Logistic burdens of cancer care: A qualitative study.

Cancer treatment often creates logistic conflicts with everyday life priorities; however, these challenges and how they are subjectively experienced have been largely unaddressed in cancer care. Our goal was to describe time and logistic requirements of cancer care and whether and how they interfered with daily life and well-being. We conducted interviews with 20 adults receiving cancer-directed treatment at a single academic cancer center. We focused on participants' perception of the time, effort, and energy-intensiveness of cancer care activities, organization of care requirements, and preferences in how to manage the logistic burdens of their cancer care. Participant interview transcripts were analyzed using an inductive thematic analysis approach. Burdens related to travel, appointment schedules, healthcare system navigation, and consequences for relationships had roots both at the system-level (e.g. labs that were chronically delayed, protocol-centered rather than patient-centered bureaucratic requirements) and in individual circumstances (e.g. greater stressors among those working and/or have young children versus those who are retired) that determined subjective burdensomeness, which was highest among patients who experienced multiple sources of burdens simultaneously. Our study illustrates how objective burdens of cancer care translate into subjective burden depending on patient circumstances, emphasizing that to study burdens of care, an exclusive focus on objective measures does not capture the complexity of these issues. The complex interplay between healthcare system factors and individual circumstances points to clinical opportunities, for example helping patients to find ways to meet work and childcare requirements while receiving care.

Urban public health emergencies and the COVID-19 pandemic. Part 2: Infrastructures, urban governance and civil society.

COVID-19 had sudden and dramatic impacts on the organisation and governance of urban life. In Part 2 of this Special Issue on public health emergencies we question the extent to which the pandemic ushered in fundamentally new understandings of urban public health, noting that ideas of urban pathology and the relation of dirt, disease and danger in cities, have long informed practices of planning. Emphasising important continuities in the way pandemics are associated with minoritised and vulnerable groups, past and present, we note that public health initiatives can often exacerbate existing health divides, and actually deepen health crises. Against this, we document the emergence of participatory, community-led responses to the pandemic that offered the promise of more inclusive urban policy, often characterised by self-organisation. While we argue that any public health policy needs to be mindful of local contingencies, the promise of inclusive policies is that they will lead to healthier cities for all, not simply protect the health of the wealthy few.

Urban public health emergencies and the COVID-19 pandemic. Part 1: Social and spatial inequalities in the COVID-city.

COVID-19 has had unprecedented impacts on urban life on a global scale, representing the worst pandemic in living memory. In this introduction to the first of two parts of a Special Issue on urban public health emergencies, we suggest that the COVID-19 outbreak, and associated attempts to manage the pandemic, reproduced and ultimately exacerbated the social and spatial divides that striate the contemporary city. Here, we draw on evidence from the papers in Part 1 of the Special Issue to summarise the uneven urban geographies of COVID-19 evident at the inter- and intra-urban level, emphasising the particular vulnerabilities and risks borne by racialised workers who found it difficult to practise social distancing in either their home or working life. Considering the interplay of environmental, social and biological factors that conspired to create hotspots of COVID-19 infection, and the way these are connected to the racialised capitalism that underpins contemporary urban development, this introduction suggests that reflection on public health emergencies in the city is not just essential from a policy perspective but helps enrich theoretical debates on the nature of contemporary urbanisation in its 'planetary' guise.

Personalizing the dichotomy of fixed and flexible activities in everyday life: deriving prism anchors from GPS-enabled survey data.

Space-time prism is a fundamental concept in time geography that can model an individual's accessibility to resources under space-time constraints. A prism anchor is often defined by work, school, or home activity with a fixed location and schedule. Trips and other activities are relatively flexible and scheduled between prism anchors. This fixity-flexibility dichotomy may not capture the increasing complexity of human mobility behaviors or variations among individuals. Recent developments in location-aware technologies allow us to collect person-level mobility data with detailed space-time paths and contextual information. This article develops methods to extract prism anchors from these GPS-based survey data and examines whether home, work, and school activities can always be used to define prism anchors for everyone. To illustrate our methods, we use data collected in Minnesota and Beijing as two study cases. Results in both study cases suggest that not everyone has home, work, or school anchors, and people with the same socio-demographic background tend to have similar anchor types. By deriving home, work, and school anchors, we can better understand how a person's everyday schedules are governed by home, work, and school and refine person-based accessibility measures.

