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Item Predicting COVID-19 community infection relative risk with a Dynamic Bayesian Network(Frontiers, 2022) Johnson, Daniel P.; Lulla, Vijay; Geography, School of Liberal ArtsAs COVID-19 continues to impact the United States and the world at large it is becoming increasingly necessary to develop methods which predict local scale spread of the disease. This is especially important as newer variants of the virus are likely to emerge and threaten community spread. We develop a Dynamic Bayesian Network (DBN) to predict community-level relative risk of COVID-19 infection at the census tract scale in the U.S. state of Indiana. The model incorporates measures of social and environmental vulnerability—including environmental determinants of COVID-19 infection—into a spatial temporal prediction of infection relative risk 1-month into the future. The DBN significantly outperforms five other modeling techniques used for comparison and which are typically applied in spatial epidemiological applications. The logic behind the DBN also makes it very well-suited for spatial-temporal prediction and for “what-if” analysis. The research results also highlight the need for further research using DBN-type approaches that incorporate methods of artificial intelligence into modeling dynamic processes, especially prominent within spatial epidemiologic applications.Item Population-Based Disparities in U.S. Urban Heat Exposure from 2003 to 2018(MDPI, 2022) Johnson, Daniel P.; Geography, School of Liberal ArtsPrevious studies have shown, in the United States (U.S.), that communities of color are exposed to significantly higher temperatures in urban environments than complementary White populations. Studies highlighting this disparity have generally been cross-sectional and are therefore “snapshots” in time. Using surface urban heat island (SUHI) intensity data, U.S. Census 2020 population counts, and a measure of residential segregation, this study performs a comparative analysis between census tracts identified as prevalent for White, Black, Hispanic and Asian populations and their thermal exposure from 2003 to 2018. The analysis concentrates on the top 200 most populous U.S. cities. SUHI intensity is shown to be increasing on average through time for the examined tracts. However, based on raw observations the increase is only statistically significant for White and Black prevalent census tracts. There is a 1.25 K to ~2.00 K higher degree of thermal exposure on average for communities of color relative to White prevalent areas. When examined on an inter-city basis, White and Black prevalent tracts had the largest disparity, as measured by SUHI intensity, in New Orleans, LA, by <6.00 K. Hispanic (>7.00 K) and Asian (<6.75 K) prevalent tracts were greatest in intensity in San Jose, CA. To further explore temporal patterns, two models were developed using a Bayesian hierarchical spatial temporal framework. One models the effect of varying the percentages of each population group relative to SUHI intensity within all examined tracts. Increases in percentages of Black, Hispanic, and Asian populations contributed to statistically significant increases in SUHI intensity. White increases in population percentage witnessed a lowering of SUHI intensity. Throughout all modeled tracts, there is a statistically significant 0.01 K per year average increase in SUHI intensity. A second model tests the effect of residential segregation on thermal inequity across all examined cities. Residential segregation, indeed, has a statistically significant positive association with SUHI intensity based on this portion of the analysis. Similarly, there is a statistically significant 0.01 K increase in average SUHI intensity per year for all cities. Results from this study can be used to guide and prioritize intervention strategies and further urgency related to social, climatic, and environmental justice concerns.Item Fatal self-injury in the United States, 1999–2018: Unmasking a national mental health crisis(Elsevier, 2021) Rockett, Ian R.H.; Caine, Eric D.; Banerjee, Aniruddha; Ali, Bina; Miller, Ted; Connery, Hilary S.; Lulla, Vijay O.; Nolte, Kurt B.; Larkin, G. Luke; Stack, Steven; Hendricks, Brian; McHugh, R. Kathryn; White, Franklin M.M.; Greenfield, Shelly F.; Bohnert, Amy S.B.; Cossman, Jeralynn S.; D'Onofrio, Gail; Nelson, Lewis S.; Nestadt, Paul S.; Berry, James H.; Jia, Haomiao; Geography, School of Liberal ArtsBackground Suicides by any method, plus ‘nonsuicide’ fatalities from drug self-intoxication (estimated from selected forensically undetermined and ‘accidental’ deaths), together represent self-injury mortality (SIM)—fatalities due to