Advancements in mapping areas suitable for wetland habitats across the conterminous United States.

Wetland habitats provide critical ecosystem services to the surrounding landscape, including nutrient and pollutant retention, flood mitigation, and carbon storage. Wetland connectivity to water bodies and related ecosystems is critical in habitat sustainability, but there are limited resources for landscape-level wetland planning. Considering the network connectivity of an ecosystem type can derive different benefits to the natural and built environment, as well as human health. The value that wetlands provide, along with incentive programs and conservation goals mandated by the government require new and improved wetland spatial data. Utilizing high quality, publicly available data, this study finds that the amount of land in the United States that could support built or restored wetlands is more than double the area of mapped existing wetlands. This study uses 17 input variables (i.e., features extracted from remotely sensed data and auxiliary datasets) at the 10-m resolution and the National Wetlands Inventory to train a random forest model to identify areas that may support a wetland habitat, or potential wetland areas. Models were calculated for each of 18 two-digit hydrologic units that encompass the conterminous United States, and model overall accuracy ranged from 78.0 % to 89.8 %. The models predicted that 21.1 % of the conterminous United States can be categorized as potential wetland area. Selecting input variables to predict areas with wetland potential, rather than to identify existing wetlands, using the random forest algorithm can be transferred to other locations, scales, and ecosystem types. Visualizing potential wetland areas using input data at the 10-m resolution and enhanced methodology improves previous work, as even slight changes in topography, soils, and landscape features can determine ecosystem connections. This product can be used to better place wetland restoration projects to serve ecosystem- and community-wide health by ensuring ecosystem success and targeting areas that face increased climate change impacts.

Our national nutrient reduction needs: Applying a conservation prioritization framework to US agricultural lands.

Targeted conservation approaches seek to focus resources on areas where they can deliver the greatest benefits and are recognized as key to reducing nonpoint source nutrients from agricultural landscapes into sensitive receiving waters. Moreover, there is growing recognition of the importance and complementarity of in-field and edge-of-field conservation for reaching nutrient reduction goals. Here we provide a generic prioritization that can help with spatial targeting and applied it across the conterminous US (CONUS). The prioritization begins with identifying areas with high agricultural nutrient surplus, i.e., where the most nitrogen (N) and/or phosphorus (P) inputs are left on the landscape after crop harvest. Subwatersheds with high surplus included 52% and 50% of CONUS subwatersheds for N and P, respectively, and were located predominantly in the Midwest for N, in the South for P, and in California for both N and P. Then we identified the most suitable conservation strategies using a hierarchy of metrics including nutrient use efficiency (proportion of new nutrient inputs removed by crop harvest), tile drainage, existing buffers for agricultural run-off, and wetland restoration potential. In-field nutrient input reduction emerged as a priority because nutrient use efficiency fell below a high but achievable goal of 0.7 (30% of nutrients applied are not utilized) in 45% and 44% of CONUS subwatersheds for N and P, respectively. In many parts of the southern and western US, in-field conservation (i.e., reducing inputs + preventing nutrients from leaving fields) alone was likely the optimal strategy as agriculture was already well-buffered. However, stacking in-field conservation with additional edge-of-field buffering would be important to conservation strategies in 35% and 29% of CONUS subwatersheds for N and P, respectively. Nutrient use efficiencies were often high enough in the Midwest that proposed strategies focused more on preventing nutrients from leaving fields, managing tile effluent, and buffering agricultural fields. Almost all major river basins would benefit from a variety of nutrient reduction conservation strategies, underscoring the potential of targeted approaches to help limit excess nutrients in surface and ground waters.

Using cellular device location data to estimate visitation to public lands: Comparing device location data to U.S. National Park Service's visitor use statistics.

Understanding human use of public lands is essential for management of natural and cultural resources. However, compiling consistently reliable visitation data across large spatial and temporal scales and across different land managing entities is challenging. Cellular device locations have been demonstrated as a source to map human activity patterns and may offer a viable solution to overcome some of the challenges that traditional on-the-ground visitation counts face on public lands. Yet, large-scale applicability of human mobility data derived from cell phone device locations for estimating visitation counts to public lands remains unclear. This study aims to address this knowledge gap by examining the efficacy and limitations of using commercially available cellular data to estimate visitation to public lands. We used the United States' National Park Service's (NPS) 2018 and 2019 monthly visitor use counts as a ground-truth and developed visitation models using cellular device location-derived monthly visitor counts as a predictor variable. Other covariates, including park unit type, porousness, and park setting (i.e., urban vs. non-urban, iconic vs. local), were included in the model to examine the impact of park attributes on the relationship between NPS and cell phone-derived counts. We applied Pearson's correlation and generalized linear mixed model with adjustment of month and accounting for potential clustering by the individual park units to evaluate the reliability of using cell data to estimate visitation counts. Of the 38 parks in our study, 20 parks had a correlation of greater than 0.8 between monthly NPS and cell data counts and 8 parks had a correlation of less than 0.5. Regression modeling showed that the cell data could explain a great amount of the variability (conditional R-squared = 0.96) of NPS counts. However, these relationships varied across parks, with better associations generally observed for iconic parks. While our study increased our confidence in using cell phone data to estimate visitation, we also became aware of some of the limitations and challenges which we present in the Discussion.

