Faculty Bibliography

Throughout the first decade of the 2000s the homicide mortality rate (HMR) showed a significant reduction in the state and the city of São Paulo (MSP). The aim of this study is to describe the trend of HMR, socio-demographic indicators, and the investment in social and public security, and to analyze the correlation between HMR and independent variables in the MSP between 1996 and 2008. An exploratory time series ecological study was conducted. The following variables were included: HMR per 100,000 inhabitants, socio-demographic indicators, and investments in social and public security. The moving-averages for all variables were calculated and trends were analyzed through Simple Linear Regression models. Annual percentage changes, the average annual change and periodic percentage changes were calculated for all variables, and the associations between annual percentage changes were tested by Spearman's correlation analysis. Correlations were found for the proportion of youth in the population (r = 0.69), unemployment rate (r = 0.60), State budget for education and culture (r = 0.87) and health and sanitation (r = 0.56), municipal (r = 0.68) and State (r = 0.53) budget for Public Security, firearms seized (r = 0.69) and the incarceration rate (r = 0.71). The results allow us to support the hypothesis that demographic changes, acceleration of the economy, in particular the fall in unemployment, investment in social policies and changes in public security policies act synergistically to reduce HMR in São Paulo. Complex models of analysis, incorporating the joint action of different potential explanatory variables, should be developed.

BACKGROUND: Accidental drug overdose is a major cause of mortality among drug users. Fears of police arrest may deter witnesses of drug overdose from calling for medical help and may be a determinant of drug overdose mortality. To our knowledge, no studies have empirically assessed the relation between levels of policing and drug overdose mortality. We hypothesized that levels of police activity, congruent with fears of police arrest, are positively associated with drug overdose mortality. METHODS: We assembled cross-sectional time-series data for 74 New York City (NYC) police precincts over the period 1990-1999 using data collected from the Office of the Chief Medical Examiner of NYC, the NYC Police Department, and the US Census Bureau. Misdemeanor arrest rate-reflecting police activity-was our primary independent variable of interest, and overdose rate our primary dependent variable of interest. RESULTS: The mean overdose rate per 100,000 among police precincts in NYC between 1990 and 1999 was 10.8 (standard deviation=10.0). In a Bayesian hierarchical model that included random spatial and temporal effects and a space-time interaction, the misdemeanor arrest rate per 1000 was associated with higher overdose mortality (posterior median=0.003, 95% credible interval=0.001, 0.005) after adjustment for overall drug use in the precinct and demographic characteristics. CONCLUSIONS: Levels of police activity in a precinct are associated with accidental drug overdose mortality. Future research should examine aspects of police-community interactions that contribute to higher overdose mortality.

OBJECTIVE:To describe homicide mortality in the municipality of São Paulo according to type of weapon, sex, race or skin color, age, and areas of socioeconomic inequalities, between 1996 and 2008. METHOD/METHODS:For this ecological time-series study, data about deaths in the municipality of São Paulo were collected from the municipal program for improvement of mortality information, using International Classification of Diseases, 10th revision (ICD-10) codes. Homicide mortality rates (HMR) were calculated for the overall population and specifically for each sex, race or skin color, age range, type of weapon, and occurrence in social deprivation/affluence areas. HMR were adjusted for age using the direct method. The percentage age of variation in HMR was calculated for the study period. For areas of socioeconomic inequalities, the relative risk of death from homicide was calculated. RESULTS:HMR fell 73.7% between 2001 and 2008. A reduction in HMR was observed in all groups, especially males (-74.5%), young men between 15 and 24 years of age (-78.0%), and residents in areas of extreme socioeconomic deprivation (-79.3%). The reduction occurred mostly in firearm homicide rates (-74.1%). The relative risk of death from homicide in areas of extreme socioeconomic deprivation, as compared to areas with some degree of socioeconomic deprivation, was 2.77 in 1996, 3.9 in 2001, and 2.13 in 2008. In areas of high socioeconomic deprivation, the relative risk was 2.07 in 1996 and 1.96 in 2008. CONCLUSIONS:To understand the reduction in homicide rates in the municipality of São Paulo, it is important to take into consideration macrodeterminants that affect the entire municipality and all population subgroups, as well as micro/local determinants that have special impact on homicides committed with firearms and on subgroups such as the young, males, and residents of areas of high socioeconomic deprivation.

