Showing papers by "Sandro Galea published in 2002"
TL;DR: There was a substantial burden of acute PTSD and depression in Manhattan after the September 11 attacks, and experiences involving exposure to the attacks were predictors of current PTSD, and losses as a result of the events were predictions of current depression.
Abstract: 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, ...
1,654 citations
Journal Article•
TL;DR: Public health interventions aimed at improving the health of drug users must address the social factors that accompany and exacerbate the health consequences of illicit drug use.
Abstract: OBJECTIVES: This article reviews the evidence on the adverse health consequences of low socioeconomic status, homelessness, and incarceration among drug users. OBSERVATIONS: Social and economic factors shape risk behavior and the health of drug users. They affect health indirectly by shaping individual drug-use behavior; they affect health directly by affecting the availability of resources, access to social welfare systems, marginalization, and compliance with medication. Minority groups experience a disproportionately high level of the social factors that adversely affect health, factors that contribute to disparities in health among drug users. CONCLUSION: Public health interventions aimed at improving the health of drug users must address the social factors that accompany and exacerbate the health consequences of illicit drug use. Language: en
460 citations
TL;DR: A framework is suggested to guide inquiry into features of the urban environment that affect health and well-being and cross-national research may provide insights about the key features of cities and how urbanization influences population health.
Abstract: 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.
440 citations
TL;DR: The results of this study suggest a substantial increase in substance use in the acute postdisaster period after the September 11th attacks, which may be associated with the presence of different comorbid psychiatric conditions.
Abstract: 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.
424 citations
TL;DR: Specific disaster-related television images were associated with PTSD and depression among persons who were directly exposed to a disaster and future research should address causal directionality of this association.
Abstract: 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.
319 citations
TL;DR: Assessment of the prevalence and correlates of acute posttraumatic stress disorder in residents of Manhattan 5–8 weeks after the terrorist attacks of September 11th can help guide resource planning for future disasters in densely populated urban areas.
Abstract: 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.
197 citations
TL;DR: Parents' own level of posttraumatic stress was associated with whether their children received counseling related to the September 11 attacks, and this finding has important implications, because parents act as decision makers for their children in seeking health care.
Abstract: 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. (Psychiatric Services 53:815–822, 2002)
145 citations
TL;DR: The relationship between social capital and violence over time is non-linear and dynamic and more complex analytic models describing the relationship between violence and ecological social determinants need to be considered.
112 citations
Journal Article•
TL;DR: In Manhattan following the September 11th terrorist attacks, a random-digit-dial telephone survey was conducted 5 to 8 weeks afterwards, among 988 randomly selected adult householders over 17 years old (females = 52, whites = 72, mean age = 42) as mentioned in this paper.
Abstract: To assess mental health utilization in Manhattan following the September 11th terrorist attacks, a random-digit-dial telephone survey was conducted 5 to 8 weeks afterwards, among 988 randomly selected adult householders over 17 years old (females = 52%; whites = 72%; mean age = 42). 16.9% (95% confidence interval [CI] = 14.4-19.5) of residents reported using mental health services 30 days before the attacks and 19.4% (95% CI = 16.7-22.2) reported using these services 30 days afterwards (pre/post NcMemar's chi2 = 8.0, df = 1, p = 0.005, odds ratio[OR] = 2.0). 10.0% (95% CI = 7.9-12.0) increased mental health utilization 30 days after the attacks, compared to 30 days before and 5.3% (95% CI = 3.7-6.9) decreased utilization. Risk factors associated with increased mental health utilization in multivariate analyses included: being 45-64 years of age (vs. 65+; OR = 8.3, p = 0.011) female gender (OR = 2.3, p = 0.004), experiencing 4+ lifetime traumatic events (vs. none; OR = 3.5, p = 0.002), experiencing 2+ stressful life events in the past 12 months (vs. none; OR = 3.3, p < 0.001), and experiencing an acute panic attack during the disaster (OR = 3.3, p < 0.001). Neither current post-traumatic stress disorder (PTSD) nor current depression was predictive of increased post-disaster utilization when panic attack was included in the multivariate analysis. While we did find a statistically significant increase in pre- vs. post-disaster utilization among the general population in Manhattan this increase was not substantial, except among specific subgroups, including those who had a perievent panic attack, among those exposed to previous stressors, among women, and among those less than 65 years old.
99 citations
TL;DR: This special issue of Health Education&Behavior examines efforts of the Urban ResearchCenters (URCs) to use community-based participatory approaches to understand and develop interventions to address social determinants of health (SDOH) in three urban communities: New York City, Detroit, and Seattle.
Abstract: Medical and public health research and practice in the second half of the 20th century primarily have focused on understanding and addressing individual risk factors for diseases such as smoking, dietary practices, and blood pressure. Despite the tremendous resources expended on these individual risk factors, disparities between the health of thosewho aremost advantaged and thosewith fewer economic and social privileges have continued and in some cases have increased. Residents of urban communitieswith high concentrations of poverty in particular suffer fromadisproportionate burden ofmorbidity andmortality. Finding effective means to understand, and more important, to intervene on, the factors that contribute to racial and socioeconomic disparities in health remains one of the most pressing problems facing public health professionals today. In this special issue ofHealth Education&Behavior, we examine efforts of the Urban ResearchCenters (URCs), as part of theUrbanHealth Initiative funded by theCenters for Disease Control and Prevention, to use community-based participatory approaches to understand and develop interventions to address social determinants of health (SDOH) in three urban communities: New York City, Detroit, and Seattle. Each of these sites has engaged in community-based participatory research and interventions to address SDOH from a somewhat different perspective. This special issue offers an opportunity to examine these approaches and to highlight their potential benefits and their challenges. In this introductory article, we first discuss a definition of social determinants and examine their role in racial and socioeconomic disparities in health, with a particular focus on urban health. Second, we discuss partnership approaches to research and practice and the particular role of such partnerships in research and interventions addressing SDOH.We particularly examine implications of inequalities in the social context as they
97 citations
TL;DR: Differences in health outcome variability reflect differences in SES impact on health, and health variability at the ecological level might reflect the impact of stressors on vulnerable populations.
