Identifying high-vulnerable garbage accumulation areas in Coimbatore City, India: an AHP-GIS approach for effective waste management.

Urbanization has resulted in a surge in municipal solid waste (MSW) generation, posing critical waste management challenges in urban areas. To tackle this issue, we introduce a novel approach for mapping garbage vulnerability zones (GVZ) in Coimbatore City, India, combining the analytic hierarchy process (AHP) and Geographic Information System (GIS). Seven criteria, including per capita waste generation, open dumping, land use land cover, road/railway networks, and population, were integrated and analyzed in GIS. AHP pairwise comparison method assigned weights to each criterion and principal component analysis (PCA) further validated the interconnectedness of the criteria and their impact on the GVZs. The results indicated that open dumping locations and population density are the most influential factors contributing to the risk of garbage accumulation, making up 23.7% and 21.2% of the total weight, respectively. The GVZ map reveals that 94.6% of Coimbatore City is at risk of MSW accumulation, with 20.2% highly and 74.4% moderately vulnerable. Eleven high GVZ clusters were identified, with Saravanampatti, located in the northeastern part of Coimbatore City, being the most vulnerable area. The H3 hexagon format of the GVZ map enhances its usability for monitoring and mitigation capabilities. In conclusion, our comprehensive AHP-GIS approach facilitates effective waste management practices, sustainable resource utilization, and better environmental and public health outcomes in urban areas. The demonstrated methodology has the potential for application in similar developing urban areas in South Asia and the Global South, serving as a valuable tool to address the challenges posed by increasing MSW generation.

The Association between State-Level Structural Racism and Alcohol and Tobacco Use Behaviors among a National Probability Sample of Black Americans.

BACKGROUND: Structural racism is how society maintains and promotes racial hierarchy and discrimination through established and interconnected systems. Structural racism is theorized to promote alcohol and tobacco use, which are risk factors for adverse health and cancer-health outcomes. The current study assesses the association between measures of state-level structural racism and alcohol and tobacco use among a national sample of 1,946 Black Americans. METHODS: An existing composite index of state-level structural racism including five dimensions (subscales; i.e., residential segregation and employment, economic, incarceration, and educational inequities) was merged with individual-level data from a national sample dataset. Hierarchical linear and logistic regression models, accounting for participant clustering at the state level, assessed associations between structural racism and frequency of alcohol use, frequency of binge drinking, smoking status, and smoking frequency. Two models were estimated for each behavioral outcome, one using the composite structural racism index and one modeling dimensions of structural racism in lieu of the composite measure, each controlling for individual-level covariates. RESULTS: Results indicated positive associations between the incarceration dimension of the structural racism index and binge drinking frequency, smoking status, and smoking frequency. An inverse association was detected between the education dimension and smoking status. CONCLUSIONS: Results suggest that state-level structural racism expressed in incarceration disparities, is positively associated with alcohol and tobacco use among Black Americans. IMPACT: Addressing structural racism, particularly in incarceration practices, through multilevel policy and intervention may help to reduce population-wide alcohol and tobacco use behaviors and improve the health outcomes of Black populations.

Integrating human activity into food environments can better predict cardiometabolic diseases in the United States.

The prevalence of cardiometabolic diseases in the United States is presumably linked to an obesogenic retail food environment that promotes unhealthy dietary habits. Past studies, however, have reported inconsistent findings about the relationship between the two. One underexplored area is how humans interact with food environments and how to integrate human activity into scalable measures. In this paper, we develop the retail food activity index (RFAI) at the census tract level by utilizing Global Positioning System tracking data covering over 94 million aggregated visit records to approximately 359,000 food retailers across the United States over two years. Here we show that the RFAI has significant associations with the prevalence of multiple cardiometabolic diseases. Our study indicates that the RFAI is a promising index with the potential for guiding the development of policies and health interventions aimed at curtailing the burden of cardiometabolic diseases, especially in communities characterized by obesogenic dietary behaviors.

