Practicing community geography in times of crisis.

Community geography emphasizes the centrality of community engagement to socially transformative research. This introduction to a special issue of GeoJournal on community geography outlines how this growing subfield provides a model for collaborative action with the crises of our time, from white supremacy through climate change. As the co-editors of this special issue, we summarize the contents of these 14 articles, grouping them by the shared themes of power, institutional partnerships, pedagogy, and methods.

Regional differences in exertional heat illness rates among Georgia USA high school football players.

Many high school associations in recent years are developing policies to improve player safety regarding exertional heat illnesses (EHIs). A question is whether states with diverse climates need multiple sets of guidelines with different activity modification thresholds. We examine this question in the state of Georgia, which has a diverse climate. Our study leverages a multi-year dataset of exertional heat illnesses (EHIs) among high school football players to test the hypothesis that EHI rates under similar wet bulb globe temperatures (WBGTs) will be greater among athletes in the cooler, northern region versus warmer, southern region of the state. The focus of this study is on a 3-year period (2012-2014) when uniform heat safety polices, including acclimatization and activity modification guidelines, were implemented across the state. Results show that athletes in the northern region acclimatize to cooler conditions. Almost 68% of practices have WBGTs < 27.8 °C (82 °F) compared to the southern region where athletes receive many times the exposures to hotter WBGTs in the 27.8-30.5 °C and 30.6-32.2 °C categories. In the post-acclimatization period, we observed statistically significantly (p < .05) greater EHI rates among athletes in the northern region of the state, even when controlling for meteorological conditions. Our findings suggest that differential acclimatization between football players in the northern and southern regions of the state is impacting EHI rates and that regional heat safety guidelines may be needed in Georgia and other states with similarly diverse climates.

Impact of Grocery Store Proximity on Store Preference Among Atlanta SNAP-Ed Participants.

OBJECTIVE: To assess the association between grocery store proximities and the individual's grocery store preferences among Supplemental Nutrition Assistance Program Education participants in Atlanta. METHODS: University of Georgia Supplemental Nutrition Assistance Program Education participants (n = 615, response rate is 36%) in 3 counties provided their preferred grocery store chains. The association between store proximity (both network distance and driving time) and store preference was measured through logistic regression controlling for age, sex, and race. RESULTS: Descriptive statistics showed participants had widely varying proximities to grocery stores. Model results were significant for all smaller chains (Aldi, Big Bear, Wayfield, Food Depot, and Save-A-Lot), Kroger (P < 0.01), as well as for Walmart (time only, P = 0.002). CONCLUSIONS AND IMPLICATIONS: Future studies might identify whether local groceries are more willing to partner on interventions or are more effective at reaching local residents. Surveys or techniques such as sketch mapping could also show whether individuals shop in neighborhoods close to work or friends and family.

Racial disparities for COVID19 mortality in Georgia: Spatial analysis by age based on excess deaths.

INTRODUCTION: This study uses multiple measures of excess deaths to analyze racial disparities in COVID-19 mortality across Georgia. METHODS: The Georgia Department of Public Health provided monthly mortality data for 2010-2020 stratified by race/ethnicity, age, county, and recorded cause of death. We first calculate crude mortality rates by health district during the time period for all groups for March through June for our historical period to identify significant time-series outliers in 2020 distinguishable from general trend variations. We then calculate the mean and standard deviation of mortality rates by age and racial subgroup to create historic confidence intervals that contextualize rates in 2020. Lastly, we use risk ratios to identify disparities in mortality between Black and White mortality rates both in the 2010-2019 period and in 2020. RESULTS: Time-series analysis identified three health districts with significant increases in mortality in 2020, located in metro Atlanta and Southwest Georgia. Mortality rates decreased sharply in 2020 for children in both racial categories in all sections of the state, but rose in a majority of districts for both categories in adult and older populations. Risk ratios also increased significantly in 2020 for children and older populations, showing rising disparities in mortality during the pandemic even as crude mortality rates declined for children classified as Black. CONCLUSIONS: Increased mortality during the COVID-19 outbreak disproportionately affected African-Americans, possibly due, in part, to pre-existing disparities prior to the pandemic linked to social determinants of health. The pandemic deepened these disparities, perhaps due to unequal resources to effectively shelter-in-place or access medical care. Future research may identify local factors underlying geographically heterogenous differences in mortality rates to inform future policy interventions.

Geographic Disparities in Availability of Opioid Use Disorder Treatment for Medicaid Enrollees.

OBJECTIVE: To examine county-level geographic variation in treatment admissions among opioid treatment programs (OTPs) that accept Medicaid in the continental United States. DATA SOURCES/STUDY SETTING: Data come from the 2012 National Survey of Substance Abuse Treatment Services. STUDY DESIGN/DATA COLLECTION: We used local measures of spatial autocorrelation (LISA) analysis to identify (1) clusters of counties with higher and lower than average rates of opioid use disorders and (2) clusters of counties with higher and lower than average treatment admissions among OTPs that accept Medicaid, adjusting for county population size. PRINCIPAL FINDINGS: Our results reveal several clusters of counties with higher than average rates of opioid use disorder (OUD) and lower than average treatment admissions among OTPs that accept Medicaid. These clusters are highly concentrated in the Southeast region of the country and include Arkansas, Kentucky, Louisiana, Mississippi, and Tennessee. CONCLUSIONS: Medicaid enrollees in areas in the Southeast have the largest gaps between county-level OUD rates and estimated county-level capacity for treatment, as measured by county-level total treatment admissions among OTPs that accept Medicaid. Policy makers should consider strategies to increase the availability of OTPs with the capacity to serve Medicaid enrollees.

