Studies on Health, Place, and Education

Good health is positively associated with education outcomes, and likewise higher education-related achievement is positively associated with good health. Similarly, social disadvantage follows a cyclical pattern. It is cumulative; both accruing over the life course and across generations. Moreover, this relationship disproportionately impacts our most vulnerable populations, including both minorities and children living in or near poverty. For example, since the 1990s asthma, the most common chronic illness among youth, has seen the greatest increases in urban environments, and among racial and ethnic minorities in or near poverty. Still, consideration of the interdependence between health, place, and education remains underdeveloped in the literature. Place provides an opportunity to examine the ways in which health and education interact to limit or encourage maximal growth for children, shaping their development and opportunity. This dissertation both affirms prior research examining these relationships and further deepens our understanding of the ways in which health and place interact to impact outcomes for young children. The introductory chapter provides the theoretical framework and a brief review of the literature guiding the studies included in the dissertation. The first study utilizes a large national dataset to examine chronic and recurrent early childhood health conditions and their impact on reading and math skills of children at kindergarten entry. The final two studies utilize social epidemiological methods which allow for the examination of population level, social-structural factors and health conditions and their impact on developmental and educational outcomes for youth at both regional and local levels. Central to all three studies is the element of geography or place. A final chapter considers the findings of the dissertation as a whole, offering lessons learned and directions for future research

The Role of Geospatial Thinking and Geographic Skills in Effective Problem Solving with GIS: K-16 Education

Effective use of a Geographic Information System (GIS) is hampered by the limited geospatial reasoning abilities of students. The ability to reason with spatial relations, more specifically apply geospatial concepts, including the identification of spatial patterns and spatial associations, is important to geographic problem solving in a GIS context. This dissertation examines the broad influence of three factors on GIS problem solving: 1) affection towards computers, geography, and mathematics, 2) geospatial thinking, as well as 3) geographic skills. The research was conducted with 104 students in Waterloo, Ontario, Canada. Students were drawn from four educational levels: grade 9 students, 13 to 14 years of age; 1st year undergraduate university students, 3rd and 4th year undergraduate geography majors; and geography students at the graduate level ranging from 22 to 32 years of age. The level of affection is measured with modified scales borrowed from psychology. Results show that students in general exhibit positive sentiments toward computers and geography but less so towards mathematics. Spatial thinking and knowledge of geospatial concepts are measured by a 30-item scale differentiating among spatial thinkers along a novice-expert continuum. Scores on the scale showed an increase in spatial reasoning ability with age, grade, and level of education, such that grade 9 students averaged 7.5 out of 30 while the mean score of graduate students was 20.6. The final exercise assessed pertinent skills to geography namely inquiry, data collection, and analysis. In general, there was a positive correlation in the scores such that the skill proficiency increased with grade. Related analysis found three factors that affect problem-solving performance with a GIS. These include age, geographic skills (inquiry and analysis), and geospatial thinking (subscales analysis, representation, comprehension, and application). As well, the relationship(s) between performance on the geospatial scale and the observed problem-solving sequences and strategies applied on a GIS was examined. In general, students with lower scores were more apt to use basic visualization (zoom/measure tools) or buffer operations, while those with higher scores used a combination of buffers, intersection, and spatial queries. There were, however, exceptions as some advanced students used strategies that overly complicated the problem while others used visualization tools alone. The study concludes with a discussion on future research directions, followed by a series of pencil and paper games aimed to develop spatial thinking within a geographic setting

Correlations Between Childhood Obesity and Obesogenic Environmental Variables Within Durham County, North Carolina

