Does Where You Live Make You Fat? Obesity and Access to Chain Grocers

This paper investigates the role that aspects of the physical environment play in determining health outcomes in adults as measured by body mass index (BMI). Using spatial econometric techniques that allow for spatial spillovers and feedback processes, this research specifically examines how differing levels of access to large chain grocers has on individual health outcomes. While other studies have investigated the impact of proximity to food retailers, the pointcoordinate data used in this paper is uniquely suited to spatial econometric estimation at the individual level. In addition to modeling spatial dependence and allowing for unobserved neighborhood effects, the flexibility of the model is increased by incorporating potential spatial heterogeneity between wealthier and lower-income neighborhoods. Using survey responses tied to geographic location, demographic, behavioral, and access to chain grocers, this study finds evidence of spatial dependence pointing to locational impacts on BMI. The effect on individual health outcomes of retailer access improvements varies depending on neighborhood characteristics. Our findings suggest structural differences in the variation and sensitivity of BMI dependent jointly on individual and neighborhood characteristics.body mass index, obesity, spatial dependence, obesogenic environments

Obesity in Urban Food Markets: Evidence from Geo-referenced Micro Data

This paper provides quantitative estimates of the effect of proximity to fast food restaurants and grocery stores on obesity in urban food markets. Our empirical model combined georeferenced micro data on access to fast food restaurants and grocery stores with data about salient personal characteristics, individual behaviors, and neighborhood characteristics. We defined a "local food environment" for every individual utilizing 0.5-mile buffers around a person's home address. Local food landscapes are potentially endogenous due to spatial sorting of the population and food outlets, and the body mass index (BMI) values for individuals living close to each other are likely to be spatially correlated because of observed and unobserved individual and neighborhood effects. The potential biases associated with endogeneity and spatial correlation were handled using spatial econometric estimation techniques. Our policy simulations for Indianapolis, Indiana, focused on the importance of reducing the density of fast food restaurants or increasing access to grocery stores. We accounted for spatial heterogeneity in both the policy instruments and individual neighborhoods, and consistently found small but statistically significant effects for the hypothesized relationships between individual BMI values and the densities of fast food restaurants and grocery stores.obesity, fast food, grocery store, spatial econometrics, micro data, Agricultural and Food Policy, Community/Rural/Urban Development, Consumer/Household Economics, Food Consumption/Nutrition/Food Safety, Health Economics and Policy, Public Economics, Research Methods/ Statistical Methods, C31, D12, I12, I18,

The Politics of the Multi-Local in Disaster Governance

‘Localisation’ became the new buzzword after the World Humanitarian Summit in 2016. However, the nature of the commitment to localisation since has been questioned. What is ‘the local’? How does localisation work in practice? With little empirical research, generalities in theory and practice have prevailed, preventing a nuanced approach to conceptualising the local. This study aims to build a foundation for the understanding of connotative, nuanced ‘locals’ and to explore the multiple dimensions of the local in both theory and practice. The methodology of a case study research, with a semi-structured and flexible approach, facilitated the identification of different elements of a locally led response that resounded in each of the cases. Combined with a literature review, this article aims to answer the questions: What underlying assumptions regarding the local are found in localisation rhetoric, and how do multi-local dynamics challenge locally led disaster response in practice? Answering this question necessitates deconstructing the multi-local in theory and critically examining expressions concerning the local in practice. In this study, one dimension of the local that was observed was ‘the local as locale,’ with the local describing primarily national actors as opposed to the international, without taking local power dynamics into account. The local was also seen in terms of governance, where local–national relations and intranational strife characterised locally led responses, and the national focus excluded local actors who were not usually involved in governance. The local also became a source of legitimation, with local, national and international actors all using the discourse of ‘the state in charge’ and ‘the community knows best’ to legitimise their own role as response actors while disputing others’ capacities. The multi-local lens provides a perspective with potential to change current practices and contribute to a more transformative agenda

Bi/Multiracial Identity and Women's and Gender Issues in the U.S.

