Faculty Bibliography
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292
Prescription opioid mortality trends in New York City, 1990-2006: examining the emergence of an epidemic
BACKGROUND: The drug overdose mortality rate tripled between 1990 and 2006; prescription opioids have driven this epidemic. We examined the period 1990-2006 to inform our understanding of how the current prescription opioid overdose epidemic emerged in urban areas. METHODS: We used data from the Office of the Chief Medical Examiner to examine changes in demographic and spatial patterns in overdose fatalities induced by prescription opioids (i.e., analgesics and methadone) in New York City (NYC) in 1990-2006, and what factors were associated with death from prescription opioids vs. heroin, historically the most prevalent form of opioid overdose in urban areas. RESULTS: Analgesic-induced overdose fatalities were the only types of overdose fatalities to increase in 1990-2006 in NYC; the fatality rate increased sevenfold from 0.39 in 1990 to 2.7 per 100,000 persons in 2006. Whites and Latinos were the only racial/ethnic groups to exhibit an increase in overdose-related mortality. Relative to heroin overdose decedents, analgesic and methadone overdose decedents were more likely to be female and to concurrently use psychotherapeutic drugs, but less likely to concurrently use alcohol or cocaine. Analgesic overdose decedents were less likely to be Black or Hispanic, while methadone overdose decedents were more likely to be Black or Hispanic in contrast to heroin overdose decedents. CONCLUSIONS: The distinct epidemiologic profiles exhibited by analgesic and methadone overdose fatalities highlight the need to define drug-specific public health prevention efforts.
PMCID:3748247
PMID: 23357743
ISSN: 1879-0046
CID: 1595692
Navigating non-positivity in neighbourhood studies: an analysis of collective efficacy and violence
BACKGROUND: In multilevel studies, strong correlations of neighbourhood exposures with individual and neighbourhood confounders may generate problems with non-positivity (ie, inferences that are 'off-support'). The authors used propensity restriction and matching to (1) assess the utility of propensity restriction to ensure analyses are 'on-support' and (2) examine the relation between collective efficacy and violence in a previously unstudied city. METHODS: Associations between neighbourhood collective efficacy and violent victimisation were estimated in data from New York City in 2005 (n=4000) using marginal models and propensity matching. RESULTS: In marginal models adjusted for individual confounders and limited to observations 'on-support', under conditions of high collective efficacy, the estimated prevalence of violent victimisation was 3.5/100, while under conditions of low collective efficacy, it was 7.5/100, resulting in a difference of 4.0/100 (95% CI 2.6 to 5.8). In propensity-matched analysis, the comparable difference was 4.0/100 (95% CI 2.1 to 5.9). In analyses adjusted for individual and neighbourhood confounders and limited to observations 'on-support', the difference in violent victimisation associated with collective efficacy was 3.1/100 (95% CI 1.2 to 5.2) in marginal models and 2.4/100 (95% CI 0.2 to 4.5) in propensity-matched analysis. Analyses without support restrictions produced surprisingly similar results. CONCLUSIONS: Under conditions of high collective efficacy, there was about half the prevalence of violence compared with low collective efficacy. The results contribute to a growing body of evidence that suggests collective efficacy may shape violence, and illustrate how careful techniques can be used to disentangle exposures from highly correlated confounders without relying on model extrapolation.
PMCID:3551615
PMID: 22918895
ISSN: 1470-2738
CID: 1595732
Posttraumatic stress disorder across two generations: concordance and mechanisms in a population-based sample
BACKGROUND:Research conducted using small samples of persons exposed to extreme stressors has documented an association between parental and offspring posttraumatic stress disorder (PTSD), but it is unknown whether this association exists in the general population and whether trauma exposure mediates this association. We sought to determine whether mothers' posttraumatic stress symptoms were associated with PTSD in their young adult children and whether this association was mediated by higher trauma exposure in children of women with PTSD. METHODS:Using data from a cohort of mothers (n = 6924) and a cohort of their children (n = 8453), we calculated risk ratios (RR) for child's PTSD and examined mediation by trauma exposure. RESULTS:Mother's lifetime posttraumatic stress symptoms were associated with child's PTSD in dose-response fashion (mother's 1-3 symptoms, child's RR = 1.2; mother's 4-5 symptoms, RR = 1.3; mother's 6-7 symptoms, RR = 1.6, compared with children of mothers with no symptoms, p < .001 for each). Mother's lifetime symptoms were also associated with child's trauma exposure in dose-response fashion. Elevated exposure to trauma substantially mediated elevated risk for PTSD in children of women with symptoms (mediation proportion, 74%, p < .001). CONCLUSIONS:Intergenerational association of PTSD is clearly present in a large population-based sample. Children of women who had PTSD were more likely than children of women without PTSD to experience traumatic events; this suggests, in part, why the disorder is associated across generations. Health care providers who treat mothers with PTSD should be aware of the higher risk for trauma exposure and PTSD in their children.