A longitudinal assessment of racial and ethnic inequities in food environment exposure and retail market concentration.

OBJECTIVE: This paper assesses trends in food environment and market concentration and racial and ethnic inequities in food environment exposure and food retail market concentration at the US census tract level from 2000 to 2019. DESIGN: Establishment-level data from the National Establishment Time Series were used to measure food environment exposure and food retail market concentration. We linked that dataset to race, ethnicity and social vulnerability information from the American Community Survey and the Agency for Toxic Substances and Disease Registry. A geospatial hot-spot analysis was conducted to identify relatively low and high healthy food access clusters based on the modified Retail Food Environment Index (mRFEI). The associations were assessed using two-way fixed effects regression models. SETTING: Census tracts spanning all US states. PARTICIPANTS: 69 904 US census tracts. RESULTS: The geospatial analysis revealed clear patterns of areas with high and low mRFEI values. Our empirical findings point to disparities in food environment exposure and market concentration by race. The analysis shows that Asian Americans are likelier to live in neighbourhoods with a low food environment exposure and low retail market concentration. These adverse effects are more pronounced in metro areas. The robustness analysis for the social vulnerability index confirms these results. CONCLUSION: US food policies must address disparities in neighbourhood food environments and foster a healthy, profitable, equitable and sustainable food system. Our findings may inform equity-oriented neighbourhood, land use and food systems planning. Identifying priority areas for investment and policy interventions is essential for equity-oriented neighbourhood planning.

A longitudinal study of social, religious, and spiritual capital and physical and emotional functioning in a national sample of African-Americans.

The present study builds on prior research by examining the moderating relationships between different types of capital on physical functioning, emotional functioning, and depressive symptoms using a 2.5-year longitudinal design with a national sample of African-American adults. Results indicated a significant T1 social capital × T1 religious capital interaction such that among low T1 religious capital participants, those with high T1 social capital had lower T2 physical functioning than those with lower T1 social capital. There was also a marginally significant T1 social capital × T1 spiritual capital interaction suggesting that among low T1 spiritual capital participants, those with higher T1 social capital reported a decline in depressive symptoms compared to those with lower T1 social capital. Future research and implications for intervention and policy development are discussed.

'Transgender Persons (Protection of Rights) Act' of India: An Analysis of Substantive Access to Rights of a Transgender Community.

The amendments to the Transgender Persons (Protection of Rights) Act of India in 2019 address non-binary persons' constitutional rights, recognition of their gender identity, and non-discrimination laws across institutional spaces (for example, family, workplace, education, and healthcare). The Act discusses legal rights in isolation of praxis, structural support and, more importantly, lacks guidelines needed to substantively access rights. Such a disconnection relegates human rights to merely legal changes with limited practice. In this article, we discuss the achievements and failures of the act from the perspective of a transgender community in India, and the impact it has had on their lives from its formulation in 2014. Although non-binary communities are recognized, they face severe abuse and discrimination. We analyse accounts of 15 transgender persons' lived experiences and challenges they faced in claiming their rights in Kolkata, a metropolis in eastern India. We used the framework of substantive access to rights, that is, the actual ability to practice and access documented rights, to critically discuss our findings across family, work, education, and healthcare spaces, often showing the gaps between achieved legal status, and the practical realities on the ground. We provide several recommendations to bridge these gaps-improving educational equity for non-binary people, including transgender specific training for healthcare providers and, more importantly, increasing the adequate representation of non-binary people in the positions of negotiation. The road to claiming social and economic rights following legal rights for non-binary gender communities cannot be achieved without overcoming their erasure within families and hypervisibility in public spaces.

Disability and Health in African Americans: Population Research and Implications for Occupational Therapy Community-Based Practice.