This issue brief will focus on an analysis of bi/multiracial Americans' views on various women's and gender issues, especially the intersection of racism and sexism, feminism, and reproductive rights

Reconsultation, self-reported health status and costs following treatment at a musculoskeletal Clinical Assessment and Treatment Service (CATS): a 12-month prospective cohort study

Objectives To determine (1) reconsultation frequency, (2) change in self-reported health status, (3) baseline factors associated with reconsultation and change in health status and (4) associated healthcare costs and quality-adjusted life-years (QALYs), following assessment at a musculoskeletal Clinical and Assessment Treatment Service (CATS). Design Prospective cohort study. Setting Single musculoskeletal CATS at the primary–secondary care interface. Participants 2166 CATS attenders followed-up by postal questionnaires at 6 and 12 months and review of medical records. Outcome measures Primary outcome was consultation in primary care with the same musculoskeletal problem within 12 months. Secondary outcome measures were consultation at the CATS with the same musculoskeletal problem within 12 months, physical function and pain (Short Form-36), anxiety and depression (Hospital Anxiety and Depression Scale), time off work, healthcare costs and QALYs. Results Over 12 months, 507 (38%) reconsulted for the same problem in primary care and 345 (26%) at the CATS. Primary care reconsultation in the first 3 months was associated with baseline pain interference (relative risk ratio 5.33; 95% CI 3.23 to 8.80) and spinal pain (1.75; 1.09 to 2.82), and after 3–6 months with baseline assessment by a hospital specialist (2.06; 1.13 to 3.75). Small mean improvements were seen in physical function (1.88; 95% CI 1.44 to 2.32) and body pain (3.86; 3.38 to 4.34) at 6 months. Poor physical function at 6 months was associated with obesity, chronic pain and poor baseline physical function. Mean (SD) 6-month cost and QALYs per patient were £422.40 (660.11) and 0.257 (0.144), respectively. Conclusions While most patients are appropriate for a ‘one-stop shop’ model, those with troublesome, disabling pain and spinal pain commonly reconsult and have ongoing problems. Services should be configured to identify and address such clinical complexity

The MUARC-TAC enhanced crash investigation study: study update, analysis of crash types and contributing factors [Abstract]

This paper presents an update of the Monash University Accident Research Centre (MUARC) – Transport Accident Commission (TAC) Enhanced Crash Investigation Study (ECIS) as well as an exploration of the characteristics of injured drivers, crash types and factors implicated in crash occurrence. Three configurations are of particularly high frequency and severity, whilst crashes involving young and older drivers are different in nature and have different contributing factors. Fatigue, driver error, and pre-crash driver blackouts due to medical conditions were prominent contributing factors. Injury severity would be significantly lower in 32% of cases if either front or side airbags were fitted. The findings point to key risk factors that can be addressed in road safety strategies

A gene based combination test using GWAS summary data

Article describes how gene-based association tests provide a useful alternative and complement to the usual single marker association tests, especially in genome-wide association studies (GWAS). The authors propose a test named OWC based on summary statistics from GWAS data

The MUARC-TAC enhanced crash investigation study: a platform to understand the causes and consequences of serious injury crashes.

Background: In recognising the consequences of serious injury crashes, the Transport Accident Commission (TAC) commissioned Monash University Accident Research Centre (MUARC) to undertake the Enhanced Crash Investigation Study (ECIS). This paper describes the program components, seven key research questions and technical innovations used in the study. We describe the information collected and outline a ‘Safe Systems Failure Analysis’ used for each case. Project Method: Participants in ECIS include drivers aged 18 years and older seriously injured in crashes on public Victorian roads. Drivers are recruited whilst inpatients at a major trauma hospital and where possible interviews conducted. The ECIS team inspects their crashed vehicle and critically analyses the crash environment. Event Data Recorder (EDR, black-box) data is acquired from vehicles where possible and crash reconstructions are undertaken. Each case is submitted to an internal panel review with a sub-sample of cases presented to external panels throughout Victoria. This process leads to each case being submitted to a Safe Systems Failure Analysis where contributing factors and countermeasures are identified by a broad group of stakeholders. The ECIS control arm permits examination of the relationship between certain factors, such as speed and crash occurrence. Results and Discussion: In addition to describing the study, we provide an example of how the identification of crash factors, using a Safe Systems paradigm based on real-world serious injury crashes, can lead to the identification of targeted countermeasures, each with an identified policy action. Implications: This paper will demonstrate a method for creating a robust evidence base upon which government road safety policy can be built. By scaling up individual crash findings to the broader crash population, countermeasures and associated policy actions can be appropriately prioritised

What drivers do while speeding: examining the associations between speeding and driver distraction through the Enhanced Crash Investigation Study protocol [Abstract]

This paper represents an exploratory analysis to assess the feasibility of assessing the relationship between driver speed and engagement in potentially distracting behaviours. Control data from the ECIS project are examined. These data include both objective speed measurements recorded via laser camera positioned at ECIS case-vehicle crash locations as well as retrospective self-reported driving behaviours from drivers recorded at these sites. Exploratory analysis suggests that the activities reported by drivers with recorded speeds above the limit may differ from the activities reported by those recorded on or below the limit