Addressing social determinants of health inequities: learning from doing.
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Health Policy↗
Biomedical subjects
Sandro Galea
Publications and source records attributed to Sandro Galea.
Social factors associated with AIDS and SARS.
We conducted a survey of 928 New York City area residents to assess knowledge and worry about AIDS and SARS. Specific sociodemographic groups of persons were more likely to be less informed and more worried about contracting the diseases.
Adolescent↗
Drug and alcohol use as determinants of New York City homicide trends from 1990 to 1998.
In this population-level study, we analyzed how well changes in drug and alcohol use among homicide victims explained declining homicide rates in New York City between 1990 and 1998. Victim demographics, cause of death, and toxicology were obtained for all homicide (N = 12573) and accidental death victims (N = 6351) between 1990 and 1998 from the Office of the Chief Medical Examiner of New York (OCME). The proportion of homicide and accident decedents positive for cocaine fell between 1990 and 1998 (13% and 9% respectively); the proportion of homicide and accident decedents positive for opiates and/or alcohol did not change significantly. Changing patterns of drug and alcohol use by homicide victims were comparable to changing patterns of drug and alcohol use in accident victims, suggesting that changes in drug and alcohol use among homicide victims between 1990 and 1998 cannot solely explain the decline in NYC homicide rates.
Adolescent↗
War-related psychological sequelae among emergency department patients in the former Republic of Yugoslavia.
BACKGROUND: Residents of the Republic of Serbia faced civil war and a NATO-led bombing campaign in 1999. We sought to assess the burden of metal health dysfunction among emergency department (ED) patients presenting for care three years post-war in Serbia. METHODS: This study was conducted during July and August 2002 at two sites: a university hospital ED in Belgrade, Serbia and an ED in a remote district hospital serving a Serbian enclave in Laplje Selo, Kosovo. Investigators collected data on a systematic sample of non-acute patients presenting to the ED. All respondents completed a structured questionnaire assessing demographics and symptoms of post-traumatic stress disorder (PTSD) (using the Harvard Trauma Questionnaire), and major depression (using the Center for Epidemiologic Studies Depression Scale). RESULTS: A total of 562 respondents participated (310 in Belgrade, 252 in Laplje Selo); the response rate was 83.8%, 43% were female, and mean age was 37.6 years (SD = 13.4). Overall, 73 (13.0%) participants had symptoms consistent with PTSD, and 272 (49.2%) had symptoms consistent with depression. Sixty-six respondents had both disorders (11.9%). In separate multivariable logistic regression models, predictors of PTSD were refugee status and residence in Laplje Selo, and predictors of depression were older age, current unemployment, and lower social support. CONCLUSIONS: Three years post-war, symptoms of PTSD and major depression in Serbia remained a significant public health concern, particularly among refugees, those suffering subsequent economic instability, and persons living in rural, remote areas.
Adult↗
Mental health status among ethnic Albanians seeking medical care in an emergency department two years after the war in Kosovo: a pilot project.
STUDY OBJECTIVE: The long-term psychological effects of war are under appreciated in clinical settings. Describing the postwar psychosocial burden on medical care can help direct public health interventions. We performed an emergency department (ED)-based assessment of the mental health status of ethnic Albanian patients 2 years after the North Atlantic Treaty Organization-led bombing of Serbia and Kosovo in 1999. METHODS: This study was conducted July 30, 2001, to August 30, 2001, in the ED of a hospital in Pristina, Kosovo. Investigators collected data through systematic sampling of every sixth nonacute ED patient presenting for care; 87.7% of patients agreed to participate. Respondents completed a structured questionnaire, including demographic characteristics, the Short Form-36, and the Harvard Trauma Questionnaire. RESULTS: All 306 respondents were ethnic Albanians; mean age was 39 years (SD 17.9 years). Of respondents, 58% had become refugees during the war. Two hundred ninety-six (97%) reported experiencing at least one traumatic event during the war; the average number of traumatic events encountered by participants was 6.6. Forty-three (14%) reported symptoms that met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for posttraumatic stress disorder; mean Short Form-36 Mental Component Summary score was 42.1 (SD 12.5). Separate multivariable linear regression models confirmed our belief that older age, female sex, less than a high school education, and having experienced a greater number of traumatic events would be associated with more posttraumatic stress disorder symptoms and lower Mental Component Summary scores. CONCLUSION: Mental health problems among ED patients in Kosovo, particularly among specific vulnerable populations, are a significant public health concern 2 years after the conflict.
Adult↗
Hispanic ethnicity and post-traumatic stress disorder after a disaster: evidence from a general population survey after September 11, 2001.
