This study integrates publicly available datasets to provide a county-based assessment of socio-economic disparities of population exposure to flood hazards in the United States. Statistical analyses ...were applied to reveal the national trends and local deviations from the trends. Results show that approximately 21.8 million (6.87% of) U.S. population are exposed to 100-year-flood in 2015, and most of the exposure is near water bodies (e.g. ocean and rivers). Additionally, communities near water bodies are more responsive to potential flood hazards by avoiding residence in flood zones than inland communities. At the national scale, economically disadvantaged population are more likely to reside in flood zones than outside. At the local scale, economically disadvantaged population tend to reside in flood zones in inland areas, while coastal flood zones are more occupied by wealthier and elderly people. These findings point to an alarming situation of inland communities where people are generally less responsive to flood hazards and people in flood zones are in a lower economic condition. Using “hot spot” analysis, local clusters of disadvantaged population groups with high flood exposure were identified. Overall, this study provides important baseline information for policymaking at different levels of administration and pinpoints local areas where diversified and ad hoc strategies are needed to mitigate flood risk in communities with diverse socio-economic conditions. This study provides empirical evidence of socio-economic disparities and environmental injustice associated with flood exposure in the U.S. and offers valuable insights to the underlying factors.
•21.8 million (6.87%) U.S. population are exposed to 100-year-flood.•Coastal and riverine communities are more responsive to flood hazards.•Nationally, economically disadvantaged population tend to reside in flood zones.•Economically disadvantaged people tend to reside in flood zones in inland areas.•Old and wealthy people are more crowded in coastal flood zones.
With the rapid spatial expansion of the warehousing industry in major metropolitan areas, environmental impacts associated with warehousing activities have been growing in the recent decades. This ...study focuses on the disproportionate distribution of warehousing facilities in disadvantaged neighborhoods and discusses how the disparities result from the interactions between various socioeconomic processes. From the perspective of environmental justice, warehousing-related environmental hazards affect the spatial relationship between warehouses and local communities. The changing factors in the firm location choice of warehousing facilities and the housing location choice of disadvantaged population jointly lead to the environmental justice problem in warehousing location.
Risk of asthma hospitalization and its disparities associated with air pollutant exposures are less clear within socioeconomically disadvantaged populations, particularly at low degrees of exposure.
...To assess effects of short-term exposures to fine particulate matter (particulate matter with an aerodynamic diameter of ⩽2.5 μm PM
), warm-season ozone (O
), and nitrogen dioxide (NO
) on risk of asthma hospitalization among national Medicaid beneficiaries, the most disadvantaged population in the United States, and to test whether any subpopulations were at higher risk.
We constructed a time-stratified case-crossover dataset among 1,627,002 hospitalizations during 2000-2012 and estimated risk of asthma hospitalization associated with short-term PM
, O
, and NO
exposures. We then restricted the analysis to hospitalizations with degrees of exposure below increasingly stringent thresholds. Furthermore, we tested effect modifications by individual- and community-level characteristics.
Each 1-μg/m
increase in PM
, 1-ppb increase in O
, and 1-ppb increase in NO
was associated with 0.31% (95% confidence interval CI, 0.24-0.37%), 0.10% (95% CI, 0.05 - 0.15%), and 0.28% (95% CI, 0.24 - 0.32%) increase in risk of asthma hospitalization, respectively. Low-level PM
and NO
exposures were associated with higher risk. Furthermore, beneficiaries with only one asthma hospitalization during the study period or in communities with lower population density, higher average body mass index, longer distance to the nearest hospital, or greater neighborhood deprivation experienced higher risk.
Short-term air pollutant exposures increased risk of asthma hospitalization among Medicaid beneficiaries, even at concentrations well below national standards. The subgroup differences suggested individual and contextual factors contributed to asthma disparities under effects of air pollutant exposures.
