Showing papers by "Sandro Galea published in 2006"

Psychological Resilience After Disaster New York City in the Aftermath of the September 11th Terrorist Attack

Abstract: Research on adult reactions to potentially traumatic events has focused almost exclusively on post-traumatic stress disorder (PTSD). Although there has been relatively little research on the absence of trauma symptoms, the available evidence suggests that resilience following such events may be more prevalent than previously believed. This study examined the prevalence of resilience, defined as having either no PTSD symptoms or one symptom, among a large (n = 2,752) probability sample of New York area residents during the 6 months following the September 11th terrorist attack. Although many respondents met criteria for PTSD, particularly when exposure was high, resilience was observed in 65.1% of the sample. Resilience was less prevalent among more highly exposed individuals, but the frequency of resilience never fell below one third even among the exposure groups with the most dramatic elevations in PTSD.

Mental illness and suicidality after Hurricane Katrina

Abstract: Objective To estimate the impact of Hurricane Katrina on mental illness and suicidality by comparing results of a post-Katrina survey with those of an earlier survey. Methods The National Comorbidity Survey-Replication, conducted between February 2001 and February 2003, interviewed 826 adults in the Census Divisions later affected by Hurricane Katrina. The post-Katrina survey interviewed a new sample of 1043 adults who lived in the same area before the hurricane. Identical questions were asked about mental illness and suicidality. The post-Katrina survey also assessed several dimensions of personal growth that resulted from the trauma (for example, increased closeness to a loved one, increased religiosity). Outcome measures used were the K6 screening scale of serious mental illness and mild–moderate mental illness and questions about suicidal ideation, plans and attempts. Findings Respondents to the post-Katrina survey had a significantly higher estimated prevalence of serious mental illness than respondents to the earlier survey (11.3% after Katrina versus 6.1% before; c²1= 10.9; P < 0.001) and mild–moderate mental illness (19.9% after Katrina versus 9.7% before; c²1 = 22.5; P < 0.001). Among respondents estimated to have mental illness, though, the prevalence of suicidal ideation and plans was significantly lower in the post-Katrina survey (suicidal ideation 0.7% after Katrina versus 8.4% before; c²1 = 13.1; P < 0.001; plans for suicide 0.4% after Katrina versus 3.6% before; c²1 = 6.0; P = 0.014). This lower conditional prevalence of suicidality was strongly related to two dimensions of personal growth after the trauma (faith in one’s own ability to rebuild one’s life, and realization of inner strength), without which between-survey differences in suicidality were insignificant. Conclusion Despite the estimated prevalence of mental illness doubling after Hurricane Katrina, the prevalence of suicidality was unexpectedly low. The role of post-traumatic personal growth in ameliorating the effects of trauma-related mental illness on suicidality warrants further investigation.

The impact of resource loss and traumatic growth on probable PTSD and depression following terrorist attacks.

Abstract: The authors interviewed by phone 2,752 randomly selected individuals in New York City within 6 to 9 months after the attacks of September 11, 2001 on the World Trade Center, and 1,939 of these were reinterviewed at a 12- to 16-month follow-up. It was hypothesized that resource loss would significantly predict probable posttraumatic stress disorder (PTSD) and probable depression since September 11, and that resource loss's impact would be independent of previously identified predictors relating to individuals' demographic characteristics, history of stressful event exposure, prior trauma history, peritraumatic experience, and social support. Second, it was predicted that reported traumatic growth would be related to greater, not lesser, psychological distress. The authors' findings supported their hypotheses for resource loss, but traumatic growth was unrelated to psychological outcomes when other predictors were controlled.

Risk and protective factors for psychopathology among older versus younger adults after the 2004 Florida hurricanes

Abstract: Objective: Previous research demonstrates increased resiliency to psychopathology after disasters among older adults. However, little is known about differences in age-based risk and protective factors for postdisaster mental illness. Method: The authors used random-digit dialing methodology to survey 1,130 older adults (60 years) and 413 younger adults residing in Florida counties directly affected by the 2004 hurricanes. Assessed risk and protective factors included demographics, social support, displacement, incurred dollar losses, perceived positive outcomes, and selfrated health status. Outcome variables included symptom counts of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-defined posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD). Results: Older adults reported fewer symptoms of PTSD, MDD, and GAD. Explanatory risk variables accounted for large proportions of variance, but differed in meaningful ways across age groups. Conclusion: Although older adults are less symptomatic, their psychologic reactions appear more closely connected to economic consequences of disasters. (Am J Geriatr Psychiatry 2006; 14:1051–1059)

Methods for disaster mental health research.