mental disorders or distress. SIM is especially important to examine given frequent undercounting of suicides amongst drug overdose deaths. We report suicide and SIM trends in the United States of America (US) during 1999–2018, portray interstate rate trends, and examine spatiotemporal (spacetime) diffusion or spread of the drug self-intoxication component of SIM, with attention to potential for differential suicide misclassification. Methods For this state-based, cross-sectional, panel time series, we used de-identified manner and underlying cause-of-death data for the 50 states and District of Columbia (DC) from CDC's Wide-ranging Online Data for Epidemiologic Research. Procedures comprised joinpoint regression to describe national trends; Spearman's rank-order correlation coefficient to assess interstate SIM and suicide rate congruence; and spacetime hierarchical modelling of the ‘nonsuicide’ SIM component. Findings The national annual average percentage change over the observation period in the SIM rate was 4.3% (95% CI: 3.3%, 5.4%; p<0.001) versus 1.8% (95% CI: 1.6%, 2.0%; p<0.001) for the suicide rate. By 2017/2018, all states except Nebraska (19.9) posted a SIM rate of at least 21.0 deaths per 100,000 population—the floor of the rate range for the top 5 ranking states in 1999/2000. The rank-order correlation coefficient for SIM and suicide rates was 0.82 (p<0.001) in 1999/2000 versus 0.34 (p = 0.02) by 2017/2018. Seven states in the West posted a ≥ 5.0% reduction in their standardised mortality ratios of ‘nonsuicide’ drug fatalities, relative to the national ratio, and 6 states from the other 3 major regions a >6.0% increase (p<0.05). Interpretation Depiction of rising SIM trends across states and major regions unmasks a burgeoning national mental health crisis. Geographic variation is plausibly a partial product of local heterogeneity in toxic drug availability and the quality of medicolegal death investigations. Like COVID-19, the nation will only be able to prevent SIM by responding with collective, comprehensive, systemic approaches. Injury surveillance and prevention, mental health, and societal well-being are poorly served by the continuing segregation of substance use disorders from other mental disorders in clinical medicine and public health practice.Item Strategic placement of urban agriculture: A spatial optimization approach(Wiley, 2021) Thapa, Bhuwan; Banerjee, Aniruddha; Wilson, Jeffrey; Hamlin, Samantha; Geography, School of Liberal ArtsStrategic placement of urban agriculture such as community gardens can expand alternate food supply, support physical activity, and promote social interactions. While social and health benefits are critical priorities when planning new urban agriculture locations, no widely accepted site selection methods have been established. We developed a spatial optimization model to identify new urban agriculture locations in the City of Indianapolis, Marion County, Indiana. Considering block groups with vacant parcels as potential locations, the study uses p-median optimization to identify the 25 best locations that would minimize travel from any block group in the city to potential garden locations. We weighted each block group based on food access and prevalence of obesity, where food access was characterized on three dimensions: economic, geographical, and informational. The model was simulated for three policy scenarios with equal, stakeholder-driven, and obesity-driven weights, and the results were compared with randomly selected locations. We found that optimally selected locations were 52% more efficient than randomly chosen locations in terms of the average distance traveled by residents based on the p-median solution. However, there was no significant difference in travel distance among the three policy scenarios. The spatial optimization model can help policymakers and practitioners strategically locate urban agriculture sites.Item Sky View Factor Measurements in Support of Local Climate Zone Classification(Indiana View, 2020) Adhikari, Bikalpa; Wilson, Jeffrey; Geography, School of Liberal ArtsIncreasing urbanization coupled with threats from global climate change are driving research innovations that seek to inform sustainability of urban socio-ecological systems. The Local Climate Zone (LCZ) classification system developed by Stewart and Oke (2012) provides a framework for examining relationships between urban morphology and temperature, as well as a standardized approach to facilitate data integration from around the globe. In addition to urban heat island studies, parameters used to define LCZs are increasingly applied in related fields, such as modeling fine-scale variations in urban air quality (Badach et al., 2020).Item Spatiotemporal Associations Between Social Vulnerability, Environmental Measurements, and COVID‐19 in the Conterminous United States(AGU, 2021-07-21) Johnson, Daniel P.; Ravi, Niranjan; Braneon, Christian V.; Geography, School of Liberal ArtsThis study summarizes the results from fitting a Bayesian hierarchical spatiotemporal model to coronavirus disease 2019 (COVID-19) cases and deaths at the county level in the United States for the year 2020. Two models were created, one for cases and one for deaths, utilizing a scaled Besag, York, Mollié model with Type I spatial-temporal interaction. Each model accounts for 16 social vulnerability and 7 environmental variables as fixed effects. The spatial pattern between COVID-19 cases and deaths is significantly different in many ways. The spatiotemporal trend of the pandemic in the United States illustrates a shift out of many of the major metropolitan areas into the United States Southeast and Southwest during the summer months and into the upper Midwest beginning in autumn. Analysis of the major social vulnerability predictors of COVID-19 infection and death found that counties with higher percentages of those not having a high school diploma, having non-White status and being Age 65 and over to be significant. Among the environmental variables, above ground level temperature had the strongest effect on relative risk to both cases and deaths. Hot and cold spots, areas of statistically significant high and low COVID-19 cases and deaths respectively, derived from the convolutional spatial effect show that areas with a high probability of above average relative risk have significantly higher Social Vulnerability Index composite scores. The same analysis utilizing the spatiotemporal interaction term exemplifies a more complex relationship between social vulnerability, environmental measurements, COVID-19 cases, and COVID-19 deaths.Item Visitor bikeshare usage: tracking visitor spatiotemporal behavior using big data(Taylor & Francis, 2020-09-11) Buning, Richard J; Lulla, VijayBikeshare programs are a popular, convenient, and sustainable mode of transportation that provide a range of benefits to urban communities such as reduction in carbon emissions, decreased travel times, financial savings, and heightened physical activity. Although, tourists are especially inclined to use bikeshare to explore a destination as the programs are a convenient, cheap, flexible, and an active alternative to vehicles and mass transit little research or attention has focused on visitor usage. As such the current study investigated the spatial-temporal usage patterns of bikeshare by visitors to an urban community using GPS based big data (N = 353,733). The results revealed differential usage patterns between visitors and local residents based on user provided ZIP Codes using a 50 mile geometric circular buffer around the urban destination. The visitors and residents significantly varied on numerous trip behaviors including route selection, time of rental, checkout/check-in locations, distance, speed, duration, and physical activity intensity. The user patterns uncovered suggest visitors primarily use bikeshare for leisure based urban exploration, compared to residents’ primary use of bikeshare to be public transportation related. Implications for bikeshare, urban planning, and tourism management are provided aimed at delivering a more sustainable and richer visitor experience.Item Identifying risk factors for healthcare-associated infections from electronic medical record home address data(BMC, 2010-09-17) Wilson, Jeffrey S.; Shepherd, David C.; Rosenman, Marc B.; Kho, Abel N.; Geography, School of Liberal ArtsBackground Residential address is a common element in patient electronic medical records. Guidelines from the U.S. Centers for Disease Control and Prevention specify that residence in a nursing home, skilled nursing facility, or hospice within a year prior to a positive culture date is among the criteria for differentiating healthcare-acquired from community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections. Residential addresses may be useful for identifying patients residing in healthcare-associated settings, but methods for categorizing residence type based on electronic medical records have not been widely documented. The aim of this study was to develop a process to assist in differentiating healthcare-associated from community-associated MRSA infections by analyzing patient addresses to determine if residence reported at the time of positive culture was associated with a healthcare facility or other institutional location. Results We identified 1,232 of the patients (8.24% of the sample) with