Issue addressed: This article reports the qualitative evaluation of "Artspace," an innovative clinical program combining creative arts with physical and mental health care for young women. The ...program, provided since 2004, comprises weekly visual arts sessions alongside a youth health clinic offering drop-in appointments with a nurse, GP and counsellor.
Methods: A qualitative evaluation of Artspace was conducted between 2016 and 2017.
Results: The evaluation showed that Artspace was particularly beneficial for those clients who had considerable exposure to social adversity and trauma, and were experiencing related serious health impacts. Artspace facilitated their recovery by enabling equitable access facilitation, social inclusion, creating a "holding" environment, and through the directly therapeutic benefits of artist-led arts processes.
Conclusions: Our study highlights the positive impact of artist-led programs such as Artspace. It also attests to the importance of long-term sustainability of services, to allow the time needed for young people to experience genuine and sustained recovery, and to reduce the otherwise likely disadvantages associated with mental and physical health problems, as they move into their adult lives.
So what?: Youth health researchers have been recommending arts programs at health services as a means of engaging young people in health care for over 15 years, however, it remains an underutilised approach in primary care settings. Our evaluation affirms the effectiveness of art programs for this, and also demonstrates that art programs can be a key contributor to recovery from the serious health impacts of adversity and trauma.
Pulmonary hypertension (PH) is a common and debilitating medical condition with high mortality. PH research has traditionally focused on pulmonary arterial hypertension and its management in expert ...PH centres. Other forms of PH such as PH associated with cardiac or respiratory disease are more common, less well‐understood and associated with higher mortality. Epidemiology of PH in disadvantaged, remote and rural regions, remains largely undocumented. In this review, we discuss the unique challenges in identifying PH in rural and disadvantaged populations using the Top End region of the Northern Territory of Australia as an example. We propose a simple diagnostic approach, ideally suited to regions where resource allocation is scarce, using clinical skills, echocardiography, and an escalation algorithm. The brief history, epidemiology and current literature on PH are summarised to inform the busy clinicians. We highlight two case examples from the Top End to illustrate the challenges and potential solutions.
Disadvantaged populations usually adopt risk behaviours, resulting in obesity and mental health-related disorders. Grounded in the socioecological model and self-determination theory, the aims were ...firstly to describe and implement a two-year multiple health behaviour change intervention, and secondly, to assess the strengths and weaknesses of the intervention. In total, 11 women from a disadvantaged population participated in this programme, which encompassed 117 sessions. Qualitative techniques were used to collect data and a thematic analysis was conducted. The variety of activities and the group-based intervention were the main strengths, and the decrease in attendance and the programme's tight schedule were the main weaknesses. This is the first intervention in a disadvantaged population mainly comprised of Roma women. The design described in detail and its assessment provide relevant knowledge to improve their health status and decrease inequalities. The practical implications for future research are useful for replicating interventions in similar contexts.
There remains a need to identify effective smoking cessation interventions in severely disadvantaged populations. This trial aimed to examine the effectiveness of an intervention (Call it Quits) ...developed to promote smoking cessation and delivered by community social service case-workers.
Call it Quits was a pragmatic, parallel randomised trial of a case-worker delivered smoking cessation intervention conducted in a non-government community social service organisation in New South Wales (NSW), Australia. Adult smokers requiring financial assistance were randomly assigned to the five-session Call it Quits intervention or usual care control group. Of the 618 eligible individuals, 300 were randomised to the intervention group, of whom 187 (62%) consented and 318 were randomised to the control group, of whom 244 (77%) consented, resulting in 431 participants.
The primary outcome measure was self-reported continuous abstinence up to 6-month follow-up with biochemical verification. Primary analysis was performed using all the available data from participants under the assumption the data is missing completely at random, followed by sensitivity analyses.
No statistically significant differences in the primary outcome were found (1.4% in the control group versus 1.0% in the intervention group, OR = 0.77, p = 0.828).
