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The troubling trend of rising heat-associated mortalities in an urban desert region (Maricopa County, AZ, USA) has motivated us to explore the extent to which environmental factors may contribute to increased heat-health risks. Summertime data from 2010 to 2019 were used to construct a suite of models for daily heat-associated mortalities. The best-performing full model included the following predictors, ordered from strongest to weakest influence: daily average air temperature, average of previous 5 days daily average air temperature, year, day of year, average of previous 5 days daily average dew point temperature, average of previous 5 days daily average PM2.5, and daily average PM10. This full model exhibited a 5.39% reduction in mean absolute error in daily heat-associated mortalities as compared to the best-performing model that included only air temperature as an environmental predictor. The extent to which issued and modeled excessive heat warnings (from both the temperature only and full models) corresponded with heat-associated mortalities was also examined. Model hindcasts for 2020 and 2021 showed that the models were able to capture the high number of heat-associated mortalities in 2020, but greatly undercounted the highest yet observed number of heat-associated mortalities in 2021. Results from this study lend insights into environmental factors corresponding to an increased number of heat-associated mortalities and can be used for informing strategies towards reducing heat-health risks. However, as the best-performing model was unable to fully capture the observed number of heat-associated mortalities, continued scrutiny of both environmental and non-environmental factors affecting these observations is needed.

Health researchers have examined the physiological impacts of extreme air temperature on the human body. Yet, the mental health impacts of temperature have been understudied. Research has shown that the environment can create circumstances that exacerbate mental health issues. This may be particularly challenging for some of the fastest growing cities, located in hot, dry climates. Given the theoretical relationship between air temperature and mental health, we seek to measure the association between temperature and schizophrenia hospital admissions in an arid urban climate and quantify the associated public health burden. We collected 86,672 hospitalization records for schizophrenia from 2006 to 2014 in Maricopa County, Arizona, USA. Using a distributed lag non-linear model (DLNM), we tested for a statistical association between temperature and schizophrenia hospital admissions after controlling for year, season, weekends, and holidays. We calculated the cumulative attributable risk of nighttime temperature on schizophrenia for the entire dataset as well as among demographic subgroups. The relative risk of schizophrenia hospital admissions increased with both high and low temperatures. Statistical models using daily minimum temperature were more strongly associated with hospitalization than those using mean or maximum. Schizophrenia hospital admissions increased on days with minimum temperatures above 30 °C and below 3 °C, with some subgroups experiencing higher rates of hospitalization. The total fraction of schizophrenia hospital admissions attributable to non-optimal minimum temperature is 3.45 % (CI: -4.91-10.80 %) and high minimum temperature is 0.28 % (CI: -1.18-1.78 %). We found that non-whites and males appear to be at a slightly increased risk than the general population, although there did not appear to be a statistically significant difference. A conservative estimate of healthcare costs annually from non-optimal temperature attributed schizophrenia hospitalization is $1.95 million USD. Therefore, nighttime cooling strategies and efforts could increase the accessibility of shelters to reduce overnight exposure to extreme air temperature.

Extreme heat exposure increases the risk for heat-related illnesses (HRIs) and deaths, and comprehensive strategies to prevent HRIs are increasingly important in a warming climate (1). An estimated 702 HRI-associated deaths and 67,512 HRI-associated emergency department visits occur in the United States each year (2,3). In 2020, Phoenix and Yuma, Arizona, experienced a record 145 and 148 days, respectively, of temperatures100°F (37.8°C), and a record 522 heat-related deaths occurred in the state. HRIs are preventable through individual and community-based strategies*

As demand for electricity increases on an already strained electrical supply due to urbanization, population growth, and climate change, the likelihood of power outages will also increase. While researchers understand that the number of electrical grid disturbances is increasing, we do not adequately understand how increased power outages will affect a society that has become increasingly dependent on a reliable electric supply. This systematic review aims to understand how power outages have affected society, primarily through health impacts, and identify populations most vulnerable to power outages based on the conclusions from prior studies. Based on search parameters, 762 articles were initially identified, of which only 50 discussed the social impacts of power outages in North America. According to this literature, racial and ethnic minorities, especially Blacks or African Americans, those of lower socioeconomic status, children, older adults, and those living in rural areas experienced more significant impacts from previous power outages. Additionally, criminal activity increased during prolonged power outages with both pro-social and anti-social behaviors observed. Providing financial assistance or resources to replace spoiled goods can reduce crime. Future research on this topic must consider the financial effects of power outages, how power outage impacts seasonally vary, and the different durations of power outage impacts.