Abstract: 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.
TL;DR: No evidence of harmful effects discarded needles/syringes, pharmacy altercations) resulting from ESAP were observed and efforts are underway to increase ESAP awareness and reduce socioenvironmental barriers to ESAP.
Abstract: Objective To evaluate the New York State Expanded Syringe Access Demonstration Program (ESAP) through injection drug user (IDU) surveys, discarded needles and syringes studies, and pharmacy sales and experiences surveys. Design Pre–post comparison. Setting In Harlem, New York City, risk surveys among street-recruited IDUs, needle/syringe street counts on 27 systematically sampled city blocks, and Harlem pharmacist reports of sales and experiences. Main Outcome Measures Number and types of IDU syringe sources, block mean counts of discarded needles and syringes, level of pharmacy nonprescription syringe sales (NPSS), and pharmacists' experiences. Results Comparing 209 pre-ESAP with 396 post-ESAP IDUs, pharmacies as a primary syringe source increased: 3.4% to 5.3% ( P ever pharmacy use increased: 4.9% to 12.5% ( P Conclusion To date, no evidence of harmful effects (discarded needles/syringes, pharmacy altercations) resulting from ESAP were observed. While NPSS have increased in Harlem, pharmacy use among IDUs remains low. In Harlem, efforts are underway to increase ESAP awareness and reduce socioenvironmental barriers to ESAP.
TL;DR: A complex role of drugs in firearm-related deaths in New York City between 1990 and 1998 is suggested, with 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 largerportion of African Americans tested cannabis positive.
Abstract: 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.
01 Jan 2002
TL;DR: On the morning of September 11, 2001, four commercial airliners were hijacked from U.S. airports and crashed into the twin towers of the World Trade Center in lower Manhattan, New York City, killing more than 3,000 people.
Abstract: On the morning of September 11, 2001, four commercial airliners were hijacked from U.S. airports. Two of the planes crashed into the twin towers of the World Trade Center (WTC) in lower Manhattan, New York City. The WTC towers collapsed in the hours after they were hit. Although most people working inside the twin towers evacuated the buildings soon after the planes hit, the collapse of the towers resulted in the death of more than 3,000 people. Among the dead were office workers in the buildings at the time of their collapse and rescue personnel who had been climbing the towers in an attempt to bring survivors down to ground level. The terrorist attacks of September 11 were the largest single terrorist attack ever on U.S. soil.
TL;DR: An assessment of the mental health of New Yorkers 5—8 weeks after the September 11, 2001, attack designed and implemented an assessment that 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.
Abstract: 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.
TL;DR: The community advisory board (CAB) of the Harlem Urban Research Center initiated the development of a wellness guide to provide informational support for substance users to improve access to community services.
Abstract: 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 "hot- line" 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.
TL;DR: The CAB process that led to the model of social determinants, development of surveys, and interpretation of results are discussed; the authors discuss survey results and how the URC will use these results to develop interventions.
Abstract: 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.
TL;DR: In the days that followed the WTC attack, life in New York City proceeded at a surreally detached pace; many missed work, ongoing bomb threats evacuated landmark skyscrapers repeatedly, and the city’s perpetual movement just stopped.
Abstract: Soon after reports that firefighters and police officers were entering the buildings, Tower Two, then Tower One, collapsed. We heard reports that the Pentagon had been attacked, and then a number of other “fog-of-war” rumors, including the presence of a car bomb at the Mall in Washington, DC, and, perhaps more alarming for New Yorkers, that another four planes had been hijacked and remained unaccounted. We saw images we never imagined. Workers, some holding hands, jumped from over 100 stories; soot and debris covered workers streaming north like refugees; and an eerie, gradual, all-enveloping stillness blanketed the city as it seemed that all life in the city ground to a halt. The remainder of the day brought more experiences—long walks home amid crowds of office employees carrying briefcases; an uneasy, silent sky devoid of commercial aircraft; and a growing uncertainty about those responsible for the attack, their motivation, and America’s potential response. For many residents of New York City, these fears were coupled with uncertainty about the fate of family, friends, and acquaintances who had not been heard from since the event. In the days that followed the WTC attack, life in New York City proceeded at a surreally detached pace; many missed work, ongoing bomb threats evacuated landmark skyscrapers repeatedly, and the city’s perpetual movement just stopped. Few cars were on the roads, and no cars at all were allowed in areas below 14th Street; subways were erratic and empty. The toll of dead and missing climbed above 5,000, with at least that many more injured in the attack. Latest reports suggest about 3,000 people died in the attacks. Residents of lower Manhattan were evacuated and have, only very slowly, returned to their homes. Some remain displaced, even now months after the attack. Companies with offices in the WTC complex worked out of employees’ homes or quickly leased space further uptown in Manhattan or across the Hudson in New Jersey. The event continues to dominate life in New York City. Telephone and Internet
01 Jan 2002
TL;DR: In this article, the authors examined the role that personal characteristics and event-exposures played in determining the elevated risk of posttraumatic stress disorder (PTSD) and depression among Hispanics.
TL;DR: Although overall homicide rates in NYC declined between 1990–98, there remained substantial disparities in homicide rates between whites, AAs, and Hispanics at the end of the decade.