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Where We Live Matters: Social Determinants of HIV Risk

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An overview of social factors contributing to HIV risk, including Philadelphia-specific information and maps.

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Where We Live Matters: Social Determinants of HIV Risk

  1. 1. WHERE WE LIVE MATTERS:SOCIAL DETERMINANTS OF HIV RISK Presented by
  2. 2. TOPICS TO BE DISCUSSED• Racial/Ethnic Populations Distribution• Socio-economic Status  Poverty  Educational Attainment• Neighborhood Stability• Crime/Violence • Theft • Assault • Homicide• STDs• HIV/AIDS
  3. 3. OUR PLACE DETERMINES OUR HEALTH SOCIAL/But all of POLITICAL /these factors ECONOMICdetermine our DEMOGRAPHICS ENVIRONMENTplace INCOME
  4. 4. WHAT FACTORS IMPACT HEALTH?• Genetics• Access to medical care• Health literacy• Social networks• Stress levels/coping mechanisms• Income• Social Stigma (racism, sexism, ageism, etc.)• Education• Safety/Violence• Water, air, and soil quality• Access to healthy foods• Working conditions• Transportation
  5. 5. SOCIAL DETERMINANTS – WHAT?  Health is impacted by where we live, work, play and learn  Many factors outside of our control impact health and well being  Our early life experiences affect later health
  6. 6. SOCIAL DETERMINANTS• Social and economic factors are extremely powerful predictors of death and ill-health across a wide range of diseases and injuries• Three distinct components: – Socio-economic determinants • Age, sex, education – Psycho-social risk factors • Social support, self esteem, chronic stress – Community and societal characteristics • Income inequality, level of trust, social capital
  7. 7. SOCIOECONOMIC DETERMINANTS Age  Occupation Gender  Income Race  Religion Ethnicity  Housing Education Employment
  8. 8. PSYCHOSOCIAL RISK FACTORS Poor social networks  High physical/ Low self-esteem psychological demand Self-efficacy  Chronic stress Depression  Isolation Anxiety  Anger/hostility Insecurity  Coping Loss of sense of  Perception/ expectations control
  9. 9. COMMUNITY AND SOCIETALCHARACTERISTICS Social networks  Poverty Social and community  Residence (urban, participation rural) Civic and political  Income inequality involvement  Crime rate Trust in people and  Domestic violence social institutions  Unemployment rate Tolerance of diversity Altruism, charity work
  10. 10. SOCIO-ECONOMIC STATUS AND HEALTH Association between health and socio- economic status is causal  Our social and economic status can be the cause of either declining health or illness/disease  As income/education/status increase, health and well being increases (Ansari, Carson et. al, 2003)
  11. 11. SOCIAL DETERMINANTS AND HIV• Where we live affects health and HIV risk behaviors – Living in a socially disadvantaged neighborhood can lead to fatalism, risky coping mechanisms (substance abuse, risky sexual behaviors) – Some communities have limited or no access to health information or medical/mental health services – Social networks impact sexual and drug use behaviors and health
  12. 12. SOCIAL NETWORKS
  13. 13. WHO’S IN OUR SOCIAL NETWORK MATTERSComposition of social networks impacts HIV risk Individual risk is not determined by personal risk behavior alone, but also the “pool” of disease in their sexual/drug using networks (Augustine and Bridges, 2008; Adimora & Schoenbach, 2005; Aral, Adimora, Fenton, 2008)
  14. 14. WHO’S IN OUR SOCIAL NETWORK MATTERSComposition of social networks impacts HIV risk Factors impacting the intensity of HIV in a network:  Density – how many people in a network have had sexual contact with each other  Sorting – tendency of people with similar characteristics (race, age, neighborhood) to associate with one another and not others outside the community  Mixing – when someone has sexual contact with someone outside their primary network  Concurrent partnerships – having more than one sexual partner at a time
