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Sandro Galea

Publications and source records attributed to Sandro Galea.

At least 19 recordsLinked to original sources
PubMed2020

Epigenome-wide meta-analysis of PTSD across 10 military and civilian cohorts identifies methylation changes in AHRR.

Epigenetic differences may help to distinguish between PTSD cases and trauma-exposed controls. Here, we describe the results of the largest DNA methylation meta-analysis of PTSD to date. Ten cohorts, military and civilian, contribute blood-derived DNA methylation data from 1,896 PTSD cases and trauma-exposed controls. Four CpG sites within the aryl-hydrocarbon receptor repressor (AHRR) associate with PTSD after adjustment for multiple comparisons, with lower DNA methylation in PTSD cases relative to controls. Although AHRR methylation is known to associate with smoking, the AHRR association with PTSD is most pronounced in non-smokers, suggesting the result was independent of smoking status. Evaluation of metabolomics data reveals that AHRR methylation associated with kynurenine levels, which are lower among subjects with PTSD. This study supports epigenetic differences in those with PTSD and suggests a role for decreased kynurenine as a contributor to immune dysregulation in PTSD.

Basic Helix-Loop-Helix Proteins↗
PubMed2007

Psychopathological consequences after a terrorist attack: an epidemiological study among victims, the general population, and police officers.

BACKGROUND AND AIM: To assess the prevalence and correlates of post-traumatic stress disorder (PTSD), major depression and anxiety disorders other than PTSD, among three samples with different level of exposure to the March 11, 2004 terrorist attacks in Madrid. METHOD: We sampled three groups of persons-those injured in the attacks, the residents of Alcala de Henares, and police officers involved with the rescue effort-with different exposure to the March 11, 2004 terrorist attacks, using random sampling from comprehensive censuses of all three groups. In person interviews were conducted with all three groups between 5 and 12 weeks after March 11, 2004. Questionnaire included assessment of socio-demographic characteristics, of PTSD using the Davidson trauma scale, and of a range of psychiatric illnesses using the mini international neuropsychiatric interview (MINI). RESULTS: The overall sample included 127 persons injured in the attack, 485 residents of Alcalá de Henares, and 153 policemen involved in rescue. Of all three groups 57.5%, 25.9% and 3.9% of persons, respectively, reported symptoms consistent with any assessed psychiatric disorder. The use of psychoactive medication before March 11, 2004 was consistently the main predictor of PTSD and major depression among those injured and of major depression and anxiety disorders others than PTSD among residents of Alcala. CONCLUSIONS: There was a substantial burden of psychological consequences of the March 11, 2004 terrorist attacks two months after the event. Persons with prior mental illness are at higher risk of post-event psychopathology, across groups of exposure.

Adult↗
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

Emergency department visits for behavioral and mental health care after a terrorist attack.

STUDY OBJECTIVE: We assess emergency department (ED) utilization by a population whose health care encounters can be tracked and quantified for behavioral and mental health conditions in the aftermath of the terrorist attacks of September 11, 2001. METHODS: We assessed presentations to EDs by using Medicaid analytic extract files for adult New York State residents for 2000 and 2001. We created 4 mutually exclusive geographic areas that were progressively more distant from the World Trade Center and divided data into 4 periods. All persons in the files were categorized by their zip code of residence. We coded primary ED diagnoses for posttraumatic stress disorder, substance abuse, psychogenic illness, severe psychiatric illness, depression, sleep disorders, eating disorders, stress-related disorders, and adjustment disorders. RESULTS: There was a 10.1% relative temporal increase in the rate of ED behavioral and mental health diagnoses after the September 11, 2001, terrorist attacks for adult Medicaid enrollees residing within a 3-mile radius of the World Trade Center site. Other geographic areas experienced relative declines. In population-based comparisons, Medicaid recipients who lived within 3 miles of the World Trade Center after the September 11, 2001, terrorist attacks had a 20% increased risk of an ED mental health diagnosis (prevalence density ratio 1.2; 95% confidence interval 1.1 to 1.3) compared to those who were non-New York City residents. CONCLUSION: The complex role that EDs may play in responding to terrorism and disasters is becoming increasingly apparent. To the best of our knowledge, this is the first report of a quantifiable increase in ED utilization for mental health services by persons exposed to a terrorist attack in the United States.

Adult↗
PubMed2006

Multilevel community-based intervention to increase access to sterile syringes among injection drug users through pharmacy sales in New York City.

