Sue C. Grady

Effects of Green Buildings on Employee Health and Productivity

We investigated the effects of improved indoor environmental quality (IEQ) on perceived health and productivity in occupants who moved from conventional to green (according to Leadership in Energy and Environmental Design ratings) office buildings. In 2 retrospective-prospective case studies we found that improved IEQ contributed to reductions in perceived absenteeism and work hours affected by asthma, respiratory allergies, depression, and stress and to self-reported improvements in productivity. These preliminary findings indicate that green buildings may positively affect public health.

Measuring geographic access to health care: raster and network-based methods

BackgroundInequalities in geographic access to health care result from the configuration of facilities, population distribution, and the transportation infrastructure. In recent accessibility studies, the traditional distance measure (Euclidean) has been replaced with more plausible measures such as travel distance or time. Both network and raster-based methods are often utilized for estimating travel time in a Geographic Information System. Therefore, exploring the differences in the underlying data models and associated methods and their impact on geographic accessibility estimates is warranted.MethodsWe examine the assumptions present in population-based travel time models. Conceptual and practical differences between raster and network data models are reviewed, along with methodological implications for service area estimates. Our case study investigates Limited Access Areas defined by Michigan’s Certificate of Need (CON) Program. Geographic accessibility is calculated by identifying the number of people residing more than 30 minutes from an acute care hospital. Both network and raster-based methods are implemented and their results are compared. We also examine sensitivity to changes in travel speed settings and population assignment.ResultsIn both methods, the areas identified as having limited accessibility were similar in their location, configuration, and shape. However, the number of people identified as having limited accessibility varied substantially between methods. Over all permutations, the raster-based method identified more area and people with limited accessibility. The raster-based method was more sensitive to travel speed settings, while the network-based method was more sensitive to the specific population assignment method employed in Michigan.ConclusionsDifferences between the underlying data models help to explain the variation in results between raster and network-based methods. Considering that the choice of data model/method may substantially alter the outcomes of a geographic accessibility analysis, we advise researchers to use caution in model selection. For policy, we recommend that Michigan adopt the network-based method or reevaluate the travel speed assignment rule in the raster-based method. Additionally, we recommend that the state revisit the population assignment method.

Prenatal Care Need and Access: A GIS Analysis

Many municipalities provide special prenatal care services targeted to low-income women whose access to prenatal care is constrained. For such services to be successful and effective, they must be geographically targeted to the places where low-income, high-need mothers live. This paper presents a GIS analysis of prenatal care need and clinic services for low-income mothers in Brooklyn, NY. We analyze fine-grained geographic variation in need using data on the residential locations of recent mothers who lack health insurance or are covered by Medicaid. Spatial statistical methods are used to create spatially smoothed maps of the density of mothers and corresponding maps of the density of prenatal clinics. For these mothers, clinic density is positively associated with early initiation of prenatal care. Although clinic locations conform relatively well to the residential concentrations of high-need women, we identify several underserved areas with large numbers of needy women and few clinics available.

Geographic analysis of low birthweight and infant mortality in Michigan using automated zoning methodology

BackgroundInfant mortality is a major public health problem in the State of Michigan and the United States. The primary adverse reproductive outcome underlying infant mortality is low birthweight. Visualizing and exploring the spatial patterns of low birthweight and infant mortality rates and standardized incidence and mortality ratios is important for generating mechanistic hypotheses, targeting high-risk neighborhoods for monitoring and implementing maternal and child health intervention and prevention programs and evaluating the need for health care services. This study investigates the spatial patterns of low birthweight and infant mortality in the State of Michigan using automated zone matching (AZM) methodology and minimum case and population threshold recommendations provided by the National Center for Health Statistics and the US Census Bureau to calculate stable rates and standardized incidence and mortality ratios at the Zip Code (n = 896) level. The results from this analysis are validated using SaTScan. Vital statistics birth (n = 370,587) and linked infant death (n = 2,972) records obtained from the Michigan Department of Community Health and aggregated for the years 2004 to 2006 are utilized.ResultsFor a majority of Zip Codes the relative standard errors (RSEs) of rates calculated prior to AZM were greater than 20%. Spurious results were the result of too few case and birth counts. Applying AZM with a target population of 25 cases and minimum threshold of 20 cases resulted in the reconstruction of zones with at least 50 births and RSEs of rates 20–22% and below respectively, demonstrating the stability reliability of these new estimates. Other AZM parameters included homogeneity constraints on maternal race and maximum shape compactness of zones to minimize potential confounding. AZM identified areas with elevated low birthweight and infant mortality rates and standardized incidence and mortality ratios. Most but not all of these areas were also detected by SaTScan.ConclusionUnderstanding the spatial patterns of low birthweight and infant deaths in Michigan was an important first step in conducting a geographic evaluation of the States reported high infant mortality rates. AZM proved to be a useful tool for visualizing and exploring the spatial patterns of low birthweight and infant deaths for public health surveillance. Future research should also consider AZM as a tool for health services research.

