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Sandro Galea

Publications and source records attributed to Sandro Galea.

At least 127 records · Page 7Linked to original sources
PubMed2003

Awareness and perceptions of a communitywide mental health program in New York city after September 11.

The Project Liberty program was established after the terrorist attacks of September 11, 2001, to offer free mental health services to New York City residents. The authors used data from a random-digit-dial telephone survey to assess public awareness of and willingness to make use of Project Liberty's services. They found that 24 percent of the New York City residents surveyed (480 of 2001 respondents) had heard of Project Liberty four months after September 11. Persons with lower socioeconomic status and those who had psychological symptoms consistent with posttraumatic stress disorder were more likely to say that they would contact Project Liberty. The results of the study suggest that although awareness of this public mental health services was low, Project Liberty was well received among the people who may be most likely to need its services.

Adolescent↗
PubMed2003

Racial differences in discrimination experiences and responses among minority substance users.

OBJECTIVES: Discrimination is associated with both mental and physical health, and may be a particularly important determinant of health among marginalized groups. This study assessed differences in discrimination experiences and responses to discrimination between Black and Latino active substance users in New York City. METHODS: 500 Black and 419 Latino active substance users were recruited through outreach workers, service agencies, and word of mouth. We collected data about different types of discrimination experienced (eg, discrimination due to race, gender, substance use), the domains in which it occurred (eg, at work, with police), and participants' responses to unfair treatment. RESULTS: Discrimination due to drug use was the most commonly reported type of discrimination among both Blacks and Latinos. Black respondents were more likely than Latinos to report discrimination due to their drug use (79% to 70%), race (39% to 23%), poverty (38% to 26%), gender (18% to 9%), and sexual orientation (38% to 6%). However, among those reporting discrimination due to drug use, Latinos experienced more rejection from family (81% to 70%), friends (73% to 60%), police (86% to 79%), employers (72% to 56%), and medical care professionals (29% to 18%). Black respondents were more likely to respond actively to discrimination, whereas Latino respondents were more likely to internalize experiences. CONCLUSIONS: Substantial differences exist in discrimination experiences and responses to discrimination between Black and Latino substance users. These differences may help explain racial and ethnic differences in health among marginalized populations, and identify avenues for effective, targeted intervention.

Adult↗
PubMed2002

Increased use of cigarettes, alcohol, and marijuana among Manhattan, New York, residents after the September 11th terrorist attacks.

The September 11, 2001, terrorist attacks were the largest human-made disaster in the United States since the Civil War. Studies after earlier disasters have reported rates of psychological disorders in the acute postdisaster period. However, data on postdisaster increases in substance use are sparse. A random digit dial telephone survey was conducted to estimate the prevalence of increased cigarette smoking, alcohol consumption, and marijuana use among residents of Manhattan, New York City, 5-8 weeks after the attacks. Among 988 persons included, 28.8% reported an increase in use of any of these three substances, 9.7% reported an increase in smoking, 24.6% reported an increase in alcohol consumption, and 3.2% reported an increase in marijuana use. Persons who increased smoking of cigarettes and marijuana were more likely to experience posttraumatic stress disorder than were those who did not (24.2% vs. 5.6% posttraumatic stress disorder for cigarettes; 36.0% vs. 6.6% for marijuana). Depression was more common among those who increased than for those who did not increase cigarette smoking (22.1 vs. 8.2%), alcohol consumption (15.5 vs. 8.3%), and marijuana smoking (22.3 vs. 9.4%). The results of this study suggest a substantial increase in substance use in the acute postdisaster period after the September 11th attacks. Increase in use of different substances may be associated with the presence of different comorbid psychiatric conditions.

Adolescent↗
PubMed2002

Psychological sequelae of the September 11 terrorist attacks in New York City.

