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Immigrant workers often commute by transit more than other workers. Although immigrants' reliance on transit is often attributed to the same factors as women's reliance on transit: low incomes, limited access to cars, and a tendency to work close to home, gender differences are discussed rarely in analyses of immigrant commuting. Using 2016 Census of Canada microdata, we examine the use of four commute modes: driving, transit, active commuting in the form of walking and biking and being driven to work by immigrant men and women. Multinomial logistic regression indicates how economic, social, housing and metropolitan characteristics influence the use of each commute mode. Immigrant women, especially recent immigrants, are more likely to use alternative modes than immigrant men in all metropolitan areas. The findings underscore the importance of rapid and reliable transit to ensure equitable geographical access to employment for immigrant women, particularly during their first 10 years in Canada.

The COVID-19 pandemic amplified social, economic, and environmental inequalities in American cities, including inequities in commuting and access to employment. Frontline workers—those who had to work on site during the pandemic—experienced these inequalities in every aspect of their daily lives. We examine the labor force characteristics and commuting of frontline workers in New York City with a focus on gender and race/ethnic disparities in wages and commuting modes and times. Using Census PUMS microdata for a sample of New York City residents in the 2015–2019 period, we identify frontline workers from detailed industry and occupation codes and compare characteristics of frontline workers with those of essential workers who could work remotely. The data highlight wide disparities between frontline and remote workers. Minority men and women are concentrated in the frontline workforce. The residential geographies of frontline and remote workers differ greatly, with the former concentrated in low- and moderate- income areas distant from work sites and with long commute times. Compared to men, women frontline workers rely heavily on public transit to commute and transit dependence is highest among Black and Latina women. Low-wage employment, long commute times, and transit dependence intersected to increase minority women’s economic and social vulnerability during the pandemic.

In this commentary we reflect on the potential and power of geographical analysis, as a set of methods, theoretical approaches, and perspectives, to increase our understanding of how space and place matter for women. We emphasize key aspects of the field, including accessibility, urban change, and spatial interaction and behavior, providing a high-level research agenda that indicates a variety of gaps and routes for future research that will not only lead to more equitable and aware solutions to local and global challenges, but also innovative and novel research methods, concepts, and data. We close with a set of gender, representation, and inclusion challenges to our discipline, researchers, and publication outlets.

Introduction Rural communities often face chronic challenges of high rates of serious health conditions coupled with inadequate access to health care services—challenges exacerbated by the COVID-19 pandemic. One strategy with the potential to mitigate these problems is the increased use of telehealth technology. A feature of telehealth applications—collaboration between health care providers for consultation and other purposes—referred to herein as Rural Provider-to-Provider Telehealth (RPPT), introduces important expertise that may not exist locally in rural communities. Literature indicates that RPPT is operationalized through many methods with an array of purposes. While RPPT is a promising strategy that brings additional expertise to patient-centered rural care delivery, there is limited evidence addressing important considerations, including how patient access and outcomes, provider satisfaction and performance, and payment may be affected by its use. Methods Recognizing the significant potential of RPPT and the need for more information associated with its use, the National Institutes of Health convened a Pathways to Prevention (P2P) workshop to further understand RPPT's effectiveness and impact on improving health outcomes in rural settings. The P2P initiative, supported by several federal health agencies, engaged rural health stakeholders and experts to examine four key questions, identify related knowledge gaps, and provide recommendations to advance understanding of the use and impact of RPPT. Results Included in this report is a description of the process used to generate information about RPPT, the identification of key knowledge gaps, and specific recommendations to further build needed evidence. Discussion The emerging use of RPPT is an important tool for bridging gaps in access to care that impacts rural populations. However, to fully understand the value and effects of RPPT, new research is needed to fill the knowledge gaps identified in this report. Additionally, this report should help engage providers, payors, and policymakers interested in supporting evidence-informed RPPT practice, policy, and payment, with the ultimate aim of improving access to health care and health status of rural communities in the United States and worldwide.

In many central districts in cities across the world, different types of stores form clusters resulting from the benefits of spatial agglomeration. To precisely analyze co-location relationships in...

