1
|
Marco M, López-Quílez A, Sánchez-Sáez F, Escobar-Hernández P, Montagud-Andrés M, Lila M, Gracia E. The Spatio-Temporal Distribution of Suicide-related Emergency Calls in a European City: Age and Gender Patterns, and Neighborhood Influences. PSYCHOSOCIAL INTERVENTION 2024; 33:103-115. [PMID: 38706710 PMCID: PMC11066811 DOI: 10.5093/pi2024a8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/14/2024] [Indexed: 05/07/2024]
Abstract
Objective: The aim of this study was to conduct a comprehensive spatio-temporal analysis of suicide-related emergency calls in the city of Valencia (Spain) over a six-year period. To this end we first examined age and gender patterns and, second, the influence of neighborhood characteristics on general and gender-specific spatio-temporal patterns of suicide-related emergency calls. Method: Geocoded data on suicide-related emergency calls between 2017 and 2022 (N = 10,030) were collected from the 112 emergency service in Valencia. Data were aggregated at the census block group level, used as a proxy for neighborhoods, and trimesters were considered as the temporal unit. Two set of analyses were performed: (1) demographic (age and gender) and temporal descriptive analyses and (2) general and gender-specific Bayesian spatio-temporal autoregressive models. Results: Descriptive analyses revealed a higher incidence of suicide-related emergency calls among females and an increase in calls among the 18-23 age group from 2020 onwards. The general spatio-temporal model showed higher levels of suicide-related emergency calls in neighborhoods characterized by lower education levels and population density, and higher residential mobility, aging population, and immigrant concentration. Relevant gender differences were also observed. A seasonal effect was noted, with a peak in calls during spring for females and summer for males. Conclusions: These findings highlight the need for comprehensive mental health targeted interventions and preventive strategies that account for gender-specific disparities, age-related vulnerabilities, and the specific characteristics of neighborhoods.
Collapse
Affiliation(s)
- Miriam Marco
- University of ValenciaDepartment of Social PsychologyValenciaSpainDepartment of Social Psychology, University of Valencia, Spain;
| | - Antonio López-Quílez
- University of ValenciaDepartment of Statistics and Operational ResearchValenciaSpainDepartment of Statistics and Operational Research, University of Valencia, Spain;
| | - Francisco Sánchez-Sáez
- Universidad Internacional de La RiojaSchool of Engineering and TechnologySpainSchool of Engineering and Technology (ESIT), Universidad Internacional de La Rioja, Spain
| | - Pablo Escobar-Hernández
- University of ValenciaDepartment of Statistics and Operational ResearchValenciaSpainDepartment of Statistics and Operational Research, University of Valencia, Spain;
| | - María Montagud-Andrés
- University of ValenciaDepartment of Social PsychologyValenciaSpainDepartment of Social Psychology, University of Valencia, Spain;
| | - Marisol Lila
- University of ValenciaDepartment of Social PsychologyValenciaSpainDepartment of Social Psychology, University of Valencia, Spain;
| | - Enrique Gracia
- University of ValenciaDepartment of Social PsychologyValenciaSpainDepartment of Social Psychology, University of Valencia, Spain;
| |
Collapse
|
2
|
The application of spatial analysis to understanding the association between area-level socio-economic factors and suicide: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02441-z. [PMID: 36805762 DOI: 10.1007/s00127-023-02441-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 02/02/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Little is known about what impact the use of different spatial methodological approaches may have on understanding the relationship between area-level socio-economic factors and suicide. METHODS In this systematic review, we searched PubMed, Embase, CINAHL and PsycInfo for original empirical studies examining the relationship between socio-economic factors and suicide with a spatial lens, published up to January 22, 2022. Data on applied spatial methods, indicators of socio-economic factors, and risk of suicide related to socio-economic factors were extracted. The protocol for this systematic review was registered with PROSPERO (CRD42021251387). RESULTS A systematic search yielded 6290 potentially relevant results; 58 studies met the inclusion criteria for review. Of the 58 included studies, more than half of the studies (n = 34; 58.6%) used methods that accounted for spatial effects in analyses of the association between socio-economic factors and suicide or examined spatial autocorrelation, while 24 (41.4%) studies applied univariate and multivariate models without considering spatial effects. Bayesian hierarchical models and spatial regression models were commonly used approaches to correct for spatial effects. The risk of suicide relating to socio-economic factors varied greatly by local areas and between studies using various socio-economic indicators. Areas with higher deprivation, higher unemployment, lower income, and lower education level were more likely to have higher suicide risk. There was no significant difference in results between studies using conventional versus spatial statistic methods. CONCLUSION An increasing number of studies have applied spatial methods, including Bayesian spatial models and spatial regression models, to explore the relationship between area-level socio-economic factors and suicide. This review of spatial studies provided further evidence that area-level socio-economic factors are generally inversely associated with suicide risk, with or without accounting for spatial autocorrelation.