Association of Redlining and Natural Environment with Depressive Symptoms in Women in the Sister Study.

BACKGROUND: Improving mental health is recognized as an important factor for achieving global development goals. Despite strong evidence that neighborhood greenery promotes better mental health, there are environmental justice concerns over the distribution of neighborhood greenery. Underlying these concerns are present-day consequences of historical discriminatory financial investment practices, such as redlining which was established by the U.S. Federal Home Owners' Loan Corporation (HOLC) in the 1930s. The impacts of redlining on environmental and health disparities have been researched extensively. However, the influences of redlining on the associations between neighborhood environment and health outcomes have not been fully assessed. OBJECTIVES: The aim of this study was to examine whether associations between residential tree cover and depressive symptoms vary across areas subject to HOLC practices. METHODS: Depressive symptoms were defined by the 10-item Center for Epidemiologic Studies Depression Scale collected during the period 2008-2012 for 3,555 women in the Sister Study cohort residing in cities subject to HOLC practices across the United States. HOLC rating maps were obtained from the Mapping Inequality Project, University of Richmond, with neighborhoods graded as A (best for financial investment, green), B (still desirable, blue), C (declining, yellow), and D (hazardous, red-known as redlined). Tree cover within 500m and 2,000m from residences was estimated using 2011 U.S. Forest Service Percent Tree Canopy Cover. Mixed model using climate zone as the random effect was applied to evaluate the associations with adjustments for potential covariates. Analyses were stratified by HOLC grade. RESULTS: Tree cover was significantly higher in neighborhoods with better HOLC grades. A 10% increase in tree cover was associated with reduced odds of depressive symptoms for the full study population, with adjusted odds ratios (AORs) of 0.93 [95% confidence interval (CI): 0.88, 0.99], and 0.91 (0.85, 0.97) for 500-m and 2,000-m buffer, respectively. Across HOLC grades, the strongest associations were observed in redlined neighborhoods, with respective AORs of 0.72 (95% CI: 0.52, 0.99) and 0.63 (95% CI: 0.45, 0.90) for 500-m and 2,000-m buffer. DISCUSSION: Findings support a remediation strategy focused on neighborhood greenery that would address multiple public health priorities, including mental health and environmental justice. https://doi.org/10.1289/EHP12212.

Improving intelligent dasymetric mapping population density estimates at 30 m resolution for the conterminous United States by excluding uninhabited areas.

Population change impacts almost every aspect of global change from land use, to greenhouse gas emissions, to biodiversity conservation, to the spread of disease. Data on spatial patterns of population density help us understand patterns and drivers of human settlement and can help us quantify the exposure we face to natural disasters, pollution, and infectious disease. Human populations are typically recorded by national or regional units that can vary in shape and size. Using these irregularly sized units and ancillary data related to population dynamics, we can produce high-resolution gridded estimates of population density through intelligent dasymetric mapping (IDM). The gridded population density provides a more detailed estimate of how the population is distributed within larger units. Furthermore, we can refine our estimates of population density by specifying uninhabited areas which have impacts on the analysis of population density such as our estimates of human exposure. In this study, we used various geospatial datasets to expand the existing specification of uninhabited areas within the United States (US) Environmental Protection Agency's (EPA) EnviroAtlas Dasymetric Population Map for the conterminous United States (CONUS). When compared to the existing definition of uninhabited areas for the EnviroAtlas dasymetric population map, we found that IDM's population estimates for the US Census Bureau blocks improved across all states in the CONUS. We found that IDM performed better in states with larger urban areas than in states that are sparsely populated. We also updated the existing EnviroAtlas Intelligent Dasymetric Mapping toolbox and expanded its capabilities to accept uninhabited areas. The updated 30 m population density for the CONUS is available via the EPA's Environmental Dataset Gateway (Baynes et al., 2021, https://doi.org/10.23719/1522948) and the EPA's EnviroAtlas https://www.epa.gov/enviroatlas, last access: 15 June 2022; Pickard et al., 2015).

