Sandro Galea

Massachusetts Department of Public Health, Boston, Massachusetts, United States

Are you Sandro Galea?

Claim your profile

Publications (747)2210.95 Total impact

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Posttraumatic stress disorder (PTSD) is comorbid with major depressive disorder (MDD; Kessler et al., 1995) and generalized anxiety disorder (GAD; Brown et al., 2001). We aimed to (1) assess discrete patterns of post-trauma PTSD-depression-GAD symptoms using latent profile analyses (LPAs), and (2) assess covariates (gender, income, education, age) in defining the best fitting class solution. The PTSD Checklist (assessing PTSD symptoms), GAD-7 scale (assessing GAD symptoms), and Patient Health Questionnaire-9 (assessing depression) were administered to 1266 trauma-exposed Ohio National Guard soldiers. Results indicated three discrete subgroups based on symptom patterns with mild (class 1), moderate (class 2) and severe (class 3) levels of symptomatology. Classes differed in symptom severity rather than symptom type. Income and education significantly predicted class 1 versus class 3 membership, and class 2 versus class 3. In conclusion, there is heterogeneity regarding severity of PTSD-depression-GAD symptomatology among trauma-exposed soldiers, with income and education predictive of class membership.
    Journal of Psychiatric Research 09/2015; 68:19-26. DOI:10.1016/j.jpsychires.2015.05.014 · 4.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We assessed gun ownership rates in 2013 across the USA and the association between exposure to a social gun culture and gun ownership. We used data from a nationally representative sample of 4000 US adults, from 50 states and District of Columbia, aged >18 years to assess gun ownership and social gun culture performed in October 2013. State-level firearm policy information was obtained from the Brady Law Center and Injury Prevention and Control Center. One-third of Americans reported owning a gun, ranging from 5.2% in Delaware to 61.7% in Alaska. Gun ownership was 2.25-times greater among those reporting social gun culture (PR=2.25, 95% CI 2.02 to 2.52) than those who did not. In conclusion, we found strong association between social gun culture and gun ownership. Gun cultures may need to be considered for public health strategies that aim to change gun ownership in the USA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Injury Prevention 06/2015; DOI:10.1136/injuryprev-2015-041586 · 1.94 Impact Factor
  • Source
    Sarah R Lowe, Sandro Galea
    [Show abstract] [Hide abstract]
    ABSTRACT: Mass shooting episodes have increased over recent decades and received substantial media coverage. Despite the potentially widespread and increasing mental health impact of mass shootings, no efforts to our knowledge have been made to review the empirical literature on this topic. We identified 49 peer-reviewed articles, comprised of 27 independent samples in the aftermath of 15 mass shooting incidents. Based on our review, we concluded that mass shootings are associated with a variety of adverse psychological outcomes in survivors and members of affected communities. Less is known about the psychological effects of mass shootings on indirectly exposed populations; however, there is evidence that such events lead to at least short-term increases in fears and declines in perceived safety. A variety of risk factors for adverse psychological outcomes have been identified, including demographic and pre-incident characteristics (e.g., female gender and pre-incident psychological symptoms), event exposure (e.g., greater proximity to the attack and acquaintance with the deceased), and fewer psychosocial resources (e.g., emotion regulation difficulties and lower social support). Further research that draws on pre-incident and longitudinal data will yield important insights into the processes that exacerbate or sustain post-incident psychological symptoms over time and provide important information for crisis preparedness and post-incident mental health interventions. © The Author(s) 2015.
