18 research outputs found
Challenges in Understanding Disparities in Drug Use and its Consequences
Racial/ethnic disparities in health have long been documented in a broad
range of medical conditions in the United States. For example, Blacks have higher HIV
incidence and AIDS-related mortality than do Whites. This article summarizes racial/
ethnic differences in drug use and its consequences in the United States and proposes
three key challenges to the study of disparities in drug use and its consequences. These
are (a) patterns of drug use and misuse are complex, with different patterns of use of
different drugs in different racial/ethnic groups; (b) racial/ethnic differences in use of
drugs are not always associated with comparable differences in the consequences of
drug use; and (c) the consequences of drug use are associated with drug use itself and
other social/economic circumstances. Each of these challenges is discussed, and suggestions
offered for future research that may help overcome them.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40362/2/Galea_Challenges in Understanding Disparities in Drug_2005.pd
Drug use, misuse, and the urban environment
Urbanization is probably the single most important demographic shift world-wide throughout the past and the new century and
represents a sentinel change from how most of the world’s population has lived for the past several thousand years. As urban
living becomes the predominant social context for the majority of the world’s population, the very ubiquity of urban living
promises to shape health directly and to indirectly affect what we typically consider risk factors or determinants of population
health. Although a growing body of research is exploring how characteristics of the urban environment may be associated with
health (e.g. depression) and risk behaviours (e.g. exercise patterns), relatively little research has systematically assessed how the
urban environment may affect drug use and misuse. In this paper we will propose a conceptual framework for considering how
different characteristics of the urban environment (e.g. collective efficacy, the built environment) may be associated with drug
use and misuse, summarize the existing empiric literature that substantiates elements of this framework, and identify potential
directions for future research.http://deepblue.lib.umich.edu/bitstream/2027.42/40353/2/Galea_Drug Use, Misuse, and the Urban Environment_2005.pd
Urban built environment and depression: a multilevel analysis
Study objective: To assess the relations between characteristics of the neighbourhood internal and external
built environment and past six month and lifetime depression.
Design and setting: Depression and sociodemographic information were assessed in a cross sectional
survey of residents of New York City (NYC). All respondents were geocoded to neighbourhood of
residence. Data on the quality of the built environment in 59 NYC neighbourhoods were collected from the
United Status census, the New York City housing and vacancy survey, and the fiscal 2002 New York City
mayorâs management report.
Main results: Among 1355 respondents, residence in neighbourhoods characterised by a poor quality
built environment was associated with greater individual likelihood of past six month and lifetime
depression in multilevel models adjusting for individual age, race/ethnicity, sex, and income and for
neighbourhood level income. In adjusted models, persons living in neighbourhoods characterised by
poorer features of the built environment were 29%â58% more likely to report past six month depression
and 36%â64% more likely to report lifetime depression than respondents living in neighbourhoods
characterised by better features of the built environment.
Conclusions: Living in neighbourhoods characterised by a poor quality built environment is associated
with a greater likelihood of depression. Future prospective work designed to assess potential mechanisms
underlying these associations may guide public health and urban planning efforts aimed at improving
population mental health.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40324/2/Galea_Urban Built Environment and Depression_2005.pd
Overdose prevention for injection drug users: Lessons learned from naloxone training and distribution programs in New York City
BACKGROUND: Fatal heroin overdose is a significant cause of mortality for injection drug users (IDUs). Many of these deaths are preventable because opiate overdoses can be quickly and safely reversed through the injection of Naloxone [brand name Narcan], a prescription drug used to revive persons who have overdosed on heroin or other opioids. Currently, in several cities in the United States, drug users are being trained in naloxone administration and given naloxone for immediate and successful reversals of opiate overdoses. There has been very little formal description of the challenges faced in the development and implementation of large-scale IDU naloxone administration training and distribution programs and the lessons learned during this process. METHODS: During a one year period, over 1,000 participants were trained in SKOOP (Skills and Knowledge on Opiate Prevention) and received a prescription for naloxone by a medical doctor on site at a syringe exchange program (SEP) in New York City. Participants in SKOOP were over the age of 18, current participants of SEPs, and current or former drug users. We present details about program design and lessons learned during the development and implementation of SKOOP. Lessons learned described in the manuscript are collectively articulated by the evaluators and implementers of the project. RESULTS: There were six primary challenges and lessons learned in developing, implementing, and evaluating SKOOP. These include a) political climate surrounding naloxone distribution; b) extant prescription drug laws; c) initial low levels of recruitment into the program; d) development of participant appropriate training methodology; e) challenges in the design of a suitable formal evaluation; and f) evolution of program response to naloxone. CONCLUSION: Other naloxone distribution programs may anticipate similar challenges to SKOOP and we identify mechanisms to address them. Strategies include being flexible in program planning and implementation, developing evaluation instruments for feasibility and simplicity, and responding to and incorporating feedback from participants
