Urban Planning & Public Policy

Introduction: The World Health Organization estimates that one million people die by suicide every year. Few studies have looked at factors associated with disposition in patients with chief complaints of depression, suicidal ideation (SI) and suicidal attempts (SA) who present to the emergency department (ED). Our objective was to assess individual determinants associated with ED disposition of patients in depressed patients presenting to the ED.

Methods: We conducted a retrospective study using the National Hospital Ambulatory Medical Care Survey from 2006 to 2008. We used logistic regression to identify factors associated with discharge, in SI, SA and depression patients. Independent variables included socio-demographic information, vital signs, mode of arrival, insurance status, place of residence and concomitant psychiatric diagnosis.

Results: Of the 93,030 subjects, 2,314 met the inclusion criteria (1,362 depression, 353 SI and 599 SA). Patients who arrived by ambulance were less likely to be discharged (odds ratio [OR] 0.63, 95% confidence interval [CI] 0.43-0.92). Hispanic patients and patients age 15 to 29 were likely to be discharged (OR 1.61, 95% CI 1.16-2.24 and OR 1.55, 95% CI 1.15-2.10 respectively). Insurance status and housing status were not significantly associated patient was being discharge from EDs.

Conclusion: The Hispanic population had higher discharge rates, but the reasons are yet to be explored. Patients with SA and SI are discharged less frequently than those with depression, regardless of insurance type or housing status. [West J Emerg Med. 2014;15(2):211–216.]

Introduction: Toxicologic exposures (TE) are a major preventable public health issue, with most cases due to unintentional causes. Although these cases are well documented and reported via the National Poison Data System, there is little information regarding toxicologic exposure cases in the emergency department (ED). The aim of this study was to identify demographic groups at risk for potential poisoning.

Methods: This was a cross-sectional study. We used data from the California State Emergency Department Database (SEDD) 2011 for statistical analysis.

Results: The study included 10,124,598 ED visits in California in 2011. The prevalence of TE was 383.4 (379.6-387.3) per 100,000 visits. Toxicologic exposures were most common among patients aged <10 years (555.4, 95% confidence interval [CI], 544.5-566.5 per 100,000 visits). Overall, TE was more common among males. White patients showed the highest prevalence of TE compared to other racial groups (P <0.001). Subpopulation analysis showed Native American female patients ages 10-19 had a noticeably higher prevalence of TE (1,464.4, 95% CI, 802.9-2444.9 per 100,000). The prevalence of TE was higher in households of higher median income (P <0.001). Prevalence of TE among those with a history of substance use was also elevated. 

Conclusion: Toxicologic exposure cases in the ED are elevated in particular age and race/ethnicity groups, as well as among those with a diagnosis of substance use disorder. The strength of association between these factors and TE in the general population may be different because we examined ED visits only. Further preventive and education strategies are necessary and should target the demographic groups identified in this epidemiological study.

This research explores the institutional application of the "precautionary principle" to addressing scientific uncertainties, with a focus on how the international legal framework adjudicates environmental risks associated with the release of nuclear-polluted wastewater from the 2011 Fukushima Nuclear Disaster site. Scientific uncertainties tend to be amplified and escalated into political disputes due to the diversified assessments and standards on the potential risks of the discharged wastewater to public health in the East Asian region. This study asks: What institutional mechanisms can be an effective venue to manage scientific uncertainties and mitigate social amplifications of risk? This research analyzes the current legal frameworks, such as the United Nations Convention on the Law of the Sea (UNCLOS) and the World Trade Organization (WTO)'s resolution on genetically modified organism (GMO) imports to the European Union, to clarify the complexity of law and uncertainties and how they apply to the Fukushima case. Recognizing the innate gaps where technological assessment is limited, this paper suggests considering the precautionary principle as "gatekeeping" in international courts to bridge the gaps in conventional risk assessment. This approach aims to narrow methodological discrepancies between legal procedures and scientific corroboration on uncertainties, as a deliberative approach to scientific uncertainties in adjudication. Without such a mechanism, long-horizon environmental harms like those in the Fukushima case will continue to be excluded from international adjudication.

To mitigate the potential impacts of wildfire, communities across the United States are engaging in collaborative wildfire risk mitigation planning. Planning involves identifying a set of goals, developing management strategies to achieve those goals, and codifying the goals and strategies in a written document. A plan's goals and strategies are informed by values-the things plan authors and communities want to protect or enhance. Identifying and evaluating these values can give insight into whether a plan is meeting the needs of local wildfire risk and vulnerability, incorporating best practice from national policies, or simply reflecting broader cultural trends. This paper explores these tensions using the case of Community Wildfire Protection Plans (CWPPs), which are local (neighborhood to multicounty) plans developed collaboratively by diverse wildfire-related stakeholders. Drawing on a combination of manual coding and computational text analysis, we first characterize the values to be protected in 2268 CWPPs from across the United States. We then evaluate what shapes the values articulated in individual CWPPs, exploring the degree to which values reflect local wildfire risk and socioeconomic vulnerability, updates in policy guidance from US federal agencies, and/or broader cultural trends. This paper makes three primary contributions: 1) mapping local wildfire values at the national scale; 2) understanding tensions in environmental governance in a multilevel federalist system; and 3) advancing values as an important metric for evaluating the quality of management plans.