OBJECTIVES: Research has indicated that there is minimal use of pharmacies among injection drug users (IDUs) in specific neighborhoods and among Black and Hispanic IDUs. We developed a community-based participatory research partnership to determine whether a multilevel intervention would increase sterile syringe access through a new policy allowing nonprescription syringe sales in pharmacies. METHODS: We targeted Harlem, NY (using the South Bronx for comparison), and disseminated informational material at community forums, pharmacist training programs, and counseling or outreach programs for IDUs. We compared cross-sectional samples in 3 target populations (pre- and postintervention): community members (attitudes and opinions), pharmacists (opinions and practices), and IDUs (risk behaviors). RESULTS: Among community members (N = 1496) and pharmacists (N = 131), negative opinions of IDU syringe sales decreased in Harlem whereas there was either no change or an increase in negative opinions in the comparison community. Although pharmacy use by IDUs (N=728) increased in both communities, pharmacy use increased significantly among Black IDUs in Harlem, but not in the comparison community; syringe reuse significantly decreased in Harlem, but not in the comparison community. CONCLUSIONS: Targeting the individual and the social environment through a multilevel community-based intervention reduced high-risk behavior, particularly among Black IDUs.

Adolescent↗
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

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

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 self-rated 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.

Adult↗
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

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

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. METHODS: In order to improve the naloxone distribution program two focus groups were conducted in December 2004 with 13 opiate users at LESHRC to examine knowledge about overdose and overdose prevention. The focus groups assessed participants' (i) experiences with overdose response, specifically naloxone (ii) understanding and perceptions of naloxone, (iii) comfort level with naloxone administration and (iv) feedback about increasing the visibility and desirability of the naloxone distribution program. RESULTS: Analyses suggest that there is both support for and resistance to take-home naloxone, marked by enthusiasm for its potential role in reviving an overdosing individual, numerous misconceptions and negative views of its impact and use. CONCLUSION: Focus group results will be used to increase participation in the program and reshape perceptions about naloxone among opiate users, also targeting those already prescribed naloxone to increase their comfort using it. Since NYC is advancing toward a citywide naloxone distribution program, the LESHRC program will play an important role in establishing protocol for effective and wide-reaching naloxone availability.

Journal Article↗
PubMed2006

Distribution of influenza vaccine to high-risk groups.

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 community-based 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 > or = 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.

Community Networks↗
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

Internet-based intervention for mental health and substance use problems in disaster-affected populations: a pilot feasibility study.

Early interventions that reduce the societal burden of mental health problems in the aftermath of disasters and mass violence have the potential to be enormously valuable. Internet-based interventions can be delivered widely, efficiently, and at low cost and as such are of particular interest. We describe the development and feasibility analysis of an Internet-delivered intervention designed to address mental health and substance-related reactions in disaster-affected populations. Participants (n = 285) were recruited from a cohort of New York City-area residents that had been followed longitudinally in epidemiological research initiated 6 months after the terrorist attacks of September 11, 2001. The intervention consisted of 7 modules: posttraumatic stress/panic, depression, generalized anxiety, alcohol use, marijuana use, drug use, and cigarette use. Feasibility data were promising and suggest the need for further evaluation.

Adolescent↗
PubMed2006

The behavioral consequences of terrorism: a meta-analysis.

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.

Age Distribution↗
PubMed2006

Stigmatization of newly emerging infectious diseases: AIDS and SARS.

OBJECTIVES: We assessed relationships between sociodemographic characteristics and mental health status and knowledge of, being worried about, and stigmatization of 2 emerging infectious diseases: AIDS and SARS. METHODS: We conducted a random-digit-dialed survey of 928 residents of the New York City metropolitan area as part of a study of the effects of the September 11, 2001, terrorist attacks. Questions added for this study concerned respondents' knowledge of, worry about, and support of stigmatizing actions to control AIDS and SARS. RESULTS: In general, respondents with greater personal resources (income, education, social support) and better mental health status had more knowledge, were less worried, and were less likely to stigmatize. This pattern held for both AIDS and SARS. CONCLUSIONS: Personal resources and mental health factors are likely to influence the public's ability to learn about, rationally appraise the threat of, and minimize stigmatization of emerging infectious diseases such as AIDS and SARS.

Acquired Immunodeficiency Syndrome↗
PubMed2006

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

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.

Disease Outbreaks↗
PubMed2006

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

BACKGROUND: 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. METHOD: 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. RESULTS: 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). CONCLUSIONS: 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.

Adolescent↗