Cities need heat governance to plan for extreme temperatures and protect those most at risk. Cities need heat governance to plan for extreme temperatures and protect those most at risk.

Public heat alerts are important risk communication tools, but there has been no systematic analysis of how frequently they are issued, or how patterns in alert frequency relate to regional climatology or heat-health impacts. We compiled and analyzed all Excessive Heat Warnings and Heat Advisories (collectively, Heat Alerts) issued by the United States National Weather Service for 2010–2019. Heat Alert frequency was correlated to climatological indicators derived from reanalysis data aggregated to Weather Forecast Office (WFO) polygons, and to estimates of heat-attributable mortality for 134 metropolitan areas. The type of Heat Alerts used, and the frequency with which they were issued, were highly variable. Across 77% of the country, Heat Advisories were the primary product issued. The median location experienced 2.3 Heat Alert days per year. Regions with the highest frequency (approaching 25 days per year) included the southern Midwest and Great Plains, as well as the desert Southwest. The 95th percentile daily maximum heat index was the climatological indicator most strongly correlated with Heat Alert frequency across all WFOs (r=0.71). Locations that issued Heat Alerts more frequently than would be expected based on climatology were primarily located along the Pacific coast; those that issued Heat Alerts less frequently than expected were in southern Texas and southern Florida, the latter of which includes multiple cities with high rates of heat-attributable mortality. Our results suggest that the public may be receiving mixed signals about the severity of the heat hazard, with some hotter locations particularly underserved by heat risk messaging.

Thermal comfort is an important determinant of quality of life and economic vitality in cities. Strategies to improve thermal comfort may become a more critical part of urban sustainability efforts with projections of continued urban growth and climate change. A case study was performed in the hot, dry summertime climate of Tempe, Arizona to quantify the influence of evaporative misters on the thermal environment in outdoor restaurants and to understand business managers' motivations to use misters. Microclimate measurements (air temperature (Ta), wind speed, relative humidity, globe temperature) were taken at five restaurants midday within four exposures: misted sun, misted shade, sun only, and shade only. We assessed Ta, mean radiant temperature (MRT), universal thermal climate index (UTCI), and physiological equivalent temperature (PET) between these four conditions within each location. Misters improved thermal comfort across all days, sites, and exposure conditions. MRT was on average 7.6 °C lower in misted locations, which significantly lowered average PET (- 6.5 °C) and UTCI (- 4.4 °C) (p < 0.05). Thermal comfort was most improved using mist in combination with shade. Under such conditions, PET and UTCI were reduced by 15.5 °C and 9.7 °C (p < 0.05), respectively. Business managers identified customer comfort and increased seating capacity as the principal factors for mister use. Esthetics of misters further encouraged use, while cost and environmental concerns were perceived to be less important. While this case study demonstrates value in outdoor misting in a hot, dry climate, additional work is needed to more fully evaluate tradeoffs between cost, water use, and comfort with continuing urban growth.

BACKGROUND AND AIM: Heat-health epidemiologic studies often lack information on key determinants of exposure, including occupation, housing, and air conditioning, at the individual or parcel (home)...

The troubling trend of rising heat-associated mortalities in an urban desert region (Maricopa County, AZ, USA) has motivated us to explore the extent to which environmental factors may contribute to increased heat-health risks. Summertime data from 2010 to 2019 were used to construct a suite of models for daily heat-associated mortalities. The best-performing full model included the following predictors, ordered from strongest to weakest influence: daily average air temperature, average of previous 5 days daily average air temperature, year, day of year, average of previous 5 days daily average dew point temperature, average of previous 5 days daily average PM

Land change due to urbanization often results in the loss of desert ecosystems. The loss of desert land affects ecological and social processes in arid cities, such as habitat provisioning, the ext...

