Predicting opportunities for greening and patterns of vegetation on private urban lands.

This paper examines predictors of vegetative cover on private lands in Baltimore, Maryland. Using high-resolution spatial data, we generated two measures: "possible stewardship," which is the proportion of private land that does not have built structures on it and hence has the possibility of supporting vegetation, and "realized stewardship," which is the proportion of possible stewardship land upon which vegetation is growing. These measures were calculated at the parcel level and averaged by US Census block group. Realized stewardship was further defined by proportion of tree canopy and grass. Expenditures on yard supplies and services, available by block group, were used to help understand where vegetation condition appears to be the result of current activity, past legacies, or abandonment. PRIZM market segmentation data were tested as categorical predictors of possible and realized stewardship and yard expenditures. PRIZM segmentations are hierarchically clustered into 5, 15, and 62 categories, which correspond to population density, social stratification (income and education), and lifestyle clusters, respectively. We found that PRIZM 15 best predicted variation in possible stewardship and PRIZM 62 best predicted variation in realized stewardship. These results were further analyzed by regressing each dependent variable against a set of continuous variables reflective of each of the three PRIZM groupings. Housing age, vacancy, and population density were found to be critical determinants of both stewardship metrics. A number of lifestyle factors, such as average family size, marriage rates, and percentage of single-family detached homes, were strongly related to realized stewardship. The percentage of African Americans by block group was positively related to realized stewardship but negatively related to yard expenditures.

The use of insulin declines as patients live farther from their source of care: results of a survey of adults with type 2 diabetes.

BACKGROUND: Although most diabetic patients do not achieve good physiologic control, patients who live closer to their source of primary care tend to have better glycemic control than those who live farther away. We sought to assess the role of travel burden as a barrier to the use of insulin in adults with diabetes. METHODS: 781 adults receiving primary care for type 2 diabetes were recruited from the Vermont Diabetes Information System. They completed postal surveys and were interviewed at home. Travel burden was estimated as the shortest possible driving distance from the patient's home to the site of primary care. Medication use, age, sex, race, marital status, education, health insurance, duration of diabetes, and frequency of care were self-reported. Body mass index was measured by a trained field interviewer. Glycemic control was measured by the glycosolated hemoglobin A1C assay. RESULTS: Driving distance was significantly associated with insulin use, controlling for the covariates and potential confounders. The odds ratio for using insulin associated with each kilometer of driving distance was 0.97 (95% confidence interval 0.95, 0.99; P = 0.01). The odds ratio for using insulin for those living within 10 km (compared to those with greater driving distances) was 2.29 (1.35, 3.88; P = 0.02). DISCUSSION: Adults with type 2 diabetes who live farther from their source of primary care are significantly less likely to use insulin. This association is not due to confounding by age, sex, race, education, income, health insurance, body mass index, duration of diabetes, use of oral agents, glycemic control, or frequency of care, and may be responsible for the poorer physiologic control noted among patients with greater travel burdens.