerous poor physical and psychological outcomes. With the onset of the Covid-19 pandemic and civil uprisings in response to police brutality and state-sanctioned violence, the Twin Cities communities are facing overlapping crises that threaten individual and community wellbeing and food security. How do we build a just, equitable, and “crisis-proof” food system? Drawing from theoretical frameworks in social epidemiology and radical food geography, this paper assesses how the local food system and community food insecurity in …

Substance Use Disorder Program Facilities In Detroit: A Geographic Analysis, Oksana Doubrovski

Medical Student Research Symposium

Background: Over 630,000 Michiganders have a substance use disorder (SUD) and about 80% are not receiving care (1). The rate of unmet need for SUD care in the Detroit-Dearborn-Livonia area is 81% (1). Geographic placement of facilities may serve as a barrier in patient access to SUD program services. This geographic analysis investigates current Detroit SUD program facility locations and their community demographics.

Methods: ArcGIS Pro was used to visualize and analyze data by creating 2D maps and tables. Data on SUD programs, medically underserved areas, and zip codes were retrieved from government data portals. Census tract data …

Expanding The Boundaries Of Food Policy: The Turn To Equity In New York City, Nevin Cohen, Rositsa Ilieva

Publications and Research

Policymakers acknowledge that the food system is multidimensional and that social determinants affect diet-related health outcomes, yet cities have emphasized programs and policies narrowly connected to food access and nutritional health. Over the past fifteen years, the boundaries of food governance have expanded to include a wider range of issues and domains not previously considered within the purview of food policy, like labor, housing, and education policies. This paper illustrates the processes by which this shift occurs by presenting the case of New York City, which has broadened its food governance to a larger set of issues, requiring cross-sectoral initiatives …

Childhood Health And The Changing Distribution Of Foreign Aid: Evidence From Nigeria’S Transition To Lower-Middle-Income Status, Carrie B. Dolan, Mckinley Saunders, Ariel Benyishay

Arts & Sciences Articles

With sustained economic growth in many parts of the developing world, an increasing number of countries are transitioning away from the most subsidized development finance as they exceed income and other qualification requirements. Cross-country evidence suggests that Development Assistance Committee (DAC) donors view the crossing over of the World Bank’s International Development Association (IDA) eligibility threshold to signal that a country needs less aid, with subsequent reductions in both IDA and other donors’ concessional funding. Within the health sector, it is particularly important to understand the implications of these status changes for children under five years of age since improving …

Urban Warfare: Emerging Geopolitical Conundrum, Bert Chapman

Libraries Faculty and Staff Presentations

Urban warfare is as old as human history. It is becoming increasingly important in international political and military planning due to increasing global urbanization and the presence of megacities (urban areas with populations exceeding 10 million) in many global regions and being in areas of recent and potential military conflict. 2018 World Bank data notes that approximately 56% of the world's population lives in urban areas which is up from 34% in 1960. Many of these megacities, including New York City, Los Angeles, Sao Paulo, Mumbai, Shanghai, and Manila are adjacent to oceanic waters and vulnerable to trade and supply …

Detroit Food Metrics Report 2019, Alex B. Hill

Urban Studies and Planning Faculty Research Publications

This report provides a snapshot of data and information on Detroit’s food system as well as trends over time. The report includes a broad range of programs and initiatives that local organizations, the Detroit Food Policy Council, and the City of Detroit are undertaking to address food insecurity, increase healthy food access and awareness, and support a more sustainable and just food system.