The application of geographic information systems was used to map obesogenic conditions by zip code tabulation areas in Durham County, North Carolina and evaluated associations between those conditions and the understudied area of early childhood obesity. Of the thirty one percent of the children in Durham County, North Carolina who were considered obese in 2010, four hundred and thirty three (1:5) 2 - 4 year old children who received supplemental nutrition services for women, infants and children were obese with BMI levels greater or equal to the 95th percentile and were used as the criterion variable in the study (N=433). The study\u27s research questions examined conditions of the neighborhood that impeded the weight status of young children. The theoretical framework included the environmental stress, socioeconomic, multiple exposures-multiple effects, and attachment theories. The twenty - six variables used in this secondary quantitative study included demographics on socioeconomic and education levels, home occupancy and vacancy rates, age of homes, and neighborhood accessibility features: access to parks; recreation facilities; grocery stores verses convenience stores; fast food restaurants; medical facilities; schools; day cares; and neighborhood incivilities such as numbers of reported crimes. The t - test were configured as Grouping Variables with the cut-point of 18.7% and with an Alpha of .05 and produced statistical significance on five of twenty - six variables. A mean rate of 19.3% yielded statistical significance on ten of twenty - six variables. The Levene\u27s Test for Equality of Variances expressed assumptions on scores met for statistical significance on t-test at the Alpha = 0.05 level for twenty - four of the twenty - six variables. The results of this study would possibly increase the use of the innovative geographic information systems to inform policy decisions, environmental interventions and environmental design on obesogenic correlates between the understudied area of early childhood obesity and the built environment

Sustaining Glasgow's Urban Networks: the Link Communities of Complex Urban Systems