Development of the United States Environmental Protection Agency's Facilities Status Dashboard for the COVID-19 Pandemic: Approach and Challenges.

Objectives: Develop a tool for applying various COVID-19 re-opening guidelines to the more than 120 U.S. Environmental Protection Agency (EPA) facilities. Methods: A geographic information system boundary was created for each EPA facility encompassing the county where the EPA facility is located and the counties where employees commuted from. This commuting area is used for display in the Dashboard and to summarize population and COVID-19 health data for analysis. Results: Scientists in EPA's Office of Research and Development developed the EPA Facility Status Dashboard, an easy-to-use web application that displays data and statistical analyses on COVID-19 cases, testing, hospitalizations, and vaccination rates. Conclusion: The Dashboard was designed to provide readily accessible information for EPA management and staff to view and understand the COVID-19 risk surrounding each facility. It has been modified several times based on user feedback, availability of new data sources, and updated guidance. The views expressed in this article are those of the authors and do not necessarily represent the views or the policies of the U.S. Environmental Protection Agency.

A landscape assessment and associated dataset of stream confluences for the conterminous U.S.

Stream confluences are important components of fluvial networks. Hydraulic forces meeting at stream confluences often produce changes in streambed morphology and sediment distribution. These changes often increase habitat heterogeneity relative to upstream and downstream locations, which have led some to identify them as biological hotspots. Despite their potential ecological importance, there are relatively few empirical studies documenting ecological patterns upstream and downstream of confluences. We have produced a publicly available dataset of stream confluences and associated watershed attributes for the conterminous USA. The dataset includes 1,085,629 stream confluences and 383 attributes for each confluence organized into 15 dataset tables for both tributary and mainstem upstream catchments and watersheds. Themes in the dataset include hydrology (e.g., stream order), land cover, land cover change, geology (e.g., calcium content of underlying lithosphere), physical condition (e.g., precipitation), measures of ecological integrity, and stressors (e.g., impaired streams). Additionally, we used measures of ecological integrity to assess the condition of the stream confluences. Aside from a generally positive east-to-west gradient in ecological condition, we found that approximately one-third of the confluences had markedly contrasting ecological conditions between mainstem and tributary, catchment and watershed, or both. The dataset should support many, multifaceted studies of stream confluence ecology.

Types and spatial contexts of neighborhood greenery matter in associations with weight status in women across 28 U.S. communities.

Excess body weight is a risk factor for many chronic diseases. Studies have identified neighborhood greenery as supportive of healthy weight. However, few have considered plausible effect pathways for ecosystem services (e.g., heat mitigation, landscape aesthetics, and venues for physical activities) or potential variations by climate. This study examined associations between weight status and neighborhood greenery that capture ecosystem services most relevant to weight status across 28 U.S. communities. Weight status was defined by body mass index (BMI) reported for 6591 women from the U.S. Sister Study cohort. Measures of greenery within street and circular areas at 500 m and 2000 m buffer distances from homes were derived for each participant using 1 m land cover data. Street area was defined as a 25 m-wide zone on both sides of street centerlines multiplied by the buffer distances, and circular area was the area of the circle centered on a home within each of the buffer distances. Measures of street greenery characterized the pedestrian environment to capture physically and visually accessible greenery for shade and aesthetics. Circular greenery was generated for comparison. Greenery types of tree and herbaceous cover were quantified separately, and a combined measure of tree and herbaceous cover (i.e., aggregate greenery) was also included. Mixed models accounting for the clustering at the community level were applied to evaluate the associations between neighborhood greenery and the odds of being overweight or obese (BMI > 25) with adjustment for covariates selected using gradient boosted regression trees. Analyses were stratified by climate zone (arid, continental, and temperate). Tree cover was consistently associated with decreased odds of being overweight or obese. For example, the adjusted odds ratio [AOR] was 0.92, 95% Confidence Interval [CI]: 0.88-0.96, given a 10% increase in street tree cover at the 2000 m buffer across the 28 U.S. communities. These associations held across climate zones, with the lowest AOR in the arid climate (AOR: 0.74, 95% CI: 0.54-1.01). In contrast, associations with herbaceous cover varied by climate zone. For the arid climate, a 10% increase in street herbaceous cover at the 2000 m buffer was associated with lower odds of being overweight or obese (AOR: 0.75, 95% CI: 0.55-1.03), whereas the association was reversed for the temperate climate, the odds increased (AOR: 1.19, 95% CI: 1.05-1.35). Associations between greenery and overweight/obesity varied by type and spatial context of greenery, and climate. Our findings add to a growing body of evidence that greenery design in urban planning can support public health. These findings also justify further defining the mechanism that underlies the observed associations.