BACKGROUND:The purpose of this review is to systematically appraise the peer-reviewed literature about the genetic and environmental determinants of psychiatric comorbidity, focusing on four of the most prevalent types of psychopathology: anxiety disorders, depression, conduct disorder and substance abuse. METHODS:We summarize existing empirical research on the relative contribution that genetic, nonshared and shared environmental factors make to the covariance between disorders, and evidence about specific genes and environmental characteristics that are associated with comorbidity. RESULTS:Ninety-four articles met the inclusion criteria and were assessed. Genetic factors play a particularly strong role in comorbidity between major depression and generalized anxiety disorder or posttraumatic stress disorder, while the non-shared environments make an important contribution to comorbidity in affective disorders. Genetic and non-shared environmental factors also make a moderate-to-strong contribution to the relationship between CD and SA. A range of candidate genes, such as 5HTTLPR, MAOA, and DRD1-DRD4, as well as others implicated in the central nervous system, has been implicated in psychiatric comorbidity. Pivotal social factors include childhood adversity/life events, family and peer social connections, and socioeconomic and academic difficulties. LIMITATIONS/CONCLUSIONS:Methodological concerns include the use of clinical case-control samples, the focus on a restricted set of individual-level environmental risk factors, and restricted follow-up times. CONCLUSIONS:Given the significant mental health burden associated with comorbid disorders, population-based research on modifiable risk factors for psychiatric comorbidity is vital for the design of effective preventive and clinical interventions.

OBJECTIVES: We assessed whether New York City's gun-related homicide rates in the 1990s were associated with a range of social determinants of homicide rates. METHODS: We used cross-sectional time-series data for 74 New York City police precincts from 1990 through 1999, and we estimated Bayesian hierarchical models with a spatial error term. Homicide rates were estimated separately for victims aged 15-24 years (youths), 25-34 years (young adults), and 35 years or older (adults). RESULTS: Decreased cocaine consumption was associated with declining homicide rates in youths (posterior median [PM] = 0.25; 95% Bayesian confidence interval [BCI] = 0.07, 0.45) and adults (PM = 0.07; 95% BCI = 0.02, 0.12), and declining alcohol consumption was associated with fewer homicides in young adults (PM = 0.14; 95% BCI = 0.02, 0.25). Receipt of public assistance was associated with fewer homicides for young adults (PM = -104.20; 95% BCI = -182.0, -26.14) and adults (PM = -28.76; 95% BCI = -52.65, -5.01). Misdemeanor policing was associated with fewer homicides in adults (PM = -0.01; 95% BCI = -0.02, -0.001). CONCLUSIONS: Substance use prevention policies and expansion of the social safety net may be able to cause major reductions in homicide among age groups that drive city homicide trends.

OBJECTIVES: We investigated the relationship between the depressive symptoms of older adults over time and the characteristics of the neighborhoods in which they live. METHODS: We surveyed a random sample of 1325 New York City residents aged 50 years or older in 2005 and conducted 808 follow-up interviews in 2007. We assessed the compositional characteristics of the respondents' neighborhoods at a census-tract level and determined the relationships between these characteristics and changes in respondents' depressive symptoms. RESULTS: In multivariable models that adjusted for individual-level covariates including income, a range of neighborhood characteristics predicted worsening depressive symptoms. Factor analysis suggested that these characteristics operated in 3 clusters: neighborhood socioeconomic influences, residential stability, and racial/ethnic composition, with positive neighborhood socioeconomic influences being significantly protective against worsening symptoms. Life stressors, personality trait neuroticism, African American race, and daily baseline contact with social networks were also associated with worsening symptoms. CONCLUSIONS: An older adult's neighborhood of residence is an important determinant of his or her mental health. Those making efforts to improve mental health among the elderly need to consider the role of residential context in improving or impairing mental health.

