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Biomedical subjects

Sandro Galea

Publications and source records attributed to Sandro Galea.

At least 109 records · Page 6Linked to original sources
PubMed2004

Gender, social support, and posttraumatic stress in postwar Kosovo.

The effects of social support and traumatic experiences on mental health in conflict situations may be different by gender. The Kosovo Emergency Department Study was conducted in July and August 2001 to assess mental health 2 years after the end of the war in Kosovo. Of 306 emergency department patients (87.7% response rate), all were ethnic Albanian, 97.4% had experienced traumatic events, and 89.5% had posttraumatic stress symptoms. Women and persons who experienced more traumatic events had higher posttraumatic stress scores. Persons with social support had lower posttraumatic stress scores. In a final model, social support had a greater protective effect for women, whereas traumatic events had a greater detrimental effect on men. Two years after the war in Kosovo, there remained a high prevalence of posttraumatic stress symptoms, particularly among women with low social support. Interventions targeting social support may be important public health efforts in the postwar context.

Adult↗
PubMed2004

Mental health service and medication use in New York City after the September 11, 2001, terrorist attack.

OBJECTIVE: A survey assessed use of mental health services and psychiatric medications in New York City four to five months after the September 11, 2001, attack on the World Trade Center. METHODS: A telephone survey using random-digit dialing was conducted among 2,001 adult householders. RESULTS: During the interviews, 7.6 percent of respondents reported use of mental health services in the past 30 days and 7.7 percent reported use of psychiatric medications. Factors associated with service use included experiencing four or more lifetime traumatic events, experiencing two or more stressful life events in the past 12 months, having posttraumatic stress disorder (PTSD), and having depression. African-American and Hispanic respondents were less likely than white respondents to use services. Greater service use after the attack was associated with a graduate education, increased alcohol use after the attack, and depression. Factors associated with medication use included being in either of two age groups (25 to 44 years and 45 to 64 years), having a primary care physician, experiencing two or more stressful life events in the past 12 months, and having depression. African-American and Hispanic respondents were less likely than white respondents to be taking medications. Greater use after the attack was associated with having depression. Mental health visits in Manhattan appeared to decrease compared with the first two months after the attack. However, among respondents with PTSD or depression, those who were nonwhite, younger, without a primary care physician, or without health insurance were less likely to use postdisaster services. CONCLUSIONS: Service use after the terrorist attack was related to mental status and to the amount of trauma and stress experienced. Overall, white respondents, those aged 25 to 64 years, and those with a primary care physician were more likely to use services.

Adolescent↗
PubMed2004

Unmet need for counseling services by children in New York City after the September 11th attacks on the World Trade Center: implications for pediatricians.

OBJECTIVE: The objectives of this study were to describe the prevalence of counseling services, contrasted with the need after the terrorist attacks of September 11, 2001, the types of counseling received, and the predictors of receipt of counseling services. METHODS: A cross-sectional, random-digit-dial survey was conducted in New York City (NYC) of parents (N = 434) of children who were 4 to 17 years of age 4 months after the September 11th terrorist attacks on the World Trade Center. RESULTS: Overall, 10% of NYC children received some type of counseling after the September 11th attacks, according to parental report. Among these, 44% received counseling in schools, 36% received counseling from medical or professional providers, and 20% received counseling from other sources. However, only 27% of the children who had severe/very severe posttraumatic stress reactions (PTSR) after the attacks received counseling services. In a multivariate model, receipt of counseling before the September 11th attacks (odds ratio: 4.44) and having severe/very severe PTSR (odds ratio: 3.59) were the most important predictors of use of counseling services after the September 11th attacks. Minority status and having a parent who experienced the loss of a friend or a relative were also associated with receipt of services. CONCLUSIONS: There was substantial disparity between apparent need (as indicated by severe/very severe PTSR) for and receipt of mental health services for children after the September 11th attacks. There is need for intensified efforts to identify, refer, and treat children in need, especially for children who are not already in a therapeutic relationship. An enhanced role for pediatricians is indicated.

Adolescent↗
PubMed2004

Sustained increased consumption of cigarettes, alcohol, and marijuana among Manhattan residents after september 11, 2001.

We compared reports of increased substance use in Manhattan 1 and 6 months after the September 11, 2001, terrorist attacks. Data from 2 random-digit-dial surveys conducted 1 and 6 months after September 11 showed that 30.8% and 27.3% of respondents, respectively, reported increased use of cigarettes, alcohol, or marijuana. These sustained increases in substance use following the September 11 terrorist attacks suggest potential long-term health consequences as a result of disasters.

