Gordon Stephen Smith

West Virginia University | WVU · Epidemiology, School of Public health

Throughout the world, injuries are the leading cause of death during more than half of the average life span. This book documents the nature and magnitude of the problem and provides basic approaches to injury prevention. Injury statistics are given for many developing countries and indigenous populations as well as industrialized nations. Importan...

Background Research conducted in urban areas has highlighted the impact of housing instability on people who inject drugs (PWID), revealing that it exacerbates vulnerability to drug-related harms and impedes syringe service program (SSP) use. However, few studies have explored the effects of houselessness on SSP use among rural PWID. This study exa...

We used firearm mortality and sales data to assess the impact of HB 4145, a May 2016 law that legalized concealed firearm carry without a permit in West Virginia. Firearm mortality was significantly higher (29%) in the years after the enactment of the law; handgun mortality was also higher (48% increase), whereas long gun deaths and firearm sales w...

Background: Methamphetamine use is common among persons with opioid use disorder. This study evaluated associations between methamphetamine use and treatment with agonist medications for opioid use disorder (MOUD, specifically buprenorphine, and/or methadone) in U.S. rural communities. Methods: The Rural Opioid Initiative (ROI) is a consortium s...

This cross-sectional study used time series forecasting to estimate excess firearm mortality in the US during the COVID-19 pandemic.

Background Evidence suggests that rates of occupational injuries in the US are decreasing. As several different occupational injury surveillance systems are used in the US, more detailed investigation of this trend is merited. Furthermore, studies of this decrease remain descriptive and do not use inferential statistics. The aim of this study was t...

Background: Despite being added to numerous products, little is known about cannabidiol. Drowsiness is a self-reported side effect, which could impact cognitive functioning. Objectives: To determine whether cannabidiol impacts cognition and psychomotor function. Methods: A volunteer sample of healthy, college students were recruited for this r...

Background: Opioid-related overdose deaths recently accelerated. In response, overdose education and naloxone distribution (OEND) has been implemented widely, though access remains sparse in rural Appalachia. Despite increasing OEND, risk factors for non-evidence-based overdose responses among the training-naïve remain unknown. Methods: We enrolled...

Background: Acute Kidney Injury (AKI) is a common complication after cardiac surgery and is associated with worse outcomes. Its management relies on early diagnosis, and therefore, electronic alerts have been used to alert clinicians for development of AKI. Electronic alerts are, however, associated with high rates of alert fatigue. Objectives:...

Background and objectives: The involvement of xylazine, a veterinary drug, in West Virginia (WV) human drug-related deaths was examined. Methods: WV drug deaths from 2019 (when xylazine was first identified) to mid-2021. Characteristics including toxicology findings were compared between xylazine and nonxylazine deaths. Results: Of 3292 drug d...

Background West Virginia(WV) drug poisoning rates were low before 2000 but now are the nation’s highest. We explore the role of excessive opioid prescribing in imitating this epidemic. Methods WV age-adjusted overdose fatality trends 1979 to 2020 were examined along with toxicology data from our medical examiner(ME) containing drug levels on all d...

Introduction A common side effect of cannabidiol is drowsiness, which could impact safe driving. This study's purpose was to determine feasibility and whether cannabidiol impacts simulated driving performance. Methods This was a randomized, parallel-group, sex-stratified, double-blind, pilot trial which consisted of a volunteer sample of healthy,...

Objective: Medications used to treat opioid use disorder (OUD) reduce drug overdose risk. Buprenorphine is often the preferred treatment for OUD because of its high safety profile. Given expanding buprenorphine use, this study sought to examine buprenorphine-involved deaths (BIDs) and compare them with other drug-related deaths. Method: West Vir...

Objectives The purpose of this study was to examine the relationship between test site availability and testing rate within the context of social determinants of health. Study Design A retrospective ecological investigation was conducted using statewide COVID-19 testing data between March 2020 and December 2021. Methods Ordinary least squares and...

Importance: Overdoses continue to increase in the US, but the contribution of methamphetamine use is understudied in rural communities. Objective: To estimate the prevalence of methamphetamine use and its correlates among people who use drugs (PWUD) in rural US communities and to determine whether methamphetamine use is associated with increased...