BACKGROUND: The scope of the terrorist attacks of September 11, 2001, was unprecedented in the United States. We assessed the prevalence and correlates of acute post-traumatic stress disorder (PTSD) and depression among residents of Manhattan five to eight weeks after the attacks. METHODS: We used random-digit dialing to contact a representative sample of adults living south of 110th Street in Manhattan. Participants were asked about demographic characteristics, exposure to the events of September 11, and psychological symptoms after the attacks. RESULTS: Among 1008 adults interviewed, 7.5 percent reported symptoms consistent with a diagnosis of current PTSD related to the attacks, and 9.7 percent reported symptoms consistent with current depression (with "current" defined as occurring within the previous 30 days). Among respondents who lived south of Canal Street (i.e., near the World Trade Center), the prevalence of PTSD was 20.0 percent. Predictors of PTSD in a multivariate model were Hispanic ethnicity, two or more prior stressors, a panic attack during or shortly after the events, residence south of Canal Street, and loss of possessions due to the events. Predictors of depression were Hispanic ethnicity, two or more prior stressors, a panic attack, a low level of social support, the death of a friend or relative during the attacks, and loss of a job due to the attacks. CONCLUSIONS: There was a substantial burden of acute PTSD and depression in Manhattan after the September 11 attacks. Experiences involving exposure to the attacks were predictors of current PTSD, and losses as a result of the events were predictors of current depression. In the aftermath of terrorist attacks, there may be substantial psychological morbidity in the population.

Adult↗
PubMed2002

Social capital and violence in the United States, 1974-1993.

Social capital is a characteristic of communities. Cross-sectional studies have shown that social capital is inversely associated with homicide and violent crime. We hypothesized that variations in social capital in US states over time can predict variations in regional homicide mortality both across and within time periods. We analyzed serial cross-sectional data for measures of social capital and age-adjusted homicide rates between 1974 and 1993. We used perception of social trust and per capita membership in voluntary associations, obtained from responses to the General Social Surveys, as the principal measures of social capital. We controlled for potential confounding by mean levels of income, urbanization, and region. Measures of perceived trust were strongly inversely correlated with homicide rates in an aggregate cross-sectional analysis (r=-0.51, p<0.001) and also within each time period. Social capital was an independent predictor of rates of violence when controlling for income, region, and urbanization (p<0.001). Homicide rates also predicted levels of social capital in adjusted models (p<0.001). To investigate directionality of this relationship we developed Markov transition matrices that described the change in the states' levels of social capital and homicide across time intervals. Analysis of the transitional probabilities confirmed that a simple unidirectional association between social capital and violence was not sufficient to describe this association. There is likely an impact of violence on levels of perceived trust in communities that complements the hypothesized effect of social capital on homicide. We conclude that the relationship between social capital and violence over time is non-linear and dynamic. More complex analytic models describing the relationship between violence and ecological social determinants need to be considered.

Adult↗
PubMed2002

An investigation of the psychological effects of the September 11, 2001, attacks on New York City: developing and implementing research in the acute postdisaster period.

The September 11, 2001, attack on New York City was the largest human-made disaster in United States history. In the first few days after the attack, it became clear that the scope of the attacks (including loss of life, property damage, and financial strain) was unprecedented and that the attacks could result in substantial psychological sequelae in the city population. Researchers at the Center for Urban Epidemiologic Studies at the New York Academy of Medicine designed and implemented an assessment of the mental health of New Yorkers 5-8 weeks after the attacks. To implement this research in the immediate postdisaster period, researchers at the center had to develop, in a compressed time interval, new academic collaborations, links with potential funders, and unique safeguards for study respondents who may have been suffering from acute psychological distress. Results of the assessment contributed to a New York state mental health needs assessment that secured Federal Emergency Management Agency funding for mental health programs in New York City. This experience suggests that mechanisms should be in place for rapid implementation of mental health assessments after disasters.

Journal Article↗
PubMed2002

Drugs and firearm deaths in New York City, 1990-1998.

