Mapping Mobility: Utilizing Local-Knowledge-Derived Activity Space to Estimate Exposure to Ambient Air Pollution among Individuals Experiencing Unsheltered Homelessness

Predicting hotspots of unsheltered homelessness using geospatial administrative data and volunteered geographic information

Unsheltered homelessness is an increasingly prevalent phenomenon in major cities that is associated with adverse health and mortality outcomes. This creates a need for spatial estimates of population denominators for resource allocation and epidemiological studies. Gaps in the timeliness, coverage, and spatial specificity of official Point-in-Time Counts of unsheltered homelessness suggest a role for geospatial data from alternative sources to provide interim, neighborhood-level estimates of counts and trends. We use citizen-generated data from homeless-related 311 requests, provider-based administrative data from homeless street outreach cases, and expert reports of unsheltered count to predict count and emerging hotspots of unsheltered homelessness in census tracts across the City of Los Angeles for 2019 and 2020. Our study shows that alternative data sources can contribute timely insights into the state of unsheltered homelessness throughout the year and inform the delivery of interventions to this vulnerable population.

Concurrent Heat and Air Pollution Exposures among People Experiencing Homelessness

BACKGROUND

Extreme heat and air pollution are important human health concerns; exposure can affect mental and physical well-being, particularly during periods of co-occurrence. Yet, the impacts on people are largely determined by underlying health conditions, coupled with the length and intensity of exposure. Preexisting adverse health conditions and prolonged exposure times are more common for people experiencing homelessness, particularly those with intersectional identity characteristics (e.g., disease, ability, age, etc.). Partially due to methodological limitations, such as data scarcity, there is a lack of research at the intersection of this at-risk population within the climate-health domain.

OBJECTIVES

We have three distinct objectives throughout this article: a) to advance critical discussions around the state of concurrent high heat and air pollution exposure research as it relates to people experiencing homelessness; b) to assert the importance of heat and air pollution exposure research among a highly vulnerable, too-often homogenized population-people experiencing homelessness; and c) to underline challenges in this area of study while presenting potential ways to address such shortcomings.

DISCUSSION

The health insights from concurrent air pollution and heat exposure studies are consequential when studying unhoused communities who are already overexposed to harmful environmental conditions. Without holistic data sets and more advanced methods to study concurrent exposures, appropriate and targeted prevention and intervention strategies cannot be developed to protect this at-risk population. We highlight that a) concurrent high heat and air pollution exposure research among people experiencing homelessness is significantly underdeveloped considering the pressing human health implications; b) the severity of physiological responses elicited by high heat and air pollution are predicated on exposure intensity and time, and thus people without means of seeking climate-controlled shelter are most at risk; and c) collaboration among transdisciplinary teams is needed to resolve data resolution issues and enable targeted prevention and intervention strategies. https://doi.org/10.1289/EHP13402.

The Geographic Context of Racial Disparities in Aggressive Endometrial Cancer Subtypes: Integrating Social and Environmental Aspects to Discern Biological Outcomes

The number of Endometrial Carcinoma (EC) diagnoses is projected to increase substantially in coming decades. Although most ECs have a favorable prognosis, the aggressive, non-endometrioid subtypes are disproportionately concentrated in Black women and spread rapidly, making treatment difficult and resulting in poor outcomes. Therefore, this study offers an exploratory spatial epidemiological investigation of EC patients within a U.S.-based health system's institutional cancer registry (n = 1748) to search for and study geographic patterns. Clinical, demographic, and geographic characteristics were compared by histotype using chi-square tests for categorical and t-tests for continuous variables. Multivariable logistic regression evaluated the impact of risks on these histotypes. Cox proportional hazard models measured risks in overall and cancer-specific death. Cluster detection indicated that patients with the EC non-endometrioid histotypes exhibit geographic clustering in their home address, such that congregate buildings can be identified for targeted outreach. Furthermore, living in a high social vulnerability area was independently associated with non-endometrioid histotypes, as continuous and categorical variables. This study provides a methodological framework for early, geographically targeted intervention; social vulnerability associations require further investigation. We have begun to fill the knowledge gap of geography in gynecologic cancers, and geographic clustering of aggressive tumors may enable targeted intervention to improve prognoses.