Given the importance of children being fitted properly in car seats, all caregivers should have access to resources to help them understand appropriate use. However, this is not always the case, especially for caregivers who reside in areas of lower socioeconomic statuses (SES) or urban areas (Tessier 2010). This disparity is displayed through the decreases in death and injury among individuals of higher SES over the past two decades, while those in lower SES have seen a slower decline (Sauber-Schatz et al. 2014). Further, caregiver behavior is different based on SES, with individuals from low-income areas reporting significantly less car seat usage than those in higher income areas (Harper et al. 2015; Laflamme et al. 2010). Some of this difference can be attributed to low-income families having less access to health and preventative resources as well as less financial ability to obtain often expensive items such as car seats for their children (Rok Simon et al. 2016; Fleary et al. 2013).
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One potential way to help address some of the disparities in car seat use is for hospitals and facilities (e.g., external organizations such as YMCAs or local resource centers) in low-income areas to offer community outreach efforts aimed at educating caregivers on how to properly install car seats and provide information on legislative guidelines. These outreach efforts can be led by Child Passenger Safety Technicians (CPSTs) who are trained to work in community settings to help educate parents on car passenger safety (Ross et al. 2007). Previous literature has shown the efficacy of CPST led programs on increasing caregiver car seat knowledge, yet the impact that at an educational program can have in a low-income, clinical setting has not been examined (Louis and Louis 1997; Schwebel et al. 2017). Therefore, the goal of the present study was to measure the effectiveness of a car seat program in an urban, Level I Pediatric Trauma Center on caregiver car seat knowledge to promote child safety.
In consultation with the Steering Committee of the Canadian Physical Activity Guidelines and Measurement Project and the authors who were completing the adult and older adult systematic reviews, a decision was made to limit the pediatric systematic review to: 1) studies examining the key health indicators above, and 2) for observational studies, the outcomes must have been measured in a dichotomous (yes or no) manner and presented as prevalences or ratio scores (odds ratio, relative risk, hazard ratio). This decision was made for three reasons: (i) to help ensure that the systematic review would be manageable in size and scope for a single research team to complete in a timely manner, (ii) to eliminate many of the observational studies with small sample sizes, and (iii) to ensure that the health outcomes, at least for the observational studies, were presented in a reasonably consistent pattern from study to study. This helped us to make comparisons between studies and to characterize the magnitude of effect for physical activity.
First, we created six candidate urbanized diet indices for consideration based on inclusion and exclusion of specific food variables. Second, we tested associations for each of the six candidate diet urbanization indices with overall urbanization in unadjusted, age- and sex-adjusted, and fully adjusted (age, sex and smoking, average daily energy intake, region, educational attainment, per capita household income, and physical activity) mixed linear regression models, with random intercepts to account for correlation at the household and community level. We used these model results to select a final diet urbanization measure based on the strength of association with overall urbanization, and degree of missingness.
We expected that HTN, overweight, and T2DM would be positively associated with an urban diet. Yet the positive association for diabetes was no longer statistically significant once we adjusted for overall urbanization. Our urbanized diet index was negatively associated with HTN and positively associated with T2DM in minimally adjusted models, but after adjustment for potential confounders, including sociodemographic factors, the association was no longer statistically significant. The positive association between urbanized diet and HTN, while not statistically significant was similar in the model with control for overall urbanization index. It is important to consider that the index we generated does not measure quality of diet, thus a more urbanized diet does not necessarily indicate a less nutritious diet, which would suggest an association with CMD. For example, our index includes nutritious foods like fruit and nuts and seeds, along with foods like fried foods and high fat meat, which can have opposing impacts on cardiometabolic health. In their examination using 2006 CHNS data, Wang et al. also found inconsistent associations between two diet quality measures and odds of CMD, finding an association between the China Dietary Guideline Index (CDGI) and odds of T2DM in men, but not with the tailored Alternative Healthy Eating Index (tAHEI). Wang et al. found an association between CDGI and abdominal obesity in men, but not with the tAHEI. They found null associations between each diet quality measure and elevated blood pressure and metabolism syndrome in men [34]. As seen in Supplemental Table 2, many sociodemographic factors were statistically associated with CMDs. It is possible that these and other non-dietary factors play a role in shaping CMD risk with urbanization. For example, the urbanization process may influence dietary changes, such as increases in macronutrient intake, energy balance, as well as changing the microbiome, or a chronic stress response resulting from lifestyle and other changes.