The mobility of food retailers: How proximity to SNAP authorized food retailers changed in Atlanta during the Great Recession.

Retailer mobility, defined as the shifting geographic patterns of retail locations over time, is a significant but understudied factor shaping neighborhood food environments. Our research addresses this gap by analyzing changes in proximity to SNAP authorized chain retailers in the Atlanta urban area using yearly data from 2008 to 2013. We identify six demographically similar geographic clusters of census tracts in our study area based on race and economic variables. We use these clusters in exploratory data analysis to identify how proximity to the twenty largest retail food chains changed during this period. We then use fixed effects models to assess how changing store proximity is associated with race, income, participation in SNAP, and population density. Our results show clear differences in geographic distribution between store categories, but also notable variation within each category. Increasing SNAP enrollment predicted decreased distances to almost all small retailers but increased distances to many large retailers. Our chain-focused analysis underscores the responsiveness of small retailers to changes in neighborhood SNAP participation and the value of tracking chain expansion and contraction in markets across time. Better understanding of retailer mobility and the forces that drive it can be a productive avenue for future research.

Growth In SNAP Retailers Was Associated With Increased Client Enrollment In Georgia During The Great Recession.

Policies to improve food accessibility in underserved areas often use direct financial incentives to attract new food retailers. Our analysis of data on the Supplemental Nutrition Assistance Program (SNAP) in Georgia before and after the Great Recession suggests that increased program enrollment improves access to food for SNAP beneficiaries by acting as an indirect subsidy to retailers. We divided food stores into four categories: large, midsize, small, and specialty retailers. Between 2008 and 2011 the number of SNAP enrollees increased by 87 percent, and between 2007 and 2014 the number of SNAP retailers in Georgia increased by 82 percent, primarily because of growth in the number of authorized small retailers. Inside metropolitan Atlanta, changes in the numbers of SNAP enrollees and authorized retailers were positively and significantly associated for small retailers. For the areas outside of metropolitan Atlanta, the association between changes in numbers of enrollees and authorized retailers was strongest for small retailers; more modest associations were also seen for large and specialty retailers. Policy makers should consider how retailers' sensitivity to and reliance on SNAP funding can be leveraged to improve not only food availability, but also access to healthy foods.

Characteristics of Older Georgians Receiving Older Americans Act Nutrition Program Services and Other Home- and Community-Based Services: Findings from the Georgia Aging Information Management System (GA AIMS).

This descriptive study examined characteristics of older Georgians receiving Older Americans Act Nutrition Program Services and other home- and community-based services (HCBS) using state aging administrative data (N = 31,341, mean age: 76.6 ± 9.2 y, 71.2% female, 52.3% White). Home-delivered meals (HDM) was used most frequently. The characteristics of older Georgian HCBS participants varied by the type and number of HCBS received. Those receiving HDM and other in-home and caregiving services were more likely to show poorer sociodemographic, economic, and functional characteristics, and food insecurity. Those receiving multiple HCBS were most vulnerable, but showed lower level of food insecurity than those receiving single HCBS, suggesting potential combined benefits of receiving multiple programs. This study underscores the importance of documenting dynamic needs for HCBS, especially HDM, among vulnerable older adults as part of standard administrative process to identify those at high risk of institutionalization, optimize HCBS delivery and coordination, and maximize HCBS benefits.

What does SNAP benefit usage tell us about food access in low-income neighborhoods?

Current GIS based research on food access has focused primarily on the proximity of food sources to places of residence in low-income communities, with relatively little attention given to actual practices of food procurement. This project addresses this issue by using dasymetric mapping techniques to develop fine scale estimates of benefit usage for the Supplemental Nutrition Assistance Program (SNAP) in the Twin Cities of Minneapolis and St. Paul, Minnesota, drawing from existing zip code level data on benefit distribution and redemptions. Based on this data, this research shows that while supermarkets receive almost all SNAP benefits in suburban areas, these stores have a smaller share of all SNAP redemptions in low-income core neighborhoods. In these latter areas, both convenience stores and mid-sized grocers (e.g., discount grocers, food cooperatives, ethnic markets) play a much larger role in residents' food shopping, even when supermarkets are also present. In addition, these core neighborhoods have a net "outflow" of SNAP dollars, meaning that residents of these areas receive more in benefits than is spent at neighborhood food retailers. This finding confirms existing research showing that low-income residents often travel outside their neighborhoods to get food, regardless of the presence or absence of supermarkets. Rather than simply increasing the number of large food outlets in low-access areas, this research suggests that efforts to improve food access and community health must take into account the geographically complex ways residents interact with the food system.

When are food deserts? Integrating time into research on food accessibility.

The food desert concept is used as a means for defining regions as having inadequate spatial and socioeconomic access to vendors selling nutritious foods. This primarily aggregate-level and static method for understanding the food environment is commonly used by researchers and policy makers seeking to improve health outcomes of those affected by reduced access. However, recent research findings have brought the association between living in a food desert and adverse health outcomes into question. In this viewpoint, we put forward the idea that the food desert concept, and food accessibility research more generally, should be expanded to include a temporal component, and note potential avenues for future research.