As cities grow in population size and became more crowded (UN DESA, 2018), the main future challenges around the world will remain to be accommodating the growing urban population while drastically reducing environmental pressure. Contemporary urban agglomerations (large or small) constantly impose burden on the natural environment by conveying ecosystem services to close and distant places, through coupled human nature [infrastructure] systems (CHANS). Tobler’s first law in geography (1970) that states that “everything is related to everything else, but near things are more related than distant things” is now challenged by globalization. When this law was first established, the hypothesis referred to geological processes (Campbell and Shin, 2012, p.194) that were predominantly observed in pre-globalized economy, where freight was costly and mainly localized (Zhang et al., 2018). With the recent advances and modernisation made in transport technologies, most of them in the sea and air transportation (Zhang et al., 2018) and the growth of cities in population, natural resources and bi-products now travel great distances to infiltrate cities (Neuman, 2006) and satisfy human demands. Technical modernisation and the global hyperconnectivity of human interactions and trading, in the last thirty years alone resulted with staggering 94 per cent growth of resource extraction and consumption (Giljum et al., 2015). Local geographies (Kennedy, Cuddihy and Engel-Yan, 2007) will remain affected by global urbanisation (Giljum et al., 2015), and as a corollary, the operational inefficiencies of their local infrastructure networks, will contribute even more to the issues of environmental unsustainability on a global scale. Another challenge for future city-regions is the equity of public infrastructure services and policy creation that promote the same (Neuman and Hull, 2009). Public infrastructure services refer to services provisioned by networked infrastructure, which are subject to both public obligation and market rules. Therefore, their accessibility to all citizens needs to be safeguarded. The disparity of growth between networked infrastructure and socio-economic dynamics affects the sustainable assimilation and equal access to infrastructure in various districts in cities, rendering it as a privilege. Yet, the empirical evidence of whether the place of residence acts as a disadvantage to public service access and use, remains rather scarce (Clifton et al., 2016). The European Union recognized (EU, 2011) the issue of equality in accessibility (i.e. equity) critical for territorial cohesion and sustainable development across districts, municipalities and regions with diverse economic performance. Territorial cohesion, formally incorporated into the Treaty of Lisbon, now steers the policy frameworks of territorial development within the Union. Subsequently, the European Union developed a policy paradigm guided by equal access (Clifton et al., 2016) to public infrastructure services, considering their accessibility as instrumental aspect in achieving territorial cohesion across and within its member states. A corollary of increasing the equity to public infrastructure services among growing global population is the potential increase in environmental pressure they can impose, especially if this pressure is not decentralised and surges at unsustainable rate (Neuman, 2006). This danger varies across countries and continents, and is directly linked to the increase of urban population due to; [1] improved quality of life and increased life expectancy and/or [2] urban in-migration of rural population and/or [3] global political or economic immigration. These three rising urban trends demand new approaches to reimagine planning and design practices that foster infrastructure equity, whilst delivering environmental justice. Therefore, this research explores in depth the nature of growth of networked infrastructure (Graham and Marvin, 2001) as a complex system and its disparity from the socio-economic growth (or decline) of Glasgow and Clyde Valley city-region. The results of this research gain new understanding in the potential of using emerging tools from network science for developing optimization strategy that supports more cecentralized, efficient, fair and (as an outcome) sustainable enlargement of urban infrastructure, to accommodate new and empower current residents of the city. Applying the novel link clustering community detection algorithm (Ahn et al., 2010) in this thesis I have presented the potential for better understanding the complexity behind the urban system of networked infrastructure, through discovering their overlapping communities. As I will show in the literature review (Chapter 2), the long standing tradition of centralised planning practice relying on zoning and infiltrating infrastructure, left us with urban settlements which are failing to respond to the environmental pressure and the socio-economic inequalities. Building on the myriad of knowledge from planners, geographers, sociologists and computer scientists, I developed a new element (i.e. link communities) within the theory of urban studies that defines cities as complex systems. After, I applied a method borrowed from the study of complex networks to unpack their basic elements. Knowing the link (i.e. functional, or overlapping) communities of metropolitan Glasgow enabled me to evaluate the current level of communities interconnectedness and reveal the gaps as well as the potentials for improving the studied system’s performance. The complex urban system in metropolitan Glasgow was represented by its networked infrastructure, which essentially was a system of distinct sub-systems, one of them mapped by a physical and the other one by a social graph. The conceptual framework for this methodological approach was formalised from the extensively reviewed literature and methods utilising network science tools to detect community structure in complex networks. The literature review led to constructing a hypothesis claiming that the efficiency of the physical network’s topology is achieved through optimizing the number of nodes with high betweenness centrality, while the efficiency of the logical network’s topology is achieved by optimizing the number of links with high edge betweenness. The conclusion from the literature review presented through the discourse on to the primal problem in 7.4.1, led to modelling the two network topologies as separate graphs. The bipartite graph of their primal syntax was mirrored to be symmetrical and converted to dual. From the dual syntax I measured the complete accessibility (i.e. betweenness centrality) of the entire area and not only of the streets. Betweenness centrality of a node measures the number of shortest paths that pass through the node connecting pairs of nodes. The betweenness centrality is same as the integration of streets in space syntax, where the streets are analysed in their dual syntax representation. Street integration is the number of intersections the street shares with other streets and a high value means high accessibility. Edges with high betweenness are shared between strong communities. Based on the theoretical underpinnings of the network’s modularity and community structure analysed herein, it can be concluded that a complex network that is both robust and efficient (and in urban planning terminology ‘sustainable’) is consisted of numerous strong communities connected with each other by optimal number of links with high edge betweenness. To get this insight, the study detected the edge cut-set and vertex cut-set of the complex network. The outcome was a statistical model developed in the open source software R (Ihaka and Gentleman, 1996). The model empirical detects the network’s overlapping communities, determining the current sustainability of its physical and logical topologies. Initially, an assumption was that the number of communities within the infrastructure (physical) network layer were different from the one in the logical. They were detected using the Louvain method that performs graph partitioning on the hierarchical streets structure. Further, the number of communities in the relational network layer (i.e. accessibility to locations) was detected based on the OD accessibility matrix established from the functional dependency between the household locations and predefined points of interest. The communities from the graph of the ‘relational layer' were discovered with the single-link hierarchical clustering algorithm. The number of communities observed in the physical and the logical topologies of the eight shires significantly deviated

The built environment and health: a spatial analysis of type 2 diabetes and childhood weight status in urban New Zealand.