    Trauma Violence & Abuse 06/2015; DOI:10.1177/1524838015591572 · 3.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Several studies have suggested strong associations between economic downturns and suicide mortality, but are at risk of bias due to unmeasured confounding. The rationale for our study was to provide more robust evidence by using a quasi- experimental design. We analysed 955 561 suicides occurring in the USA from 1980 to 2010 and used a broad index of economic activity in each US state to measure economic conditions. We used a quasi-experimental, fixed-effects design and we also assessed whether the effects were heterogeneous by demographic group and during periods of official recession. After accounting for secular trends, seasonality and unmeasured fixed characteristics of states, we found that an economic downturn similar in magnitude to the 2007 Great Recession increased suicide mortality by 0.14 deaths per 100 000 population [95% confidence interval (CI) 0.00, 0.28] or around 350 deaths. Effects were stronger for men (0.28, 95% CI 0.07, 0.49) than women and for those with less than 12 years of education (1.22 95% CI 0.83, 1.60) compared with more than 12 years of education. The overall effect did not differ for recessionary (0.11, 95% CI -0.02, 0.25) vs non- recessionary periods (0.15, 95% CI 0.01, 0.29). The main study limitation is the potential for misclassified death certificates and we cannot definitively rule out unmeasured confounding. We found limited evidence of a strong, population-wide detrimental effect of economic downturns on suicide mortality. The overall effect hides considerable heterogeneity by gender, socioeconomic position and time period. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.
    International Journal of Epidemiology 06/2015; DOI:10.1093/ije/dyv009 · 9.20 Impact Factor
  • Abdulrahman M El-Sayed, Sandro Galea
    [Show abstract] [Hide abstract]
    ABSTRACT: Although obesity continues to challenge the public's health, effective policy solutions are wanting. Borrowing from environmental protection efforts, we explored the potential for a "calorie offset" regulatory mechanism, which is similar to the carbon emission offsets used to curb greenhouse gas emissions, to mitigate the harmful health externalities of unhealthy food production. This approach might have a number of advantages over traditional policy tools, and warrants attention from health policymakers and industry alike. (Am J Public Health. Published online ahead of print June 11, 2015: e1-e3. doi:10.2105/AJPH.2015.302678).
    American Journal of Public Health 06/2015; DOI:10.2105/AJPH.2015.302678 · 4.23 Impact Factor
  • Source
  • PLoS ONE 06/2015; 10(6):e0129169. DOI:10.1371/journal.pone.0129169 · 3.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Recent epidemiologic studies have shown that nonmedical use of prescription opioids (NMUPO) and major depression frequently co-occur. Comorbid forms of drug use and mental illness such as NMUPO and depression pose a greater disease burden than either condition alone. However, sociodemographic and substance use differences between individuals with either NMUPO or depression and those with comorbid conditions have not yet been fully investigated. Data came from the 2011 and 2012 National Survey on Drug Use and Health (NSDUH). Adolescents and adults were examined independently because of differences in screening for major depressive episodes (MDE). Weighted multinomial logistic regression investigated differences between persons with either past-year NMUPO (4.0%) or MDE (5.5%) and those with comorbid NMUPO and MDE (0.6%), compared to persons with neither condition. Females were more likely than males to report either MDE-alone and comorbid NMUPO and MDE, whereas adult men were marginally more likely to report NMUPO-alone (not significant among adolescents). Polydrug use and alcohol use disorders were more pronounced among those with comorbid NMUPO and MDE than persons with either NMUPO-alone or MDE-alone. Persons with independent and comorbid NMUPO and MDE were more likely to report lower income and unemployment versus employment. This study found that independent and comorbid NMUPO and MDE were disproportionately clustered with burdens of lower socioeconomic position, suggesting that a population-based approach to address NMUPO would target these social determinants of health, whereas a high-risk approach to prevention should be tailored to females experiencing MDE symptoms and polydrug users. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Drug and alcohol dependence 05/2015; DOI:10.1016/j.drugalcdep.2015.05.010 · 3.28 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Several individual-level factors are known to promote psychological resilience in the aftermath of disasters. Far less is known about the role of community-level factors in shaping postdisaster mental health. The purpose of this study was to explore the influence of both individual- and community-level factors on resilience after Hurricane Sandy. A representative sample of household residents ( N = 418) from 293 New York City census tracts that were most heavily affected by the storm completed telephone interviews approximately 13–16 months postdisaster. Multilevel multivariable models explored the independent and interactive contributions of individual- and community-level factors to posttraumatic stress and depression symptoms. At the individual-level, having experienced or witnessed any lifetime traumatic event was significantly associated with higher depression and posttraumatic stress, whereas demographic characteristics (e.g., older age, non-Hispanic Black race) and more disa
    PLoS ONE 05/2015; 10:e0125761. DOI:10.1371/journal.pone.0125761 · 3.53 Impact Factor
  • David S Fink, Sandro Galea
    [Show abstract] [Hide abstract]
    ABSTRACT: Traumatic events are ubiquitous exposures that interact with life course events to increase risk of acute psychopathology and alter mental health trajectories. While the majority of persons exposed to trauma experience mild to moderate psychological distress followed by a return to pre-trauma health, many persons exposed to trauma experience substantial distress that lasts for several years. Therefore, in an effort to understand why exposure to trauma can provoke such a range of reactions, we apply a life course approach that considers the complex accumulation and interaction of life experiences that range from social to biological factors, which occur over the life span-from gestation to death and across generations. We present this evidence in three categories: genetics and biology, individual exposures, and community experiences, followed by discussing challenges in existing research and directions for future study.
