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Biomedical subjects

Jennifer Ahern

Publications and source records attributed to Jennifer Ahern.

At least 19 recordsLinked to original sources
PubMed2007

Television watching and the risk of incident probable posttraumatic stress disorder: a prospective evaluation.

The relation between viewing television coverage of a mass disaster and the development of posttraumatic stress disorder (PTSD) is poorly understood. A cohort of New Yorkers without baseline probable PTSD (N=1787) was assessed 1 year following the September 11, 2001, attacks. The primary outcome was new-onset probable PTSD assessed through a validated scale, and the primary exposure was number of hours of September 11 anniversary news coverage viewed. A total of 99 (5.6%) of participants had developed probable PTSD at the 1-year follow-up. Watching 12 or more hours of September 11 attack anniversary news coverage was associated with a 3.4-fold increased risk of new-onset probable PTSD (p=0.004). Exposure to television coverage of the September 11 anniversary was associated with new-onset probable PTSD among a cohort of New Yorkers with no probable PTSD at baseline.

Adult↗
PubMed2006

Education inequality and use of cigarettes, alcohol, and marijuana.

Education inequality at the neighborhood-level may influence population health and health behavior. We assessed the relations between education inequality and substance use in 59 New York City (NYC) neighborhoods. We used Gini coefficients of education to describe neighborhood education inequality and data from a random-digit-dial phone survey of adult residents of NYC to assess use of substances. Among 1355 respondents (female=56.2%; white=35.7%; mean age=40.4), 23.9% (95% confidence interval [CI]=20.3-27.5) reported smoking, 39.4% (95% CI=35.3-43.4) drinking, and 5.4% (95% CI=3.6-7.3) using marijuana in the previous 30 days. In multilevel models controlling for neighborhood education, neighborhood income inequality, and individual covariates, living in a neighborhood with high education inequality was associated with a greater prevalence of drinking (p=0.02) and of smoking marijuana (p=0.004) but among current drinkers it was associated (p=0.03) with having fewer drinks. The odds of alcohol use (OR=1.70) and marijuana use (OR=3.49) were greater in neighborhoods in the 75th percentile of education Gini compared to neighborhoods in the 25th percentile of education Gini. Statisical interactions suggest that there may be a stronger relation between education inequality and marijuana use in neighborhoods with low mean education than in neighborhoods with higher mean levels of education. These findings, taken together, suggest a complex relation between education inequality and substance use; likelihood of the use of alcohol and marijuana was higher in areas with higher education inequality suggesting potential roles for substance use norms and availability, whereas quantity used among drinkers was higher in areas with low education inequality, suggesting potential roles for both disadvantage and norms.

Adolescent↗
PubMed2006

Stigma, discrimination and the health of illicit drug users.

Persons who use illicit drugs are stigmatized in the United States. The conferral of a deviant social status on illicit drug users may serve to discourage use. However, stigmatization may also adversely affect the health of those who use illicit drugs, through exposure to chronic stress such as discrimination and as a barrier to accessing care. We hypothesized that aspects of stigma and discrimination would be associated with mental and physical health among illicit drug users. Using street outreach techniques, 1008 illicit drug users were interviewed about stigma and discrimination related to their drug use, and their health. We measured discrimination related to drug use, alienation, perceived devaluation, and responses to discrimination and stigma. Health measures included mental and physical health measures from the Medical Outcomes Study Short Form-36, depression symptoms from the Center for Epidemiological Studies Depression scale, and a sum of health conditions. In adjusted models, discrimination and alienation were both associated with poorer mental health, and only discrimination was associated with poorer physical health. Angry responses to discrimination and stigma were associated with poorer mental health. The association of stigma and discrimination with poor health among drug users suggests the need for debate on the relative risks and benefits of stigma and discrimination in this context.

Adolescent↗
PubMed2006

A failure of resilience: estimating response of New York City's public health ecosystem to sudden disaster.

Adapting methodology from resilience theory in ecology, we develop an empirical model of the response of the New York City public health ecosystem to sudden disaster. Contrary to cultural expectation, 'good' and 'bad' neighborhoods-starkly differentiated by public health status reflecting longstanding economic and racial segregation-respond similarly to challenge. This suggests that the difference in health between neighborhoods is primarily predicated on the extent to which they have been, and continue to be, exposed to differing patterns of stressors and affordances, rather than to any difference in underlying socio-economic vulnerability. Paradoxically, then, these urban neighborhoods constitute a single, highly interdependent, health ecosystem, despite substantial socioeconomic and racial segregation.

Disasters↗
PubMed2006

What explains the association between neighborhood-level income inequality and the risk of fatal overdose in New York City?