Collapse
|
3
|
Sauer J, Stewart K. Geographic information science and the United States opioid overdose crisis: A scoping review of methods, scales, and application areas. Soc Sci Med 2023; 317:115525. [PMID: 36493502 DOI: 10.1016/j.socscimed.2022.115525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/23/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Opioid Overdose Crisis (OOC) continues to generate morbidity and mortality in the United States, outpacing other prominent accident-related reasons. Multiple disciplines have applied geographic information science (GIScience) to understand geographical patterns in opioid-related health measures. However, there are limited reviews that assess how GIScience has been used. OBJECTIVES This scoping review investigates how GIScience has been used to conduct research on the OOC. Specific sub-objectives involve identifying bibliometric trends, the location and scale of studies, the frequency of use of various GIScience methodologies, and what direction future research can take to address existing gaps. METHODS The review was pre-registered with the Open Science Framework ((https://osf.io/h3mfx/) and followed the PRISMA-ScR guidelines. Scholarly research was gathered from the Web of Science Core Collection, PubMed, IEEE Xplore, ACM Digital Library. Inclusion criteria was defined as having a publication date between January 1999 and August 2021, using GIScience as a central part of the research, and investigating an opioid-related health measure. RESULTS 231 studies met the inclusion criteria. Most studies were published from 2017 onward. While many (41.6%) of studies were conducted using nationwide data, the majority (58.4%) occurred at the sub-national level. California, New York, Ohio, and Appalachia were most frequently studied, while the Midwest, north Rocky Mountains, Alaska, and Hawaii lacked studies. The most common GIScience methodology used was descriptive mapping, and county-level data was the most common unit of analysis across methodologies. CONCLUSIONS Future research of GIScience on the OOC can address gaps by developing use cases for machine learning, conducting analyses at the sub-county level, and applying GIScience to questions involving illicit fentanyl. Research using GIScience is expected to continue to increase, and multidisciplinary research efforts amongst GIScientists, epidemiologists, and other medical professionals can improve the rigor of research.
Collapse
Affiliation(s)
- Jeffery Sauer
- Department of Geographical Sciences, University of Maryland at College Park, 4600 River Road, Suite 300, Riverdale, MD, 20737, USA.
| | - Kathleen Stewart
- Department of Geographical Sciences, University of Maryland at College Park, 4600 River Road, Suite 300, Riverdale, MD, 20737, USA.
| |
Collapse
|
4
|
Singal AK, Kuo YF, Arab JP, Bataller R. Racial and Health Disparities among Cirrhosis-related Hospitalizations in the USA. J Clin Transl Hepatol 2022; 10:398-404. [PMID: 35836764 PMCID: PMC9240250 DOI: 10.14218/jcth.2021.00227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/15/2021] [Accepted: 10/10/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS Alcohol-associated liver disease (ALD) is the most common cause of advanced liver disease worldwide, including in the USA. Alcohol use and cirrhosis mortality is higher in American Indian/Alaska Native (AI/AN) compared to Whites. Data are scanty on ALD as a liver disease etiology in AI/AN compared to other races and ethnicities. METHODS The National Inpatient Sample on 199,748 cirrhosis-related hospitalizations, 14,241 (2,893 AI/AN, 2,893 Whites, 2,882 Blacks, 2,879 Hispanics, and 2,694 Asians or other races) matched 1:1 for race/ethnicity on demographics, insurance, and income quartile of the residence zip code analyzed. RESULTS After controlling for geographic location and hospital type, odds ratio (OR) and 95% confidence interval (CI) for ALD as cirrhosis etiology was higher among admissions in AI/AN vs. Whites [1.55 (1.37-1.75)], vs. Blacks [1.87 (1.65-2.11)], vs. Hispanic [1.89 (1.68-2.13)] and Asians/other races [2.24 (1.98-2.53)]. OR was also higher for AI/AN vs. all other races for alcohol-associated hepatitis (AH) as one of the discharge diagnoses. The findings were similar in a subgroup of 4,649 admissions with decompensated cirrhosis and in a cohort of 350 admissions with acute-on-chronic liver failure as defined by EASL-CLIF criteria. Alcohol use disorder diagnosis was present in 38% of admissions in AI/AN vs. 24-30% in other races, p<0.001. A total of 838 (5.9%) admissions were associated with in-hospital mortality. OR (95% CI) for in-hospital mortality in AI/AN individuals was 34% reduced vs. Blacks [0.66 (0.51-0.84)], but no difference was observed on comparison with other races. CONCLUSIONS ALD, including AH, is the most common etiology among cirrhosis-related hospitalizations in the USA among AI/AN individuals. In-hospital mortality was observed in about 6% of admissions, which was higher for Blacks and similar in other races compared to admissions for AI/AN. Public health policies should be implemented to reduce the burden of advanced ALD among AI/AN individuals.
