The operation of Glen Canyon Dam on the Colorado River affects several downstream resources and water uses including water supply for consumptive uses in Arizona, California, and Nevada, hydroelectric power production, endangered species of native fish, recreational angling for non-native fish, and recreational boating in the Grand Canyon. Decisions about the magnitude and timing of water releases through the dam involve trade-offs between these resources and uses. The numerous laws affecting dam operations create a hierarchy of legal priorities that should govern these decisions. At the top of the hierarchy are mandatory requirements for water storage and delivery and for conservation of endangered species. Other resources and water uses have lower legal priorities. The Glen Canyon Dam Adaptive Management Program ("AMP") has substituted collaborative decision making among stakeholders for the hierarchy of priorities created by law. The AMP has thereby facilitated non-compliance with the Endangered Species Act by the Bureau of Reclamation, which operates the dam, and has effectively given hydroelectric power production and non-native fisheries higher priorities than they are legally entitled to. Adaptive management is consistent with the laws governing operation of Glen Canyon Dam, but collaborative decision making is not. Nor is collaborative decision making an essential, or even logical, component of adaptive management. As implemented in the case of Glen Canyon Dam, collaborative decision making has actually stifled adaptive management by making agreement among stakeholders a prerequisite to changes in the operation of the dam. This Article proposes a program for adaptive, but not collaborative, management of Glen Canyon Dam that would better conform to the law and would be more amenable to adaptation and experimentation than would the current, stakeholder-centered program.

Purpose: Implementation of a postpartum depression (PPD) screening while using evidence-based interventions to improve depressive symptoms, enhance breastfeeding (BF) self-efficacy, and strengthen the mother-infant dyad (MID).

Background and Significance: PPD is highly prevalent among women living in the United States and threatens the physical and psychological health of MIDs. Many of these women go undiagnosed and without treatment, further worsening symptoms and outcomes. This has inspired world healthcare leaders and organizations to address maternal mental health among postpartum women.

Methods: A 12-week evidenced-based project consisted of two-sets of participants including mothers and staff. A comprehensive maternal support program guided by an informational pamphlet (IP) and implementation of PPD screening using the Edinburgh Postnatal Depression Scale served as the two-part intervention for this project. Goals were to decrease PPD, enhance BF satisfaction, and strengthen the MID. Comprehensive maternal support encompasses interventions proven to meet the project goals and includes tailored BF education and care to maternal needs, social support by peer/family involvement, skin-to-skin contact during BF, emotion-regulation strategies, and availability of community resources.

Outcomes: The BSES-SF scores did result in statistical significance based on an alpha value of 0.10, t(3) = -2.98, p = .059, proving a positive effect was seen in breastfeeding self-efficacy post intervention. The results did not show statistical significance (t(3) = 0.60, p = .591) in regard to pre and post-depression scores. However, the mean pre-score (M =3.50, SD 3.11) did decrease post-intervention (M =2.75, SD 1.26) and exemplifies clinical significance.

Conclusion: The outcomes of this Quality-Improvement project showed improved scores for depression and BF self-efficacy post-intervention. This demonstrates the value in screening for PPD using a validated screening tool and instituting comprehensive maternal support guided by evidence-based practice in a community setting.

Routine cervical cancer screening has significantly decreased the mortality rate of cervical cancer. Today, cervical cancer predominantly affects those who are rarely or never screened. Government programs are in place to provide cervical cancer screening at little to no cost, yet screening rates remain suboptimal.

This project evaluated an evidence-based intervention to increase cervical cancer screening among underserved women in a federally qualified health center (FQHC). Female patients ages 21 to 65 years without history of hysterectomy (n=1,710) were sent reminders to their phones through the electronic health record (EHR). The message included educational material about the screening process and an announcement regarding government aid for free or reduced cost screening.

The number of patients who made an appointment after receiving the message was assessed two months later. In total, 156 responses were collected, and 28 patients made an appointment for screening. The most frequently observed category of Ethnicity was Hispanic/Latina (n = 24, 86%). The most frequently observed category of Insurance was Title X (n = 13, 46%). The observations for Age had an average of 41.04 (SD = 9.93). Using an EHR communication function to send motivational reminders has shown some promise for increasing cervical cancer screening, thereby reducing cervical cancer mortality among the underserved.

Background: Extreme heat is a public health challenge. The scarcity of directly comparable studies on the association of heat with morbidity and mortality and the inconsistent identification of threshold temperatures for severe impacts hampers the development of comprehensive strategies aimed at reducing adverse heat-health events.

Objectives: This quantitative study was designed to link temperature with mortality and morbidity events in Maricopa County, Arizona, USA, with a focus on the summer season.

Methods: Using Poisson regression models that controlled for temporal confounders, we assessed daily temperature–health associations for a suite of mortality and morbidity events, diagnoses, and temperature metrics. Minimum risk temperatures, increasing risk temperatures, and excess risk temperatures were statistically identified to represent different “trigger points” at which heat-health intervention measures might be activated.

Results: We found significant and consistent associations of high environmental temperature with all-cause mortality, cardiovascular mortality, heat-related mortality, and mortality resulting from conditions that are consequences of heat and dehydration. Hospitalizations and emergency department visits due to heat-related conditions and conditions associated with consequences of heat and dehydration were also strongly associated with high temperatures, and there were several times more of those events than there were deaths. For each temperature metric, we observed large contrasts in trigger points (up to 22°C) across multiple health events and diagnoses.

