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Background: Path quality has not been well studied as a correlate of active transport to school. We hypothesize that for urban-dwelling children the environment between home and school is at least as important as the environment immediately surrounding their homes and/or schools when exploring walking to school behavior. Methods: Tools from spatial statistics and geographic information systems (GIS) were applied to an assessment of street blocks to create a walking path quality measure based on physical and social disorder (termed "incivilities") for each child. Path quality was included in a multivariate regression analysis of walking to school status for a sample of 362 children. Results: The odds of walking to school for path quality was 0.88 (95% CI: 0.72-1.07), which although not statistically significant is in the direction supporting our hypothesis. The odds of walking to school for home street block incivility suggests the counter intuitive effect (OR = 1.10, 95% CI: 1.08-1.19). Conclusions: Results suggest that urban children living in communities characterized by higher incivilities are more likely to walk to school, potentially placing them at risk for adverse health outcomes because of exposure to high incivility areas along their route. Results also support the importance of including path quality when exploring the influence of the environment on walking to school behavior. [ABSTRACT FROM AUTHOR]

Background: Reactive case detection (RCD) seeks to enhance malaria surveillance and control by identifying and treating parasitaemic individuals residing near index cases. In Zambia, this strategy starts with passive detection of symptomatic incident malaria cases at local health facilities or by community health workers, with subsequent home visits to screen-and-treat residents in the index case and neighbouring (secondary) households within a 140-m radius using rapid diagnostic tests (RDTs). However, a small circular radius may not be the most efficient strategy to identify parasitaemic individuals in low-endemic areas with hotspots of malaria transmission. To evaluate if RCD efficiency could be improved by increasing the probability of identifying parasitaemic residents, environmental risk factors and a larger screening radius (250 m) were assessed in a region of low malaria endemicity. Methods: Between January 12, 2015 and July 26, 2017, 4170 individuals residing in 158 index and 531 secondary households were enrolled and completed a baseline questionnaire in the catchment area of Macha Hospital in Choma District, Southern Province, Zambia. Plasmodium falciparum prevalence was measured using PfHRP2 RDTs and quantitative PCR (qPCR). A Quickbird™ high-resolution satellite image of the catchment area was used to create environmental risk factors in ArcGIS, and generalized estimating equations were used to evaluate associations between risk factors and secondary households with parasitaemic individuals. Results: The parasite prevalence in secondary (non-index case) households was 0.7% by RDT and 1.8% by qPCR. Overall, 8.5% (n = 45) of secondary households had at least one resident with parasitaemia by qPCR or RDT. The risk of a secondary household having a parasitaemic resident was significantly increased in proximity to higher order streams and marginally with increasing distance from index households. The adjusted OR for proximity to third- and fifth-order streams were 2.97 (95% CI 1.04–8.42) and 2.30 (95% CI 1.04–5.09), respectively, and that for distance to index households for each 50 m was 1.24 (95% CI 0.98–1.58). Conclusion: Applying proximity to streams as a screening tool, 16% (n = 3) more malaria-positive secondary households were identified compared to using a 140-m circular screening radius. This analysis highlights the potential use of environmental risk factors as a screening strategy to increase RCD efficiency. [ABSTRACT FROM AUTHOR]

In the early 20th century, public health nurse, Lillian Wald, addressed the social determinants of health (SDOH) through her work in New York City and her advocacy to improve policy in workplace conditions, education, recreation, and housing. In the early 21st century, addressing the SDOH is a renewed priority and provides nurse researchers with an opportunity to return to our roots. The purpose of this methods paper is to examine how the incorporation of geospatial data and spatial methodologies in community research can enhance the analyses of the complex relationships between social determinants and health. Geospatial technologies, software for mapping and working with geospatial data, statistical methods, and unique considerations are discussed. An exemplar for using geospatial data is presented regarding associations between neighborhood greenspace, neighborhood violence, and children's asthma control. This innovative use of geospatial data illustrates a new frontier in investigating nontraditional connections between the environment and SDOH outcomes. [ABSTRACT FROM AUTHOR]

Background: Walking to school is an important source of physical activity among children. There is a paucity of research exploring environmental determinants of walking to school among children in urban areas. Methods: A cross-sectional secondary analysis of baseline data (2007) from 365 children in the "Multiple Opportunities to Reach Excellence" (MORE) Study (8 to 13 years; Mean 9.60 years, SD 1.04). Children and caregivers were asked about walking to school and perceived safety. Objective measures of the environment were obtained using a validated environmental neighborhood assessment. Results: Over half (55.83%) of children reported walking to school most of the time. High levels of neighborhood incivilities were associated with lower levels of perceived safety (OR: 0.39, 95% CI: 0.21 to 0.72). Living on a block above the median in incivilities was associated with a 353% increase in odds of walking to school (OR: 3.53; 95% CI: 1.68 to 7.39). Conclusions: Children residing in neighborhoods high in incivilities are more likely to walk to school, in spite of lower levels of perceived safety. As a high proportion of children residing in disadvantaged neighborhoods walk to school, efforts should be directed at minimizing exposure to neighborhood hazards by ensuring safe routes to and from school. [ABSTRACT FROM AUTHOR]