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The Centers for Disease Control recommends pneumococcal vaccination for U.S. adults aged 19–64 years with chronic or immunocompromising conditions, however, vaccination coverage is low and regional variations in coverage are rarely studied. This study examined pneumococcal vaccination coverage at the metropolitan statistical area (MSAs) level and identified regional factors associated with pneumococcal vaccination using the combined IBM® Watson Health MarketScan® Commercial and Medicare Supplemental databases. Pneumococcal vaccination coverage, clinical and socioeconomic factors were calculated for each MSA. Ordinary least square and spatial regression models were used to examine factors associated with vaccination. Results indicated that the national pneumococcal vaccination coverage was 13.4% with a large variation across MSAs (0–34%). The spatial error model, model with the best fit, showed that proportions of the population who were ≥50 years of age, received an influenza vaccine, or had health maintenance organization health plans were positively associated with pneumococcal vaccination coverage. In summary, we found that national pneumococcal vaccination coverage was low and there was substantial variation across MSAs. Regional factors identified may help inform interventions to improve pneumococcal vaccination coverage across geographies.

Using MSA-level data over 1994–2014, we study the effect of bank failures on local business dynamics, in the form of net business formation and net job creation. We find that at least one bank failure in the metropolitan statistical area (MSA) with the mean population prevents approximately 475 net businesses from forming in that area, compared with MSAs that experience no bank failures, ceteris paribus. The equivalent effect on net job creation is 16,433 net job losses. Our results are even stronger for small businesses, which are usually more dependent on bank-firm relationships. These effects point to significant welfare losses stemming from bank failures, highlighting an important role for government intervention. We show that the Troubled Asset Relief Program (TARP) is effective in reducing the negative effects of bank failures on local business dynamics. This positive effect of TARP is quite uniform across small and large firms. [ABSTRACT FROM AUTHOR]

Consumers of healthcare services are demanding more convenient and accessible options to care. Technologic advancements can support this demand, but telehealth knowledge is lacking. This article will describe the current state of telehealth and examine the role that NPs can play in furthering its adoption. [ABSTRACT FROM AUTHOR]

The Centers for Disease Control recommends pneumococcal vaccination for U.S. adults aged 19-64 years with chronic or immunocompromising conditions, however, vaccination coverage is low and regional variations in coverage are rarely studied. This study examined pneumococcal vaccination coverage at the metropolitan statistical area (MSAs) level and identified regional factors associated with pneumococcal vaccination using the combined IBM® Watson Health MarketScan® Commercial and Medicare Supplemental databases. Pneumococcal vaccination coverage, clinical and socioeconomic factors were calculated for each MSA. Ordinary least square and spatial regression models were used to examine factors associated with vaccination. Results indicated that the national pneumococcal vaccination coverage was 13.4% with a large variation across MSAs (0-34%). The spatial error model, model with the best fit, showed that proportions of the population who were ≥50 years of age, received an influenza vaccine, or had health maintenance organization health plans were positively associated with pneumococcal vaccination coverage. In summary, we found that national pneumococcal vaccination coverage was low and there was substantial variation across MSAs. Regional factors identified may help inform interventions to improve pneumococcal vaccination coverage across geographies.

Objectives: We examined the survival rates after diagnosis of HIV infection stage 3 (AIDS) in the United States by population density area of residence at diagnosis. Methods: We used data from the National HIV Surveillance System to calculate survival rates among people aged ≥ 13 with HIV infection stage 3 (AIDS) diagnosed from 2005 through 2010. We determined survival rates for more than 12, 24, and 36 months after diagnosis; overall and by demographic characteristics; and across 3 population density area categories (large metropolitan statistical areas [MSAs, ≥500000 people], small-to-medium MSAs [50000 to 499999 people], and nonmetropolitan areas [<50 000 people]). Results: The survival rates for more than 12, 24, and 36 months after diagnosis were highest among people residing in large MSAs (90.2%, 87.2%, and 84.9%, respectively) and lowest among people residing in nonmetropolitan areas (87.3%, 84.1%, and 81.4%, respectively). With a few exceptions, survival rates were lower in those residing in nonmetropolitan areas than those residing in large MSAs and small-to-medium MSAs across most subgroups by age at diagnosis, race/ethnicity, sex, transmission category, region of residence, and year of diagnosis. Between 2005 and 2010, significant year-to-year increases occurred in the proportion of people surviving more than 36 months after diagnosis across all 3 population density area categories (estimated annual percentage change: large MSAs [0.88; 95% confidence interval (CI), 0.56-1.20]; small-to-medium MSAs [0.94; 95% CI, 0.06-1.83]; and nonmetropolitan areas [1.26; 95% CI, 0.07-2.46]). Conclusions: Although survival rates for those with HIV infection stage 3 (AIDS) improved in all 3 population density area categories, efforts to remove barriers to care and promote treatment adherence in nonmetropolitan areas will be necessary to eliminate survival disparities. [ABSTRACT FROM AUTHOR]