Alcohol-induced mortality has been increasing in the USA for over a decade, but whether increases are specific to particular birth cohorts remains inadequately understood, in part because estimating age–period–cohort (APC) models is methodologically controversial. The present study compares four different age–period–cohort models for alcohol-induce...

Introduction Life-threatening infections such as infective endocarditis (IE) are increasing simultaneously with the injection drug use epidemic in West Virginia (WV). We utilized a newly developed, statewide database to describe epidemiologic characteristics and healthcare utilization among patients with (DU-IE) and without (non-DU-IE) drug use-ass...

Opioid and other drug-related overdoses and suicides are leading causes of injury death and represent a significant public health threat in the United States (U.S.). This study examined clinical factors of three patient groups from two inpatient addiction treatment facilities in Appalachian West Virginia (n = 66). Patients were classified as having...

Objective To characterize and address the opioid crisis disproportionately impacting rural U.S. regions. Methods The Rural Opioid Initiative (ROI) is a two-phase project to collect and harmonize quantitative and qualitative data and develop tailored interventions to address rural opioid use. The baseline quantitative survey data from people who us...

Infectious diseases like infective endocarditis (IE) may manifest or progress differently between sexes. This study sought to identify the differences in demographic and clinical characteristics among male and female patients with IE. Data were obtained from a newly developed registry comprising all adult patients with first IE admission at the fou...

Background: Women who use drugs (WWUD) have low rates of contraceptive use and high rates of unintended pregnancy. Drug use is common among women in rural U.S. communities, with limited data on how they utilize reproductive, substance use disorder (SUD), and healthcare services. Objective: We determined contraceptive use prevalence among WWUD in...

Background and objectives: Compare proportion of all-cause and cause-specific mortality among West Virginia Medicaid enrollees who were discharged from infective endocarditis (IE) hospitalization with and without opioid use disorder (OUD) diagnosis. Methods: The proportions of cause-specific deaths among those who were discharged from IE-related...

Background Methamphetamine-related deaths have been rising along with those involving synthetic opioids, mostly fentanyl and fentanyl analogs (FAs). However, the extent to which methamphetamine involvement in deaths differs from those changes occurring in synthetic opioid involvement is unknown. Objectives To determine the patterns and temporal ch...

During the COVID-19 pandemic, West Virginia developed an aggressive SARS-CoV-2 testing strategy which included utilizing pop-up mobile testing in locations anticipated to have near-term increases in SARS-CoV-2 infections. This study describes and compares two methods for predicting near-term SARS-CoV-2 incidence in West Virginia counties. The first...

During the COVID-19 pandemic, West Virginia developed an aggressive SARS-CoV-2 testing strategy which included utilizing pop-up mobile testing in locations anticipated to have near-term increases in SARS-CXoV-2 infections. In this study, we describe and compare two methods for predicting near-term SARS-CoV-2 incidence in West Virginia counties. The...

Background: The aim of this study was to determine epidemiology and outcomes of acute kidney injury (AKI) in patients on extracorporeal membrane oxygenation (ECMO) and to assess if age modifies the effect of AKI on mortality. Methods: Using National (Nationwide) Inpatient Sample Database for hospitalizations in the USA from 2003 to 2014, we iden...

Background Heart failure is becoming increasingly common among patients under 50 years of age, particularly in African Americans and patients with stimulant use disorder. Yet the sources of these disparities remain poorly understood. This study identified key demographic and clinical factors associated with stimulant use disorder in a largely rural...

Background Opioid-related overdose deaths have accelerated in recent years. In response, overdose education and naloxone distribution (OEND) programs have been implemented across the United States, although many rural Appalachians continue to lack access. Despite the growing number of OEND programs, risk factors for inappropriate overdose response...

Lower extremity amputation due to peripheral artery disease (PAD) and diabetes (DM) is a life-altering event that identifies disparities in access to healthcare and management of disease. West Virginia (WV), a highly rural state, is an ideal location to study these disparities. The WVU longitudinal health system database was used to identify 1) ris...