Background: Population-based research and community-based interventions are integral to occupational therapy's scope of practice, yet they are underdeveloped in actual implementation. Therefore, this paper focuses on some health challenges facing the African American population, guided by the Person-Environment-Occupation-Performance Model. Method: Using data from an observational cross-sectional nationwide telephone survey of African American adults, we examined differences between African Americans who are receiving disability payments (RDP) and those who are employed full time (FTE) on several physical health behaviors and psychosocial health indicators. We further compared the differences between African Americans RDP versus those FTE on those physical health behaviors and psychosocial health indicators across five US regions. Results: Findings suggest that African Americans RDP are engaging in fewer positive physical health behaviors and experiencing worse psychosocial health compared to their counterparts FTE. There are also nuanced regional variations in the differences between African Americans RDP and FTE in physical health behaviors and psychosocial health indicators. Conclusion: This research highlighted some health challenges of African Americans RDP and FTE using a regional lens, demonstrating the value of OT population-based research. There is a need for OT population-specific community-based practice to address the health disparities of underserved and minority populations, such as African Americans.

Correction: mHealth Intervention to Improve Treatment Outcomes Among People With HIV Who Use Cocaine: Protocol for a Pilot Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/28332.].

mHealth Intervention to Improve Treatment Outcomes Among People With HIV Who Use Cocaine: Protocol for a Pilot Randomized Controlled Trial.

BACKGROUND: Antiretroviral therapy is effective in reducing HIV-related morbidity, mortality, and transmission among people with HIV. However, adherence and persistence to antiretroviral therapy are crucial for successful HIV treatment outcomes. People with HIV who use cocaine have poor access to HIV services and lower retention in care. OBJECTIVE: The primary goal of this paper is to provide a detailed description of a mobile health intervention. This study is designed to improve medication adherence among people with HIV who use cocaine. A secondary goal is to list the important challenges and adaptations incorporated in the study design. METHODS: This study, titled Project SMART, used a wireless technology-based intervention, including cellular-enabled electronic pillboxes called TowerView Health and smartphones, to provide reminders and feedback on adherence behavior. The intervention design was based on the theoretical frameworks provided by the self-determination theory and the Motivation Technology Model. The 12-week pilot randomized controlled trial with four arms provided three types of feedback: automated feedback, automated+clinician feedback, and automated feedback+social network feedback. RESULTS: The study was funded by the National Institute of Drug Abuse (R21DA039842) on August 1, 2016. The institutional review board for the study was approved by Yale University on March 21, 2017. Data collection lasted from June 2017 to January 2020. The final enrollment was 71 participants, of whom 57 (80%) completed the study. The data are currently undergoing analysis, and the manuscript is being developed for publication in early 2022. CONCLUSIONS: Implementing complex mobile health interventions for high-risk and marginalized populations with multicomponent interventions poses certain challenges, such as finding companies with adequate technology for clients and financial stability and minimizing the research-related burden for the study population. Conducting feasibility studies is important to recognize these challenges and the opportunity to address these challenges with solutions while keeping the design of a randomized controlled trial as true as possible. TRIAL REGISTRATION: Clinicaltrials.gov NCT04418076; https://clinicaltrials.gov/ct2/show/NCT04418076. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/28332.

Studying physical and mental health status among hijra, kothi and transgender community in Kolkata, India.