Collapse
Affiliation(s)
- Ashwani K. Singal
- Department of Medicine, University of SD Sanford School of Medicine, Sioux Falls, SD, USA
- Division of Transplant Hepatology, Avera Transplant Institute, Sioux Falls, SD, USA
- Correspondence to: Ashwani K. Singal, University of South Dakota, Sanford School of Medicine, Avera McKennan University Hospital Transplant Institute, Sioux Falls, SD 57105, USA. ORCID: https://orcid.org/0000-0003-1207-3998. Tel: +1-605-322-8545, Fax: +1-605-322-8536, E-mail:
| | - Yong-Fang Kuo
- Department of Biostatistics, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Juan P. Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ramon Bataller
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
5
|
Kerr WC, Ye Y, Williams E, Mulia N, Cherpitel CJ. Trends and disparities in American Indian/Alaska Native unintentional injury mortality from 1999 to 2016. Inj Prev 2021; 27:435-441. [PMID: 33093126 PMCID: PMC8519032 DOI: 10.1136/injuryprev-2020-043951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Alcohol and drug use are significant problems in the US, and American Indian/Alaska Native (AI/AN) communities and individuals are known to be among the most affected. This study evaluates disparities in unintentional injury mortality causes since 1999. METHODS Analyses in 2020 of unintentional injury mortality rate disparities between AI/ANs and white population over the 1999-2016 period with attention to motor vehicle crashes, alcohol poisoning, drug poisoning and all other cause types. Rates in each of the 10 states with the largest AI/AN populations were also investigated to account for geographical concentration. RESULTS Motor vehicle mortality rates declined for both AI/AN and white groups, but a large racial disparity was maintained. Conversely, poisoning mortality rates rose substantially in both groups, with a jump in rates in 2007 due to a coding change, resulting in a large disparity that was maintained through 2016. Comparison of alcohol and drug poisonings showed that the AI/AN alcohol poisoning rate was about eight times the white rate, whereas drug poisoning rates were similar. For 'all other' unintentional injuries, the highest rates were seen for AI/AN men, with rates generally rising over the study period. State-specific analyses found substantial variation in AI/AN rates, with few or no disparities in New York and Texas. CONCLUSIONS Results indicate substantial and persisting disparities in unintentional injury mortality, with especially large differences in alcohol poisoning. The absence of disparities in New York and Texas suggest the importance of situational factors.
Collapse
Affiliation(s)
- William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Edwina Williams
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Cheryl J Cherpitel
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| |
Collapse
|
6
|
Kelley A, Steinberg R, McCoy TP, Pack R, Pepion L. Exploring recovery: Findings from a six-year evaluation of an American Indian peer recovery support program. Drug Alcohol Depend 2021; 221:108559. [PMID: 33548899 DOI: 10.1016/j.drugalcdep.2021.108559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 11/16/2020] [Accepted: 01/02/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We aimed to identify correlates of short-term recovery among American Indians who participated in the Transitional Recovery and Culture (TRAC) Program, a Peer Recovery Support (PRS) program. Research aims (As) were A1. How do recovery capital resources and indicators of recovery differ between TRAC participants who completed a six-month follow-up and those who did not? A2. How much did recovery capital resource measures change between intake and six-month follow-up? A3. Which recovery capital resources are associated with balanced recovery? METHODS We used the medicine wheel evaluation framework. Each concept within the framework - spiritual, emotional, mental, and physical health - was incorporated into a composite recovery outcome variable. TRAC enrolled 422 American Indians from 2014 to 2019 living in Montana and Wyoming. Six-month change was examined among 214 program participants that completed the six-month program. RESULTS We observed significant change for the following recovery capital resources: stable housing, being occupied, attending recovery groups, interacting with family and friends, past substance use activity, and self-reported health status. Logistic regression results for balanced short-term recovery showed that improving or maintaining occupation (AOR = 6.73, p = 0.0026), interacting with family or friends (AOR = 4.66, p = 0.0050), and still receiving services at follow-up (AOR = 2.25, p = 0.0487) were associated with significant increased odds of higher balanced short-term recovery scores. CONCLUSION PRS helps American Indian people achieve short-term recovery. Future efforts should focus on how to retain peers in PRS programs, and the recovery capital needed to sustain long-term recovery.