Heat has become a central concern for cities everywhere, but heat governance has historically lagged behind other climate change hazards. This study examines 175 municipal plans from the 50 most populous cities in the United States to understand which aspects of urban heat are included or not in city plans and what factors explain inclusion. We find that a majority of plans mention heat, but few include strategies to address it and even fewer cite sources of information. The term ‘extreme heat event’ (EHE) is significantly more likely to be paired with institutional actions as a part of hazard planning, while ‘urban heat island’ (UHI) is more likely to be paired with green and grey infrastructure interventions as a part of general planning. Disparity and thermal comfort framings are not significantly related to any solutions and are used least. Plan type, followed by environmental networks (e.g. C40, Urban Sustainability Directors Network, Rockefeller 100 Resilient Cities), explain variation in plan content; social and environmental context do not. Findings point to the emergence of two independent heat governance systems, EHE and UHI, and several gaps in heat planning: integration, specificity, solutions, disparity, economy, and thermal comfort.

Climate change affects human health; however, there have been no large-scale, systematic efforts to quantify the heat-related human health impacts that have already occurred due to climate change. Here, we use empirical data from 732 locations in 43 countries to estimate the mortality burdens associated with the additional heat exposure that has resulted from recent human-induced warming, during the period 1991–2018. Across all study countries, we find that 37.0% (range 20.5–76.3%) of warm-season heat-related deaths can be attributed to anthropogenic climate change and that increased mortality is evident on every continent. Burdens varied geographically but were of the order of dozens to hundreds of deaths per year in many locations. Our findings support the urgent need for more ambitious mitigation and adaptation strategies to minimize the public health impacts of climate change., We thank the participants of the ISIMIP Health workshop in Barcelona in November 2018 where this work was discussed for the first time. This study was supported by the Medical Research Council UK (grant no. MR/M022625/1), the Natural Environment Research Council UK (grant no. NE/R009384/1) and the European Union’s Horizon 2020 Project Exhaustion (grant no. 820655). N.S. was supported by the NIEHS-funded HERCULES Center (P30ES019776). Y.H. was supported by the Environment Research and Technology Development Fund of the Environmental Restoration and Conservation Agency, Japan (JPMEERF15S11412). J.J.J.K.J. was supported by Academy of Finland (grant no. 310372). V.H. was supported by the Spanish Ministry of Economy, Industry and Competitiveness (grant no. PCIN-2017-046) and the German Federal Ministry of Education and Research (grant no. 01LS1201A2). J.K. and A.U. were supported by the Czech Science Foundation (grant no. 20-28560S). J.M. was supported by the Fundação para a Ciência e a Tecnologia (FCT) (SFRH/BPD/115112/2016). S.R. and F.d.R. were supported by European Union’s Horizon 2020 Project EXHAUSTION (grant no. 820655). M.H. was supported by the Japan Science and Technology Agency as part of SICORP, grant no. JPMJSC20E4. Y.G. was supported by the Career Development Fellowship of the Australian National Health and Medical Research Council (APP1163693). S.L. was support by the Early Career Fellowship of the Australian National Health and Medical Research Council (APP1109193). Y.L.L.G. was supported by the Taiwan Ministry of Science and Technology (MOST110-2918-I-002-007) as a visiting academic at the University of Sydney.

Extreme weather and climate events, such as heat waves, cyclones, and floods, are an expression of climate variability. These events and events influenced by climate change, such as wildfires, continue to cause significant human morbidity and mortality and adversely affect mental health and well-being. Although adverse health impacts from extreme events declined over the past few decades, climate change and more people moving into harm's way could alter this trend. Long-term changes to Earth's energy balance are increasing the frequency and intensity of many extreme events and the probability of compound events, with trends projected to accelerate under certain greenhouse gas emissions scenarios. While most of these events cannot be completely avoided, many of the health risks could be prevented through building climate-resilient health systems with improved risk reduction, preparation, response, and recovery. Conducting vulnerability and adaptation assessments and developing health system adaptation plans can identify priority actions to effectively reduce risks, such as disaster risk management and more resilient infrastructure. The risks are urgent, so action is needed now.