Ecosystem services consideration in the remediation process for contaminated sites.

In 2009, the U.S. Environmental Protection Agency's Science Advisory Board recommended activities to advance consideration of ecosystem services (ES) to enhance existing remediation and redevelopment processes in the U.S. This article examines advancements in the decade since, focusing on providing those involved in cleanup of contaminated sites a basic understanding of ES concepts and guidelines for considering ES at cleanup sites using a new, four-step transferable framework. Descriptions, including activities for site teams and case study applications of ES tools, are presented for each step: (1) identify site-specific ES; (2) quantify relevant ES; (3) examine how cleanup activities affect ES; and (4) identify, select, and implement solutions (e.g., Best Management Practices). The goal of this article is to provide site cleanup stakeholders, including project managers, contractors, and site responsible parties, with a stronger foundation and shared understanding to consider ES during the cleanup process for their given site. Anticipated outcomes include identifying ES benefits to inform management and tradeoff analyses, a reduction in unintended impacts on ES during site operations, and attention to developing a robust suite of ES relevant for site reuse.

Practical Family Medicine: After-Hours Video Telehealth, Office Procedures, Polyp Follow-up in Older Patients, Terminology for Domestic Violence Intervention.

This issue primarily contains practice-based research reports. For a commentary on these articles, see Tapp.1 JABFM also has a call for submissions and accepted pre-print articles specifically on COVID at our Web site, www.jabfm.org These online COVID-related articles will be collated into a future print issue. This issue also has additional articles, encompassing a range of issues, as is common for JABFM.

Sediment retention by natural landscapes in the conterminous United States.

Soils provide vital ecosystem services, from sequestering carbon to providing food and moderating floods. Soil erosion threatens the provisioning of these services and degrades downstream water quality. Vegetation plays an important role in soil retention: by holding it in place, soil can continue to provide ecosystem goods and services and protect water resources. The aims of this study were to: (1) develop a 30-meter resolution map of erosion in the conterminous United States, and (2) quantify the soil retention service of natural vegetation. Using the Revised Universal Soil Loss Equation and physiographic and remote sensing datasets, we estimated sheet and rill erosion. We also developed a map of sediment delivery ratio to connect erosion to downstream delivery using hydrologic connectivity. The estimated sheet and rill erosion in the conterminous United States was 1.55 Pg yr-1, of which 0.52 Pg yr-1 reached waterbodies. Natural land cover prevents 12.3 Pg yr-1 of sheet and rill erosion and 5.1 Pg yr-1 in delivery to waterbodies. The value of natural land cover in retaining sediment is a function of the land cover, physiographic characteristics, and spatial context. This study has implications for spatial prioritization of natural land cover preservation and agricultural land management to minimize sediment erosion and delivery.

Earth Observation-Based Ecosystem Services Indicators for National and Subnational Reporting of the Sustainable Development Goals.

Decision-making that impacts sustainability occurs at national and subnational levels, highlighting the need for multi-scale Earth observations (EO) and geospatial data for assessing the United Nations' Sustainable Development Goals (SDGs). EnviroAtlas, developed by the United States Environmental Protection Agency and partners, provides a collection of web-based, interactive maps of environmental and socio-economic data relevant to the SDGs. EnviroAtlas maps ecosystem services indicators at national, regional, and local extents that can contribute to targets set forth in numerous goals, such as SDG 6 for clean water, SDG 11 for sustainable cities and communities, and SDG 15 for life on land. Examples of EnviroAtlas indicators that provide a way to view spatial inequalities, help fill gaps in environmental indicators, and integrate socio-economic and environmental data for the SDGs are explored herein. Remotely sensed EO data are essential for producing these indicators and informing planning and decision-making for the SDGs at subnational scales. The National Land Cover Dataset is the basis for many EnviroAtlas maps at the national extent, while National Agriculture Imagery Program and Light Detection and Ranging (LiDAR) data are used to classify Meter-scale Urban Land Cover in select US metro areas. These 30 meter and 1 meter land cover products are combined with demographic and other geospatial data (remotely sensed and otherwise) to produce integrated indicators that can aid in target setting of the SDGs. Though EnviroAtlas was created for the conterminous US, the methods for indicator creation are transferable, and the open-source code for the EnviroAtlas resource may serve as an example for other nations. Achieving the SDGs means assessing targets and decision-making outcomes at local, regional, and national levels using consistent and accurate data. Geospatial resources like EnviroAtlas that provide open access to indicators based on EO data and allow for assessment at multiple extents and resolutions are critical to broadly addressing national to subnational SDG goals and targets.

