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.

OBJECTIVE: Schools play an essential role in providing mental health care for adolescents. School closures during COVID-19, as well as re-opening to remote-only instruction in Fall 2020, may indirectly affect the utilization of emergency psychiatric care. We examine COVID-19-related changes in emergency psychiatric care among youth during the school closure and after school reopening (with remote instruction). METHODS: We use Box-Jenkins interrupted time series methods to analyze psychiatric emergency department (ED) visits among patients 10-19 years at LAC + USC Medical Center (LAC + USC) between January 5th, 2018, and December 31st, 2020. We control for the 1st societal shutdown in LA County (i.e., the nine weeks from March 13 to May 14, 2020) when analyzing the potential return to remote school shock. RESULTS: Youth psychiatric ED visits fell by 15.3 per week during the Spring 2020 school closure (p < .05). The return to remote school coefficient (i.e., August 14th to September 10, 2020), by contrast, is positive but does not reach statistical detection above expected values (p = .11). However, the proportion of psychiatric ED visits rises 38% among youth during the return to remote school period (p = 0.006). CONCLUSION: The initiation of Fall 2020 remote instruction corresponded with a greater proportion of youth ED visits that are classified as psychiatric.

Recognizing that centuries of mistreatment of low-income and minority communities by governments and corporations have resulted in widespread exposure to environmental harms, academics and policymakers are seeking ways to improve environmental justice. While it is commonly assumed that improved procedural justice (meaningful participation in decision making) should improve distributive justice (equitable distribution of environmental harms and benefits), empirical evidence of this link is nascent. This paper evaluates whether differing approaches to procedural justice shape recognition of distributive injustices by policymakers, focusing on implementation of the National Environmental Policy Act (NEPA) in Puerto Rico. NEPA requires federal agencies to evaluate the potential environmental impacts of projects they implement, fund, or permit; this review commonly includes an assessment of the project's impacts on distributive justice. Drawing on document analysis and interviews with project developers, regulators, and community organizations, we explore how and why four NEPA reviews consider distributional impacts. In all four cases, the community mobilized to voice concerns about the proposed projects' impacts, but the lead agencies and project developers did not always create the space for those voices to collaboratively shape the review. This demonstrates the role of the project developer in how distributive justice considerations are treated, as project leads have discretion on whether and when to provide space for community groups to participate in the process. This research makes two primary contributions. First, by linking features of the decision-making process with environmental justice-related outputs, this research provides practical understanding of ways to support distributive justice and expands knowledge about how participatory governance works within the context of US environmental policy. Second, by studying NEPA's implementation in Puerto Rico, we assess challenges associated with implementing Environmental Impact Assessment in a territorial setting, where the demographics and intensity of environmental problems are distinct from the 'traditional' American context the policies were designed to protect.

Social capital is frequently invoked as a reason for engaging in collaborative environmental governance. Yet we have a limited understanding of how collaborative environmental governance mobilizes different types of social capital and how the advantages and costs of social capital accrue for different groups of people. Explicit measures of social capital, such as through social network methods, will help build an understanding of how social capital facilitates collective processes and for whom. We reviewed highly cited articles in Web of Science and Scopus using ‘social capital’ as the search term to identify foundational and emergent social capital concepts. In the context of collaborative environmental governance, we operationalized these social capital concepts with network measures drawn from our expertise and highlighted existing empirical relationships between such network measures and collaborative outcomes. We identified two different perspectives on social capital—one based on social relations that could be readily operationalized with social network measures and the other based on actor characteristics that can further contextualize network data. Relational social capital concepts included social relations among actors; the collective social setting in which relations are embedded; and the advantages and costs that social capital confers to individuals and the collective. Social capital concepts based on actor characteristics included socio-cognitions (e.g. trust, norms, identification with a group, shared meanings) and community engagement (e.g. group membership, civic participation, volunteerism). Empirical evidence using social network approaches to measure social capital reveals patterns in relationship building that influence collaborative and other sustainability outcomes. Social network approaches described here may help define and quantify the social capital mobilized by collaborative governance. Additional research is necessary to track the social capital of collaboratives over time, link it to outcomes, and better understand the social justice implications of collaborative governance.

Urban landscapes homogenize our world at global scales, contributing to “extinction of experience”, a progressive decline in human interactions with native greenspace that can disconnect people from the services it provides. College age adults report feeling disconnected from nature more than other demographics, making universities a logical place to explore interventions intended to restore a connection with nature. This study surveyed 1088 students and staff across four university campus communities in Southern California, USA and used multicriteria decision analysis to explore their landscape preferences and the implications of those preferences for combatting extinction of experience. Our results suggest that perspectives of, and preferences for, different greenspace forms vary significantly (i.e., they are not perceived as substitutable). Support for native ecosystems, particularly coastal sage scrub (top ranked landscape) was generally high, suggesting that disaffection with wild nature is not particularly widespread. Programs for replacing turf grass lawns (lowest ranked landscape) with native plants were also well supported, but support for stormwater bioswales was more moderate (and variable). This may reflect their relative newness, both on university campuses and in urban spaces more generally. Not all members of campus communities preferred the same landscapes; preferences differed with degree of pro-environmentalism and university status (undergraduate student, graduate student, staff). Even so, all respondents exhibited landscape preferences consistent with at least one approach for combatting extinction of experience, suggesting that ecologists, engineers and urban planners have a viable set of generalizable tools for reconnecting people with nature.