Abstract: Part I: Introduction to the Field. McFarlane, Norris, Definitions and Concepts in Disaster Research. Norris, Elrod, Psychosocial Consequences of Disasters: A Review of Past Research. Part II: Research Fundamentals. North, Norris, Choosing Research Methods to Match Research Goals in Studies of Disaster or Terrorism. Benight, McFarlane, Norris, Formulating Questions About Postdisaster Mental Health. Fleischman, Collogan, Tuma, Ethical Issues in Disaster Research. Part III: Methods for Sampling and Data Collection. Bromet, Havenaar, Basic Epidemiological Approaches to Disaster Research: Value of Face-to-face Procedures. Galea, Bucuvalas, Resnick, Boyle, Vlahov, Kilpatrick, Telephone-based Research Methods in Disaster Research. Schlenger, Silver, Web-based Methods in Disaster Research. La Greca, School-based Studies of Children Following Disasters. Palinkas, Qualitative Approaches to Studying the Effects of Disasters. Part IV: Research for Planning, Policy, and Service Delivery. Galea, Norris, Public Mental Health Surveillance and Monitoring. Rosen, Young, Mental Health Services and Evaluation Research: Precepts, Pragmatics, and Politics. Gibson, Hamblen, Zvolensky, Vujanovic, Evidence-based Treatments for Traumatic Stress: An Overview of the Research with an Emphasis on Disaster Settings. Marshall, Amsel, Neria, Suh, Strategies for Dissemination of Evidence-based Treatments: Training Clinicians After Large-scale Disasters. Part V: Special Challenges in Disaster Research. A. M. Steinberg, Brymer, J.R. Steinberg, Pfefferbaum, Conducting Research with Children and Adolescents After Disaster. Fullerton, McCarroll, Ursano, Conducting Research with Military and Uniformed Service Workers. Jones, Hadder, Carvajal, Chapman, Alexander, Conducting Research in Minority and Marginalized Communities. Murphy, Perilla, Jones, Conducting Research in Other Countries. Friedman, Disaster Mental Health Research: Challenges for the Future. Appendix 1. Galea, Disasters Mentioned in the Text. Appendix 2. Lerner, Searching the Traumatic Stress Literature.

PTSD and depression after the Madrid March 11 train bombings.

Abstract: 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 of Madrid 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.

Collective Efficacy and Major Depression in Urban Neighborhoods

Abstract: Depression contributes substantially to the global burden of disease and disability Population-level factors that shape depression may be efficient targets for intervention to decrease the depression burden The authors aimed to identify the relation between neighborhood collective efficacy and major depression Analyses were conducted on data from the New York Social Environment Study (n = 4,000), a representative study of residents of New York, New York, conducted in 2005 Neighborhood collective efficacy was measured as the average neighborhood response on a well-established scale Major depression was assessed with the Patient Health Questionnaire A marginal modeling approach was applied to present results on the additive scale relevant to public health and intervention Analyses were adjusted for demographic and socioeconomic characteristics, recent life events that could contribute to both depression and change in residence, and individual perception of collective efficacy Collective efficacy was related to major depression among older adults; marginal models estimated a 62% (95% confidence interval: 01, 175) lower prevalence of depression if all older adults (65 years and older) had lived in high versus low collective efficacy neighborhoods Similar results were suggested among younger adults; however, the confidence interval crossed the null These and other study findings suggest that community-randomized trials targeting collective efficacy merit consideration

Alcohol use, mental health status and psychological well-being 2 years after the World Trade Center attacks in New York City.

