The complexities of measuring access to parks and physical activity sites in New York City: a quantitative and qualitative approach

<p>Abstract</p> <p>Background</p> <p>Proximity to parks and physical activity sites has been linked to an increase in active behaviors, and positive impacts on health outcomes such as lower rates of cardiovascular disease, diabetes, and obesity. Since populations with a low socio-economic status as well as racial and ethnic minorities tend to experience worse health outcomes in the USA, access to parks and physical activity sites may be an environmental justice issue. Geographic Information systems were used to conduct quantitative and qualitative analyses of park accessibility in New York City, which included kernel density estimation, ordinary least squares (global) regression, geographically weighted (local) regression, and longitudinal case studies, consisting of field work and archival research. Accessibility was measured by both density of park acreage and density of physical activity sites. Independent variables included percent non-Hispanic black, percent Hispanic, percent below poverty, percent of adults without high school diploma, percent with limited English-speaking ability, and population density.</p> <p>Results</p> <p>The ordinary least squares linear regression found weak relationships in both the park acreage density and the physical activity site density models (R_a²= .11 and .23, respectively; AIC = 7162 and 3529, respectively). Geographically weighted regression, however, suggested spatial non-stationarity in both models, indicating disparities in accessibility that vary over space with respect to magnitude and directionality of the relationships (AIC = 2014 and -1241, respectively). The qualitative analysis supported the findings of the local regression, confirming that although there is a geographically inequitable distribution of park space and physical activity sites, it is not globally predicted by race, ethnicity, or socio-economic status.</p> <p>Conclusion</p> <p>The combination of quantitative and qualitative analyses demonstrated the complexity of the issues around racial and ethnic disparities in park access. They revealed trends that may not have been otherwise detectable, such as the spatially inconsistent relationship between physical activity site density and socio-demographics. In order to establish a more stable global model, a number of additional factors, variables, and methods might be used to quantify park accessibility, such as network analysis of proximity, perception of accessibility and usability, and additional park quality characteristics. Accurate measurement of park accessibility can therefore be important in showing the links between opportunities for active behavior and beneficial health outcomes.</p

Not Just A Walk in The Park: methodological improvements for determining environmental justice implications of park access in New York City for the promotion of physical activity

The purpose of this study is to test the hypothesis that access to parks in New York City is not equitable across racial and ethnic categories. It builds on previous research that has linked access to parks and open space with increased physical activity, which in turn may reduce the risk for adverse health outcomes related to obesity. Systematic patterns of uneven access to parks might help to explain disparities in these health outcomes across sociodemographic populations that are not fully explained by individual-level risk factors and health behaviors, and therefore access to parks becomes an environmental justice issue. This study is designed to shed light on the “unpatterned inequities” of park distributions identified in previous studies of New York City park access. It uses a combination of network analysis and a cadastral-based expert dasymetric system (CEDS) to estimate the racial/ethnic composition of populations within a reasonable walking distance of 400m from parks. The distance to the closest park, number of parks within walking distance, amount of accessible park space, and number of physical activity sites are then evaluated across racial/ethnic categories, and are compared to the city-wide populations using odds ratios. The odds ratios revealed patterns that at first glance appear to contradict the notion of distributional inequities. However, discussion of the results points to the need for reassessing what is meant by “access” to more thoroughly consider the aspects of parks that are most likely to contribute to physical activity and positive health outcomes

Medication deserts: survey of neighborhood disparities in availability of prescription medications