This study investigates malaria incidence during the hot-wet summer (June to September) and cool-dry winter (January to March) seasons in Khartoum, Sudan. Using data on malaria cases, LandScan grid...

In the late 1960s, Indonesia established community health centres (CHCs) throughout the country to provide basic healthcare services for the poor. However, CHC expenditures and investments vary widely at the sub-provincial level, among administrative areas known as cities and regencies, raising concern that facilities and services do not correspond to population needs. This study aimed to examine spatial and socioeconomic inequalities in the availability of CHCs in the Jakarta region. We used spatial and statistical analysis methods at the village level to investigate these inequalities based on CHC data from the Ministry of Health and socioeconomic data from Indonesia Statistics. Results show that CHCs and the healthcare workers within them are unevenly distributed. In areas with high need, the availability of CHCs and healthcare workers were found to be low. There is a mismatch in healthcare services and delivery for low-income, unemployed populations at the village level that needs to be addressed. The findings discussed in this paper suggest that Jakarta Department of Health should coordinate with local public health districts to determine locations for new CHCs and assign healthcare workers to each CHC based on need as this would improve access to essential health services for the low-income population.

To describe and elucidate rates in breast cancer incidence by subtype in the federally designated Mississippi Delta Region, an impoverished region across eight Southern/Midwest states with a high proportion of Black residents and notable breast cancer mortality disparities. Cancer registry data from seven LMDR states (Missouri was not included because of permission issues) were used to explore breast cancer incidence differences by subtype between the LMDR’s Delta and non-Delta Regions and between White and Black women within the Delta Region (2012–2014). Overall and subtype-specific age-adjusted incidence rates and rate ratios were calculated. Multilevel negative binomial regression models were used to evaluate how individual-level and area-level factors, like race/ethnicity and poverty level, respectively, affect rates of breast cancers by subtype. Women in the Delta Region had higher rates of triple-negative breast cancer, the most aggressive subtype, than women in the non-Delta (17.0 vs. 14.4 per 100,000), but the elevated rate was attenuated to non-statistical significance in multivariable analysis. Urban Delta women also had higher rates of triple-negative breast cancer than non-Delta urban women, which remained in multivariable analysis. In the Delta Region, Black women had higher overall breast cancer rates than their White counterparts, which remained in multivariable analysis. Higher rates of triple-negative breast cancer in the Delta Region may help explain the Region’s mortality disparity. Further, an important area of future research is to determine what unaccounted for individual-level or social area-level factors contribute to the elevated breast cancer incidence rate among Black women in the Delta Region.

Geographies of home and work have changed as public investment has favored central and distant suburban locations and as income inequality has increased. These changes result in shifting ge...

We discuss the use of quantitative data and methods to understand where and how COVID-19 spreads, to estimate and predict its impacts on population health and wellbeing, and to plan effective public health responses. Geographic approaches often involve developing multi-scalar and dynamic models that incorporate geographic processes and variability, harnessing big and real-time data on people’s mobilities and interactions, and paying attention to how gender, ethnicity, and other dimensions of people’s identities intersect with larger structures in impacting the uneven geographies of COVID-19 risk. Our chapter addresses each of these topics while highlighting the need for critical and place-based approaches that are sensitive to local and regional variability in COVID-19 processes and impacts.