Abstract: Over the past 30 years, studies have shown that survivors of community-wide disasters suffer from a variety of physical and mental health problems. Researchers also have documented increased substance use in the aftermath of these disasters. In the present study, we examined the relationship between alcohol use and mental health status within the context of the terrorist attacks on the World Trade Center in New York City (NYC). The data for the present report come from a 2-wave panel study of adults living in NYC on the day of the attacks. Wave 1 (W1) and Wave 2 (W2) interviews occurred one year and two years after the attacks, respectively. Overall, 2,368 individuals completed the W1 survey (cooperation rate, 63%) and 1,681 completed the W2 survey (re-interview rate, 71%). The alcohol use variables examined were binge drinking, alcohol dependence, increased days drinking, and increased drinks per day. The outcomes examined included measures of posttraumatic stress disorder (PTSD), major depression, BSI-1...

Stigmatization of Newly Emerging Infectious Diseases: AIDS and SARS

Abstract: Both the fear of people who are different and the fear of disease can lead to social stigmatization.1 Occasionally these fears co-occur, resulting in severe stigmatization of strangers with diseases. Such stigmatization can increase the adverse consequences of a disease in multiple ways. First, stigmatization can substantially increase the suffering of persons with the disease. Second, persons with or at risk for the disease may avoid seeking health care, making it much harder for public health authorities to control the disease. Third, professionals and volunteers working in the field may also become stigmatized, leading to higher rates of stress and burnout.2 Finally, stigmatization may generate considerable economic losses if people avoid groups or geographic areas associated with the disease. Many diseases have been stigmatized throughout history. For example, persons with the plague were stigmatized during the Middle Ages, and sexually transmitted diseases have been stigmatized throughout the last several centuries.3,4 Acquired immunodeficiency syndrome (AIDS) has been one of the most feared and stigmatized diseases of the last 20 years. There is abundant evidence that the stigmatization of AIDS has been detrimental to the health of those with AIDS and has played a role in limiting public health and medical efforts to control the disease.5,6 For example, early stigmatization of AIDS as a disease of homosexual men contributed to low levels of funding for AIDS research in the1980s.3,4,7 Over the last several years, severe acute respiratory syndrome (SARS) has emerged as a new feared disease associated with strangers (Asians, particularly Chinese) and has generated considerable stigmatization.8,9 Reduced travel to SARS-affected areas clearly led to large economic losses for those areas,10,11 but there has been relatively little systematic research on fear of SARS or stigmatization of persons with or at risk for the disease.12 In one study of medical access patterns in Taiwan, Chang and colleagues found that “fear of SARS” led to substantial reductions in seeking medical care: a 23.9% reduction for ambulatory care, a 35.2% reduction for inpatient care, and a 16.7% reduction for dental care.13 Presumably, people avoided seeking medical care out of fear of becoming infected with SARS in these medical settings. Studying the stigmatization of SARS may provide us with insight into the stigma associated with emerging infectious diseases and the potential consequences of such stigmatization. A potentially useful model for considering stigmatization of SARS and other newly emerging infectious diseases may be found in the work of Pryor et al.14 They suggest a 2-factor theory of HIV- related stigma: (1) an immediate affective reaction, based on multiple negative qualities associated with the disease (e.g., death, promiscuity, drug use, homosexuality), possibly followed by (2) a cognitive rule-based system that ameliorates stigmatization “if perceivers have enough time, motivation, and cognitive resources.”14(p1189) Within this formulation, availability of additional information about the disease should lead to a reduction in stigmatization. This prediction is consistent with the activities of many public health authorities who hope to reduce stigmatization through increased public education on diseases such as AIDS. We compared stigmatizing attitudes toward AIDS and SARS in a representative sample of persons living in the New York City (NYC) metropolitan area and examined factors associated with these attitudes.

Was there unmet mental health need after the September 11, 2001 terrorist attacks?