Online Grocery Shopping By Nyc Public Housing Residents Using Supplemental Nutrition Assistance Program (Snap) Benefits: A Service Ecosystems Perspective, Nevin Cohen, Katherine Tomaino-Fraser, Chloe Arnow, Michelle Mulcahy, Christophe Hille

Publications and Research

This paper examines adoption of online grocery shopping, and potential cost and time savings compared to brick and mortar food retailers, by New York City public housing residents using Supplemental Nutrition Assistance Program (SNAP) benefits. A mixed methods action research project involving the co-creation of an online shopping club, the Farragut Food Club (FFC), recruited 300 members who registered to shop online using SNAP, and received waivers on delivery minimums and provided technical assistance and centralized food delivery. We conducted a survey (n = 206) and focus groups to understand shopping practices; FFC members collected receipts of groceries over two …

Google-Truthing To Assess Hot Spots Of Food Retail Change: A Repeat Cross-Sectional Street View Of Food Environments In The Bronx, New York, Nevin Cohen, Michael Chrobok, Olivia Caruso

Publications and Research

Google Street View (GSV) images can be used to “ground-truth” current and historical food retail data from approximately 2007 - when GSV was launched in a few US cities - to the present, facilitating analyses of food environments over time. A review of GSV images of all food retailers listed in a government database of licensed establishments in the Bronx, New York enabled records to be verified, businesses classified, and retail change quantified. The data revealed several trends likely to affect food access and health: increasing overall numbers of food retailers; the growth of dollar stores; and numerous openings, closings, …

Colon Cancer Care Of Hispanic People In California: Paradoxical Barrio Protections Seem Greatest Among Vulnerable Populations, Keren M. Escobar, Mollie Sivaram, Kevin M. Gorey, Isaac N. Luginaah, Sindu M. Kanjeekal, Frances C. Wright

Social Work Publications

Background: We examined paradoxical and barrio advantaging effects on cancer care among socioeconomically vulnerable Hispanic people in California. Methods: We secondarily analyzed a colon cancer cohort of 3,877 non-Hispanic white (NHW) and 735 Hispanic people treated between 1995 and 2005. A third of the cohort was selected from high poverty neighborhoods. Hispanic enclaves and Mexican American (MA) barrios were neighborhoods where 40% or more of the residents were Hispanic or MA. Key analyses were restricted to high poverty neighborhoods. Results: Hispanic people were more likely to receive chemotherapy (RR=1.18), especially men in Hispanic enclaves (RR=1.33) who were also advantaged on …

Supports For Migrant Farmworkers: Tensions In (In)Access And (In)Action, Susana Caxaj, Amy Cohen, Sarah Marsden

Health and Rehabilitation Sciences Publications

Purpose: This study examined the role of support actors in promoting or hindering access to migrant agricultural workers' (MAWs) needs, and, to determine the factors that influence adequate support for this population.
Methodology: Employing a Situational Analysis methodology, we carried out focus groups and interviews with 35 support actors complimented by a community scan (n=28) with public-facing support persons and a community consultation with migrant agricultural workers (MAWs).
Findings: Two major themes were revealed: (In)access and (In)action, and; Blurred Lines in Service Provision. The first illustrated how support actors could both reinforce or challenge barriers for this population through tensions …

The Interface Between Invasive Species And The Increased Incidence Of Tick-Borne Diseases, And The Implications For Federal Land Managers, Ed Clark, Janis Mcfarland, Blaine Parker, Slade Franklin

National Invasive Species Council

Includes information on the dynamics of tick-borne disease, factors affecting the occurrence and density of ticks, matrices of ties between habitat, human activities, invasive plants, and ticks, federal resources and programs related to ticks and vector-borne disease in the United States, with references and an annotated bibliography of literature on ticks, vector-borne diseases, and invasive species.

Conceptualizing Youth Participation In Children’S Health Research: Insights From A Youth-Driven Process For Developing A Youth Advisory Council, Mohammad El-Bagdady, Krishna Arunkumar, Drew Bowman, Stephanie Coen, Christina Ergler, Jason Gilliland, Ahad Mahmood, Suraj Paul

Geography & Environment Publications

Given the power asymmetries between adults and young people, youth involvement in research is often at risk of tokenism. While many disciplines have seen a shift from conducting research on youth to conducting research with and for youth, engaging children and teens in research remains fraught with conceptual, methodological, and practical challenges. Arnstein’s foundational Ladder of Participation has been adapted in novel ways in youth research, but in this paper, we present a new rendering: a ‘rope ladder.’ This concept came out of our youth-driven planning process to develop a Youth Advisory Council for the Human Environments Analysis Laboratory, an …

Detroit Food Metrics Report 2018, Alex B. Hill, Amy Kuras

Urban Studies and Planning Faculty Research Publications

This report provides a snapshot of data and information on Detroit’s food system as well as trends over time. The report includes a broad range of programs and initiatives that local organizations, the Detroit Food Policy Council, and the City of Detroit are undertaking to address food insecurity, increase healthy food access and awareness, and support a more sustainable and just food system.

