Effects of residence and race on burden of travel for care: cross sectional analysis of the 2001 US National Household Travel Survey

BACKGROUND: Travel burden is a key element in conceptualizing geographic access to health care. Prior research has shown that both rural and minority populations bear disproportionate travel burdens. However, many studies are limited to specific types of patient or specific locales. The purpose of our study was to quantify geographic and race-based differences in distance traveled and time spent in travel for medical/dental care using representative national data. METHODS: Data were drawn from 2001 National Household Travel Survey (NHTS), a nationally representative, cross-sectional household survey conducted by the US Department of Transportation. Participants recorded all travel on a designated day; the overall response rate was 41%. Analyses were restricted to households reporting at least one trip for medical and/or dental care; 3,914 trips made by 2,432 households. Dependent variables in the analysis were road miles traveled, minutes spent traveling, and high travel burden, defined as more than 30 miles or 30 minutes per trip. Independent variables of interest were rural residence and race. Characteristics of the individual, the trip, and the community were controlled in multivariate analyses. RESULTS: The average trip for care in the US in 2001 entailed 10.2 road miles (16.4 kilometers) and 22.0 minutes of travel. Rural residents traveled further than urban residents in unadjusted analysis (17.5 versus 8.3 miles; 28.2 versus 13.4 km). Rural trips took 31.4% longer than urban trips (27.2 versus 20.7 minutes). Distance traveled did not vary by race. African Americans spent more time in travel than whites (29.1 versus 20.6 minutes); other minorities did not differ. In adjusted analyses, rural residence (odds ratio, OR, 2.67, 95% confidence interval, CI 1.39 5.1.5) was associated with a trip of 30 road miles or more; rural residence (OR, 1.80, CI 1.09 2.99) and African American race/ethnicity (OR 3.04. 95% CI 2.0 4.62) were associated with a trip lasting 30 minutes or longer. CONCLUSION: Rural residents and African Americans experience higher travel burdens than urban residents or whites when seeking medical/dental care

Associations of Neighborhood and Family Factors with Trajectories of Physical and Social Aggression During Adolescence

Adolescents develop within multiple contexts that synergistically influence their behavior and health. To understand the simultaneous influence of neighborhood and family contexts on adolescents, this study examined relationships of neighborhood socioeconomic disadvantage, neighborhood social disorganization, family conflict, parent-child bonding and parental control with trajectories of physical and social aggression. The sample included 5,118 adolescents between ages 11 and 18 (50% female, 52% Caucasian) living in predominantly rural areas. Multilevel growth curve models showed an interaction between neighborhood disadvantage, family conflict and gender on the physical aggression trajectories. The interaction suggested more rapid processes of both increase in and desistance from physical aggression over time for boys with high neighborhood disadvantage and high family conflict, as well as a higher starting point, more gradual increase and slower process of desistance over time for girls in similar neighborhood and family contexts. Less parent-child bonding and less parental control also were associated with higher initial levels of physical aggression. For social aggression, an interaction between family conflict and gender showed girls with high family conflict had the highest initial levels of social aggression, with a more gradual increase over time for these girls compared to their male counterparts in high-conflict families or their female counterparts in low-conflict families. Less parent-child bonding was associated with higher initial levels and a faster increase over time of social aggression, and less parental control was associated with higher initial levels of social aggression. The findings suggest early family-based interventions may help prevent perpetration of both physical and social aggression during adolescence

Economic analysis for ecosystem service assessments

The paper seeks to contribute to the expanding literature on ecosystem service assessment by considering its integration with economic analyses of such services. Focussing upon analyses for future orientated policy and decision making, we initially consider a single period during which ecological stocks are maintained at sustainable levels. The flow of ecosystems services and their contribution to welfare bearing goods is considered and methods for valuing resultant benefits are reviewed and illustrated via a case study of land use change. We then broaden our time horizon to discuss the treatment of future costs and benefits. Finally we relax our sustainability assumption and consider economic approaches to the incorporation of depleting ecological assets with a particular focus upon stocks which exhibit thresholds below which restoration is compromised