Sandro Galea

Boston University, Boston, Massachusetts, United States

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Publications (804)2486.18 Total impact

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    ABSTRACT: Although firearm-related homicide-suicides and firearm-related suicides are tragic and catastrophic events, there is increasing evidence that the two events have different precipitants and that understanding these precipitants may help prevention efforts. We aimed to assess the role of interpersonal conflict (IPC) and recent crises in firearm-related homicide-suicides as compared with firearm-related suicides alone. We also assessed whether these differences were consistent across young and old perpetrators. Using an unmatched case-control study, we compared firearm-related homicide-suicides andsuicides alone from 2003 to 2011 in the National Violent Death Registry data to assess the risk associated with IPC and crisis. Survival analysis was performed to compare time-to-incident of homicide-suicide versus suicide only. We derived odds ratios (ORs) and 95% confidence intervals (95%CI) due to IPC and recent crisis from mixed logistic regression models. Stratified analysis by age on the effect of IPC and recent crisis, and type of incident was also performed. After adjusting for relevant covariates, homicide-suicides were more likely than suicide alone following IPC (OR = 20.6, 95%CI = [16.6, 25.7]) and recent crisis (OR = 14.5, 95%CI = [12.4, 16.9]). The risk of firearm homicide-suicide compared with suicide associated with IPC was twice greater among those >30 years compared with those ≤30 years (p-interaction = .033), and no differential by age associated with recent crisis (p-interaction = .64). IPC and recent crisis are risk factors for committing homicide-suicides compared with suicides alone, with the risk doubly greater among older than younger perpetrators.
    No preview · Article · Feb 2016 · Journal of Interpersonal Violence
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    ABSTRACT: Psychosocial stress is thought to play a key role in the acceleration of immunological aging. This study investigated the relationship between lifetime and past-year history of post-traumatic stress disorder (PTSD) and the distribution of T cell phenotypes thought to be characteristic of immunological aging.
    No preview · Article · Feb 2016 · Psychoneuroendocrinology
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    ABSTRACT: Objectives: To demonstrate a spatial epidemiologic approach that could be used in the aftermath of disasters to (1) detect spatial clusters and (2) explore geographic heterogeneity in predictors for mental health and general wellness. Methods: We used a cohort study of Hurricane Ike survivors (n=508) to assess the spatial distribution of postdisaster mental health wellness (most likely resilience trajectory for posttraumatic stress symptoms [PTSS] and depression) and general wellness (most likely resilience trajectory for PTSS, depression, functional impairment, and days of poor health) in Galveston, Texas. We applied the spatial scan statistic (SaTScan) and geographically weighted regression. Results: We found spatial clusters of high likelihood wellness in areas north of Texas City and spatial concentrations of low likelihood wellness in Galveston Island. Geographic variation was found in predictors of wellness, showing increasing associations with both forms of wellness the closer respondents were located to Galveston City in Galveston Island. Conclusions: Predictors for postdisaster wellness may manifest differently across geographic space with concentrations of lower likelihood wellness and increased associations with predictors in areas of higher exposure. Our approach could be used to inform geographically targeted interventions to promote mental health and general wellness in disaster-affected communities. (Disaster Med Public Health Preparedness. 2016;page 1 of 13).
    Full-text · Article · Jan 2016 · Disaster Medicine and Public Health Preparedness
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    ABSTRACT: We investigated how different models of HIV transmission, and assumptions regarding the distribution of unprotected sex and syringe-sharing events ('risk acts'), affect quantitative understanding of HIV transmission process in people who inject drugs (PWID). The individual-based model simulated HIV transmission in a dynamic sexual and injecting network representing New York City. We constructed four HIV transmission models: model 1, constant probabilities; model 2, random number of sexual and parenteral acts; model 3, viral load individual assigned; and model 4, two groups of partnerships (low and high risk). Overall, models with less heterogeneity were more sensitive to changes in numbers risk acts, producing HIV incidence up to four times higher than that empirically observed. Although all models overestimated HIV incidence, micro-simulations with greater heterogeneity in the HIV transmission modelling process produced more robust results and better reproduced empirical epidemic dynamics.