  15. 15. CONCURRENT PARTNERSHIPS Concurrent sexual partnerships or partnerships that overlap in time raise HIV transmission risks more than having multiple consecutive monogamous partnerships. Recent research found that African American men had 2.56 higher odds of engaging in concurrent relationships as White men. Poverty, substance use and abuse, and incarceration are associated with concurrent partnerships (Nunn, Dickman, Cornwall, et. al 2011)
  16. 16. SEX RATIO IMBALANCE Some African American communities have more females than males  Due to high infant mortality and death to violence and disease, as well as high incarceration rates  Imbalance grows as the population age increases – more boys for children, less males in elderly population  Imbalance affects behavior of both males and females, in terms of concurrency and risk behaviors  Women may perceive a shortage of men and tolerate behavior/risk they might not otherwise  Men have some leverage in relationships, because there are other women available
  17. 17. PHILADELPHIA FACTORS - CONCURRENCY Philly has the 4th highest incarceration rate in the U.S. – 5.7 per 100 residents Nearly 45% of African Americans have never been married Fewer than 10% of individuals living below the poverty line are married Philly has sex ratio of .82 for African Americans (Nunn, Dickman, Cornwall, et. al 2011)
  18. 18. HEALTH/MORTALITY
  19. 19. HEALTHCARE SYSTEM• Most socioeconomically disadvantaged populations tend to use more primary and secondary health services, but make less use of prevention services like: prenatal care, immunizations, health screening and dental services • Primary health services – regular doctor visits • Secondary health services – treatment of specialists to manage/cure disease
  20. 20. MORTALITY Black:White ratios of mortality from coronary heart disease, cancer and diabetes were larger in 1990s than 1950s. Researchers at CDC estimated that 38% of the excess mortality among Black adults compared to White adults was related to differences in income Krieger et. al estimated if everyone experienced the mortality of the wealthiest 20% of Whites, between 1960 and 2002 we would have avoided:  14% of premature deaths among Whites  30% of premature deaths for Blacks (Williams & Collins, 2001; Woolf & Braverman, 2011)
  21. 21. RACE AND ETHNICITYSegregation and social factors
  22. 22. RACIAL/ETHNIC COMPOSITION Philadelphia population: 1,526,006  White: 626,221 or 41.0 %,  46,893 Male & 66,239 Female below the poverty level (2009)  Black: 661,839 or 43.4 %  79,976 Male & 111,335 Female below the poverty level (2009)  Hispanic: 172,483 or 11.3%  31,600 Male & 37,799 Female below the poverty level (2009)  Asian: 96,405 or 6.3%  Male 9,877 & 9,835 Female below the poverty level (2009) (US Census Data)
  23. 23. RACIAL/ETHNIC DISPARITIESCompared with Whites, Black and Hispanics: Generally  Earn less income and have less schooling  At the same educational level, have lower incomes  At the same educational/income level, are more likely to have grown up in disadvantaged circumstances  At a given income level  Have less wealth (all earnings, properties, investments)  Live in unstable neighborhoods (RWJF 2011)
  24. 24. RACIAL SEGREGATION AND SOCIAL FACTORS Race may help determine place, but people of different ethnic/racial groups experience similar health outcomes in severely disadvantaged neighborhoods Segregation is the primary cause of racial differences in socio- economic status (SES) The worst urban context in which Whites live is better than the average context for Black communities. Many segregated areas have high levels of multiple sources of stress including:  Violence  Financial stress  Family separation  Chronic illness  Death  Family turmoil (Williams & Collins, 2001; Woolf & Braverman, 2011)
  25. 25. EDUCATIONAL ATTAINMENT ANDINCOME
  26. 26. EDUCATIONAL ATTAINMENT Educational attainment affects health through:  Health knowledge  Employment and income  Sense of control  Social networks People with more education are more likely to:  Live longer  Experience better health outcomes  Practice health-promoting behaviors  Have close friends on whom they can rely  Have greater family stability and supportive marriages (RWJ, 2011)