Homicide as Infectious Disease: Using Public Health Methods to Investigate the Diffusion of Homicide

This study examined the spatial and temporal movement of homicide in Newark, New Jersey from January 1982 through September 2008. We hypothesized that homicide would diffuse in a similar process to an infectious disease with firearms and gangs operating as the infectious agents. A total of 2,366 homicide incidents were analyzed using SaTScan v.9.0, a cluster detection software. The results revealed spatio-temporal patterns of expansion diffusion: overall, firearm and gang homicide clusters in Newark evolved from a common area in the center of the city and spread southward and westward over the course of two decades. This pattern of movement has implications in regards to the susceptibility of populations to homicide, particularly because northern and eastern Newark remained largely immune to homicide clusters. The theoretical and practical implications of the findings, as well as recommendations for future research, are discussed.

Costs and Benefits of IEQ Improvements in LEED Office Buildings

Costs and benefits resulting from improved indoor environmental quality (IEQ) in Leadership in Energy and Environmental Design (LEED)-certified buildings are often hypothesized; however, the precise quantification of such costs and benefits remains a challenge. This research examined the incremental hard and soft costs of realizing IEQ improvements in LEED office buildings and related benefits to occupant well-being and productivity using a case study approach. Self-reported well-being and productivity data were collected by surveying employees occupying conventional offices compared to similar data upon their move to LEED offices. These pre- and postmove findings were analyzed using the life cycle cost analysis (LCCA) framework to calculate the potential economic gains of IEQ improvements to the organizations. The results indicate economically viable investments in LEED-IEQ credits and offers directions for future research. These preliminary findings may assist building owners/investors/policymakers in making better-informed building decisions towards IEQ improvements in buildings from the economic perspective of sustainability.

Ethnic Density and Maternal and Infant Health Inequalities: Bangladeshi Immigrant Women in New York City in the 1990s

How do the social and material characteristics of residential contexts in the host country affect immigrant maternal and infant health? We examine this question through the lens of the ethnic density hypothesis, a hypothesis that posits beneficial effects on immigrant health of living in areas of high ethnic density; that is, among a socially and linguistically similar population. We analyze the association between infant low birth weight and ethnic density for Bangladeshi immigrant mothers in New York City during a period of rapid and sustained immigration (1990–2000). For Bangladeshi immigrant women, ethnic neighborhoods can provide an important source of social and material support during pregnancy. Geographic information systems (GIS) and spatial analysis methods are used to create a fine-grained indicator of ethnic density. Results show that the relationship between ethnic density and infant low birth weight changed over time. The lack of association in the early years (1990 and 1993) might reflect the fact that the Bangladeshi population had not yet reached a sufficient size, or spatially clustered settlement pattern, to provide dense ethnic neighborhoods and concentrations of social and material resources. In 2000, we observe a U-shaped association between low birth weight and density: Women living in ethnically isolated settings and those living in high-density enclaves are more vulnerable to adverse infant health outcomes. The results suggest the need for a more nuanced understanding of immigrant maternal and infant health and ethnic density that incorporates the dynamism of immigrant experiences and their associations with shifting spatially and socially defined residential environments.

Racial residential segregation impacts on low birth weight using improved neighborhood boundary definitions.