Depression and Anxiety During the COVID-19 Pandemic in an Urban, Low-Income Public University Sample
Mental health disparities in the aftermath of national disasters and the protective role of socioeconomic status are both well documented. We assessed the prevalence of depression and anxiety symptoms among underresourced public university students during the COVID-19 pandemic in New York City. Between April 8, 2020, and May 2, 2020, adult students (N = 1,821) across the CUNY system completed an online survey examining COVID-19–related stressors and mental health and sociodemographic factors. Using multivariable logistical regression to assess the association between COVID-19–related stressors and depression and anxiety symptoms, we found a high prevalence and severity of depression and anxiety symptoms. We also observed that more exposure to COVID-19–related stressors was associated with increased depressive (27.0%, 41.4%, and 63.1% for low-, medium-, and high-level stressors, respectively) and anxiety symptoms (19.3%, 34.6%, 52.2%). In addition, the degree of exposure to COVID-19–related stressors served as an important predictor of depression and anxiety symptoms. Compared to high levels of stressors, the odds of depression were 0.2, 95% CI [0.2, 0.3] for low- and 0.4, 95% CI [0.3, 0.5] for medium-level stressors; for anxiety, the odds were 0.2, 95% CI [0.2, 0.3] for low and 0.05, 95% CI [0.4, 0.6] for medium stressors. Finally, household savings of less than $5,000 increased the risk of anxiety but not depression symptoms, OR = 1.3, 95% CI [1.0,1.6]. Together, these findings tell a devastating story of psychological distress among students from lower socioeconomic groups living in the COVID-19 epicenter of the U.S. pandemic
Overdose prevention for injection drug users: Lessons learned from naloxone training and distribution programs in New York City
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/49370/1/markham piper_overdose prevention for IDUs_2007.pd
Evaluation of a naloxone distribution and administration program in New York City
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/60330/1/markham piper_evaluation of a naloxone program_2008.pd
Alcohol Drinking Problems Among New York City Residents after the September 11 Terrorist Attacks
Recent studies have shown an increase in alcohol use in New York City in the months
after the September 11 terrorist attacks; thus far there have been no studies documenting
changes in drinking problems. In 2002, a random digit dial phone survey was conducted
of residents of New York City. This study provided us with estimates of the prevalence of
alcohol drinking problems among residents of New York City 6 months after September
11 compared with the 6 months before September 11. Among 1,570 adults, the prevalence
of drinking problems was 3.7% in the 6 months before September 11 and 4.2% in the
6 months after September 11. The incidence of drinking problems among those without
drinking problems before September 11 was 2.2%. Persons with incident drinking
problems were more likely than those without to report symptoms consistent with
posttraumatic stress disorder (17.4% vs. 0.4% in those without drinking problems
and 1.4% in nondrinkers), and depression (23.5% vs 5.6% vs. 4.9%, respectively) after
September 11. After a disaster, a link between drinking problems and posttraumatic
stress disorder or depression should be assessed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40250/2/vlahov_alcohol drinking problems among NYC residents_2006.pd
PTSD and Depression After the Madrid March 11 Train Bombings
The March 11, 2004, train bombings in Madrid, Spain, caused the largest loss of life from a single
terrorist attack in modern European history.We used a cross-sectional random digit dial survey ofMadrid
residents to assess the prevalence of posttraumatic stress disorder (PTSD) and major depression in the
general population of Madrid 1 to 3 months after the March 11 train bombings. Of respondents 2.3%
reported symptoms consistent with PTSD related to the March 11 bombings and 8.0% of respondents
reported symptoms consistent with major depression. The prevalence of PTSD was substantially lower,
but the prevalence of depression was comparable to estimates reported after the September 11 attacks
in Manhattan. The findings suggest that across cities, the magnitude of a terrorist attack may be the
primary determinant of the prevalence of PTSD in the general population, but other factors may be
responsible for determining the population prevalence of depression.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40310/2/Miguel-Tobal_PTSD and Depression After the Madrid_2006.pd
Participant Reactions to Survey Research in the General Population After Terrorist Attacks
There remains concern that survey research after a disaster can precipitate or exacerbate distress
among study participants. The authors surveyed 5,774 persons in three random-digit-dial telephone
surveys of the general population of New York City conducted 1–2 months, 4–5 months, and 6–9
months after the terrorist attack on September 11, 2001. Overall, 746 (12.9%) people who finished
the surveys said that the survey questions were upsetting but only 57 (1.0% overall) were
still upset at the end of the interview, and 19 (0.3%) wanted assistance from a counselor. Ten persons
who did not finish the survey also received counselor assistance. Persons with mental health
symptoms were more likely to find the survey questions emotionally upsetting as were participants
who lacked salutary resources, including health insurance and a regular health care provider. Although
relatively few of those interviewed found the survey assessment disturbing, the presence
of a small number of respondents who wanted mental health assistance suggests the need for a
mental health backup system for research conducted soon after exposure to large-scale traumatic
events.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40338/2/Galea_Participant Reactions to Survey Research_2005.pd