Using the concept of activity space to understand the social health of older adults living with memory problems and dementia at home.

Globally as the population ages, the prevalence of dementia will increase. Simultaneously, there is a trend toward people ageing at home. Therefore, more people will be ageing at home with dementia, as opposed to institutional environments. In this context, there has been a recent shift in research exploring ways that people can live well with the consequences of the disease. As a part of this emerging research, the social and spatial aspects of the lives of people living with memory problems are becoming increasingly of interest. The aim of this article is to use the concept of activity space to examine the social health of older adults with memory problems and dementia who live at home. Activity space data were collected from seven older adults experiencing memory problems and living at home in the Netherlands. Using a mixed-methods approach, insight into their activity spaces were gained through walking interviews, 14 days of global positioning system (GPS) movement data, travel diary entries and in-depth interviews. The GPS data, travel diary data and interview transcripts were analyzed using a grounded visualization approach. Our findings show that participants interact independently in routine activity spaces but depend on others to participate in occasional activity spaces. Interactions within both these spaces contribute to the social health of older adults with memory problems and dementia who live at home. Additionally, participants used coping strategies and decision-making to maintain autonomy in daily life. The findings can inform dementia-friendly initiatives and social health care planning.

What Differences Do They See? Using Mixed Methods to Capture Adolescent Perceptions of Neighborhood Contexts.

Recent neighborhood research emphasizes the importance of individuals' perceptions of their neighborhoods, as well as expands the definition of "neighborhood" to include the different contexts encountered during routine daily activities (Coulton et al., 2013; Kwan, 2012). The present study uses qualitative interviews, sketch mapping, and survey data to explore adolescents' experiences of different neighborhoods within their activity space. Participants included 55 racially diverse youth aged 11-19 (M = 14.64, SD = 2.33) who resided in low-income neighborhoods in a small city in the Midwest. The majority reported spending time in multiple self-defined neighborhoods, noting significant differences between neighborhoods on collective efficacy, street code, and on participant-generated dimensions. Self-defined neighborhoods did not correspond to Census tracts, and Census indicators were not associated with youth's perceptions (e.g., collective efficacy, street code). Youth spent time in neighborhoods that differed significantly on multiple Census indicators of structural disadvantage, though within-individual differences tended to be small in magnitude. Type of routine activity was largely not predictive of distance traveled from home, though some findings suggest youth were more likely to cross neighborhood boundaries to engage in structured activities compared to different unstructured activities. Implications for neighborhood research and interventions are discussed.

Tobacco use in the sexual borderlands: The smoking contexts and practices of bisexual young adults.

Little is known about why bisexual people use tobacco at higher rates than any other sexual identity group. Non-binary sexualities, such as bisexuality, exist within the socially constructed borderland between homosexuality and heterosexuality. Exploration of the everyday smoking contexts and practices of bisexual individuals may reveal unique mechanisms driving tobacco use. We employed a novel mixed method, integrating real-time, smartphone-administered surveys of (non)smoking situations, location tracking, spatial visualization of participant data, and subsequent map-led interviews. Participants (n = 17; ages 18-26, California) identified as bisexual, pansexual, and/or queer. Most were cisgender women. Survey smoking patterns and situational predictors were similar to other young adults'. However, interviews revealed unique roles of tobacco use in participants' navigation of differently sexualized spaces in everyday life: 1) stepping away from uncomfortable situations related to bisexual identity; 2) facilitating belonging to LGBTQ+ community; and 3) recovering from bisexual identity perception management. Similar studies can examine the place-embedded practices and spatio-temporal patterns of other substance use and other stigmatized identity experiences.

A geographically explicit ecological momentary assessment (GEMA) mixed method for understanding substance use.