Individuals with diverse sexual orientation and gender identities have historically experienced the major share of stigma, discrimination, and marginalization among all the LGTBIQ+ communities in India. Transgender, intersex, or queer individuals are deprived of their basic rights, self-dignity, bodily autonomy, and healthcare leading to significant negative health status. Recent legal reforms such as the decriminalization of Section 377 of the Indian Penal Code (prohibited same-sex activity) and amendments to the Transgender Persons (Protection of Rights) Bill may improve their health. In this context, the study has the following objectives: 1) to measure the physical and the mental health status of hijra, kothi, and transgender (HKT) individuals using the Short Form 12 (SF-12) questionnaire; 2) understand the variation in their health status by social determinants; and 3) identify spatial patterns of HKTs general, physical, and mental health. Data was collected using a Bengali version of SF-12 (N = 98). We calculated physical (PCS) and mental (MCS) health composite scores and conducted relevant statistical and spatial analysis. Findings revealed that HKT individuals had poor mental health (mean MCS = 42.3) compared to their physical health (mean PCS = 49.0). ANOVA tests showed statistically significant variation of PCS and MCS among HKTs by their age and income. Participants with both poor and good health conditions were evenly distributed in the study area, with no significant spatial clustering. This study was the first attempt to assess the health-related quality of life among the HKT individuals using SF-12, not previously adapted to gender-diverse communities in India. Results clearly indicate that there is a pressing need to address both physical and mental health among gender-diverse communities by not only improving awareness of their healthcare rights but by also removing social and structural barriers to health programs, increasing targeted health interventions, grassroot level activism, and government advocacy.

Do neighborhood characteristics contribute beyond individual demographics to cancer control behaviors among African American adults?

BACKGROUND: Recent years have seen increased interest in the role of neighborhood factors in chronic diseases such as cancers. Less is known about the role of neighborhood factors beyond individual demographics such as age or education. It is particularly important to examine neighborhood effects on health among African American men and women, considering the disproportionate impact of cancer on this group. This study evaluated the unique contribution of neighborhood characteristics (e.g., racial/ethnic diversity, income) beyond individual demographics, to cancer control behaviors in African American men and women. METHODS: Individual-level data were drawn from a national survey (N = 2,222). Participants' home addresses were geocoded and merged with neighborhood data from the American Community Survey. Multi-level regressions examined the unique contribution of neighborhood characteristics beyond individual demographics, to a variety of cancer risk, prevention, and screening behaviors. RESULTS: Neighborhood racial/ethnic diversity, median income, and percentage of home ownership made modest significant contributions beyond individual factors, in particular to smoking status where these factors were associated with lower likelihood of smoking (ps < .05). Men living in neighborhoods with older residents, and greater income and home ownership were significantly more likely to report prostate specific antigen testing (ps < .05). Regional analyses suggested different neighborhood factors were associated with smoking status depending on the region. CONCLUSION: Findings provide a more nuanced understanding of the interplay of social determinants of health and neighborhood social environment among African American men and women, with implications for cancer control interventions to eliminate cancer disparities.

A longitudinal examination of social support as a mediator of the personality-health relationship in a national sample of African Americans.

The present study investigates whether social support mediates the relationship between personality traits and health among African Americans over a five-year period, filling a gap in the literature on longitudinal tests of the personality-health association. Data were collected from a national probability sample of African American adults (N = 200). Personality was assessed at Time 1 (T1), social support was assessed 2.5 years later (T2), and physical functioning was examined 5 years (T3) after T1. Telephone surveys included measures of the Five Factor Model personality traits (T1), social support (T2), and physical functioning (T3). Results suggested that relationships between the T1 personality traits and T3 physical functioning were not mediated by T2 social support. Secondary analyses found that among all T1 personality traits, higher openness and lower neuroticism uniquely predicted higher T2 social support. Further, among T1 personality traits, higher conscientiousness uniquely predicted better T3 physical functioning. This information may be useful to healthcare providers and community members in developing prevention and intervention strategies for African Americans.

Associations between Body Mass Index and Urban "Green" Streetscape in Cleveland, Ohio, USA.