    No preview · Article · Jan 2016 · Epidemiology and Infection
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    ABSTRACT: Background and aims: There is a documented link between common psychiatric disorders and substance use in adolescent males. This study addressed two key questions: 1) Is there a within-person association between an increase in psychiatric problems and an increase in substance use among adolescent males?; and 2) Are there sensitive periods during male adolescence when such associations are more evident? Design: Analysis of longitudinal data collected annually on boys randomly selected from schools based on a comprehensive public school enrollment list from the Pittsburgh Board of Education SETTING: Recruitment occurred in public schools in Pittsburgh, Pennysylvania, USA. Participants: 503 boys assessed at ages 13-19, average cooperation rate = 92.1% MEASUREMENTS: DSM-oriented affective, anxiety, and conduct disorder problems were measured with items from the caregiver, teacher, and youth version of the Achenbach scales. Scales were converted to T-scores using age- and gender-based national norms and combined by taking the average across informants. Alcohol and marijuana use were assessed semi-annually by a 16-item Substance Use Scale adapted from the National Youth Survey. Findings: When male adolescents experienced a one-unit increase in their conduct problems T-score, their rate of marijuana use subsequently increased by 1.03 (95% confidence interval (CI): 1.01, 1.05), and alcohol quantity increased by 1.01 (95% CI: 1.0002, 1.02). When adolescents experienced a one-unit increase in their average quantity of alcohol use, their anxiety problems T-score subsequently increased by 0.12 (95% CI: 0.05, 0.19). These associations were strongest in early and late adolescence. Conclusions: When adolescent boys experience an increase in conduct disorder problems, they are more likely to exhibit a subsequent escalation in substance use. As adolescent boys increase their intensity of alcohol use, they become more likely to develop subsequent anxiety problems. Developmental turning points such as early and late adolescence appear to be particularly sensitive periods for boys to develop comorbid patterns of psychiatric problems and substance use. This article is protected by copyright. All rights reserved.
    No preview · Article · Jan 2016 · Addiction
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    Preview · Article · Dec 2015 · The Journal of Clinical Psychiatry
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    ABSTRACT: Background: Our knowledge about the impact of coping behavior styles in people exposed to stressful disaster events is limited. Effective coping behavior has been shown to be a psychosocial stress modifier in both occupational and nonoccupational settings. Methods: Data were collected by using a web-based survey that administered the Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian, General Coping Questionnaire-30, and a supplementary questionnaire assessing various risk factors. Logistic regression models were used to test for the association of the 3 coping styles with probable PTSD following disaster exposure among federal disaster responders. Results: In this sample of 549 study subjects, avoidant coping behavior was most associated with probable PTSD. In tested regression models, the odds ratios ranged from 1.19 to 1.26 and 95% confidence intervals ranged from 1.08 to 1.35. With control for various predictors, emotion-based coping behavior was also found to be associated with probable PTSD (odds ratio=1.11; 95% confidence interval: 1.01-1.22). Conclusion: This study found that in disaster responders exposed to traumatic disaster events, the likelihood of probable PTSD can be influenced by individual coping behavior style and other covariates. The continued probability of disasters underscores the critical importance of these findings both in terms of guiding mental health practitioners in treating exposed disaster responders and in stimulating future research. (Disaster Med Public Health Preparedness. 2015;0:1-10).
    No preview · Article · Dec 2015 · Disaster Medicine and Public Health Preparedness
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    ABSTRACT: Alcohol use disorders (AUD) are commonly comorbid with anxiety and mood disorders; however, a strategy for AUD prevention remains unclear in the presence of three competing etiological models that each recommends different high-risk groups. Therefore, the investigation of the three hypotheses in a characteristically unique cohort is critical to identifying pervasive characteristics of AUD that can inform a universal prevention strategy. The current study evaluated the temporality and onset of comorbid AUD and psychiatric disorders in a representative sample of 528 Ohio Army National Guard soldiers using structured clinical interviews from 2009 to 2012. We examined temporality both statistically and graphically to identify patterns that could inform prevention. General estimating equations with dichotomous predictor variables were used to estimate odds ratios between comorbid psychiatric disorders and AUDs. An annualized rate of 13.5 % persons per year was diagnosed with any AUD between 2010 and 2012. About an equal proportion of participants with comorbid psychiatric disorders and AUD initiated the psychiatric disorder prior to the AUD and half initiated the psychiatric disorder after the AUD. Regardless of onset, however, the majority (80 %) AUD initiated during a short interval between the ages of 16 and 23. Focused primary prevention during this narrow age range (16-23 years) may have the greatest potential to reduce population mental health burden of AUD, irrespective of the sequencing of comorbid psychiatric disorder.
