Sandro Galea

Boston University, Boston, Massachusetts, United States

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Publications (764)2348.67 Total impact

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    ABSTRACT: The majority of the world’s population now lives in urban areas. Mental health problems are known to be prevalent in the rapidly urbanizing megacities of low-income countries and range at the third place in the list of the ten leading factors of the burden of disease in low-income countries in a projection for 2030. Urbanization is most pronounced in Asia having the largest number of megacities, that is, cities with more than 10 million inhabitants worldwide. There are several characteristics of rapidly urbanizing megacities of low-income countries that can contribute to poor mental health, including, social segregation, lack of infrastructure, and exposure to ongoing adversity and life stressors. However, there is a paucity of data about the relation between characteristics of urban environments and mental health. Using a spatial epidemiological approach, this paper assessed factors linked to mental well-being in the slums of Dhaka, the second fastest growing megacity in the world, which currently accommodates an estimated population of more than 15 million, including at least 3.4 million slum dwellers. Furthermore, we investigated the spatial variability of mental well-being for different population groups in several slums of Dhaka. Specifically, we hypothesized (i) that socio-ecological environmental characteristics of informal settlements are associated with the mental well-being of slum dwellers after adjusting for personal factors such as age, gender and other diseases. We further investigated the hypotheses (ii) that mental well-being shows a significant spatial pattern (that is, spatial clustering) for different population groups, and (iii) that spatially auto-correlated socio-ecological factors relate to the spatial patterns of mental well-being.
    Spatial Analysis in Health Geography, Edited by Antonio Páez, Eric Delmelle, Pavlos Kanaroglou, 10/2015: chapter 9; Ashgate Publishing, Ltd.., ISBN: 147241621X, 9781472416216
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    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. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Psychiatric Research 09/2015; 68:19-26. DOI:10.1016/j.jpsychires.2015.05.014 · 3.96 Impact Factor
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    ABSTRACT: The majority of disaster survivors suffering from psychiatric disorders do not utilize mental health services. Only one study to date has explored postdisaster service use after Hurricane Sandy, and the disaster literature is further limited by a lack of attention to survivors' perceived need for services. We drew on data from a population-based sample of adults living in New York City neighborhoods that were most severely affected by Hurricane Sandy (N = 454). Less than 10 % of participants reported service needs (7.8 %) and service use (4.4 %) since the hurricane, 5.9 % were classified as having unmet needs (i.e., needs without use), and 2.5 % as using services without needs. Predictors of unmet mental health service needs included younger age, male gender, higher education, and exposure to more disaster-related stressors. The results suggest that efforts to reduce unmet postdisaster service needs could focus on reaching survivors with these characteristics.
    Community Mental Health Journal 09/2015; DOI:10.1007/s10597-015-9947-4 · 1.03 Impact Factor
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    ABSTRACT: Violence-related post-traumatic stress disorder (PTSD) remains a prevalent and disabling psychiatric disorder in urban areas. However, the most effective allocation of resources into prevention and treatment to reduce this problem is unknown. We contrasted the impact of two interventions on violence-related PTSD: (1) a population-level intervention intended to prevent violence (i.e., hot-spot policing), and (2) an individual-level intervention intended to shorten PTSD duration (i.e., cognitive-behavioral therapy-CBT). We used agent-based modeling to simulate violence and PTSD in New York City under four scenarios: (1) no intervention, (2) targeted policing to hot spots of violence, (3) increased access to CBT for people who suffered from violence-related PTSD, and (4) a combination of the two interventions. Combined prevention and treatment produced the largest decrease in violence-related PTSD prevalence: hot-spot policing plus a 50% increase in CBT for 5 years reduced the annual prevalence of violence-related PTSD from 3.6% (95% confidence interval = 3.5%, 3.6%) to 3.4% (3.3%, 3.5%). It would have been necessary to implement hot-spot policing or to increase CBT by 200% for 10 years for either intervention to achieve the same reduction in isolation. This study provides an empirically informed demonstration that investment in combined strategies that target social determinants of mental illness and provide evidence-based treatment to those affected by psychiatric disorders can produce larger reductions in the population burden from violence-related PTSD than either preventive or treatment interventions alone. However, neither hot-spot policing nor CBT, alone or combined, will produce large shifts in the population prevalence of violence-related PTSD.
