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GOOD AFTERNOON WELCOME TO THE DECEMBER BEHAVIORAL AND SOCIAL SCIENCE LECTURE MY NAME IS DEBORAH OLSTER FROM THE OFFICE OF BEHAVIORAL AND SOCIAL SCIENCES RESEARCH I’M PLEASED TO INTRODUCE OUR SPEAKER DR ELLEN CROMLEY, FROM THE UNIVERSITY OF CONNECTICUT SCHOOL OF MEDICINE, DEPARTMENT OF COMMUNITY MEDICINE AND HEALTHCARE AND ALSO WE DO HAVE SOMEONE DOING SIGN LANGUAGE INTERPRETATION WHO WILL BE HERE FOR THOSE OF YOU WHO MIGHT NEED IT BUT IF THERE IS NO ONE THAT NEEDS IT SHE’LL PROBABLY TAKE OFF SO THANK YOU SO ELLEN IS A MEDICAL GEOGRAPHER AND SHE COMPLETE AD BCH LOR’S DEGREE IN URBAN AND ENVIRONMENTAL STUDIES AT CASE WESTERN RESERVE AND MASTERS FROM OHIO STATE UNIVERSITY AND Ph.D. IN GEOGRAPHY FROM THE UNIVERSITY OF KENTUCKY I GUESS AS A GEOGRAPHER SHE GETS AROUND A LITTLE BIT THAT’S MY LITTLE JOKE FOR THE DAY SO SHE SPENT — SHE STARTED OFF HER CAREER AT THE HUNTER HEALTH PLANNING LEXINGTON, KENTUCKY AND THAIBD HEALTH CENTER AND WORKED FOR THE APPROXIMATE PLAY SHEN REGIONAL HOSPITAL BEFORE HER PROFESSOR CAREER AT THE DEPARTMENT OF GEOGRAPHY UNIVERSITY OF CONNECTICUT SH’S ACTIVE ON PROJECTS — SHE’S ACTIVE ON PROJECTS FUNNED BY THE MANY INSTITUTES,xF!r AN ALCOHOLISM, THE NATIONAL INSTITUTE ON DRUG ABUSE, AND THE NATIONAL INSTITUTE OF MENTAL HEALTH SHE’S ALSO BEEN CONSULTANT ON A PROJECT FUNDED BY THE NATIONAL CANCER INSTITUTE SO I DON’T WANT TO SPEND A LOT OF TIME TALKING ABOUT HER MANY ACCOMPLISHMENTS BECAUSE I THINK WE’D ALL MUCH RATHER HEAR FROM ELLEN THAN FROM ME I WILL SAY SHE’S ALSO PARTICIPATED IN OUR OFFICES INSTITUTE AND SYSTEM SCIENCE AND HEALTH LAST SUMMER WHERE SHE WAS A RESOUNDING SUCCESS AND I WAS THERE TO SEE THAT SO TODAY SHE’LL TALK ABOUT GEOSPATIAL METHODS AND HEALTH RESEARCH PLEASE JOIN ME IN WELCOMING ELLEN CROMLEY [APPLAUSE] >> THANK YOU TO RONALD ABALES AND DEBORAH ALLSTE FOR INVITING ME TO SPEAK WITH YOU AS PART OF THE BEHAVIORAL SOCIAL SCIENCE LECTURE SERIES THANK YOU FOR ATTENDING MY PRESENTATION CONSIDERS GEOSPATIAL METHODS AS THEY MIGHT BE RELATED TO THE MISSION OF THE NATIONAL INSTITUTES OF HEALTH THAT MISSION IS TO SEEK FUNDAMENTAL KNOWLEDGE ABOUT THE NATURE AND BEHAVIOR OF LIVING SYSTEMS AB THE APPLICATION OF THAT KNOWLEDGE TO ENHANCE HEALTH, LENGTHEN LIFE AND REDUCE BURDENS OF ILLNESS I’M A GEOGRAPHER AND GEOGRAPHERS HAVE A GOOD EXCUSE FOR BEING PRACTICALLY ANYWHERE MY FIELD IS THE STU STUDY OF THE EARTH’S SURFACE AS LIVING ENVIRONMENT OF HUMAN POPULATION AS A MEDICAL GEOGRAPHER I STUDY PATTERNS OF HEALTH AND DISEASE, THE ORGANIZATION OF HEALTH SERVICES AN JOCK IF I CANAL FACTORS AFFECTING THEIR UTILIZATION AND THE APPLICATION OF GEOSPATIAL METHODS IN THIS RESEARCH THIS AFTERNOON WE’LL CONSIDER THREE MAIN TOPICS FIRST, FOR THE FIRST TEN MINUTES WE’LL CONSIDER SOME KEY CONCEPTS IN GEOSPATIAL ANALYSIS AND THE IMPORTANCE OF THIS APPROACH WHY WE NEED IT SECOND, THE BULK OF MY PRESENTATION WILL BE AN EXPLORATION OF A RANGE OF GEOSPATIAL METHODS BY SHOWING HOW THEY HAVE BEEN USED IN HEALTH RESEARCH FINALLY, THE LAST SLIDE OFFERS MY IDEAS ABOUT SOME OPPORTUNITIES FOR ADVANCING THE USE OF GEOSPATIAL METHODS AT NIH I HAVE PROVIDE AD COPY OF MY PRESENTATION IN THE FORM OF NOTES, PAGES, SHOWING EACH SLIDE AND THEN ON THE BOTTOM THERE’S THE TEXT OF MY REMARKS AND THIS TEXT INCLUDES CITATIONS TO THE JOURNAL LITERATURE AND SOME OF THE WEBSITES, SO IF YOU’RE INTERESTED THERE IS A COPY HERE, YOU CAN GRAB A COPY OR I’M SURE DEB CAN HELP YOU FIND ONE SO YOU CAN JUST SIT BACK AND LISTEN WHAT ARE GEOSPATIAL METHOD? BROADLY SPEAKING, THEY ARE METHODS THAT TAKE INTO ACCOUNT LOCATION OR POSITION IN SPACE THERE ARE A NUMBER OF DISCIPLINES THAT TAKE LOCATION OF PHENOMENA AND THE DISTANCES SEPARATING THEM INTO ACCOUNT PHYSICS, ASTRONOMY, GEOGRAPHY, THESE ARE EXAMPLES OF SPATIAL SCIENCES THE TERM GEOSPATIAL INDICATES

THAT THE SPACE OF INTEREST IS THE SURFACE OF THE EARTH GEOSPATIAL METHODS ARE THE KEY TO UNDERSTANDING PROCESSES WHERE RESULTS CHANGE WHEN THE LOCATIONS OF THE PHENOMENON BEING ANALYZED CHANGE FOR EXAMPLE, THE SPEED OF INFECTIOUS DISEASE DIFFUSION MIGHT CHANGE IF PEOPLE WERE SPREAD FURTHER APART IN SPACE THE BEST LOCATION FOR CONDUCTING A CLINICAL TRIAL MIGHT DEPEND ON LOCATIONS OF POSSIBLE PARTICIPANTS AND THEIR NEIGHBORHOOD CONDITIONS GEOSPATIAL METHODS COVER A BROAD RANGE OF NUMERICAL METHODS INCLUDING MEASUREMENT, SPATIAL STATISTICAL METHODS, NORMATIVE MODELING AND OTHERS THE COMMON FEATURE OF THESE METHODS IS THEY REQUIRE INFORMATION ABOUT THE LOCATIONS OF FEATURES OF INTEREST GEOSCIENCE IS RESEARCH FIELD SEEKING ANSWERS TO FUNDAMENTAL QUESTIONS ABOUT HOW WE REPRESENT AND ANALYZE GEOGRAPHIC DATA IN CANADA AND EUROPE THE TERM GEOMATICS HAS BEEN USED, SIMILAR TO MEANING TO THE TERM JI SCIENCE SO GEOSPATIAL METHODS ARE DEVELOPED THROUGH GI SCIENCE GEOGRAPHIC DATA ARE DATA RESULTING FROM OBSERVATION AND MEASUREMENT OF PHENOMENA REFERENCED TO THEIR LOCATIONS ON THE EARTH A GEOGRAPHIC INFORMATION SYSTEM OR GIS, IS A DIGITAL SYSTEM FOR INTEGRATING AND ANALYZING GEOGRAPHIC DATA AND THE BASIS FOR INTEGRATE DATA IN A GIS IS LOCATION SO WE’RE STACKING THESE MULTIPLE LAYERS OF DATA TOGETHER BASED ON LOCATION THE SCIENCE UNDERPINNINGD=x THE DEVELOPMENT OF GEOSPATIAL METHODS AND MANY OF THE METHODS THEMSELVES, HAS A RICH HISTORY, PRE-DATING TECHNOLOGICAL DEVELOPMENTS AND CAPTURING, MANAGING AND DISPLAYING GEOSPATIAL DATA AT THE SAME TIME, RECENT TECHNOLOGICAL ADVANCES HAVE PUSHED THE DEVELOPMENT OF THE SCIENCE AND METHODS BY MAKING IT POSSIBLE TO MANAGE AND ANALYZE VERY LARGE DATABASES IN NEW WAYS THERE’S NO DOUBT THAT GEOSPATIAL TECHNOLOGIES AND ANALYSIS METHODS HAVE MADE IMPORTANT CONTRIBUTIONS TO HEALTH RESEARCH AND PUBLIC HEALTH PRACTICE OVER THE LAST 30 YEARS IT’S WORTH CONSIDERING FOR A MOMENT SOME OF THE KEY MILESTONES IN THE DEVELOPMENT OF GEOSPATIAL AND RELATED TECHNOLOGIES AND SOME OF THE KEY HEALTH ISSUES THAT EMERGED AROUND THE SAME TIME THE FIRST LAND SAT SATELLITE FOR IMAGERY WAS LAUNCHED IN 1972, THE YEAR I GRADUATED HIGH SCHOOL SO THIS SLIDE IS KIND OF LIKE MY LIFE PASSING BEFORE MY EYES THE — FOR THE 1980 CENSUS, THE INNOVATIVE GBF DIME FILES WERE DEVELOPED TO HELP CONDUCT CENSUS IN URBAN AREAS THE 1990s WERE A DECADE OF ENORMOUS CHANGE IN GEOSPATIAL TECHNOLOGY THE TIGER LINE FILES DEVELOPED BY THE CENSUS WERE ONE OF THE FIRST DIGITAL SPATIAL DATABASES IN THE UNITED STATES, THAT COVERED THE ENTIRE COUNTRY THIS DECADE ALSO WITNESSED THE LAUNCH OF THE WORLD WIDE WEB FOR THE INTERNET FOR INTERNET BROWSING, WHICH LED TO THE DEVELOPMENT OF SEARCH ENGINES SUCH AS GOOGLE DURING THIS TIME WE HAD THE FIRST DESKTOP GIS SOFTWARE, THE DEVELOPMENT OF OPEN SPATIAL DATA FORMATS LIKE SHAPE FILE, AND THE CREATION OF META DATA STANDARD FOR GEOSPATIAL DATA THE COMPLETION OF THE GLOBAL POSITIONING SYSTEM REVOLUTIONIZED OUR ABILITY TO CAPTURE DATA ON LOCATION THE FIRST GIS AND HEALTH CONFERENCES IN THE UNITED STATES WERE HELD WITH FEDERAL AGENCIES SUCH AS ATSDR AND NCHS TAKING THE LEAD THE 2000s BROUGHT THE FIRST GIS AND HEALTH TEXTBOOKS AND JOURNALS SUCH AS INTERNATIONAL JOURNAL OF HEALTH GEOGRAPHIC WHICH IS IS AN OPEN ACCESS JOURNAL GIS SOFTWARE COMPANIES BEGAN TO CONSIDER THE HEALTH COMMUNITY, YOU, AS A MAJOR MARKET FOR PRODUCTS SPATIAL STATISTICAL SOFTWARE LIKE SAT SCAN AND GEOGRAPHIC WEIGHTED REGRESSION WERE DEVELOPED, SOME FULLY AND LOOSELY COUPLED WITH GIS SOFTWARE PACKAGES WE ALSO SAW DID I HAVE FUTION AN GIS TO EVERY AREA OF THE WORLD GOOGLE HEALTH AND GOOGLE MAPS, SMART PHONES ALONG WITH A RANGE OF OTHER GO ENABLED MOBILE DEVICES ARE CHANGING HOW WE ACCESS AND VIEW DIGITAL SPATIAL DATA IN THE EARLY PART OF THIS DECADE WHY DOES IT ALL MATTER? I THINK I MUST HAVE HIT THE SPACE BAR THERE, SORRY WHAT IS THE VALUE OF GEOSPATIAL METHODS IN ADDRESSING THE PRESSING HEALTH ISSUES OF OUR DAY? GEOSPATIAL METHODS ARE IMPORTANT BECAUSE THEY PROVIDE US WITH ESSENTIAL SUPPORT FOR HEALTH RESEARCH CE CAN’T GET ANY OTHER WAY A SIMPLE EXAMPLE I HOPE WILL