Despite the substantial number of studies on the relationships between crime patterns and built environments, the impacts of street-level built environments on crime patterns have not been definitively determined due to the limitations of obtaining detailed streetscape data and conventional analysis models. To fill these gaps, this study focuses on the non-linear relationships and threshold effects between built environments and local crime patterns at the level of a street segment in the City of Santa Ana, California. Using Google Street View (GSV) and semantic segmentation techniques, we quantify the features of the built environment in GSV images. Then, we examine the non-linear relationships and threshold effects between built environment factors and crime by applying interpretable machine learning (IML) methods. While the machine learning models, especially Deep Neural Network (DNN), outperformed negative binomial regression in predicting future crime events, particularly advantageous was that they allowed us to obtain a deeper understanding of the complex relationship between crime patterns and environmental factors. The results of interpreting the DNN model through IML indicate that most streetscape elements showed non-linear relationships and threshold effects with crime patterns that cannot be easily captured by conventional regression model specifications. The non-linearities and threshold effects revealed in this study can shed light on the factors associated with crime patterns and contribute to policy development for public safety from crime.

Cash transfer policies have been widely discussed as mechanisms to curb intergenerational transmission of socioeconomic disadvantage. In this paper, we take advantage of a large casino-funded family transfer program introduced in a Southeastern American Indian Tribe to generate difference-in-difference estimates of the link between childrens cash transfer exposure and third grade math and reading test scores of their offspring. Here we show greater math (0.25 standard deviation [SD], p =.0148, 95% Confidence Interval [CI]: 0.05, 0.45) and reading (0.28 SD, p = .0066, 95% CI: 0.08, 0.49) scores among American Indian students whose mother was exposed ten years longer than other American Indian students to the cash transfer during her childhood (or relative to the non-American Indian student referent group). Exploratory analyses find that a mothers decision to pursue higher education and delay fertility appears to explain some, but not all, of the relation between cash transfers and childrens test scores. In this rural population, large cash transfers have the potential to reduce intergenerational cycles of poverty-related educational outcomes.

INTRODUCTION: To better understand the development of the growing opioid crisis in the early 21st century, the authors studied trends in substance use disorder among 46,132,211 emergency department (ED) visit discharges in California between 2006 and 2011. METHODS: Utilizing the California State Emergency Department Database, the authors identified substance use based on International Classification of Diseases, Ninth Revision codes. Tabular and multivariable analysis methods were applied. ED visits were considered clustered at the level of patient. RESULTS: The authors observed a notable increase in substance use prevalence from 7.32 ± 6.07 to 12.21 ± 9.35 per 1000 ED visits. Nonopioid substance use was more prevalent among individuals aged ≤ 50 years old. Opioid use disorder (OUD) was associated with a higher mortality rate in the ED. In 2011, OUD was significantly higher among American Indians visiting the ED. A multivariable analysis revealed that OUD was an independent predictor for increased ED visits after controlling for demographic factors. DISCUSSION: Despite an overall decrease in mortality rate, opioid-related ED visits showed a higher mortality rate, underscoring the grave consequences of OUD. Nonopioid substance use was prevalent among younger age groups, suggesting a need for age-specific interventions. A major finding was the elevated OUD among American Indians, indicating persistent health disparities impacting this demographic. OUD was an independent risk factor for excess ED visits, which could strain health care systems. The authors suggest strategies like nonopioid pain management, community-level programs, and bridging ED with outpatient treatment facilities to mitigate the opioid crisis and ED overutilization. CONCLUSION: These findings advocate for tailored public health strategies, addressing the underlying disparities to combat the opioid epidemic effectively.

Pregnancies ending before 26 weeks contribute 1% of births but 40% of infant deaths in the United States. The rate of these periviable births to non-Hispanic (NH) Black women exceeds four times that for NH whites. Small male periviable infants remain most likely to die. NH white periviable males weigh more than their NH Black counterparts. We argue that male infants born from twin gestations, in which one fetus died in utero (i.e., the vanishing twin syndrome), contribute to the disparity. We cannot directly test our argument because vanishing typically occurs before clinical recognition of pregnancy. We, however, describe and find associations that would emerge in vital statistics were our argument correct. Among male periviable singleton births from 288 monthly conception cohorts (January 1995 through December 2018), we found an average NH white advantage of 30 grams (759 grams versus 729 grams). Consistent with our argument, however, cohorts signaling relatively few survivors of the vanishing twin syndrome showed no disparity.