A multi-component smoking cessation intervention delivering motivational interviewing-based counselling and free NRT by a trained case-worker within a community social service setting was not effective at achieving abstinence in a highly disadvantaged sample of smokers but increased attempts to stop and led to a reduction in number of cigarettes smoked daily.
•First smoking cessation trial in a community based social service setting•Participants were socioeconomically disadvantaged smokers with comorbidity•Case-worker delivered intervention were not effective at aiding abstinence•Important gains were made in reductions in cigarettes smoked and quit attempts.
•Smoking + other nicotine product concurrent use (CU) was 67.2% in this homeless adult sample.•Common motives for CU were to cut back/quit cigarettes and financial limitations.•CU (vs smokers-only) ...endorsed more quit attempts and greater risks from smoking.•CUs may be apt targets for cessation at agencies with limited treatment resources.
Cigarette smoking rates among homeless adults are exceptionally high, contributing to health disparities experienced by this disadvantaged population. Concurrent nicotine and tobacco product use have been shown to result in greater health problems than cigarette smoking alone, and little is known about the rates, motives, and perceived impacts of concurrent use in this group. The purpose of this study is to explore concurrent use rates and constructs of interest among homeless adult daily smokers and to examine differences between concurrent users and non-concurrent users on cigarette dependence, perceived risk of smoking, readiness to quit, and the receipt of recent cessation intervention.
Participants (N = 396) were recruited from six homeless-serving agencies and/or shelters in Oklahoma City. Enrolled participants completed self-report questionnaires.
The rate of concurrent use was high −67.2%. Participants most frequently endorsed lower cost and a desire to cut down on cigarette smoking as motives for concurrent product use. Concurrent users indicated both a greater likelihood of developing a smoking-related disease if they did not quit for good and a greater number of past year quit attempts relative to non-concurrent users. There was no significant difference between concurrent users and non-concurrent users on readiness to quit or having received recent smoking cessation intervention.
The need for cessation efforts that account for concurrent use for homeless adult smokers is great. Study findings indicate that concurrent users are commonly pursuing the reduction or elimination of cigarette usage and should be specifically targeted for cessation intervention.
The difference in the individuals’ preference of activity destination choice is a new explanation for the activity-space segregation. This study investigates individuals’ preference in the ...destination choice for their daily activities. It uses revealed preference survey for the choice of the activity destination, and mobile phone dataset for the ambient population at the activity destination in Guangzhou, China. It has found that (1) the activity-space segregation is strongly influenced by the residential segregation, but disadvantaged populations are more spatially constrained by the distance decay effect; (2) all individuals prefer a destination with high diversity of built environment; and (3) migrant people tend to be self-segregated at the activity space, but people with higher education status prefer to take activities at an integrated place.
Background: The social determinants of health (SDOH) of patients with COVID-19-related thrombosis have been scarcely explored. Our objective was to investigate the cases of thrombosis in a group of ...socially disadvantaged populations with COVID-19. Methods: We investigated the thrombotic events that occurred in a cohort of migrant and Spanish patients with COVID-19 that were admitted to a medicalized hotel in Madrid. Demographic data, past medical history, and socio-economic backgrounds, such as monthly household income, level of education, and living conditions, were explored to determine the factors related to thrombosis. Results: A cohort of 383 subjects (mean age 55.4 ± 14.6 years old, 69% male), of which 58% were migrants, was studied. Fourteen (3.6%) cases of thrombosis were reported. Thrombosis was more frequent in Spanish than in migrant individuals (OR 5.3, 95%CI 1.4–19.5, p = 0.005). Neither a low monthly household income nor a low education level showed a statistical association with thrombosis (p ≥ 0.05). History of venous thromboembolism (OR 8.1, 95%CI 2.2–28.6) and being a current smoker (OR 4.7, 95%CI 1.3–16.0) were factors associated with thrombosis. Conclusions: The SDOH studied were not associated with thrombosis; however, further investigation must be performed to investigate the socio-economic conditions of subjects with COVID-19 with adverse outcomes such as thrombotic events.
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