Public health researchers are increasingly interested in assessing the impact of neighborhood environment on physical activities and chronic health issues among humans. Walkable streets and proximity to green space have long been believed to promote active lifestyles in cities, which contribute to positive health outcomes among residents. Traditionally, urban environmental metrics were calculated at the area level to describe the physical environment of neighborhoods. However, considering the fact that streets are the basic unit for human activities in cities, it is important to understand how the streetscape environment can influence human health conditions. In this study, we investigated the influence of street greenery and walkability on body mass index in Cleveland, Ohio, USA. Different from the area level and overhead view greenery metrics, we used the green view index calculated from the Google Street View to represent the amount of street greenery. The Walk Score was used to indicate the walkability of neighborhoods also at the street level. Statistical analysis results show that the Walk Score has a more significant association with decreased BMI for males than females and the street greenery has a more significant association with decreased BMI for females than males in Cleveland, Ohio. The results of this study would provide a reference for designing gender-specific healthy cities.

Varying age-gender associations between body mass index and urban greenspace.

Urban greenspace benefits urbanites in numerous ways ranging from regulating flooding, air quality, and local climate to providing opportunities for exercise and relaxation. These benefits may influence human health. Greenspace, for example, may facilitate exercise, thereby helping to reduce body mass index (BMI) and combat obesity, a current epidemic of great public health concern. Little evidence exists to support this assertion, however, and we lack a full understanding of the mechanisms whereby this relationship operates, the populations for whom greenspace is linked to weight status, and the aspects of urban greenspace that are linked to weight status. This study seeks to identify relationships among the composition and arrangement of greenspace and BMI for different populations using regression models for eight age and gender groups in Cleveland, Ohio, US. We find that several greenspace variables are related to BMI for women under 65 years and males under 51 years, but not for older groups, and that the aspects and types of greenspace that are significantly related to BMI vary among groups. Relationships between greenspace attributes and BMI are generally stronger for female groups and for younger groups. Providing access to greenspace with particular attributes such as greenspaces with water, canopy cover, or connected greenspaces could support a healthy weight status for some populations, but these attributes are not consistent across age and gender groups. These results could help to inform policy aimed at designing urban greenspace to benefit the health of different population subgroups.

Social Network Strategies to Address HIV Prevention and Treatment Continuum of Care Among At-risk and HIV-infected Substance Users: A Systematic Scoping Review.

Social network analysis (SNA) and social network-based interventions (SNI) are important analytical tools harnessing peer and family influences critical for HIV prevention and treatment among substance users. While SNA is an effective way to measure social network influences, SNI directly or indirectly involves network members in interventions. Even though these methods have been applied in heterogeneous ways, leading to extensive evidence-based practices, systematic reviews are however, lacking. We searched five bibliographic databases and identified 58 studies involving HIV in substance users that had utilized SNA or SNI as part of their methodology. SNA was used to measure network variables as inputs in statistical/mathematical models in 64 % of studies and only 22 % of studies used SNI. Most studies focused on HIV prevention and few addressed diagnosis (k = 4), care linkage and retention (k = 5), ART adherence (k = 2), and viral suppression (k = 1). This systematic review highlights both the advantages and disadvantages of social network approaches for HIV prevention and treatment and gaps in its use for HIV care continuum.

Accessibility and utilization patterns of a mobile medical clinic among vulnerable populations.

We mapped mobile medical clinic (MMC) clients for spatial distribution of their self-reported locations and travel behaviors to better understand health-seeking and utilization patterns of medically vulnerable populations in Connecticut. Contrary to distance decay literature, we found that a small but significant proportion of clients was traveling substantial distances to receive repeat care at the MMC. Of 8404 total clients, 90.2% lived within 5 miles of a MMC site, yet mean utilization was highest (5.3 visits per client) among those living 11-20 miles of MMCs, primarily for those with substance use disorders. Of clients making >20 visits, 15.0% traveled >10 miles, suggesting that a significant minority of clients traveled to MMC sites because of their need-specific healthcare services, which are not only free but available at an acceptable and accommodating environment. The findings of this study contribute to the important research on healthcare utilization among vulnerable population by focusing on broader dimensions of accessibility in a setting where both mobile and fixed healthcare services coexist.

What role do local grocery stores play in urban food environments? A case study of Hartford-Connecticut.

