Faculty Bibliography

BACKGROUND:Overdose prevention centers (OPCs) may reduce public drug use and, with it, policing of people who use drugs in the communities surrounding these sites. We applied an augmented synthetic control method to assess changes in pedestrian stops before and after the November 2021 opening of two OPCs (Washington Heights and East Harlem) in New York City (NYC). METHODS:We retrieved pedestrian stop information from the New York Police Department's (NYPD) Stop, Question, and Frisk, program from January 2017 to December 2024, and created bimonthly averages using five- and ten-minute walking buffers surrounding the OPCs and 57 donor sites (syringe service and opioid treatment programs) as outcomes. Covariates were derived from American Community Survey, NYPD Calls for Services, and SafeGraph pedestrian mobility estimates. RESULTS:The opening of the Washington Heights OPC was associated with a reduction of 2.8 bimonthly average pedestrian stops in the post-intervention period when using five-minute walking buffers, although results were compatible with increases and reductions (95%CI=-9.4, 4.0). For ten-minute walking buffers, results were compatible with a wide range of reductions (ATT=-9.2 [95%CI=-18.3, -1.3]). East Harlem OPC showed larger point estimates when examining both distances (ATT=-8.4 [95%CI=-12.2, -4.5] and ATT=-13.7 [95%CI=-22.1, -4.2] with five- and ten-minute walking buffers, respectively). For both sites, permutation tests suggested that these reductions fell within the range of possible donor-unit placebo effects. CONCLUSIONS:Our study shows limited evidence of an effect of NYC's first two OPCs on pedestrian stops in their immediate vicinity, with a potential decrease concentrated in the first two years at the East Harlem location.

Given substantial reporting delays in overdose deaths, state health departments increasingly use non-fatal overdose data to inform geographically targeted rapid overdose response efforts. We sought to evaluate the extent to which non-fatal overdose events were associated with concurrent and future overdose deaths in Rhode Island. We aggregated non-fatal overdose data from emergency medical services records (2019-2023) and fatal overdose data from the State Unintentional Drug Overdose Reporting System (2020-2023) in 1-, 3-, and 6-month intervals at census block group and census tract levels. Rates of fatal overdose were estimated, relative to non-fatal overdose lagged by 0-12 months, using negative binomial regression, and relative to monthly spikes in non-fatal overdose burden, using zero-inflated Poisson regression. Estimation was implemented using integrated nested Laplace approximation. Each additional non-fatal overdose event per census block group was associated with fatal overdose rates that were 48% higher (95% credible interval: 1.37-1.59) than expected in concurrent months, with smaller associations at the census tract level, in wider time intervals, and when non-fatal overdose data were lagged. Spikes in non-fatal overdose activity were associated with elevated overdose mortality in concurrent periods with fine temporal and geographic granularity, but not in larger time frames and geographic areas.

INTRODUCTION/BACKGROUND:Firearm violence remains a public health crisis in the United States, disproportionately affecting racially marginalized and historically disinvested neighborhoods. The relationship between neighborhood-level disability prevalence and healthcare access with firearm violence risk remains poorly understood. METHODS:This ecological, spatiotemporal analysis of 77 community areas in Chicago from 2011 to 2023 used Bayesian negative binomial models to estimate associations between community-level disability prevalence and healthcare underservice-defined as proportion of land designated as a Medically Underserved Area (MUA)-with annual rates of nonfatal firearm victimizations and firearm homicides. Stratified models by neighborhood racial/ethnic plurality were also explored. Analyses were conducted from April 2025 to March 2026. RESULTS:A 5-percentage point increase in disability prevalence was associated with a 10% higher rate of firearm victimization (95% credible interval [CrI], 2%-18%) and an 19% higher rate of firearm homicide (95% CrI, 8%-31%). A 5-percentage point increase in MUA coverage was associated with a 10% increase in firearm victimization (95% CrI, 6%-15%) and 9% increase in firearm homicide (95% CrI, 5%-13%). In stratified models, disability was most strongly associated with firearm violence in plurality non-Hispanic Black neighborhoods. Associations between MUA coverage and firearm violence were largest in plurality non-Hispanic white and Hispanic neighborhoods. CONCLUSIONS:Neighborhood-level disability and healthcare underservice are significantly associated with firearm violence in Chicago, with differences by racial/ethnic composition. Findings underscore the need to integrate disability and healthcare access into public health violence prevention frameworks.

