Spatial Trends in Opiate Overdose Death in North Carolina: 1999-2015

The United States has experienced a serious and growing opiate epidemic over the past 20 years. North Carolina has been identified as a state of particular concern along with other Southern and Appalachian states. This study characterizes the opiate epidemic in North Carolina along three axes: space, time, and drug type. Using data from the North Carolina State Center for Health Statistics, I calculated county-level mortality rates for prescription opioids, methadone, synthetic opioids, and heroin for each year from 1999 to 2015. Then I performed mean center, cluster, and spatial regression analyses to identify areas of high and low mortality rates and associated socioeconomic correlates. My results show that mortality due to prescription opioids in North Carolina increased by 612 percent and heroin increased by 800 percent over the study period. Average mortality rates from prescription opioids were highest in the western, Appalachian counties, while the highest rates for heroin mortality occurred in urban counties along the Piedmont Crescent and in Wilmington. Mean center analysis by year showed prescription mortality rates were pulled to the west during the entire study period with a notable trend east in 2014 and 2015. Heroin mortality rate mean centers were consistently east of the unweighted mean center, although they also showed a higher variance. Discrete Poisson-based cluster models in SaTScan identified high clusters of mortality rates for both drug types in similar areas as the descriptive analysis, however it also determined intraregional hotspots including Richmond and Carteret counties for prescription opioid mortality. Regression models for average mortality rate by county for the entire study period for prescription opioids and heroin produced R squared values of 0.62 and 0.36 respectively. Prescription opioid mortality increased with percent with disability and decreased with percent Black and percent Hispanic. Heroin mortality increased with urbanity and decreased with percent holding a college degree. This study confirms trends in the opiate epidemic with high rates of prescription opioid mortality among White, rural, Appalachian counties and heroin mortality in urban areas. Policymakers and intervention workers can use these findings to develop appropriate measures to combat this epidemic and target their work based on place and drug type.Bachelor of Art

Multi-dimensional measures of geography and the opioid epidemic: place, time and context

The opioid crisis has hit the United States hard in recent years. Behavioral patterns and social environments associated with opioid use and misuse vary significantly across communities. It is important to understand the geospatial prevalence of opioid overdoses and other impacts related to the crisis in order to provide a targeted response at different locations. This dissertation contributes a framework for understanding spatial and temporal patterns of drug prevalence, treatment services access and associated socio-environmental factors for opioid use and misuse. This dissertation addresses three main questions related to geography and the opioid epidemic: 1) How did drug poisoning deaths involving heroin evolve over space and time in the U.S. between 2000-2016; 2) How did access to opioid use disorder treatment facilities and emergency medical services vary spatially in New Hampshire during 2015-2016; and 3) What were the relations between socio-environmental factors and numbers of emergency department patients with drug-related health problems over space and time in Maryland during 2016-2018. For the first study, this dissertation developed a spatial and temporal data model to investigate trends of heroin mortality over a 17-year period (2000-2016). The research presented in this dissertation also involved developing a composite index to analyze spatial accessibility to both opioid use disorder treatment facilities and emergency medical services and compared these locations with the locations of deaths involving fentanyl to identify possible gaps in services. In the third study for this dissertation, I utilized socially-sensed data to identify neighborhood characteristics and investigated spatial and temporal relationships with emergency department patients with drug-related health problems admitted to the four hospitals in the western Baltimore area in Maryland during 2016 to 2018, in order to identify the dynamic patterns of the associations in terms of various socio-environmental factors

Health Place

Over the past several years, the death rate associated with drug poisoning has increased by over 300% in the U.S. Drug poisoning mortality varies widely by state, but geographic variation at the substate level has largely not been explored. National mortality data (2007-2009) and small area estimation methods were used to predict age-adjusted death rates due to drug poisoning at the county level, which were then mapped in order to explore: whether drug poisoning mortality clusters by county, and where hot and cold spots occur (i.e., groups of counties that evidence extremely high or low age-adjusted death rates due to drug poisoning). Results highlight several regions of the U.S. where the burden of drug poisoning mortality is especially high. Findings may help inform efforts to address the growing problem of drug poisoning mortality by indicating where the epidemic is concentrated geographically.20132015-11-25T00:00:00ZCC999999/Intramural CDC HHS/United States24333939PMC4659494721