Background Only a small amount of research has focused on the relationship between socio-economic status (SES) and geographic access to prescription medications at community pharmacies in North America and Europe. To examine the relationship between a community’s socio-economic context and its residents’ geographic access to common medications in pharmacies, we hypothesized that differences are present in access to pharmacies across communities with different socio-economic environments, and in availability of commonly prescribed medications within pharmacies located in communities with different socio-economic status. Methods We visited 408 pharmacies located in 168 socio-economically diverse communities to assess the availability of commonly prescribed medications. We collected the following information at each pharmacy visited: hours of operation, pharmacy type, in-store medication availability, and the cash price of the 13 most commonly prescribed medications. We calculated descriptive statistics for the sample and fitted a series of hierarchical linear models to test our hypothesis that the in-stock availability of medications differs by the socio-economic conditions of the community. This was accomplished by modeling medication availability in pharmacies on the socio-economic factors operating at the community level in a socio-economically devise urban area. Results Pharmacies in poor communities had significantly higher odds of medications being out of stock, OR=1.24, 95% CI [1.02, 1.52]. There was also a significant difference in density of smaller, independent pharmacies with very limited stock and hours of operation, and larger, chain pharmacies in poor communities as compared to the middle and low-poverty communities. Conclusions The findings suggest that geographic access to a neighborhood pharmacy, the type of pharmacy, and availability of commonly prescribed medications varies significantly across communities. In extreme cases, entire communities could be deemed “medication deserts” because geographic access to pharmacies and the availability of the most prescribed medications within them were very poor. To our knowledge, this study is first to report on the relationship between SES and geographic access to medications using small area econometric analysis techniques. Our findings should be reasonably generalizable to other urban areas in North America and Europe and suggest that more research is required to better understand the relationship of socio-economic environments and access to medications to develop strategies to achieve equitable medication access

Integrating Social Determinants of Health With Treatment and Prevention: A New Tool to Assess Local Area Deprivation

We assessed the appropriate geographic scale to apply an area deprivation index (ADI), which reflects a geographic area’s level of socioeconomic deprivation and is associated with health outcomes, to identify and screen patients for social determinants of health. We estimated the relative strength of the association between the ADI at various geographic levels and a range of hospitalization rates by using age-adjusted odds ratios in an 8-county region of New York State. The 10-km local ADI estimates had the strongest associations with all hospitalization rates (higher odds ratios) followed by estimates at 20 km, 30 km, and the regional scale. A locally sensitive ADI is an ideal measure to identify and screen for the health care and social services needs and to advance the integration of social determinants of health with clinical treatment and disease prevention

Menstrual Product Insecurity Resulting From COVID-19‒Related Income Loss, United States, 2020.

To identify key effects of the pandemic and its economic consequences on menstrual product insecurity with implications for public health practice and policy. Study participants (n = 1496) were a subset of individuals enrolled in a national (US) prospective cohort study. Three survey waves were included (March‒October 2020). Menstrual product insecurity outcomes were explored with bivariate associations and logistic regression models to examine the associations between outcomes and income loss. Income loss was associated with most aspects of menstrual product insecurity (adjusted odds ratios from 1.34 to 3.64). The odds of not being able to afford products for those who experienced income loss was 3.64 times (95% confidence interval [CI] = 2.14, 6.19) that of those who had no income loss and 3.95 times (95% CI = 1.78, 8.79) the odds for lower-income participants compared with higher-income participants. Pandemic-related income loss was a strong predictor of menstrual product insecurity, particularly for populations with lower income and educational attainment. Provision of free or subsidized menstrual products is needed by vulnerable populations and those most impacted by pandemic-related income loss.( 2022;112(4):675-684. (https://doi.org/10.2105/AJPH.2021.306674)

Household factors and the risk of severe COVID-like illness early in the U.S. pandemic

Objective To investigate the role of children in the home and household crowding as risk factors for severe COVID-19 disease. Methods We used interview data from 6,831 U.S. adults screened for the Communities, Households and SARS/CoV-2 Epidemiology (CHASING) COVID Cohort Study in April 2020. Results In logistic regression models, the adjusted odds ratio [aOR] of hospitalization due to COVID-19 for having (versus not having) children in the home was 10.5 (95% CI:5.7–19.1) among study participants living in multi-unit dwellings and 2.2 (95% CI:1.2–6.5) among those living in single unit dwellings. Among participants living in multi-unit dwellings, the aOR for COVID-19 hospitalization among participants with more than 4 persons in their household (versus 1 person) was 2.5 (95% CI:1.0–6.1), and 0.8 (95% CI:0.15–4.1) among those living in single unit dwellings. Conclusion Early in the US SARS-CoV-2 pandemic, certain household exposures likely increased the risk of both SARS-CoV-2 acquisition and the risk of severe COVID-19 disease