Background Spatial access to primary care has been associated with late‐stage and fatal breast cancer, but less is known about its relation to outcomes of other screening‐preventable cancers such as colorectal cancer. This population‐based retrospective cohort study examined whether spatial access to primary care providers associates with colorectal cancer‐specific survival. Methods Approximately 26 600 incident colorectal cancers diagnosed between 2000 and 2008 in adults residing in Cook County, Illinois were identified through the state cancer registry and georeferenced to the census tract of residence at diagnosis. An enhanced two‐step floating catchment area method measured tract‐level access to primary care physicians (PCPs) in the year of diagnosis using practice locations obtained from the American Medical Association. Vital status and underlying cause of death were determined using the National Death Index. Fine‐Gray proportional subdistribution hazard models analyzed the association between tract‐level PCP access scores and colorectal cancer‐specific survival after accounting for tract‐level socioeconomic status, case demographics, tumor characteristics, and other factors. Results Increased tract‐level access to PCPs was associated with a lower risk of death from colorectal cancer (hazard ratio [HR], 95% confidence interval [CI]) = 0.87 [0.79, 0.96], P = .008, highest vs lowest quintile), especially among persons diagnosed with regional‐stage tumors (HR, 95% CI = 0.80 [0.69, 0.93], P = .004, highest vs lowest quintile). Conclusions Spatial access to primary care providers is a predictor of colorectal cancer‐specific survival in Cook County, Illinois. Future research is needed to determine which areas within the cancer care continuum are most affected by spatial accessibility to primary care such as referral for screening, accessibility of screening and diagnostic testing, referral for treatment, and access to appropriate survivorship‐related care., In this population‐based retrospective cohort study of approximately 26 600 incident colorectal cancers diagnosed in Cook County, IL between 2000 and 2008, spatial access to primary care was associated with colorectal cancer‐specific survival independent of neighborhood socioeconomic status, tumor stage, and other factors. To elucidate the underlying mechanisms, future research is needed to determine which areas within the cancer care continuum are most affected by spatial accessibility to primary care.

Purpose To characterize spatial access to mammography services across 8 Lower Mississippi Delta Region (LMDR) states. These states include the Delta Region, a federally designated, largely rural, and impoverished region with a high proportion of black residents and low mammography utilization rates. Methods Using the enhanced 2-step floating catchment area method, we calculated spatial accessibility scores for mammography services across LMDR census tracts. We compared accessibility scores between the Delta and non-Delta Regions of the LMDR. We also performed hotspot analysis and constructed spatial lag models to detect clusters of low spatial access and to identify sociodemographic factors associated with access, respectively. We obtained mammography facility locations data from the Food and Drug Administration and sociodemographic variables from the American Community Survey and the US Department of Agriculture. Results Overall, there were no differences in spatial accessibility scores between the Delta and non-Delta Regions, though there was some state-to-state variation. Clusters of low spatial access were found in parts of the Arkansas, Mississippi, and Tennessee Delta. Spatial lag models found that poverty was associated with greater spatial access to mammography. Conclusions The lack of identified differences in spatial access to mammography in the Delta and non-Delta Regions suggests that psychosocial or financial barriers play a larger role in lower mammography utilization rates. Identifying clusters of low spatial access to mammography services can help inform resource allocation. Further, our study underscores the value of using coverage-based methods rather than travel time or container measures to evaluate spatial access to care.

Many cities in the United States and Canada offer a 311 helpline to their residents for submitting requests for non-emergency municipal services. By dialing 311, urban residents can report a range of public issues that require governmental attention, including potholes, graffito, sanitation complaints, and tree debris. The demand for these municipal services fluctuates greatly with time and location, which poses multiple challenges to effective deployment of limited resources. To address these challenges, this study uses a locally adaptive space-time kernel approach to model 311 requests as an inhomogeneous Poisson process and presents an analytical framework to generate predictions of 311 demand in space and time. The predictions can be used to optimally allocate resources and staff, reduce response time, and allow long-term dynamic planning. We use a bivariate spatial kernel to identify the spatial structure and weigh each kernel by corresponding past observations to capture the temporal dynamics. Short-term serial dependency and weekly temporality are modeled through the temporal weights, which are adaptive to local community areas. We also transform the computation-intensive parameter estimation procedure to a low dimensional optimization problem by fitting to the autocorrelation function of historical requests. The presented method is demonstrated and validated with sanitation service requests in Chicago. The results indicate that it performs better than common industry practice and conventional spatial models with a comparable computational cost.

