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Background: Cannabis dispensaries have proliferated exponentially in Oklahoma since the state legalized medical cannabis in 2018. Oklahoma is unique from many other legalized states given its high number of lower income, rural, and uninsured residents, who may seek medical cannabis as an alternative to traditional medical treatment. Methods: This study examined demographic and neighborhood characteristics associated with dispensary density (n = 1,046 census tracts) in Oklahoma. Results: Compared to census tracts with no dispensaries, those with at least one dispensary had a higher proportion of uninsured individuals living below the poverty level and a greater number of hospitals and pharmacies. Almost half (42.35%) of census tracts with at least one dispensary were classified as a rural locale. In fully adjusted models, percent uninsured, percent of household rentals, and the number of schools and pharmacies were positively associated with greater number of cannabis dispensaries, while the number of hospitals was negatively associated. In the best fitting interaction models, dispensaries were predominant in areas with a higher percentage of uninsured residents and no pharmacies, suggesting that cannabis retailers may capitalize on the health needs of communities with limited healthcare outlets or access to medical treatment. Conclusions: Policies and regulatory actions that seek to decrease disparities in dispensary locations should be considered. Future studies should examine whether people living in communities with a scarcity of health resources are more likely to associate cannabis with medical uses than those living in communities with more resources.

Disaster preparedness is a major but necessary undertaking for every health care facility. The 2019 coronavirus (SARS-CoV-2) provided an unforeseen opportunity to compare the response of two radiology departments, University Health System A (UHSA) and University Health System B (UHSAB). Preparing for this disaster was unique since though unexpected, was thought to be detected early enough to allow for sufficient preparation. Unlike many other disasters which are short-term, single events, this has been an on-going event. Changes at both health systems included workflow alterations for exposure reduction to faculty, trainees, and staff. UHSA was able to quickly divert workflow to previously deployed home workstations, while University of Utah Health Sciences Center required 2 to 3 weeks to procure and initialize enough remote workstations to significantly affect departmental operations. Other measures such as universal masking, temperature screening at facility entrances, virtual appointments, and physical barriers were used by both systems to limit patient-to-patient, patient-to-staff, staff-to-patient, and staff-staff physical interaction to help decrease exposure risk. The goal of these preparations is to allow each department to fulfill imaging needs in support of the organizational clinical mission with the flexibility to adapt to the unique and dynamic nature of this disaster.

Background: American Indians experience disproportionally high rates of diet-related metabolic disorders. Suboptimal retail food environments make obtaining healthy food difficult, particularly for rural American Indians, and contribute to ill health. Objective: This project examined food availability in food stores within a tribal community. Design: Audits were conducted of all retail stores that sell food within nine communities within the Cheyenne & Arapaho Tribal Jurisdictional Area.Main Measures: Freedman Grocery Store Survey and the Healthy Food Assessment Survey.Key Results: Local populations were often reliant on convenience and dollar stores that prominently featured alcohol, tobacco, and ultra-processed food—and offered very little fresh produce. Convenience stores comprised more than half of all area food stores and were the only source of food in one-third of the communities. Only larger communities had supermarkets that sold fresh produce as well as ultraprocessed food. Dollar stores stocked primarily alcohol, tobacco, and ultraprocessed foods, and were rapidly displacing local markets that sold fresh produce. In general, alcohol and tobacco were far more available than vegetables and fruits in food stores. Conclusions: The limited availability of healthy food helps to explain our previous findings on dysbiotic microbiomes in Cheyenne & Arapaho individuals. The predominance of convenience stores and the growth of dollar stores in the tribal jurisdictional area contributed to a suboptimal food environment.