positive cultures as probable cases of healthcare-associated MRSA based on residential addresses contained in electronic medical records. Combining manual review with linking to institutional address databases improved geocoding rates from 11,870 records (79.37%) to 12,549 records (83.91%). Standardization of patient home address through geocoding increased the number of matches to institutional facilities from 545 (3.64%) to 1,379 (9.22%). Conclusions Linking patient home address data from electronic medical records to institutional residential databases provides useful information for epidemiologic researchers, infection control practitioners, and clinicians. This information, coupled with other clinical and laboratory data, can be used to inform differentiation of healthcare-acquired from community-acquired infections. The process presented should be extensible with little or no added data costs.Item Measuring and Visualizing Chlamydia and Gonorrhea Inequality: An Informatics Approach Using Geographical Information Systems(University of Illinois at Chicago, 2019-09-19) Lai, Patrick T.S.; Wilson, Jeffrey; Wu, Huanmei; Jones, Josette; Dixon, Brian E.; Geography, School of Liberal ArtsBackground: Health inequality measurements are vital in understanding disease patterns in identifying high-risk patients and implementing effective intervention programs to treat and manage sexually transmitted diseases. Objectives: To measure and identify inequalities among chlamydia and gonorrhea rates using Gini coefficient measurements and spatial visualization mapping from geographical information systems. Additionally, we seek to examine trends of disease rate distribution longitudinally over a ten-year period for an urbanized county. Methods: Chlamydia and gonorrhea data from January 2005 to December 2014 were collected from the Indiana Network for Patient Care, a health information exchange system that gathers patient data from electronic health records. The Gini coefficient was used to calculate the magnitude of inequality in disease rates. Spatial visualization mapping and decile categorization of disease rates were conducted to identify locations where high and low rates of disease persisted and to visualize differences in inequality. A multiple comparisons ANOVA test was conducted to determine if Gini coefficient values were statistically different between townships and time periods during the study. Results: Our analyses show that chlamydia and gonorrhea rates are not evenly distributed. Inequalities in disease rates existed for different areas of the county with higher disease rates occurring near the center of the county. Inequality in gonorrhea rates were higher than chlamydia rates. Disease rates were statistically different when geographical locations or townships were compared to each other (p < 0.0001) but not for different years or time periods (p = 0.5152). Conclusion: The ability to use Gini coefficients combined with spatial visualization techniques presented a valuable opportunity to analyze information from health information systems in investigating health inequalities. Knowledge from this study can benefit and improve health quality, delivery of services, and intervention programs while managing healthcare costs.Item Factorial Invariance of the Abbreviated Neighborhood Environment Walkability Scale among Senior Women in the Nurses’ Health Study Cohort(Taylor & Francis (Routledge): SSH Titles, 2019) Starnes, Heather A.; McDonough, Meghan H.; Wilson, Jeffrey S.; Mroczek, Daniel K.; Laden, Francine; Troped, Philip J.; Geography, School of Liberal ArtsThe purpose of this study was to examine the factorial invariance of the Abbreviated Neighborhood Environment Walkability Scale (NEWS-A) across subgroups based on demographic, health-related, behavioral, and environmental characteristics among Nurses’ Health Study participants (N = 2,919; age M = 73.0, SD = 6.9 years) living in California, Massachusetts, and Pennsylvania. A series of multi-group confirmatory factor analyses were conducted to evaluate increasingly restrictive hypotheses of factorial invariance. Factorial invariance was supported across age, walking limitations, and neighborhood walking. Only partial scalar invariance was supported across state residence and neighborhood population density. This evidence provides support for using the NEWS-A with older women of different ages, who have different degrees of walking limitations, and who engage in different amounts of neighborhood walking. Partial scalar invariance suggests that researchers should be cautious when using the NEWS-A to compare older adults living in different states and neighborhoods with different levels of population density.