Randomized Informational Intervention and Adult Park Use and Park-Based Physical Activity in Low-Income, Racially Diverse Urban Neighborhoods.

BACKGROUND: Neighborhood parks are important locations to encourage and stimulate physical activity (PA) among the urban population. This study aims to evaluate the impact of an informational intervention on adult park use and PA behaviors in 3 low-income, racially diverse urban neighborhoods in Minneapolis, MN. METHOD: The study employed a household-level randomized controlled trial and collected baseline and follow-up data from 171 participants. Within each neighborhood, participants were randomized to an informational intervention or to a no-intervention comparison. Intervention households received monthly, neighborhood-specific newsletters about park-based PA opportunities, park program brochures, trail maps, and activity guides. RESULTS: The average treatment effect of the newsletter intervention was positive yet moderated by respondent age. For a 20-year-old resident, treatment was associated with 0.97 (P < .05) additional park visits and 31.24 (P < .05) additional minutes of park-based PA over a 3-day recall period. For 40-year-old respondents, these positive effects are smaller at 0.36 (P < .05) additional visits and 4.66 (P < .05) additional minutes, respectively. CONCLUSIONS: An intervention to increase awareness about park-based PA opportunities and benefits increased self-reported park visits and in-park PA among adults who lived in low-income, racially diverse neighborhoods.

Three-Year Changes in Low-Income Children's Physical Activity: Prospective Influence of Neighborhood Environment and Parent Supportive Behavior.

Objectives: To prospectively evaluate parent supportive behaviors (PSB) for child physical activity (PA) and neighborhood environment variables on changes in child PA over 3 years. Study design: Secondary data analysis of the Now Everybody Together for Amazing and Healthful Kids-Works study with 534 parent-child (age 2-4 years) dyads randomized to a community-based pediatric obesity prevention intervention for 3 years (92% retention). PSB and neighborhood environmental variables were examined in relation to changes in child moderate-to-vigorous PA (MVPA), light and sedentary activity, and screen time. Child and parent accelerometry data were collected at visit 0, 12, 24, and 36 months. Mixed multivariate models were used to examine independent and interactive effects of parent-level and neighborhood-level variables on changes in child PA outcomes. Results: PSB significantly interacted with visit on change in child MVPA (ß = 0.12) and sedentary behaviors (ß = -0.18). Over 3 years, a 1-unit increase in PSB was associated with an average increase of 4.3 minutes/day of MVPA and an average decrease of 6.5 minutes/day of sedentary time. Significant main effects were observed for PSB and 3-year change in child screen time (ß = -0.05). The children of parents with higher PSB at baseline watched an average of 1.8 fewer minutes/day of screen time compared with parents with lower baseline PSB. Neighborhood-level variables were not significantly associated with changes in child PA outcomes. Conclusions: Parents who increase their supportive behaviors for their child's PA have children who are more physically active and less sedentary over time. Interventions to increase preschool-age children's PA may enhance their effectiveness by targeting parents' supportive behaviors for their child's PA.

Iterated multisource exchangeability models for individualized inference with an application to mobile sensor data.

Researchers are increasingly interested in using sensor technology to collect accurate activity information and make individualized inference about treatments, exposures, and policies. How to optimally combine population data with data from an individual remains an open question. Multisource exchangeability models (MEMs) are a Bayesian approach for increasing precision by combining potentially heterogeneous supplemental data sources into analysis of a primary source. MEMs are a potentially powerful tool for individualized inference but can integrate only a few sources; their model space grows exponentially, making them intractable for high-dimensional applications. We propose iterated MEMs (iMEMs), which identify a subset of the most exchangeable sources prior to fitting a MEM model. iMEM complexity scales linearly with the number of sources, and iMEMs greatly increase precision while maintaining desirable asymptotic and small sample properties. We apply iMEMs to individual-level behavior and emotion data from a smartphone app and show that they achieve individualized inference with up to 99% efficiency gain relative to standard analyses that do not borrow information.

Understanding subjective well-being: perspectives from psychology and public health.

