Gordon Stephen Smith

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

Doctor of Medicine

About

344
Publications
69,672
Reads
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13,060
Citations
Introduction
Gordon Smith is an expert in in trauma and other injury research. He has received widespread recognition for his methodological expertise in injury research, especially data linkage and studies of the relationship of alcohol and other drugs to injuries. Dr. Smith has a medical degree from Otago University, and postgraduate training at the Harvard School of Public Health and the US Centers for Disease Control. His current studies include a study to examine drug involvement in traffic fatalities in three states, reducing the consequences of injection drug use in rural areas of West Virginia examining alcohol and drug involvement in trauma patients and how these predict the risk of current and repeat injuries and risk of future drug overdose deaths
Additional affiliations
August 2007 - present
University of Maryland, Baltimore
Position
  • Professor (Full) Epidemiology and Public Health

Publications

Publications (344)
Article
Background Nephrotoxin exposure may worsen kidney injury and impair kidney recovery if continued in patients with acute kidney injury (AKI). Objectives This study aimed to determine if tiered implementation of a clinical decision support system (CDSS) would reduce nephrotoxin use in cardiac surgery patients with AKI. Methods We assessed patients ad...
Article
Amputation is a devastating complication of diabetes and peripheral artery disease and a marker for health inequity. Implementation Science (IS) and Community Engaged-Research (CenR) allow for real-world adaptation of evidence-based interventions and provide critical frameworks for reproducibility and sustainability. However, few amputation interve...
Article
Objectives. To analyze War on Drugs encounters and their relationships to health care utilization among White people who use drugs (PWUD) in 22 Appalachian rural counties in Kentucky, West Virginia, Ohio, and North Carolina. Methods. We recruited White PWUD using chain referral sampling in 2018 to 2020. Surveys asked about criminal–legal encounters...
Article
Background: To examine sex differences in overdose (OD) mortality based upon substances involved. Methods: A retrospective database analysis of West Virginia OD decedents (12,666 unintentional OD deaths, 2005-early 2023). Exposures were substances judged to contribute to death. The main outcome measure was determination of male to female death r...
Article
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Selective serotonin reuptake inhibitors (SSRIs) including citalopram are commonly used antidepressants that can be involved in drug-related deaths along with opioids and other substances. This study characterized citalopram involvement in West Virginia (WV) drug-related deaths compared to other SSRI and non-SSRI-related deaths. All 2005–2021 WV dru...
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Aim Illicitly manufactured fentanyl and its analogs are the primary drivers of opioid overdose deaths in the United States (U.S.). People who use drugs may be exposed to fentanyl or its analogs intentionally or unintentionally. This study sought to identify strategies used by rural people who use drugs to reduce harms associated with unintentional...
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Background The steep rise in substance use and substance use disorder (SUD) shows an urgency to assess its prevalence using valid measures. This systematic review summarizes the validity of measures to assess the prevalence of substance use and SUD in the US estimated in population and sub-population-based surveys. Methods A literature search was...
Article
The objective of this study was to understand barriers to healthcare and social service utilization among older adults residing in rural areas who use drugs. A cross-sectional survey of persons who use opioids or inject drugs in rural counties with high overdose rates across ten states was conducted. For this analysis, participants were restricted...
Preprint
Background: Healthcare reimbursement and coding is dependent on accurate extraction of International Classification of Diseases- tenth revision clinical modification (ICD-10-CM) codes from clinical documentation. Attempts to automate this task have had limited success. This study aimed to evaluate the performance of large language models (LLMs) in...
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Objective The goal of this study is to propose and test a scalable framework for machine learning algorithms to predict near-term SARS-CoV-2 cases by incorporating and evaluating the impact of real-time dynamic public health data. Materials and Methods Data used in this study include patient-level results, procurement, and location information of...
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Introduction The 2010 release of an abuse deterrent formulation (ADF) of OxyContin, a brand name prescription opioid, has been cited as a major driver for the reduction in prescription drug misuse and the associated increasing illicit opioid use and overdose rates. However, studies of this topic often do not account for changes in supplies of other...
Book
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...
Article
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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...
Article
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...
Article
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...
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This cross-sectional study used time series forecasting to estimate excess firearm mortality in the US during the COVID-19 pandemic.
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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...
Article
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...
Article
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...
Article
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:...
Article
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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...
Conference Paper
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...
Article
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,...
Article
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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...
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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...
Article
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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...
Article
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...
Article
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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...
Article
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...
Article
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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...
Article
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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...
Article
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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...
Article
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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...
Article
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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...
Article
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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...
Preprint
Full-text available
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...
Article
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...
Article
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...
Preprint
Full-text available
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...
Article
Full-text available
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...
Article
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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...
Article
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...
Conference Paper
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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...
Article
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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...
Article
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...
Article
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...
Article
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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...
Article
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...
Article
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...
Article
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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...
Article
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...
Article
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...
Article
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...
Article
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...
Article
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...
Article
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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...
Article
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...
Article
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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...
Conference Paper
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...
Article
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...
Article
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...
Article
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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...
Article
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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-...
Article
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...
Article
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...