Medications, Medicating, and Medicated-When, Where, and How-Opioids and Others.

Medication therapy emerged as a theme for this issue-from many perspectives and for different conditions. We have several articles on opioids, including for pain/noncancer pain; use by older drivers and their reported driving; and the advantages of family medicine treatment sites. A related article explores chronic widespread pain and concurrent low back pain. In addition, this issue covers the gamut of prescribing inappropriate medications for older individuals and prescribing antibiotics when a CT scan of the abdomen would not have found an indication for such treatment. Other included topics include social complexity and impact on primary care physician income.

Well-Being, New Technologies, and Clinical Evidence for Family Physicians.

This special issue contains several articles on well-being. Not surprisingly, many of these articles are specifically about burnout. The evidence shows differences in the rates of burnout between men and women family physicians as well as their responses. Clinical team structure and organizational change also contribute to burnout. What about the electronic medical record? We are also reminded that burnout is an international issue. There are also several articles on how technology is changing the way family physicians practice. Two articles report on issues regarding screening for frequently seen clinical entities, specifically breast cancer and alcohol misuse. There are also articles looking at the cost of medical assistant turnover in practices, the impact of continuity with a provider on the retention of patients in clinical trials, and much more of interest to family physicians.

How do natural features in the residential environment influence women's self-reported general health? Results from cross-sectional analyses of a U.S. national cohort.

BACKGROUND: The relationship between health and human interaction with nature is complex. Here we conduct analyses to provide insights into potential health benefits related to residential proximity to nature. OBJECTIVES: We aimed to examine associations between measures of residential nature and self-reported general health (SRGH), and to explore mediation roles of behavioral, social, and air quality factors, and variations in these relationships by urbanicity and regional climate. METHODS: Using residential addresses for 41,127 women from the Sister Study, a U.S.-based national cohort, we derived two nature exposure metrics, canopy and non-gray cover, using Percent Tree Canopy and Percent Developed Imperviousness from the National Land Cover Database. Residential circular buffers of 250 m and 1250 m were considered. Gradient boosted regression trees were used to model the effects of nature exposure on the odds of reporting better SRGH (Excellent/Very Good versus the referent, Good/Fair/Poor). Analyses stratified by urbanicity and regional climate (arid, continental, temperate) and mediation by physical activity, social support, and air quality were conducted. RESULTS: A 10% increase in canopy and non-gray cover within 1250 m buffer was associated with 1.02 (95% CI: 1.00-1.03) and 1.03 (95% CI: 1.01-1.04) times the odds of reporting better SRGH, respectively. Stronger associations were observed for the urban group and for continental climate relative to other strata. Social support and physical activity played a more significant mediation role than air quality for the full study population. DISCUSSION: Findings from this study identified a small but important beneficial association between residential nature and general health. These findings could inform community planning and investments in neighborhood nature for targeted health improvements and potential societal and environmental co-benefits.

Many Family Medicine Successful Interventions and Clinical Reviews for Common Illnesses.

Family physician researchers continue to provide assistance to improve family medicine care. Commentaries on social determinants of health lead off this issue. Next, we have several papers on successful interventions by clinicians and/or patients to improve diabetes control, and then other provide information on other practice interventions that make a difference in overall care. Drug advertising continues to mislead. There is costly and nonproductive overuse of specific types of care. Herein is also a Scoping Review of possible indices for determining timely initiation of advance care planning. The issue's clinical reviews on use of transgender care, cervical myelopathy, and inhaled steroids for chronic obstructive pulmonary disease are pertinent, thorough, and timely.

Increasing Article Visibility: JABFM and Author Responsibilities and Possibilities.

JABFM seeks to widely disseminate its peer-reviewed publications, increasing article visibility for the purpose of advancing scientific knowledge. We describe the journal's approach to dissemination and recommend a number of strategies for authors to implement, including press releases and social media. Providing the article's digital object identifier (DOI) is most useful, compared with links that can break, or attaching the article PDF, which will depress reader metrics. All JABFM articles are freely accessible online worldwide.