Faculty Bibliography

The objective of this review was to assess the effectiveness of bystander naloxone administration and overdose education programs by synthesizing quantitative results reported in the research literature. Studies meeting predefined criteria were identified and reviewed, and their results were synthesized through meta-analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for overdose recoveries for individuals who received naloxone dispensed by non-medical community members, and the standardized mean difference was calculated for test scores of non-medical volunteers who received training in overdose management versus the scores of untrained volunteers. Pooled data from four studies showed that naloxone administration by bystanders was associated with a significantly increased odds of recovery compared with no naloxone administration (OR = 8.58, 95% CI = 3.90 to 13.25). Data from five studies of overdose education indicated that average scores were significantly higher for trained participants than untrained participants for tests on naloxone administration, overdose recognition, and overdose response (standardized mean difference = 1.35, 95% CI = 0.92 to 1.77). Empirical evidence in the research literature suggests that bystander naloxone administration and overdose education programs are associated with increased odds of recovery and with improved knowledge of overdose recognition and management in non-clinical settings.

BACKGROUND: Safe Routes to School (SRTS) is a federally funded transportation program for facilitating physically active commuting to and from school in children through improvements of the built environment, such as sidewalks, bicycle lanes, and safe crossings. Although it is evident that SRTS programs increase walking and bicycling in school-age children, their impact on pedestrian and bicyclist injury has not been adequately examined. METHODS: We analyzed quarterly traffic crash data between January 2008 and June 2013 in Texas to assess the effect of the SRTS program implemented after 2009 on school-age pedestrian and bicyclist injuries. RESULTS: The annualized rates of pedestrian and bicyclist injuries between pre- and post-SRTS periods declined 42.5% (95% confidence interval (CI) 39.6% to 45.4%) in children aged 5 to 19 years and 33.0% (95% CI 30.5% to 35.5%) in adults aged 30 to 64 years. Negative binomial modeling revealed that SRTS intervention was associated with a 14% reduction in the school-age pedestrian and bicyclist injury incidence rate ratio (IRR 0.86, 95% CI 0.75 to 0.98). The effect of the SRTS intervention on pedestrian and bicyclist fatalities was similar though smaller in magnitude and was not statistically significant (adjusted IRR 0.90, 95% CI 0.67 to 1.21). CONCLUSIONS: These results indicate that the implementation of the SRTS program in Texas may have contributed to declines in school-age pedestrian and bicyclist injuries.

OBJECTIVES: We determined the demographic characteristics, behaviors, injuries, and outcomes of commercial bicyclists who were injured while navigating New York City's (NYC's) central business district. METHODS: Our study involved a secondary analysis of prospectively collected data from a level 1 regional trauma center in 2008 to 2014 of bicyclists struck by motor vehicles. We performed univariable and multivariable logistic regression analyses. RESULTS: Of 819 injured bicyclists, 284 (34.7%) were working. Commercial bicyclists included 24.4% to 45.1% of injured bicyclists annually. Injured commercial bicyclists were more likely Latino (56.7%; 95% confidence interval [CI] = 50.7, 62.8 vs 22.7%; 95% CI = 19.2, 26.5). Commercial bicyclists were less likely to be distracted by electronic devices (5.0%; 95% CI = 2.7, 8.2 vs 12.7%; 95% CI = 9.9, 15.9) or to have consumed alcohol (0.7%; 95% CI = 0.9, 2.5 vs 9.5%; 95% CI = 7.2, 12.3). Commercial and noncommercial bicyclists did not differ in helmet use (38.4%; 95% CI = 32.7, 44.4 vs 30.8%; 95% CI = 26.9, 34.9). Injury severity scores were less severe in commercial bicyclists (odds ratio = 0.412; 95% CI = 0.235, 0.723). CONCLUSIONS: Commercial bicyclists represent a unique cohort of vulnerable roadway users. In NYC, minorities, especially Latinos, should be targeted for safety education programs. (Am J Public Health. Published online ahead of print August 13, 2015: e1-e6. doi:10.2105/AJPH.2015.302738).

Study Objectives: New York City (NYC) recently expanded its bicycle routes by demarcating bike lanes with paint and constructing 30 miles of protected paths that physically separate automobile traffic from bicyclists to address increases in bicyclist fatalities. Our objective was to determine whether bike lanes and protected paths result in safety benefits for bicyclists in NYC. We hypothesized that bike lanes would be associated with reduced injury severity among bicyclists colliding with motor vehicles and that protected paths would be associated with an even greater safety benefit. Methods: We performed a secondary analysis of bicyclist injury data collected from December 2008 to August 2014 at a Level 1 Trauma Center in NYC. We evaluated the association of protected paths and bike lanes on injury severity while controlling for potential confounders including patient demographics, scene-related and environmental information, helmet use, traffic law compliance, street characteristics, and injury mechanism. Data were obtained from patient interviews and medical records. Injury severity score (ISS) was categorized according to National Trauma Data Bank (NT

