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Obesity is a growing issue in the United States, and it affects millions of people. Obesity-related illness accounts for billions of dollars in medical expenses each year, heightening the need for prevention and intervention strategies. Physical activity is essential in maintaining a healthy weight, yet population groups have unequal access to physical activity opportunities. This research utilizes an environmental justice framework to examine variations in access and quality of recreational facilities among different socio-demographic groups in Danville, VA. Data for this research include secondary and primary sources. Race data were obtained from the 2010 U.S. Census. The Physical Activity Resource Assessment (PARA) tool was utilized to audit all recreational facilities within the City of Danville for features, amenities, and incivilities. Telephone survey data provided individual level-BMI, physical activity minutes per week, and variables of socioeconomic status, including income, education attainment, employment status, and gender. Analysis included ANOVAs, linear, and bivariate logistic regression. Predominant block group race was a significant predictor of incivilities at physical activity outlets. Proximity to recreational facilities was not a predictor of physical activity or BMI. Interventions must be made to improve the quality of recreational facilities in black or African American block groups. / Master of Science

Lyme disease is the most significant vector-borne disease in the United States. Its southward advance over the last several decades has been quantified, and previous research has examined the potential role of climate change on the disease's expansion, but no research has considered the role of future land cover patterns upon its distribution. This research examines Lyme disease risk in the southeastern United States based on estimated land cover projections under four different Intergovernmental Panel on Climate Change Special Report Emissions Scenarios (IPCC-SRES) A1B, A2, B1, and B2. Results are aggregated to census tracts which are the basic unit of analysis for this study. This study applied previously established relationships between Lyme disease and land cover in Virginia to the projected land cover layers under each scenario. The study area, the southeastern United States, was defined from Level III Ecoregions that are present in Virginia and extend throughout the Southeast. Projected land cover data for each scenario were obtained from the USGS. The projected land cover datasets are compatible with the National Land Cover Dataset (NLCD) categories and had seventeen land cover categories. The raster datasets were reclassified to four broad land cover types: Water, Developed, Forest, and Herbaceous areas and the relationship between certain landscape configurations were analyzed using FRAGSTATS 4.2. Significant variables established in previous research were used to develop a spatial Poisson regression model to project Lyme disease incidence for each decade to the year 2100. Results indicated that potential land cover suitability for Lyme disease transmission will increase under two scenarios (A1B and A2) while potential land cover suitability for Lyme disease transmission was predicted to decrease under the other two scenarios (B1 and B2). Total area under the highest category of potential land cover suitability Lyme disease transmission was calculated for each year under each scenario. The A2 scenario experiences the most rapid acceleration of potential land cover suitability for Lyme disease transmission, with an average increase of 16,163.95 km² per decade, while the A1B scenario was projected to show an average increase of 3,458.47 km² per decade. Conversely, the B1 scenario showed an average decrease of 595.7 km² per decade and the B2 scenario showed the largest decrease of potential land cover suitability for Lyme disease transmission with an average decrease of 2,006.83 km² per decade. This study examined the potential spatial distribution of potential land cover suitability for Lyme disease transmission in the southeastern United States under four different future land cover scenarios. The results indicate geographic regions of the study area that are at greatest risk of potential land cover suitability for Lyme disease transmission under four different predictive scenarios developed by the IPCC. The A1B and A2 land cover projections are predicted to have an overall increase in areas where the Lyme disease transmission cycle will be enhanced by 2100 and the scenarios have a primary focus on economic development. Economic concerns outweigh environmental concerns for the A1B scenario, in addition to a high standard of living. The A2 scenario describes rapid population growth which results in high rates of land cover conversion to developed land; in addition, this scenario describes a reduction of environmental protection. The B1 and B2 land cover projections are predicted to have an overall decrease in areas of high Lyme disease transmission by 2100 and these scenarios have a central focus on environmental sustainability. The B1 scenario is characterized by a high environmental awareness which results in lower demand for forest products. A common theme for the B1 scenario is restoration and forest protection. Finally, the B2 scenario is described as improving local and regional environmental value which results in a high demand for biofuels and repossession of degraded lands, and an overall increase of forest cover. This study was the first to predict potential land cover suitability for Lyme disease risk and geographic distribution using projected land cover in the southeastern United States, and the results of this research can aid in the reduction of Lyme disease as it continues to expand in the south. / Master of Science

Before the consolidation of the germ theory of human diseases at the end of the nineteenth century, medical explanations about disease causation were dominated by the environmental notions of medical geography. This dissertation explores how nineteenth-century Colombian physicians transformed the medical geographical approach using the early concepts and technologies of the emerging Pasteurian germ theory. I follow this transformation in the cases of periodic fevers (yellow fever and malaria), continuous fevers (typhoid fever and typhus) and leprosy. The analysis reveals that by mid century physicians had incorporated neo-Hippocratic versions of disease causation and French medical geographical ideas in order to make sense of disease of the warm, temperate and cold lands. Their conceptual network revolved around the specific, predisposing and occasional causes in which climate and geography played a determinant role. Evidence indicates that this was the case of periodic fevers of the warm lands (yellow fever and malaria). I argue that the “parasitic” hypothesis of yellow fever was accepted during the controversy around the prophylactic inoculations inspired by Pasteurism that were applied in Colombia in 1887. However, doctors struggled to reconcile the medical geographical and the bacteriological perspective of both yellow fever and malaria. Continuous fevers, on the other hand, were also framed within the medical geography scheme of disease causation. I show how during the debates about typhoid fever and typhus happening in the Colombian highlands during the 70s, 80s and 90s, doctors used medical geographical notions and developed anti-pasteurian arguments, while the international scientific community had identified the specific bacilli for typhoid fever. Finally, I argue that the strong interest of Colombian doctors on leprosy –also understood in neo-Hippocratic terms- that foster the search for local treatments based on Pasteurism (antiseptics in the 1880s and serotherapy in the 1890s) also prompted the extension of the bacteriological model and techniques to other diseases in those decades.