Conclusion: Consideration of multiple health events and diagnoses together with a comprehensive approach to identifying threshold temperatures revealed large differences in trigger points for possible interventions related to heat. Providing an array of heat trigger points applicable for different end-users may improve the public health response to a problem that is projected to worsen in the coming decades.

This research evaluates the climatic summertime representation of the diurnal cycle of near-surface temperature using the Weather Research and Forecasting System (WRF) over the rapidly urbanizing and water-vulnerable Phoenix metropolitan area. A suite of monthly, high-resolution (2 km grid spacing) simulations are conducted during the month of July with both a contemporary landscape and a hypothetical presettlement scenario. WRF demonstrates excellent agreement in the representation of the daily to monthly diurnal cycle of near-surface temperatures, including the accurate simulation of maximum daytime temperature timing. Thermal sensitivity to anthropogenic land use and land cover change (LULCC), assessed via replacement of the modern-day landscape with natural shrubland, is small on the regional scale. The WRF-simulated characterization of the diurnal cycle, supported by previous observational analyses, illustrates two distinct and opposing impacts on the urbanized diurnal cycle of the Phoenix metro area, with evening and nighttime warming partially offset by daytime cooling. The simulated nighttime urban heat island (UHI) over this semiarid urban complex is explained by well-known mechanisms (slow release of heat from within the urban fabric stored during daytime and increased emission of longwave radiation from the urban canopy toward the surface). During daylight hours, the limited vegetation and dry semidesert region surrounding metro Phoenix warms at greater rates than the urban complex. Although prior work has suggested that daytime temperatures are lower within the urban complex owing to the addition of residential and agricultural irrigation (i.e., “oasis effect”) we show that modification of Phoenix's surrounding environment to a biome more representative of temperate regions eliminates the daytime urban cooling. Our results indicate that surrounding environmental conditions, including land cover and availability of soil moisture, play a principal role in establishing the nature and evolution of the diurnal cycle of near-surface temperature for the greater Phoenix, Arizona, metropolitan area relative to its rural and undeveloped counterpart.

Maricopa County, Arizona, anchor to the fastest growing megapolitan area in the United States, is located in a hot desert climate where extreme temperatures are associated with elevated risk of mortality. Continued urbanization in the region will impact atmospheric temperatures and, as a result, potentially affect human health. We aimed to quantify the number of excess deaths attributable to heat in Maricopa County based on three future urbanization and adaptation scenarios and multiple exposure variables.

Two scenarios (low and high growth projections) represent the maximum possible uncertainty range associated with urbanization in central Arizona, and a third represents the adaptation of high-albedo cool roof technology. Using a Poisson regression model, we related temperature to mortality using data spanning 1983–2007. Regional climate model simulations based on 2050-projected urbanization scenarios for Maricopa County generated distributions of temperature change, and from these predicted changes future excess heat-related mortality was estimated. Subject to urbanization scenario and exposure variable utilized, projections of heat-related mortality ranged from a decrease of 46 deaths per year (− 95%) to an increase of 339 deaths per year (+ 359%).

Projections based on minimum temperature showed the greatest increase for all expansion and adaptation scenarios and were substantially higher than those for daily mean temperature. Projections based on maximum temperature were largely associated with declining mortality. Low-growth and adaptation scenarios led to the smallest increase in predicted heat-related mortality based on mean temperature projections. Use of only one exposure variable to project future heat-related deaths may therefore be misrepresentative in terms of direction of change and magnitude of effects. Because urbanization-induced impacts can vary across the diurnal cycle, projections of heat-related health outcomes that do not consider place-based, time-varying urban heat island effects are neglecting essential elements for policy relevant decision-making.

Public transit systems have been identified as a critical component to reducing energy use and greenhouse gas emissions associated with the transportation sector to mitigate future climate change impacts. A unique aspect of public transit is its use almost always necessitates environmental exposure and the design of these systems directly influences rider exposure via rider ingress, egress, and waiting. There is a tension between policies and programs which promote transit use to combat climate change and the potential impact an uncertain climate future may have on transit riders.

In the American Southwest, extreme heat events, a known public health threat, are projected to increase between 150 and 840% over the next decade, and may be a health hazard for transit riders. There are opportunities to incorporate rider health risks in the overall planning process and develop alternative transit schedules during extreme heat events to minimize these risks. Using Los Angeles Metro as a case studies, we show that existing transit vehicles can be reallocated across the system to significantly reduce exposure for riders who are more vulnerable to heat while maintaining a minimum level of service across the system. As cities continue to invest in public transit it is critical for them to understand transit use as an exposure pathway for riders and to develop strategies to mitigate potential health risks.

Climate change is predicted to increase the intensity and negative impacts of urban heat events, prompting the need to develop preparedness and adaptation strategies that reduce societal vulnerability to extreme heat. Analysis of societal vulnerability to extreme heat events requires an interdisciplinary approach that includes information about weather and climate, the natural and built environment, social processes and characteristics, interactions with stakeholders, and an assessment of community vulnerability at a local level. In this letter, we explore the relationships between people and places, in the context of urban heat stress, and present a new research framework for a multi-faceted, top-down and bottom-up analysis of local-level vulnerability to extreme heat. This framework aims to better represent societal vulnerability through the integration of quantitative and qualitative data that go beyond aggregate demographic information. We discuss how different elements of the framework help to focus attention and resources on more targeted health interventions, heat hazard mitigation and climate adaptation strategies.