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PURPOSE: Receipt of alcohol-related care for alcohol use is particularly low among those residing in the U.S.-Mexico border region. One reason for this disparity may be limited treatment accessibility, making it difficult for those who need it to access needed treatment. The current study assesses whether differences in treatment utilization are mediated by differences in treatment accessibility in cities within and outside of the border region. METHODS: We used data from the U.S.-Mexico Study of Alcohol and Related Conditions involving a probability sample of Mexican-origin adults surveyed in three cities in Texas (2011-2013). We included only participants with a lifetime history of alcohol use disorder (AUD) (n = 792). We examined two lifetime measures of self-reported alcohol treatment utilization: considering getting help for an alcohol problem and receipt of treatment. We geocoded locations of facilities listed in the SAMHSA National Directory of Drug and Alcohol Abuse Treatment Facilities. We considered three types of facilities: any outpatient treatment, programs offering fee assistance, and programs offering Spanish-language services. We measured treatment accessibility by density of treatment (i.e., number of facilities within a 20-mile radius of participant's residence) and proximity to treatment (i.e., travel time to nearest facility). We assessed direct and indirect effects of two cities in the border region (versus one nonborder city) on the outcomes through treatment accessibility using generalized structural equation models that accounted for clustering of respondents in cities and in neighborhoods, weighted for sampling and nonresponse and adjusted for covariates. RESULTS: Of 792 respondents with lifetime AUD, 22% had considered getting help and 11% had received treatment, with consideration of getting help being less likely in cities in the border region. We observed no significant differences in treatment receipt across cities. Reduced densities of all three types of treatment programs were significant mediators for the effect of residing in a border region on considering getting help. Time to nearest Spanish-language program also mediated the effect of residing in a border region on considering getting help for one city. CONCLUSIONS: Border cities had lower density of treatment and because treatment density was positively associated with considering getting help, residence in a city in the border region was associated with lower odds of considering getting help, regardless of type of treatment. These findings suggest increasing the number of treatment locations available within cities along the U.S.-Mexico border may encourage those with AUD to consider getting help.

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OBJECTIVE: Evidence suggests that spatial accessibility to primary care is a contributing factor to appropriate health care utilization, with limited primary care access resulting in avoidable hospitalizations and emergency department visits which are burdensome on individuals and our health care system. Limited research, however, has examined the effects on children. METHODS: We evaluated associations of spatial accessibility to primary care on health care utilization among a sample of 16,709 children aged 0 to 3 years in Philadelphia who were primarily non-White and publicly insured. Log-Poisson models with generalized estimating equations were used to estimate incidence rate ratios (RR) and 95% confidence intervals (CI), while accounting for 3 levels of clustering (within individual, within primary care practice, within neighborhood). RESULTS: In age-adjusted models, the lowest level of spatial accessibility was associated with 7% fewer primary care visits (RR 0.93, 95% CI 0.91, 0.95), 15% more emergency department visits (RR 1.15, 95% CI 1.09, 1.22), and 18% more avoidable hospitalizations (RR 1.18, 95% CI 1.01, 1.37). After adjustment for individual- (race/ethnicity, sex, number of chronic conditions, insurance status) and neighborhood-level (racial composition and proportion of housing units with no vehicle), spatial accessibility was not significantly associated with rate of health care utilization. CONCLUSIONS: Individual-level predisposing factors, such as age, race, and need, attenuate the association between accessibility to primary care and use of primary care, emergency department visits, and avoidable hospitalization. Given the possibility of modifying access to primary care unlike immutable individual factors, a focus on spatial accessibility to primary care may promote appropriate health care utilization.

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Due to restrictions on personnel availability, the service capacity at a health facility may vary day to day based on an established schedule. This temporal variability influences a user's choice set, modifying their possible choices. As a result, the spatial accessibility of public health care may be constantly reshaped rather than being a relatively static experience as commonly represented in place-based spatial accessibility literature. Building on the latest advances in the two-step floating catchment method, this study presents further advancements through the inclusion of health facility schedules to better represent health care availability in the assessment of accessibility. The results show that the proposed method reveals communities with relatively poor accessibility that are hidden with many existing methods. By exposing the available care within time windows, a more accurate picture of the services available to be accessed is revealed. The findings suggest that improvement in the number of doctor hours at health facilities may reduce the disparities found in accessibility scores for communities. Further, in public health care systems similarly structured, the spatial configuration of facilities with doctors can be considered at the administrative level to ensure adequate levels of access across the jurisdiction.