Mycobacterium ulcerans is sweeping across sub-Saharan Africa, but little is known about the mode of transmission and its natural reservoirs. Since the only effective treatment is excision of the infection and surrounding tissue, early diagnosis and treatment is the only way to reduce the havoc associated with Buruli ulcer. Using data from a national case search survey conducted in Ghana during 2000 and suspected risk factors this study tests the hypothesized factors and probes the challenges of developing a spatial epidemiological regression model to explain Buruli ulcer prevalence in the southwestern region of Ghana representing 42 districts. Results suggest that prevalence is directly related to the degree of land cover classified as soil, elevation differential, and percent rural population of the area.

Orientador: Sandra Elisa Contri Pitton / Banca: Ana Tereza Caceres Cortez / Banca: Roseana Corrêa Grilo / Resumo: As epidemias infectocontagiosas tais como cólera, dengue, malária, sarampo, tuberculose e AIDS assolam a sociedade humana, desestruturando a população nos segmentos sociais, econômicos e políticos. Dentre essas doenças optou-se em estudar os casos de AIDS, através da observação das categorias de exposição (sexo, preferência sexual, uso de drogas, faixa etária e razão por sexo) e das características sócio-territoriais da AIDS, permitindo-se assim trabalhar duas vertentes: o recorte do assistencialismo, o qual é responsável em cronificar a doença, evitando a morte do paciente, e, também elucidar uma possível mudança no perfil da doença. Essa discussão desenvolveu-se segundo a abordagem qualitativa e sob a perspectiva da Geografia socioambiental, utilizando-se de diferentes metodologias, as quais possibilitaram a construção dos mapas sócio-territoriais, gráficos e tabelas, traçando, dessa maneira, o perfil da epidemia na cidade de Piracicaba, visando contribuir com as políticas públicas para a saúde, assegurando acessibilidade aos serviços / Abstract: The contagious epidemics such as cholera, dengue fever, malaria, measles, tuberculosis and AIDS devastates the human society, disintegrating the human society in social, economical and political segments. Among those diseases, it was decided to study the cases of AIDS, through the observation of different ways of exposition (sex, sexual option, use of drugs, age range and proportion of infected man to women ) and the characteristics related to social-geographical characteristics of AIDS, allowing to work in two different points of view: the welfare system, which is responsible for preventing a reinfection , avoiding the death of the patient and also, elucidate a possible change in the characteristics of the disease. This discussion developed according to a qualitative approach under the perspective of the socio-environmental Geography using different methodologies, which allow the construction of social-gegraphical maps, graphs and tables, outlining, this way, the characteristics of the epidemics in the city of Piracicaba, in order to contribute to the public policies for health, assuring the accessibility to the services / Mestre

The associations of neighborhood level socioeconomic deprivation and low birth weight were investigated among 1,030,443 singleton live births in the State of Florida between the years 1992 and 1997. Census data for per capita income, unemployment, percent of individuals living below the poverty line, vehicle ownership and educational attainment were used as neighborhood level indicators of socioeconomic status. Additionally, these variables were combined into a deprivation index to measure relative deprivation of neighborhoods across Florida. Birth data were linked to census block groups and tracts, which were used as proxies for low birth weight. Multilevel models were used to model the relationship between the deprivation index and each of the indicators and low birth weight, while adjusting for individual level risk factors. After adjusting for individual level factors no consistent relationship between neighborhood socioeconomic measures and low birth weight could be established. The relationship between neighborhood socioeconomic factors and low birth weight varied across ethnic categories. Among White Non-Hispanics and Hispanics measures of socioeconomic deprivation had a small association with low birth weight. However, for Black Non-Hispanics neighborhood measures had little consistency in predicting the occurrence of low birth weight

<p>The study focuses on the political and economic geographies of pharmaceutical delivery. In 1997 the South African government passed the Medicines and Related Substances Control Amendment Act, sparking outrage from both the local and international pharmaceutical industry, and resulting in court action in 2001. The industry believed that South Africa was in breach of its obligations under international intellectual property law. Those fighting for pharmaceutical security hoped the court case would be a &lsquo / landmark&rsquo / in the global campaign for equitable access to medicines. This investigation seeks to analyse the domestic and international legacy of the court action. The inquiry takes its significance from the high prevalence rates of treatable diseases and the need for pharmaceutical security in South Africa and its neighbouring African countries. The absence of a sustainable international medicines delivery system is a global political, economic and moral failure. A solution is required that balances the positive productive forces of the market with a philosophy of justice and equity.</p>

Thesis (Ph. D.)--University of Missouri-Columbia, 1999. / Typescript. Vita. Includes bibliographical references (leaves 122-127). Also available on the Internet.