  27. 27. EDUCATIONAL ATTAINMENT Residential segregation has led to highly segregated primary and secondary schools and is the fundamental cause of racial differences in the quality of education Children’s health is strongly linked to their parents’ education, particularly mother’s
  28. 28. PHILADELPHIA- EDUCATIONAL ATTAINMENT 80% of Philadelphians 25 years and older have HS diploma/GED or greater  6% less than 9th grade  13.4% have 9-12th grade  16.6% Some college/no degree  12.8% Bachelor’s degree  9.8% Graduate degree  Philadelphia drop out rate is 3.37% in 2010, highest in PA
  29. 29. POVERTY AND CHRONIC STRESS Poverty/near poverty is often stressful because so much time/energy devoted to daily tasks and securing necessities Stress can lead to harmful coping mechanisms like smoking, drug use and risky sex Chronic stress or stress during critical periods can lead to illness in adulthood through the neuroendocrine (nervous system transmitters), immune, inflammatory pathways/systems  Chronic diseases like diabetes and heart disease  Low birth weight, prematurity  Neuroendocrine problems with lifelong effects (some cancers (RWJF, 2011)
  30. 30. POVERTY AND FAMILIES Total Married Male Female Families Couple Householder Householder Families with no wife no husband own children present with present with under 18 own children own children present under 18 under 18 311,055 64,488 or 13,818 or 64,800 or 20.73% 4.44% 20.83%Families below 59,827 8,056 or 4,271 or 33,734 orpoverty line in 13.47% 7.14% 56.39%2009 inflation-adjusted $ Average Family Income -$45,842 (in 2009 inflation adjusted $’s) Philadelphia has highest poverty rate of the 10 largest cities
  31. 31. THE GAP WIDENSBetween 2005 and 2009 the average net worthof households decreased considerably: • Fell by 16% Whites • From $134,992 to $113,149 • Fell by 53% Blacks • From $12,124 to $5,677 • Fell by 66% Hispanics • From $18,359 to $6,325 (Woolf & Braverman, 2011)
  32. 32. VIOLENCE AND SOCIALDISADVANTAGE
  33. 33. SOCIAL DISADVANTAGE AND VIOLENCEPeople with limited income and social support/resources are more likely to:  Have social networks which include others of limited means and ability to provide support and comfort  Experience social disorganization  Experience conditions which deepen feelings of anger, frustration, hopelessness which may make it more likely to resort to violence  Have peers who engage in and encourage violent responses to conflict (RWJF, 2011)
  34. 34. LINKS BETWEEN VIOLENCE AND HEALTH Violence can affect health-related behaviors  Violence-associated stress affects motivation and capability to adopt and adhere to health-promoting behaviors and/or increases the use of health-harming coping behaviors Violence-related stress may lead to poorer health  Chronic stress has been linked to more rapid onset and progression of chronic illnesses and bodily wear and tear (which accelerates aging) Violence can influence health through its impact on social and economic conditions  Violence can lead to widespread feelings of fear, distrust and isolation  Violence can act as an obstacle to investments in health- promoting community resources and opportunities (supermarkets, jobs, parks) (RWJ, 2011)
  35. 35. NEIGHBORHOOD CHARACTERISTICS Extremely disadvantaged neighborhoods are characterized by a high degree of social isolation from mainstream society Most profound effects of living conditions may be delayed consequences that unfold over a lifetime Higher vacancy rates and greater prevalence of renters produce significantly higher levels of property crime Many studies have found relationships between neighborhood disadvantage and health, even after considering individual characteristics (behavior, income, etc.)  Distressed homes and neighborhoods can induce disease (lead, allergens, pollution)  Shortage of health care providers, especially primary care (Krivo & Peterson, 1993; Woolf & Braverman, 2011)