PURPOSE: Prescription drug overdose (PDO) deaths are a critical public health problem in the United States. This study aims to assess the association between emergency department (ED) utilization patterns in a cohort of ED patients and the risk of subsequent unintentional PDO mortality. METHODS: Using data from the New York Statewide Planning and Research Cooperative System for 2006-2010, a nested case-control design was used to examine the relationship between ED utilization patterns in New York State residents of age 18-64 years and subsequent PDO death. RESULTS: The study sample consisted of 2732 case patients who died of PDO and 2732 control ED patients who were selected through incidence density sampling. With adjustment for demographic characteristics, and diagnoses of pain, substance abuse, and psychiatric disorders, the estimated odds ratios of PDO death relative to one ED visit or less in the previous year were 4.90 (95% confidence interval [CI]: 4.50-5.34) for those with two ED visits, 16.61 (95% CI: 14.72-18.75) for those with three ED visits, and 48.24 (95% CI: 43.23-53.83) for those with four ED visits or more. CONCLUSIONS: Frequency of ED visits is strongly associated with the risk of subsequent PDO death. Intervention programs targeting frequent ED users are warranted to reduce PDO mortality.

BACKGROUND: This study quantifies the spatiotemporal risk of pedestrian and bicyclist injury in New York City at the census tract level over a recent 10-year period, identifies areas of increased risk, and evaluates the role of socioeconomic and traffic-related variables in injury risk. METHODS: Crash data on 140,835 pedestrian and bicyclist injuries in 1908 census tracts from 2001 to 2010 were obtained from the New York City Department of Transportation. We analyzed injury counts within census tracts with Bayesian hierarchical spatial models using integrated nested Laplace approximations. The model included variables for social fragmentation, median household income, and average vehicle speed and traffic density, as well as a spatially unstructured random effect term, a spatially structured conditional autoregression term, a first-order random walk-correlated time variable, and an interaction term for time and place. Incidence density ratios, credible intervals, and probability exceedances were calculated and mapped. RESULTS: The yearly rate of crashes involving injuries to "pedestrians" (including bicyclists) decreased 16.2% over the study period, from 23.7 per 10,000 population to 16.2 per 10,000. The temporal term in the spatiotemporal model indicated that much of the decrease over the study period occurred during the first 4 years of the study period. Despite an overall decrease, the model identified census tracts that were at persistently high risk of pedestrian injury throughout the study period, as well as areas that experienced sporadic annual increases in risk. Aggregate social, economic, and traffic-related measures were associated with pedestrian injury risk at the ecologic level. Every 1-unit increase in a standardized social fragmentation index was associated with a 19% increase in pedestrian injury risk (incidence density ratio = 1.19 [95% credible interval = 1.16 - 1.23]), and every 1 standardized unit increase in traffic density was associated with a 20% increase in pedestrian injury risk (1.20 [1.15 - 1.26]). Each 10-mile-per-hour increase in average traffic speed in a census tract was associated with a 24% decrease in pedestrian injury risk (0.76 [0.69 - 0.83]). CONCLUSIONS: The risk of a pedestrian or bicyclist being struck by a motor vehicle in New York City decreased from 2001 to 2004 and held fairly steady thereafter. Some census tracts in the city did not benefit from overall reductions or experienced sporadic years of increased risk compared with the city as a whole. Injury risk at the census tract level was associated with social, economic, and traffic-related factors.

BACKGROUND:Abuse of prescription drugs, particularly opioid analgesics, has become a major source of injury mortality and morbidity in the United States. To prevent the diversion and misuse of controlled substances, many states have implemented prescription drug monitoring programs (PDMPs). This study assessed the impact of state PDMPs on drug overdose mortality. METHODS:We analyzed demographic and drug overdose mortality data for state-quarters with and without PDMPs in 50 states and the District of Columbia during 1999-2008, and estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) of drug overdose mortality associated with the implementation of state PDMPs through multivariable negative bionomial regression modeling. RESULTS:During the study period, annual national death rates from drug overdose increased by 96%, from 5.7 deaths per 100,000 population in 1999 to 11.2 in 2008. The impact of PDMPs on drug overdose mortality varied greatly across states, ranging from a 35% decrease in Michigan (aRR = 0.65; 95% CI = 0.54-0.77) to a more than 3-fold increase in Nevada (aRR = 3.37; 95% CI = 2.48-4.59). Overall, implementation of PDMPs was associated with an 11% increase in drug overdose mortality (aRR = 1.11; 95% CI = 1.02-1.21). CONCLUSIONS:Implementation of PDMPs did not reduce drug overdose mortality in most states through 2008. Program enhancement that facilitates the access and use of prescription drug monitoring data systems by healthcare practitioners is needed.

Advances in injury epidemiology and prevention are among the landmark achievements in epidemiology and public health in the past century. Despite remarkable success and growth, the field of injury epidemiology did not have its own publication outlet until now. This commentary marks the debut of the new academic journal Injury Epidemiology and introduces the reader to the first batch of peer-reviewed manuscripts accepted for publication in this new journal.