The built environment is an integral aspect of everyday life. It provides the context in which individual behaviours are set and can affect both individual and population health. It is shaped by distal systematic drivers which influence demographic and epidemiological changes such as the globalisation of economic processes, urbanisation, mechanisation, changing agricultural and trade policies, and dietary transitions. These systematic drivers, in turn, influence local environments which act as proximal determinants of population outcomes. Subsequently, the contextual impact of the local built environment is considered to be an influential aspect of spatial disparities in population health outcomes. The focus of this thesis is on health outcomes of high weight status in children and population level Type 2 Diabetes Mellitus (T2DM). The prevalence of these health issues has increased alongside societal, demographic and cultural changes. While there are various biological, behavioural and environmental risk factors which influence the development of these health issues there is still much to be learned about both direct and indirect causes. The overall aim of this thesis is to analyse the built environment in urban New Zealand and investigate associations with the spatial epidemiology of two health outcomes, high weight status in children and population level T2DM. Despite substantial research and significant public attention directed toward these health issues within Aotearoa New Zealand, there are still critical gaps in the spatial understanding of such health outcomes. Current literature also highlights a lack of research which focuses on T2DM. This thesis addresses such research gaps using an ecological approach to analysis which utilises Geographic Information Systems (GIS) and spatial epidemiological methods. This is the first study in New Zealand to spatially quantify the effects of multiple environmental exposures on health outcomes of both high weight status in children and population level T2DM, for all urban areas, using a geospatial approach. It establishes novel measures of the built environment using data on fast food outlets, takeaways, dairy/convenience stores, supermarkets, fruit and vegetable stores, physical activity facilities, and greenspace to assess potential associations between contextual factors and health outcomes. In the context of this study, the former three of these categories are considered unhealthy exposures and detrimental to overall health. The latter four categories, in contrast, are considered to be healthy exposures and health-promoting. This thesis has, in turn, made original contributions to the current body of knowledge by: (1) including the use of both established and novel approaches to measuring various aspects of the built environment, and (2) analysing spatial data on health outcomes of high weight status in children and population level T2DM for all urban areas of New Zealand and assessing potential associations with the built environment. Such analysis also provides the opportunity to assess how the built environment may relate to not only outcomes of multiple chronic health conditions, but also different population groups. When considering relationships between measures of the built environment and socioeconomic deprivation, results of this study indicate that accessibility to both and unhealthy and healthy exposures is generally higher in the most deprived areas compared to the least deprived areas. This study also found some notable results when looking at the spatial distribution of both high weight status in children and population level T2DM, finding that T2DM is more spatially clustered than high weight status in children. Both health outcomes were also shown to be heavily influenced by demographic factors and associated with accessibility to environmental exposures. Interestingly, results show that both of these health issues may be more heavily influenced by health-promoting resources than those considered detrimental to health. Health-promoting resources were shown to have a consistently positive effect on both health outcomes, while those considered detrimental to health showed varying, and largely insignificant, associations. Caution must be exercised, however, to ensure that a balanced approach is taken within prevention efforts which addresses environmental factors as well as economic accessibility, individual behaviours and societal norms. The current study has implications for both policy and future research efforts as a deeper knowledge of local environments forms a basis on which to better understand spatial associations between the built environment and health as well as formulate policy directed toward environmental influences on chronic health conditions. It is vital to consider such contextual influences in order to better understand the spatial epidemiology of chronic health conditions in Aotearoa New Zealand. Accounting for these contextual influences within both research and policy can not only enhance understandings of such health concerns, but can also identify opportunities for prevention efforts. This thesis has, in turn, provided insight into such associations and a base from which to further address the complexities of such issues using a geospatial approach

The ecology of organizational forms in local and regional food systems: exploring the scaling-up challenge via a species concept