  36. 36. HOMICIDE Higher levels of relative and absolute deprivation are associated with higher levels of homicide Black-White segregation leads to higher rates of Black killing (stranger and acquaintance homicides)  Social isolation may act as the mechanism (Peterson & Krivo, 1993)
  37. 37. STIS AND HIV
  38. 38. SEXUALLY TRANSMITTED INFECTIONSSocial determinants create the epidemiological context for individual behaviors and STI transmission:  SES is one of the most important determinants of sexual health  High unemployment rates, low mean income and low education levels are associated with higher STI rates  Disparities in incarceration rates and high mortality for Black males have lead to disproportionate sex ratios in some communities (more women than men) (Hogben and Leichter, 2008; Thomas, Torrone, et al., 2009)
  39. 39. STIS AND HIV CDC identified higher HIV prevalence among heterosexual individuals who had previously received an STI diagnosis (4.0%) vs. those who did not (1.7%) Transmission and acquisition of HIV may be increased up to 10 times by the presence of other sexually transmitted infections (CDC MMWR 8/12/2011, Logan, Cole & Leukefield, 2002)
  40. 40. HIV/AIDSNational and Local Epidemiological Contexts
  41. 41. NATIONAL INCIDENCE DATA Estimated 48,100 HIV infections in 2009 in adults and adolescents (95% CI, 42,200 – 54,000) Estimated incidence 19.0 infections per 100,000 population 44% among blacks, 20% Latinos 61% among MSM, 27% heterosexual 39% among 13-29 year olds (AACO, 2011)
  42. 42. HIV IN PHILADELPHIA 25,563 people are living with HIV/AIDS in the Philadelphia 9 county region, almost 75% of those live in Philly Estimated another 5,000 HIV+ people are not aware of HIV+ status Philly’s HIV incidence rates are 4 times national average It is estimated that 2% of African Americans in Philly are HIV+
  43. 43. 2009 ESTIMATE OF HIV INCIDENCE -PHILADELPHIA Local estimate of 941 new HIV infections in 2009 in adults and adolescents (95% CI, 659 – 1,222) Case rate of 76.8 new HIV infections per 100,000 population  4 times the national rate  90% increase in incidence among youth, 13-24 between 2006 to 2009  Driven by increases in young, black, MSM
  44. 44. LOCAL INCIDENCE ESTIMATE - RACE 2009 HIV Diagnoses 2009 HIV Incidence N=913 N=941 38% 37% 62% 63% Black Non-Black Black Non-Black
  45. 45. LOCAL INCIDENCE ESTIMATE - AGE 2009 HIV Diagnoses 2009 HIV Incidence N=913 N=941 17% 27% 25% 30% 48% 53% 13-24 25-44 45+ 13-24 25-44 45+
  46. 46. LOCAL INCIDENCE ESTIMATE - MODE 2009 HIV Diagnoses 2009 HIV Incidence N=913 N=941 36% 39% 47% 50% 14% 14% MSM IDU Hetero MSM IDU Hetero
  47. 47. Mistrust of Health Care System SocialInequalityHistoric and Modern Inequality Increased Risk of HIV and STD Drug and Alcoho l Abuse Unprotected Sex Unsafe/ Unstable Concurrent Incarceration Neighborhoods Partnerships (Advocates for Youth, 2008)
  48. 48. NEIGHBORHOOD CHARACTERISTICS AND HIV Philadelphia neighborhoods with high rates of HIV (GENERALLY) have these characteristics:  Low socio-economic status  High concentration of Black/African American residents  High death rates due to homicide, AIDS, septicemia or other illness  High birth risk  High neighborhood instability  High crime rates of multiple types (PHMC, 2011)
  49. 49. INCOME AND HIV Material poverty is associated with an increase in risk behaviors CDC found HIV prevalence associated with socioeconomic status:  Prevalence higher among those :  With less than high school education* (2.8%)  Incomes at or below poverty* (2.3%)  Unemployed *(2.6%)  Homeless (3.1%) *statistically significant differences (CDC MMWR 8/12/2011)
  50. 50. Northeast Fairmont Airport Park La Salle PennypackClark Park ParkCobbsCreekParkPhila Int.Airport
  51. 51. BLACK POPULATION 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19139 19123 19123 19104 Legend 19104 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 m n La Salle, City Hall 19143 Airport 19146 19146 19147 19147 Runway FCC Parks 19142 19142 Rivers and Streams 19145 19145 tracts 19148 19148 BLACK POP % 0.07% - 4.44% 4.45% - 12.75% 12.76% - 32.4% 19112 19112 19153 19153 32.41% - 69.17% 69.18% - 94.44% 94.45% - 98.65% Zip Code Boundaries 19113 19113 0 0.40.8 1.6 Miles