Research on local racial residential segregation and health generally utilize census tract boundaries as a proxy from within which to estimate individual exposures. Census tracts however, may not accurately reflect the neighborhood environments in which people live and interact. Census tract geography may also capture non-exchangeable populations in socially stratified cities, impacting statistical assumptions of independence. To address these concerns, this study assessed the impact of racial residential segregation (i.e., racial isolation and racial clusters) on low birth weight (i.e., intrauterine growth retardation (IUGR) and preterm birth) in the Detroit Metropolitan Area using optimized neighborhood boundary definitions. Automated zone-matching (AZM) methodology was applied to redefine neighborhood (zones). Maternal and infant health information was obtained from Michigans vital statistics birth registry (n=137,965) for the years 2004-2006. Multilevel models were estimated to assess the effect of high racial isolation and high racial clusters on IUGR and preterm birth, controlling for maternal race, single marital status, smoking and area-level poverty. The results from this study showed that high racial isolation had a significant effect on IUGR, while the odds of preterm birth were higher in racially clustered zones. African American mothers were at increased odds of having IUGR or preterm infants than other mothers; however, these disparities reduced in highly segregated zones. The predicted incidence of IUGR across racially isolated zones and census tracts differed indicating a modifiable area unit problem (MAUP). MAUP effects were not observed in models predicting preterm incidence in high racial clusters or IUGR or preterm incidence in high poverty areas, demonstrating the stability-reliability of these estimates. Future research should continue to optimize neighborhood boundary definitions, while assessing the sensitivity of segregation measures to changes in scale, to improve our understanding of segregation impacts on racial disparities in low birth weight.

Spatial Methods to Study Local Racial Residential Segregation and Infant Health in Detroit, Michigan

Over the last several decades, blacks in the United States have experienced substantial health disadvantages compared to other racial and ethnic groups. These disadvantages have been observed for important types of morbidity and early mortality, which public health interventions have achieved limited progress in improving. A promising new direction in health geographic research investigates the relationships among racial residential segregation, neighborhood socioeconomic inequality, and racial health disparities in urban areas of the United States. Historical evidence shows that as class isolation increases in racially segregated neighborhoods, poverty is concentrated, resulting in reduced opportunities and available and accessible amenities and resources, important factors in the promotion and maintenance of population health and well-being. Contemporary evidence shows that the ability to modify the structural constraints that create and exacerbate these unhealthy “place” environments are limited by social and public health policies. This study therefore explores modifiable pathways by which to inform social and public health policy to improve the health of black residents living in concentrated poverty. The historical context of racial residential segregation and neighborhood socioeconomic inequality in the United States is reviewed. A contemporary case study of racial disparities in low birth weight in the Detroit, Michigan, metropolitan area is also presented to demonstrate the persistence of racial health disparities. To address racial health disparities it is recommended that future health policy be linked to housing policy as a way to provide social mobility options for residents living in racially segregated, concentrated poverty neighborhoods.

Modeling the Movement of Homicide by Type to Inform Public Health Prevention Efforts

OBJECTIVES We modeled the spatiotemporal movement of hotspot clusters of homicide by motive in Newark, New Jersey, to investigate whether different homicide types have different patterns of clustering and movement. METHODS We obtained homicide data from the Newark Police Department Homicide Units investigative files from 1997 through 2007 (n = 560). We geocoded the address at which each homicide victim was found and recorded the date of and the motive for the homicide. We used cluster detection software to model the spatiotemporal movement of statistically significant homicide clusters by motive, using census tract and month of occurrence as the spatial and temporal units of analysis. RESULTS Gang-motivated homicides showed evidence of clustering and diffusion through Newark. Additionally, gang-motivated homicide clusters overlapped to a degree with revenge and drug-motivated homicide clusters. Escalating dispute and nonintimate familial homicides clustered; however, there was no evidence of diffusion. Intimate partner and robbery homicides did not cluster. CONCLUSIONS By tracking how homicide types diffuse through communities and determining which places have ongoing or emerging homicide problems by type, we can better inform the deployment of prevention and intervention efforts.