BACKGROUND: Individual subjective well-being (SWB) is essential for creating and maintaining healthy, productive societies. The literature on SWB is vast and dispersed across multiple disciplines. However, few reviews have summarized the theoretical and empirical tenets of SWB literature across disciplinary boundaries. METHODS: We cataloged and consolidated SWB-related theories and empirical evidence from the fields of psychology and public health using a combination of online catalogs of scholarly articles and online search engines to retrieve relevant articles. For both theories and determinants/correlates of SWB, PubMed, PsychINFO, and Google Scholar were used to obtain relevant articles. Articles for the review were screened for relevance, varied perspectives, journal impact, geographic location of study, and topicality. A core theme of SWB empirical literature was the identification of SWB determinants/correlates, and over 100 research articles were reviewed and summarized for this review. RESULTS: We found that SWB theories can be classified into four groups: fulfillment and engagement theories, personal orientation theories, evaluative theories, and emotional theories. A critical analysis of the conflicts and overlaps between these theories reveals the lack of a coherent theoretical and methodological framework that would make empirical research systematically comparable. We found that determinants/correlates of SWB can be grouped into seven broad categories: basic demographics, socioeconomic status, health and functioning, personality, social support, religion and culture, and geography and infrastructure. However, these are rarely studied consistently or used to test theories. CONCLUSIONS: The lack of a clear, unifying theoretical basis for categorizing and comparing empirical studies can potentially be overcome using an operationalizable criterion that focuses on the dimension of SWB studied, measure of SWB used, design of the study, study population, and types of determinants and correlates. From our review of the empirical literature on SWB, we found that the seven categories of determinants/correlates identified may potentially be used to improve the link between theory and empirical research, and that the overlap in the determinant/correlates as they relate to multiple theory categories may enable us to test theories in unison. However, doing so in the future would require a conscious effort by researchers in several areas, which are discussed.

Are low income children more physically active when they live in homes with bigger yards? A longitudinal analysis of the NET-Works Study.

This study prospectively examined the relationship of home yard-size to objectively measured physical activity over three years among a cohort of 531 low-income pre-school-aged children. An adjusted total-effect association of 12.72 additional minutes per week of moderate/vigorous physical activity (MVPA) was observed for each additional hectare of yard-size. The direct-effect association, adjusting for previous year MVPA, was not statistically significant. This study provides evidence that the private or semi-private space around the house may impact children's' physical activity. Public health and urban planning practitioners should consider these results to identify built environment solutions for improving MVPA among low-income minority children.

Connecting Air Quality with Emotional Well-Being and Neighborhood Infrastructure in a US City.

Cities in the United States have announced initiatives to become more sustainable, healthy, resilient, livable, and environmentally friendly. However, indicators for measuring all outcomes related to these targets and the synergies between them have not been well defined or studied. One such relationship is the linkage between air quality with emotional well-being (EWB) and neighborhood infrastructure. Here, regulatory monitoring, low-cost sensors (LCSs), and air quality modeling were combined to assess exposures to PM2.5 and traffic-related NOx in 6 Minneapolis, MN, neighborhoods of varying infrastructure parameters (median household income, urban vs suburban, and access to light rail). Residents of the study neighborhoods concurrently took real-time EWB assessments using a smart phone application, Daynamica, to gauge happiness, tiredness, stress, sadness, and pain. Both LCS PM2.5 observations and mobile-source-simulated NOx were calibrated using regulatory observations in Minneapolis. No statistically significant (α = 0.05) PM2.5 differences were found between urban poor and urban middle-income neighborhoods, but average mobile-source NOx was statistically significantly (α = 0.05) higher in the 4 urban neighborhoods than in the 2 suburban neighborhoods. Close proximity to light rail had no observable impact on average observed PM2.5 or simulated mobile-source NOx. Home-based exposure assessments found that PM2.5 was negatively correlated with positive emotions such as happiness and to net affect (the sum of positive and negative emotion scores) and positively correlated (ie, a higher PM2.5 concentration led to higher scores) for negative emotions such as tiredness, stress, sadness, and pain. Simulated mobile-source NOx, assessed from both home-based exposures and in situ exposures, had a near-zero relationship with all EWB indicators. This was attributed to low NOx levels throughout the study neighborhoods and at locations were the EWB-assessed activities took place, both owing to low on-road mobile-source NOx impacts. Although none of the air quality and EWB responses were determined to be statistically significant (α = 0.05), due in part to the relatively small sample size, the results are suggestive of linkages between air quality and a variety of EWB outcomes.