    Current Psychiatry Reports 05/2015; 17(5):566. DOI:10.1007/s11920-015-0566-0 · 3.05 Impact Factor
  • Bindu Kalesan, Sandro Galea
    [Show abstract] [Hide abstract]
    ABSTRACT: Firearm injuries are a major health problem contributing to significant morbidity and mortality. Depression is associated with increased risk of adverse health outcomes in trauma patients and those hospitalized for serious disorders. We examined the relation between preexisting depression and adverse hospital outcomes and related injury severity among adult (>16-years) firearm hospitalizations (FH). Using nationally representative Nationwide Inpatient Sample (2005 to 2011) and survey weighted multinomial logistic regression, we calculated odds ratios (OR) and 95% confidence intervals (95%CI) to determine the risk of care facility discharge and in-hospital mortality by pre-existing depression. Pre-existing depression was associated with a 3-fold risk of discharge to care facility (OR=2.91, 95%CI=2.57-3.30) and a 2-fold risk of in-hospital mortality (OR=2.05, 95%CI=1.69-2.47). ORs for risk of care facility discharge compared to routine discharge associated with depression among assault/legal-FH, unintentional-FH, suicide-FH and undetermined-FH was 2.73 (95%CI=2.23-3.33), 1.90 (95%CI=1.50-2.41), 1.52 (95%CI=1.26-1.83) and 2.42 (95%CI=1.60-3.67), while risk of inhospital mortality was 0.17 (95%CI=0.05-0.54), 0.60 (95%CI=0.28-1.29), 0.79 (95%CI=0.63-0.98) and 0.74 (95%CI=0.36-1.52). Lack of information regarding re-hospitalization due to the cross-sectional data. Persons with depression who were hospitalized due to firearm-related injury were less likely to survive than those without depression, and those discharged alive were at higher risk of discharge to a facility. Depression was associated with greater risk of discharge to facility among all intents, and lower risk of in-hospital mortality among assault- and suicide-FH. These findings are important considering the increasing numbers of non-fatal firearm hospitalizations and the associated increase in healthcare expenditure. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 05/2015; 183. DOI:10.1016/j.jad.2015.05.010 · 3.71 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: High rates of mental health (MH) problems have been documented among disaster relief workers. However, few workers utilize MH services, and predictors of service use among this group remain unexplored. The purpose of this study was to explore associations between predisposing, illness-related, and enabling factors from Andersen's behavioral model of treatment-seeking and patterns of service use among participants who completed at least one full day of cleanup work after the Deepwater Horizon oil spill and participated in home visits for the NIEHS GuLF STUDY (N = 8931). Workers reported on MH symptoms and whether they had used counseling or medication for MH problems since the oil spill. Hierarchical logistic regression models explored associations between predictors and counseling and medication use in the full sample, and type of use (counseling only, medication only, both) among participants who used either service. Analyses were replicated for subsamples of participants with and without symptom inventory scores suggestive of probable post-disaster mental illness. Having a pre-spill MH diagnosis, pre-spill service use, more severe post-spill MH symptoms, and healthcare coverage were positively associated with counseling and medication use in the full sample. Among participants who used either service, non-Hispanic Black race, pre-spill counseling, lower depression, and not identifying a personal doctor or healthcare provider were predictive of counseling only, whereas older age, female gender and pre-spill medication were predictive of medication only. The results were generally consistent among participants with and without probable post-disaster mental illness. The results suggest variability in which factors within Andersen's behavioral model are predictive of different patterns of service use among disaster relief workers. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Social Science & Medicine 04/2015; 130. DOI:10.1016/j.socscimed.2015.02.009 · 2.56 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The present study investigated symptom relations between two highly comorbid disorders - posttraumatic stress disorder (PTSD) and generalized anxiety disorder (GAD) - by exploring their underlying dimensions. Based on theory and prior empirical research it was expected that the dysphoria factor of PTSD would be more highly related to GAD. As part of a longitudinal project of mental health among Ohio National Guard Soldiers, 1266 subjects were administered the Posttraumatic Stress Disorder Checklist (PCL) and Generalized Anxiety Disorder-7 scale (GAD-7). Confirmatory factor analyses (CFAs) were conducted to examine two models of PTSD and to determine which PTSD factors were more related to the GAD factor. The results indicate that the GAD factor was significantly more highly correlated with PTSD׳s dysphoria factor than with all other PTSD factors, including PTSD׳s reexperiencing factor, avoidance factor, and hyperarousal factor. Results indicate GAD was not significantly more highly correlated with numbing than most other factors of PTSD. The results are consistent with prior research. Implications of the results are discussed in regards to PTSD in DSM-5, comorbidity and diagnostic specificity. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    04/2015; 228(1). DOI:10.1016/j.psychres.2015.04.034
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Only very few studies have investigated the geographic distribution of psychological resilience and associated mental health outcomes after natural or man made disasters. Such information is crucial for location-based interventions that aim to promote recovery in the aftermath of disasters. The purpose of this study therefore was to investigate geographic variability of (1) posttraumatic stress (PTS) and depression in a Hurricane Sandy affected population in NYC and (2) psychological vulnerability and resilience factors among affected areas in NYC boroughs. Cross-sectional telephone survey data were collected 13 to 16 months post-disaster from household residents (N = 418 adults) in NYC communities that were most heavily affected by the hurricane. The Posttraumatic Stress Checklist for DSM-5 (PCL-5) was applied for measuring posttraumatic stress and the nine-item Patient Health Questionnaire (PHQ-9) was used for measuring depression. We applied spatial autocorrelation and spatial regimes regression analyses, to test for spatial clusters of mental health outcomes and to explore whether associations between vulnerability and resilience factors and mental health differed among New York City's five boroughs. Mental health problems clustered predominantly in neighborhoods that are geographically more exposed towards the ocean indicating a spatial variation of risk within and across the boroughs. We further found significant variation in associations between vulnerability and resilience factors and mental health. Race/ethnicity (being Asian or non-Hispanic black) and disaster-related stressors were vulnerability factors for mental health symptoms in Queens, and being employed and married were resilience factors for these symptoms in Manhattan and Staten Island. In addition, parental status was a vulnerability factor in Brooklyn and a resilience factor in the Bronx. We conclude that explanatory characteristics may manifest as psychological vulnerability and resilience factors differently across different regional contexts. Our spatial epidemiological approach is transferable to other regions around the globe and, in the light of a changing climate, could be used to strengthen the psychosocial resources of demographic groups at greatest risk of adverse outcomes pre-disaster. In the aftermath of a disaster, the approach can be used to identify survivors at greatest risk and to plan for targeted interventions to reach them.