    Epidemiology (Cambridge, Mass.) 09/2015; 26(5):681-689. DOI:10.1097/EDE.0000000000000350 · 6.20 Impact Factor
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    ABSTRACT: This article examines the relationship between childhood adversity and postdeployment new-onset psychopathology among a sample of U.S. National Guard personnel deployed during Operation Iraqi Freedom and Operation Enduring Freedom with no history of post-traumatic stress disorder (PTSD) or depression. We recruited a sample of 991 Ohio Army National Guard soldiers and conducted structured interviews to assess traumatic event exposure, a history of childhood adversity, and postdeployment depression, and PTSD, consistent with the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. We assessed childhood adversity by using questions from the Childhood Adverse Events Survey. In multivariable logistic models, a history of any childhood adversity was significantly associated with new-onset depression, but not PTSD, postdeployment. This finding suggests that a history of childhood adversity is predisposing for new-onset depression, among U.S. National Guard soldiers who were deployed with no prior history of PTSD or depression. This highlights the centrality of childhood experience for the production of mental health among soldiers. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.
    09/2015; 180(9):972-8. DOI:10.7205/MILMED-D-14-00626
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    ABSTRACT: Few studies have explored interactions between genes and social environmental exposures (GxSEs) for trauma-related psychopathology, including symptoms of posttraumatic stress (PTS) and major depression (MD). The extant literature suggests the possibility of a GxSE between the rs2267735 variant of the ADCYAP1R1 gene and neighborhood crime. The current study aimed to explore this possibility among a predominantly African American sample of trauma-exposed women. Female participants (N=1361) were recruited from a public hospital, and completed measures of PTS and MD symptoms and provided DNA samples. Participants' home addresses were mapped onto 300 neighborhoods (2010 census tracts), and data on crime within neighborhoods was collected. Multilevel models detected a significant GxSE between rs2267735 and neighborhood crime for MD symptoms (p=.01). Having two copies of the risk (C) allele was associated with higher MD symptoms for participants living in high-crime neighborhoods. At least six limitations are noteworthy: (1) low statistical power; (2) use of self-report symptom inventories; (3) lack of information on symptom onset; (4) homogeneous sample from a single metropolitan area; (5) non-specific index of crime; and (6) use of census tracts to define neighborhoods. The results provide further evidence of GxSEs for psychiatric outcomes among trauma-exposed populations. Further investigations of genetic factors for trauma-related psychopathology should include careful assessments of the social environment. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 08/2015; 187:147-150. DOI:10.1016/j.jad.2015.08.002 · 3.38 Impact Factor
  • Ronald Bayer · Sandro Galea
    New England Journal of Medicine 08/2015; 373(6):499-501. DOI:10.1056/NEJMp1506241 · 55.87 Impact Factor
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    ABSTRACT: We review weighting adjustment methods for panel attrition and suggest approaches for incorporating design variables, such as strata, clusters, and baseline sample weights. Design information can typically be included in attrition analysis using multilevel models or decision tree methods such as the chi-square automatic interaction detection algorithm. We use simulation to show that these weighting approaches can effectively reduce bias in the survey estimates that would occur from omitting the effect of design factors on attrition while keeping the resulted weights stable. We provide a step-by-step illustration on creating weighting adjustments for panel attrition in the Galveston Bay Recovery Study, a survey of residents in a community following a disaster, and provide suggestions to analysts in decision-making about weighting approaches. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
    Statistics in Medicine 08/2015; DOI:10.1002/sim.6618 · 1.83 Impact Factor
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    ABSTRACT: The CHANGE (Cessation of Heroin: A Neighborhood Grounded Exploration) Study aimed to understand factors associated with the initiation and maintenance of sustained heroin cessation from the perspective of users themselves and specifically set out to document the correlates of natural recovery. The CHANGE Study was a case-control study conducted in New York City from 2009 to 2011. Cases were former heroin users, abstinent for 1-5 years in the past 5 years. Controls used heroin at least weekly during the past 5 years and were (1) continuous heroin users without a quit attempt of ≥2 weeks' duration or (2) relapsed heroin users who were currently using and had a quit attempt of ≥2 weeks' duration during the past 5 years. Recruitment and data collection methods are described along with limitations and a brief description of the study sample. In contrast to many studies of drug use and cessation, the CHANGE Study was designed to model success (i.e., initiation and maintenance of heroin cessation) and not failure.