Includes vita.Over the past 30 years, Western nations have developed alternative systems for exchanging agrofood products which incorporate social values into the transactional environment. These systems are comprised of many different exchange relationships, structured to transmit information about social values and attach credence attributes to the products. New organizational forms, institutions, and networks arise to achieve the values demanded by the underlying social movement. One movement centers on the social value of a commitment to place. It seeks to create relocalized and socially embedded means of exchange. Policy initiatives have responded, making investments in local and regional food systems. The primary challenge faced by these initiatives: how to increase the of scale while maintaining the value premiums associated with the movement's objectives. I view these complex networks as ecologies and seek to understand how different organizational forms interact to scale-up LRFSs. I make three crucial developments: (1) a framework to define LRFSs; (2) a model on the metaphysics of social objects and their kinds; and (3) an Organizational Species Concept to consistently identify organizational forms. Together these developments enable an ecological approach by providing a means of identifying distinct organizational populations. I apply my OSC to the case of food hubs – coordinating intermediaries identified as a key for increased scale. This yields six "species". I find that each fills a different functional role and contributes differently to scaling-up LRFSs. I highlight how this is helpful for targeted policymaking.Includes bibliographical references (pages 286-301

The shrinking city school: following trajectories of shrinkage across three decades of an urban school desert

Late on the evening of January 12th, 2021, the Saint Louis Public Schools (SLPS) Board voted to close seven of its schools and transition one of its high schools to a middle school (Clancy, 2021). Sweeping closures are not a new phenomenon for the residents of St. Louis. Just in the last three decades, SLPS has closed 54 buildings, reducing its sites by 67 percent. What we understand about urban school closure, like those occurring in the city of St. Louis, encompasses official justifications for closure, the history and terms of the policies supporting or driving closure, and the actions taken by school districts as they enact closure. This study joins two spatial concepts, shrinkage and school deserts, through Doreeen Massey's relational politics of the spatial (2008) to explore a) the trajectories of shrinkage (out-migration, economic shifts, and housing) which require negotiation by the Saint Louis Public Schools and b) the resultant uneven distribution of educational access and academic pathways for St. Louis students. Through the creation of a Geographic Information Systems database this study utilizes descriptive statistics as produced from two spatial modeling tools in ARCGIS, each model established a layer which was combined to produce a final GIS database. Two key findings surfaced from this series of analysis. The first is that the variables of shrinkage are not randomly distributed across the St. Louis Metropolitan Area but in fact clustered. The second is a school desert patterning which suggests a) residents of south city, select west and north counties have greater access to a local public school while residents of north city have lost many of their local public schools since the year 2000 and b) a consequential relationship where a block group which shares boundaries with a flourishing school oasis is more likely to be a struggling school desert.Includes bibliographical references

