Jeralynn S. Cossman

Preliminary Evidence for an Emerging Nonmetropolitan Mortality Penalty in the United States

We discovered an emerging non-metropolitan mortality penalty by contrasting 37 years of age-adjusted mortality rates for metropolitan versus nonmetropolitan US counties. During the 1980s, annual metropolitan-nonmetropolitan differences averaged 6.2 excess deaths per 100,000 nonmetropolitan population, or approximately 3600 excess deaths; however, by 2000 to 2004, the difference had increased more than 10 times to average 71.7 excess deaths, or approximately 35,000 excess deaths. We recommend that research be undertaken to evaluate and utilize our preliminary findings of an emerging US nonmetropolitan mortality penalty.

Underlying Causes of the Emerging Nonmetropolitan Mortality Penalty

The nonmetropolitan mortality penalty results in an estimated 40 201 excessive US deaths per year, deaths that would not occur if nonmetropolitan and metropolitan residents died at the same rate. We explored the underlying causes of the nonmetropolitan mortality penalty by examining variation in cause of death. Declines in heart disease and cancer death rates in metropolitan areas drive the nonmetropolitan mortality penalty. Future work should explore why the top causes of death are higher in nonmetropolitan areas than they are in metropolitan areas.

FEAR OF CRIME AND PERSONAL VULNERABILITY: EXAMINING SELF-REPORTED HEALTH

This research considers the relationship between self-reported health and fear of crime. Fear of crime literature suggests women, the elderly, or the impoverished may experience heightened fear of crime. It is hypothesized that it is a sense of vulnerability that leads individuals to believe they would be unable to protect themselves should an attack occur, increasing their personal fear of crime. We argue in this article that poor self-reported health may also lead to a sense of vulnerability and elevate fear of crime. We test this hypothesis using data from the General Social Survey (GSS). Using a variety of health measures, our results indicate that some indicators of health are related to a heightened fear of crime and that this relationship varies by gender. Women are at a double disadvantage, in that they feel more vulnerable to crime than men, and women also have more negative perceptions of health.

Persistent Clusters of Mortality in the United States

We explored how place shapes mortality by examining 35 consecutive years of US mortality data. Mapping age-adjusted county mortality rates showed both persistent temporal and spatial clustering of high and low mortality rates. Counties with high mortality rates and counties with low mortality rates both experienced younger population out-migration, had economic decline, and were predominantly rural. These mortality patterns have important implications for proper research model specification and for health resource allocation policies.

A brief visual primer for the mapping of mortality trend data

Maps are increasingly used to visualize and analyze data, yet the spatial ramifications of data structure are rarely considered. Data are subject to transformations made throughout the research process and then used to map, visualize and conduct spatial analysis. We used mortality data to answer three research questions: Are there spatial patterns to mortality, are these patterns statistically significant, and are they persistent across time? This paper provides differential spatial patterns by implementing six data transformations: standardization, cut-points, class size, color scheme, spatial significance and temporal mapping. We use numerous maps and graphics to illustrate the iterative nature of mortality mapping, and exploit the visual nature of the International Journal of Health Geographics journal on the World Wide Web to present researchers with a series of maps.

Does familiarity breed respect? Physician attitudes toward nurse practitioners in a medically underserved state

Purpose: An evolving primary care environment underscores the importance of physician and nurse practitioner (NP) interactions. We analyze how physician characteristics and close working relationships (presence of NPs in practice) influence physicians’ attitudes toward NPs. Data sources: Bivariate analyses of 2007–2008 Missisisppi Physician Workforce Study survey data (response rate 23.3%) identified Mississippi physician characteristics associated with having NPs in practices and discrete NP‐attitudinal items. Generalized physician attitudes toward NPs were modeled using multivariate regression. Conclusions: Generalists, physicians in public sector employment and physicians in larger practices are more likely to work in practices that also include NPs. Physicians working with NPs are somewhat younger than those who do not. Regression analysis indicates that male physicians had less‐positive attitudes toward NPs, while physicians who practice alongside NPs and who have been in practice longer have the most positive generalized attitudes toward NPs. Implications for practice: Physicians who work in the same practice with NPs have more positive attitudes toward them. However, regardless of work arrangements, MS physicians are reluctant for NPs to practice independently. Physicians with early collaborative training with NPs may have more positive attitudes, but even such exposure will not necessarily lead physicians to support NPs’ independent practice.