A Spatial Inquiry of the U.S. Opioid Epidemic and Geodemographic Segmentation Systems

The objective of this dissertation research was to explore the use of geodemographic segmentation as a socioeconomic variable to spatially analyze opioid related mortalities and hospital discharges. Opioid data were investigated by three ICD-10 classifications: heroin, other opioids, and other synthetic narcotics. Demographic and spatial characteristics of opioid mortality were examined using data from the Centers for Disease Controls (CDC) National Vital Statistics System mortality (NVSS-M) multiple causes of death dataset via the WONDER database for the year 2017. This was followed by a literature review of previous research that investigated the use of geodemographic segmentation systems in health research.Spatial rules association data mining was used to explore the relationship between county level ESRI Tapestry segmentation and opioid mortality rates from the CDC NVSS-M for the years 2015-2017. These findings were further examined by comparing the results to the 2017 Tennessee opioid mortality and Tapestry data at the ZIP code level. Additional demographic analysis was conducted using county level socioeconomic variables, unemployment, and opioid prescribing rates.Tennessee opioid related hospital discharge and mortality data from the year 2017 were analyzed using rate mapping, ANOVA, descriptive statistics, and spatial rules based association data mining. The rates were associated with ESRI Tapestry LifeMode groupings. The results of the analysis of Tennessees ZIP code level data were compared to the CDCs county level data from 2017 to examine scale dependency of the analysis and data

BIG DATA APPLICATIONS AND CHALLENGES IN GISCIENCE (CASE STUDIES: NATURAL DISASTER AND PUBLIC HEALTH CRISIS MANAGEMENT)

This dissertation examines the application and significance of user-generated big data in Geographic Information Science (GIScience), with a focus on managing natural disasters and public health crises. It explores the role of social media data in understanding human-environment interactions and in informing disaster management and public health strategies. A scalable computational framework will be developed to model extensive unstructured geotagged data from social media, facilitating systematic spatiotemporal data analysis.The research investigates how individuals and communities respond to high-impact events like natural disasters and public health emergencies, employing both qualitative and quantitative methods. In particular, it assesses the impact of socio-economic-demographic characteristics and the digital divide on social media engagement during such crises. In addressing the opioid crisis, the dissertation delves into the spatial dynamics of opioid overdose deaths, utilizing Multiscale Geographically Weighted Regression to discern local versus broader-scale determinants. This analysis foregrounds the necessity for targeted public health responses and the importance of localized data in crafting effective interventions, especially within communities that are ethnically diverse and economically disparate. Using Hurricane Irma as a case study, this dissertation analyzes social media activity in Florida in September 2017, leveraging Multiscale Geographically Weighted Regression to explore spatial variations in social media discourse, its correlation with damage severity, and the disproportionate impact on racialized communities. It integrates social media data analysis with political-ecological perspectives and spatial analytical techniques to reveal structural inequalities and political power differentials. The dissertation also tackles the dissemination of false information during the COVID-19 pandemic, examining Twitter activity in the United States from April to July 2020. It identifies misinformation patterns, their origins, and their association with the pandemic\u27s incidence rates. Discourse analysis pinpoints tweets that downplay the pandemic\u27s severity or spread disinformation, while spatial modeling investigates the relationship between social media discourse and disease spread. By concentrating on the experiences of racialized communities, this research aims to highlight and address the environmental and social injustices they face. It contributes empirical and methodological insights into effective policy formulation, with an emphasis on equitable responses to public health emergencies and natural disasters. This dissertation not only provides a nuanced understanding of crisis responses but also advances GIScience research by incorporating social media data into both traditional and critical analytical frameworks

Framing the Crisis in the Merrimack Valley: The Opioid Epidemic, White Despair and Authoritarian Populism on the New England Borderlands