ILLUSTRATE THIS POINT THE SCIENCE OF HEALTH RESEARCH RELIES ON DATA AND THERE ARE DIFFERENT WAYS OF VIEWING DATA HERE WE HAVE TWO TABLES OF DATA ON STUDENTS AND CLASSROOMS THESE TABLES ARE IDENTICAL THAT IS, WE HAVE THE SAME NUMBER OF STUDENTS WITH THE SAME NAMES AND EACH STUDENT WITH THE SAME NAME HAS THE SAME GRADE OR OUTCOME IN THE TWO CLASSES IF WE TAKE THE A SPATIAL STATISTICAL VIEW OF THE DATA, THEREFORE ALSO THE SAME WE HAVE THE SAME END, THE SAME FREQUENCY DISTRIBUTION THE SAME MEDIAN GRADE THE SAME RANGE OF GRADES THE SAME RELATIONSHIP BETWEEN GRADES AND GENDER AND SO ON IF WE TAKE THE SPATIAL VIEW WHEN WE LOOK AT MAPS OF CLASSROOMS THE TWO CLASSES AROUND THE SAME IN ONE ON THE LEFT THE GRADES ARE APPARENTLY RANDOMLY DISTRIBUTED AND THE SECOND ON THE RIGHT, THERE’S A >> MR McCLEARY: SPAIBL PATTERN OF EDUCATIONAL — SPATIAL PATTERN OF EDUCATIONAL OUTCOMES MAPPING OUTCOMES TO VISUALIZE PATTERNS AN SUCH MAPS WERE MADE OF CASES ON SLIDES CARRYING — FLIGHTS CARRYING PASSENGERS LATER DIAGNOSED WITH SARS IN 2003, NOT THEIR GRADES BUT WHETHER OR NOT THEY GOT SICK GEOSPATIAL ANALYSIS METHODS, NOT JUST MAPPING BUT ALSO THE GEOSPATIAL ANALYSIS METHODS ARE EQUALLY IMPORTANT AS MAPPING AND VISUALIZATION BECAUSE THEY HELP US TO UNDERSTAND WHETHER OR NOT AN APPARENT PATTERN COULD LIKELY HAVE OCCURRED BY CHANCE THESE ARE ONLY TWO OF THE MANY MAPS WE CAN CREATE FROM THAT SAME TABLE THAT IS, THERE ARE MANY WAYS THE NINE STUDENTS COULD BE ARRANGED IN THE CLASSROOM SPACE WE COULD ALSO REGARD THESE STUDENTS REPRESENTATIVE OF SOME LARGER POPULATION FOR WHICH THE OVERALL PROPORTION OF GRADES WAS KNOWN AND WE COULD ARRANGE THEM BASED ON THAT SAMPLING ASSUMPTION THESE NUMEROUS MAPS FORM A SAMPLING DISTRIBUTION OF SPATIAL PATTERNS OF DISPARITIES AND OUTCOMES AND WE CAN USE THAT SAMPLING DISTRIBUTION TO IDENTIFY STATISTICALLY SIGNIFICANT SPATIAL PATTERNS IF WE FIND SIGNIFICANT SPATIAL DEPENDENCIES, WHAT WE CALL SPATIAL AUTOCORRELATION, GEOSPATIAL METHODS SUCH AS SPATIAL REGRESSION ANALYSIS HELP TAKE THESE INTO ACCOUNT SO OUR PARAMETER ESTIMATES WILL BE UNBIASED OTHERWISE IF YOU HAVE THE SPATIAL DEPENDENCIES ON THE RIGHT IT’S POSSIBLE THAT YOU WOULD BE VIOLATING ONE OF THE UNDERLYING PRINCIPLES OF MULTI-VARIANT INFERENCIAL STATISTICS, THE PROBABLY OF ONE STUDENT GETTING AN A IS THE PROBABILITY FROM ANOTHER STUDENT GETTING AN A SPATIAL METHODS HELP US TO INTEGRATE THESE OUTCOMES DATA WITH OTHER DATABASED ON LOCATION SO WE CAN UNDERSTAND ENVIRONMENTAL CONDITIONS OR BEHAVIORS IN THE CLASSROOM THAT MAY HAVE AFFECTED THE PATTERN OF OUTCOMES FOR EXAMPLE, LIGHTING NOISE CHEATING NOT ONLY DOES THE SPATIAL VIEW PROVIDE US WITH INFORMATION WE CANNOT OBTAIN IN ANY OTHER WAY, THAT IS THROUGH TABLES AND STATISTICS, THAT INFORMATION IS IMPORTANT INFORMATION TO HAVE BECAUSE ONE OF THESE TWO VIEWS BETTER DESCRIBES THE REALITY WE’RE TRYING TO UNDERSTAND ABOUT PROCESSES, MECHANISMS AND OUTCOMES THAT’S THE FIRST PART OF THE TALK NOW THAT WE HAVE REVIEWED SOME OF THE KEY CONCEPTS WE CAN EXPLORE HOW GEOSPATIAL METHODS ARE USED IN HEALTH RESEARCH BY WALKING THROUGH THE STEPS WE TAKE TO UNDERSTAND A HEALTH PROBLEM AT EACH STEP WE’LL BE LOOKING AT EXAMPLES DRAWN FROM THE LITERATURE, THESE EXAMPLES WILL NOT BE DRAWN FROM A SINGLE STUDY BUT SHOULD PROVIDE YOU WITH A SENSE OF HOW GEOSPATIAL ANALYSIS OF A HEALTH QUESTION WOULD PROCEED THE FIRST STEP IN ANY GEOSPATIAL ANALYSIS OF HEALTH IS MEASURING LOCATION THAT IS, PUTTING THE FEATURES OF INTEREST ON TO THE EARTH’S SURFACE TODAY THIS IS ACCOMPLISHED BY USING THE GLOBAL POSITIONING SYSTEM AND OTHER SIMILAR TECHNOLOGIES THAT AREN’T NECESSARILY SATELLITE-BASED THROUGH ADDRESS MATCHED GEOCODINGING OR BY ACQUIRING DIGITAL SPATIAL DATABASES FROM SECONDARY PUBLIC AND PRIVATE SOURCES OFTEN BY DOWNLOADING DATA FROM A WEBSITE THESE DATA CAN BE ADDEDDED TO OR IN THE CASE OF ADDRESS MATCH GEOCODING CREATED USING THE SOFTWARE FUNCTION OF A GIS APPLICATION THIS MAP SHOWS US PART OF THE RICH HISTORY OF GEOSPATIAL METHODS IMPLEMENTED BEFORE THE ADVENT OF THE NEW TECHNOLOGIES THIS MAP IS FROM 1819 AND IT PLOTS YELLOW FEVER CASES NEAR OLD SLIP IN LOWER MANHATTAN AND WE HAVE THE EAST RIVER ALONG THE BOTTOM AND THE STREET ON THE FAR RIGHT IS WALL STREET SO IT’S THE VERY SOUTHERN PART OF MANHATTAN AND WE HAVE ROTATED THE VIEW A VERSION OF THIS MAP WHICH IS IN THE PUBLIC DOMAIN, IS IN THE NATIONAL LIBRARY OF MEDICINE ALONG WITH EARLIER YELLOW FEVER

MAPS FOR CITIES DATING TO 1976, BEFORE SNOW’S MAP OF CHOLERA THESE MAP SHOAS HIGHLY DISAGGREGATE INDIVIDUAL LEVEL DATA MAPPED BY RESIDENTS THEY WERE MADE TO INVESTIGATE THE CAUSE OF YELLOW FEVER AT A TIME WHEN ITS ETIOLOGY WAS UNKNOWN THE CASES ON THIS MAP ARE ALSO LABELED TO SHOW THE TEMPORAL ORDER OF THICKENING SO WE KNOW THAT TIME SPACE PATTERNS WERE OF INTEREST IN 1819 UNFORTUNATELY WE WILL NOT BE ABLE TO DISCUSS TIME AND TIME SPACE METHODS TODAY BUT I HOPE YOU WILL BE ABLE TO CONSIDER THESE IN ANOTHER LECTURE IN YOUR SERIES THERE ARE STRONG CONNECTIONS BETWEEN MEDICAL MAPPING AND THE DEVELOPMENT OF THEMEATIC CARTOGRAPHY THEMEATIC MAPS SHOW A SPATIAL PATTERN, NOT THE KIND OF MAP YOU USE TO FIGURE OUT HOW TO GET FROM POINT A TO POINT B ALTHOUGH THE SPATIAL VIEW OF DATA IS POWERFUL, IT’S ALSO LIMITED AND POTENTIALLY MISLEADING THIS IS A MAP OF MOTOR VEHICLE COLLISIONS OCCURRING ON FEDERAL AND STATE ROADS IN CONNECTICUT IN 1995 AND 1996 WHAT YOU’RE SEEING HERE ARE THE DOTS REPRESENTING THE COLLISIONS THIS ISN’T THE ROAD SO THAT’S HOW MANY COLLISIONS THERE WERE MOTOR VEHICLE COLLISIONS ARE AN IMPORTANT CAUSE OF TRAUMATIC INJURY IN THE U.S. AND MANY OTHER COUNTRIES AROUND THE WORLD THERE ARE A LEADING CAUSE OF DEATH IN THE U.S. ESPECIALLY AMONG PEOPLE UNDER 35 YEARS OF AGE AND RANK THIRD OVERALL BEHIND CANCER AND DISEASES OF THE HEART IN TERMS OF YEARS OF LIFE LOST COLLISION DATABASES ARE INTERESTING BECAUSE THEY’RE ONE OF THE FEW SOURCES OF SURVEILLANCE DATA REPORTING INDIVIDUAL, ENVIRONMENTAL AND BEHAVIORAL ELEMENTS OF THE HEALTH EVENT THE DATA FOR THIS STUDY WERE DRAWN FROM THE CONNECTICUT CODES PROJECT THAT STANDS FOR CRASH OUTCOME DATA EVALUATION SYSTEM AND THESE PROJECTS WERE FUNDED BY THE NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION THE CONNECTICUT DOT DEPARTMENT OF TRANSPORTATION GEOCODED THE COLLISION LOCATIONS BY LONGITUDE, LATITUDE SO THIS IS THE 124,053 COLLISIONS ON FEDERAL AND STATE ROADS IN CONNECTICUT IN 1995 AND 1996 TAKE NOTE OF THE SCALE, CONNECTICUT IS A REALLY SMALL STATE, ABOUT 50-MILES NORTH, SOUTH, ABOUT 100-MILES EAST TO WEST WE’RE ABOUT THE SAME SIZE AS HARRIS COUNTY, TEXAS WHICH IS WHERE HOUSTON IS LOCATED SO WE’RE TALKING A REALLY SMALL SPACE HERE ONCE WE HAVE LOCATED THE PHENOMENA OF INTEREST, THE NEXT STEP IN AN ANALYSIS OFTEN INVOLVES CALCULATING DISTANCE DISTANCE IS A MEASURE OF SEPARATION IN SPACE IT’S A KEY GEOGRAPHIC CONCEPT AND A REQUIRED MEASURE IN MANY GEOSPATIAL METHODS AS WE’LL SEE THERE ARE VARIOUS WAYS WE CAN MEASURE DISTANCE IF WE’RE USING LOCATIONS ON THE GEOGRAPHIC GRID, A MODEL OF THE GLOBE WE COMPUTE SPHERICAL DISTANCE MEASURING THE ARC OF THE CIRCLE THAT CONNECTS THE TWO POINTS ON THE GLOBE DEALING WITH PROJECTED DATA WHICH PUTS THIS INFORMATION INTO A TWO DIMENSIONAL PLANNER SPACE WE CAN CALCULATE DISTANCE, WHICH YOU PROBABLY REMEMBER FROM HIGH SCHOOL, OR STRAIGHT LINE DISTANCE, WE CAN CALCULATE TAXICAB DISTANCE OR DISTANCE ALONG THE STREET NETWORK GIS SOFTWARE FUNCTIONS ENABLE US TO CALCULATE THE CENSUS IN SPATIAL ANALYTIC FUNCTIONS ALLOW US TO SPECIFY WHICH METHOD WE WANT TO EWE WHEN CALCULATING DISTANCE DIFFERENT METHODS FOR CALCULATING DISTANCE YIELD DIFFERENT RESULTS SO HERE WE APPLY PLEA METHODS FOR CALCULATING THE DISTANCE BETWEEN A PERSON’S HOME AND TWO DIFFERENT FOOD STORES SO DISTANCE MEASURES OF THIS TYPE ARE WIDELY USED IN STUDIES OF THE FOOD ENVIRONMENT AND OBESITY, FOR EXAMPLE THE DISTANCE BY DEFINITION IS SHORTEST, THE CIRCLE SHOWS A QUARTER MILE BUFFER AROUND THE HOME LOCATION AS THE CROW FLIES AND NOTE THAT STORE NUMBER 2 IS JUST INSIDE THE BUFFER AND STORE NUMBER 1 IS JUST OUTSIDE OF IT WHEN WE MEASURE DISTANCE THE WAY A PERSON MIGHT ACTUALLY WALK IT, ALONG THE STREET NETWORK, WE CAN SEE STORE NUMBER 1 WHICH IS OUTSIDE THE BUFFER IS ACTUALLY CLOSER TO THE HOME THAN STORE NUMBER 2 IT’S IMPORTANT TO PAY ATTENTION HOW DISTANCE IS CALCULATED ONE WAY WE CAN TRY TO MAKE SENSE OF THE MASSIVE DATA WE HAVE BEFORE US, IS TO AGGREGATE THE DATA GEOSPATIAL METHODS HELP US TO GROUP OBSERVATIONS BASED ON SPATIAL RELATIONSHIPS THE POINT IN POLL GONE METHOD OF AGGREGATION IS ONE OF THE MOST WIDELY USED AND USUALLY THE POLYGONES REPRESENT POLITICAL OR ADMINISTRATIVE UNITS LIKE COUNTIES OR SOMETHING LIKE THAT SO WE TAKE THE POINTS THAT REPRESENT A HEALTH EVENT AND USE GEOSPATIAL METHODS TO DETERMINE WHICH POLYGONE, WHICH COUNTY, WHICH CENSUS TRACK AND SO ON, THE POINT LIES WITHIN WE ADD THE NUMBER OF POINTS WITHIN EACH AREA AND MAKE A MAP