BACKGROUND:International health research collaborations (IHRCs) between High Income countries (HICs) and Low-and Middle-Income Countries (LMICs) are essential in global health research, yet ethical challenges including the inequitable sharing of rewards and burdens among the research actors remain insufficiently addressed. We explored the notices of funding opportunities and official guidance documents of three major research funders to assess how funding agencies structure and promote the ethical conduct of IHRCs. METHODS:We conducted a content analysis of publicly available notices of funding opportunities and official guidance documents from the National Institutes of Health, European Commission, and Wellcome Trust. Using a structured data collection instrument, we cataloged content within the notices related to equitable data sharing, scientific capacity development, authorship, and intellectual property ownership. RESULTS:We reviewed 21 International Health Research Collaboration (IHRC)-related documents issued between 2017 and 2021. Documents reviewed included funding opportunity announcements, grant compliance documents, and funders' code of ethics. While all three funders had general provisions for data sharing, none had guidelines specific to data management within IHRC context including the potential use of data for secondary purposes without the prior consent of researchers in LMICs. Although all funders had general guidelines on the ownership of results, guidelines specifying the distribution of ownership rights among HIC and LMIC collaborators were absent. Specific guidelines on how researchers in LMICs and HICs would benefit from each other's expertise as well as authorship guidelines within the IHRC context were absent from all funder's notices of funding opportunities. CONCLUSIONS:Guidelines that promote ethical conduct of IHRCs were absent from documents reviewed from the three top funders of global health research. Development and inclusion of such guidelines in funding announcements could promote ethical IHRCs.

Overdose prevention centers (OPCs) are associated with improved community health and decreased crime, but opponents argue that OPCs depress nearby property values. We estimated the association of the opening of the first two public recognized OPC in the United States with neighborhood residential rents and real estate sales in the East Harlem and Washington Heights neighborhoods of New York City (NYC). Using augmented synthetic controls, we analyzed quarterly and semiannual rental listings and annual and semiannual sales within 300- and 500-meter buffers around the OPCs. Donor units were buffers around syringe service programs without OPCs and opioid treatment programs. Primary outcomes were median quarterly rental listing price and median annual sales price. Overall, we found no changes in neighborhood rental or sales prices. For quarterly rentals at 300 m, we estimated (ATT, 95% CI) $145 (-$780, $1070) in East Harlem and -$505 (-$1279, $269) in Washington Heights. For annual sales at 500 m, we estimated -$542 993 (-$1 228 024, $142038) in East Harlem and $1 121 706 (-$431 285, $2674697) in Washington Heights. Conformal inference identified no detectable time-point effects. Overall, OPC implementation in NYC was not associated with changes in rents or sales, suggesting these facilities may not generate appreciable effects on local housing values.

As predictive analytics become more widely integrated into local public health responses to the United States overdose epidemic, community-based substance use service providers have begun to adopt machine learning-based predictive tools to guide the allocation and delivery of overdose prevention services. While these tools hold promise for anticipating community overdose risk and enhancing the efficiency of overdose prevention resource distribution, outreach, and education efforts, their use in community settings raises substantial ethical and practical challenges. In this Viewpoint, we examine the application of predictive analytics to community-based overdose prevention through a public health ethics lens, drawing on principles of distributive justice, transparency, community participation, and implementation readiness. We outline five key ethical considerations for developers (i.e., institutional responsibility, oversimplification of complex social realities, data and algorithmic bias, community displacement in decision making, and equity trade-offs) and corresponding practical challenges for service providers. We offer five recommendations for developers, public health authorities, and frontline organizations to overcome challenges and ensure responsible, equity-driven implementation. As data-driven approaches to overdose prevention proliferate, ethical and participatory frameworks will be essential to ensure predictive tools strengthen, rather than undermine, community trust and health equity.

IMPORTANCE/UNASSIGNED:Overdose prevention centers (OPCs) are interventions to reduce overdose mortality and support health care engagement. In the US, concerns have been raised that OPCs may be associated with reduced economic activity in their surrounding neighborhoods. OBJECTIVE/UNASSIGNED:To evaluate changes in the local economic activity in New York City (NYC), measured by neighborhood-level foot traffic and consumer spending, following the opening of the first 2 publicly recognized OPCs in the US. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cohort study used anonymized mobility and spending data from June 1, 2021, to June 13, 2022, for the areas surrounding the East Harlem and Washington Heights OPCs in NYC. These neighborhoods were defined using 5-minute and 10-minute walking buffers and Business Improvement Districts (BIDs). Synthetic control donors included walking buffers and BIDs around syringe service programs without OPCs and opioid treatment programs that were operational as of OPCs' opening. Analyses were conducted from February to July 2025. EXPOSURES/UNASSIGNED:Opening of the 2 NYC OPCs on November 30, 2021. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Primary outcomes were foot traffic and in-person consumer spending within 10-minute walking buffers. Secondary analyses considered 5-minute walking buffers and BIDs. Augmented synthetic control models were adjusted for neighborhood-level demographic and socioeconomic features, with fit assessed using root mean squared error before OPC opening. Permutation tests and conformal inference were used to assess significance. RESULTS/UNASSIGNED:A total of 27 biweekly observations (13 in pre-OPC and 14 in post-OPC periods) were analyzed. The 10-minute walking buffer analyses captured 1259 consumer spending sites and 7816 foot traffic sites across 2 treated buffers and 56 donor buffers. In East Harlem, the average treatment effect on the treated (ATT) estimate (SE) was -$21.96 ($40.53) for consumer spending (P = .16) and 1.28 (5.40) visits for foot traffic (P = .19). In Washington Heights, ATT (SE) estimates were $14.94 ($37.38) for consumer spending (P = .13) and 0.44 (3.54) visits for foot traffic (P = .97). Secondary analyses produced consistent results. No statistically significant results were observed at any post-OPC time point. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This cohort study found that OPC opening was not associated with significant changes in local economic activity. Given the absence of observed economic harms, policy debates should instead focus on the public health implications of OPCs.