To address locally relevant cancer-related health issues, health departments frequently need data beyond that contained in standard census area-based statistics. We describe a geographic information system-based method for calculating age-standardized cancer incidence rates in non-census defined geographical areas using publically available data. Aggregated records of cancer cases diagnosed from 2009 through 2013 in each of Chicago’s 77 census-defined community areas were obtained from the Illinois State Cancer Registry. Areal interpolation through dasymetric mapping of census blocks was used to redistribute populations and case counts from community areas to Chicago’s 50 politically defined aldermanic wards, and ward-level age-standardized 5-year cumulative incidence rates were calculated. Potential errors in redistributing populations between geographies were limited to

In the U.S., substantial employment and wage gaps persist between workers with and without disabilities. A lack of accessible transportation is often cited as a barrier to employment in higher wage jobs for people with disabilities, but little is known about the intraurban commuting patterns of employed people with disabilities in relation to their wage earnings. Our study compares wages and commute times between workers with and without disabilities in the New York metropolitan region and identifies the intraurban zones where residents experience higher inequities in wage earnings and commute times. We obtained our data from the Public Use Microdata Sample (PUMS) of the American Community Survey (ACS) for the 2008–2012 time period. We used linear mixed-effects models and generated separate models with log hourly wage or one-way commute time as the dependent variable. We find significant differences in wages and commute times between workers with and without disabilities at the scale of the metropolitan region as well as by intraurban zone. At the metropolitan scale, disabled workers earn 16.6% less and commute one minute longer on average than non-disabled workers. High commute and wage inequalities converge in the center, where workers with disabilities are more likely to use public transit, earn 17.1% less, and travel nearly four minutes longer on average than workers without disabilities. These results suggest that transport options are less accessible and slower for disabled workers than they are for non-disabled workers. Our findings indicate a need for more accessible and quicker forms of transportation in the center along with an increased availability of centrally located and affordable housing to reduce the disability gap in wages and commute times. We also find that workers with disabilities generally seek higher wages in exchange for longer commute times, but the results differ by race/ethnicity and gender. Compared to white men, minority workers earn much less, and white and Hispanic women have significantly shorter commute times. Our findings offer new geographic insights on how having a disability can influence wage earnings and commute times for workers in different intraurban zones in the New York metropolitan region., Highlights • Workers with disabilities earn significantly lower wages & have longer commute times. • High wage & commute disparities by disability status converge in the center. • In the center, workers with disabilities earn $6.52 less per hour in median wages. • Workers with disabilities earn higher wages in exchange for longer commute times. • White and Hispanic women with disabilities have significantly shorter commutes.

Single mothers are an important and growing segment of the U.S. workforce. As primary breadwinners and caregivers, they shoulder a 'double burden' that often constrains their access to job opportunities and reinforces their commuting challenges. In the urban areas where most single mothers live, ongoing transformations of the built environment associated with gentrification and uneven transit investment may exacerbate their commuting challenges. We examine the impacts of built environment characteristics on single mothers' reliance on various transportation modes for their commuting trips in the New York metropolitan region. Our analysis focuses on changes in mode use during the 2000s, a period of rapid change in the region's built environment. Using microdata from the 2000 and 2008–2012 U.S. Census PUMS, we analyse geographic and racial/ethnic inequalities in single mothers' mode choices and the socioeconomic and contextual factors that influence transit dependence. Our results show that transit use is increasing both among single and married mothers, as working mothers shift away from commuting by car. At the same time, single mothers increasingly live in suburban and peripheral areas where access to transit is limited. Although only a relatively small percentage of suburban single mothers commute via transit, that percentage increased from 2000 to 2010. Transit dependence is especially high among minority single mothers and that disparity persists after controlling residential location, transit access, hourly earnings and sociodemographic characteristics.

Health researchers and policy-makers increasingly use volunteered geographic information (VGI) to analyze spatial variation in health and wellbeing and to develop interventions. As socially constructed data, health VGI reflect the people who perceive issues and choose to report them, and the digital systems that structure the reporting process. We propose a conceptual framework that describes the interlocking effects of socioeconomic, behavioral, geographic, and technological processes on VGI accuracy and credibility. GIS and statistical methods are used to analyze social and geographical biases in health-related VGI through a case study of bed bug complaint data from New York City's 311 system. Reports of bed bug infestation from 311 are mapped and modeled to uncover associations with socioeconomic and built environment characteristics. Factors associated with bed bug report credibility are examined by comparing characteristics of confirmed reports with those for reports in which inspectors found no evidence of infestation (negative reports). A multilevel model of credibility incorporating report-, building-, and tract-level variables reveals strong geographical and socioeconomic biases, with negative reports generated more frequently from high-value residential buildings located in high-income neighborhoods with predominately white, non-Hispanic populations. Using 311 data for all bed bug reports, rather than confirmed reports, obscures the burden of these pests in high poverty neighborhoods and diminishes socioeconomic disparities. Mistaken reporting also has economic costs, as each report triggers an inspection by city inspectors that entails time, monetary, and opportunity costs.