BASED ON AREA IT’S ALSO POSSIBLE TO PERFORM THIS ANALYSIS ON AREAS WHOSE BOUNDARIES ARE DETERMINED IN OTHER WAYS FROM ENVIRONMENTAL SAMPLING, WE MIGHT BE ABLE TO IDENTIFY REGIONS WHERE CONTAMINATION IS PRESENT OR ABSENT AND WE CAN GROUP INDIVIDUALS BASED ON WHETHER THEY’RE RESIDENCES WERE IN A CONTAMINATION AREA OR NOT WE CAN DEFINE REGIONS BASED ON FLOWS IN SPACE OR DISTANCE FROM ORIGIN IN THIS WAY WE CAN FIND POINTS WITHIN 30-MILES OF THE HEALTH SERVICES FACILITY AS THE CROW FLIES OR BASED ON STREET NETWORK DISTANCE WE CAN GROUP POLYGONES TOGETHER WE MIGHT GROUP CENSUS TRACKS INTO COUNTIES OR CENSUS TRACKS INTO HEALTH SERVICES REGIONS THE APPROACH TAKEN IN THE COLLISION STUDY WAS TO USE GEOSPATIAL METHODS TO AGGREGATE DATA IN A DIFFERENT WAY DOESN’T MAKE MUCH SENSE TO PUT THESE INTO COUNTIES OR CENSUS TRACKS OR SOMETHING LIKE THAT SO WE WANTED TO FIND MEANINGFUL AREAS THAT WOULD CAPTURE SOMETHING ABOUT THE PROCESS WHICH HAS TO DO WITH BREAKING TIME AND DECELERATION ALONG A SEGMENT OF A STREET NETWORK THIS APPROACH WAS POSSIBLE, THE ONE I’M GOING TO DESCRIBE IN A MINUTE, BECAUSE WE HAD THE COLLISION LOCATIONS AVAILABLE TO US AS POINTS WHAT WE DID WAS, I’M GOING TO TALK FIXED OBJECT COLLISIONS, THESE ARE COLLISIONS WHERE THE CAR SLIDES OFF THE ROAD AND HITS A FIXED OBJECT LIKE A TELEPHONE POLL OR TREE WE USE A DISTANCE OF ONE QUARTER MILE AROUND THE COLLISION LOCATION ON THE STREET NETWORK IF YOU CAN PICTURE GOING TO A COLLISION AND LOOKING AT THIS DIRECTION ALONG THE STREET NETWORK AND MAKING A LITTLE RECTANGLE AROUND THAT, WE CANK LOOK AT THAT DLITION — CAN LOOK AT THAT AND ALL THE OTHER COLLISIONS THAT HAPPENED IN THIS AREA THAT WAS DERMTED BY ACTUALLY LOOKING UP ENGINEERING TESTS AN HOW LONG IT TAKES YOU TO STOP A CAR TRAVELING A CERTAIN NUMBER OF MILES AN HOUR ON DRY ROAD AFTER YOU HIT THE BRAKE SO WE GENERATED THESE COLONELS OR BOX WINDOWS AROUND EVERY SINGLE COLLISION IN THIS DATABASE I’M ONLY GOING TO TALK FIXED OBJECTS AND ONLY THE TOP TEN BUT BECAUSE SOME COLLISIONS OCCUR CLOSE TO EACH OTHER, WHEN YOU DEFINE THOSE AREAS THERE’S OBVIOUSLY OVERLAP OR COLIN AREATY IN THE MEMBERSHIP OF THOSE GROUPS SO TO GET AROUND THAT WE LOOKED AT THE AREA THAT HAS THE GREATEST NUMBER OF FIXED OBJECT COLLISIONS IN IT AND WE TOOK THAT AND ALL THE NEIGHBORING COLLISIONS OUT AND THEN WE LOOPED THROUGH THE DATA AGAIN AND PICKED THE NEXT AREA AND SO ON AND SO ON TO ELIMINATE THESE OVERLAPPING PLACES WHAT WE WERE LEFT WITH WAS THESE AS THE TOP TEN PLACES WITH THE HIGHEST FREQUENCY OF FIXED OBJECT COLLISIONS DURING THAT TWO YEAR PERIOD, EVEN THOUGH AT THIS SCALE OF THE MAP THESE PLACES OVERLAP, THEY ARE GEOGRAPHICALLY DISTINCT THE SYMBOL REFLECT IT IS COLLISIONS WITHIN THIS AREA THAT WE HAD A LOT OF FIXED OBJECT COLLISIONS YOU CAN GO THROUGH THE ENTIRE DATABASE AND CREATE THESE AREAS NOW, THE APPROACH TO AGGREGATING COLLISION DATA WAS DESIGNED TO AVOID PROBLEMS WITH UNITS LIKE CENSUS TRACKS TO AGGREGATE DATA THOSE UNITS HAVE BOUNDARIES THAT ARE ARBITRARILY DETERMINED WITHOUT REGARD TO UNDERLYING DISTRIBUTION OF THE PHENOMENON WE’RE TRYING TO UNDERSTAND IT CAN MASK SPATIAL PATTERNS SO GOING BACK TO THE LITTLE EXAMPLE OF THE CLASSROOM, IF WE DECIDED TO MAKE THREE CENSUS TRACKS IN THE CLASSROOM, RILE RIGHT F WE DREW ON THE LEFT AND AGGRAVATED THE DATA, WE WOULDN’T SEE ANY SPATIAL VARIATION ACROSS THOSE THREE CENSUS TRACKS BUT IF WE DREW THEM ON RIGHT SAME NUMBER OF TRACKS, SAME NUMBER OF PEOPLE IN IT TRACT, WE WOULD SEE A VERY CLEAR GRADIANT IN OUTCOMES HOW DATA ARE AGGRAVATED GEOGRAPHICALLY AFFECT RESULTS OF STATISTICAL ANALYSES AS WELL, NOT JUST VISUALIZATION THIS IS WHAT IS KNOWN AS THE MODIFIABLE AREA UNIT PROBLEM THIS PROBLEM HAS TWO COMPONENTS THERE’S A SCALE PROBLEM, THIS IS THE GENERALIZATION THAT OCCURS AS WE AGGREGATE AREAS INTO PROGRESSIVELY LARGER UNITS LIKE GOING FROM CENSUS TRACK TO COUNTY TO STATE AND SO ON THERE IS A ZONE PROBLEM WHICH CAN ARISE WHEN PARTITION THE AREA AT IS SAME SCALE THIS IS AN EXAMPLE OF THE ZONATION PROBLEM THIS IS AN AREA UNIT PROBLEM AND I HAVE GIVEN YOU REFERENCES THERE ARE NO REAL SOLUTIONS TO THE PROBLEM, BUT WE CAN MAKE AN EFFORT TO USE DATA AT THE MOST DISAGGREGATE LEVEL POSSIBLE TO ADDRESS THE SCALE PROBLEM AND CREATE REGIONS WITH INTELLIGENT BOUNDARIES THAT IS BOUNDARIES

THAT REFLECT THE DISTRIBUTION OF THE PHENOMENON WE’RE TRYING TO UNDERSTAND TO ADDRESS ZONEATION PROBLEM IT’S ALSO USEFUL EXPLORING THE SPATIAL STRUCTURE OF A PROBLEM SO THE COMPUTER ENVIRONMENT WILL LET US EXPERIMENT WITH WAYS TO ZONE THINGS AND LOOK AT THE CONSEQUENCES OF THAT THIS HAS REAL IMPLICATIONS FOR SPATIAL SAMPLING AS WELL IT’S IMPORTANT TO UNDERSTAND THAT THERE ARE TWO TYPES OF SPATIAL SAMPLES A SAMPLE OF SPACE INVOLVES SAMPLING SOME LOCATIONS FROM THE SET OF ALL PLACES WHEN WE SELECT SITES FOR ENVIRONMENTAL MONITORING LIKE WHERE WE PUT OUR MONITORING STATIONS OR SELECT ONE OR MORE STUDY COMMUNITIES, WE’RE TAKING A SAMPLE FROM THE SET OF ALL PLACES BECAUSE THERE ARE AN INFINITE NUMBER OF LOCATIONS ON THE SURFACE OF THE EARTH, IT’S TIME CON SEWELLING AND EXPENSIVE TO LOOK EVERYWHERE AND PROBABLY NOT NECESSARY TO DO SO THE DESIGN OF ENVIRONMENTAL MODELING SYSTEMS OR APPROACH TO COMMUNITY SELECTION RAISES IMPORTANT SAMPLING QUESTIONS HOW MANY SITES ARE NEEDED AND WHERE SHOULD THEY BE LOCATED A SAMPLE IN SPACE INVOLVES A SAMPLE FROM A GEOGRAPHICALLY POPULATION EVERY SAMPLE FROM A HUMAN POPULATION IS IMPLICITLY A SPATIAL SAMPLE, WHETHER YOU THINK YOU’RE DOING IT OR NOT YOU ARE PICKING PEOPLE FROM PARTICULAR PLACES AND A RANDOM SAMPLE OF ALL PEOPLE WILL THEREFORE NOT BE A RANDOM SAMPLE OF ALL PLACES UNLESS PEOPLE ARE UNIFORMLY DISTRIBUTED WHICH THEY BASICALLY NEVER ARE THIS MEANS THERE MAYBE NO ONE RESIDING IN AN AREA OF INTEREST OR OUR SAMPLE CANNOT CAPTURE VARIATION OF INTEREST FOR EXAMPLE, SAY EAR TESTING A VACCINE FOR A HEALTH PROBLEM LIKE LIEM DISEASE VERY IMPORTANT WHERE I LIVE THE RISK FOR LYME DISEASE IS GREATER IN WOODLAND AREAS THAN FOR PEOPLE IN MORE DEVELOPED PLACES MORE DEVELOPED PLACES HAVE LARGER POPULATIONS SO IF YOU TOOK A RANDOM SAMPLE MOST OF THE TIME YOU BE GETTING MORE PEOPLE WHO LIVE IN CITIES FOR TESTING YOUR VACCINE WHERE IN THOSE PEOPLE HAVE A LOWER RISK FOR ACQUIRING LYME DISEASE TO BEGIN WITH, WHAT ARE THE IMPLICATIONS OF THIS OR HOW THESE TRIALS ARE DESIGNED THERE’S LITERATURE COMING OUT NOW WITH RESPECT TO CERTAIN TYPES OF ENVIRONMENTAL HEALTH PROBLEMS VERY IMPORTANT GEOSPATIAL METHODS CAN HELP US EXPLORE THIS ISSUE OF WHAT IS THE SPATIAL BASIS OF EVIDENCE IF THE LITERATURE ON NEIGHBORHOOD CONTEXTUAL EFFECTS ON HEALTH IS TRUE AND IT TELLS US AREAS AFFECT HEALTH, THEN WHERE WE CHOOSE TO LOOK IS GOING TO HAVE AN IMPLICATION FOR WHAT WE SEE SO BECAUSE SO MANY HEALTH STUDIES HAVE BEEN CONDUCTED IN A LIMITED NUMBER OF PLACES WITH A LIMITED NUMBER OF PARTICIPANTS, META ANALYSIS METHODS HAVE BEEN DEVELOPED TO IMPROVE STATISTICAL POWER IN THE ANALYSIS OF THE DATA THESE STUDIES GENERALLY DO NOT CONSIDER WHERE THE STUDIES HAVE BEEN CONDUCTED DR BLAIR JOHNSON, DEPARTMENT OF PSYCHOLOGY CENTER FOR HEALTH INTERVENTION AND PREVENTION AT THE UNIVERSITY OF CONNECTICUT STORES HAS BEEN WORKING ON META ANALYSES OF PUBLISHED STUDIES OF TRIALS IN AFRICAN NATIONS VERY STRICT INCLUSION CRITERIA WERE APPLIED IN SELECTING THE STUDIES THEY ALL EVALUATED EFFICACY OF AN INTERPERSONALLY DELIVERED HIV AIDS PREVENTION EFFORT INITIATED0.– FROM 1986 TO 2008, AND THE INTERVENTION WAS FOCUSED ON BEHAVIORAL OUTCOME RELATIVE TO A CONTROL GROUP OR A BASELINE ASSESSMENT THERE WERE 93 STUDIES IDENTIFIED AND SOME HAD MULTIPLE PARTS TO THEM THIS MAP SHOWS WHERE THE STUDIES WERE CONDUCTED FOR SOME STUDIES, LOCATION IS REPORTED DOWN TO A CITY OR TOWN LEVEL FOR SOME STUDIES ONLY TO REGIONAL LEVEL, THESE ARE INTERPERSONALLY DELIVERED INTERVENTIONS, NOT LIKE PUBLIC SERVICE ANNOUNCEMENTS THAT WILL BE BROADCAST OVER LARGE AREAS SO MOST OF THESE INTERVENTIONS HAPPEN IN CLINICS AN SCHOOLS AN SPECIFIC PLACES WE COULD ONLY GET THESE DOWN TO SORT OF A CITY OR TOWN LEVEL THE COUNTS ARE MAPPED TO THE SEN TRIEDS OF THE CITY REGION OR COUNTRY AND THE SIZE OF SYMBOL REPRESENTS THE COUNT OF STUDIES THAT INVOLVED THAT PLACE SO HERE — THIS IS WHERE WE HAVE — THESE AREN’T JUST NIH FUNDED STUDIES, BUT WE’LL BE ABLE TO SHOW YOU THE MAP OF NIH FUNDED VERSUS OTHER STUDIES AND WE CAN MAKE AN ANIMATED MAP THAT SHOWED HOW THESE PROGRESS THROUGH TIME BUT THIS IS WHERE WE HAVE SOME EVIDENCE OF THE EFFECT ON A BEHAVIORAL OUTCOME OF HIV AIDS INTERVENTIONS IN AFRICA LOOKING AT THE STUDIES, WILL