We developed a physically-based environmental account of US food production systems and integrated these data into the environmental-input–output life cycle assessment (EIO-LCA) model. The extended model was used to characterize the food, energy, and water (FEW) intensities of every US economic sector. The model was then applied to every Bureau of Economic Analysis metropolitan statistical area (MSA) to determine their FEW usages. The extended EIO-LCA model can determine the water resource use (kGal), energy resource use (TJ), and food resource use in units of mass (kg) or energy content (kcal) of any economic activity within the United States. We analyzed every economic sector to determine its FEW intensities per dollar of economic output. This data was applied to each of the 382 MSAs to determine their total and per dollar of GDP FEW usages by allocating MSA economic production to the corresponding FEW intensities of US economic sectors. Additionally, a longitudinal study was performed for the Los Angeles–Long Beach–Anaheim, CA, metropolitan statistical area to examine trends from this singular MSA and compare it to the overall results. Results show a strong correlation between GDP and energy use, and between food and water use across MSAs. There is also a correlation between GDP and greenhouse gas emissions. The longitudinal study indicates that these correlations can shift alongside a shifting industrial composition. Comparing MSAs on a per GDP basis reveals that central and southern California tend to be more resource intensive than many other parts of the country, while much of Florida has abnormally low resource requirements. Results of this study enable a more complete understanding of food, energy, and water as key ingredients to a functioning economy. With the addition of the food data to the EIO-LCA framework, researchers will be able to better study the food–energy–water nexus and gain insight into how these three vital resources are interconnected. Applying this extended model to MSAs has demonstrated that all three resources are important to a MSA’s vitality, though the exact proportion of each resource may differ across urban areas.

Abstract: This study contributes to the literature on applied urban geography by examining spatial patterns and processes of changing racial/ethnic diversity within the intra-urban context of Knoxville metropolitan statistical area. Knoxville embraces a diverse economic set up with opportunities in high-tech research and development, manufacturing, tertiary/service-sectors, construction, as well as entertainment industry. This serves well for its continued population growth, including minorities during 1990–2009. This paper explores how the neighborhood-level socioeconomic, demographic, and built-environment characteristics relate to tract-level racial/ethnic diversity, measured by multi-group diversity score and its components. Tools such as isarithmic surface density maps, correlations, principal components and regression analyses are used to examine processes of change. Results indicate that diversity in 1990 associates with negative change whereas diversity in 2000 associates with positive change. Though overall diversity sprawls and increases during 1990–2009, diversity among non-White declines during 2000–2009 and shows spatial confinement. Regressions suggest complicated mosaics of changing neighborhoods, providing evidence of invasion-succession, filtering and resurgence of ethnic-enclaves in specific neighborhoods. Concerning the six counties of the MSA, Knox is the most diverse whereas Union the least, though the share of Hispanics tops in Loudon and Asians in Knox. In terms of strategic planning, findings from this research can be used in creating equitable and sustainable urban communities that can improve the overall well-being of people by reducing racial/ethnic and socio-economic disparities that might occur as undesirable consequences of fast increasing diversity. [Copyright &y& Elsevier]

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Abstract: The effect of economic change on the Latino to non-Latino White earnings gap has been well documented; however much of this research has focused on Latinos as a general category with little focus on subgroup variations. Despite varied histories and demographic characteristics Mexicans, Puerto Ricans and Cubans, the largest Hispanic subgroups, have usually been combined in analyses of earnings gaps. Consequently, we know little about differential effects of the “new economy” on earnings by subgroup across labor markets. Using a sample consisting of Mexicans, Cubans, Puerto Ricans, and non-Hispanic Whites residing in 106 metropolitan statistical areas (MSA) from the 2000 1-percent I-PUMS, we examine the influence of human capital, deindustrialization, immigration, and ‘new economy’ measures on Latino/a earnings gaps. Multi-level model analyses reveal that Latino subgroups have differently sized earnings gaps, that human capital and demographic characteristics reduce the gaps by more than seventy percent, that the gaps vary independently across MSAs and that the effects of labor market characteristics on these gaps vary by subgroup. New economy characteristics are most important for non-Hispanic White males, thereby indirectly modifying gender-ethnicity gaps. These findings highlight the importance of gender/ethnicity-specific earnings analyses. [Copyright &y& Elsevier]