INTRODUCTION: Research on urban food environments emphasizes limited access to healthy food, with fewer large supermarkets and higher food prices. Many residents of Hartford, Connecticut, which is often considered a food desert, buy most of their food from small and medium-sized grocery stores. We examined the food environment in greater Hartford, comparing stores in Hartford to those in the surrounding suburbs, and by store size (small, medium, and large). METHODS: We surveyed all small (over 1,000 ft2), medium, and large-sized supermarkets within a 2-mile radius of Hartford (36 total stores). We measured the distance to stores, availability, price and quality of a market basket of 25 items, and rated each store on internal and external appearance. Geographic Information System (GIS) was used for mapping distance to the stores and variation of food availability, quality, and appearance. RESULTS: Contrary to common literature, no significant differences were found in food availability and price between Hartford and suburban stores. However, produce quality, internal, and external store appearance were significantly lower in Hartford compared to suburban stores (all p<0.05). Medium-sized stores had significantly lower prices than small or large supermarkets (p<0.05). Large stores had better scores for internal (p<0.05), external, and produce quality (p<0.01). Most Hartford residents live within 0.5 to 1 mile distance to a grocery store. DISCUSSION: Classifying urban areas with few large supermarkets as 'food deserts' may overlook the availability of healthy foods and low prices that exist within small and medium-sized groceries common in inner cities. Improving produce quality and store appearance can potentially impact the food purchasing decisions of low-income residents in Hartford.

What are we 'tweeting' about obesity? Mapping tweets with Topic Modeling and Geographic Information System.

Public health related tweets are difficult to identify in large conversational datasets like Twitter.com. Even more challenging is the visualization and analyses of the spatial patterns encoded in tweets. This study has the following objectives: How can topic modeling be used to identify relevant public health topics such as obesity on Twitter.com? What are the common obesity related themes? What is the spatial pattern of the themes? What are the research challenges of using large conversational datasets from social networking sites? Obesity is chosen as a test theme to demonstrate the effectiveness of topic modeling using Latent Dirichlet Allocation (LDA) and spatial analysis using Geographic Information System (GIS). The dataset is constructed from tweets (originating from the United States) extracted from Twitter.com on obesity-related queries. Examples of such queries are 'food deserts', 'fast food', and 'childhood obesity'. The tweets are also georeferenced and time stamped. Three cohesive and meaningful themes such as 'childhood obesity and schools', 'obesity prevention', and 'obesity and food habits' are extracted from the LDA model. The GIS analysis of the extracted themes show distinct spatial pattern between rural and urban areas, northern and southern states, and between coasts and inland states. Further, relating the themes with ancillary datasets such as US census and locations of fast food restaurants based upon the location of the tweets in a GIS environment opened new avenues for spatial analyses and mapping. Therefore the techniques used in this study provide a possible toolset for computational social scientists in general and health researchers in specific to better understand health problems from large conversational datasets.

Geospatial study of psychiatric mental health-advanced practice registered nurses (PMH-APRNs) in the United States.

OBJECTIVE: The objectives of this study were to identify geographic regions with shortages of psychiatric mental health-advanced practice registered nurses (PMH-APRNs), describe rural-urban differences in the distribution of PMH-APRNs, and discuss implications of the uneven geographic distribution. METHODS: The data source was a complete listing, provided by the American Nurses Credentialing Center, of the employment zip codes of certified PMH-APRNs during 2007 (N=10,452). Geographic information science techniques and spatial statistics were used to conduct a cluster analysis of the spatial distribution of PMH-APRNs. RESULTS: After adjustment for population on the basis of U.S. census reports, statistically significant clusters of counties with high and low density of PMH-APRNs, an indicator of uneven accessibility, were identified. Rural-urban differences in the distribution were also illustrated. CONCLUSIONS: The interdisciplinary approach, including both mapping and statistical analyses, identified shortage areas and provided the groundwork for directing future education, clinical practice, and public policy initiatives.