Objective To examine the contributions of individual- and neighborhood-level spatial access to care to the utilization of emergency departments (EDs) for preventable conditions through implementation of novel local spatial access measures. Data Sources/Study Setting Emergency department admissions data are from four HealthLNK member hospitals in Chicago from 2007 to 2011. Primary care physician office and clinic locations were obtained from the American Medical Association and the City of Chicago. Study Design Multilevel logit regression was used to model the relationship between individual- and neighborhood-level attributes and preventable ED use. Data Collection/Extraction Methods Emergency department admissions data were classified based on the primary diagnosis for each encounter. Spatial access to care indices were generated in ArcGIS, and values were extracted at each ZIP code centroid to match patients' ZIP codes. Principal Findings Beyond sociodemographic factors such as gender and race, patients living in medically underserved areas (MUAs) and areas with lower spatial access to primary care clinics had higher odds of preventable ED use. Conclusions Preventable ED use can be associated with sociodemographic characteristics, as well as spatial access to primary care services. This study reveals potential for using local measures of spatial accessibility for preventable ED analyses.

Disparities in breast cancer outcomes between rural and urban populations are of great interest as environmental, social, and technological processes unevenly affect rural and urban landscapes. This chapter examines research on rural-urban disparities in breast cancer. The first section briefly reviews recent literature on variations in breast cancer incidence, stage, survival, quality of life, treatment and costs in rural and urban areas. The next section critically evaluates this work by presenting six suppositions about rural and urban places and populations. Each supposition discusses a key issue concerning how rural and urban categories and disparities are defined, measured, and analyzed. I argue that rural and urban are complex, heterogeneous categories that are difficult to define and that change over time complicates our understanding of breast cancer disparities. The complexity, heterogeneity, and dynamism of urban and rural places and populations give rise to unequal and varying BC outcomes. In addition, people’s differing experiences of urban and rural places strongly influence important risks and exposures, while also affecting access to diagnosis and treatment facilities, leading to people- and place-based heterogeneity in breast cancer outcomes. Implications for future research on rural-urban disparities are discussed.

Background Violent crime is a major public health issue. Currently, information on the relationship between food retail outlet availability and violent crime occurrence is limited. Objective Evaluate US county-level associations between the availability of healthy (grocery stores, supercenters, and farmers’ markets) and unhealthy (convenience stores and fast food restaurants) and violent crime rate after adjusting for socio-demographic factors. We hypothesized that counties with fewer healthy food retailers would have a higher violent crime rate. Study Design, Settings, and Participants Data collected in 2014 on 3,126 counties were obtained from two sources: The United States Department of Agriculture Food Environment Atlas and the United States Department of Justice Uniform Crime Reporting Program. Measures on resident socio-demographics (e.g., % Non-Hispanic black, % Hispanic, poverty rate, etc.), per capita food retail outlets, and per capita violent crimes were analyzed. Measurable Outcome/Analysis Violent crime rate reflects the total number of murders, robberies, forcible rapes, and aggravated assaults per 10,000 county residents. The CDC's Modified Retail Food Environment Index (mRFEI) was applied to assess the healthfulness of each county's retail food environment. Multivariable-adjusted linear regression models were used to examine associations between food retail outlet availability and violent crime rate. Results After adjusting for socio-demographic measures, increased availability of grocery stores (P = .01) and farmers’ markets (P Conclusion US counties with fewer healthy food retailers had a higher violent crime rate after adjusting for socio-demographic factors. These findings highlight the need for additional research on the role of the retail food environment in community violence.

In the 1990s, many women commuted shorter distances and less time than men, and research underscored the pernicious effects of racial and ethnic segregation and access to transportation on minority...