Like many low-lying coastal nations, Liberia faces severe threats from sea level rise, coastal erosion, and flooding. These threats are particularly acute for residents of informal slum communities, who are relegated to high-hazard areas that lack basic infrastructure and are frequently overlooked by government officials. In addition, Liberia's limited national institutional capacity has left adaptation to coastal residents and other local stakeholders. This research examines how collective action shapes coastal climate adaptation strategies in two of the largest slum communities in Liberia, West Point and New Kru Town. Drawing on semi-structured interviews, this research investigates how residents experience and respond to coastal hazards, the role of government and civil society actors in supporting adaptation, and barriers to effective collective action. The study reveals disparities in government attention between the two communities, with New Kru Town receiving more infrastructural support than West Point, as well as gaps in government-community collaboration, funding limitations, and fragmented policy frameworks that undermine coastal resilience efforts. Despite these challenges, the communities sustain resilience through a variety of grassroots efforts. This study highlights the need for durable, government-backed solutions and stronger institutional accountability to support frontline communities in low-income, climate-vulnerable urban settings.

ABSTRACT Alternative sources of freshwater, provided by various innovations, have long been available to countries facing acute water stress. We hypothesize that avoiding and/or resolving conflict with neighbors—caused by the uncertainty of continued access to shared surface water and groundwater sources—is another driver of innovation adoption. Furthermore, adoption of alternative freshwater sources may help alleviate transboundary disputes and, thus, hasten water supply independence among neighboring countries. We explore this thesis by examining the experience of Israel and Singapore, two countries that have pursued several innovations including desalination, wastewater reuse, and rainwater harvesting. They have also experienced conflicts with neighbors over water. After examining these nations' motives for adopting innovations, as well as the structure and operation of water innovation governance in each country, we examine the role these supply innovations have played in transboundary disputes. We find that the introduction of these innovations has had an important, but not decisive role in helping to alleviate larger conflicts with thirsty neighbors, even when they are explicitly part of negotiations aimed at long‐term transboundary dispute resolution. The extent to which innovations can actually help resolve transboundary conflicts depends on parties' confidence in larger transboundary water agreements, an inclination to share water data and information, and a willingness to collaborate on water projects of mutual benefit. The availability of water innovations alone does not serve to alleviate transboundary conflicts. 摘要 长期以来, 各种创新技术提供的替代淡水资源一直被面临严重水资源短缺的国家所利用。我们假设, 避免和/或解决因持续获取共享地表水和地下水资源的不确定性而引发的与邻国的冲突, 是推动创新技术应用的另一个驱动因素。此外, 采用替代淡水资源可能有助于缓解跨界争端, 从而加快邻国实现供水独立。我们通过考察以色列和新加坡的经验来探讨这一论点。这两个国家都推行了包括海水淡化、废水回用和雨水收集在内的多项创新技术, 并且都曾与邻国发生过水资源冲突。在考察了这两个国家采用创新技术的动机, 以及各自水资源创新治理的结构和运作之后, 我们分析了这些供水创新技术在跨界争端中所扮演的角色。我们发现, 即使这些创新技术被明确纳入旨在解决长期跨界争端的谈判中, 它们在缓解与缺水邻国之间的重大冲突方面也发挥了重要但并非决定性的作用。创新技术在多大程度上能够真正帮助解决跨界冲突, 这取决于各方对更广泛的跨界水资源协议的信心、共享水资源数据和信息的意愿, 以及在互惠互利的水资源项目上开展合作的意愿。仅靠水资源创新技术本身并不能缓解跨界冲突。 RESUMEN Las fuentes alternativas de agua dulce, gracias a diversas innovaciones, han estado disponibles desde hace tiempo para los países que sufren una grave escasez de agua. Nuestra hipótesis es que evitar o resolver conflictos con los países vecinos—causados por la incertidumbre del acceso continuo a las fuentes compartidas de agua superficial y subterránea—es otro factor que impulsa la adopción de innovaciones. Además, la adopción de fuentes alternativas de agua dulce puede ayudar a mitigar las disputas transfronterizas y, por lo tanto, acelerar la independencia hídrica entre países vecinos. Exploramos esta tesis examinando la experiencia de Israel y Singapur, dos países que han impulsado diversas innovaciones, como la desalinización, la reutilización de aguas residuales y la captación de agua de lluvia. Ambos países también han experimentado conflictos con sus vecinos por el agua. Tras analizar los motivos que llevaron a estas naciones a adoptar innovaciones, así como la estructura y el funcionamiento de la gobernanza de la innovación hídrica en cada país, examinamos el papel que estas innovaciones en el suministro han desempeñado en las disputas transfronterizas. Observamos que la introducción de estas innovaciones ha tenido un papel importante, aunque no decisivo, para ayudar a mitigar los conflictos más amplios con los países vecinos con escasez de agua, incluso cuando forman parte explícitamente de negociaciones destinadas a la resolución a largo plazo de disputas transfronterizas. La medida en que las innovaciones pueden contribuir a resolver los conflictos transfronterizos depende de la confianza de las partes en los acuerdos transfronterizos de agua de mayor envergadura, su predisposición a compartir datos e información sobre el agua y su voluntad de colaborar en proyectos hídricos de beneficio mutuo. La mera disponibilidad de innovaciones en materia de agua no basta para mitigar los conflictos transfronterizos.