Over 30 years have passed since scientist Roger S. Ulrich first began to examine some of the psycho-physiological changes induced by vegetation-rich scenes of nature (relative to urban scenes). His initial studies found that immediately subsequent to a required one-hour course examination, undergraduate students who viewed photographic scenes of nature (vs. urban built scenes) had a rapid improvement in positive mental outlook and a decline in reported fear and arousal [13]. These subjective reports were subsequently corroborated in separate work involving objective markers of stress physiology including electromyography (EMG), skin conductance (SC) and pulse transit time (PTT) [14]. Specifically, after viewing a stressful video on workplace accidents ("It didn't have to happen" - a video previously confirmed to elevate a stress response), participants subsequently viewed images of nature scenes or an urban built environment for 10 minutes. The physiological markers (EMG, SC, PTT) showed a consistent pattern of rapid and more complete recovery from stress/arousal upon exposure of vegetation-rich nature scenes. Ulrich was the first to use electroencephalograph (EEG) apparatus to evaluate brain wave activity while otherwise healthy adults viewed photographic scenes of nature vs. urban built scenes [15]. The results confirmed higher alpha wave activity when viewing scenes of vegetation-rich (and aesthetically unspectacular) nature, indicative of a state of relaxed wakefulness and lowered anxiety.
Within the next several decades the human transition from rural to city residence will accelerate at an even faster rate, with some 90 percent of North Americans and 70 percent of global residents projected to call a city their home [81]. Humans are incredibly social creatures, so it is not at all un-natural that urban centers should grow and thrive. There are, however, some alarming concerns with this inevitable trend. Research shows that cities are far from a panacea for mental health disorders, indeed, rates of depression, anxiety and schizophrenia are consistently reported to be higher among urban residents [33]. Based on the research discussed above, and assuming for a moment that it grows more robust in its scientific strength, the need for access to urban green space may be a mental health necessity. Access to green space and other natural settings affords opportunity for connectivity to nature, and this connectivity, in turn, may provide a layer of insulation against the psychological downsides to urban living; among almost 550 urban men and women, higher scores on the connectivity to nature scale was associated overall psychological well-being, vitality and meaningfulness in life [82]. These strong connections between nature connectivity and personal well-being are found broadly in the population - from private sector executives, high-ranking government employees, to university students, the positive relationship is evident [83]. Urban green space also provides opportunity for contemplation and mindfulness, and a recent study involving over 450 university students shows that mindfulness appears to act as a conduit between connectivity to nature and overall psychological well-being [84].
The second difference between movement tactics was resident animals selected areas closer to pasture fences, which contradicted the results for migrant animals. Multiple inferences can be ascertained from this unexpected result. First, resident animals may be occupying areas with higher pasture fence densities and therefore could not distribute themselves away from fences, which resulted in the higher relative selection strength in proximity to pasture fences as seen in Fig. 4. Secondly, resident animals, as a result of remaining on the same range year-round, may have greater site familiarity of their surroundings [70]. It has previously been shown that pronghorn have spatial memory of known fence crossing locations; areas along fences where they know they can cross easily [37]. Resident animals may have greater familiarity to these known crossing sites which allows them to be more comfortable in proximity to fences. Thirdly, fence design may be impeding passage by resident animals creating a semi-permeable barrier effect with resident animals being in proximity to the fence more frequently than migrants, but unable to cross. Therefore, one or several of these fence related inferences may be a factor contributing to the loss of migration by individuals classified as residents. It has been demonstrated that the cost to migrate increases when avoidance of barriers increases [12]. Van Moorter et al. [12] concluded that the proportion of a population undergoing migration would decrease to the extent that the population becomes fully residential when complete avoidance from barriers occurs. While beyond the scope of our study, there is the opportunity to examine the affects of different densities of linear disturbances to determine threshold levels that may result in negative affects to migration and fitness across a population [12, 13]. 2ff7e9595c
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