No study has examined Prescription Drug Monitoring Program (PDMP) data for West Virginia or among specialty practices, such as veterinary medicine. The objectives of this study were to conduct time series modeling to describe the PDMP policy reform impact on prescribing rates for human and veterinary providers. We obtained data from the WV PDMP for...

Accurate and reliable information on drug use by road users is essential to inform safety policy development but the reliability of national data has been questioned. There are two primary repositories of drug test information from fatal motor vehicle crashes in Maryland: (1) the Fatality Analysis Reporting System (FARS), which is a national crash...

Background Rural West Virginia leads the US in overdose deaths. The role of multiple drug combinations in fatality trends is unclear especially given rapid increases in methamphetamine involvement. Methods Toxicology data from our WV Forensic Drug Database contains drug levels on all drug-involved deaths in WV, including determinations if drugs ca...

Background: Though electronic health record (EHR) data have been linked to national and state death registries, such linkages have rarely been validated for an entire hospital system's EHR. Objectives: The aim of the study is to validate West Virginia University Medicine's (WVU Medicine) linkage of its EHR to three external death registries: the...

Background Driving under the influence of drugs (DUID) is a burgeoning public health concern in the USA. Because little is known about individuals who engage in DUID, the purpose of this study was to analyse potential sociodemographic characteristics and behavioural risk factors associated with the behaviour. Methods Self-reported data from driver...

Introduction Premature mortality associated with opioid-related overdose and suicide is a significant public health problem in the United States. Approximately 20–30% of individuals with opioid use disorder (OUD) have a history of both suicide attempt and unintentional opioid overdose. The objective of this study is to evaluate the feasibility of a...

The rate of acute hepatitis B in West Virginia (WV) has been increasing since 2006. To reduce new infections, WV implemented a vaccine intervention (WV Pilot Project), which provided over 10,000 doses of hepatitis B vaccine to at-risk adults in 18 counties. The objectives of this study were to describe yearly changes in acute hepatitis B incidence...

Background To quantify how alcohol, polysubstance use and other factors influence opioid concentrations in drug-related deaths in West Virginia (WV), United States. Methods Multiple linear regression models were employed to identify relationships among alcohol, other factors, and the concentrations of four commonly identified opioids (fentanyl, hy...

Objective: Primary amputation (ie, without attempted revascularization) is a devastating complication of peripheral artery disease. Racial disparities in primary amputation have been described; however, rural disparities have not been well investigated. The purpose of this study was to examine the impact of rurality on risk of primary amputation a...

Background Motor vehicle collisions comprise the majority of occupational-related fatalities in the United States and West Virginia has one of the highest occupational-related fatality rates in the nation. The purpose of this study was to compare work and non-work-related collisions, crash locations, and the characteristics of in-state and out-of-s...

Objective: Amputation is a devastating but preventable complication of diabetes and peripheral arterial disease (PAD). Multiple studies have focused on disparities in amputation rates based on race and socioeconomic status, but few focus on amputation trends in rural populations. The objective of this study was to identify the prevalence of major...

Purpose: The objective of our study was to incorporate stricter probable nonfatal opioid overdose case criteria, and advanced epidemiologic approaches to more reliably detect local clustering in nonfatal opioid overdose activity in EMS runs data. Methods: Data were obtained using emsCharts for our study area in southwestern Pennsylvania from 200...

Background: To describe and analyze the involvement of fentanyl and fentanyl analogs (FAs) in drug-related deaths in West Virginia (WV), United States. Methods: Retrospective analyses of all WV drug-related deaths from 2005 to 2017 were performed, including comparisons of demographic and toxicological characteristics among total deaths, deaths i...

Introduction: We aimed to investigate in-hospital outcomes of traumatic brain injury (TBI) based on blood alcohol concentration (BAC) and mechanism of injury (MOI). Methods: We conducted a retrospective study for patients admitted with TBI between 2010 and 2014. Based on BAC, patients were classified into [negative (-BAC) and positive (+BAC) group...