Methods for Real-Time Prediction of the Mode of Travel Using Smartphone-Based GPS and Accelerometer Data.

We propose and compare combinations of several methods for classifying transportation activity data from smartphone GPS and accelerometer sensors. We have two main objectives. First, we aim to classify our data as accurately as possible. Second, we aim to reduce the dimensionality of the data as much as possible in order to reduce the computational burden of the classification. We combine dimension reduction and classification algorithms and compare them with a metric that balances accuracy and dimensionality. In doing so, we develop a classification algorithm that accurately classifies five different modes of transportation (i.e., walking, biking, car, bus and rail) while being computationally simple enough to run on a typical smartphone. Further, we use data that required no behavioral changes from the smartphone users to collect. Our best classification model uses the random forest algorithm to achieve 96.8% accuracy.

Park-Use Behavior and Perceptions by Race, Hispanic Origin, and Immigrant Status in Minneapolis, MN: Implications on Park Strategies for Addressing Health Disparities.

The study examines the connections between minority status, park use behavior, and park-related perceptions using recent survey data from three low-income neighborhoods in Minneapolis, MN. Blacks and foreign-born residents are found to underutilize parks. Blacks, Asians, and American Indians perceive fewer health benefits of parks than whites, including the benefits of parks for providing exercise/relaxation opportunities and family gathering spaces. Foreign-born residents, blacks, and Hispanics perceive greater and unique barriers to park use in terms of not feeling welcome, cultural and language restrictions, program schedule and pricing concerns, and/or facility maintenance and mismatch concerns. When designing park strategies for addressing health disparities, we recommend to focus the efforts on increasing awareness of park-related health benefits and removing specific park use barriers among minority and foreign-born communities.

Park use is associated with less sedentary time among low-income parents and their preschool child: The NET-Works study.

INTRODUCTION: Parks are an important component of the neighborhood environment, and their presence is believed to support higher levels of physical activity among residents. The present study examined park use frequency among a sample of 534 low-income parents of preschool aged children. Associations with child and parent physical activity, neighborhood characteristics and physical characteristics of the block immediately surrounding the home were examined. METHODS: Data are from baseline measurements completed in 2012-2014 as part of larger study (NET-Works: Now Everybody Together for Amazing and Healthy Kids) targeting low-income preschool children and their parents (N = 534 parent-child dyads). Physical activity was measured in parent and child using accelerometry. Parents reported their frequency of use with their child of parks within a half kilometer from their residence. Block audits were performed by trained research staff to describe the quality and walkability of the streets around the home. STATISTICAL ANALYSIS: Bivariate associations between demographic variables, perceptions of the neighborhood environment, parent support for child physical activity, and physical activity were examined using regression or Chi square analysis. RESULTS: Park use frequency was not significantly associated with child accelerometry light, moderate or vigorous physical activity. However, it was marginally significantly inversely associated with child accelerometry sedentary time (p < 0.06). Television viewing hours on weekend days (but not on weekdays) were significantly fewer among children in the high park use group compared with children who visited the park less frequently (p < 0.01). Park use frequency was significantly positively associated with parent accelerometry moderate physical activity (p < 0.004), and was significantly inversely associated with parent accelerometry sedentary time (p < 0.002). Frequent park use was significantly positively associated with parent report of the child frequency of being taken to a park or playground outside the home (p < 0.0001), past week visit to park and recreation center (p < 0.0001) and parent-reported supportive behaviors for child physical activity (p < 0.0001). Parents who reported having to cross busy streets to reach play areas reported less frequent park use (p < 0. 02). Walkable neighborhoods (p < 0.003) and more incivilities (p < 0.02) in the immediate block surrounding the home were significantly associated with more frequent park use. CONCLUSIONS: Frequent park use with their preschool child may support higher levels of physical activity among low-income parents and reduce sedentary time for both child and parent.

Family structure and park use among parents.