    International Journal of Health Geographics 04/2015; 14(16). DOI:10.1186/s12942-015-0008-6 · 2.62 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Exposure to ongoing political violence and stressful conditions increases the risk of post traumatic stress disorder (PTSD) in low-resource contexts. However, much of our understanding of the determinants of PTSD in these contexts comes from cross-sectional data. Longitudinal studies that examine factors associated with incident PTSD may be useful to the development of effective prevention interventions and the identification of those who may be most at-risk for the disorder. Methods A 3-stage cluster random stratified sampling methodology was used to obtain a representative sample of 1,196 Palestinian adults living in Gaza, the West Bank and East Jerusalem. Face-to-face interviews were conducted at two time points 6-months apart. Logistic regression analyses were conducted on a restricted sample of 643 people who did not have PTSD at baseline and who completed both interviews. Results The incidence of PTSD was 15.0 % over a 6-month period. Results of adjusted logistic regression models demonstrated that talking to friends and family about political circumstances (aOR = 0.78, p = 0.01) was protective, and female sex (aOR = 1.76, p = 0.025), threat perception of future violence (aOR = 1.50, p = 0.002), poor general health (aOR = 1.39, p = 0.005), exposure to media (aOR = 1.37, p = 0.002), and loss of social resources (aOR = 1.71, p = 0.006) were predictive of incident cases of PTSD. Conclusions A high incidence of PTSD was documented during a 6-month follow-up period among Palestinian residents of Gaza, the West Bank, and East Jerusalem. Interventions that promote health and increase and forestall loss to social resources could potentially reduce the onset of PTSD in communities affected by violence.
    Social Psychiatry and Psychiatric Epidemiology 04/2015; 50(4):561-568. DOI:10.1007/s00127-014-0984-z · 2.58 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Depression and anxiety have been inconsistently associated with diabetes. Sex differences in the biological and behavioral correlates of these forms of distress could partially explain these inconsistencies. We investigated sex-specific associations between depression/anxiety symptoms and diabetes in two separate samples. The First National Health and Nutrition Examination Survey enrolled 3233 participants aged 25 to 74 years from 1971 to 1974. Depression and anxiety symptoms were measured via General Well Being schedule subscales. Incident diabetes for 17 years was defined by the following: a) death certificate, b) participant self-report, or c) health care facility discharge. The Detroit Neighborhood Health Study enrolled 1054 participants 18 years or older from 2008 to 2010. The Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 assessed depression and anxiety. Participants' self-reported physician-diagnosed prevalent diabetes. In the First National Health and Nutrition Examination Survey, the risk ratio (RR; 95% confidence interval) for incident diabetes among men with high versus low anxiety symptoms was 0.85 (0.56-1.29) and that among women was 2.19 (1.17-4.09; p for interaction = .005). RRs comparing high versus low depressive symptoms for men and women were 0.69 (0.43-1.100) and 2.11 (1.06-4.19); p for interaction = .007. In the Detroit Neighborhood Health Study, the RRs for prevalent diabetes comparing those with high versus low anxiety symptoms were 0.24 (0.02-2.42) for men and 1.62 (0.61-4.32) for women (p for interaction = < .001), whereas RRs for depression were 1.30 (0.46-3.68) for men and 2.32 (1.10-4.89) for women (p for interaction = .16). In two separate samples, depressive symptoms were related to increased diabetes risk among women but not men. Although less robust, findings for anxiety were differentially associated with diabetes by sex.
    Psychosomatic Medicine 04/2015; 77(4). DOI:10.1097/PSY.0000000000000169 · 4.09 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We examined the association between posttraumatic stress disorder (PTSD) and gene expression using whole blood samples from a cohort of trauma-exposed white non-Hispanic male veterans (115 cases and 28 controls). 10,264 probes of genes and gene transcripts were analyzed. We found 41 that were differentially expressed in PTSD cases versus controls (multiple-testing corrected p<0.05). The most significant was DSCAM, a neurological gene expressed widely in the developing brain and in the amygdala and hippocampus of the adult brain. We then examined the 41 differentially expressed genes in a meta-analysis using two replication cohorts and found significant associations with PTSD for 7 of the 41 (p<0.05), one of which (ATP6AP1L) survived multiple-testing correction. There was also broad evidence of overlap across the discovery and replication samples for the entire set of genes implicated in the discovery data based on the direction of effect and an enrichment of p<0.05 significant probes beyond what would be expected under the null. Finally, we found that the set of differentially expressed genes from the discovery sample was enriched for genes responsive to glucocorticoid signaling with most showing reduced expression in PTSD cases compared to controls. Published by Elsevier Ltd.