    No preview · Article · Dec 2015 · Prevention Science
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    Preview · Article · Dec 2015
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    ABSTRACT: Objectives To determine the temporal patterns and the difference in trends by race/ethnicity of pediatric firearm hospitalizations (FH) among those aged 15 years or younger in the United States. Methods Data on pediatric FH was retrieved from the Nationwide Inpatient Sample between 1998 and 2011 (n = 16,998,470) using external cause of injury codes (E-codes) of the International Classification of Diseases, Ninth Revision, Clinical modification, (assault: E9650-E9654, unintentional: E9220-E9224, E9228, and E9229, suicide: E9550-E9554, E9556, and E9559, undetermined: E9850-E9854, and E9856 and legal: E970). Meta-regression was used to determine the significance of temporal trends. Survey logistic regression adjusted for survey year was used to examine association of pediatric FH with social and demographic characteristics. Results An annual reduction of 1.07 per 100,000 hospitalizations (p-trend = 0.011) was observed between 1998 and 2011. There was reduction in rate of unintentional-FH (p-trend = 0.013), suicide-FH (p-trend = 0.029), and undetermined-FH (p-trend = 0.002), but not assault-FH (p-trend = 0.18). A decline in rates of FH was observed among whites (p-trend = 0.021) and Hispanics (p-trend = 0.03) while an increase in rates of assault-FH was observed among black children. All other intents and all other racial/ethnic groups showed declining rates during this interval. Conclusions There was an overall decline in rates of pediatric FHs in this time period driven by a decline in unintentional-FHs. However there was an increase in assault FH among black children during this same time period.
    No preview · Article · Dec 2015 · Maternal and Child Health Journal
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    ABSTRACT: DICER1 is an enzyme that generates mature microRNAs (miRNAs), which regulate gene expression post-transcriptionally in brain and other tissues and is involved in synaptic maturation and plasticity. Here, through genome-wide differential gene expression survey of post-traumatic stress disorder (PTSD) with comorbid depression (PTSD&Dep), we find that blood DICER1 expression is significantly reduced in cases versus controls, and replicate this in two independent cohorts. Our follow-up studies find that lower blood DICER1 expression is significantly associated with increased amygdala activation to fearful stimuli, a neural correlate for PTSD. Additionally, a genetic variant in the 3' un-translated region of DICER1, rs10144436, is significantly associated with DICER1 expression and with PTSD&Dep, and the latter is replicated in an independent cohort. Furthermore, genome-wide differential expression survey of miRNAs in blood in PTSD&Dep reveals miRNAs to be significantly downregulated in cases versus controls. Together, our novel data suggest DICER1 plays a role in molecular mechanisms of PTSD&Dep through the DICER1 and the miRNA regulation pathway.
    Full-text · Article · Dec 2015 · Nature Communications
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    ABSTRACT: To identify trajectories of depression and posttraumatic stress (PTS) symptom groups after deployment and determine the effect of alcohol use disorder on these trajectories, depression symptoms were modeled using the 9-item Patient Health Questionnaire in 727 Ohio National Guard members, and PTS symptoms were modeled using the PTSD Checklist in 472 Ohio National Guard members. There were 55.8% who were resistant to depression symptoms across the 4 years of study, and 41.5% who were resistant to PTS symptoms. There were 18.7% and 42.2% of participants who showed resilience (experiencing slightly elevated symptoms followed by a decline, according to Bonanno et al., 2002) to depression and PTS symptoms, respectively. Mild and chronic dysfunction constituted the smallest trajectory groups across disorders. Marital status, deployment to an area of conflict, and number of lifetime stressors were associated with membership into different latent groups for depression (unstandardized β estimates range = 0.69 to 1.37). Deployment to an area of conflict, number of lifetime traumatic events and education predicted membership into different latent groups for PTS (significant unstandardized β estimate range = 0.83 to 3.17). AUD was associated with an increase in both symptom outcomes (significant unstandardized β estimate range = 0.20 to 9.45). These results suggested that alcohol use disorder may have contributed substantially to trajectories of psychopathology in this population.