    Journal of Urban Health 07/2015; DOI:10.1007/s11524-015-9973-0 · 1.90 Impact Factor
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    ABSTRACT: Adolescent use of marijuana is associated with adverse later effects, so the identification of factors underlying adolescent use is of substantial public health importance. The relationship between US state laws that permit marijuana for medical purposes and adolescent marijuana use has been controversial. Such laws could convey a message about marijuana acceptability that increases its use soon after passage, even if implementation is delayed or the law narrowly restricts its use. We used 24 years of national data from the USA to examine the relationship between state medical marijuana laws and adolescent use of marijuana.
    The Lancet Psychiatry 07/2015; 2(7):601-608. DOI:10.1016/S2215-0366(15)00217-5
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    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
    Injury Prevention 06/2015; DOI:10.1136/injuryprev-2015-041586 · 1.89 Impact Factor
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    ABSTRACT: Rodent models implicate metabotropic glutamate receptors (mGluRs) and downstream signaling pathways in addictive behaviors through metaplasticity. One way mGluRs can influence synaptic plasticity is by regulating the local translation of AMPA receptor trafficking proteins via eukaryotic elongation factor 2 (eEF2). However, genetic variation in this pathway has not been examined with human alcohol use phenotypes. Among a sample of adults living in Detroit, Michigan (Detroit Neighborhood Health Study; n = 788; 83% African American), 206 genetic variants across the mGluR-eEF2-AMPAR pathway (including GRM1, GRM5, HOMER1, HOMER2, EEF2K, MTOR, EIF4E, EEF2, CAMK2A, ARC, GRIA1 and GRIA4) were found to predict number of drinking days per month (corrected P-value < 0.01) when considered as a set (set-based linear regression conducted in PLINK). In addition, a CpG site located in the 3'-untranslated region on the north shore of EEF2 (cg12255298) was hypermethylated in those who drank more frequently (P < 0.05). Importantly, the association between several genetic variants within the mGluR-eEF2-AMPAR pathway and alcohol use behavior (i.e., consumption and alcohol-related problems) replicated in the Grady Trauma Project (GTP), an independent sample of adults living in Atlanta, Georgia (n = 1034; 95% African American), including individual variants in GRM1, GRM5, EEF2, MTOR, GRIA1, GRIA4 and HOMER2 (P < 0.05). Gene-based analyses conducted in the GTP indicated that GRM1 (empirical P < 0.05) and EEF2 (empirical P < 0.01) withstood multiple test corrections and predicted increased alcohol consumption and related problems. In conclusion, insights from rodent studies enabled the identification of novel human alcohol candidate genes within the mGluR-eEF2-AMPAR pathway.