  52. 52. HISPANIC POPULATION 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19139 19123 19123 19104 Legend 19104 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 m n La Salle, City Hall 19143 Airport 19146 19146 19147 19147 Runway FCC Parks 19142 19142 Rivers and Streams 19145 19145 tracts 19148 19148 HISPANIC POP % 0.26% - 1.24% 1.25% - 1.88% 1.89% - 2.75% 19112 19112 19153 19153 2.76% - 4.22% 4.23% - 10.01% 10.02% - 88.49% Zip Code Boundaries 19113 19113 0 0.40.8 1.6 Miles
  53. 53. WHITE POPULATION 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19139 19123 19123 19104 Legend 19104 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 m n La Salle, City Hall 19143 Airport 19146 19146 19147 19147 Runway FCC Parks 19142 19142 Rivers and Streams 19145 19145 tracts 19148 19148 WHITE / POP2000 0.28% - 2.41% 2.42% - 16.5% 16.51% - 45.3% 19112 19112 19153 19153 45.31% - 73.6% 73.61% - 90.16% 90.17% - 100% Zip Code Boundaries 19113 19113 0 0.40.8 1.6 Miles
  54. 54. FEMALE-HEADED HOUSEHOLDS WITHCHILDREN, 2010 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19122 19122 19151 19151 19125 19125 Legend 19130 19139 19139 19104 19104 19130 19102 19102 19123 19123 m n La Salle, City Hall 19143 m n 19103 19107 19103 19107 19106 19106 Zip Code Boundaries Airport 19143 19146 19146 19147 19147 Runway FCC 19142 19142 Parks 19145 19145 19148 19148 Rivers and Streams tracts 19112 19112 FHH_CHILD / HOUSEHOLDS 19153 19153 0.34% - 3.99% 4% - 6.93% 19113 19113 6.94% - 11.34% 11.35% - 16.44% 0 0.40.8 1.6 Miles 16.45% - 20.32% 20.33% - 50%
  55. 55. LIVING BELOW POVERTY, 2010 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19139 19123 19123 19104 Legend 19104 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 m n La Salle, City Hall 19143 Airport 19146 19146 19147 19147 Runway FCC Parks 19142 19142 Zip Code Boundaries 19145 19145 Rivers and Streams 19148 19148 tracts TPOPBELP / POP2010 1.19% - 8.34% 8.35% - 13.04% 19112 19112 19153 19153 13.05% - 19.97% 19.98% - 29.04% 29.05% - 38.28% 38.29% - 83.13% 19113 19113 0 0.40.8 1.6 Miles
  56. 56. LESS THAN HIGH SCHOOL, MALES > 25, 2010 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19139 19123 19123 19104 Legend 19104 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 m n La Salle, City Hall 19143 Airport 19146 19146 19147 19147 Runway FCC Parks 19142 19142 Zip Code Boundaries 19145 19145 Rivers and Streams 19148 19148 tracts M12THGNL / POP2010 0% 0.01% - 5.85% 19112 19112 19153 19153 5.86% - 8.1% 8.11% - 10.73% 10.74% - 13.17% 13.18% - 56.79% 19113 19113 0 0.40.8 1.6 Miles
  57. 57. LESS THAN HIGH SCHOOL, FEMALES >25, 2010 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19123 19123 19139 Legend 19104 19104 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 m n La Salle, City Hall 19143 Airport 19146 19146 19147 19147 Runway FCC Parks 19142 19142 Zip Code Boundaries 19145 19145 Rivers and Streams 19148 19148 tracts F12THGNL / POP2010 0% 0.01% - 6.54% 19112 19112 19153 19153 6.55% - 10.07% 10.08% - 13.21% 13.22% - 16.73% 16.74% - 37.5% 19113 19113 0 0.40.8 1.6 Miles
  58. 58. LICENSE AND INSPECTION DEMO, 2005 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19139 19123 19123 19104 19104 Legend 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 m n La Salle, City Hall 19143 Airport 19146 19146 19147 19147 Runway FCC Parks 19142 19142 Zip Code Boundaries 19145 19145 Rivers and Streams 19148 19148 tracts LIDEMORATE05 / HSE_UNITS 0% 0.01% - 0.16% 19112 19112 19153 19153 0.17% - 0.68% 0.69% - 1.74% 1.75% - 4.79% 4.8% - 43.31% 19113 19113 0 0.40.8 1.6 Miles
  59. 59. L & I PENDING DEMO, 2005 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19139 19123 19123 19104 19104 Legend 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 m n La Salle, City Hall 19143 Airport 19146 19146 19147 19147 Runway FCC Parks 19142 19142 Zip Code Boundaries 19145 19145 Rivers and Streams 19148 19148 tracts .LIPENDDEMO05 0 1-4 19112 19112 19153 19153 5 - 10 11 - 20 21 - 36 37 - 128 19113 19113 0 0.40.8 1.6 Miles

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