PERMIT DR JOHNSON AND HIS TEAM TO DEVELOP SPATIAL META ANALYSES TO ANALYZE CONTEXTUAL FACTORS LIKE SUPPORT WOMEN’S RIGHTS OR LEVELS OF INCOME AS FACTORS THAT MIGHT AFFECT INTERVENTION EFFICACY AND INVESTIGATE WHETHER OR NOT THERE ARE SPATIAL PATTERNS IN INTERVENTION EFFICACY WITH MORE EFFICACIOUS INTERVENTIONS CONDUCTED IN PARTICULAR AREAS IT HELPS TO SEE WHERE TRIALS HAVE BEEN CONDUCTED AND WHERE THEY HAVEN’T PERHAPS THE MOST DOMINANT USE OF GEOSPATIAL METHODS IN HEALTH TODAY HAS BEEN ANALYZING NEIGHBORHOOD CONTEXT OF HEALTH EVENTS SO I WON’T TALK A LOT ABOUT THIS THIS INVOLVES USING GEOSPATIAL METHODS TO PUT AN INDIVIDUAL IN AN AREA AND TAKE INTO ACCOUNT AREA CHARACTERISTICS AND EXPLAINING THE HEALTH OF THE INDIVIDUAL HIERARCHICAL MODELS IS USED IN THIS RESEARCH THIS APPROACH HAS MADE HEALTH STUDIES MORE GEOGRAPHIC IN THE SENSE WE KNOW SOMETHING ABOUT LOCAL ENVIRONMENT BUT NOT NECESSARILY MADE THIS RESEARCH MORE SPATIAL BECAUSE WE DON’T TAKE INTO ACCOUNT THE SPATIAL AUTO CORRELATION OR DEPENDENCIES FROM ONE NEIGHBORHOOD TO THE NEXT AND I HAVE A CITATION IF YOU WANT TO FOLLOW THIS AS A RESULT WE SOMETIMES SEE INCONSISTENT RESULTS IN STUDIES CONDUCTED ACROSS DIFFERENT LOCALITIES DOES THE PRESENCE OF A PARK LEAD TO MORE PHYSICAL ACTIVITY OR NOT? IN ADDITION WE HAVE DIFFICULTIES IDENTIFYING GROUPS OF PLACES WITH THE SAME CONFIGURATIONS OF FACTORS AFFECTING HEALTH OUTCOMES SO DESPITE ALL THIS DETAILED SPATIALLY EXTENSIVE DATA MANY ANALYSIS — MANY ANALYSTS ARE STILL FALLING BACK ON AGGREGATE OR GLOBAL METHODS OF ANALYSIS WIDOW NOT HELP US UNCOVER KEY SPATIAL PATTERNS OF INTEREST GEOSPATIAL METHODS ARE USED TO ANALYZE SPATIAL PATTERNS AND PROCESSES I’M GOING TO TALK ABOUT PATTERNS FIRST SPATIAL CLUS EVERYTHING METHOD — CLUSTERING DATA HELP ANALYZE DATA THERE’S A WIDE RANGE OF CLUSTERING METHODS SOME ARE GLOBAL METHODS, BY THIS THEY IDENTIFY WHETHER OR NOT THERE’S OVERALL PATTERN OF CLUSTERING OTHERS ARE LOCAL METHODS USED TO IDENTIFY THE NUMBER AND LOCATIONS OF INDIVIDUAL CLUSTERS ALL THESE TECHNIQUES HAVE IN COMMON THEY RELY ON BEING ABLE TO DESCRIBE THE DISTANCES SEPARATING OR THE PROXIMITY OF NEIGHBORING AREA OR HEALTH EVENTS THIS IS A TABLE ADAPTED FROM GEOGRAPHICALLY REGRESSION ANALYSIS OF SPATIAL RELATIONSHIPS AND CONTRASTS THE IDEA OF LOCAL VERSUS GLOBAL STATISTICS GLOBAL STATISTICS SUMMARIZE DATA FOR ENTIRE REGIONS YIELDING A SINGLE STATISTIC WHICH IS OFTEN ASPATIAL AND CAN CAN PROVIDE MISLEADING INTERPRETATIONS OF LOCAL RELATIONSHIPS LOCAL STATISTIC, ON THE OTHER HAND, SUMMARIZE DATA FOR INDIVIDUAL PLACES, WITHIN ENTIRE REGIONS SO YOU GET MULTIPLE STATISTICS, ONE FOR EACH PLACE THESE ARE POTENTIALLY INTERESTING WHEN MAPPED AND THEY’RE USEFUL FOR EXPLORATORY DATA ANALYSIS, FOR CONFIRMATORY ANALYSIS AND BUILDING MORE POWERFUL GLOBAL MODELS THE MOST RECENT VERSIONS OF WIDELY USED GIS SOFTWARE PACKAGES ARE INCORPORATING MORE SPATIAL STATISTICAL FUNCTIONS FOR GLOBAL AND LOCAL ANALYSES FOR EXAMPLE, WE CAN PERFORM GLOBAL AND LOCAL CLUSTERING ANALYSES OR WE CAN DO AN ORDINARY LEASE SQUARES REGRESSION, WE CAN CHECK FOR SPATIAL AUTOCORRELATION, AND THEN WE CAN RUN A SPATIAL REGRESSION MODEL OR WE CAN DO GEOGRAPHICALLY WEIGHTED REGRESSION IN WHICH SPATIAL VARIATIONS IN THE REGRESSION PARAMETERS CAN BE OBSERVED (INDISCERNIBLE) EYE IS A SPATIAL PATTERN CLUSTERING AUTOCORRELATION AN DATA POSITIVE SPATIAL AUTOCORRELATION MEANS LIKE VALUES ARE CLUSTERED TOGETHER LIKE THAT CLASSROOM ON THE RIGHT NEGATIVE SPECIAL AUTOCORRELATION MEANS HIGH AND LOW VALUES ALTERNATE IN A CHECKER BOARD PATTERN OR RANDOM PATTERN OF VALUES MOREAN’S EYE WAS HERE TO INVESTIGATE WHETHER OR NOT THERE WAS A PATTERN OF OVERALL CLUSTERING OF AVERAGE SYMPTOM SCORES AMONG COMMUNITY LIVING ELDERLY PARTICIPANTS NP A TELEPHONE SURVEY CONDUCTED IN NEW JERSEY A SIGNIFICANT PATTERN OF POSITIVE SPATIAL AUTOCORRELATION WAS FOUND SO THE RED DOTS MEAN THESE ARE CENSUS TRACK SEN TRIEDS WHERE A SURVEY RESPONDENT REPORTED A DEPRESSIVE SYMPTOM SCORE GREATER THAN OR EQUAL TO TEN IF THERE’S A BLACK GOT THERE WAS A PARTICIPANT AT LEAST ONE PARTICIPANT AT THAT LOCATION AN