Extreme temperatures claim more lives than any other weather-related event, posing escalating socio-technical and governance challenges that few urban communities have addressed in a systematic, coordinated and comprehensive way. Scholars have only recently begun to investigate the granular scales at which distributions of thermal risk are produced, people’s individual subjective thermal experiences and environmental justice dimensions of the hazard. Advances in research pave the way for concomitant improvements in management and policies, but bridges are needed to connect the thermal vulnerability knowledge base with place-based protective practices that are climatically, politically and culturally appropriate. The research presented in this paper uses actor–network theory (ANT) to describe the planning phase framework of a socio-technical collaborative for managing thermal extremes. The Thermally Resilient Communities Collaborative (TRCC) is a framework for planning and test-bed design phases of a thermal management system. Drawing lessons from two case studies, the framework examines how socio-cognitive spaces for collaboration change with technical and policy disruptions, and provides a way to design experiments that test how technical and governance interventions can enable collective action around urban thermal management. 'Practice relevance' Thermal extremes claim more lives than all other weather events and pose an escalating socio-technical challenge. Often the problem is exacerbated by lack of clarity about organizational responsibilities and coordination between local governmental departments or agencies. The TRCC framework can be used to understand current practices, identify data gaps and create opportunities to engage in cross-sectoral management. This approach engages actors in identifying built environments and societal practices that create hazardous indoor and outdoor thermal conditions, develops effective ways to convey microclimate information and peoples’ subjective thermal experiences to responders and prevention planners, and elevates experiences of marginalized communities. The TRCC describes how governance networks are harnessed to solve collective action problems by integrating new data, technology, and governance capacities. Two case studies indicate how this process was used to create capacities to protect vulnerable people from the impacts of extreme temperatures in two US cities: Tempe, Arizona, and Buffalo, New York.

Thermal comfort is an important determinant of quality of life and economic vitality in cities. Strategies to improve thermal comfort may become a more critical part of urban sustainability efforts with projections of continued urban growth and climate change. A case study was performed in the hot, dry summertime climate of Tempe, Arizona to quantify the influence of evaporative misters on the thermal environment in outdoor restaurants and to understand business managers' motivations to use misters. Microclimate measurements (air temperature (T

Many cities aim to progress toward their sustainability and public health goals by increasing use of their public transit systems. However, without adequate protective infrastructure that provides thermally comfortable conditions for public transit riders, it can be challenging to reach these goals in hot climates. We took micrometeorological measurements and surveyed riders about their perceptions of heat and heat-coping behaviors at bus stops with a variety of design attributes in Phoenix, AZ, USA, during the summer of 2018. We identified the design attributes and coping behaviors that made riders feel cooler. We observed that current infrastructure standards and material choices for bus stops in Phoenix are insufficient to provide thermal comfort, and can even expose riders to health risks. Almost half of the study participants felt hot or very hot at the time they were surveyed, and more than half reported feeling thermally uncomfortable. On average, shade reduced the physiological equivalent temperature (PET) by 19 °C. Moreover, we found significant diurnal differences in PET reductions from the shade provided by various design attributes. For instance, all design attributes were effective in reducing PET in the morning; however, a vegetated awning did not provide statistically significant shade reductions in the afternoon. Temperatures of sun-exposed surfaces of man-made materials exceeded skin burn thresholds in the afternoon, but shade was effective in bringing the same surfaces to safe levels. Aesthetically pleasing stops were rated as cooler than stops rated as less beautiful. We conclude that cities striving to increase public transit use should prioritize thermal comfort when designing public transit stops in hot climates.