Kisumu County Hospital Patient Demographic Analysis: Looking Toward Universal Health Coverage, Lauren Scheffey

Independent Study Project (ISP) Collection

Universal health coverage is priority sought after by developed and developing nations alike, and Kenya sits on the list of countries seeking to achieve this goal in the coming years. The definition of “coverage” can vary by country, but three criteria are commonly found in the discussion of UHC globally: access, affordability, and quality. Affordability is determined by the state’s healthcare financing system; quality refers to the services provided by health facilities; and access, at least in part, concerns the geographic placement of health services providers in relation to the population they intend to serve. This geographic element is the …

Elucidating The Role Of Neighborhood Deprivation In Hypertensive Disorders Of Pregnancy, Kelly M. Winter

FIU Electronic Theses and Dissertations

This dissertation examined risk factors for hypertensive disorders of pregnancy (HDP) — specifically whether neighborhood socioeconomic deprivation exacerbates individual socioeconomic disadvantage (deprivation amplification) to increase the likelihood of developing HDP. To select the optimal areal unit at which to investigate HDP, geographic proxies for neighborhoods were explored.

A thematic review qualitatively examined nontraditional neighborhood boundaries identified through internet sources. Data from 2008–2012 Miami-Dade County, Florida birth records (n=121,421) and the U.S. Census Bureau were used for the remaining analyses. Ordinary least squares (OLS) and geographically weighted regression (GWR) analysis empirically compared the proportion of HDP prevalence explained by six areal …

Spatial Distribution Of Partner-Seeking Men Who Have Sex With Men Using Geosocial Networking Apps: Epidemiologic Study, Angel B. Algarin, Patrick J. Ward, W. Jay Christian, Abby E. Rudolph, Ian W. Holloway, April M. Young

Epidemiology and Environmental Health Faculty Publications

Background: Geosocial networking apps have made sexual partner-seeking easier for men who have sex with men, raising both challenges and opportunities for human immunodeficiency virus and sexually transmitted infection prevention and research. Most studies on men who have sex with men geosocial networking app use have been conducted in large urban areas, despite research indicating similar patterns of online- and app-based sex-seeking among men who have sex with men in rural and midsize cities.

Objective: The goal of our research was to examine the spatial distribution of geosocial networking app usage and characterize areas with increasing numbers of partner-seeking men …

Correcting For The Inconveniences Of Cultivation: Foraging As A Food Source In Southwestern Burkina Faso, Julia Deryn Morgan

Geography Honors Projects

Malnutrition is an important public health issue in Burkina Faso where 30 % of children are underweight for their age and 92% suffer from iron deficiency. Such statistics indicate that there is a significant lack of adequate nutrition in the country. With approximately 80% of the population employed in the agricultural sector, development projects have focused on increasing agricultural production and commercializing output to ameliorate poor nutrition. However, this strategy ignores the importance of local knowledge and food traditions, most notably by neglecting to acknowledge foraging as a significant source of food. To address this concern, I seek to understand …

Wdph 2017 Summer Internship Report, Lauren Meininger

Mosakowski Institute for Public Enterprise

In the spring of 2014, the Worcester Division of Public Health, UMass Memorial Health Care, and Clark University’s Mosakowski Institute for Public Enterprise joined forces to begin developing a partnership that would combine academic resources, student input, and public health needs in the City of Worcester. Founders of this program were motivated to seek and implement innovative interventions for public health issues while simultaneously inspiring a new generation of public health professionals.

Each year, the Academic Health Collaborative of Worcester (AHCW) brings in student interns to work on the pressing public health issues of the moment. Interns work alongside epidemiologists, …