BACKGROUND: Despite the increasingly diversified family structure in the U.S., little research examines differences in park use between nontraditional and traditional family structures. PURPOSE: This study examines family-structure differences in parent park use. It was hypothesized that working single parents and dual-worker parents have lower levels of park use than parents in two-parent, single-worker families. METHODS: Data from a 2010 park-use survey in three urban neighborhoods in Minneapolis MN (N=261 parents) were analyzed in 2012. Multiple variables of park use were developed, including recalled measures over the past 3 days and over the past year. Family-structure differences in these variables were examined using multivariate regression analyses. RESULTS: After controlling for spatial clustering effects and confounding factors, working single parents reported 32.6% (p<0.10) fewer park visits and 62.0% (p<0.05) less time spent in parks in the past 3 days than parents in two-parent, single-worker families. Dual-worker parents did not report fewer park visits in the past 3 days than parents in two-parent, single-worker families, yet the length of time they spent in parks during these visits was 41.5% (p<0.10) less. Family-structure differences in past-year park-use measures were not significant. CONCLUSIONS: This research shows the importance of including family-structure variables and both recent and longer-term recalled measures of park use in park-use studies. Greater attention to the recreation needs of working single parents and dual-worker parents is needed in descriptive and intervention research aiming to promote park use among families with children.

Family functioning as a mediator between neighborhood conditions and children's health: evidence from a national survey in the United States.

This study examines whether the associations between neighborhood conditions and children's health can be indirect and operate through aspects of family functioning. We use data from the 2007 National Survey of Children's Health in the United States with the interviewed parents/guardians as the only source of the data. Our study sample includes 53,023 children aged between 6 and 17 years. Using structural equation modeling, we test both direct and indirect relationships between a family functioning index, a general indicator of children's health status, and three neighborhood factors: neighborhood physical resources, environmental threats, and collective efficacy. Covariates in the analysis include gender, age, income, race, family structure, parental education, and health insurance coverage. All the three neighborhood factors show direct associations with children's general health status, as well as indirect associations mediated by aspects of family functioning. Among the three neighborhood factors, collective efficacy and environmental threats are found to have much stronger associations with children's general health than physical resources. When designing health-promoting neighborhoods for children and families, it may be more efficient for urban planners and health professionals to focus on community programs that reduce environmental stressors and foster neighborhood cohesion than programs that solely improve physical infrastructure. This study also verifies that aspects of family functioning mediate the associations between neighborhood conditions and children's health. It is recommended that both family and neighborhood are critical points for child health intervention.

Neighborhood green, social support, physical activity, and stress: assessing the cumulative impact.

We estimate the cumulative stress mitigating impact of neighborhood greenness by investigating whether neighborhood green mitigates stress directly, and indirectly by encouraging physical activity and/or fostering social support. Using data from a recent community health survey in Chicago and two-stage instrumental variables regression modeling, we find that different components of neighborhood green play distinct roles in influencing stress. Park spaces are found to indirectly mitigate stress by fostering social support. Overall neighborhood vegetation is found to have direct stress mitigation impact, yet the impact is counteracted by its negative effect on social support. When comparing the effect size, park spaces show a more positive impact on health and well-being than the overall neighborhood vegetation level. Policy makers are recommended to focus on creating structured green spaces with public recreation and socialization opportunities rather than simply conserving green spaces in the neighborhood. Previous studies, as they often investigate the direct impact only and rarely use multiple measures of greenness, may have mis-estimated health benefits of neighborhood green.

Is sprawl associated with a widening urban-suburban mortality gap?

This paper examines whether sprawl, featured by low development density, segregated land uses, lack of significant centers, and poor street connectivity, contributes to a widening mortality gap between urban and suburban residents. We employ two mortality datasets, including a national cross-sectional dataset examining the impact of metropolitan-level sprawl on urban-suburban mortality gaps and a longitudinal dataset from Portland examining changes in urban-suburban mortality gaps over time. The national and Portland studies provide the only evidence to date that (1) across metropolitan areas, the size of urban-suburban mortality gaps varies by the extent of sprawl: in sprawling metropolitan areas, urban residents have significant excess mortality risks than suburban residents, while in compact metropolitan areas, urbanicity-related excess mortality becomes insignificant; (2) the Portland metropolitan area not only experienced net decreases in mortality rates but also a narrowing urban-suburban mortality gap since its adoption of smart growth regime in the past decade; and (3) the existence of excess mortality among urban residents in US sprawling metropolitan areas, as well as the net mortality decreases and narrowing urban-suburban mortality gap in the Portland metropolitan area, is not attributable to sociodemographic variations. These findings suggest that health threats imposed by sprawl affect urban residents disproportionately compared to suburban residents and that efforts curbing sprawl may mitigate urban-suburban health disparities.