Tobacco use is increasingly concentrated within marginalized groups, including LGBTQ+ young adults. Developing tailored interventions to reduce tobacco-related health disparities requires understanding the mechanisms linking individual and contextual factors associated with tobacco use to behavior. This paper presents an in-depth exploration of three cases from a novel mixed method study designed to identify the situational factors and place-based practices of substance use among high-risk individuals. We combined geographically explicit ecological momentary assessment (GEMA) with an adapted travel diary-interview method. Participants (young adult bisexual smokers, ages 18-26) reported on non-smoking and smoking situations for 30 days with a smartphone app. GEMA surveys captured internal and external situational factors (e.g., craving intensity, location type, seeing others smoking). Continuous locational data was collected via smartphone GPS. Subsequently, participants completed in-depth interviews reviewing maps of their own GEMA data. GEMA data and transcripts were analyzed separately and integrated at the case level in a matrix. Using GEMA maps to guide the interview grounded discussion in participants' everyday smoking situations and routines. Interviews clarified participant interpretation of GEMA measures and revealed experiences and meanings of smoking locations and practices. The GEMA method identified the most frequent smoking locations/times for each participant (e.g., afternoons at university). Interviews provided description of associated situational factors and perceptions of smoking contexts (e.g., peer rejection of bisexual identity) and the roles of smoking therein (e.g., physically escape uncomfortable environments). In conclusion, this mixed method contributes to advancing qualitative GIS and other hypothesis-generating approaches working to reveal the richness of individuals' experiences of the everyday contexts of health behavior, while also providing reliable measures of situational predictors of behaviors of interest, such as substance use. Limitations of and future directions for the method are discussed.

Walk-friendly suburbs for older adults? Exploring the enablers and barriers to walking in a large suburban municipality in Canada.

The neighbourhood environment may enable active aging by allowing the integration of walking into an older adult's daily routine. This study explores the relationship between the neighbourhood built environment and walking among a small group of older adults in a large suburban municipality in Canada. In-depth interviews using a photo-voice approach revealed that the participants walked largely to accumulated physical activity. Older adults who lived in either conventional residential or condominium neighbourhoods discussed poor traffic conditions and lack of benches/trees/places as barriers, and proximity to parks and access to shops as enablers to walking. Poor sidewalk quality, absence of street lights and personal safety concerns were major barriers to walking only for those living in suburban residential neighbourhoods. Our results indicate that high quality- and safe walking infrastructure may facilitate walking for physical activity among older adults living in the suburban communities.

Area restrictions, risk, harm, and health care access among people who use drugs in Vancouver, Canada: A spatially oriented qualitative study.

Area restrictions prohibiting people from entering drug scenes or areas where they were arrested are a common socio-legal mechanism employed to regulate the spatial practices of people who use drugs (PWUD). To explore how socio-spatial patterns stemming from area restrictions shape risk, harm, and health care access, qualitative interviews and mapping exercises were conducted with 24 PWUD with area restrictions in Vancouver, Canada. Area restrictions disrupted access to health and social resources (e.g., HIV care) concentrated in drug scenes, while territorial stigma prevented PWUD from accessing supports in other neighborhoods. Rather than preventing involvement in drug-related activities, area restrictions displaced these activities to other locations and increased vulnerability to diverse risks and harms (e.g., unsafe drug use practices, violence). Given the harms stemming from area restrictions there is an urgent need to reconsider this socio-legal strategy.

Qualitative GIS and the Visualization of Narrative Activity Space Data.

Qualitative activity space data, i.e. qualitative data associated with the routine locations and activities of individuals, are recognized as increasingly useful by researchers in the social and health sciences for investigating the influence of environment on human behavior. However, there has been little research on techniques for exploring qualitative activity space data. This research illustrates the theoretical principles of combining qualitative and quantitative data and methodologies within the context of GIS, using visualization as the means of inquiry. Through the use of a prototype implementation of a visualization system for qualitative activity space data, and its application in a case study of urban youth, we show how these theoretical methodological principles are realized in applied research. The visualization system uses a variety of visual variables to simultaneously depict multiple qualitative and quantitative attributes of individuals' activity spaces. The visualization is applied to explore the activity spaces of a sample of urban youth participating in a study on the geographic and social contexts of adolescent substance use. Examples demonstrate how the visualization may be used to explore individual activity spaces to generate hypotheses, investigate statistical outliers, and explore activity space patterns among subject subgroups.