Faculty Bibliography

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.

BACKGROUND:Unintentional drug overdose has increased markedly in the past two decades and surpassed motor vehicle crashes as the leading cause of injury mortality in many states. The purpose of this study was to understand the trajectory of the drug overdose epidemic in the United States by applying Farr's Law. Farr's "law of epidemics" and the Bregman-Langmuir back calculation method were applied to United States drug overdose mortality data for the years 1980 through 2011 to project the annual death rates from drug overdose from 2012 through 2035. FINDINGS/RESULTS:From 1980-2011, annual drug overdose mortality increased from 2.7 to 13.2 deaths per 100,000 population. The projected drug overdose mortality would peak in 2016-2017 at 16.1 deaths per 100,000 population and then decline progressively until reaching 1.9 deaths per 100,000 population in 2035. CONCLUSION/CONCLUSIONS:The projected data based on Farr's Law suggests that drug overdose mortality in the United States will decline in the coming years and return to the 1980 baseline level approximately by the year 2034.

BACKGROUND:In 2005, the US Congress allocated $612 million for a national Safe Routes to School (SRTS) program to encourage walking and bicycling to schools. We evaluated the effectiveness of a SRTS in controlling pedestrian injuries among school-age children. METHODS:Bayesian changepoint analysis was applied to model the quarterly counts of pedestrian injuries among 5- to 19-year old children in New York City between 2001 and 2010 during school-travel hours in census tracts with and without SRTS. Overdispersed Poisson model was used to estimate difference-in-differences in injury risk between census tracts with and without SRTS following the changepoint. RESULTS:In SRTS-intervention census tracts, a change point in the quarterly counts of injuries was identified in the second quarter of 2008, which was consistent with the timing of the implementation of SRTS interventions. In census tracts with SRTS interventions, the estimated quarterly rates of pedestrian injury per 10,000 population among school-age children during school-travel hours were 3.47 (95% Credible Interval [CrI] 2.67, 4.39) prior to the changepoint, and 0.74 (95% CrI 0.30, 1.50) after the changepoint. There was no change in the average number of quarterly injuries in non-SRTS census tracts. Overdispersed Poisson modeling revealed that SRTS implementation was associated with a 44% reduction (95% Confidence Interval [CI] 87% decrease to 130% increase) in school-age pedestrian injury risk during school-travel hours. CONCLUSIONS:Bayesian changepoint analysis of quarterly counts of school-age pedestrian injuries successfully identified the timing of SRTS intervention in New York City. Implementation of the SRTS program in New York City appears to be effective in reducing school-age pedestrian injuries during school-travel hours.

Many studies have examined the relations between drug use and sexual behaviors; however, few have utilized episodic data to examine the co-occurrence of both behaviors within the same episode. This study surveyed 403 racially and ethnically diverse gay, bisexual, and other young men who have sex with men (YMSM; ages 18-29) in New York City. Men were surveyed about their sexual behavior and concurrent use of illicit substances and alcohol during their most recent sexual encounter with their main and/or casual partner(s). Logistic regression models were built to analyze predictors of unprotected oral and anal intercourse with main and casual partners. Results suggest that use of inhalant nitrates and alcohol increased the odds of men engaging in unprotected receptive anal intercourse (URAI) and men who identified as middle or high socioeconomic status (SES) were at lower odds of engaging in URAI with their main partner. Use of other illicit substances was not associated with unprotected sexual intercourse. These findings indicate a need to further consider the role of licit substances used by YMSM as a means of further reducing the incidence of HIV infection in this population. In addition, the high rates of unprotected anal intercourse among men reporting a main partner has the potential to be a significant source of HIV risk, and should be further explored among YMSM. © 2014 © Taylor & Francis Group, LLC.

Research has repeatedly indicated a strong relation between methamphetamine use and risky sex leading to HIV-seroconversion. Despite the high prevalence of HIV among Black gay, bisexual, and other men-who-have-sex-with-men (BMSM) and the strong association between methamphetamine use and HIV-seroconversion, treatment research on methamphetamine use and HIV-risk behaviors among BMSM is limited. The goal of this exploratory study was to investigate treatment strategies for BMSM that may be used to inform methamphetamine treatment programs tailored for BMSM. Data was collected on a sample of HIV-negative and HIV-positive gay, bisexual, and heterosexual BMSM (N = 52) in New York City. Participants were asked to discuss methamphetamine treatment strategies they believed would be successful in treating their own methamphetamine abuse and that of other BMSM who use methamphetamine. Results indicated four treatment areas salient for BMSM seeking treatment for methamphetamine used disorders: (a) outreach/recruitment strategies, (b) therapist qualities, (c) group characteristics, and (d) intervention elements themselves. Findings gathered here and through literature review underscore the importance of adapting evidence-based methamphetamine treatment strategies to include culturally-relevant treatment strategies that address the specific needs of BMSM who use methamphetamine.