NONE OF THOSE PARTICIPANTS REPORTED A DEPRESSIVE SYMPTOM SCORE GREATER THAN OR EQUAL TO TEN THE GRAY SHADED„K AREAS ARE TRACKS WITH AT LEAST ONE PARTICIPANT, THE BIG BOUNDARIES ARE COUNTY BOUNDRIES SO WHAT THIS TELLS US IS GLOBAL MEASURE IS, YES, THERE’S CLUSTERING OF DEPRESSIVE ELDERLY PEOPLE WITH DEPRESSIVE SYMPTOMS BASED ON RESIDENCES BUT IT DOESN’T TELL HOW MANY CLUSTERS AN WHERE THEY ARE THE LISA STATISTIC IS A LOCAL MEASURE OF SPATIAL AUTOCORRELATION THAT STANDS FOR LOCAL INDICATORS OF SPATIAL AUTOCORRELATION AN IT MEASURES THE ASSOCIATION BETWEEN THE VALUE AT A PARTICULAR PLACE AND THE VALUES FOR NEIGHBORING AREAS AND THERE ARE DIFFERENT WAYS TO DEFINE NEIGHBORING AREAS THIS MAP SHOWS THE LOCATIONS OF CENSUS TRACKS WITH HIGH AVERAGE DEPRESSIVE SYMPTOM SCORES THAT ARE SURROUNDED BY OTHER TRACKS WITH HIGH DEPRESSIVE SYMPTOM SCORES SO WE’RE GETTING AWAY FROM THIS AS THE CENSUS TRACK BOUNDARY IS SPLITTING UP A PATTERN OF INTEREST THESE CLUSTERS ARE STATISTICALLY SIGNIFICANT MEANING UNLIKELY THAT THESE COULD HAVE OCCURRED BY CHANCE THIS METHOD CAN IDENTIFY CLUSTERS WITH TRACKS WITH LOW AVERAGE SCORES ARE SURROUNDED BY TRACKS WITH LOW AVERAGE SCORES, COOL SPOTS, OR TRACKS WITH HIGH AVERAGE SCORES SURROUNDEDLY TRACKS WITH LOW AVERAGE SCORES AND SO ON AND WE CAN GO BACK TO INDIVIDUAL PEOPLE AND FIND INDIVIDUAL WHOSE HAD LOW DEPRESSIVE SYMPTOM SCORES BUT THEY WERE LIVING IN TRACKS WHERE EVERYBODY ELSE WAS HIGH AND THEY WERE SURROUNDED BY HIGH PEOPLE, THOSE WOULD BE REALLY INTERESTED PEOPLE TO LOOK AT BECAUSE IT’S LIKE WHAT ACCOUNTS FOR THEIR RESILIENCE WITH THIS UNDERSTANDING OF DATA WE CAN DESIGN BETTER STUDIES WITH NEIGHBORHOOD CONTEXTUAL EFFECTS INTERVENTION TRIALS AN SERVICE DELIVERY SYSTEMS IN ADDITION TO ANALYZING SPATIAL PATTERNS IN DATA WE CAN USE SPATIAL STATISTICAL METHODS TO INVESTIGATE PROCESSES SPATIAL METHODS TAKE INTO ACCOUNT LOCATION I’M GOING TO TALK SPATIAL REGRESSION ANALYSIS AS A GLOBAL STATISTIC AND THEN WE’LL LOOK AT A COUPLE OF EXAMPLES OF LOCAL SPATIAL STATISTICS GLOBAL SPATIAL STATISTICS WERE EFFECTIVELY USED TO MODEL GROWTH AND DEVELOPMENT OF DRUG MARKETS FOR METH METHAMPHETAMINE IN CALIFORNIA IN RELATION SO CHANGING PATTERNS OF ENFORCEMENT RESEARCHERS USE ZIP LEVEL SPATIAL DATA AND SIMULTANEOUS AUTOREGRESSIVE SPATIAL MODELS TO CORRECT FOR SPATIAL AUTOCORRELATION OF MODEL RESIDUALS WHICH IF UNCORRECTED WOULD INDUCE BIAS IN THE PARAMETER ESTIMATES THE AUTHORS ELOQUENTLY EXPRESSED THE VALUE OF SPATIALLY EXTENSIVE APPROACH AND I’M QUOTING THEM THE SCALE OF THE MARKET IS NOT THAT OF A SINGLE SOLID NETWORK, NEIGHBORHOOD OR CITY BUT RATHER THAN OF NEIGHBORHOODS WITHIN CITIES AND COMMUNITIES ACROSS THE STATE AND ACROSS NATIONAL BOUNDARIES I.E., BETWEEN CALIFORNIA AND MEXICO THE RESULTS WERE CONSISTENT WITH TWO POSSIBLE EXPLANATIONS AN INCREASE IN L CA CAL OVER THE TIME PERIOD BUT THIS COULD HAVE BEEN TO KIND OF ENLARGEMENT OF THE OVERALL OPERATION OF THIS MARKET WITH DIFFUSION OF METH LABS TO RURAL AREAS OR COULD HAVE BEEN A DISPLACEMENT OF THE METH LABS OUT OF URBAN AREAS INTO RURAL AREAS WHERE ENFORCEMENT COULD BE BETTER EVADED THIS IS HOW YOU WOULD FORMULATE A SPECIAL REGRESSION MODEL THIS LOOKS PRETTY FAMILIAR TO YOU EXCEPT THE THIR TERM THAT THIRD TERM BASICALLY IS PULLING OUT WHAT WOULD BE THE RANDOM ERROR TERM, THE SPATIALLY AUTOCORRELATED ERROR SO WE’RE DEALING WITH THE SPATIAL ERROR ON ITS OWN AND WE HAVE A RANDOM ERROR LEFT OVER HERE THE NON-RANDOM SPATIAL ERROR WHICH CAP CHR IT IS SPATIAL STRUCTURE OF THE SPATIALLY DEPENDENT ERROR HAS LAMDA AS THE CO-EFFICIENT OR ERROR PARAMETER AND WHAT’S IN THE SUMMATION SIGN IS THE SUM OF WEIGHS MULTIPLIED BY DEPENDENT ERROR WITH RESPECT TO OBSERVATION I YOU CAN COMPUTE A SPATIAL WEIGHTS MATRIX USING A DIFFERENT APPROACH USING GIS SOFTWARE ONCE YOU HAVE ALL THE INFORMATION ON — IN YOUR SOFTWARE APPLICATION RETURNING TO STUDY OF CLIGS WE CAN LOOK HOW LOCAL SPATIAL STACKS WERE USED AT THE VARIOUS COLLISION SITES LOCAL PROPORTIONS AN LOCAL ODDS RATIOS WERE CALCULATED TO ASSESS THE IMPORTANCE OF INDIVIDUAL, ENVIRONMENTAL AND BEHAVIORAL FACTORS ASSOCIATED WITH COLLISIONS AT DIFFERENT PLACES ARE THE SAME FACTORS ASSOCIATED

WITH THE SAME OUTCOME FIXED OBJECT COLLISIONS ACROSS ALL PLACES SO THIS IS HOW WE WOULD CALCULATE A GEOGRAPHICALLY WEIGHTED PROPORTION THIS LOOKS REALLY FANCY BUT ALL WE’RE SAYING GO TO THE COLONEL AREA, AND LOOK AT THE PROPORTION OF COLLISIONS IN THIS AREA THAT HAPPENED ON A DAY WHEN RAINING OR WHEN THE ROAD WAS WET OR HAD A DRIVER CERTAIN AGE, SO ON AND DO THIS PROPORTION LIKE WE WOULD FOR THE STATE AS A WHOLE IF YOU WANT TO, YOU CAN WEIGHT THE CLIGS BASED ON WHERE THEY ARE WITHIN THIS AREA, BUT I USE A SIMPLE BINARY WEIGHTING WHERE IT’S ZERO IF IT’S OUTSIDE THE COLONEL AREA OR IF IT’S ONE INSIDE AND THE GEOGRAPHICALLY WEIGHTED ODDS RATIO IS BASICALLY DOING THE SAME, CALCULATING AN ODDS RATIO FOR FIXED OBJECT VERSUS OTHER TYPES OF COLLISIONS BASED ON SOME OTHER DIMENSION LIKE ROAD WAS WET OR DRY WITHIN THIS KERNAL AREA I KNOW THAT YOU CAN’T SEE ALL OF THESE IN DETAIL BUT IF YOU GET THE POWERPOINT YOU WILL BE ABLE TO SEE THESE WHAT I WANT YOU TO FOCUS ON IS THESE SIGNIFICANT LOCAL PROPORTIONS VARY ACROSS THIS CHART SO WE HAVE THE TOP TEN PLACES, THOSE ARE THE ROW, THE STATE IS AT THE BOTTOM AND THEN WE HAVE WHETHER OR NOT IT WAS A FIXED OBJECT CRASH, RAIN OR SNOW, ON A DRY ROAD, DAY LIGHT CONDITION, THE DRIVER WAS BETWEEN 25 AND 44 YEARS, MALE, WHAT THE PERSON WAS DOING, IN THIS CASE DRIVING TOO FAST FOR CONDITIONS SO FOR ALL CLIGS IN THE STATE AS WHOLE ACROSS THE BOTTOM ROW WHICH YOU CAN’T READ, ONLY 24% OCCURRED WHEN RAINING SLEETING OR SNOWING 65% OCCURRED ON DRY ROADS AND 70% OCCURRED DURING DAYLIGHT CONDITIONS IF YOU LOOK AT THIS YOU THINK WEATHER IS NOT THAT BIG A FACTOR IN MOTOR VEHICLE COLLISIONS IN CONNECTICUT BUT WITH RESPECT TO AGE, DRIVERS OR PEDESTRIANS UNDER 25 ARE OLDER THAN 44, WE’RE AT FAULT IN 54% OF COLLISIONS AN 61% OF THE DRIVERS WERE MALE THESE INDIVIDUAL AGE AND SEX CHARACTERISTICS ARE WITH THE COLLISIONS REPORTED IN THE LITERATURE ANALYSIS OF LOCAL PROPORTIONS AN ODDS RATIOS REPORTS DIFFERENT VARIABLE PATTERNS FOR THESE VARIOUS HIGH-COLLISION FREQUENCY LOCATIONS ROWS 2 AND 62 AND 6, VERY HIGH NUMBERS OF CRASHES WERE FIXED OBJECT COLLISIONS AND MANY OCCURRED WHEN ROAD SURFACES WERE WET, WHEN DRIVERS WERE OPERATING VEHICLES TOO FAST FOR CONDITIONS SO IN SOME PLACES IF NOT A RAINY DAY WE DON’T HAVE CRASHES BUT THAT DOESN’T APPLY EVERYWHERE IN CONNECT CONNECT BUT IF WE FIGURE OUT WHAT TO DO IN THESE PLACES TO STOP THESE HEALTH EVENTS FROM OCCURRING, WE NEED TO KNOW WHAT THE CONFIGURATION OF EVENTS IS THAT’S COMING TOGETHER IN A PARTICULAR LOCATION IT MAY NOT BE THE SAME EVERYWHERE ACROSS THE STATE IF YOU LOOK AT PLACE NUMBER 10, THERE AREN’T ANY DIFFERENCES BETWEEN THE CHARACTERISTICS OF COLLISIONS OCCURRING AT THOSE PLACES AND THE STATE BUT IF YOU LOOK AT PLACE NUMBER 5, IT HAS SIGNIFICANTLY DIFFERENT THINGS GOING ON THERE IN ALMOST EVERY DIMENSION FROM COLLISIONS IN THE STATE AS A WHOLE AND ALSO FROM SOME OF THE OTHER HIGH FIXED OBJECT COLLISION SITES LOCAL ODDS RATIOS REVEAL CERTAIN PATTERNS OF INTEREST AND ODDS RATIOS IN ADDITION TO PROPORTIONS PLAY 6 FOR EXAMPLE THE LOCAL ODDS WERE NOT SIGNATURE CAB FOR RAIN OR SNOW, FIXED OBJECT COLLISIONS HAPPENED ON RAINY OR SNOWY DAYS THAT SUGGESTS ALL TYPES OF COLLISIONS OCCURRING THERE, NOT JUST THE FIXED OBJECT ONES, WERE AFFECTED BY RAIN AND SNOW I HOPE THIS GIVES YOU THE IDEA THIS LEADS US TO THE IDEA OF SPATIALLY VARYING RELATIONSHIPS WE CAN USE GEOSPATIAL METHODS TO MAP DATA ON THE AMOUNT OF TIME A PERSON SPENDS OUTDOORS FOR EXAMPLE THAT WOULD VARY SPATIALLY PERHAPS WE CAN USE GEOSPATIAL TECHNIQUES TO MOBTOR, MODEL AND MAP GEOGRAPHICAL VARIATIONS IN AIR QUALITY BUT IT’S ALSO POSSIBLE THAT THE VERY RELATIONSHIP BETWEEN THE AMOUNT OF TIME YOU SPEND OUTDOORS, AIR QUALITY AND HEALTH OUTCOME, ITSELF VARIES GEOGRAPHICALLY IF THIS IS THE CASE WE NEED TO BE ABLE TO FIND THE SET OF PLACES OR WHAT WE MIGHT CALL THE SPATIAL DOMAIN, WHERE PARTICULAR PROCESSES ARE AT WORK THEY DON’T — I DON’T WANT YOU TO THINK THIS IS AN EXAMPLE OF WHAT WE CALL IN GEOGRAPHY, EXCEPTIONALISM EVERY PLACE IS JUST SO SPECIAL AND WE CAN’T MAKE GENERALIZATIONS IT’S NOT THAT, IT’S THAT WE NEED TO SEARCH FOR THE SET OF PLACES ACROSS WHICH PARTICULAR SET OF