    Psychoneuroendocrinology 04/2015; 57. DOI:10.1016/j.psyneuen.2015.03.016 · 5.59 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Studies about racial disparities in infant mortality suggest that racial differences in socioeconomic position (SEP) and maternal risk behaviors explain some, but not all, excess infant mortality among Blacks relative to non-Hispanic Whites. We examined the contribution of these to disparities in specific causes of infant mortality. We analyzed data about 2,087,191 mother-child dyads in Michigan between 1989-2005. First, we calculated crude Black-White infant mortality ratios independently and by specific cause of death. Second, we fit multivariable Poisson regression models of infant mortality, overall and by cause, adjusting for SEP and maternal risk behaviors. Third, Crude Black-White mortality ratios were compared to adjusted predicted probability ratios, overall and by specific cause. SEP and maternal risk behaviors explained nearly a third of the disparity in infant mortality overall, and over 25% of disparities in several specific causes including homicide, accident, sudden infant death syndrome, and respiratory distress syndrome. However, SEP and maternal risk behaviors had little influence on disparities in other specific causes, such as septicemia and congenital anomalies. These findings help focus policy attention toward disparities in those specific causes of infant mortality most amenable to social and behavioral intervention, as well as research attention to disparities in specific causes unexplained by SEP and behavioral differences. Copyright © 2015. Published by Elsevier Inc.
    Preventive Medicine 04/2015; 76. DOI:10.1016/j.ypmed.2015.03.021 · 2.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We used an individual-based model to evaluate the effects of hypothetical prevention interventions on HIV incidence trajectories in a concentrated, mixed epidemic setting from 2011 to 2021, and using Cabo Verde as an example. Simulations were conducted to evaluate the extent to which early HIV treatment and optimization of care, HIV testing, condom distribution, and substance abuse treatment could eliminate new infections (i.e., reduce incidence to less than 10 cases per 10,000 person-years) among non-drug users, female sex workers (FSW), and people who use drugs (PWUD). Scaling up all four interventions resulted in the largest decreases in HIV, with estimates ranging from 1.4 (95 % CI 1.36-1.44) per 10,000 person-years among non-drug users to 8.2 (95 % CI 7.8-8.6) per 10,000 person-years among PWUD in 2021. Intervention scenarios prioritizing FWS and PWUD also resulted in HIV incidence estimates at or below 10 per 10,000 person-years by 2021 for all population sub-groups. Our results suggest that scaling up multiple interventions among entire population is necessary to achieve elimination. However, prioritizing key populations with this combination prevention strategy may also result in a substantial decrease in total incidence.
    International Journal of Public Health 04/2015; 60(4). DOI:10.1007/s00038-015-0676-9 · 2.70 Impact Factor
  • Source
    Jennifer Ahern, Laura Balzer, Sandro Galea
    [Show abstract] [Hide abstract]
    ABSTRACT: Alcohol outlet density and norms shape alcohol consumption. However, due to analytic challenges we do not know: (a) if alcohol outlet density and norms also shape alcohol use disorder, and (b) whether they act in combination to shape disorder. We applied a new targeted minimum loss-based estimator for rare outcomes (rTMLE) to a general population sample from New York City (N=4000) to examine the separate and combined relations of neighborhood alcohol outlet density and norms around drunkenness with alcohol use disorder. Alcohol use disorder was assessed using the World Mental Health Comprehensive International Diagnostic Interview (WMH-CIDI) alcohol module. Confounders included demographic and socioeconomic characteristics, as well as history of drinking prior to residence in the current neighborhood. Alcohol use disorder prevalence was 1.78%. We found a marginal risk difference for alcohol outlet density of 0.88% (95% CI 0.00-1.77%), and for norms of 2.05% (95% CI 0.89-3.21%), adjusted for confounders. While each exposure had a substantial relation with alcohol use disorder, there was no evidence of additive interaction between the exposures. Results indicate that the neighborhood environment shapes alcohol use disorder. Despite the lack of additive interaction, each exposure had a substantial relation with alcohol use disorder and our findings suggest that alteration of outlet density and norms together would likely be more effective than either one alone. Important next steps include development and testing of multi-component intervention approaches aiming to modify alcohol outlet density and norms toward reducing alcohol use disorder. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Drug and Alcohol Dependence 03/2015; 151. DOI:10.1016/j.drugalcdep.2015.03.014 · 3.28 Impact Factor