Designing cities for thermal comfort should be a priority in the warming and urbanizing world. As cities continue to break extreme heat records, it is necessary to develop new sensing approaches capable of tracking thermal sensations of actual users of urban spaces. The Influence of built infrastructure on the microclimate at a human scale and residents’ thermal sensations is not well explored, but combining sensing techniques with simultaneous collection of user experiences is a promising research direction to shorten the gap.We explored the relationships between the built environment, heat perception, and behavioral coping mechanisms in one of the most heat vulnerable Phoenix neighborhoods. Using Phoenix as an example, where extreme summer temperatures are a norm, can help to address heat challenges of other cities that have started facing temperature extremes in the recent years.This study is an experimental citizen science project in which participants helped to create a “heat map” of the neighborhood. Participants were engaged in a 1-hour walk around the neighborhood and recorded their experience in a field guide. A smaller group participated in walking interviews and wore GPS devices and UV meters to gain deeper insights on subjective heat perception and physical body heat accumulation during the walk. Results revealed the differences in heat perception across a variety of urban landscapes. Participants identified preferred and most challenging locations, and gave ideas on what could improve their experience. Combined heart rate, UV exposure and microclimate data mapped in GIS visualized dependencies between the streetscape and physiological conditions of the study participants.This project is one of the first to examine the impact of urban environment on dynamic psychological and physiological responses to heat. Using sensing techniques and qualitative research instruments, this research will inform the design changes in the neighborhood that will undergo redevelopment. It can serve as an example for other cities striving to adapt urban microclimates to new extremes.

On behalf of the Multi-Country Multi-City Collaborative (MCC) Research Network.Background & Aim: Climate change is considered the most important environmental threat to human health. Substantial mortality and morbidity burden have been directly or indirectly attributed to climate-sensitive environmental stressors. However, limited quantitative evidence exists on how much of this burden can be attributed to man-made influences on climate. In this large health attribution study, we aimed at quantifying the proportion of excess heat-related mortality attributed to anthropogenic climate change in recent decades across 626 locations across 41 countries in various regions of the world included in MCC database.Methods: We first estimated the location-specific heat-mortality associations through two-stage time-series analyses with quasi-Poisson regression with distributed lag non-linear models and multivariate multilevel meta-regression using observed data. We then quantified the heat-related excess mortality in each location using daily modelled series derived from historical (factual) and preindustrial control (counterfactual) simulations from 5 general circulation models (ISIMIP2b database) in the period between 1991 and 2019. We finally computed the proportion of heat-related excess mortality attributable to anthropogenic influences as the difference between the two scenarios, with associated measures of uncertainty.Results: We found a steep increase in level of warming, expressed as the difference in annual average temperature between scenarios, with an average increase of 1.0°C (from 0.7°C to 1.2°C) across the 626 locations between 1991 and 2019. Overall excess heat-mortality fractions of 1.92% [95% confidence interval: 0.41, 3.25] and 1.28% [0.20, 2.50] were estimated under the factual and counterfactual scenarios, respectively, with an overall difference of 0.76% [0.25,1.74]. This translates to 33% of historical heat-excess mortality that can be attributed to anthropogenic climate change. Larger proportions were found in North America (46%), Central America (47%), South America (43%), South Africa (48%), Middle-East Asia (61%), South East-Asia (50%) and Australia (42%), although highly imprecise in most of cases.Conclusions: Our findings suggest that current warming driven by anthropogenic influences is already responsible for a considerable proportion of the heat-related mortality burden. These results stress the importance of strengthening current mitigation strategies to reduce further warming of the planet and related health impacts.

Background: Research has not yet examined how hot weather moderates the relationship between the built environment and outdoor physical activity levels. The authors posited that hot days will increase the magnitude of the expected directional effect of built environment features on physical activity. Methods: This longitudinal study included 134 US adults from the Three city Heat and Electrical failure AdapTation study. Adults self-reported physical activity for multiple summer days (nstudy-days = 742) in 2016. Hot days were defined as ≥90th percentile of daily maximum heat index. Built environment features included density, safety, trees, hilliness, connectivity, access to parks, and access to shops + services. Separate growth curve models with interaction terms (ie, hot day × built environment feature) were run for daily minutes of outdoor physical activity (ie, any activity and recommended activity). Results: Neither hot days nor built environment features impacted outdoor physical activity significantly, and hot days did not moderate the relationship between built environment features and physical activity (P > .05). Conclusions: With adults failing to modify behavior on hot days, cities may be placing adults at increased risk of exertional heat illness. The authors recommend incorporating the risk of exertional heat illness in health impact assessments and deploying heat management strategies.

