The inequitable geographic distribution of health care resources has long been recognized as a problem in the United States. Traditional measures, such as a simple ratio of supply to demand in an area or distance to the closest provider, are easy measures for spatial accessibility. However the former one does not consider interactions between patients and providers across administrative borders and the latter does not account for the demand side, that is, the competition for the supply. With advancements in GIS, however, better measures of geographic accessibility, variants of a gravity model, have been applied. Among them are (1) a two-step floating catchment area (2SFCA) method and (2) a kernel density (KD) method. This microscopic study compared these two GIS-based measures of accessibility in our case study of dialysis service centers in Chicago. Our comparison study found a significant mismatch of the accessibility ratios between the two methods. Overall, the 2SFCA method produced better accessibility ratios. There is room for further improvement of the 2SFCA method-varying the radius of service area according to the type of provider or the type of neighborhood and determining the appropriate weight equation form-still warrant further study.
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Child maltreatment is a preventable public health problem. Research has demonstrated that neighborhood structural factors (e.g. poverty, crime) can influence the proportion of a neighborhood’s children who are victims of maltreatment. A newer strategy is the identification of potentially modifiable social processes at the neighborhood level that can also influence maltreatment. Toward this end, this study examines neighborhood-level data (maltreatment cases substantiated by Illinois’ child protection agency, 1995–2005, social processes measured by the Project on Human Development in Chicago Neighborhoods, U.S. Census data, proportions of neighborhoods on public assistance, and crime data) that were linked across clusters of contiguous, relatively homogenous Chicago, IL census tracts with respect to racial/ethnic and socioeconomic composition. Our analysis—an ecological-level, repeated cross-sectional design utilizing random-intercept logit models— with a sensitivity analysis using spatial models to control for spatial autocorrelation – revealed consistent associations between neighborhood social processes and maltreatment. Neighborhoods higher in collective efficacy, intergenerational closure, and social networks, and lower in disorder had lower proportions of neglect, physical abuse, and sexual abuse substantiated cases, controlling for differences in structural factors. Higher collective efficacy and social network size also predicted a lower proportion of substance-exposed infants. This research indicates that strategies to mobilize neighborhood-level protective factors may decrease child maltreatment more effectively than individual and family-focused efforts alone.
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