Publication Stats

16k Citations
2,210.95 Total Impact Points

Institutions

  • 2015
    • Massachusetts Department of Public Health
      Boston, Massachusetts, United States
  • 2012–2015
    • McGill University
      • Department of Epidemiology, Biostatistics and Occupational Health
      Montréal, Quebec, Canada
    • University of Oxford
      • Department of Public Health
      Oxford, ENG, United Kingdom
  • 2008–2015
    • Boston University
      • Department of Psychiatry
      Boston, Massachusetts, United States
  • 2002–2015
    • Columbia University
      • • Department of Epidemiology
      • • Teachers College
      New York, New York, United States
  • 2005–2014
    • CUNY Graduate Center
      New York City, New York, United States
    • City University of New York - Hunter College
      Borough of Manhattan, New York, United States
  • 2013
    • Stony Brook University Hospital
      Stony Brook, New York, United States
    • Wayne State University
      • Center for Molecular Medicine and Genetics
      Detroit, MI, United States
  • 2004–2013
    • Gracie Square Hospital, New York, NY
      New York City, New York, United States
    • New York Presbyterian Hospital
      • Department of Emergency Medicine
      New York City, NY, United States
  • 2007–2012
    • Yale University
      • Department of Psychiatry
      New Haven, Connecticut, United States
    • Harvard University
      Cambridge, Massachusetts, United States
    • New York State Psychiatric Institute
      New York City, New York, United States
  • 2005–2012
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2002–2012
    • University of Michigan
      • • Department of Epidemiology
      • • Department of Health Behavior and Health Education
      Ann Arbor, Michigan, United States
  • 2011
    • New York City Department of Health and Mental Hygiene
      New York, United States
    • City University of New York - John Jay College of Criminal Justice
      New York City, New York, United States
    • University of California, San Francisco
      • Division of Hospital Medicine
      San Francisco, CA, United States
    • George Mason University
      페어팩스, Virginia, United States
  • 2006–2011
    • University of California, Berkeley
      • Division of Epidemiology
      Berkeley, CA, United States
    • Cornell University
      • Department of Public Health
      Итак, New York, United States
    • Idaho State University
      • Department of Psychology
      Idaho Falls, ID, United States
    • Beth Israel Medical Center
      New York City, New York, United States
    • San Francisco State University
      • Department of Health Education
      San Francisco, CA, United States
  • 2010
    • University of Haifa
      • School of Political Sciences
      Haifa, Haifa District, Israel
  • 2009–2010
    • Rush University Medical Center
      • Department of Behavioral Sciences
      Chicago, IL, United States
    • University of Washington Seattle
      • School of Social Work
      Seattle, WA, United States
  • 2001–2010
    • New York Academy of Medicine
      New York City, New York, United States
  • 2003–2009
    • Weill Cornell Medical College
      • Department of Psychiatry
      New York City, NY, United States
    • Medical University of South Carolina
      • Department of Psychiatry and Behavioral Sciences
      Charleston, SC, United States
  • 2005–2008
    • Johns Hopkins Bloomberg School of Public Health
      • • Department of Epidemiology
      • • Department of Mental Health
      Baltimore, MD, United States
  • 2004–2006
    • Complutense University of Madrid
      • Facultad de Psicología
      Madrid, Madrid, Spain
  • 2003–2005
    • Icahn School of Medicine at Mount Sinai
      • Department of Psychiatry
      Manhattan, New York, United States
  • 1990
    • University of Toronto
      • Department of Immunology
      Toronto, Ontario, Canada