BACKGROUND: Homicide contributes substantially to the burden of death in the US and remains a key contributor to the gap in white-black life expectancy. It has been hypothesized that "broken-windows" policing is associated with lower homicide rates and that physical disorder may mediate this association. However, the empiric evidence is limited and conflicting. METHODS: We used pooled, cross-sectional time-series data for 74 New York City (NYC) Police Precincts between 1990 and 1999 to test the relation between neighborhood misdemeanor policing (an indicator of physical order) and homicide in NYC in the 1990s. We applied Bayesian hierarchical models, including a random effect of place, to account for serial correlations in homicide across adjacent neighborhoods. RESULTS: An increase of 5000 misdemeanor arrests in a precinct with 100,000 people was associated with a reduction of 3.5 homicides (95% credible interval = -5.00 to -1.00). However, increased misdemeanor arrests were associated with lower physical order (posterior median = -0.015 [-0.025 to -0.01]), and physical order was unrelated to homicide. CONCLUSIONS: Our study replicated prior findings suggesting that misdemeanor policing reduces homicide rates, but offered no support for the hypothesis that physical disorder is a mediator of the impact of such policing. Factors responsible for the dramatic decline in US homicides in the last decade remain unclear.

OBJECTIVE: To characterize the influence of the residential neighborhood of older adults on the prevalence of disability. METHODS: We combined Census data on disability in older adults living in New York City with environmental information from a comprehensive geospatial database. We used factor analysis to derive dimensions of compositional and physical neighborhood characteristics and linear regression to model their association with levels of disability. Measures of neighborhood collective efficacy were added to these models to explore the impact of the social environment. RESULTS: Low neighborhood socioeconomic status, residential instability, living in areas with low proportions of foreign born and high proportions of Black residents, and negative street characteristics were associated with higher prevalence of both "physical" disability and "going outside the home" disability. High crime levels were additionally associated with physical disability, although this relationship disappeared when misdemeanor arrests were removed from the crime variable. Low levels of collective efficacy were associated with more going-outside-the-home disability, with racial/ethnic composition dropping out of this model to be replaced by an interaction term. CONCLUSION: The urban environment may have a substantial impact on whether an older adult with a given level of functional impairment is able to age actively and remain independent.

Alcohol use increased in the New York City (NYC) metropolitan area in the first months after the 11 September 2001 terrorist attacks. AIMS: To investigate alcohol use trajectories in the NYC metropolitan area in the 3 years after 11 September and examine the relative contributions of acute exposure to the attacks and ongoing stressors to these trajectories. DESIGN: We used a population-based cohort of adults recruited through a random-digit-dial telephone survey in 2002; participants completed three follow-up interviews over 30 months. SETTING: The NYC metropolitan area. PARTICIPANTS: A total of 2752 non-institutionalized adult residents of NYC. MEASUREMENTS: We used growth mixture models to assess trajectories in levels of total alcohol consumption and bingeing in the past 30 days, and predictors of these trajectories. FINDINGS: We identified five trajectories of alcohol consumption levels and three bingeing trajectories. Predictors of higher levels of use over time included ongoing stressors, traumatic events and lower income. Ongoing exposure to stressors and low income also play a central role in bingeing trajectories. CONCLUSIONS: While point-in-time mass traumatic events may matter in the short term, their contribution subsides over time. Accumulated stressors and traumatic events, in contrast, lead to higher levels of consumption among respondents already vulnerable to high alcohol use. Interventions to mitigate post-disaster stressors may have substantial benefit in reducing alcohol abuse in the medium- to long term.

OBJECTIVES/OBJECTIVE:We sought to identify neighborhood-level resources associated with lower levels of aggression and delinquency among youths aged 9-15 years at baseline after accounting for risk factors and other types of resources. METHODS:Data were derived from the Project on Human Development in Chicago Neighborhoods, which focused on 2226 ethnically diverse, urban youths, their caregivers, and the 80 neighborhoods in which they resided at baseline. RESULTS:Living in a neighborhood with a higher concentration of organizations or services serving young people and adults was associated with lower levels of aggression (odds ratio [OR]=0.9; 95% confidence interval [CI]=0.8, 1.0); living in such a neighborhood also moderated family, peer, and mentor resources. For example, the presence of well-behaved peers was associated with lower levels of aggression among youths living in neighborhoods where the concentration of organizations and services was at least 1 standard deviation above the mean; the association was less strong among youths living in neighborhoods with organizations and services 1 standard deviation below the mean or less. CONCLUSIONS:Certain family, peer, and mentoring resources may confer benefits only in the presence of neighborhood resources. Increasing neighborhood resources should be considered in interventions designed to reduce urban youths' involvement in violence.