This dissertation examines how discourses and ideologies about the opioid crisis were framed, produced and constructed in the geographic specificity of the Merrimack Valley in the period leading up to the 2016 presidential election. Applying the theoretical and methodological frameworks offered by the cultural studies tradition, this dissertation project attempts to map out the complex interplay between the news media, law enforcement, policymakers, and citizens in producing, circulating, amplifying, framing and sustaining public anxiety about the opioid crisis in the Merrimack Valley and beyond. Employing a mix of qualitative and quantitative forms of inquiry, including interpretation of data collected through text mining, text visualization, sentiment and emotion analysis, and coding software, this project examines the dominant framing devices used in local television coverage of the opioid crisis in New Hampshire, analyzes images and discourses to three prominent opioid analgesic poisoning cases in the Merrimack Valley, and investigates the dominant discursive themes in several dozen speeches delivered by Jeff Sessions during his short tenure as Attorney General. Together, these analyses demonstrate that strategic portrayals of drugs, addiction, treatment, and justice can frame the opioid crisis to advance particular political and social agendas

The Political Economy of the Overdose Crisis in Western Canada: An Exploratory Case Study

Background: Canada is in the throes of a drug/substance overdose crisis causing unprecedented numbers of overdose and death. Responses to the crisis have been largely reactive and/or medical in nature, highlighting the need for better understanding of its underlying structural determinants. The crisis has emerged in an era of neoliberal capitalism which has deepened health and social inequities and brought changes to the organization of work leading to increased precarity. Such broader economic influences have been identified as among important determinants of substance use and related harms in other contexts. Scant research evidence exists investigating structural determinants in the Western Canadian context and no studies have explored potential links among these confluent dynamics. Methodology: The study used a qualitative case study methodology to explore the contextual influences on the overdose crisis in Western Canada. A contextual synthesis and analysis combined different sources of data to better understand economic influences of the crisis in four sites of study (Saskatoon, SK; Fort McMurray, AB; Kelowna, BC; and Nanaimo, BC). The study drew on three sources of data: publicly available crisis-related data and reports from federal, provincial, and First Nations bodies, 45 interviews with 51 key informants from the sites, and publicly available economic data from Statistics Canada. Within-site and across-site analyses were completed to understand both local and broader economic influences of the crisis. Crystallization, a multidimensional enhancement of triangulation, and member checking were used to build trustworthiness of this research. Findings: Patterns of deaths in the overdose crisis in Western Canada reveal an inequitable distribution of harms where working-aged men, First Nations people, and those working in blue- collar and service industries are overrepresented in overdose deaths. Thematic analysis of key informant interviews in each site reveals socioeconomic pressures, the illicit drug trade and prescription opioids and pain management as economic influences on overdose deaths within and across sites. Increased precarity due to employment changes inherent to neoliberalization is explored as a potential link to increased substance use for particular populations, reflected in the patterns of death amid the overdose crisis. Observations on data sources and limitations for exploring contextual dynamics of the crisis are noted throughout. Conclusion: The overdose crisis in Western Canada is evolving within neoliberal capitalist structures that may be creating risk of substance use and related harms for particular populations. Pathways between those structures and risk appear to be numerous, economically driven, and unevenly distributed among different groups. Data limitations and the nature of exploratory study restrict conclusions about the structural drivers of the crisis, yet certain trends are evident. This study provides emerging insight on the economic influences of crisis-related harms in a Western Canadian context, offering a theoretical framework and suggested hypotheses for ongoing inquiry and suggestive of upstream intervention

Differences in Socialization Factors in Relation to Prescription Drug Misuse Between Rural and Urban Juveniles

Juvenile misuse of prescription drugs in the United States has continuously increased over the last few decades, especially within rural regions of the country. Despite continuous increase in rates of misuse, limited research exists on elements of socialization that may function to prevent drug use. The current study utilized the Monitoring the Future Survey data to explore prescription drug misuse between different populations of juveniles. While using Hirschi’s (1969) theory of social bonds as a theoretical framework, different elements of socialization were explored to determine whether they work to contribute or prevent prescription drug misuse among rural and urban juveniles. Results indicated that parental attachment served as the most substantial protective factor among both populations of juveniles. Additionally, socialization differed in relation to prescription drug use among rural and urban youth. These findings could be implicated in future anti-drug programs that specifically target different regions of the country