GENERALIZATIONS APPLY AND GENERALIZATIONS MIGHT NOT APPLY EVERYWHERE ONE OF THE IMPORTANT TECHNIQUES WE HAVE AVAILABLE FOR INVESTIGATING SPATIALLY VARYING PROCESSES IS GEOGRAPHICALLY-WEIGHTED REGRESSION THIS IS A MODEL THAT EVALUATES RELATIONSHIPS AMONG INDEPENDENT AND DEPENDENT VARIABLES IN A WAY FOR PARTICULAR PLACES SO THESE REGRESSION PARAMETERS CAN VARY SPATIALLY GWR WAS USED IN A STUDY OF MORTALITY IN THE ATLANTA METROPOLITAN AREA SOCIOECONOMIC STATUS RACE AND URBANIZATION WAS ASSOCIATED WITH STANDARDIZED MORTALITY RATES ACROSS 431 CENSUS TRACKS LOCAL PARAMETER ESTIMATES WERE MAPPED AND I HAVE GIVEN YOU THE CITATION TO THIS ARTICLE AND LOW SOCIOECONOMIC STATUS FOR EXAMPLE WAS FOUND TO BE PARTICULARLY SIGNIFICANT IN ESTIMATING MORTALITY IN THE NORTHERN SUBURBS OF ATLANTA BUT HAD A LESSER AND LESS SIGNIFICANT EFFECT IN THE SOUTHERN REGION OF THE STUDY AREA NEGLECTED AREA IN RESEARCH ON HUMAN HEALTH OUTCOMES IS THE ROLE OF HEALTH SERVICES SO MUCH HEALTH RESEARCH, I STARTED MY CAREER IN THE HEALTH SERVICES SIDE OF THINGS, IS DESIGNED AS IF THE STRUCTURE AND FUNCTIONING OF THE HEALTHCARE SYSTEM HAS NOTHING TO DO WITH HEALTH OUTCOMES WE’RE OBSERVING WE NEED TO EXPLICITLY ADDRESS HOW THE STRUCTURE OF THE VARIOUS HEALTHCARE SYSTEMS, PLURALS IN THE U.S., STATE AND LOCAL REGULATIONS ON INSURANCE, PRACTITIONER LICENSING AND OTHER COMPONENTS AFFECT THE PATTERNS OF HEALTH AND DISEASE WE’RE TRYING TO UNDERSTAND GEOSPATIAL METHOD CAN PLAY A ROLE BY USING MODELS TO EVALUATE ACCESSIBILITY TO EXISTING SERVICES, DON’T HAVE TIME TO TALK ABOUT THAT TODAY BUT I WANT TO INTRODUCE YOU TO SOMETHING YOU’RE PROBABLY LESS FAMILIAR WITH WHICH IS NORMATIVE MODELING TECHNIQUES TO LOCATE AND EVALUATE OPTIMAL LOCATIONS WHAT IS A NORMATIVE MODEL? WHE WE’RE ANSWERING THE QUESTION WHAT’S THE BEST WHRKS’S THE WORST, WHAT TEASE LEAST, WHAT’S THE MOST, WE’RE IN THE WORLD OF NORMATIVE MODELING AND THE KEY ELEMENTS OF NORMATIVE MODEL ARE OBJECTIVE FUNCTI+ IF WE WANT TO ALLOCATE PATIENTS FROM A SET OF DEMAND SITES TO A SET OF CLINICS TO MINIMIZE THE TOTAL TRAVEL COSTS, THE TRAVEL COSTS OF YOU PLUS ME PLUS YOU PLUS YOU TO THESE CLINICS, THAT IS OUR OBJECTIVE, OUR DEFINITION OF WHAT’S BEST IN MEETING THIS OBJECTIVE WE HAVE A SET OF CONSTRAINTS HERE WE’RE SAYING EVERY PATIENT MUST BE SERVED BUT YOU WOULDN’T HAVE TO SAY THAT THE NUMBER OF PATIENTS ALLOCATED TO A CLINIC CAN’T EXCEED CLINIC CAPACITY AND THE NUMBER OF PATIENTS ALLOCATED TO FACILITY CAN’T BE NEGATIVE WE CAN’T HAVE A NEGATIVE NUMBER OF PEOPLE GOING FOR SERVICE THIS IS A NON-NEGATIVITY REQUIREMENT AND MOST REAL WORLD PROBLEMS HAVE THESE THEN THE STRUCTURE OF THE PROBLEM GIVES YOU THE DATA REQUIREMENTS FROM THIS ENGLISH LANGUAGE DESCRIPTION OF THE PROBLEM, WE CAN DEVELOP THE MODEL FORMULATION USING MATHEMATICAL EXPRESSION AND YOU CAN LOOK AT THAT CLEARLY YOU UNDERSTAND YOU CAN YIEWK THE GIS TO PRESENT THE DATA, SO YOU CAN LOCATE THE PATIENTS HERE TO THE SEN TRIED OF THE TOWNS, AND WE KNOW HOW MANY PATIENTS ARE COMING FROM EACH TOWN WE CAN LOCATE THE CLINICS IN GIS AND PUT IN DATA ON THEIR CAPACITIES AND WE CAN USE THE GIS TO COMPUTE AN ORIGIN DESTINATION COST MATRIX TO TELL US WHAT THE TRAVEL COST IS FOR EVERY PERSON STARTING IN ONE TOWN AND GOING TO A PARTICULAR CLINIC FOR VERY LARGE PROBLEMS WE CAN’T SOLVE THESE INSIDE THE GIS SOFTWARE PACKAGE, WE HAVE TO USE SOMETHING LIKE SAS OR OR C OR SOME OTHER METHOD, SMALL PROBLEMS YOU CAN USE THE SOLVER AND EVEN IN XL THAT’S HOW I DID THIS ONE THIS IS THE OPTIMAL ALLOCATION AND THEN WE CAN BRING THESE DATA BACK INTO THE GIS AND MAP WHAT THE ASSIGNMENT S. AGAIN, THIS IS THE ASSIGNMENT, WHICH IS MATHEMATICALLY PROVEN TO YIELD THE LOWEST TOTAL TRANSPORT COST OF GETTING THIS NUMBER OF PATIENTS AT THESE LOCATIONS TO THIS NUMBER OF FACILITIES WITH THESE CAPACITY YOU CAN’T DO BETTER THAN THIS WE DEAL WITH THIS EVERY DAY WE SAY ONLY 24 HOURS IN A DAY, CAN’T BE IN TWO PLACES AT ONCE THESE ARE POWERFUL METHODS THAT HAVE BEEN I THINK SOMEWHAT NEGLECTED SO THE TOTAL — THE ANSWER IS, WHAT IS THE MINIMUM TOTAL TRAVEL COST? 301,614.2-MILES ONCE WE COMPLETED OUR ANALYSES OF HEALTH PROBLEMS, WE WANT TO SHARE OUR FINDINGS AND DATA WITH OTHERS GEOSPATIAL METHS OVER THE WEB — METHODS OVER THE WEB PLAY AN IMPORTANT ROLE HELPING US DO THIS THE MALARIA ATLAS PROJECT

INITIATED IN 2006 ILLUSTRATES JUST SUCH A PROJECT AND WE’RE GETTING CLOSE TO THE END, I’M GOING TO FINISH ON TIME I THINK AND BUT I WOULD ENCOURAGE YOU TO GO TO THIS WEBSITE AND LOOK AT IT MALARIA IS CLEARLY NOT AT PRESENT A SIGNIFICANT HEALTH THREAT IN THE U.S. BUT THIS PROJECT OFFERS AN INTERESTING MODEL OF THE KINDS OF WORK WE COULD BE UNDERTAKING MAPPING MALARIA IS CHALLENGING BECAUSE TRANSMISSION INTENSITY IS GEOGRAPHICALLY HETEROGENEOUS RESEARCH IS INTERESTED IN MALARIA, REALIZE THAT WE DID NOT HAVE A GOOD MAP OF MALARIA PREVALENCE MEANING THE PROPORTION OF THE POPULATION THAT WAS CONFIRMED POSITIVE FOR FOR MALARIA PARASITES THIS WAS MAKING IT DIFFICULT TO EVALUATE THE IMPACT OF DIFFERENT MALARIA CONTROL PROJECTS BEING IMPLEMENTED IN DIFFERENT PARTS OF THE WORLD SO THEY TOOK MORE THAN 8,000 REPORTS, LIKE A META ANALYSIS, THEY APPLIED STRICT INCLUSION CRITERIA, THEY INTEGRATED THESE SPATIALLY AND TEMPORALLY USING A GEOSTATISTICCAL METHODS AND THEY HAD A CONTINUOUS AGE STANDARDIZED URBAN COLLECTED MALARIA PREVALENCE MAP EVERYTHING, SOURCE DATA, HOW THEY DID IT AND THE RESULTS IN THE FORM OF MAPS AND THE DATA ITSELF IS AVAILABLE FOR FREE ON THE INTERNET SO THIS IS AN EXAMPLE OF A REGIONAL LIMIT AND ENDOMICITY MAP DOWNLOADABLE IN PDF FORMAT FROM THE WEB AND ALSO DOWNLOAD THE GRIDDED DATA IN GEOTIF FORMAT AND ASCI FORMAT TIF IS A TIF FILE WITH INFORMATION SO YOU CAN REGISTER TO ITS CORRECT PLACE ON THE SURFACE OF THE EARTH NOW THEY’RE SERVING THE DATA SO OTHER RESEARCHERS CAN USE THESE DATA FOR WHATEVER THEY WANT TO MORE IMPORTANTLY, BECAUSE THEY USE GEOSPATIAL STATISTICAL METHODS, IN BAYESIAN TECHNIQUES THEY WERE ABLE TO GENERATE INFORMATION ABOUT SPATIAL ERROR, FOR SOME PARTS OF THE WORLD BASED ON UNDERLYING DISTRIBUTION OF REPORTS, MORE REPORTS ARE MORE CONFIDENT WE KNOW MA WHAT THE TRUE PREVALENCE IS SO THEY PUBLISH SPATIAL ERROR MAPS AND WE NEED TO DO MORESjqÖ WORK ON SPATIAL CONCENTRATION AND ERROR THE BRIGHT GREEN AREA ON THIS MAP SHOWS HIGHER UNCERTAINTY IN THE PREVALENCE DATA THESE ARE DOWNLOADABLE AS PDF MAPS AND IN GEOTIF AND ASCI FORMATS FOR THE DATA FINALLY GEOSPATIAL DATA ON INDIVIDUALS DOES POSE A RISK TO PRIVACY AND CONFIDENCIALITY OF HEALTH DATA INCREASINGLY THE WIDESPREAD USE OF GEOENABLED DEVICES IS CREATING CONCERNS ABOUT UNWANTED SURVEILLANCE THE PACE OF TECHNOLOGICAL CHANGE AND ALSO SHIFTS IN THE ADOPTION OF THESE TECHNOLOGIES IS MAKING IT DIFFICULT TO ADDRESS PROBLEMS BUT THERE’S A BODY OF LITERATURE INVESTIGATING OW METHODS CAN BE USED TO ADDRESS PRIVACY AND CONFIDENTIALITY CONCERNS, SOME USE STATISTICAL APPROACHES, SOME USE NORMATIVE MODELING TECHNIQUES IN THE NOTES I INCLUDED REFERENCES TO THE RELEVANT LITERATURE IMPROVED INFORMED CONSENT PROCEDURES DIRECTLY ADDRESSING GEOSPATIAL RISK, GEOSPATIAL DATA RISK AND PROTECTIONS ARE GREATLY NEEDED LAST SLIDE WHAT CAN NIH DO? I INVITE YOU TO CONSIDER FOUR STEPS YOU CAN TAKE TO SUPPORT GEOSPATIAL METHODS IN HEALTH RESEARCH FIRST, ENGAGE WITH HEALTH RESEARCH EDUCATORS TO MAKE SURE THE GEOSPATIAL METHODS ARE REQUIRED PREPARATION FOR PEOPLE COMING TO THE FIELD THERE’S TREMENDOUS GROWTH IN THE USE OF GIS AN HEALTH BUT THEY’RE NOT WIDELY AND DEEPLY EMBEDDED IN THE EDUCATION OF PUBLIC HEALTH PROFESSIONALS, EPIDEMIOLOGISTS AN HEALTH RESEARCHERS P MOST PEOPLE STILL HAVE NO EXPOSURE TO THESE METHODS AND THEY’RE CRITICAL SECOND, SUPPORT RESEARCH LINKING GROUPS OF HEALTH RESEARCHERS AND HEALTH PROFESSIONALS IN SPATIALLY EXTENSIVE STUDIES THAT USE THE SAME METHODS ACROSS MULTIPLE SITE SITES SELECT THE SITES CAREFULLY AN INVESTIGATE PATTERNS AN SIGNIFICANT PATTERNS OF SPATIAL ERROR THE DAYS WHEN WE’RE DOING A ONE OFF STUDY IN A PARTICULAR COMMUNITY USING HIGHLY SPECIALIZED METHOD WE MIGHT RECONSIDER THAT IF I WROTE NOTES HERE, DON’T HARANG PEOPLE, THEY’RE DOING THIS IN EUROPE WITH GREAT SUCCESS YOU’LL HAVE 25 TEAMS OF RESEARCHERS USING THE SAME LAND