OBJECTIVES: Poor child diet is influenced by nutrition environments surrounding schools and homes; influence of these environments on Early Care and Education (ECE) settings is not understood. The purpose of this study was to determine associations between community nutrition environments and ECE classroom nutrition practices, by ECE context [Head Starts, community-based childcare (CBCs), and family child care homes (FCCHs)]. METHODS: Cross-sectional study including licensed Oklahoma ECEs. Locations of 457 grocery stores were determined in-person. Locations of participating ECEs and grocery stores were geocoded and analyzed in ArcMap 10.6. ECEs were considered located within a “Food Desert” if no grocery stores were available within a 0.25-mile radius for urban ECEs, or 10-mile radius for rural ECEs. ECE directors completed the Nutrition and Physical Activity Self-Assessment tool (i.e., NAP SACC); items were reported on a Likert-type scale and subscores were calculated for nutrition practices. Wilcoxon Rank Sum test was performed to compare practice scores among those located within a Food Desert versus Non-Desert. Benjamini Hochberg calculations for False Discovery Rate were applied (α< 0.004). RESULTS: 54 Head Starts, 159 CBCs, and 160 FCCHs participated with 24%, 27% and 37%- respectively- being located within a Food Desert. ECE descriptive characteristics including food purchasing and meal planning strategies varied by ECE context. Head Starts demonstrated the highest classroom nutrition scores for mealtime practices, and nutrition education and policy. Food Desert status was not related to classroom nutrition practice scores for any ECE context (P > 0.004). CONCLUSIONS: Contrary to studies in residential areas and schools, nutrition environments were not related to nutrition practices in ECEs. This suggests that ECEs may serve as protective micro-environments supporting health for children more vulnerable to the health environments of their nearby residing communities. Supporting health practices for ECEs may be achieved most effectively through within-center intervention and policy. FUNDING SOURCES: This study was funded by the Early Care and Research Scholars: Head Start Graduate Student Research Grant (HHS2017-ACF-OPRE-YR-1219), OUHSC College of Allied Health Student Research and Creativity Grant, and Department of Nutritional Sciences.

The influence of community-built environments on physical activity (PA) support in Early Childhood Education settings (ECEs) is unknown. The purpose of this cross-sectional study was to determine associations between community PA environments and ECE classroom PA practices. We included licensed Oklahoma ECE directors serving 3-to-5-year-old children. Parks and playground locations were exported from Google Earth. National Walkability Index was derived from 2010 US Census data. ArcMap 10.6 was used to geocode ECE locations, which were within an Activity Desert if no parks/playgrounds were located within a 1-mile radius or if Walkability Index was 10.5 or below. Classroom PA practices were determined by using the Nutrition and PA Self-Assessment tool (NAP SACC). Barriers to implementing practices were reported. Most Head Starts (n = 41, 80.3%), center-based childcare settings (CBC, n = 135, 87.0%), and family childcare homes (FCCHs, n = 153, 96.4%) were in an Activity Desert. Parks/playgrounds within a 10-mile buffer were correlated with classroom PA practices in FCCHs only (p &lt, 0.001). Activity Desert status was not related to classroom PA practices for any ECE context (p &gt, 0.029). While FCCHs may be the most vulnerable to lack of park and playground access, overall findings suggest ECEs provide a healthful micro-environment protective of the typical influence of community-built environments.

Background Early Childhood Education (ECEs) directors and teachers experience substantial barriers to implementing childhood nutrition recommendations. Diet in older children is influenced by nutrition environments surrounding homes and schools; influence of the community environment on ECEs is not understood. Objective Determine associations between community nutrition environments and ECE barriers to classroom nutrition practices, by ECE context [Head Starts, community-based childcare (CBCs), and family child care homes (FCCHs)]. Study Design, Setting, Participants Cross-sectional study including licensed Oklahoma ECEs. Locations of 457 grocery stores were determined in-person. Locations of participating ECEs and grocery stores were geocoded and analyzed using ArcMap 10.6. Measurable Outcome/Analysis ECEs were considered located within a “Food Desert” if no grocery stores were available within a 0.25-mile radius for urban ECEs, or 10-mile radius for rural ECEs. Presence of barriers to serving healthier foods and beverages were reported. Fisher's exact test was used to compare differences in barriers among those within Food Deserts versus Non-Deserts. Benjamini Hochberg calculations for False Discovery Rate were applied (α Results Fifty-four Head Starts, 159 CBCs, and 160 FCCHs participated with 24%, 27% and 37%- respectively- being located within a Food Desert. ECE descriptive characteristics including food purchasing and meal planning strategies varied by ECE context. Among Head Starts and CBCs, barriers were not different by Food Desert status (P > 0.0004). In FCCHs only, those located within Food Deserts reported a 20% higher prevalence of concern for food waste compared to those within Non-Deserts (P Conclusion Food Desert status was related to reported barriers in FCCHs only; therefore, those provider's experiences and perceptions may be most susceptible to influence of the community nutrition environment, compared to other ECE contexts. Findings suggest a need for future research and policy implementation to support FCCHs residing in low-access areas and experiencing difficulty implementing classroom health practices. Funding Early Care and Research Scholars: Head Start Graduate Student Research Grant (HHS2017-ACF-OPRE-YR-1219), OUHSC College of Allied Health Student Research and Creativity Grant, and Department of Nutritional Sciences.