Three Essays in Applied Economics

This thesis consists of three papers, two studying the effectiveness of policy interventions curbing the opioid crisis, and one studying the value of network ties in the Chinese bureaucracy. The two chapters on the opioid crisis are coauthored with Daniel Guth, a fellow Caltech graduate student. The first chapter studies the effectiveness of the OxyContin reformulation in reducing opioid misuse and overdose. Purdue Pharma reformulated OxyContin in 2010 to make it more difficult to abuse. Previous research argued that OxyContin misuse fell dramatically and OxyContin users switched directly to heroin. Using a novel and fine-grained source of all oxycodone sales from 2006-2014, we show that the reformulation led users to substitute from OxyContin to generic oxycodone and the reformulation had no overall impact on opioid or heroin mortality. In addition, the chapter finds that generic oxycodone, instead of OxyContin, was the driving factor in the transition to heroin in recent years. These findings highlight the important role generic oxycodone played in the opioid epidemic and the limited effectiveness of a partial supply-side intervention. The second chapter studies the spatial spillover effect of Prescription Drug Monitoring Programs (PDMPs). PDMPs seek to potentially reduce opioid misuse by restricting the sale of opioids in a state. This chapter examines discontinuities along state borders, where one side may have a PDMP and the other side may not. We find that electronic PDMP implementation, whereby doctors and pharmacists can observe a patient's opioid purchase history, reduces a state's opioid sales but increases opioid sales in neighboring counties on the other side of the state border. We also find systematic differences in opioid sales and mortality between border counties and interior counties. These differences decrease when neighboring states both have PDMPs, which is consistent with the hypothesis that the differences were caused by cross-border opioid shopping. Our work highlights the importance of understanding the opioid market as connected across counties or states, as we show that states are affected by the opioid policies of their neighbors. The third chapter examines the value of patronage ties at lower levels of Chinese bureaucracy. A growing literature shows that connection with the right higher-level politicians is beneficial for advancements in the Communist Party of China. In this chapter, I use a self-collected data set to examine the value of patronage ties in the city committees, a previously overlooked but important level of the Chinese government. I present empirical evidence that the party secretaries are involved in the appointment of committee members. But upon departure, the party secretaries' career success does not improve the committee members' future promotion likelihood. This work highlights that the value of interpersonal connection in China is highly dependent on which level of the government is under inspection.</p

Accuracy of Death Certificate Data in Reporting Suicide in the United States

Suicide is one of the leading causes of death in the United States. Death certificates are currently being used by public health professionals and policy makers as a main source of public health surveillance data on suicide. The accuracy of death certificates in tracking and reporting suicides has not been well quantified or evaluated in the United States. Death certificates from other countries have been found to under-report suicide. The purpose of this study was to evaluate the accuracy of death certificates in reporting suicides in the United States. The National Violence Death Reporting System (NVDRS) collects information on all violent deaths from multiple sources including medical records, law enforcement reports, and vital records. Suicide cases recorded in the NVDRS data from 2003 through 2017 were used as a reference standard to evaluate the accuracy of death certificates in reporting suicide in the United States (n = 201,912). Using a multifactorial conceptual framework and a quantitative cross-sectional design, several risk factors were analyzed to determine if they influenced the accurate reporting of suicide on the death certificate. Using a binomial logistic regression model, 13.4% (Nagelkerke R2 = .134) of the variation in accuracy can be attributed to age, race, marital status, education, method of suicide, substance abuse status, year, and state. This study establishes that the death certificate is highly accurate (99.57%) at reporting suicide deaths overall. Therefore, death certificate data can be used as an accurate data source upon which to base public health decisions, interventions, and tracking. It is important that policy and intervention decisions be based on accurate data to effectively and efficiently influence social change