USE REGRESSION MODEL TO PREDICT AT ATMOSPHERIC POLLUTION IN DIFFERENCE COUNTRIES THEY VALIDATED AGAINST OBSERVATIONAL DATA, THEY CAN ANALYZE SPATIAL ERROR AND THAT FEEDS BACK INTO BUILDING BETTER LAND USE REGRESSION MODELS THIRD, I WOULD LOVE IT IF YOU COULD IMPROVE THE GEOCODING OF ITEMS IN PUBMED ALONG WITH SPATIAL SEARCH CAPABILITY AND DEVELOP A SPATIAL DATA SHARING PLATFORM, YOU CAN START NOW AND GO FORWARD FROM NIH FUNDED RESEARCH SO IT WILL BE EASY TO ANSWER QUESTIONS ABOUT WHERE STUDIES WERE ACTUALLY CONDUCTED, WHEN THEY WERE CONDUCTED, WHAT THE METHOD WAS AND TO SHARE SPATIAL DATA THAT’S BEEN CONDUCTED YOU ALREADY HAVE KEY WORDS FOR ARTICLES IN PUBMED THOSE KEY WORDS SHOULD INCLUDE THE WHERE AND THE TIME OF THE DATA COLLECTION OTHERWISE WE JUST CAN’T SEARCH — I DON’T THINK THIS IS — MAYBE I’M WRONG, I WAS WORKING WITH KOLETTE HOCKSTEEN AND THERE’S A PROCESS TO GET MORE TERMNOLOGY OF THESE METHODS IN AS SUB HEADINGS I UNDERSTAND THERE’S A LONG PROCESS BUT IF NOTHING ELSE NEXT TIME CONGRESS CALLS AN WANTS TO KNOW HOW MANY RESEARCH DOLLARS HAVE WE SPENT IN EGYPT YOU’LL BE ABLE TO EASILY ANSWER THAT QUESTION IT WON’T BE SO HARD FINALLY, IF YOU COULD GET OHRP, TO ORGANIZE THE TRAINING PROGRAM ON GEOSPATIAL DATA PRIVACY AND CONFIDENTIALITY, TO IMPRO-PRACTICE, SET A RESEARCH AGENDA AND HAVE CENTER FOR SCIENTIFIC REVIEW STAFFERS AND REVIEWERS PARTICIPATE, PEOPLE AT NIH, EDITORS OF JOURNALS AND HEALTH PROFESSIONALS AND SO ON, AND WE IN THE HEALTH FIELD NEED TO BE ENGAGED IN ONGOING PUBLIC POLICY DEBATE ABOUT WHAT’S HAPPENING WITH DATA PRIVACY I DON’T THINK WE HAVE BEEN SUFFICIENTLY I’M READY TO TAKE YOUR QUESTIONS BUT PLEASE REMEMBER IF YOU REMEMBER NOTHING ELSE FROM THIS TALK THAT THE SPACE PART OF THE SCIENCE, THE LOCATION ISN’T SOMETHING THAT GETS ADDED ON LATER IT’S PART OF THE DATA AND SHOULD BE PART OF THE METHODS TOO THANK YOU VERY MUCH [APPLAUSE] >> QUESTIONS, COMMENTS? DON’T BE AFRAID YES (OFF MIC) >> WELL, WHY DON’T YOU (OFF MIC) >> YOU WOULD HAVE TO START WITH FROM THE GET GO, IF YOU’RE LOOKING AT SOMEBODY WHO IS MY AGE, I’M GOING TO BE 58 AND I LIVE IN CONNECTICUT BUT I DIDN’T LIVE IN CONNECTICUT ALL MY LIFE SO IF YOU THINK THE LOCATION HAS SOMETHING TO SAY AB YOUR PATIENT’S HEALTH, THEN IT’S NOT — I MEAN, WHERE THEY LIVE NOW IS SOMETHING OF INTEREST BUT NOT JUST WHERE THEY LIVE, IT’S WHERE YOU WORK, HOW YOU GET TO WORK, SORT OF THE TOTAL LIFE COURSE AND CURRENT ENVIRONMENT OF THE PERSON WE DO HAVE GOOD SPATIAL METHODS TO CAPTURE WHAT’S CALLED THE ACTIVITY SPACE OF THE PERSON IF YOU LIVE IN ONE PLACE WHICH MOST OF US DO THOUGH NOT EVERYBODY AND YOU WORK IN ONE PLACE, THERE’S A SPATIAL ROUTINE, YOU GET UP IN THE MORNING, TAKE THE SAME ROOT TO WORK, SPEND YOUR DAY AT WORK AND MAYBE A COUPLE OF OTHER PLACES YOU GO SO WE HAVE MADE PROGRESS IN MODELING THE ENVIRONMENT OF THE PERSON NOW WHAT WE NEED TO DO IS FIGURE WAYS TO GROUP PEOPLE WHO SHARE THE SAME ENVIRONMENTS BECAUSE

BECAUSE IF YOU LIVE WITH CHILDREN OR HAVE A SPOUSE, THOUGH YOU SHARE THE SAME RESIDENTIAL LOCATION YOU MAY CIRCULATE IN VERY DIFFERENT PARTS OF THE WASHINGTON D.C SPACE ANOTHER INTERESTING QUESTION AROUND THAT FROM THE POINT OF VIEW OF DISEASE TRANSMISSION, IS IT THE ROUTINE GEOGRAPHY OF THE PERSON OR — I MEAN, I’M WAY OUT OF MY ACTIVITY SPACE TODAY LIKE THE PERSON ON THE PLANE WHO GETS SARS IS IT THE — IS IT THE UNPREDICTABLE TRIP YOU MAKE THAT HAS INFLUENCES THE DISEASES YOU’RE EXPOSED TO WE’RE AT A DISADVANTAGE IN THE UNITED STATES BECAUSE WE DONE MAINTAIN DETAILED RESIDENTIAL HISTORY DATA ON MOST PEOPLE IN THE UNITED STATES BUT IN OTHER COUNTRIES OF THE WORLD PARTICULARLY SCANDINAVIAN COUNTRIES, THEY HAVE COMPLETE DETAILED RESIDENTIAL HISTORIES FOR EVERY PERSON IN THE COUNTRY THAT CAN TELL YOU WHERE THEY LIVE AND HOW LONG THEY LIVE THERE HAD SO IT’S POSSIBLE TO RECREATE THESE TYPES OF TRAJECTORIES THROUGH TIME AN SPACE SO YOU CAN GO BACK AND SEE NOT JUST ARE YOU LIVING CLOSE TO SOME FACILITY NOW THAT’S HIGHLY POLLUTING BUT DID YOU LIVE THERE DURING SOME CRITICAL PERIOD OF YOUR LIFE SO WE NEED TO BUILD TIME AND SPACE INTO IT THE MORE EXTENSIVE THE STUDIES ARE THE BETTER WE CAN LOOK FOR ERRORS OR ANOMALIES OR THINGS THAT DON’T MAKE SENSE I THINK THAT WHEN I WAS GROWING UP MY FAMILY HAD A GENERAL PRACTITIONER HE CAME TO OUR HOUSE HAD AN EAR INFECTION HE CAME TO OUR HOUSE AND TOOK CARE OF US THINK ABOUT WHAT THAT DOES FOR A PHYSICIAN TO REALLY UNDERSTAND THE ENVIRONMENT OF THE PATIENT, THE LIVING ENVIRONMENT MOST PATIENTS TODAY DON’T DO THAT WHAT IS YOUR SPATIAL BASIS AS EVIDENCE? THE EXAMINATION ROOM AND THE PERSON SITTING IN IT, YOU HAVE TAKEN THAT PERSON OUT OF CONTEXT FAMILY PRACTITIONERS CAN FIND OUT A LOT ABOUT THE FAMILY CONTEXT, THE SORT OF WHAT YOU THINK OF AS THE ENVIRONMENTAL CONTEXT ISN’T THE ONLY RELEVANT CONTEXT DO YOU LIVE ALONE, DID YOUR SON TRY TO COMMIT SUICIDE THREE MONTHS AGO THIS IS GOING TO HAVE AFFECT FAMILY PRACTICERS UNDERSTAND THAT CONTEXT AS WELL SO THOSE ARE THE KINDS OF THINGS THAT I THINK WE NEED TO BE AWARE OF IN THE WORK PATTY IS DOING, AND AT THE BSSR CONFERENCE OPT NETWORK SHOP THAT I WAS A FACILITATOR AT, ACROSS THE BOARD WHETHER GENE ENVIRONMENT, WHETHER IT’S CULTURAL INFLUENCES, EVERYONE WAS SAYING THE SAME THING, WE HAVE MASSIVE AMOUNTS OF DATA FROM THE NEW TECHNOLOGY AND WE DONE KNOW HOW TO ANALYZE IT TEMPORALLY AND SPATIALLY EVEN A WHOLE SERIES OF BRAIN IMAGES OR SOMETHING SO I THINK IF WE CAN START TO COME TOGETHER AND TRY TO WORK ON THESE TEMPORAL AN SPATIAL ISSUES, WE CAN ADVANCE OUR UNDERSTANDING OF THINGS I HOPE THAT’S SOMEWHAT RESPONSIVE TO YOUR QUESTION LINDA (OFF MIC) >> I THINK MANY INDIVIDUALS WHO SERVE ON IRBs BECAUSE OF THE EDUCATION PROBLEM I MENTIONED IN POINT ONE ARE NOT AS KNOWLEDGEABLE AS THEY MIGHT BE ABOUT THESE METHODS AND THAT’S WHY I THINK WE REALLY NEED A MASSIVE EDUCATION EFFORT I SPENT — WHEN I WORKED AT THE INSTITUTE OR COMMUNITY RESEARCH WE HAD OWN OWN IRB AND I SPENT TIME EXPLAINING TO PEOPLE WHAT WE WANTED TO DO I THINK INFORMED CONSENT IS THE KEY AND I THINK YOU SHOULD BE LOOKING AT THIS PROSPECTIVELY GOING FORWARD AND SAYING TO

PEOPLE ONE, PEOPLE NEED TO BE INFORMED THAT ANY GEOGRAPHIC DATA YOU’RE COLLECTING ABOUT THEM, WHERE THEY LIVE OR WHATEVER IS PART OF THE DATA FOR THE STUDY I HAVE BEEN IRRITATED IN THE PAST WHEN LOOKING AT GRANTS AND PEOPLE HAD CONTACT INFORMATION AND THEY REALIZE THEY’RE SITTING ON SPATIAL DATA AND CAN GO BACK AND GEOCODE IT BUT THOSE INDIVIDUALS NEVER CONSENTED THAT THAT ADDRESS INFORMATION WAS GOING TO BE USED THAT WAY SO WE NEED TO RECOGNIZE THE SPACE IS PART OF THE SCIENCE, PART OF THE DATA FOR THE STUDY AND PEOPLE NEED TO HAVE THIS SPECIFICALLY MENTIONED TO THEM THEY NEED TO BE TOLD TOLD ABOUT THE RISKS TO PRIVACY LIKE IF YOU MAKE A MAP SHOWING INDIVIDUAL LOCATIONS, THAT CAN BE REVERSED GEOCODED AND USED O TO IDENTIFY PEOPLE EXPLAIN THAT BRIEFLY AND YOU CAN COME UP WITH LANGUAGE FOR THIS AND SAY WHAT STEPS YOU TAKE TO ENSURE YOU’RE NOT GOING TO PUBLISH THOSE MAPS MOST OF THEM DON’T UNDERSTAND IT EITHER AND THIS GOES BEYOND MAPPING WITH YOUR GEOENABLED DEVICE, IF THEY DON’T KNOW ANYTHING AND YOU THEY CAN TRIANGULATE AND GET CLOSE TO YOUR HOME LOCATION SO THAT THE TECHNOLOGY ITSELF IS MOVING RAPIDLY AWAY THE ANSWER TO THAT IS TO SAY YOU TELL PARTICIPANTS THIS IS GOING INTO DATA SHARING AND GOING TO THIS TECHNIQUE, WHATEVER MASKING AGGREGATION, WHATEVER TECHNIQUE IT MIGHT BE TO PRESERVE THE PRIVACY AND CONFIDENTIALITY OR YOU MAY GET SOMEBODY SAYING OKAY, I DON’T CARE SOME PEOPLE DON’T CARE OTHER PEOPLE LIKE ME DO I’M SENSITIVE TO THIS STUFF IN MY PERSONAL LIFE THAT’S WHERE WE NEED TO BE BUT I DON’T THINK MOST PEOPLE ON IRBs ARE THERE YET AND THEIR INCLINATION IS TO BE CONSERVATIVE, I THINK WISELY, IF THEY DON’T UNDERSTAND IT AND THEY THRI’S A THREAT THEY JUST — AND THEY THINK THERE’S A THREAT THEY JUST SAY NO BUT IF WE COULD EVEN JUST GEOCODE COME UP WITH A GEOREFERENCE OF WHERE THESE STUDIES WERE TAKING PLACE YOU DON’T NEED A GIS TO DO THAT GO TO GOOGLE MAPS AN PAN OVER TO INDIA, YOU CAN FIND THE SCHOOL ON THE GOOGLE MAPS AND IF YOU RIGHT CLICK SCROLL DOWN TO WHAT’S HERE, THE LONGITUDE, LATITUDE WILL COME UP THAT’S ALL SOMEBODY HAS TO DO TO GIVE YOU A GEOCODE FOR THIS PLACE WHEN THE STUDY OCCURRED OR ZOOM OUT TO THE TOWN AND PUT THAT IN THERE’S A GREAT BOOKLY LINDA HILL CALLED IT’S MORE COMPLICATED THAN THAT BUT WE NEED TO PUSH IT IN THIS DIRECTION I DON’T THINK WE’RE THERE YET, EVEN CLOSE WITH IRBs BUT WE NEED TO GIVE THIS INFORMATION WE NEED THIS WORK (OFF MIC) >> NO, MOST THINGS I LISTED HERE TO ME TRYING TO BUILD STUFF YOU’RE DOING ALREADY WHAT YOU DO PUBMED, YOU DO KEY WORDS, WE’RE TRYING TO TWEAK IT YOU DO HUMAN SUBJECTS STUFF, WE JUST NEED TO TWEAK THAT I ALSO WANT TO SAY TO PEOPLE WHO WORK FOR THE GOVERNMENT WHICH MOST OF YOU DO, I WAS AT A CONFERENCE SPONSORED BY ESRI, SOFTWARE COMPANIES, 15 YEARS AGO IN WASHINGTON, A GENTLEMAN STOOD UP AND SAID I WORK FOR A COMPANY THAT MANAGES THE PRESCRIPTION DRUG BENEFIT FOR AN THEM SOMEBODY SOMEBODY AND WE HAVE A DATABASE FOR EVERY PRESCRIPTION WRITTEN BY OUR INSURERS IN THE UNITED STATES I’M HERE TO FINE OUT HOW TO ANALYZE THESE DATA I ALMOST FELL OFF THE PODIUM THE MESSAGE, ANOTHER MESSAGE I WANT TO LEAVE WITH YOU HERE AT NIH OR IF YOU’RE FROM CDC OR WHATEVER, BELIEVE ME, THE PRIVATE SECTOR HAS THIS INFORMATION ABOUT US, THEY’RE USING IT BUT THEY’RE USING IT IN WAYS THAT WE CAN’T SEE BECAUSE THEY’RE PROPRIETARY INTERKS INTEREST I DON’T KNOW HOW YOU GET O THE REGULATORY THING AROUND THAT IF WE’RE IN A SITUATION WHERE LANDS END BECAUSE IT KNOWS ABOUT WAIST SIES SIZES AN TROUSERS ORDERED HAS BETTER BODY MASS INFORMATION THAN CDC DOES, WE’RE IN TROUBLE BECAUSE LAND END ISN’T NECESSARILY CONCERNED WITH ADVANCING THE HEALTH OF THE PEOPLE OF THE UNITED STATES THEY’RE CONCERNED WITH MAKING MONEY FROM SELLING US PANTS SO WE NEED TO UNDERSTAND WHEN STUDENTS SAY WHAT GOOD IS IT TO STUDY SOCIAL SCIENCE BELIEVE ME, BUSINESSES USE SOCIAL SCIENCE ALL THE TIME