Environmental heat is a growing public health concern in cities. Urbanization and global climate change threaten to exacerbate heat as an already significant environmental cause of human morbidity and mortality. Despite increasing risk, very little is known regarding determinants of outdoor urban heat exposure. To provide additional evidence for building community and national-scale resilience to extreme heat, we assess how US outdoor urban heat exposure varies by city, demography, and activity. We estimate outdoor urban heat exposure by pairing individual-level data from the American Time Use Survey (2004-2015) with corresponding meteorological data for 50 of the largest metropolitan statistical areas in the US. We also assess the intersection of activity intensity and heat exposure by pairing metabolic intensities with individual-level time-use data. We model an empirical relationship between demographic indicators and daily heat exposure with controls for spatiotemporal factors. We find higher outdoor heat exposure among the elderly and low-income individuals, and lower outdoor heat exposure in females, young adults, and those identifying as Black race. Traveling, lawn and garden care, and recreation are the most common outdoor activities to contribute to heat exposure. We also find individuals in cities with the most extreme temperatures do not necessarily have the highest outdoor heat exposure. The findings reveal large contrasts in outdoor heat exposure between different cities, demographic groups, and activities. Resolving the interplay between exposure, sensitivity, adaptive capacity, and behavior as determinants of heat-health risk will require advances in observational and modeling tools, especially at the individual scale.

A more precise understanding of individual-level heat exposure may be helpful to advance knowledge about heat-health impacts and effective intervention strategies, especially in light of projected increases in the severity and frequency of extreme heat events. We developed and interrogated different metrics for quantifying personal heat exposure and explored their association with social risk factors. To do so, we collected simultaneous personal heat exposure data from 64 residents of metropolitan Phoenix, Arizona. From these data, we derived five exposure metrics: Mean Individually Experienced Temperature (IET), Maximum IET, Longest Exposure Period (LEP), Percentage Minutes Above Threshold (PMAT), and Degree Minutes Above Threshold (DMAT), and calculated each for Day Hours, Night Hours, and All Hours of the study period. We then calculated effect sizes for the associations between those metrics and four social risk factors: neighborhood vulnerability, income, home cooling type, and time spent outside. We also investigated exposure misclassification by constructing linear regression models of observations from a regional weather station and hourly IET for each participant. Our analysis revealed that metric choice and timeframe added depth and nuance to our understanding of differences in exposure within and between populations. We found that time spent outside and income were the two risk factors most strongly associated with personal heat exposure. We also found evidence that Mean IET is a good, but perhaps not optimal, measure for assessing group differences in exposure. Most participants' IETs were poorly correlated with regional weather station observations and the slope and correlation coefficient for linear regression models between regional weather station data and IETs varied widely among participants. We recommend continued efforts to investigate personal heat exposure, especially in combination with physiological indicators, to improve our understanding of links between ambient temperatures, social risk factors, and health outcomes.