PURPOSE: To assess ethnic differences in the risk of post-traumatic stress disorder (PTSD) after a disaster, and to assess the factors that may explain these differences. METHODS: We used data from a representative survey of the New York City metropolitan area (n=2,616) conducted 6 months after September 11, 2001. Linear models were fit to assess differences in the prevalence of PTSD between different groups of Hispanics and non-Hispanics and to evaluate potential explanatory variables. RESULTS: Hispanics of Dominican or Puerto Rican origin (14.3% and 13.2%, respectively) were more likely than other Hispanics (6.1%) and non-Hispanics (5.2%) to report symptoms consistent with probable PTSD after the September 11 terrorist attacks. Dominicans and Puerto Ricans were more likely than persons of other races/ethnicities to have lower incomes, be younger, have lower social support, have had greater exposure to the September 11 attacks, and to have experienced a peri-event panic attack upon hearing of the September 11 attacks; these variables accounted for 60% to 74% of the observed higher prevalence of probable PTSD in these groups. CONCLUSION: Socio-economic position, event exposures, social support, and peri-event emotional reactions may help explain differences in PTSD risk after disaster between Hispanic subgroups and non-Hispanics.
Adult↗
Epidemiologic research and disasters.
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Disasters↗
Club drug use among minority substance users in New York City.
Surveillance data suggests that club drug use (Ecstasy, GHB, ketamine, LSD, methamphetamine, PCP and flunitrazepam) has been a predominantly White adolescent and young adult phenomenon in the United States. The authors investigated the use of club drugs among 323 street-recruited minority substance users in northern New York City (66.3% were Hispanic, 23.8% were Black, and 9.9% were White/other race; median age = 32 years old). While Whites were more likely than others to have used club drugs, club drug use among Hispanics and Blacks was not uncommon; 45.3% Hispanics and 56.4% of Blacks reported a lifetime history of club drug use. PCP was the most commonly reported club drug used among all racial/ethnic groups. Further investigation of club drug use in minority populations is warranted.
Adolescent↗
Consumption of cigarettes, alcohol, and marijuana among New York City residents six months after the September 11 terrorist attacks.
Early analyses following the September 11 terrorist attacks on New York City showed an increase in cigarette, alcohol, and marijuana use, but it was unknown whether these increases would persist. A random-digit dial phone survey was conducted to estimate the prevalence of increased substance use among residents of New York City six to nine months after the attacks. Among 1570 adults, 9.9% reported an increase in smoking, 17.5% an increase in alcohol use, and 2.7% an increase in marijuana use compared to the month before September 11. These increases were comparable to increases reported in the first one to two months after September 11. Persons who increased use of cigarettes were more likely than those who did not to report symptoms consistent with posttraumatic stress disorder (PTSD) in the past month (4.3% and 1.2% respectively). Depression was more common among those who increased use of cigarettes (14.6% and 5.2% respectively), alcohol (11.8% vs. 5.2%), and marijuana (34.1% vs. 5.3%). Among residents living in Manhattan below One Hundred Tenth Street, the prevalence of PTSD and depression declined by more than half in the first six months after September 11, while the increase in substance use did not decline substantially. These results suggest that the increase in substance use after a disaster may be a cause for public health concern in the long-term.
Adolescent↗
The social epidemiology of substance use.
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Age Factors↗
Updating the infection risk reduction hierarchy: preventing transition into injection.
Current approaches to prevention of blood-borne infections in injection drug users include referral to drug abuse treatment, access to sterile syringes, bleach disinfection of injection equipment, and education about not sharing equipment. However, rates of some blood-borne infections (e.g., hepatitis C virus) remain elevated among injection drug users, especially early after initiation into injection drug use. With lower infection rates in noninjectors and transition into injection drug use occurring most commonly among these noninjectors, prevention of transition into injection drug use as an additional step to reduce risk for acquisition and transmission of blood-borne infections merits closer attention.
Blood-Borne Pathogens↗
Hepatitis C incidence--a comparison between injection and noninjection drug users in New York City.
Hepatitis C virus (HCV) burdens injection drug users (IDUs) with prevalence estimated from 60-100% compared to around 5% among noninjection drug users (non-IDUs). We present preliminary data comparing the risk for HCV among IDUs and non-IDUs to inform new avenues of HCV prevention and intervention planning. Two cohorts, new IDUs (injecting < or =3 years) and non-IDUs (smoke/sniff heroine, crack or cocaine < or =10 years), ages 15-40, were street-recruited in New York City. Participants underwent risk surveys and HCV serology at baseline and 6-month follow-up visits. Person-time analysis was used to estimate annual HCV incidence. Of 683 non-IDUs, 653 were HCV seronegative, 422 returned for at least 1 follow-up visit, and 1 became HCV seropositive. Non-IDUs contributed 246.3 person-years (PY) yielding an annual incident rate of 0.4/100 PY (95% Confidence Interval [CI]=0.0-1.2). Of 260 IDUs, 114 were HCV seronegative, 62 returned for at least 1 follow-up visit, and 13 became HCV seropositive. IDUs contributed 36.3 PY yielding an annual incidence rate of 35.9/100 PY (95%CI=19.1-61.2). Among IDUs, HCV seroconverters tended to be younger (median age 25 vs. 28, respectively), and inject more frequently (61.5% vs. 34.7%, respectively) than non-seroconverters. These interim data suggest that IDUs may have engaged in high-risk practices prior to being identified for prevention services. Preventing or at least delaying transition into injection could increase opportunity to intervene. Identifying risk factors for transition into injection could inform early prevention to reduce onset of injection and risk of HCV.