AGAINST US, MAYBE NOT NECESSARILY ALWAYS TO SERVE OUR INTEREST, I GOT TO STOP APPROXIMATE LEAVE TIME FOR MORE QUESTIONS DEB (OFF MIC) >> NO, IT’S NOT IF YOU’RE ASKING A QUESTION YOU DON’T KNOW THE ANSWER TO IT’S NOT A STUPID QUESTION (OFF MIC) >> THAT’S ANOTHER HUGE PROBLEM I HAVE HARANGED THE OTHER SIDE OF THE TABLE ON THIS SOME AREAS ARE BETTER THAN OTHERS IF YOU LOOK AT WEATHER AND CLIMATE AND SOME KINDS OF ENVIRONMENTAL DATA, WE DO HAVE BIG, LONG ARCHIVES OF THAT TYPE OF DATA AT WHATEVER SCALE AND THERE MAYBE PROBLEMS WITH IT IF YOU’RE LOOK AT SOMETHING LIKE WHAT IS THE STRUCTURE OF THE P PUBLIC DRINKING WATER SYSTEM IN A PARTICULAR PLACE, THESE DATA HAVE BEEN MANAGED USING GIS SYSTEMS NOW PROBABLY 15 TO 20 YEARS BY ENGINEERING DEPARTMENTS AND STUFF THE NEW WATER MAIN THEY UPDATE THE GIS DATABASE THEY’RE NOT SAVING THE OLD STUFF SO WE HAVE NO WAY, WE’RE NOT ABLE TO GO BACK, IF WE FIND THAT THERE WAS A CONTAMINATION EVENT TEN YEARS AGO WE’RE NOT ABLE TO GO BACK AND SAY WHAT WAS THE PUBLIC DRINKING WATER SYSTEM LIKE TEN YEARS AGO WHEN THE EVENT OCCURRED SO THAT’S NOT A STUPID QUESTION AT ALL WE — I THINK THAT I HAVE BAGGED HOW COME WE HAVE THE 18, 19 MASS OF YELLOW FEVER HANGING AROUND? SOMEBODY SAVED IT, SOMEBODY KEPT TRACK OF META DATA ABOUT IT, WHERE IT CAME FROM AND SOMEBODY PUT ANYTIME THE PUBLIC DOMAIN IT’S AN IRONY OF THE COMPUTER AGE THAT MANY OF US ACTUALLY HAVE LESS ACCESS TO LESS DETAILED GEOSPATIAL INFORMATION THAN WE DID IN THE 1970s WHEN A LOT OF STUFF WAS PAPER THAT’S SOMETHING WE ABSOLUTELY AS HAVE TO BE WORKING ON IT’S NOT JUST THE HEALTH COMMUNITY I ALSO WANT TO SAY THIS PROBLEM IS COMPOUNDED IN A COUNTRY LIKE THE UNITED STATES BECAUSE WE HAVE A FEDERAL SYSTEM OF GOVERNMENT EVEN THOUGH PEOPLE LIKE TO THINK WE HAVE A REALLY STRONG CENTRAL GOVERNMENT IN THE U.S. COMPARED TO OTHER COUNTRIES WE REALLY DON’T MOST THINGS HAPPEN AT THE STATE LEVEL OR LOCAL LEVEL LAND USE, LOCAL LEVEL N. DENMARK I WAS AT THE DANISH EQUIVALENT OF USGS AND THEY WERE GIVING TALK AND IT WAS A SMALL GROUP, I WAS THERE WITH A BUNCH OF MAP LIBRARIANS AND THEY CAME AND ROLLED OUT THIS OLE MAP THAT THEY HAD TAKEN OUT OF THEIR ARCHIVES AND THEY SAID THE DANISH — THIS IS THE MAP OF LIKE PROPERTY RECORDS, DATES TO THE 9TH CENTURY, IT CAN GO BACK TO THE 9TH CENTURY AND FIGURE OUT WHO OWNS PARCELS OF LAND IN CONNECTICUT WE HAVE PARCELS THAT HAVE NEVER BEEN SURVEYED, THEY HAD MEATS AND BOUNDS DESCRIPTIONS HANDED DOWN WITHIN FAMILIES, THERE IS A DESCRIPTION LIKE GO TO THE BIG TREE ON THE CORNER AND — YOU KNOW, SO FOR ALL THIS TECHNOLOGY IN MANY AREAS WE DON’T HAVE GOOD CONTEXTUAL DATA TO HOOK ON TO THAT YES (OFF MIC) >> THANK YOU OTHER QUESTIONS OR COMMENTS? BILL (OFF MIC)

>> THERE IS A LOT OF INTEREST I THINK YOU EVEN HOSTED SOME THINGS HERE AT NIH ON CROWD SOURCING I KNOW WHEN WE HAD SOME OF THE LATEST INFLUENZA OUTBREAKS, PEOPLE FELT THE DATA THAT WERE COMING — BEING CROWD SOURCED AND PUT UP WERE MORE CURRENT, MORE — CAME OUT FASTER THAN WHAT THE CDC WAS PUTTING OUT SO VOLUNTEER GEOGRAPHIC INFORMATION ABOUT ALL KINDS OF THINGS IS A DEFINITE POSSIBILITY EVEN SO WE STILL HAVE TO TAKE INTO ACCOUNT THESE PRIVACY AND CONFIDENTIALITY QUESTIONS WHILE I THINK THAT’S ALL GREAT, IN A SENSE YOU CAN LOOK AT THAT MALARIA ATLAS PROJECT AS KIND OF CROWD SOURCING YOU GOT A BUNCH OF PEOPLING TO AND SAID GIVE US — SHARE WITH US WHAT YOU HAVE GOT THE REASON PEOPLE WERE WILLING TO SHARE IS THEY KNEW THEY WERE GETTING SOMETHING REALLY GOOD BACK THAT THEY COULDN’T PRODUCE ON THEIR OWN SO I THINK THAT THAT’S COMING BUT AT THE SAME TIME I THINK IF YOU’RE ABOUT SCIENCE WHICH IS WHAT NIH IS, YOU ALSO KNOW WE DO HAVE TO BRING A CERTAIN KIND OF RIGOR TO THIS ASKING SOMEBODY HAVE YOU EVER HAD LYME DISEASE IS A VERY DIFFERENT MIND SET FROM HAVING SOME TYPE OF AGREED-UPON CASE DEFINITION FOR WHAT LYME DISEASE S THIS IS A REASON IT’S HUGELY CONTROVERSIAL WE HAVE TO DEAL WITH THAT ISSUE I THINK, HOW YOU CAN GET GOOD SCIENCE FROM CROWD SOURCING YOU MAY HAVE READ THINGS LIKE ON GOOGLE NOW PEOPLE ARE BEING PAID TO SAY A COFFEE SHOP IS CLOSED WHEN IT ISN’T REALLY CLOSED WE REALLY NEED TO THINK THROUGH AGAIN, WHAT IS THE BASIS OF EVIDENCE WE’RE NOT JUST ABOUT SCIENCE — TECHNOLOGICAL BELLS AN WHIS LES, WE’RE ABOUT SCIENCE AND WE NEED TO MAKE SURE WHATEVER WE’RE DOING, THE OTHER POINT I WOULD MAKE ABOUT THE YOUNG PEOPLE IS ONE REASON SARA AND I WROTE THE FIRST EDITION OF OUR BOOK TEN YEARS AGO, WE TAUGHT AND WE KNEW THAT IF YOU WANTED TO GET THINGS TAUGHT, THERE HAD TO AT LEAST BE P ONE TEXTBOOK OR A COUPLE OF TEXTBOOKS SO WE WERE HOPING IF WE WROTE A TEXTBOOK WE GET MORE TEACHING THIS IN SCHOOLS OF PUBLIC HEALTH AND OTHER AREAS THERE’S DEFINITELY BEEN A PUSH BACK COMING I WENT BEFORE A TALK I GAVE THIS SUMMER IN ATLANTA I LOOKED ONLINE AT THE RECENT ACCREDITATION CRITERIA, WHAT YOU’RE SUPPOSED TO TEACH PEOPLE GETTING DEGREES IN SCHOOLS OF PUBLIC HEALTH AND WHAT THE CURRICULUM SHOULD BE AND EVERYTHING THERE’S NOT A SINGLE MENTION OF COMMUNITY, THE WORD COMMUNITY, NEIGHBORHOOD, GIS, GEOGRAPHIC, NO TIME SPACE ANALYSES I UNDERSTAND THERE’S A WHOLE POLITICS AROUND THIS BUT I THINK IT’S A REALLY SERIOUS ISSUE IN THIS COUNTRY, WHAT — AND IT’S NOT THAT THE UNIVERSITIES DON’T HAVE ACCESS TO THE SOFTWARE, AND PROBABLY MOST SCHOOLS OF PUBLIC HEALTH HAVE COMPUTER LABS AND STUFF NOW, BUT THEY’RE NOT REQUIRED TO TAKE IT NOT REQUIRED TO KNOW IT HOW MANY GENERATIONS OVER THE LAST TEN YEARS SINCE WE HAVE HAD GPS, HOW MANY GENERATIONS, WE HAVE HAD, WHAT, TEN CLASSES OF MASTERS IN PUBLIC HEALTH STUDENTS COMING OUT THE LAST TEN YEARS, MOST WHOM HAD NO EXPOSURE TO THESE METHODS ALSO HAVE NO EXPOSURE TO THE U.S. CENSUS WHICH IS THE MAIN SOURCE OF POPULATION DATA IN OUR COUNTRY, SO ON SO THAT’S THE EDUCATIONAL ISSUE AND YOU AT NIH CAN SPEND HOWEVER MUCH MONEY YOU SPEND ON A CAREER DEVELOPMENT AWARD GETTING SOMEBODY LIKE ME TO HELP SOMEBODY LIKE BLAIR OUT FOR FREE I HELP HIM, HE GETS SOMETHING OUT OF IT THAT’S AN INEFFICIENT WAY TO ME TO EDUCATE PEOPLE I CAN SEE WHEN METHODS WERE KNEW AND PEOPLE COULD NOT HAVE BEEN EXPECTED TO HAVE BEEN TAUGHT THIS IN SCHOOL WHEN I FIRST WENT TO UCONN OUR CARTOGRAPHY COURSES WERE HAND DRAWING AND PHOTO REPRODUCTION OF MAPS THAT WAS IN 1984 WE HAD TO MAKE A DECISION WHEN THESE NEW TECHNOLOGIES CAME ONLINE THAT THEY WERE REVOLUTIONIZING OUR FIELD AND WE HAD TO GET RID OF THE DARK ROOM AND THE SAM RA AND THE DRAWING TABLES AND THE MYLAR AND PENS

AND HAD TO PUT IN COMPUTERS THAT COULD DO THE SOFTWARE AND I WAS ALREADY OUT, I HAD NEVER BEEN EDUCATED IN THIS STUFF WHEN I WAS IN GRADUATE SCHOOL BUT WE DID IT BECAUSE WE KNEW WE HAD TO AND I THINK WE NEED TO GET THERE WITH HEALTH EDUCATION THANK YOU FOR LETTING ME BE SO BLUNT WE’RE PROBABLY WAY OVER TIME (OFF MIC)

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