Background: Lactate clearance has been developed into a marker of resuscitation in trauma, but no study has compared the predictive power of the various clearance calculations. Our objective was to determine which method of calculating lactate clearance best predicted 24-hour and in-hospital mortality after injury. Study design: Retrospective ch...

Purpose: The relationship between cellphone use while driving legislation and self-reported adolescent driver behavior is poorly understood, especially across demographic subgroups. This study investigated the relationship between statewide cellphone legislation and cellphone use behaviors across adolescent driver subgroups, including age (16/17 v...

Objective: To assess the relationship between posttraumatic brain injury statin use and (1) mortality and (2) the incidence of associated morbidities, including stroke, depression, and Alzheimer's disease and related dementias following injury. Setting and participants: Nested cohort of all Medicare beneficiaries 65 years of age and older who su...

Background: Traumatic brain injury (TBI) is a significant public health concern for older adults. Small-scale human studies have suggested pre-TBI statin use is associated with decreased in-hospital mortality following TBI, highlighting the need for large-scale translational research. Objective: To investigate the relationship between pre-TBI st...

Purpose Due to psychosocial risk factors, injury severity, and post-injury exposure to narcotic analgesics, trauma patients may be at higher risk for narcotic abuse. This study examines overdose risk and modifiable risk factors that could affect mortality of trauma patients due to narcotic overdose. Methods Trauma injury patients older than 18 yea...

Background: Although alcohol misuse is associated with deleterious outcomes in critically ill patients, its detection by either self-report or examination of biomarkers is difficult to obtain consistently. Phosphatidylethanol (PEth) is a direct alcohol biomarker that can characterize alcohol consumption patterns; however, its diagnostic accuracy i...

Alcohol exposure results in reduced mortality following traumatic brain injury (TBI) in animal models, yet clinical studies reported conflicting results and clinical trials based on proposed mechanisms have been disappointing. Methodological issues common to many of the clinical studies may have contributed to spurious results. Our objective was to...

Background: In addition to lowering lipids, statins also may be beneficial for older adults sustaining a traumatic brain injury (TBI), as statin use prior to and following trauma may decrease mortality following injury. However, despite statins' potential to reduce mortality, there is limited research regarding statin use among older adults. Obje...

Background Alcohol is a well-known risk factor in unintentional drownings. Whereas psychotropic drugs, like alcohol, may cause psychomotor impairment and affect cognition, no detailed studies have focused on their association with drowning. Finland provides extensive post-mortem toxicological data for studies on drowning because of its high medico-...

Introduction: The 2011 Maryland alcohol sales tax increase from 6% to 9% provided an opportunity to evaluate the impact on rates of alcohol-positive drivers involved in injury crashes. Methods: Maryland police crash reports from 2001 to 2013 were analyzed using an interrupted time series design and a multivariable analysis employing generalized...

Objective: To provide charge estimates of treatment for traumatic brain injury (TBI), including both hospital and physician charges, among adults 65 years and older treated at a trauma center. Methods: We identified older adults treated for TBI during 2008-2012 (n = 1843) at Maryland's Primary Adult Resource Center and obtained hospital and phys...

Background Behavioural brief interventions (BI) can support people to reduce harmful drinking but multiple barriers impede the delivery and equitable access to these. To address this challenge, we developed YourCall™, a novel short message service (SMS) text message intervention incorporating BI principles. This protocol describes a trial evaluatin...

Alcohol hangover is one of the most commonly experienced consequences of alcohol consumption. An alcohol hangover develops as the blood alcohol concentrations (BAC) approaches zero, and is characterized by a general feeling of misery. More insight into the pathology of an alcohol hangover needs to be gained, in order to enhance the understanding of...

Objectives: To characterize psychotropic medication use before and after traumatic brain injury (TBI) hospitalization among older adults. A secondary objective is to determine how receipt of indicated pharmacologic treatment for anxiety and post-traumatic stress disorder (PTSD) differs following TBI. Design: Retrospective cohort. Setting: Unit...

Objective: To estimate rates of anxiety and posttraumatic stress disorder (PTSD) diagnoses after traumatic brain injury (TBI) among Medicare beneficiaries, quantify the increase in rates relative to the pre-TBI period, and identify risk factors for diagnosis of anxiety and PTSD. Participants: A total of 96 881 Medicare beneficiaries hospitalized wi...