Research suggests an important role for planners and policymakers in enhancing neighborhood access to healthy food. Spatial analysis is often used to explore relationships between proximity to sources of food and health outcomes such as food security and risk for diet-related disease. Spatial models often account for proximity based on walking distance or automobile but advancements in geospatial technologies now allow for estimates of access by transit as well as travel time to understand neighborhood level food security. One approach for addressing this gap is to employ real-time travel estimates over transit and road networks to more precisely measure food access. In this paper, we compare the Google Distance Matrix API calculating both the distance and time between origins and destinations, with other spatial approaches to understanding grocery store and full-service supermarket access in this case study of San Diego, California. Results suggest that distances between residents and food outlets are constant across modes of transport but travel times are highly differentiated by mode. Trips to stores by transit are on average, three times longer than trips by car. This paper offers a new understanding of the potential for incongruence between spatial proximity and true accessibility in the built environment.

Problem, research strategy, and findings: Farmers' markets provide one option for remedying the startling decline in fresh vegetable and fruit consumption in the United States, particularly in low-income, non-White neighborhoods where opportunities to access these components of a healthy diet are often limited. We lack empirical research on whether farmer's markets provide fresh vegetables and fruits consistently across locations. We audited product offerings at 24 farmers' markets in Los Angeles at two points in time and interviewed a sample of market managers to compare market offerings across neighborhoods to determine whether farmers' markets alleviate disparities experienced by low-income and non-White communities. Farmers' markets in low-income and non-White communities are smaller and provide fewer fresh fruits and vegetables than markets situated in more affluent communities. Managers suggest that their first priority is to stock fresh produce, but other factors such as competition and farmer recr...

Outdoor advertising proliferation and the development of land use regulations in Los Angeles illustrate the complicated nature of balancing the economic and physical aspects of urban development. Regulating outdoor advertising is part of a movement to control the spatial structure of the consumer economy and manage the appearance of the landscape through zoning. The efforts of planners to regulate outdoor advertising are frequently challenged legally or stalled by political indecision. The history of Los Angeles billboard regulation illuminates the financial demands for encouraging the spectacle of consumer landscapes as well as the persistent difficulty planners have had regulating urban appearance.

How people feel about places matters, especially in their neighborhood. It matters for their health, the health of their children, and their social cohesion and use of local resources. A growing body of research in public health, planning, psychology, and sociology bears out this point. Recently, a new methodological tack has been taken to find out how people feel about places. The sketch map, a once popular tool of behavioral geographers and environmental psychologists to understand how people perceive the structural aspects of places, is now being used in concert with geographic information systems (GIS) to capture and spatially analyze the emotional side of urban environmental perception. This confluence is generating exciting prospects for what we can learn about the characteristics of the urban environment that elicit emotion. However, due to the uncritical way this approach has been employed to date, excitement about the prospects must be tempered by the acknowledgement of its potential problems. In this paper we review the extant research on integrating sketch maps with GIS and then employ a case study of mapping youth fear in Los Angeles gang neighborhoods to demonstrate these prospects and the problems, particularly in the areas of (1) representation of environmental perception in GIS and (2) spatial analysis of these data. Keywords: sketch maps, geographic information systems (GIS), environmental perception, fear

Objectives. Our study sought to examine associations between the content of outdoor advertising and neighborhood ethnic/racial and socioeconomic composition to see whether particular communities disproportionately host harmful content. Methods. We constructed a spatial database of photographs taken from June 2012 until December 2012 in 7 identically zoned communities in Los Angeles, California, to compare outdoor advertising area and content. We selected communities to contrast by ethnicity/race, income, education, and youth population. Results. At-risk communities and communities of color hosted more outdoor advertising depicting harmful content than other communities. Among included neighborhoods, harmful content and the proportion of outdoor advertising overall were most prevalent in communities of Asian Americans and Latino Americans. In all communities, harmful content represented at least 24% of outdoor advertising space. Conclusions. This study provides evidence of the potential for land-use decisions to result in spatially inequitable health impacts. Although dictating the placement of outdoor advertising through zoning may seem sensible, such a decision might have the unintended consequence of disadvantaging the well-being of local communities. Neighborhood factors require more contextually nuanced public health and land-use policy.