Recent scholarship points to a protective association between green space and birth outcomes as well a positive relationship between blue space and wellbeing. We add to this body of literature by exploring the relationship between expectant mothers’ exposure to green and blue spaces and adverse birth outcomes in New York City. The Normalized Difference Vegetation Index (NDVI), the NYC Street Tree Census, and access to major green spaces served as measures of greenness, while proximity to waterfront areas represented access to blue space. Associations between these factors and adverse birth outcomes, including preterm birth, term birthweight, term low birthweight, and small for gestational age, were evaluated via mixed-effects linear and logistic regression models. The analyses were conducted separately for women living in deprived neighborhoods to test for differential effects on mothers in these areas. The results indicate that women in deprived neighborhoods suffer from higher rates adverse birth outcomes and lower levels of residential greenness. In adjusted models, a significant inverse association between nearby street trees and the odds of preterm birth was found for all women. However, we did not identify a consistent significant relationship between adverse birth outcomes and NDVI, access to major green spaces, or waterfront access when individual covariates were taken into account.

Introduction To evaluate disparities in breast cancer stage by subtype (categorizations of breast cancer based upon molecular characteristics) in the Delta Regional Authority (Delta), an impoverished region across eight Lower Mississippi Delta Region (LMDR) states with a high proportion of Black residents and high breast cancer mortality rates. Methods We used population-based cancer registry data from seven of the eight LMDR states to explore breast cancer staging (early and late) differences by subtype between the Delta and non-Delta in the LMDR and between White and Black women within the Delta. Age-adjusted incidence rates and rate ratios were calculated to examine regional and racial differences. Multilevel negative binomial regression models were constructed to evaluate how individual-level and area-level factors affect rates of early- and late-stage breast cancers by subtype. Results For all subtypes combined, there were no Delta/non-Delta differences in early and late stage breast cancers. Delta women had lower rates of hormone-receptor (HR+)/human epidermal growth factor 2 (HER2-) and higher rates of HR-/HER2- (the most aggressive subtype) early and late stage cancers, respectively, but these elevated rates were attenuated in multilevel models. Within the Delta, Black women had higher rates of late-stage breast cancer than White women for most subtypes; elevated late-stage rates of all subtypes combined remained in Black women in multilevel analysis (RR = 1.10; 95% CI = 1.04–1.15). Conclusions Black women in the Delta had higher rates of late-stage cancers across subtypes. Culturally competent interventions targeting risk-appropriate screening modalities should be scaled up in the Delta to improve early detection.

Rural populations experience a myriad of cancer disparities ranging from lower screening rates to higher cancer mortality rates. These disparities are due in part to individual-level characteristics like age and insurance status, but the physical and social context of rural residence also plays a role. Our objective was two-fold: 1) to develop a multilevel conceptual framework describing how rural residence and relevant micro, macro, and supra-macro factors can be considered in evaluating disparities across the cancer control continuum and 2) to outline the unique considerations of multilevel statistical modeling in rural cancer research. We drew upon several formative frameworks that address the cancer control continuum, population-level disparities, access to health care services, and social inequities. Micro-level factors comprised individual-level characteristics that either predispose or enable individuals to utilize health care services or that may affect their cancer risk. Macro-level factors included social context (e.g. domains of social inequity) and physical context (e.g. access to care). Rural-urban status was considered a macro-level construct spanning both social and physical context, as "rural" is often characterized by sociodemographic characteristics and distance to health care services. Supra-macro-level factors included policies and systems (e.g. public health policies) that may affect cancer disparities. Our conceptual framework can guide researchers in conceptualizing multilevel statistical models to evaluate the independent contributions of rural-urban status on cancer while accounting for important micro, macro, and supra-macro factors. Statistically, potential collinearity of multilevel model predictive variables, model structure, and spatial dependence should also be considered.