Exertional heat illness and stroke are serious concerns across youth and college sports programs. While some teams and governing bodies have adopted the wet bulb globe temperature (WBGT), few practitioners use measurements on the field of play; rather, they often rely on regionally modeled or estimated WBGT. However, urban development-induced heat and projected climate change increase exposure to heat. We examined WBGT levels between various athletic surfaces and regional weather stations under current and projected climates and in hot-humid and hot-dry weather regimes in the southwest U.S. in Tempe, Arizona. On-site sun-exposed WBGT data across five days (07:00–19:00 local time) in June (dry) and August (humid) were collected over five athletic surfaces: rubber, artificial turf, clay, grass, and asphalt. Weather station data were used to estimate regional WBGT (via the Liljegren model) and compared to on-site, observed WBGT. Finally, projected changes to WBGT were modeled under mid-century and late-century conditions. On-field WBGT observations were, on average, significantly higher than WBGT estimated from regional weather stations by 2.4 °C–2.5 °C, with mean on-field WBGT across both months of 28.5 ± 2.76 °C (versus 25.8 ± 3.21 °C regionally). However, between-athletic surface WBGT differences were largely insignificant. Significantly higher mean WBGTs occurred in August (30.1 ± 2.35 °C) versus June (26.9 ± 2.19 °C) across all venues; August conditions reached ‘limit activity’ or ‘cancellation’ thresholds for 6–8 h and 2–4 h of the day, respectively, for all sports venues. Climate projections show increased WBGTs across measurement locations, dependent on projection and period, with average August WBGT under the highest representative concentration pathway causing all-day activity cancellations. Practitioners are encouraged to use WBGT devices within the vicinity of the fields of play, yet should not rely on regional weather station estimations without corrections used. Heat concerns are expected to increase in the future, underlining the need for athlete monitoring, local cooling design strategies, and heat adaptation for safety.

Practitioners and researchers use vulnerability indices to understand the conditions that influence hazard risk. However, there has been little research on how well such indices depict household-scale vulnerability to specific hazards. We examined relationships between an all-hazard index and a hazard-specific index with household-level adaptive resources, adaptive behaviors, proximate sensitivities, and self-reported health outcomes related to extreme heat. Household measures were drawn from a stratified random sample survey conducted in Phoenix, Arizona, USA (n = 163). The results point to different experiences between households in more and less heat vulnerable areas. The largest differences between households stratified by the hazard-specific index (Heat Vulnerability Index) primarily involved adaptive resources and behaviors, whereas indicators of proximate sensitivity were more strongly differentiated by the all-hazard index (Social Vulnerability Index). Differences in health outcomes between more and less vulnerable neighborhoods were more evident using HVI than SoVI, although effect sizes using either index were small and confidence intervals were wide. The relationship between vulnerability indices and several survey measures varied across four study sites. The specific ways in which more and less vulnerable communities differ from one another varies based on the adaptation, sensitivity, or outcome measure of interest, location within the city, and choice of vulnerability index.

(2017). Urban Water Infrastructure for Cooling: Case Studies from Humid and Arid Cities. Regions Magazine: Vol. 306, No. 1, pp. 20-23.

Precision governance is an administrative capacity in which policy decisions are enhanced with information about individual and collective preferences and contexts. We introduce the prospects for precision governance of natural hazards through the use of both big and individual data technologies, describing what is enabled and what concerns arise with their use. We ground our perspective with a topical focus on mitigating the health risks of high temperatures in the chronically hot setting of Phoenix, Arizona, USA. A study examining individually experienced temperature data provides compelling evidence that the transition towards data-driven precision governance will enhance hazard preparedness and response efforts.

Policy analytics combines new data sources, such as from mobile smartphones, Internet of Everything devices, and electronic payment cards, with new data analytics techniques for informing and directing public policy. However, those who do not own these devices may be rendered digitally invisible if data from their daily actions are not captured. We explore the digitally invisible through an exploratory study of homeless individuals in Phoenix, Arizona, in the context of extreme heat exposure. Ten homeless research participants carried a temperature-sensing device during an extreme heat week, with their individually experienced temperatures (IETs) compared to outdoor ambient temperatures. A nonhomeless, digitally connected sample of 10 university students was also observed, with their IETs analyzed in the same way. Surveys of participants complement the temperature measures. We found that homeless individuals and university students interact differently with the physical environment, experiencing substantial differences in individual temperatures relative to outdoor conditions, potentially leading to differentiated health risks and outcomes. They also interact differently with technology, with the homeless having fewer opportunities to benefit from digital services and lower likelihood to generate digital data that might influence policy analytics. Failing to account for these differences may result in biased policy analytics and misdirected policy interventions.