Accidental drug overdose is a substantial cause of mortality for drug users. Using a multilevel case-control study we previously have shown that neighborhood-level income inequality may be an important determinant of overdose death independent of individual-level factors. Here we hypothesized that the level of environmental disorder, the level of police activity, and the quality of the built environment in a neighborhood mediate this association. Data from the New York City (NYC) Mayor's Management Report, the NYC Police Department, and the NYC Housing and Vacancy Survey were used to define constructs for the level of environmental disorder, the level of police activity and the quality of the built environment, respectively. In multivariable models the odds of death due to drug overdose in neighborhoods in the top decile of income inequality compared to the most equitable neighborhoods decreased from 1.63 to 1.12 when adjusting for the three potential mediators. Path analyses show that the association between income inequality and the rate of drug overdose mortality was primarily explained by an indirect effect through the level of environmental disorder and the quality of the built environment in a neighborhood. Implications of these findings for the reduction of drug overdose mortality associated with the distribution of income are discussed.

Adolescent↗
PubMed2006

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

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 (beta = 7.58, p = 0.1). However, among those with low individual income (< 20,000 US dollars) there was a strong significant association between income inequality and depression (beta = 35.02, p<0.01), while there was no association among those with higher 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 marginalized 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.

Adolescent↗
PubMed2006

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

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.

Acute Disease↗
PubMed2005

Period and birth-cohort effects on age of first phencyclidine (PCP) use among drug users in New York City, 1960 to 2000.

PURPOSE: The aim of the study is to determine period and birth-cohort effects in the early initiation of phencyclidine (PCP) use in drug users in New York City (NYC). METHODS: We analyzed data collected from two surveys of street-recruited drug users in NYC. We used survival analysis and proportional hazards modeling to assess period and birth-cohort effects on risk for early initiation of PCP use. RESULTS: Of 787 participants, 292 (37.1%) had used PCP by the age of 23 years. Before 1987, there was a greater risk for initiation of PCP use through the age of 23 years (hazard ratio [HR] = 34.77; 95% confidence interval [CI], 21.45-56.36). Proportional hazards modeling showed that those born in the 1971 to 1975 birth cohort compared with those born in 1976 to 1980 had a lower risk for initiation of PCP use through age 23 years (HR = 0.58; 95% CI, 0.37-0.91). Other significant predictors of PCP use by age 23 included white race and having been in a juvenile detention center. CONCLUSIONS: There are period and birth-cohort differences in the likelihood of early initiation of PCP use. Changes in drug culture and social norms may influence the likelihood of initiation of PCP use. This may have implications for interventions aimed at slowing the nationwide increase in use of PCP.

Adult↗
PubMed2005

A model of underlying socioeconomic vulnerability in human populations: evidence from variability in population health and implications for public health.

Drawing from insights into the variability of complex biologic systems we propose that the health of human populations reflects the interrelationship between underlying vulnerabilities (determined by population-level social and economic factors; e.g., income distribution) and capacities (determined by population-level salutary resources, e.g., social capital) and how populations, shaped by these vulnerabilities and capacities, respond to intermittent stressors (e.g., economic downturns) and protective events (e.g., introduction of a school). Monitoring this dynamic at the population-level can be accomplished by examining not only rates of illness and mortality, but variability in rates, either between populations or within populations over time. We used mortality data from New York City neighborhoods between 1990 and 2001 to test two related hypotheses consistent with this model of population health: (a) There is greater variability in mortality rates at a point in time between neighborhoods that are characterized by socioeconomic vulnerability; and (b) there is greater variability in mortality rates over time within neighborhoods that are characterized by socioeconomic vulnerability. We found that neighborhoods characterized by social and economic vulnerability displayed substantial variability in particular mortality rates. Mortality rates displaying the greatest variability were from causes that may be sensitive to social conditions (e.g., homicide or HIV/AIDS rates). Variability in population health existed both between neighborhoods with underlying vulnerability at one point in time and within vulnerable neighborhoods over time. The results of this analysis are consistent with a theory of underlying socioeconomic vulnerabilities of human populations and suggest that variability in population health may be an important consideration in population health assessment.

Health Status Indicators↗
PubMed2005

Interpersonal discrimination and the health of illicit drug users.