    No preview · Article · Dec 2015 · Journal of Traumatic Stress
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    ABSTRACT: Collection and processing of whole blood samples in a non-clinical setting offers a unique opportunity to evaluate community-dwelling individuals both with and without preexisting conditions. Rapid processing of these samples is essential to avoid degradation of key cellular components. Included here are methods for simultaneous peripheral blood mononuclear cell (PBMC), DNA, RNA and serum isolation from a single blood draw performed in the homes of consenting participants across a metropolitan area, with processing initiated within 2 hr of collection. We have used these techniques to process over 1,600 blood specimens yielding consistent, high quality material, which has subsequently been used in successful DNA methylation, genotyping, gene expression and flow cytometry analyses. Some of the methods employed are standard; however, when combined in the described manner, they enable efficient processing of samples from participants of population- and/or community-based studies who would not normally be evaluated in a clinical setting. Therefore, this protocol has the potential to obtain samples (and subsequently data) that are more representative of the general population.
    No preview · Article · Nov 2015 · Journal of Visualized Experiments
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    ABSTRACT: Studies have found a stronger association between anger and posttraumatic stress disorder (PTSD) severity in military populations than in nonmilitary populations. Two hypotheses have been proposed to explain this difference: Military populations are more prone to anger than nonmilitary populations, and traumas experienced on deployment create more anger than nondeployment traumas. To examine these hypotheses, we evaluated the association between anger and PTSD severity among never-deployed military service members with nondeployment traumas (n = 226) and deployed service members with deployment traumas (n = 594) using linear regression. We further examined these associations stratified by gender. Bivariate associations between anger and PTSD severity were similar for nondeployment and deployment events; however, gender modified this association. For men, the association for deployment events was stronger than for nondeployment events (β = .18, r = .53 vs. β = .16, r = .37, respectively), whereas the reverse was true for women (deployment: β = .20, r = .42 vs. nondeployment: β = .25, r = .65). Among men, findings supported the hypothesis that deployment traumas produce stronger associations between PTSD and anger and are inconsistent with hypothesized population differences. In women, however, there was not a clear fit with either hypothesis.
    Full-text · Article · Nov 2015 · Journal of Traumatic Stress
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    ABSTRACT: We evaluated a transformed core curriculum for the Columbia University, Mailman School of Public Health (New York, New York) master of public health (MPH) degree. The curriculum, launched in 2012, aims to teach public health as it is practiced: in interdisciplinary teams, drawing on expertise from multiple domains to address complex health challenges. We collected evaluation data starting when the first class of students entered the program and ending with their graduation in May 2014. Students reported being very satisfied with and challenged by the rigorous curriculum and felt prepared to integrate concepts across varied domains and disciplines to solve public health problems. This novel interdisciplinary program could serve as a prototype for other schools that wish to reinvigorate MPH training.
    No preview · Article · Nov 2015 · American Journal of Public Health
  • Sarah R Lowe · Fran H Norris · Sandro Galea
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    ABSTRACT: Objective: This study explored predisposing, illness-related, and enabling factors as predictors of mental health service use among disaster survivors with perceived need for services. Methods: Participants (N=658) were part of a three-wave, population-based study of Hurricane Ike survivors. At each wave, participants were asked whether they perceived having a need for mental health services, for example, information about stress reactions and medication for emotional problems. Those with perceived need were asked about use of eight services, such as a psychiatrist or physician, to address needs. Generalized estimating equations examined predisposing, illness-related, and enabling factors as predictors of service use among participants with perceived need (N=304). Results: More general stressors (predisposing factor) and insurance coverage (enabling factor) predicted service use among participants with perceived need. Conclusions: The results suggest that expanded access to services that do not require insurance coverage could better address survivors' mental health needs after a disaster.