Preventing heat-associated morbidity and mortality is a public health priority in Maricopa County, Arizona (United States). The objective of this project was to evaluate Maricopa County cooling centers and gain insight into their capacity to provide relief for the public during extreme heat events. During the summer of 2014, 53 cooling centers were evaluated to assess facility and visitor characteristics. Maricopa County staff collected data by directly observing daily operations and by surveying managers and visitors. The cooling centers in Maricopa County were often housed within community, senior, or religious centers, which offered various services for at least 1500 individuals daily. Many visitors were unemployed and/or homeless. Many learned about a cooling center by word of mouth or by having seen the cooling center’s location. The cooling centers provide a valuable service and reach some of the region’s most vulnerable populations. This project is among the first to systematically evaluate cooling centers from a public health perspective and provides helpful insight to community leaders who are implementing or improving their own network of cooling centers.

In September 2017, Hurricane Irma turned off power for 6.7 million people in the state of Florida. Despite increasing threats to the US electrical grid, there are few studies on household i...

An increasing number of epidemiological studies are finding statistical evidence that diurnal temperature range (DTR) is positively correlated to human morbidity and mortality despite the lack of clear clinical understanding. We examine a 14-year daily time series of emergency department (ED) admissions to the University of Virginia Medical Center in Charlottesville, Virginia, relative to long-term climate records from the Charlottesville/Albemarle County Airport weather station and the Spatial Synoptic Classification. DTR has a consistent strong positive correlation (r ~ 0.5) with maximum temperature in all months but only a weak, negative correlation (r ~- 0.1) with minimum temperature except in late summer (r ~- 0.4). Warm season DTR is highest on dry air mass days with low dew point temperatures. Cool season DTR is unrelated to morning temperature. Using a distributed lag non-linear model with an emphasis on DTR and its seasonal variation, after stratifying the models by season, we find that ED visits are linked to extreme cold events (cold days and nights) and high DTR in the cold season. In the warm season, ED visits are also linked to high DTR, but these are cool, dry, and pleasant days. The existing confusion regarding interpretation of DTR impacts on health might be rectified through a more careful analysis of the underlying physical factors that drive variations in DTR over the course of a year.

Future societies face many uncertainties in a rapidly warming and urbanizing world. One of the most critical challenges is how cities will adapt to new local temperature regimes. This chapter examines the climate hazard of extreme heat, the human health risks of high temperatures for vulnerable populations, and two complementary potential pathways for societal adaptations to climate change in Phoenix, Arizona. The challenge for the public health pathway is to protect groups that are vulnerable to heat because they either are physiologically susceptible or experience acute heat exposure. Pro-poor pathways are needed for populations that are vulnerable to climate change primarily because they live in low-income neighborhoods that are chronically exposed to the highest temperatures and lack access to economic and social resources, ecological benefits, and technological means to cope with heat. This chapter examines differences between the two pathways, using climate justice as a guiding principle for future recommendations.

Research on ecosystem services (ES) has largely focused on the ecological functions that produce services or the economic valuation of the benefits provided by ecosystems. Far less research has examined public perceptions of ES, and more so ecosystem disservices (EDS), despite evidence that ecosystem properties and functions can produce beneficial or detrimental outcomes for human well-being. To address this gap, we present a robust approach to measuring beliefs about ecosystem services and disservices. With various means to confirm the validity and reliability of ES and EDS measures, we demonstrate this approach with survey data that captures residents' perceptions about whether their local neighborhood environment (as the ecosystem of focus) provides certain positive or negative impacts in metropolitan Phoenix, Arizona. The results highlight patterns in people's views of: desirable and undesirable biota; benefits and risks pertaining to heat and stormwater; recreational and aesthetic values; and societal nuisances and problems. Composite survey scales for overall perceptions of services and disservices are presented, in addition to more distinctive dimensions of ES and EDS. To better understand and manage ecosystems for diverse benefits, the specific survey measures and the general methodological approach can be adapted to various ecosystems and contexts.