Firearm deaths remain among the leading causes of mortality in the United States. Changing law enforcement activities, incarceration, drug use, and socioeconomic conditions may have played roles in the declining rates of firearm deaths during the 1990s. Using records from the Office of the Chief Medical Examiner, we analyzed the role of drugs in firearm deaths in New York City between 1990 and 1998. Positive drug toxicology was present in over half of all firearm death victims during this time. Cocaine, cannabis, opiates, and alcohol accounted for almost all of these deaths with drug-positive toxicology. There were decreases in cocaine- and alcohol-positive toxicology for firearm deaths in New York City starting in the early 1990s; there was a more gradual decrease in heroin-positive toxicology for firearm deaths. Cannabis-positive toxicology for firearm deaths increased in the early part of the 1990s and then decreased starting in the mid-1990s. Although the disparities between minority and white firearm death rates narrowed during this time, minorities remained about three times more likely to be victims of fatal firearm violence than whites in 1998. The highest firearm death rates were among African American and Latino male decedents, with a larger proportion of Latinos testing cocaine or opiate positive, while a larger proportion of African Americans tested cannabis positive. These results suggest a complex role of drugs in firearm-related deaths.

Adolescent↗
PubMed2002

Posttraumatic stress disorder in Manhattan, New York City, after the September 11th terrorist attacks.

Estimates of acute mental health symptoms in the general population after disasters are scarce. We assessed the prevalence and correlates of acute posttraumatic stress disorder (PTSD) in residents of Manhattan 5-8 weeks after the terrorist attacks of September 11, 2001. We used random-digit dialing to contact a representative sample of adults living in Manhattan below 110th Street. Participants were interviewed about prior life events, personal characteristics, exposure to the events of September 11th, and psychological symptoms after the attack. Among 988 eligible adults, 19.3% reported symptoms consistent with PTSD at some point in their life, and 8.8% reported symptoms consistent with a diagnosis of current (within the past 30 days) PTSD. Overall, 57.8% of respondents reported at least one PTSD symptom in the past month. The most common past-month symptoms were intrusive memories (27.4%) and insomnia (24.5%). Predictors of current PTSD in a multivariable model were residence below Canal Street, low social support, life stressors 12 months prior to September 11th, perievent panic attack, losing possessions in the attacks, and involvement in the rescue efforts. These findings can help guide resource planning for future disasters in densely populated urban areas.

Adolescent↗
PubMed2002

Urbanization, urbanicity, and health.

A majority of the world's population will live in urban areas by 2007. The most rapidly urbanizing cities are in less-wealthy nations, and the pace of growth varies among regions. There are few data linking features of cities to the health of populations. We suggest a framework to guide inquiry into features of the urban environment that affect health and well-being. We consider two key dimensions: urbanization and urbanicity. Urbanization refers to change in size, density, and heterogeneity of cities. Urbanicity refers to the impact of living in urban areas at a given time. A review of the published literature suggests that most of the important factors that affect health can be considered within three broad themes: the social environment, the physical environment, and access to health and social services. The development of urban health as a discipline will need to draw on the strengths of diverse academic areas of study (e.g., ecology, epidemiology, sociology). Cross-national research may provide insights about the key features of cities and how urbanization influences population health.

City Planning↗
PubMed2002

Determinants of counseling for children in Manhattan after the September 11 attacks.

OBJECTIVE: After the September 11 terrorist attacks, many adults and children received counseling. The authors assessed the prevalence and correlates of counseling for experiences related to the disaster received by children aged four to 18 years living in Manhattan. METHODS: From a representative sample of 1,008 adult residents of Manhattan who were living below 110th Street five to eight weeks after the attacks, the authors interviewed 112 parents or primary caretakers about their child's level of exposure to the disaster, the extent of loss, receipt of counseling services, and behavioral reaction. RESULTS: Overall, 22 percent of the children had received some form of counseling related to their experiences after the disaster. More than half of the counseling received (58 percent) was delivered in schools. Predictors of counseling in a multivariate model were male sex (odds ratio=5.3), having a parent with current posttraumatic stress disorder related to the attacks (OR=4.3), and having at least one sibling living in the household (OR=3.6). CONCLUSIONS: Parents' own level of posttraumatic stress was associated with whether their children received counseling related to the September 11 attacks. This finding has important implications, because parents act as decision makers for their children in seeking health care. After the terrorist attacks, school and health care personnel provided early intervention counseling in Manhattan.