Abstract: This study examined the use of professionals for mental health problems among New York City residents who were directly affected by the September 11, 2001 terrorist attacks on the World Trade Center (WTC) or had a probable diagnosis of post-traumatic stress disorder (PTSD) or depression in its aftermath. Correlates of help seeking from professionals for mental health problems after the attacks and barriers to care were also assessed. Data were from a random digit dial telephone survey of 2,752 adults representative of the Greater New York Metropolitan area conducted 6 months after the September 11 terrorist attacks. Fifteen percent of those directly affected and 36% of those with probable PTSD or depression sought help from a professional for a mental health problem after the attacks. There was little new utilization of professionals for mental health problems after the attacks among persons who were not already receiving care prior to September 11. Barriers that prevented people from seeking help for mental health problems 6 months after the September 11 attacks included traditional barriers to care (e.g., cost) and barriers that are unique to the post-disaster context (e.g., the belief that others need the services more than oneself). This study suggests that there was potential unmet mental health need in New York City 6 months after the September 11 attacks on the WTC, but these findings should be tempered by research showing an apparent decrease in population-rates of PTSD. In the aftermath of a disaster, interventions should target persons with mental health needs who were not previously seeking help from a professional for a mental health problem.

Social context and depression after a disaster : the role of income inequality

Abstract: Study objective: To examine the association between neighbourhood income inequality and depression, both overall and among those with different levels of income, in the post-disaster context. Design: A representative cross sectional random digit dial telephone survey was conducted. Setting: New York City (NYC) six months after September 11, 2001. Participants: 1570 respondents were interviewed, of whom 1355 provided residence information permitting their inclusion in this analysis. Past six month depression was assessed using a lay administered instrument consistent with DSM-IV criteria. Income inequality was measured with the Gini coefficient. Main results: The sample was demographically representative of NYC (56.2% female, 35.7% white, 6.3% Asian 24.2% African American, 29.7% Hispanic, and 4.2% other race or ethnicity) and the prevalence of past six month depression was 12.4%. In a final adjusted model, neighbourhood level income inequality was positively associated with depression but this association was not significant (β = 7.58, p = 0.1). However, among those with low individual income ( Conclusions: In the post-disaster context, neighbourhood level income inequality was associated with depression among persons with lower income; this group may be more socially or economically marginalised and dependent on local resources. Future research should examine potential mechanisms through which income inequality and other features of the social context may affect mental health in the post-disaster context.

Fear of terrorism and preparedness in New York City 2 years after the attacks: implications for disaster planning and research.

Abstract: The terrorist attacks in New York City (NYC) on September 11, 2001, killed nearly 3,000 persons and had an adverse affect on the local economy.1 These attacks not only increased pubic concerns about terrorist threats in NYC2 but also affected the psychological status of area residents.3-7 One study reported that 11 percent of NYC adults (approximately 700,000 persons) suffered a panic attack during this event.3 Other studies conducted locally and nationally following the attacks, also found widespread psychological distress.8,9 Adding to the level of anxiety and distress among NYC residents were the anthrax attacks that occurred in New Jersey and New York City shortly after the September 11 attacks, the first publicized bioterrorism event in US history,10 and the onset of war in the Middle East.11 Recent evidence of attacks among other civilian populations provides further evidence related to the possible psychological impact of terrorism. For example, of the 5,510 persons who sought medical treatment following the Tokyo sarin attack in 1995, 12 died, 17 were critically injured, and 4,000 had minor or no apparent injuries,12,13 During the 1991 Scud missile attacks in Israel during the Gulf War, it was reported that most persons presenting to emergency departments, nearly 80 percent, were psychiatric casualties.14 In addition, although the evacuation during the World Trade Center attacks appeared to be orderly, examination of evacuation activities closer to the impact area suggested that this was not the case at all.15 In addition, outbreaks of sociogenic illnesses have also been reported following these kinds of events.16 Although there are many risk factors to consider,17 a terrorist attack involving weapons of mass destruction (WMDs), even on a small scale, could generate significant psychiatric casualties.12,17-19 Although understanding how to prevent psychiatric casualties is imperative in military operations, from a public health point of view, managing adverse psychological reactions among the public following a terrorist attack is also important.20,21 Notwithstanding the possibility of a future terrorist attack, to date much terrorism preparedness activities in the United States have mostly focused on the technological and biomedical aspects of these events.22-24 In the following, we present results from a recent NYC study that provides findings related to the potential social psychological impact of terrorist threats that should be useful in future disaster research and planning. To help guide our approach, we incorporated a Terrorism Management Theory (TMT) framework into our research design. Generally, TMT suggests that fear of terrorism is related to social background, fear of death, self-esteem, social support, as well as other factors, such as exposure to stressors events.25 This theory represents a social psychological model that has been useful in understanding reactions to terrorism.25 In this article, we construct multivariate models, based on TMT, to help assess psychosocial correlates of terrorism fears in a population recently exposed to terrorist events. We did this in order to provide empirical data to assist with disaster planning, risk communications, and new research efforts. Although our study did not focus on actual behavior during an attack, we note that we did study reported behavioral intent in future situations and current preparedness behaviors among a population exposed to terrorist attacks and ongoing threats over the past 2 years.