Spatial and locational dimensions of public health are attracting increasing attention among regional scientists whose analytic methods and frameworks can provide valuable insights into well-being challenges. Regional economic, demographic, and environmental processes are critically important to people’s health and access to health care. Such effects can be modeled and analyzed using spatial analytics and regional approaches. This chapter reviews contributions by regional scientists to public health research and intervention. Research challenges and opportunities are discussed in several broad areas of public health, including health disparities, environmental health, access to health services, and public health intervention.

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 densi...

Throughout the Midwestern United States, land owners and managers, mainly farmers, are increasingly considering the possibility of transforming industrial agricultural landscapes that currently are used almost strictly for food production to landscapes that include renewable energy production. Because most land in this region is privately owned and independently farmed, transformation of the landscape will be the product of myriad decisions by individual farmers. Little is known about the geographic, environmental, and sociocultural forces that influence farmers’ decisions. We use survey methods and a geographic information system (GIS)-aided focus group to elicit farmers’ perspectives on growing perennial energy grasses such as switchgrass in central Illinois. Approximately one third of surveyed farmers are willing to plant energy grasses if a local market exists. Farmers’ planting decisions are bound up with their understandings of land suitability for planting at the farmstead and regional scales. Thro...

Rural – urban inequalities in health and access to health care have long been of concern in health-policy formulation. Understanding these inequalities is critically important in efforts to plan a more effective geographical distribution of public health resources and programs. Socially and ethnically diverse populations are likely to exhibit different rural – urban gradients in health and well-being because of their varying experiences of place environments, yet little is known about the interplay between social and spatial inequalities. Using data from the Illinois State Cancer Registry, we investigate rural – urban inequalities in late-stage breast cancer diagnosis both for the overall population and for African-Americans, and the impacts of socioeconomic deprivation and spatial access to health care. Changes over time are analyzed from 1988 – 92 to 1998 – 2002, periods of heightened breast cancer awareness and increased access to screening. In both time periods, the risk of late-stage diagnosis is highest among patients living in the most urbanized areas, an indication of urban disadvantage. Multilevel modeling results indicate that rural – urban inequalities in risk are associated with differences in the demographic characteristics of area populations and differences in the social and spatial characteristics of the places in which they live. For African-American breast cancer patients, the rural – urban gradient is reversed, with higher risks among patients living outside the city of Chicago, suggesting a distinct set of health-related risks and place experiences that inhibit early breast cancer detection. Findings emphasize the need for combining spatial and social targeting in locating cancer prevention and treatment programs.

Differences in mosquito control practices at the local level involve the interplay of place, scale and politics. During the Chicago West Nile Virus (WNV) outbreak of 2002, mosquito abatement districts represent distinct suburban clusters of human WNV cases, independent of characteristics of the local population, housing and physical environment. We examine how the contrasting actions of four districts reveal a distinct local politics of mosquito control that may have contributed to local-scale geographic differences in WNV incidence. This politics is rooted in political, economic and philosophical differences within and between administrative boundaries.

This paper investigates the effects of multipurpose shopping on spatial competition among retail firms. Multipurpose shopping leads to a dispersion of competing firms even in Hotelling-type scenarios. The degree of dispersion depends on individual propensities for multipurpose shopping which are determined by the relative costs, demands, and prices for various goods.