Adult↗
PubMed2004

SARS control and psychological effects of quarantine, Toronto, Canada.

As a transmissible infectious disease, severe acute respiratory syndrome (SARS) was successfully contained globally by instituting widespread quarantine measures. Although these measures were successful in terminating the outbreak in all areas of the world, the adverse effects of quarantine have not previously been determined in a systematic manner. In this hypothesis-generating study supported by a convenience sample drawn in close temporal proximity to the period of quarantine, we examined the psychological effects of quarantine on persons in Toronto, Canada. The 129 quarantined persons who responded to a Web-based survey exhibited a high prevalence of psychological distress. Symptoms of posttraumatic stress disorder (PTSD) and depression were observed in 28.9% and 31.2% of respondents, respectively. Longer durations of quarantine were associated with an increased prevalence of PTSD symptoms. Acquaintance with or direct exposure to someone with a diagnosis of SARS was also associated with PTSD and depressive symptoms.

Adolescent↗
PubMed2004

Science for the community: assessing mental health after 9/11.

Reactions to the September 11 attacks across the United States were pervasive, and persons throughout the country reported experiences akin to posttraumatic stress disorder (PTSD) in the first week following the attacks. In the New York area, 2 major surveys conducted 4 to 8 weeks after the attacks found that approximately 1 in 10 persons probably met full criteria for PTSD related to September 11. Although tobacco, alcohol, and marijuana use did increase, it was largely among persons already using these substances. The greatest increase, not surprisingly, occurred among persons with PTSD and major depressive disorder. Nationwide during the same time period, rates of PTSD related to September 11 were estimated at 2.7% to 4.3%, a striking finding in that the attacks were witnessed primarily on television outside the New York area. In all studies, having anxiety symptoms or meeting criteria for PTSD was strongly associated with number of hours of television watched on September 11 and in the days afterward. A number of explanations for this new finding are possible. These data can inform our understanding of trauma-related diagnoses, further the evolving diagnostic definitions of the Diagnostic and Statistical Manual of Mental Disorders, and contribute to etiologic models of PTSD. Future directions for postdisaster survey research are briefly discussed.

Adult↗
PubMed2004

Explaining the relationship between race/ethnicity and pharmacy purchased syringes among injection drug users in New York City.

OBJECTIVE: Pharmacy syringe sales without a prescription became legal in New York State on January 1, 2001 through the Expanded Syringe Access Demonstration Program (ESAP). At the same time, Pharmacy use among Black and Hispanic injection drug users was found to be significantly lower when compared to Whites. The purpose of this study was to assess the factors that could explain the relationship between race/ethnicity and pharmacy use. DESIGN: Data were combined from 2 on-going injection drug user (IDU) studies in 2 New York City neighborhoods. Social and behavioral factors independently associated with ever purchasing a nonprescription syringe in the past 6 months and examined using cross-sectional logistic regression. RESULTS: Of 337 IDUs, the majority were male (79%), Hispanic (73%) and had a mean age of 35 years. In bivariate analysis, IDUs who reported pharmacy use were less likely to be Black or Hispanic, older, and to have reported recent syringe exchange program (SEP) attendance compared to non-pharmacy users. Additionally, pharmacy users were more likely to have knowledge of ESAP, and report discrimination by police in the past year compared to non-users. After adjustment for recent SEP attendance (adjusted odds ratio [AOR]=0.27; 95% confidence interval [CI]=0.14-0.55), ESAP knowledge (AOR=13.11; 95% CI=6.54-26.31), discrimination by police (AOR=3.56; 95% CI=1.73-7.35), and discrimination due to race (AOR=0.25, 95% CI=0.11-0.58), race/ethnicity was not a significant predictor of pharmacy use. CONCLUSIONS: Race/ethnicity may not be an important determinant of ESAP when more salient social circumstances, such as past discrimination, are considered. Educational efforts should be enhanced to reach those who continue to perceive barriers to ESAP.

Adult↗
PubMed2003

Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks.