Sea-level rise, intensifying floods, and deforestation pose urgent risks to low-income coastal countries, yet climate adaptation remains constrained by governance and resource gaps. Despite Liberia’s prominence in global vulnerability rankings, little research has examined the country’s adaptation processes and barriers. This case study addresses that gap by analyzing Liberia’s environmental vulnerabilities and institutional responses. The study first describes key vulnerabilities, including coastal erosion, urban flooding, rainfall and temperature variation, deforestation, and waste management and pollution. It then reviews the main organizations and policy frameworks engaged in climate adaptation and mitigation across the country. The study shows that despite formal policy frameworks such as the National Adaptation Plan and REDD+ Strategy, climate action remains fragmented, underfunded, and politically marginalized. Findings reveal how governance gaps, including limited institutional capacity, donor dependence, overlapping mandates, chronic neglect of basic services, and exclusion of local communities, undermine adaptation, leaving frontline communities to rely on self-organized strategies. The disconnect between national planning and local realities reveals deeper tensions between development goals and environmental sustainability. Liberia’s experience highlights how vulnerability is coproduced by socio-ecological systems and governance failures, offering insights for more inclusive, context-sensitive climate adaptation in the Global South.

Problem, research strategy, and findings: Multigenerational living arrangements have become more common in the United States as housing costs rise and family structures evolve. Accessory dwelling units (ADUs) could support this shift by allowing relatives to live nearby while maintaining privacy and independence, and advocates have invoked this promise to justify laws intended to facilitate ADU development. In the past decade, at least eight U.S. states have adopted such laws. We present the first large-scale, parcel-level test of this claim, linking permit records from 14 California counties, covering approximately two-thirds of the state’s population, to geocoded voter registration and consumer reference data, identifying multigenerational households from shared surnames and age differences across single-family parcels. Parcels with ADU permits are, on average, slightly less likely to be multigenerational than comparable parcels without permits, by roughly 2 to 3 percentage points after controlling for parcel and neighborhood characteristics. This negative association persists among owner-occupied parcels. This finding is sensible in light of prior research showing household characteristics associated with multigenerational living, such as lower incomes, are also associated with informal (i.e., unpermitted) ADU development. Takeaway for practice: Broad ADU legalization alone does not appear to have increased multigenerational living in California. Planners seeking to promote multigenerational housing should pair by-right ADU authorization with complementary measures such as preapproved plans and alternative financing methods.

The post-disaster period is often marked by discussions about the causes of the event and solutions to manage risk. From a policy-making perspective, disasters can act as focusing events, garnering the attention of the public and elites and creating a window of opportunity for policy change to reduce disaster risk. Narratives that circulate post-disaster are one of the crucial factors that influence the government’s decisions to respond to them. This study examines the narratives surrounding flood risk in Chiplun, Maharashtra, after the 2021 flooding by integrating the Narrative Policy Framework (NPF) with the Pressure and Release Framework (PAR). Our innovative framework reveals how narratives in a post-disaster policy window direct attention to certain dimensions of risk while overlooking others and its implications for flood risk reduction. Analysis of media coverage, government reports, and stakeholder interviews revealed three dominant narratives surrounding flood risk: 1) flooding as a consequence of dam (mis)management, 2) flooding as a result of sediment accumulation in the river, and 3) flooding as an outcome of development in the floodplain. We found that the narratives focusing on unsafe conditions gained traction, while those challenging power structures faced resistance. The sediment accumulation narrative was successful because it did not challenge existing power structures. Despite engaging with dynamic pressures, the floodplain development narrative faced the most resistance because it challenged the powerful economic interest groups. The analysis of competing narratives surrounding flood risk indicates that selective engagement or silence regarding different dimensions of risk makes effective flood risk management in India challenging.