Considering the Gendered Nature of Constrained Behavior Practices Among Male and Female College Students

Previous research suggests that individuals engage in a variety of constrained behaviors to protect themselves from potential victimization. Although research controls for gender and constrained behaviors in fear of crime models, few studies consider constrained behaviors through a gendered lens. Using university survey data as an exploratory case study, this article hypothesizes that men and women use different types of constrained behaviors and, using factor analysis, constructs a gender-sensitive typology of four distinctive types of constrained behaviors. The results suggest that women are more likely to engage in all four types of constrained behaviors and that a variety of gender differences in behavioral responses to fear in crime are apparent when comparing across the four categories.

Multiple Meanings of Minority Concentration: Incorporating Contextual Explanations into the Analysis of Individual-Level U.S. Black Mortality Outcomes

Prior research on mortality for U.S. blacks focuses on the detrimental effects of minority concentration and residential segregation in metropolitan areas on health outcomes. To date, few studies have examined this relationship outside of large U.S. central cities. In this paper, we extend current research on the minority concentration and mortality relationship to explain the rural advantage in mortality for nonmetropolitan blacks. Using data from the 1986–1994 linked National Health Interview Survey/National Death Index, we examine the rural-urban gap in mortality for U.S. blacks. Our findings indicate that blacks in nonmetropolitan areas experience a lower risk of mortality than metropolitan central city blacks after indicators of socio-economic and health status are controlled. Our findings also point to the importance of accounting for contextual factors. Net of individual level controls, minority concentration exerts differential effects across metropolitan and nonmetropolitan areas, such that nonmetropolitan black residents experience a lower risk of mortality in high minority concentration areas than blacks in metropolitan central city areas. This finding suggests a reconceptualization of the meaning for minority concentration with respect to studies of health outcomes in nonmetropolitan communities.

Mapping high or low mortality places across time in the United States: a research note on a health visualization and analysis project

This research note reports progress in visualizing and analyzing United States mortality data at the county level. The data visualization technique employed here may be applicable to other research situations. We dichotomized the range of mortality rates into high or low mortality counties, mapped them, and explored the clustering of high or low mortality rate counties across both space and time. We find visual evidence that high or low mortality counties spatially cluster together during individual periods of time (5 years). We find further visual evidence that there is a spatial persistence over time (30 years) of these counties with high or low mortality. This evidence leads us to conclude that relatively high or low mortality is anchored over time within a spatial region and population, suggesting that research efforts may be focused on these clusters to assess local causes of high or low mortality rates. Future research will examine the permanence of the resident population (i.e., population mixing), characteristics of the resident population, and characteristics of their place of residence over time.

PARENTS' HETEROSEXISM AND CHILDREN'S ATTITUDES TOWARD PEOPLE WITH AIDS

This research examines how parental heterosexism—negative attitudes toward homosexuals and homosexuality—and other family characteristics relate to the development of childrens attitudes toward people with HIV/AIDS (PWA). Attention is directed to the overall relationship between parents’ and childrens attitudes and to the potential mechanisms through which these linkages are manifested. Based on social learning theories of childhood socialization, a range of mechanisms is considered, focusing on heterosexist attitudes in parents and communication with children about AIDS. Findings indicate that parental attitudes concerning homosexuals influence childrens attitudes toward PWA, implying that there can be negative as well as positive consequences of parents’ beliefs on childrens attitudes. The possibility of negative parental effects on childrens prejudices toward PWA suggests that in-school HIV/AIDS education at younger ages is more important than previously thought.