The authors investigated trends in probable post-traumatic stress disorder (PTSD) prevalence in the general population of New York City in the first 6 months after the September 11 terrorist attacks. Three random digit dialing telephone surveys of adults in progressively larger portions of the New York City metropolitan area were conducted 1 month, 4 months, and 6 months after September 11, 2001. A total of 1,008, 2,001, and 2,752 demographically representative adults were recruited in the three surveys, respectively. The current prevalence of probable PTSD related to the September 11 attacks in Manhattan declined from 7.5% (95% confidence interval: 5.7, 9.3) 1 month after September 11 to 0.6% (95% confidence interval: 0.3, 0.9) 6 months after September 11. Although the prevalence of PTSD symptoms was consistently higher among persons who were more directly affected by the attacks, a substantial number of persons who were not directly affected by the attacks also met criteria for probable PTSD. These data suggest a rapid resolution of most of the probable PTSD symptoms in the general population of New York City in the first 6 months after the attacks. The psychological consequences of a large-scale disaster in a densely populated urban area may extend beyond persons directly affected by the disaster to persons in the general population.

Adolescent↗
PubMed2003

Income distribution and risk of fatal drug overdose in New York City neighborhoods.

Accidental drug overdose is a substantial cause of mortality for drug users. Neighborhood-level factors, such as income distribution, may be important determinants of overdose death independent of individual-level factors. We used data from the Office of the Chief Medical Examiner to identify all cases of accidental deaths in New York City (NYC) in 1996 and individual-level covariates. We used 1990 US Census data to calculate the neighborhood-level income distribution. This multi-level case-control study included 725 accidental overdose deaths (cases) and 453 accidental deaths due to other causes (controls) in 59 neighborhoods in NYC. Overdose deaths were more likely in neighborhoods with higher levels of drug use and with more unequal income distribution. In multi-level models, income maldistribution was significantly associated with risk of overdose independent of individual-level variables (age, race, and sex) and neighborhood-level variables (income, drug use, and racial composition). The odds of death due to drug overdose were 1.63-1.88 in neighborhoods in the least equitable decile compared with neighborhoods in the most equitable decile. Disinvestment in social and economic resources in unequal neighborhoods may explain this association. Public health interventions related to overdose risk should pay particular attention to highly unequal neighborhoods.

Adolescent↗
PubMed2003

Psychiatric medication use among Manhattan residents following the World Trade Center disaster.

To assess medication use in New York after the September 11th attacks, a telephone survey was conducted in October 2001 (N = 1,008). The prevalence of psychiatric medication use 30 days before the disaster was 8.9 and 11.6% 30 days after, a small but significant increase. The most important factor predicting postdisaster use was predisaster use--92% of those who used medications postdisaster used them predisaster. In addition, 3.3% used psychiatric medications 30 days postdisaster, but not 30 days before. Those who had panic attacks, posttraumatic stress disorder (PTSD), and insurance coverage, were the most likely medicated (26.5%). However, among those who used postdisaster medications (n = 129), new users tended to be those with panic attacks (44.1%) and those with panic attacks and PTSD (69.2%).

Adult↗
PubMed2003

Opiates, cocaine and alcohol combinations in accidental drug overdose deaths in New York City, 1990-98.

AIMS: Accidental drug overdose contributes substantially to mortality among drug users. Multi-drug use has been documented as a key risk factor in overdose and overdose mortality in several studies. This study investigated the contribution of multiple drug combinations to overdose mortality trends. DESIGN: We collected data on all overdose deaths in New York City between 1990 and 1998 using records from the Office of the Chief Medical Examiner (OCME). We standardized yearly overdose death rates by age, sex and race to the 1990 census population for NYC to enable comparability between years relevant to this analysis. FINDINGS: Opiates, cocaine and alcohol were the three drugs most commonly attributed as the cause of accidental overdose death by the OCME, accounting for 97.6% of all deaths; 57.8% of those deaths were attributed to two or more of these three drugs in combination. Accidental overdose deaths increased in 1990-93 and subsequently declined slightly in 1993-98. Changes in the rate of multi-drug combination deaths accounted for most of the change in overdose death rates, whereas single drug overdose death rates remained relatively stable. Trends in accidental overdose death rates within gender and racial/ethnic strata varied by drug combination suggesting different patterns of multi-drug use among different subpopulations. CONCLUSIONS: These data suggest that interventions to prevent accidental overdose mortality should address the use of drugs such as heroin, cocaine and alcohol in combination.

Adult↗
PubMed2003

Posttraumatic stress in women after the September 11 terrorist attacks in New York City.