Simple Summary: Human papillomavirus (HPV) vaccination disparities between urban and rural regions may moderate the vaccine's impact on reducing cervical precancer (CIN2+) and cancer incidence. We assessed population-level trends in CIN2+ incidence (2008–2018) in urban and rural areas among Medicaid-enrolled women aged 18–39 years in Tennessee, United States. A sub-group analysis among women screened for cervical cancer was conducted to control for changing screening trends. CIN2+ incidence among young women aged 18–20 and 21–24 years, who most likely benefited from the HPV vaccine, declined similarly between urban and rural areas, although significant declines began earlier in urban versus rural areas. Our results suggest evidence of HPV vaccine impact regardless of urbanicity but demonstrate lagged impact in rural areas. These findings emphasize the importance of reducing barriers to HPV vaccination, particularly in rural areas, to improve the reduction of cervical precancer and cancer incidence, toward the World Health Organization's goals of eliminating cervical cancer. Disparities in human papillomavirus (HPV) vaccination exist between urban (metropolitan statistical areas (MSAs)) and rural (non-MSAs) regions. To address whether the HPV vaccine's impact differs by urbanicity, we examined trends in cervical intraepithelial neoplasia grades 2 or 3 and adenocarcinoma in situ (collectively, CIN2+) incidence in MSAs and non-MSAs among Tennessee Medicaid (TennCare)-enrolled women aged 18–39 years and among the subset screened for cervical cancer in Tennessee, United States. Using TennCare claims data, we identified annual age-group-specific (18–20, 21–24, 25–29, 30–34, and 35–39 years) CIN2+ incidence (2008–2018). Joinpoint regression was used to identify trends over time. Age–period–cohort Poisson regression models were used to evaluate age, period, and cohort effects. All analyses were stratified by urbanicity (MSA versus non-MSA). From 2008–2018, 11,243 incident CIN2+ events (7956 in MSAs; 3287 in non-MSAs) were identified among TennCare-enrolled women aged 18–39 years. CIN2+ incident trends (2008–2018) were similar between women in MSAs and non-MSAs, with largest declines among ages 18–20 (MSA average annual percent change (AAPC): −30.4, 95% confidence interval (95%CI): −35.4, −25.0; non-MSA AAPC: −30.9, 95%CI: −36.8, −24.5) and 21–24 years (MSA AAPC: −14.8, 95%CI: −18.1, −11.3; non-MSA AAPC: −15.1, 95%CI: −17.9, −12.2). Significant declines for ages 18–20 years began in 2008 in MSAs compared to 2010 in non-MSAs. Trends were largely driven by age and cohort effects. These patterns were consistent among screened women. Despite evidence of HPV vaccine impact on reducing CIN2+ incidence regardless of urbanicity, significant declines in CIN2+ incidence were delayed in non-MSAs versus MSAs. [ABSTRACT FROM AUTHOR]

Purpose: To assess cross-population linkages in HIV/AIDS epidemics, we tested the hypothesis that the number of newly diagnosed AIDS cases among Black people who inject drugs (PWID) was positively related to the natural log of the rate of newly diagnosed HIV infections among Black non-PWID heterosexuals in 84 large U.S. metropolitan statistical areas (MSAs) in 2008-2016.Methods: We estimated a multilevel model centering the time-varying continuous exposures at baseline between the independent (Black PWID AIDS rates) and dependent (HIV diagnoses rate among Black heterosexuals) variables.Results: At MSA level, baseline (standardized β = 0.12) Black PWID AIDS rates and change in these rates over time (standardized β = 0.11) were positively associated with the log of new HIV diagnoses rates among Black heterosexuals. Thus, MSAs with Black PWID AIDS rates that were 1 standard deviation= higher at baseline also had rates of newly diagnosed HIV infections among Black non-PWID heterosexuals that were 10.3% higher. A 1 standard deviation increase in independent variable over time corresponded to a 7.8% increase in dependent variable.Conclusions: Black PWID AIDS rates may predict HIV rates among non-PWID Black heterosexuals. Effective HIV programming may be predicated, in part, on addressing intertwining of HIV epidemics across populations. [ABSTRACT FROM AUTHOR]

Purpose: Hopes are high that the delivery system reforms embodied in the patient centered medical home will improve the quality of care for patients with chronic diseases. While primary care physicians, given their training, will likely be the locus of care under this model, there are certain conditions for which urologists are well suited to provide the continuous and comprehensive care called for by the patient centered medical home. To assess the feasibility of the urology based patient centered medical home, we analyzed national survey data., Materials and Methods: For our measure of medical home infrastructure, we mapped items from the 2007 and 2008 NAMCS (National Ambulatory Medical Care Survey) to the NCQA (National Committee on Quality Assurance) standards for patient centered medical home recognition. We determined the proportion of urology practices in the United States that would achieve patient centered medical home recognition. Finally, we used NAMCS data to estimate the impact of consolidating genitourinary cancer (ie prostate, bladder, kidney and testis) followup care among the current supply of urologists., Results: Nearly three-quarters of urology practices meet NCQA standards for patient centered medical home recognition. At present, primary care physicians spend 9,295 cumulative workweeks providing direct and indirect care to survivors of genitourinary cancers. Off-loading half of this care to urology practices, in the context of the patient centered medical home, would generate an average of 0.73 additional workweeks for each practicing urologist., Conclusions: Urology practices may possess the capacity needed to direct medical homes for their patients with genitourinary cancers. Successful implementation of this model would likely require a willingness to manage some nonurological conditions., (Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)