Adolescent↗
PubMed2002

Access to resources for substance users in Harlem, New York City: service provider and client perspectives.

The Urban Research Center (URC) in Harlem, New York City, is a collaboration of community members, service providers, and academics. A Community Advisory Board (CAB) meets regularly to formulate priorities for action and to direct research. A conceptual model of social determinants of health relevant to the Harlem community was developed. Early meetings of the CAB identified substance use as a health concern in the Harlem community. Access to social services was identified as a key social determinant that should guide research and intervention efforts of the URC. Surveys of service providers and of substance users were carried out to quantify availability of information and barriers to access. This article discusses the CAB process that led to the model of social determinants, development of surveys, and interpretation of results. The authors also discuss survey results and how the URC will use these results to develop interventions.

Adult↗
PubMed2002

Development of a "survival" guide for substance users in Harlem, New York City.

The community advisory board (CAB) of the Harlem Urban Research Center, which includes community service providers, Department of Health workers, and academics, identified substance users' health as an action priority. The CAB initiated the development of a wellness guide to provide informational support for substance users to improve access to community services. Focus groups of current and former users engaged substance users in the guide development process and determined the guide's content and "look." Focus group participants recommended calling this a "survival" guide. The guide will include three sections: (a) health information and how to navigate the system to obtain services, (b) a reference list of community services, and (c) relevant "hotline" numbers. The design will incorporate local street art. Substance users continue to shape the guide through ongoing art workshops. Dissemination and evaluation of the guide will continue to involve substance users, community service providers, and academics.

Community Health Services↗
PubMed2002

Television images and psychological symptoms after the September 11 terrorist attacks.

Exposure to graphic television images may exacerbate psychological symptoms in disaster situations. We tested the hypotheses that (1) more frequent viewing of television images of the September 11 terrorist attacks was associated with posttraumatic stress disorder (PTSD) and depression, and that (2) direct exposure to disaster events had an interactive effect with media viewing. We recruited 1,008 adult residents of the borough of Manhattan in New York City through a random-digit-dial telephone survey conducted between October 16 and November 15, 2001. Respondents who repeatedly saw "people falling or jumping from the towers of the World Trade Center" had higher prevalence of PTSD (17.4%) and depression (14.7%) than those who did not (6.2% and 5.3%, respectively). Among respondents who were directly affected by the attacks (e.g., had a friend killed), those who watched this television image frequently were more likely to have PTSD and depression than those who did not. Among respondents not directly affected by the attacks, prevalence of PTSD and depression was not associated with frequency of television image viewing. Specific disaster-related television images were associated with PTSD and depression among persons who were directly exposed to a disaster. Future research should address causal directionality of this association.

Adult↗
PubMed2002

Variability and vulnerability at the ecological level: implications for understanding the social determinants of health.

OBJECTIVES: We examined variability in disease rates to gain understanding of the complex interactions between contextual socioeconomic factors and health. METHODS: We compared mortality rates between New York and California counties in the lowest and highest quartiles of socioeconomic status (SES), assessed rate variability between counties for various outcomes, and examined correlations between outcomes' sensitivity to SES and their variability. RESULTS: Outcomes with mortality rates that differed most by county SES were among those whose variability across counties was high (e.g., AIDS, homicide, cirrhosis). Lower-SES counties manifested greater variability among outcome measures. CONCLUSIONS: Differences in health outcome variability reflect differences in SES impact on health. Health variability at the ecological level might reflect the impact of stressors on vulnerable populations.

Adolescent↗