BACKGROUND: Women have been shown to be at higher risk than men of developing posttraumatic stress disorder (PTSD) after traumatic events. Women in New York City were more likely than men to have probable PTSD 5-8 weeks after the September 11, 2001, terrorist attacks on the World Trade Center. We explored the factors that could explain the higher prevalence of probable PTSD among women in the aftermath of the attacks. METHODS: Data from a telephone survey of a randomly selected group of residents of Manhattan living south of 110th street, conducted 5-8 weeks after September 11, were used in these analyses. The survey assessed demographic information, lifetime experience of traumatic events, life stressors, social support, event exposure variables, perievent panic attacks, postevent concerns, and probable PTSD related to the attacks. We determined the contribution of key covariates that could explain the gender-probable PTSD relation through stratified analyses and manual stepwise logistic regression model building. RESULTS: Among 988 respondents, women were two times more likely than men to report symptoms consistent with probable PTSD after the September 11 attacks. When adjusted for potential confounders, the association between gender and probable PTSD diminished from OR = 2.2 (95% confidence interval [CI] 1.3-3.6) to OR = 1.2 (95% CI 0.7-2.2). CONCLUSIONS: These results suggest that specific behavioral and biographic factors (including previous traumatic experiences and psychological disorders, social responsibilities, and perievent emotional reactions) explained most of the excess burden of probable PTSD among women after a disaster. Isolating the characteristics that place women at greater risk for probable PTSD after disasters can inform public health prevention strategies and spur further research.

Adolescent↗
PubMed2003

Racial/ethnic disparities in overdose mortality trends in New York City, 1990-1998.

Racial/ethnic disparities in health and disease have been present in the United States for the past century. Although differences such as individual access to health care and health-related behaviors account for some of these health disparities, it is likely that a combination of individual and contextual-level factors determine the differential rates of disease between racial/ethnic groups. We studied fatal accidental drug overdose in New York City between 1990 and 1998 to describe differences in racial/ethnic patterns over time and to develop hypotheses about factors that might contribute to these differences. During this period, rates of overdose death were consistently higher among blacks and Latinos compared to whites. In addition, cocaine was more common among black decedents, while opiates and alcohol were more common among Latino and white decedents. Differences in situational factors, such as differential likelihood of activating emergency medical response, may in part explain the consistently higher overdose mortality rates observed among minorities. Further study to determine the individual and contextual factors that explain these observed disparities in overdose death may identify effective areas for public health intervention and provide insight into factors underlying racial/ethnic disparities in other health outcomes.

Adolescent↗
PubMed2003

Preliminary evidence of health care provider support for naloxone prescription as overdose fatality prevention strategy in New York City.

Preliminary research suggests that naloxone (Narcan), a short-acting opiate antagonist, could be provided by prescription or distribution to heroin users to reduce the likelihood of fatality from overdose. We conducted a random postal survey of 1100 prescription-authorized health care providers in New York City to determine willingness to prescribe naloxone to patients at risk of an opiate overdose. Among 363 nurse practitioners, physicians, and physician assistants responding, 33.4% would consider prescribing naloxone, and 29.4% were unsure. This preliminary study suggests that a substantial number of New York City health care providers would prescribe naloxone for opiate overdose prevention.

Attitude of Health Personnel↗
PubMed2003

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.

Adult↗
PubMed2003

The association between multiple domains of discrimination and self-assessed health: a multilevel analysis of Latinos and blacks in four low-income New York City neighborhoods.

OBJECTIVE: This study examines the association between discrimination due to race and other attributes (e.g., sex, age) and self-assessed mental and physical health among Latinos and blacks. DATA SOURCE: Latino and black adult participants (n = 873) identified by random digit dialing were interviewed by telephone in four low-income neighborhoods in New York City: the South Bronx, East Harlem, Central Harlem, and Bedford-Stuyvesant. STUDY DESIGN: In this cross-sectional study, generalized estimating equations were used to fit multilevel multivariable models to test the association between discrimination and poor mental and physical health while controlling for socioeconomic status, access to health care, social support, smoking, and the racial and ethnic composition of each neighborhood. PRINCIPAL FINDINGS: Discrimination due to race and discrimination due to other attributes were associated with poor self-assessed mental but not physical health in separate multivariable models. Persons who experienced multiple domains of discrimination had a greater probability of reporting poor mental health than persons who experienced no discrimination. CONCLUSIONS: Discrimination due to race and other attributes was a significant correlate of mental health among Latinos and blacks independent of other accepted determinants of health.

Adolescent↗