    No preview · Article · Nov 2015 · Psychiatric services (Washington, D.C.)
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    ABSTRACT: Purpose: The objective of this study was to evaluate the relationship between factors of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) using confirmatory factor analysis (CFA) in order to further our understanding of the substantial comorbidity between these two disorders. Methods: CFA was used to examine which factors of PTSD's dysphoria model were most related to AUD in a military sample. Ohio National Guard soldiers with a history of overseas deployment participated in the survey (n = 1215). Participants completed the PTSD Checklist and a 12-item survey from the National Survey on Drug Use used to diagnosis AUD. Results: The results of the CFA indicated that a combined model of PTSD's four factors and a single AUD factor fit the data very well. Correlations between PTSD's factors and a latent AUD factor ranged from correlation coefficients of 0.258-0.285, with PTSD's dysphoria factor demonstrating the strongest correlation. However, Wald tests of parameter constraints revealed that AUD was not more correlated with PTSD's dysphoria than other PTSD factors. Conclusions: All four factors of PTSD's dysphoria model demonstrate comparable correlations with AUD. The role of dysphoria to the construct of PTSD is discussed.
    Full-text · Article · Nov 2015 · Social Psychiatry

  • No preview · Article · Nov 2015
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    ABSTRACT: Background Genes and environments often interplay to produce population health. However, in some instances, the scientific literature has favoured one explanation, underplaying the other, even in the absence of rigorous support. We examine parental race disparity on the risk of infant mortality to see if such an analysis might provide clues to understanding the extent to which genes and environment may shape perinatal risks.Methods We assessed parental racial disparities in infant mortality among singletons by analysing the risk of infant mortality among racially consonant vs. dissonant couples over time between 1989–1997 and 1998–2006 in the state of Michigan (n = 1 428 199). We calculated the degree of modification of the relation between maternal race and infant mortality by paternal race dynamically across the two time periods.ResultsInfant mortality among interracial couples decreased with time relative to white–white couples, while infant mortality among black–black couples increased with time after adjusting for socio-economic, demographic, and prenatal care differences. The degree to which paternal black race strengthened the relation between maternal black race and higher infant mortality risk relative to white mothers increased with time throughout our study.Conclusions Evidence from these data suggests that environmental factors likely play the greater role in explaining the parental race disparity and risk of infant mortality.
    No preview · Article · Nov 2015 · Paediatric and Perinatal Epidemiology

  • No preview · Conference Paper · Nov 2015

Publication Stats

20k Citations
2,486.18 Total Impact Points


  • 2015-2016
    • Boston University
      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
    • Naval Health Research Center
      San Diego, California, United States
    • Boston Children's Hospital
      • Division of General Pediatrics
      Boston, Massachusetts, United States
  • 2013
    • Brown University
      Providence, Rhode Island, 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
  • 2005-2012
    • CUNY Graduate Center
      New York, New York, United States
    • University of Michigan
      • Department of Epidemiology
      Ann Arbor, Michigan, United States
    • Icahn School of Medicine at Mount Sinai
      • Department of Psychiatry
      Manhattan, New York, 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
  • 2006-2011
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2006-2009
    • University of California, Berkeley
      • Division of Epidemiology
      Berkeley, California, United States
  • 2002-2009
    • Medical University of South Carolina
      • Department of Psychiatry and Behavioral Sciences
      Charleston, SC, United States
  • 2008
    • University of Toronto
      Toronto, Ontario, Canada
  • 2001-2008
    • New York Academy of Medicine
      New York, New York, United States
  • 2007
    • Yale University
      New Haven, Connecticut, United States
    • Cornell University
      • Department of Public Health
      Итак, New York, United States
    • New York State Psychiatric Institute
      New York, New York, United States
  • 2003-2004
    • Weill Cornell Medical College
      • Department of Psychiatry
      New York City, New York, United States