Adolescent↗
Cities and health: history, approaches, and key questions.
The majority of the world's population will live in cities in the next few years, and the pace of urbanization worldwide will continue to accelerate over the coming decades. Such a dramatic demographic shift can be expected to have an impact on population health. Although there has been historic interest in how city living is associated with health, this interest has waxed and waned and a cogent framework has yet to evolve that encompasses key issues in urban health. In this article, the authors discuss three alternate approaches to the study of urban health today; these include considering urban health from the perspective of a presumed urban health penalty, from an urban sprawl perspective, and more comprehensively, considering how urban living conditions may be associated with health. The authors also propose three key questions that may help guide the study and practice of urban health in coming decades. These include considering what specific features of cities are causally related to health, the extent to which these features are unique to a particular city or are different between cities, and ultimately, to what extent these features of cities are modifiable in order to allow interventions that can improve the health of urban populations.
Cities↗
War and anxiety disorders.
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Anxiety Disorders↗
Clinicians' knowledge, attitudes, and concerns regarding bioterrorism after a brief educational program.
We conducted this study to determine the knowledge, attitudes, and intended behaviors of New York City clinicians regarding bioterrorism-related diseases after a brief educational program. Data on clinicians' knowledge and attitudes toward bioterrorism and related diseases were collected using a self-administered questionnaire following a 3.5-hour educational program. Participants (n = 310, 82% response rate) reported increased confidence in recognizing symptoms of bioterrorism-related diseases (89%), in addressing patients' bioterrorism concerns (83%), and ability to treat bioterrorism victims (75%). Despite a high level of confidence in the efficacy of infection control precautions, participants' knowledge scores regarding safe work practices suggest that additional education is warranted. Educational programs are useful in enhancing the public health response to bioterrorism and its consequences.
Adult↗
Job loss, unemployment, work stress, job satisfaction, and the persistence of posttraumatic stress disorder one year after the September 11 attacks.
The influence of unemployment and adverse work conditions on the course of psychopathology after a mass disaster is unclear. We recruited a representative sample of adults living in the New York City metropolitan area six months after the September 11 attacks and completed follow-up interviews on 71% of the baseline sample six months later (N = 1939). At follow-up, posttraumatic stress disorder (PTSD) persisted in 42.7% of the 149 cases with PTSD at baseline. In multivariable models, unemployment at any time since baseline predicted PTSD persistence in the entire cohort (P = 0.02) and among persons employed at follow-up (P = 0.02). High levels of perceived work stress predicted PTSD persistence among persons employed at follow-up (P = 0.02). Persons unemployed in the aftermath of a disaster may be at risk for poor mental health in the long-term.
Adaptation, Psychological↗
Television images and probable posttraumatic stress disorder after September 11: the role of background characteristics, event exposures, and perievent panic.
Television viewing has been associated with posttraumatic stress disorder (PTSD) symptoms after disasters and traumas; we examined characteristics that may explain this association among New Yorkers after September 11, 2001. Among 2001 respondents to a random-digit dial telephone survey conducted 4 months after September 11, people who viewed more television images in the 7 days after September 11 had more probable PTSD. People in the highest third of viewing had a 2.32 times greater odds of probable PTSD after September 11 compared with people in the lowest third of viewing; after adjustment for explanatory variables, the relative odds of probable PTSD were 1.66. Adjustment for perievent panic accounted for 44% of the reduction in association between television and probable PTSD, suggesting that perievent emotional reactions may play an important role in the television and psychopathology association. Television may merit consideration as a potential exposure to a traumatic event.
Adolescent↗
Adverse reactions associated with studying persons recently exposed to mass urban disaster.
This study assesses the psychological consequences of participation in a mental health study among people recently exposed to the September 11 attacks. Using cross-sectional telephone surveys, we interviewed random samples of English-speaking or Spanish-speaking adults living in New York City during the attacks 1 year after this event. Altogether, 2,368 people completed the surveys, including a random sample of 1,173 respondents who received mental health services after the attacks. Results indicated that 15% of New Yorkers found some of the survey questions stressful, whereas 28% of those who sought treatment found this to be the case. However, less than 2% reported being upset at survey completion, and among these persons, only four people consented to speak to the study's mental health consultant. Although the majority of those expressing adverse reactions had sought postdisaster treatment, even among these subjects, only 3% were still upset at survey completion, and 2% wanted more information about counseling services. In addition, more than 70% of participants expressed positive sentiments about survey participation. Predictive models indicated that respondents who met study criteria for posttraumatic stress disorder, depression, or anxiety were more likely to find questions stressful, with people having posttraumatic stress disorder or depression the most likely to be upset and to consent to psychiatric consultation at completion. We suggest that, with the proper safeguards, research with persons exposed to a resent mass urban disaster generally can be conducted safely and effectively.
Adult↗