UNDERSTANDING INTERGENERATIONAL MALNUTRITION IN RURAL BANGLADESH: A SYSTEMS APPROACH

Background: Determinants of malnutrition across the lifecycle are complex. Beyond host characteristics and behavioral choices, the immediate environment and broader societal context remains a challenge to measure. The JiVitA-1 trial in rural northwest Bangladesh reveals intergenerational spatial patterns of malnutrition, based on mid-upper arm circumference (MUAC), that converge with age from early life onward, suggesting possible contextual influences. This dissertation explores these spatial patterns, and investigates interactions among biological, socioeconomic and contextual factors on trajectories of nutritional status from birth to adulthood in this typical rural South Asian population. Methods: Spatial analysis with multiple-linear regression was used to assess independent and synergistic effects of individual, household and community factors, added sequentially, on MUAC among mother-infant dyads. Explanatory improvements and spatial correlation accounted for by characteristics at each level was considered. Results: Multilevel regression models explained 13.2%, 14.5%, and 11.7% of variabilty in MUAC of infants at birth and six months and expectant mothers, respectively. Most variability in MUAC was explained by individual and household-level variables. Community influences accounted for 0.3%, 0.4%, and 0.7% of the variability in MUAC at the two infant ages and among women, respecitvely. Infant growth between birth and six months was guided by initial size (r² = 0.33), and modified further by household and community socioeconomic-status (SES) and maternal nutritional status. The full multilevel model accounted for 40% of the variance in growth rate, 1% of which was attributed to community context. Including individual- and household-level variables provided modest reductions in residual spatial autocorrelation of MUAC, compared to reductions associated with contextual factors. Promising contextual variables included neighborhood economic structure, maternal education, elevation, population density, and travel-time to markets. Many contextual variables were correlated, indicating that those living in wealthier neighborhoods enjoy healthier environments, which may reinforce benefits of greater household and neighborhood SES. Conclusions: A systems science approach revealed multi-level and age-specific influences on infant and maternal nutritional status in this rural Bangladesh setting. Contextual variables explained differences in MUAC and reduced residual spatial autocorrelation more than individual and household variables combined. Correlations between contextual variables also indicated economically-driven population sorting in this typical rural setting

Injury-related infant mortality in West Virginia, 2010-2014

Background and objective Infant mortality in United States is high relative to other more developed nations. Therefore, there is a need to curb this trend, especially in states with high infant mortality rates. Hence, this research investigated and examined characteristics associated with injury-related infant death in West Virginia. The objective of this retrospective study was to 1) investigate maternal and infant characteristics associated with injury-related infant deaths in West Virginia, 2) examine the relationship between unintentional-injury-related infant death and rurality in West Virginia, holding other variables in the model constant, and 3) compare differences in the unintentional-injury related infant mortality rate between West Virginia and the United States as a whole, stratified by race/ethnicity. Methods De-identified linked birth-infant death data for the period 2010-2014 were sourced from the West Virginia Bureau for Public Health, Charleston WV and the United States linked birth-death vital records from the Centers for Disease Control website. Additionally, 2013 Urban Influence Codes used for urban/rural classification were sourced from the United States Department of Agriculture Economic Research Service. A generalized linear model with binomial distribution was used to determine characteristics associated with injury-related infant death, and a generalized linear mixed model with binomial distribution was used to determine the relationship between unintentional injury-injury related infant death and rurality, holding other variables in the model constant. A non-model-based method, which follows a simple Poisson distribution, was used to calculate the infant mortality rate in West Virginia and the United States, stratified by race. Results Maternal characteristics associated with injury-related infant mortality in West Virginia were race/ethnicity ( = 7.48, p = .03) and smoking during pregnancy ( , p \u3c .00). Risk of a Non-Hispanic Black infant for an injury-related death was 4.0 (95% CI: 1.7 - 9.3) times that of infants of other race/ethnicities. Unintentional injury-relate infant death was significantly associated with rurality, race/ethnicity and a rurality-smoking during pregnancy interaction (p=0.02, p=0.3, and p=0.05 respectively). The relative risk for unintentional injury-related infant death in rural versus urban counties was 1.7 (95% CI: 0.7- 3.8), whereas the unintentional injury-related infant mortality rate for West Virginia and the United States Non-Hispanic Black population was 83.2 (95% CI: 26.8 - 258.0) deaths per 100,000 live births and 57.5 (95% CI: 54.8 - 60.3) deaths per 100,000 live births, respectively. Conclusion Injury-related infant mortality is associated with race/ethnicity and smoking during pregnancy. Smoking during pregnancy and living in rural counties was related to higher risk of unintentional injury-related infant death than living in urban counties, whether or not the mother smoked during pregnancy. In general, the unintentional injury-related infant mortality rate in West Virginia and the nation are similar. Findings should be interpreted with caution due to the small number of cases. Nevertheless, this study provides important information to public health stakeholders, at both the state and local levels, for designing interventions for reduction or prevention of injury-related infant mortality in West Virginia