PMCID:3412195
PMID: 22521146
ISSN: 1873-2402
CID: 3088642
The role of race/ethnicity in alcohol-attributable injury in the United States
A substantial proportion of injuries worldwide are attributable to alcohol consumption, and US estimates indicate that the drinking patterns of racial/ethnic groups vary considerably. The authors reviewed evidence from 19 publications regarding racial/ethnic differences in overall alcohol-attributable injury as well as percent blood alcohol content positivity for injury deaths in the United States. They found that Native Americans evidence higher rates of alcohol-attributable motor vehicle crash fatality, suicide, and falls compared with other racial/ethnic groups; conversely, Asians evidence lower rates of alcohol-attributable injury than other racial/ethnic groups. The rate of alcohol positivity and intoxication among Hispanics is disproportionately high relative to estimates of alcohol use. Black subgroups also evidence higher rates of alcohol positivity than would be expected given estimates of alcohol use, including for alcohol positivity among drivers of fatally injured black children and homicide. These findings highlight the continued need for public health focus on Native American populations with respect to alcohol consumption and injury. Further, the disparity in alcohol-attributable injury mortality among black and Hispanic groups relative to their reported rates of alcohol consumption is an overlooked area of research. The authors review potential social determinants of racial/ethnic disparities in alcohol-attributable injuries and identify directions for further research on these patterns.
PMCID:3283099
PMID: 21930592
ISSN: 1478-6729
CID: 3088592
[Homicide and public security indicator trends in the city of São Paulo between 1996 and 2008: a time-series ecological study]
The scope of this paper was to analyze the association between homicides and public security indicators in São Paulo between 1996 and 2008, after monitoring the unemployment rate and the proportion of youths in the population. A time-series ecological study for 1996 and 2008 was conducted with São Paulo as the unit of analysis. Dependent variable: number of deaths by homicide per year. Main independent variables: arrest-incarceration rate, access to firearms, police activity. Data analysis was conducted using Stata.IC 10.0 software. Simple and multivariate negative binomial regression models were created. Deaths by homicide and arrest-incarceration, as well as police activity were significantly associated in simple regression analysis. Access to firearms was not significantly associated to the reduction in the number of deaths by homicide (p>0,05). After adjustment, the associations with both the public security indicators were not significant. In São Paulo the role of public security indicators are less important as explanatory factors for a reduction in homicide rates, after adjustment for unemployment rate and a reduction in the proportion of youths. The results reinforce the importance of socioeconomic and demographic factors for a change in the public security scenario in São Paulo .
PMID: 23175401
ISSN: 1678-4561
CID: 3088992
Economic conditions and suicide rates in New York City
Extant analyses of the relation between economic conditions and population health were often based on annualized data and were susceptible to confounding by nonlinear time trends. In the present study, the authors used generalized additive models with nonparametric smoothing splines to examine the association between economic conditions, including levels of economic activity in New York State and the degree of volatility in the New York Stock Exchange, and monthly rates of death by suicide in New York City. The rate of suicide declined linearly from 8.1 per 100,000 people in 1990 to 4.8 per 100,000 people in 1999 and then remained stable from 1999 to 2006. In a generalized additive model in which the authors accounted for long-term and seasonal time trends, there was a negative association between monthly levels of economic activity and rates of suicide; the predicted rate of suicide was 0.12 per 100,000 persons lower when economic activity was at its peak compared with when it was at its nadir. The relation between economic activity and suicide differed by race/ethnicity and sex. Stock market volatility was not associated with suicide rates. Further work is needed to elucidate pathways that link economic conditions and suicide.
PMCID:3299418
PMID: 22362583
ISSN: 1476-6256
CID: 1595802
Beyond income: material resources among drug users in economically-disadvantaged New York City neighborhoods
BACKGROUND: Little is known about material resources among drug users beyond income. Income measures can be insensitive to variation among the poor, do not account for variation in cost-of-living, and are subject to non-response bias and underreporting. Further, most do not include illegal income sources that may be relevant to drug-using populations. METHODS: We explored the reliability and validity of an 18-item material resource scale and describe correlates of adequate resources among 1593 current, former and non-drug users recruited in New York City. Reliability was determined using coefficient alpha, omega(h), and factor analysis. Criterion validity was explored by comparing item and mean scores by income and income source using ANOVA; content validity analyses compared scores by drug use. Multiple linear regression was used to describe correlates of adequate resources. RESULTS: The coefficient alpha and omega(h) for the overall scale were 0.91 and 0.68, respectively, suggesting reliability was at least adequate. Legal income >$5000 (vs.
PMCID:3225725
PMID: 21835561
ISSN: 1879-0046
CID: 1595812
Revista panamericana de salud publica = Pan American journal of public health. 2011:29(1):17-26.DOI: 10.1590/s1020-49892011000100003
[Decline in homicide rates in São Paulo, Brasil: a descriptive analysis]
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.
PMCID:3325790
PMID: 21390415
ISSN: 1680-5348
CID: 3088972
Fall in homicides in the city of São Paulo: an exploratory analysis of possible determinants
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.
PMCID:3286232
PMID: 22218669
ISSN: 1980-5497
CID: 3088982
Policing and risk of overdose mortality in urban neighborhoods
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.
PMCID:3008306
PMID: 20727684
ISSN: 1879-0046
CID: 1595892