    Translational Psychiatry 06/2015; 5(6):e586. DOI:10.1038/tp.2015.70 · 5.62 Impact Factor
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    Sarah R Lowe · Sandro Galea
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    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
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    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; 44(3). DOI:10.1093/ije/dyv009 · 9.18 Impact Factor
  • Abdulrahman M El-Sayed · Sandro Galea
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    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; 105(8):e1-e3. DOI:10.2105/AJPH.2015.302678 · 4.55 Impact Factor
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    ABSTRACT: Purpose: To document the prevalence of depression and anxiety disorders, and their associations with mortality among hospitalized breast cancer patients. Methods: We examined the associations between breast cancer diagnosis and the diagnoses of anxiety or depression among 4,164 hospitalized breast cancer cases matched with 4,164 non-breast cancer controls using 2006-2009 inpatient data obtained from the Nationwide Inpatient Sample database. Conditional logistic regression models were used to compute odds ratios (ORs) and 95% confidence intervals (CI) for the associations between breast cancer diagnosis and diagnoses of anxiety or depression. We also used binary logistic regression models to examine the association between diagnoses of depression or anxiety, and in-hospital mortality among breast cancer patients. Results: We observed that breast cancer cases were less likely to have a diagnosis of depression (OR=0.63, 95% CI: 0.52-0.77), and less likely to have a diagnosis of anxiety (OR=0.68, 95% CI: 0.52-0.90) compared with controls. This association remained after controlling for race/ethnicity, residential income, insurance and residential region. Breast cancer patients with a depression diagnosis also had lower mortality (OR=0.69, 95% CI: 0.52-0.89) compared with those without a depression diagnosis, but there was no significant difference in mortality among those with and without anxiety diagnoses. Conclusion: Diagnoses of depression and anxiety in breast cancer patients were less prevalent than expected based on our analysis of hospitalized breast cancer patients and matched non-breast cancer controls identified in the NIS dataset using ICD-9 diagnostic codes. Results suggest that under-diagnosis of mental health problems may be common among hospitalized women with a primary diagnosis of breast cancer. Future work may fruitfully explore reasons for, and consequences of, inappropriate identification of the mental health needs of breast cancer patients.
    PLoS ONE 06/2015; 10(6):e0129169. DOI:10.1371/journal.pone.0129169 · 3.23 Impact Factor
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    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; 153. DOI:10.1016/j.drugalcdep.2015.05.010 · 3.42 Impact Factor
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    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 · 3.23 Impact Factor

Publication Stats

17k Citations
2,348.67 Total Impact Points


  • 2015
    • Boston University
      Boston, Massachusetts, United States
    • Massachusetts Department of Public Health
      Boston, Massachusetts, United States
  • 2012–2015
    • McGill University
      • Department of Epidemiology, Biostatistics and Occupational Health
      Montréal, Quebec, Canada
  • 2002–2015
    • Columbia University
      • • Department of Epidemiology
      • • Teachers College
      New York, New York, United States
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2014
    • Boston Children's Hospital
      • Division of General Pediatrics
      Boston, Massachusetts, 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
  • 2004–2013
    • Gracie Square Hospital, New York, NY
      New York City, New York, United States
    • Complutense University of Madrid
      • Facultad de Psicología
      Madrid, Madrid, Spain
    • New York Presbyterian Hospital
      • Department of Emergency Medicine
      New York City, NY, United States
  • 2005–2012
    • University of Michigan
      • Department of Epidemiology
      Ann Arbor, Michigan, United States
  • 2011
    • George Mason University
      • Department of Geography and Geoinformation Science
      페어팩스, Virginia, United States
    • University of California, San Francisco
      • Division of Hospital Medicine
      San Francisco, CA, United States
  • 2005–2011
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, 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
  • 2007–2009
    • Yale University
      New Haven, Connecticut, United States
    • New York State Psychiatric Institute
      New York City, New York, United States
  • 2006–2009
    • University of California, Berkeley
      • Division of Epidemiology
      Berkeley, California, United States
    • Cornell University
      • Department of Public Health
      Итак, New York, United States
    • San Francisco State University
      • Department of Health Education
      San Francisco, CA, United States
    • Beth Israel Medical Center
      New York City, New York, United States
  • 2003–2009
    • Medical University of South Carolina
      • Department of Psychiatry and Behavioral Sciences
      Charleston, SC, United States
  • 2001–2009
    • New York Academy of Medicine
      New York City, New York, United States
  • 1990–2006
    • University of Toronto
      • Department of Immunology
      Toronto, Ontario, Canada
  • 2003–2005
    • Icahn School of Medicine at Mount Sinai
      • Department of Psychiatry
      Manhattan, New York, United States
  • 2003–2004
    • Weill Cornell Medical College
      • Department of Psychiatry
      New York City, New York, United States