The impact of New York City's 1975 fiscal crisis on the tuberculosis, HIV, and homicide syndemic.

Abstract: In 1975, New York City experienced a fiscal crisis rooted in long-term political and economic changes in the city. Budget and policy decisions designed to alleviate this fiscal crisis contributed to the subsequent epidemics of tuberculosis, human immunodeficiency virus (HIV) infection, and homicide in New York City. Because these conditions share underlying social determinants, we consider them a syndemic, i.e., all 3 combined to create an excess disease burden on the population. Cuts in services; the dismantling of health, public safety, and social service infrastructures; and the deterioration of living conditions for vulnerable populations contributed to the amplification of these health conditions over 2 decades. We estimate that the costs incurred in controlling these epidemics exceeded 50 billion US dollars (in 2004 dollars); in contrast, the overall budgetary saving during the fiscal crisis was 10 billion US dollars. This history has implications for public health professionals who must respond to current perceptions of local fiscal crises.

Comparison of two widely used PTSD-screening instruments: implications for public mental health planning

Abstract: Epidemiological research serves a critical role in public mental health planning in the aftermath of disasters, particularly via estimation of the mental health burden and potential needs of affected communities. However, different measures are used across studies to assess mental health response, making cross-study comparison difficult. The National Women's Study Posttraumatic Stress Disorder module (NWS-PTSD) and PTSD Checklist (PCL) have been among the most widely used measures of PTSD in postdisaster research. Here, the authors used a sample of 233 New York City-area residents who were administered both the NWS-PTSD and PCL 4 months after the September 11, 2001 terrorist attacks. The PCL yielded higher prevalence estimates at the symptom, cluster, and diagnostic levels. Implications for the interpretation of epidemiological data are discussed.

Risk factors for depression after a disaster

Abstract: Environmental stressors such as mass disasters may contribute to an increased prevalence of depression within the population affected. We examined the prevalence of probable major depression and risk factors for depression in the 6-month period after the September 11, 2001, attacks on the World Trade Center among New York City (NYC) metropolitan residents. A total of 2700 persons who were representative of the NYC metropolitan area were included in this cross-sectional telephone survey. The prevalence of probable major depression in the 6 months after the attacks was 9.4%. Multivariate logistic regression covariates associated with the likelihood of probable major depression included being directly affected by the attacks, having a perievent panic attack, experiencing multiple life stressors, and having been exposed to previous traumatic events. Mass traumatic event exposure appears to be an independent environmental risk factor for depression in the postdisaster context; specific reactions such as perievent panic attacks may have prognostic value.

The Behavioral Consequences of Terrorism: A Meta-Analysis

Abstract: Effective postterrorism public health interventions require the recognition that behavioral consequences are, in fact, the intent of terrorists. The authors searched published and unpublished post-1980 studies that documented population-level behavioral and psychological consequences of terrorist incidents, focusing on posttraumatic stress disorder (PTSD). Results were tabulated, and random effects models were used to calculate overall effect sizes. The analysis indicates that in the year following terrorist incidents, the prevalence of PTSD in directly affected populations varies between 12% and 16%. The review also shows that this prevalence can be expected to decline 25% over the course of that year. These prevalence estimates mask great variability, depending on who is being studied, who is conducting the study, and where the event occurred. Higher rates of disease are reported for survivors and rescue workers, and higher overall rates are also reported from studies conducted in Western Europe compared with studies conducted in North America. Prior psychiatric diagnoses are strongly associated with subsequent PTSD and may be a useful triage factor, particularly when considered together with factors such as female gender and direct exposure to events as either a survivor or rescuer. The review indicates that these associations are consistent across study types and environments and represent important variables to consider when developing triage, outreach, and treatment programs.