Although discrimination has been shown to adversely affect the health of marginalized populations, there is a paucity of research on the health impacts of discrimination experienced by illicit drug users. The purpose of this study was to examine the association between interpersonal discrimination and the mental and physical health of illicit drug users taking into account several potential confounding factors. A sample of 1,008 active illicit substance users (defined as having used cocaine, crack, or heroin in the previous 2 months) were recruited in three New York City neighborhoods between August 2000 and January 2001 using street-outreach techniques. Discrimination due to illicit drug use was the most common form of interpersonal discrimination experienced and more than one-half the study participants reported experiencing discrimination due to more than one attribute. Discrimination was significantly associated with poor mental health (measured by the SF-36 mental health score), depression (measured by the CES-D), and the number of self-reported chronic physical health conditions. The presence of multiple stigmatizing characteristics was associated with poorer mental and physical health. Discrimination may contribute to poor mental and physical health in this marginalized population, potentially complicating the provision of substance abuse treatment.

Adult↗
PubMed2005

Urban built environment and depression: a multilevel analysis.

STUDY OBJECTIVE: To assess the relations between characteristics of the neighbourhood internal and external built environment and past six month and lifetime depression. DESIGN AND SETTING: Depression and sociodemographic information were assessed in a cross sectional survey of residents of New York City (NYC). All respondents were geocoded to neighbourhood of residence. Data on the quality of the built environment in 59 NYC neighbourhoods were collected from the United Status census, the New York City housing and vacancy survey, and the fiscal 2002 New York City mayor's management report. MAIN RESULTS: Among 1355 respondents, residence in neighbourhoods characterised by a poor quality built environment was associated with greater individual likelihood of past six month and lifetime depression in multilevel models adjusting for individual age, race/ethnicity, sex, and income and for neighbourhood level income. In adjusted models, persons living in neighbourhoods characterised by poorer features of the built environment were 29%-58% more likely to report past six month depression and 36%-64% more likely to report lifetime depression than respondents living in neighbourhoods characterised by better features of the built environment. CONCLUSIONS: Living in neighbourhoods characterised by a poor quality built environment is associated with a greater likelihood of depression. Future prospective work designed to assess potential mechanisms underlying these associations may guide public health and urban planning efforts aimed at improving population mental health.

Adolescent↗
PubMed2005

Health status among emergency department patients approximately one year after consecutive disasters in New York City.

OBJECTIVES: Emergency department (ED) patients with disaster-related experiences may present with vague symptoms not clearly linked to the event. In 2001, two disasters in New York City, the World Trade Center disaster (WTCD) and the subsequent American Airlines Flight 587 crash, presented an opportunity to study long-term consequences of cumulative disaster exposure (CDE) on health-related quality of life (HRQOL) among ED patients. METHODS: From July 15 to October 30, 2002, a systematic sample of stable, adult patients from two EDs in New York City were enrolled. Participants completed a self-administered questionnaire. The Short Form 36 (SF-36) was used to assess overall health status. Bivariate analyses were conducted to identify individual correlates of worsening health status. Multivariate regression was performed to identify the association between various factors and overall health status, while controlling for relevant sociodemographic variables. RESULTS: Four hundred seventy-one patients (54.6% female) participated. The participation rate was 73.4%. One hundred sixty-one participants (36%) reported direct, indirect, or occupational exposure to the WTCD; 55 (13.3%) had direct, indirect, or occupational exposure to the plane crash; 33 (8.1%) had both exposures. In separate multivariate models, CDE predicted lower SF-36 scores for general health (p < 0.0096), mental health (p < 0.0033), and bodily pain (p < 0.0046). CONCLUSIONS: In the year following mass traumatic events, persons with CDE had lower overall health status than those with one or no disaster exposure. Clinicians should consider the impact that traumatic events have on the overall health status of ED patients in the wake of consecutive disasters.

Adult↗
PubMed2005

Probable cigarette dependence, PTSD, and depression after an urban disaster: results from a population survey of New York City residents 4 months after September 11, 2001.

Disaster exposure may exacerbate psychopathology and substance-related disorders. Four months after September 11, 2001, using random-digit dialing to contact a representative sample of adults (N = 2001) living in New York City, we assessed cigarette smoking and symptoms of probable cigarette dependence using measures from the National Survey on Drug Use and Health. A total of 36.8% of smokers reported increased cigarette use; 10.4% of respondents reported three or more symptoms of cigarette dependence and were considered cases of probable cigarette dependence based on DSM-IV criteria. Cases were more likely to report an increase in cigarette use since September 11 than non-cases (69.4% among cases vs. 2.2% among non-cases, p < 0.001). Cases were more likely to have probable posttraumatic stress disorder (PTSD) and depression than non-cases (18.1% vs. 5.7% for PTSD, p < 0.001; 23.6% vs. 6.0% for depression, p < 0.001). Increased cigarette use since September 11 was associated with probable PTSD among cases (23.4% vs. 6.4%, p = 0.011) and non-cases (15.1% vs. 5.5%, p = 0.034) but was associated with probable depression only among cases of probable cigarette dependence (28.3% vs. 13.3%, p = 0.027). This study showed the co-occurrence of probable cigarette dependence with increased cigarette use and the co-occurrence of probable cigarette dependence with probable PTSD and depression after September 11.