Introduction: The Delta Regional Authority (DRA) is a federally designated region that includes 252 counties across 8 Lower Mississippi Delta Region states (Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee) and contains nearly 10 million residents. The DRA has a high proportion of African American residents, high levels of poverty, and is largely rural. As such, the region has limited access to health care services, which likely leads to underutilization of mammography services and the higher breast cancer mortality of the region compared to the non-DRA counties within these eight states. Limited spatial access to mammography has been shown, in some studies, to be associated with more advanced stage at diagnosis, which may contribute to greater mortality risk. Objective: To assess spatial accessibility to mammography facilities in the DRA and non-DRA counties within the Lower Mississippi Delta Region states. Methods: We obtained the locations of all mammography facilities within the Lower Mississippi Delta Region states from the Food and Drug Administration. We used data from the US Census Bureau's American Community Survey to estimate the number women of recommended screening age (i.e., 45-74, the available data most congruent with recommendations) in each census tract in these states. We implemented the enhanced two-step floating catchment area method to calculate census-tract level spatial accessibility scores (SAS). This method considers both supply of and demand for mammography services within a specified catchment area, such as 60-minute travel time, with weights applied to account for distance decay (i.e., people are less likely to access services that are further away). We calculated Global Moran's I and Local Moran's I to determine if these SAS were spatially clustered and where they were clustered, respectively, within the DRA. We also calculated univariate statistics to compare SAS in the DRA and non-DRA designations of the Lower Mississippi Delta Region states and by rural-urban status using the United States Department of Agriculture's Rural-Urban Commuting Area codes. Because SAS were skewed (i.e., not normally distributed), the nonparametric, Wilcoxon Sum Rank Test was used to compared scores. Results: Global Moran's I indicated limited, but statistically significant, spatial autocorrelation within the DRA (Moran's I=0.17, Z-score=47.67, p Discussion: Despite disparities in mammography utilization and breast cancer mortality in the DRA, we found no differences in spatial access to mammography compared to the non-DRA designation of the 8 Lower Mississippi Delta states. However, we identified clusters of low spatial access to mammography in specific parts of the DRA. These areas may be appropriate areas to target with mobile mammography initiatives or construction of free-standing mammography facilities. Citation Format: Whitney E. Zahnd, Sara McLafferty, Recinda Sherman, Susan Farner, Hillary Klonoff-Cohen, Karin Rosenblatt. Spatial accessibility to mammography services in the Lower Mississippi Delta states [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C87.

A prominent U.S. medical geographer explores the geographic dimensions of disease pandemics, examining their causes, movement over space, unequal impacts, and emergence of place-specific public health responses. She utilizes a political ecological approach to situate pandemics within a complex network of place-specific interactions among people, the physical and built environments, social institutions, and infectious agents that cause disease. The author also reviews the range of geographical strategies that governments and other institutions employ to control the spread of infectious diseases that include constructing, targeting, and manipulating place environments where diseases occur and people's interactions within them. Journal of Economic Literature, Classification Numbers: F590, H510, I180. 4 figures, 1 table, 60 references.

We discuss Susan Hanson's contributions to geography during the 1970s and 1980s through the lens of quotidian geographies, geographies of the everyday. Beginning from our own experiences as graduate students and new faculty members, we describe the social and theoretical context in which Susan published her initial studies of men's and women's activity patterns that examined gender differences in travel behavior and their origins in men's and women's different household responsibilities. We also review her success peopling the discipline of geography. We conclude that human geography has benefited from the incorporation of feminist theory and methods as Susan predicted.

Cancer stage at the time of diagnosis is critically important in affecting the long-term health and well-being of cancer patients. Detection at an early stage increases the likelihood that cancers can be successfully treated, reducing the risk of morbidity and mortality and enhancing long-term prognosis. In the United States, there are wide disparities in late-stage cancer risk among population groups and among geographic regions. Low income, vulnerable populations are more likely to be diagnosed with cancer at a distant or `late' stage. Late-stage risk also varies geographically. Some studies identify a greater risk of late-stage diagnosis among rural residents who face long distances in accessing cancer screening services. However, research on rural-urban disparities has produced mixed and conflicting findings that question whether rural residents are disadvantaged in late-stage risk. This research investigates the rural-urban gradient in late-stage cancer risk in Illinois for 1998–2002. Using data from the Illinois State Cancer Registry, we examine fine-grained patterns of rural-urban variation for four major types of cancer: breast, colorectal, lung and prostate. The objectives are to determine the extent and direction of rural-urban gradient in late-stage risk for each type of cancer and to analyze the roles of individual demographic characteristics, and ZIP code level contextual variables in accounting for rural-urban variations.

Nancy Krieger has been one of the leading voices in documenting how social ‘axes of difference’, including race, ethnicity and class make people vulnerable to poor health and limit their access to effective health care. We discuss the importance of ‘locating’ diversity in health inequalities research. This includes critically dissecting racial and ethnic axes into more nuanced social categories that incorporate differences based on immigration and other factors. It also involves considering how diverse population groups vary in their perception and use of space for health-related activities and exposures. Examples relating to immigrant populations’ health and access to health care are discussed.