Distribution of Influenza Vaccine to High-Risk Groups

Abstract: Vaccine distribution programs have historically targeted individuals at high risk of complications due to influenza. Despite recommendations from the Advisory Committee on Immunization Practices, vaccination coverage among high-risk populations has been generally low. This review systematically summarizes the recent literature evaluating programs in different settings, from within medical settings to venue-based and communitybased approaches, in an effort to identify successful program components. The published literature was identified by using the MEDLINE database from 1990 to 2006 covering studies that reported on interventions or programs aimed at vaccinating high-risk populations. The authors reviewed 56 studies. In the United States, the Healthy People 2010 goals included 90% vaccination coverage for adults aged 65 years and 60% for high-risk adults aged 18–64 years. Only a handful of the studies reviewed managed to meet those goals. Interventions that increased vaccination coverage to Healthy People 2010 goals included advertising, provider and patient mailings, registry-based telephone calls, patient and staff education, standing orders coupled with standardized forms, targeting of syringe exchange customers, and visiting nurses. Few studies evaluated the impact of vaccination programs by race/ethnicity and socioeconomic status. Few studies targeted individuals outside of the health-care and social services sectors. Given the growing disparities in health and health-care access, understanding the way in which interventions can remedy disparities is crucial.

The urban environment and sexual risk behavior among men who have sex with men.

Abstract: Increasingly, studies show that characteristics of the urban environment influence a wide variety of health behaviors and disease outcomes, yet few studies have focused on the sexual risk behaviors of men who have sex with men (MSM). This focus is important as many gay men reside in or move to urban areas, and sexual risk behaviors and associated outcomes have increased among some urban MSM in recent years. As interventions aimed at changing individual-level risk behaviors have shown mainly short-term effects, consideration of broader environmental influences is needed. Previous efforts to assess the influence of environmental characteristics on sexual behaviors and related health outcomes among the general population have generally applied three theories as explanatory models: physical disorder, social disorganization and social norms theories. In these models, the intervening mechanisms specified to link environmental characteristics to individual-level outcomes include stress, collective efficacy, and social influence processes, respectively. Whether these models can be empirically supported in generating inferences about the sexual behavior of urban MSM is underdeveloped. Conceptualizing sexual risk among MSM to include social and physical environmental characteristics provides a basis for generating novel and holistic disease prevention and health promotion interventions.

Cities and the Health of the Public

Abstract: Part I: INTRODUCTION A Framework for the Study of Urban Health Sandro Galea, Nicholas Freudenberg, David Vlahov Changing Living Conditions Changing Health: US Cities in the Last 50 years Nicholas Freudenberg, Sandro Galea, David Vlahov Part II: DETERMINANTS OF HEALTH IN CITIES The Urban Social Environment and Health Adam Coutts, Ichiro Kawachi The Urban Physical Environment and Health Susan Klitzman, Thomas D. Matte, Daniel E Kass Food, Nutrition and the Health of Urban Populations Ming-Chin Yeh, David Katz Access to Quality Health Care in U.S. Cities: Balancing Community Need and Service System Survival Dennis Andrulis Part III: LOCAL AND GLOBAL PERSPECTIVES ON CHANGING CITIES Public Health in U.S. Cities: A Historical Perspective David Rosner Cities, Suburbs, and Urban Sprawl: Their Impact on Health Howard Frumkin Fifty Ways to Destroy a City: The Health Impact of Urban Destruction Mindy Fullilove A Developing World Perspective: Health, Water and Sanitation in Urban Areas of Africa, Asia and Latin America and the Caribbean Gordon McGranhan and David Satterthwaite Part IV: HEALTH OUTCOMES AND DETERMINANTS Changing Patterns of Infectious Disease in U.S. Cities David Vlahov, Emily Gibble The Challenge of Urban Violence and Disasters Kenneth J. Ruggiero, Amy Van Wynsberghe, Tomika Stevens, Dean G. Kilpatrick Mental Health in the City Ezra Susser, Mickey Bresnahan, Sandro Galea Part V: NEXT STEPS: RESEARCH AND INTERVENTION Methodologies for the Study of Urban Health: How Do We Best Assess How Cities Affect Health? Sandro Galea, Amy Schulz Health Promotion in the City: The Science and Politics of Intervention Nicholas Freudenberg Creating Healthy Cities: Where Do We Go from Here? David Vlahov, Sandro Galea, Nicholas Freudenberg.