Adolescent↗
PubMed2005

Income inequality and risk of suicide in New York City neighborhoods: a multilevel case-control study.

Evidence on the relationship between income inequality and suicide is inconsistent. Data from the New York City Office of the Chief Medical Examiner for all fatal injuries was collected to conduct a multilevel case-control study. In multilevel models, suicide decedents (n=374) were more likely than accident controls (n=453) to reside in neighborhoods with greater income inequality even after controlling for individual characteristics; this relation was modified by age with an effect overall and among decedents aged 15-34 but not among decedents 35-64. These data suggest that income inequality may contribute to the risk of suicide in younger adults.

Adolescent↗
PubMed2005

Distribution of education and population health: an ecological analysis of New York City neighborhoods.

OBJECTIVES: We assessed the relationship between distribution of education and health indicators in a large urban area to determine if distribution of education may be a determinant of population health. METHODS: We studied the association between distribution of education, measured with the education Gini coefficient, and rates of 8 health indicators in 59 neighborhoods in New York City. RESULTS: In separate adjusted ecological models, neighborhoods with more poorly distributed education had better population health indicators that might plausibly be associated with short-term changes in the social environment (e.g., homicide and infant mortality rate); there was no association between education distribution and health indicators more likely to be associated with long-term accumulation of social and behavioral stressors (e.g., cardiovascular disease and chronic lung disease mortality rates). These findings were robust to measures of income and to adjustment for several potential confounders (e.g., gender and race/ethnicity). CONCLUSIONS: The presence in a neighborhood of highly educated people may be salutary for all residents, independent of the potentially deleterious consequences of income maldistribution.

Censuses↗
PubMed2005

Racial/ethnic differences in screening for colon cancer: report from the New York Cancer Project.

OBJECTIVE: To determine whether racial/ethnic differences in colon cancer screening are independent of socioeconomic and personal risk factors. DESIGN: Baseline cross-section for a prospective cohort. METHOD: We recruited adults between 2000 and 2002 to undergo a questionnaire and venipuncture to study cancer risks. RESULTS: Among 5595 adults over 50 years old, 40.3% reported sigmoidoscopy or colonoscopy within the prior five years; rates were 48.0% for Whites, 32.8% for Blacks, 27.9% for Hispanics, 30.3% for Asians, and 33.3% for others. Adjusting for age, gender, access to care (as income and insurance), and risk profile (as cancer in family, smoking, and obesity), Blacks and Hispanics were less likely to have been screened than Whites. CONCLUSIONS: Screening for colon cancer is low, especially among racial/ethnic minorities. Sociocultural factors merit closer attention.

Adult↗
PubMed2004

War-related psychological sequelae among emergency department patients in the former Republic of Yugoslavia.

BACKGROUND: Residents of the Republic of Serbia faced civil war and a NATO-led bombing campaign in 1999. We sought to assess the burden of metal health dysfunction among emergency department (ED) patients presenting for care three years post-war in Serbia. METHODS: This study was conducted during July and August 2002 at two sites: a university hospital ED in Belgrade, Serbia and an ED in a remote district hospital serving a Serbian enclave in Laplje Selo, Kosovo. Investigators collected data on a systematic sample of non-acute patients presenting to the ED. All respondents completed a structured questionnaire assessing demographics and symptoms of post-traumatic stress disorder (PTSD) (using the Harvard Trauma Questionnaire), and major depression (using the Center for Epidemiologic Studies Depression Scale). RESULTS: A total of 562 respondents participated (310 in Belgrade, 252 in Laplje Selo); the response rate was 83.8%, 43% were female, and mean age was 37.6 years (SD = 13.4). Overall, 73 (13.0%) participants had symptoms consistent with PTSD, and 272 (49.2%) had symptoms consistent with depression. Sixty-six respondents had both disorders (11.9%). In separate multivariable logistic regression models, predictors of PTSD were refugee status and residence in Laplje Selo, and predictors of depression were older age, current unemployment, and lower social support. CONCLUSIONS: Three years post-war, symptoms of PTSD and major depression in Serbia remained a significant public health concern, particularly among refugees, those suffering subsequent economic instability, and persons living in rural, remote areas.

Adult↗