Ischaemic conditioning and targeting reperfusion injury: a 30 year voyage of discovery

To commemorate the auspicious occasion of the 30th anniversary of IPC, leading pioneers in the field of cardioprotection gathered in Barcelona in May 2016 to review and discuss the history of IPC, its evolution to IPost and RIC, myocardial reperfusion injury as a therapeutic target, and future targets and strategies for cardioprotection. This article provides an overview of the major topics discussed at this special meeting and underscores the huge importance and impact, the discovery of IPC has made in the field of cardiovascular research

Brownfields to Greenfields: Environmental Justice Versus Environmental Gentrification

Gentrification is a growing concern in many urban areas, due to the potential for displacement of lower-income and other vulnerable populations. This process can be accelerated when neighborhood &ldquo;greening&rdquo; projects are undertaken via governmental or private investor efforts, resulting in a phenomenon termed environmental or &ldquo;green&rdquo; gentrification. Vacant land in lower-income areas is often improved by the existing community through the creation of community gardens, but this contributes to these greening efforts and paradoxically may spur gentrification and subsequent displacement of the gardens&rsquo; stewards and neighbors. &ldquo;Is proximity to community gardens in less affluent neighborhoods associated with an increased likelihood of gentrification?&rdquo; Using Brooklyn, New York as a case study, we examined this question using Geographic Information Systems and two spatial methods: a census block group proximity analysis, and a hot spot analysis, to determine the potential impact of proximity to community gardens in lower-income areas. The results of the analyses suggest that proximity to community gardens is associated with significant increases in per capita income over the five years study period, which is indicative of areas undergoing gentrification. This has implications for environmental justice because existing lower-income residents are likely to be displaced after their community is improved environmentally

"They Didn't See It Coming": Green Resilience Planning and Vulnerability to Future Climate Gentrification

Unidad de excelencia María de Maeztu CEX2019-000940-MAs cities strive to protect vulnerable residents from climate risks and impacts, recent studies have identified a challenging link between these measures and gentrification processes that reconfigure, but do not necessarily eliminate, climate insecurities. Green resilient infrastructure (GRI) may especially increase the vulnerability of lower income communities of color to gentrification, an issue that remains underexplored. Drawing on the forerunner green city of Philadelphia, Pennsylvania, as our case study, this article adopts a novel intersectional approach to assess overlapping and interdependent factors in generating vulnerability and resilience using spatial quantitative data and qualitative interviews with community-based organizers, nonprofits, and municipal stakeholders. More specifically, this article develops a new methodology to assess vulnerability to future climate gentrification and contributes to debates on the role of urban development, housing, and sustainability practices in climate justice dynamics. It also informs strategies that can reduce social and racial inequities in the context of climate adaptation planning

Neighborhood Alcohol Outlet Density, Historical Redlining, and Violent Crime in NYC 2014–2018

Alcohol outlets tend to cluster in lower income neighborhoods and do so disproportionately in areas with more residents of color. This study explores the association between on- and off-premise alcohol outlet density and history of redlining with violent crime in New York City between 2014 and 2018. Alcohol outlet density was calculated using a spatial accessibility index. Multivariable linear regression models assess associations between the history of redlining, on-premise and off-premise alcohol outlet density with serious crime. Each unit increase in on- and off-premise alcohol density was associated with a significant increase in violent crime (β = 3.1, p p p p p < 0.001). The violent crime experienced by formerly redlined communities in New York City is likely related to a legacy of racialized housing policies and may be associated with state policies that allow for high neighborhood alcohol outlet density