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BACKGROUND: The geographical accessibility of health services is an important issue especially in developing countries and even more for those sharing a border as for Haiti and the Dominican Republic. During the last 2 decades, numerous studies have explored the potential spatial access to health services within a whole country or metropolitan area. However, the impacts of the border on the access to health resources between two countries have been less explored. The aim of this paper is to measure the impact of the border on the accessibility to health services for Haitian people living close to the Haitian-Dominican border. METHODS: To do this, the widely employed enhanced two-step floating catchment area (E2SFCA) method is applied. Four scenarios simulate different levels of openness of the border. Statistical analysis are conducted to assess the differences and variation in the E2SFCA results. A linear regression model is also used to predict the accessibility to health care services according to the mentioned scenarios. RESULTS: The results show that the health professional-to-population accessibility ratio is higher for the Haitian side when the border is open than when it is closed, suggesting an important border impact on Haitians' access to health care resources. On the other hand, when the border is closed, the potential accessibility for health services is higher for the Dominicans. CONCLUSION: The openness of the border has a great impact on the spatial accessibility to health care for the population living next to the border and those living nearby a road network in good conditions. Those findings therefore point to the need for effective and efficient trans-border cooperation between health authorities and health facilities. Future research is necessary to explore the determinants of cross-border health care and offers an insight on the spatial revealed access which could lead to a better understanding of the patients' behavior.

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BACKGROUND: This study explores the spatial accessibility of outpatient drug treatment facilities and the potential relationship with drug use-related outcomes among Mexican American heroin users. METHODS: Secondary data on 219 current and former heroin-injecting Mexican American men aged 45 and older were drawn from a research study in Houston, Texas. We used geographic information systems (GIS) to derive two spatial accessibility measures: distance from one's place of residence to the closest drug treatment facility (in minutes); and the number of facilities within a 10-minute driving distance from one's place of residence. Exploratory logistic regression analyses examined the association between the spatial accessibility of drug treatment facilities and several drug use-related outcomes: internal locus of control (LOC); perceived chances and worries of injecting in the next six months; treatment utilization; and location of last heroin purchase. RESULTS: Participants with greater spatial access to treatment programs were more likely to report a higher chance of injecting in the near future. However, while current heroin users were more worried about injecting in the next six months, greater spatial access to treatment programs seemed to have a buffering effect. Finally, those who lived closer to a treatment programs were more likely to have last purchased heroin inside the neighborhood versus outside the neighborhood. Spatial accessibility was not associated with internal LOC or treatment utilization. CONCLUSION: The findings showed that the presence of outpatient treatment facilities-particularly services in Spanish-may influence perceived risk of future heroin use and purchasing behaviors among Mexican American men. Implications for future spatially-informed drug use research and the planning of culturally and linguistically responsive drug treatment programs are discussed.

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Este estudo integrou sistemas de informação geográfica e métodos analíticos geoespaciais baseados em modelos de acessibilidade espacial e de locação-alocação com o objetivo de aprimorar o planejamento espacial de diferentes programas de saúde pública em áreas urbanas. Para estimar a acessibilidade espacial foi desenvolvido o modelo de três passos de área de influência flutuante (E3SFCA - Enhancement three-step floating catchment área) baseado em uma função Gaussiana, considerando um coeficiente de atrito e distâncias ao longo de uma rede de transporte, utilizando o algoritmo de Dijkstra. A metodologia foi aplicada e validada usando os programas de vacinação contra a raiva e de esterilização para cães e gatos da cidade de Bogotá, Colômbia. A escolha do método de cálculo da distância resolveu o problema de superestimação associado com a metodologia clássica que aplica zonas buffer em torno dos locais de serviço baseado em uma distância Euclideana. Em geral, não se encontrou uma adequada acessibilidade espacial aos dois programas. As zonas norte, central e periférica da cidade revelaram baixa ou nula acessibilidade aos serviços. Para determinar a alocação e realocação efetiva dos programas foram utilizados os problemas de máxima cobertura com demanda finita e de p-mediana ou de mínima impedância. A realocação proposta pelo modelo de máxima cobertura forneceu uma melhor distribuição dos serviços nas áreas mais povoadas com cães e gatos e garantiu uma acessibilidade espacial potencial a estes programas. O desenvolvimento deste trabalho pode trazer benefícios diretos para a sociedade em geral auxiliando no planejamento estratégico e melhorando a efetividade das ações públicas em áreas urbanas da América Latina.

This study integrated geographic information systems and geospatial analytical methods based on spatial accessibility and location-allocation models in order to improve the spatial planning of different public health programs in urban areas. To estimate the spatial accessibility, a Gaussian-based three-step oating catchment area (E3SFCA) method was developed, including a friction coeffcient and using distances along a street network based on Dijkstra/'s algorithm. The methodology was applied and valiated using the rabies vaccination and sterilization programs for dogs and cats in the city of Bogotá, Colombia. The choice of the distance calculation method solve the overestimation associated with the classic methodology that applies buffer zones around vaccination sites based on Euclidean (straight-line) distance. In general it was not observed an adequate spatial accessibility to both programs. The zones north, central and peripheral of the city revealed low or no access to services. To determine the effective allocation or reallocation of these programs the maximum coverage with finite demand and the p-median or minimum impedance problems were used. The relocation proposed by the maximum coverage model provided a better distribution of the services in the most populated areas and proportioned a potential spatial accessibility to these programs. The development of this work can provide direct benefits to society assisting in the strategic planning and improving the effectiveness of public policies in urban areas of Latin America.

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