Distribution of Education and Population Health: An Ecological Analysis of New York City Neighborhoods

Objectives. We assessed the relationship between distribution of education and health indicators in a large urban area to determine if distribution of education may be a determinant of population health. Methods. We studied the association between distribution of education, measured with the education Gini coefficient, and rates of 8 health indicators in 59 neighborhoods in New York City. Results. In separate adjusted ecological models, neighborhoods with more poorly distributed education had better population health indicators that might plausibly be associated with short-term changes in the social environment (e.g., homicide and infant mortality rate); there was no association between education distribution and health indicators more likely to be associated with long-term accumulation of social and behavioral stressors (e.g., cardiovascular disease and chronic lung disease mortality rates). These findings were robust to measures of income and to adjustment for several potential confounders (e.g., gender and race/ethnicity). Conclusions. The presence in a neighborhood of highly educated people may be salutary for all residents, independent of the potentially deleterious consequences of income maldistribution.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40355/2/Galea_Distribution of Education and Population Health_2005.pd

Social context and depression after a disaster: The role of income inequality

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41236/1/ahern_social context and depression after a disater_2006.pd

Invited Commentary: Considerations about Specificity of Associations, Causal Pathways, and Heterogeneity in Multilevel Thinking

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40347/2/Galea_Invited Commentary - Considerations about Specificity_2006.pd

Immune cell census in murine atherosclerosis: cytometry by time of flight illuminates vascular myeloid cell diversity

Aims: Atherosclerosis is characterised by the abundant infiltration of myeloid cells starting at early stages of disease. Myeloid cells are key players in vascular immunity during atherogenesis. However, the subsets of vascular myeloid cells have eluded resolution due to shared marker expression and atypical heterogeneity in vascular tissues. We applied the high-dimensionality of mass cytometry to the study of myeloid cell subsets in atherosclerosis. Methods and Results: Apolipoprotein E-deficient (ApoE-/-) mice were fed a chow or a high fat (western) diet for 12 weeks. Single cell aortic preparations were probed with a panel of 35 metal-conjugated antibodies using Cytometry by time of flight (CyTOF). Clustering of marker expression on live CD45+ cells from the aortas of ApoE-/- mice identified 13 broad populations of leucocytes. Monocyte, macrophage, type 1 and type 2 conventional dendritic cell (cDC1 and cDC2), plasmacytoid dendritic cell (pDC), neutrophil, eosinophil, B cell, CD4+ and CD8+ T cell, γδ T cell, natural killer (NK) cell and innate lymphoid (ILC) cell populations accounted for approximately 95% of the live CD45+ aortic cells. Automated clustering algorithms applied to the Lin-CD11blo-hi cells revealed 20 clusters of myeloid cells. Comparison between chow and high fat fed animals revealed increases in monocytes (both Ly6C+ and Ly6C-), pDC and a CD11c+ macrophage subset with high fat feeding. Concomitantly, the proportions of CD206+ CD169+ subsets of macrophages were significantly reduced as were cDC2. Conclusions: A CyTOF-based comprehensive mapping of the immune cell subsets within atherosclerotic aortas from ApoE-/- mice offers tools for myeloid cell discrimination within the vascular compartment and it reveals that high fat feeding skews the myeloid cell repertoire towards inflammatory monocyte-macrophage populations rather than resident macrophage phenotypes and cDC2 during atherogenesis

The Challenges of Afghanistan and Iraq Veterans’ Transition from Military to Civilian Life and Approaches to Reconnection

Afghanistan and Iraq veterans experienced traumas during deployment, and disrupted connections with friends and family. In this context, it is critical to understand the nature of veterans’ transition to civilian life, the challenges navigated, and approaches to reconnection. We investigated these issues in a qualitative study, framed by homecoming theory, that comprised in-depth interviews with 24 veterans. Using an inductive thematic analysis approach, we developed three overarching themes. Military as family explored how many veterans experienced the military environment as a “family” that took care of them and provided structure. Normal is alien encompassed many veterans experiences of disconnection from people at home, lack of support from institutions, lack of structure, and loss of purpose upon return to civilian life. Searching for a new normal included strategies and supports veterans found to reconnect in the face of these challenges. A veteran who had successfully transitioned and provided support and advice as a peer navigator was frequently discussed as a key resource. A minority of respondents—those who were mistreated by the military system, women veterans, and veterans recovering from substance abuse problems—were less able to access peer support. Other reconnection strategies included becoming an ambassador to the military experience, and knowing transition challenges would ease with time. Results were consistent with and are discussed in the context of homecoming theory and social climate theory. Social support is known to be protective for veterans, but our findings add the nuance of substantial obstacles veterans face in locating and accessing support, due to disconnection and unsupportive institutions. Larger scale work is needed to better understand how to foster peer connection, build reconnection with family, and engage the broader community to understand and support veterans; interventions to support reconnection for veterans should be developed

A model of underlying socioeconomic vulnerability in human populations: evidence from variability in population health and implications for public health

Drawing from insights into the variability of complex biologic systems we propose that the health of human populations reflects the interrelationship between underlying vulnerabilities (determined by population-level social and economic factors; e.g., income distribution) and capacities (determined by population-level salutary resources, e.g., social capital) and how populations, shaped by these vulnerabilities and capacities, respond to intermittent stressors (e.g., economic downturns) and protective events (e.g., introduction of a school). Monitoring this dynamic at the population-level can be accomplished by examining not only rates of illness and mortality, but variability in rates, either between populations or within populations over time. We used mortality data from New York City neighborhoods between 1990 and 2001 to test two related hypotheses consistent with this model of population health: (a) There is greater variability in mortality rates at a point in time between neighborhoods that are characterized by socioeconomic vulnerability; and (b) there is greater variability in mortality rates over time within neighborhoods that are characterized by socioeconomic vulnerability. We found that neighborhoods characterized by social and economic vulnerability displayed substantial variability in particular mortality rates. Mortality rates displaying the greatest variability were from causes that may be sensitive to social conditions (e.g., homicide or HIV/AIDS rates). Variability in population health existed both between neighborhoods with underlying vulnerability at one point in time and within vulnerable neighborhoods over time. The results of this analysis are consistent with a theory of underlying socioeconomic vulnerabilities of human populations and suggest that variability in population health may be an important consideration in population health assessment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40366/2/Galea_A Model of Underlying Socioeconomic Vulnerability_2005.pd

Estimating the Effects of Potential Public Health Interventions on Population Disease Burden: A Step-by-Step Illustration of Casual Inference Methods

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63033/1/ahern_estimating the effect_2009.pd

Contextual Determinants of Drug Use Risk Behavior: a Theoretic Framework

Over the past two decades, public health research has emphasized the role of individual risk behaviors, primarily injection and sexual risk behaviors, in the spread of HIV infection. Much less emphasis has been given to understanding the determinants of these risk behaviors. Although individual characteristics are partly responsible for risky injection and sexual behaviors, they do not explain all the interpersonal variability in risk behavior. Contextual factors associated with HIV risk behavior may include structural factors (e.g., availability of services), social norms and attitudes (e.g., social trust), disadvantage (e.g., neighborhood socioeconomic status), and features of the physical environment (e.g., housing quality). This article presents a conceptual framework that incorporates some of the key contextual domains that may affect drug use behavior. It also presents data from a study of street-recruited drug users as an example of the relations between social contextual factors and frequency of injecting drug use, and discusses some methodological challenges in the study of contextual determinants of drug use behavior.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40342/2/Galea_Contextual Determinants of Drug Use Risk_2003.pd