Community Reentry: Perceptions of People with Substance Use Problems Returning Home from New York City Jails

Abstract: Each year about 100,000 people return to New York City communities from municipal jails. Although about four-fifths report drug or alcohol problems, few have received any formal drug treatment while in jail. Researchers and practitioners have identified a number of policies related to corrections, income, housing, and drug treatment that may be harmful to the successful reintegration of people leaving jail. In order to explore the challenges to successful community reentry, six focus groups and one in-depth interview were conducted with 37 men and women who had been released from jail or prison in the last 12 months. Participants were asked to describe their experiences prior to and immediately following release from jail. Findings suggest that many people leaving jail are not prepared for release and, upon release, face a myriad of obstacles to becoming healthy, productive members of their communities. We discuss the implications of these findings for programs and policies that promote community reintegration of individuals returning from correctional facilities.

Panic reactions to terrorist attacks and probable posttraumatic stress disorder in adolescents

Abstract: A number of factors, including subjective reactions and appraisal of danger, influence one's reaction to a traumatic event. This study used telephone survey methodology to examine adolescent and parent reactions to the 2001 World Trade Center attacks 6 to 9 months after they occurred. The prevalence of probable posttraumatic stress disorder (PTSD) in adolescents was 12.6%; 26.2% met study criteria for probable subthreshold PTSD. A probable peri-event panic attack in adolescents was strongly associated with subsequent probable PTSD and probable subthreshold PTSD. This study suggests that the early identification of peri-event panic attacks following mass traumatic events may provide an important gateway to intervention in the subsequent development of PTSD. Future studies should use longitudinal designs to examine the course and pathogenic pathways for the development of panic, PTSD, and other anxiety disorders after exposure to disasters.

Opiate users' knowledge about overdose prevention and naloxone in New York City: a focus group study.

Abstract: Background Drug-induced and drug-related deaths have been increasing for the past decade throughout the US. In NYC, drug overdose accounts for nearly 900 deaths per year, a figure that exceeds the number of deaths each year from homicide. Naloxone, a highly effective opiate antagonist, has for decades been used by doctors and paramedics during emergency resuscitation after an opiate overdose. Following the lead of programs in Europe and the US who have successfully distributed take-home naloxone, the Overdose Prevention and Reversal Program at the Lower East Side Harm Reduction Center (LESHRC) has started providing a similar resource for opiate users in NYC. Participants in the program receive a prescription for two doses of naloxone, with refills as needed, and comprehensive training to reduce overdose risk, administer naloxone, perform rescue breathing, and call 911. As of September 2005, 204 participants have received naloxone and been trained, and 40 have revived an overdosing friend or family member. While naloxone accessibility stands as a proven life-saving measure, some opiates users at LESHRC have expressed only minimal interest in naloxone use, due to past experiences and common misconceptions.

Predictors of peritraumatic reactions and PTSD following the September 11th terrorist attacks.

Abstract: In this study the authors characterize peritraumatic reactions of residents of New York City during and immediately following the September 11th terrorist attacks, identify predictors of those reactions, and identify predictors of PTSD 4 months later. A cross–sectional sample of New York residents (n = 2,001) responded to questions about sociodemographics, historical factors, event–related exposure; acute cognitive, emotional, and physiological reactions to the September 11th terrorist attacks; and current (past month) PTSD symptoms. Factor analyses of peritraumatic reactions yielded three related, but distinct, peritraumatic response patterns—dissociation, emotional reactions, and panic/physiological arousal. Several demographic, historical, and exposure–related variables predicted one or more peritraumatic reaction patterns. After controlling for demographic, historical, and exposure factors, each of the peritraumatic reactions factors, one historical factor and one event–related exposure factor remained as significant predictors of PTSD. These results support a growing literature concerning the predictive value of peritraumatic reactions in relation to PTSD. Implications for preventive efforts and suggestions for future research are discussed.