The overdose epidemic has reshaped law enforcement's relationship with public health, as police increasingly adopt overdose response measures, including naloxone training and use. This study analyzed 15 interviews with New York Police Department (NYPD) officers to examine their experiences administering naloxone in their duties. Naloxone was seen as facilitating a shift from traditional law enforcement to a broader public safety role, and officers noted its potential to improve public perceptions of police. However, tensions emerged as officers navigated dual roles in enforcement and health, with concerns that overdose reversal might enable continued drug use or crime. Additionally, officers expressed frustrations about naloxone's limitations, particularly its inability to address systemic barriers to addiction recovery. These findings underscore the need for clear policies, comprehensive training, and stronger interagency partnerships to enhance the integration of public health strategies within policing and better support officers in responding to the overdose crisis.

INTRODUCTION/BACKGROUND:Police are frequently dispatched to a wide range of 911 calls, including mental and behavioural health crises, despite lacking the training, resources and time to respond effectively. In particular, people with serious mental illness are at elevated risk of experiencing excessive use of force, arrest and continued criminal legal involvement following police contact. Following the murder of George Floyd and other highly publicised police killings, Community Safety Response (CSR) programmes, staffed by unarmed peers, mental health professionals and other trained responders, have proliferated to provide non-police responses to mental and behavioural health and other quality-of-life concerns. CSR programmes have expanded rapidly, yet the evidence base remains fragmented and largely outside the peer-reviewed literature. METHODS AND ANALYSIS/METHODS:This scoping review will synthesise peer-reviewed and grey literature from 2020 to present on CSR programmes operating in North America. Guided by Joanna Briggs Institute methodology and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) standards, we will search multiple databases (Medline, PsycINFO, Embase, SocIndex, Web of Science, Policy Commons) and employ complementary grey literature search strategies, including targeted website searches, reference tracking and review of internal and external reports and evaluations. Inclusion criteria require that programmes provide non-police first response to calls traditionally served by law enforcement and include information on programme operations or outcomes. Two reviewers will independently screen and extract data on process metrics including operational characteristics, dispatch, funding, services provided and outcomes such as populations served, diversion from police, service linkage and use of force. ETHICS AND DISSEMINATION/BACKGROUND:No ethical review for this study is required as it will not include human subjects or any identifiable information. Findings will provide the first national synthesis of CSR programme models, operations and outcomes. Results will inform policy-makers, practitioners, researchers and community members. Findings will be disseminated through peer-reviewed publications and public-facing products to support implementation, scale-up and sustainability of CSR programmes.

CONTEXT/BACKGROUND:Predictive modeling can identify neighborhoods at elevated risk of future overdose death and may assist community organizations' decisions about harm reduction resource allocation. In Rhode Island, PROVIDENT is a research initiative and randomized community intervention trial that developed and validated a machine learning model that predicts future overdose at a census block group (CBG) level. The PROVIDENT model prioritizes the top 20th percentile of CBGs at highest risk of future overdose death over the subsequent 6-month period. In CBGs assigned to the trial intervention arm, these predictions are then displayed for partnering community organizations via an interactive mapping dashboard. OBJECTIVE:To evaluate whether CBGs prioritized by the PROVIDENT model were associated with increased user engagement via an online dashboard for fatal overdose forecasting and resource planning. DESIGN/METHODS:We estimated prevalence ratios using modified Poisson regression models, adjusted for CBG-level characteristics that may confound the relationship between model predictions and dashboard engagement. SETTING/METHODS:We used CBG-level data in Rhode Island (N = 809) from November 2021 to July 2024. INTERVENTION/METHODS:Our exposure of interest was whether each CBG was prioritized by the PROVIDENT model and shown as prioritized on the interactive mapping dashboard. MAIN OUTCOME MEASURE/METHODS:Our primary outcome was whether a dashboard user from any partnering community organization engaged (eg, clicked, interacted with dashboard elements, or completed assessment or planning surveys) with each CBG on the interactive mapping dashboard. RESULTS:After adjusting for previous model predictions and dashboard engagement, nonfatal overdose counts, and distribution of race and ethnicity, poverty, unemployment, and rent burden, dashboard users were 1.0 to 2.4 times as likely to engage with CBGs prioritized by the PROVIDENT model that were shown as prioritized on the dashboard as compared to CBGs that were prioritized by the PROVIDENT model that were blinded on the dashboard. CONCLUSIONS:Interactive mapping tools with predictive modeling may be useful to support community-based harm reduction organizations in the allocation of resources to neighborhoods predicted to be at high risk of future overdose death.