Background Despite known benefits, brief interventions (BIs) for problem drinking are often not implemented in trauma care wards due to resource constraints. We evaluated a mobile phone text message intervention (YourCall) designed to overcome this challenge. Methods Of 1564 potentially eligible injured patients aged 16–69 years recruited from the...

Background The sales tax on all alcoholic drink was raised in Maryland from 6 to 9% on July 1, 2011. This study evaluates the effects of the alcohol sales tax increase on the rate of alcohol-involved drivers involved in fatal crashes. Methods Study population: All drivers involved in a fatal motor vehicle crash in MD January 1, 2001 to December 31...

Background Marijuana is one of most widely used illicit substances globally. The risks of injury experienced by marijuana users relative to non-users have been poorly quantified in prospective studies. We investigated the associations between marijuana use and fatal or hospitalised injury in the New Zealand Blood Donors’ Health Study. Methods At r...

Background Alcohol is a well-known risk factor in unintentional drownings. While psychotropic drugs may also cause psychomotor impairment and affect cognition, no detailed studies have focused on their association with drowning. Finland provides extensive post-mortem toxicological data for studies on drowning due to its high medico-legal autopsy ra...

IMPORTANCE Fatal self-injury in the United States related to deliberate behaviors is seriously underestimated due to misclassification of poisoning suicides and mischaracterization of most drug poisoning deaths as “accidental.” OBJECTIVE To compare national trends and patterns of self-injury mortality (SIM) with mortality from three proximally-ran...

Background: Racial disparities in trauma outcomes occur, but disparities in fall mortality are unknown. The objective of this study was to determine inhospital and 1-year fall mortality among patients discharged from an urban trauma center. Methods: We conducted a retrospective analysis of fall patients in our trauma registry (1997 to 2008) link...

Background: Older adults have the highest rates of hospitalization and mortality from traumatic brain injury (TBI), yet outcomes in this population are not well studied. In particular, contradictory reports on the protective effect of female sex on mortality following TBI may have been related to age differences in TBI and other injury severity an...

Objectives: The objectives of this study were to determine the association between recurrent trauma admissions (recidivism) and subsequent long-term mortality, and to identify those in most need for preventive interventions. Background: Patients with a single intentional injury have been shown to have a higher risk of future injury mortality tha...

Most studies find strong evidence that motorcycle helmets protect against injury, but a small number of controversial studies have reported a positive association between helmet use and neck injury. The most commonly cited paper is that of Goldstein (1986). Goldstein obtained and reanalyzed data from the Hurt Study, a prospective, on-scene investig...

Background: Dabigatran, a direct thrombin inhibitor, has been shown to be more effective than warfarin in the prevention of stroke in patients with atrial fibrillation. Until recently, it lacked a reversal agent, and its contribution to the risk of transfusion in injured patients is unknown. Objective: We sought to determine whether patients who...

Objective: Despite successes in the 1980s and early 1990s, progress in reducing impaired driving fatalities in the United States has stagnated in recent years. Since 1997, the percentage of drivers involved in fatal crashes with illegal blood alcohol concentration (BAC) levels has remained at approximately 20% to 22%. Many experts believe that pub...

In a major earthquake, such as the 1985 Mexican or 1988 Armenian events, intensive ground shaking near populated areas can result in the severe damage and even collapse of inadequately-constructed buildings. The potential for loss of life in such a collapse is high, in addition to the economic loss associated with the structure and its contents. No...

Objective: Vast amounts of injury narratives are collected daily and are available electronically in real time and have great potential for use in injury surveillance and evaluation. Machine learning algorithms have been developed to assist in identifying cases and classifying mechanisms leading to injury in a much timelier manner than is possible...

Introduction: Pediatric poisonings represent a major and preventable cause of morbidity and mortality throughout the world. Epidemiologic information about poisoning among children in many lower- and middle-income countries is scarce. This study describes the epidemiology of acute poisonings in children presenting to Ain Shams University's Poisoni...