Collapse
Affiliation(s)
- Allyson Kelley
- Allyson Kelley & Associates PLLC, 69705 Lake Drive Sisters, OR, 97759, USA.
| | - Rachel Steinberg
- Colorado School of Public Health, Anschutz Medical Campus, Denver Colorado, 13001 E. 17th Place Mail Stop B119, Aurora, CO, 80045, USA.
| | - Thomas P McCoy
- University of North Carolina at Greensboro, PO Box 26170, Greensboro, NC, 27402-6170, USA.
| | - Roy Pack
- Rocky Mountain Tribal Leaders Council, 2929 3rd Ave N, Ste 300 Billings, MT, 59101, USA.
| | - Lita Pepion
- Rocky Mountain Tribal Leaders Council, 2929 3rd Ave N, Ste 300 Billings, MT, 59101, USA.
| |
Collapse
|
7
|
van Draanen J, Tsang C, Mitra S, Karamouzian M, Richardson L. Socioeconomic marginalization and opioid-related overdose: A systematic review. Drug Alcohol Depend 2020; 214:108127. [PMID: 32650191 PMCID: PMC7313902 DOI: 10.1016/j.drugalcdep.2020.108127] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Socioeconomic marginalization (SEM) is an important but under-explored determinant of opioid overdose with important implications for health equity and associated public policy initiatives. This systematic review synthesizes evidence on the role of SEM in both fatal and non-fatal overdose among people who use opioids. METHODS Studies published between January 1, 2000 and March 31, 2018 were identified through searching electronic databases, citations, and by contacting experts. The titles, abstracts, citation information, and descriptor terms of citations were screened by two team members. Data were synthesized using the lumping technique. RESULTS A total of 37 studies met inclusion criteria and were included in the review, with 34 of 37 finding a significant association between at least one socioeconomic factor and overdose. The included studies contained variables related to eight socioeconomic factors: criminal justice system involvement, income, employment, social support, health insurance, housing/homelessness, education, and composite measures of socio-economic status. Most studies found associations in the hypothesized direction, whereby increased SEM was associated with a higher rate or increased likelihood of the overdose outcome measured. The review revealed an underdeveloped evidence base. CONCLUSIONS Nearly all reviewed studies found a connection between a socioeconomic variable and overdose, but more research is needed with an explicit focus on SEM, using robust and nuanced measures that capture multiple dimensions of disadvantage, and collect data over time to better inform decision making around opioid overdose.
Collapse
Affiliation(s)
- Jenna van Draanen
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Department of Sociology, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada
| | - Christie Tsang
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, School of Social Work, The Jack Bell Building, 2080 West Mall, Vancouver, BC, V6T 1Z2, Canada
| | - Sanjana Mitra
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Interdisciplinary Studies Graduate Program, 270, 2357 Main Mall, H. R. MacMillan Building, Vancouver, BC, V6T 1Z4, Canada
| | - Mohammad Karamouzian
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada; HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616913555, Iran
| | - Lindsey Richardson
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Department of Sociology, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada.
| |
Collapse
|
8
|
Emerson MA, Moore RS, Caetano R. Correlates of Alcohol-Related Treatment Among American Indians and Alaska Natives with Lifetime Alcohol Use Disorder. Alcohol Clin Exp Res 2019; 43:115-122. [PMID: 30347442 PMCID: PMC6318056 DOI: 10.1111/acer.13907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/11/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND To describe sociodemographic and selected psychiatric disorder patterns and estimate correlates of seeking alcohol treatment among American Indians and Alaska Natives (AIAN) and non-Hispanic Whites (NHW) with lifetime alcohol use disorder (AUD). METHODS Data come from the 2012 to 2013 U.S. National Epidemiologic Survey on Alcohol and Related Conditions-III. We retrospectively identified participants who completed information on lifetime AUD, race/ethnicity, and seeking alcohol treatment or help for AUD. We used a generalized linear model with a log link and Poisson distribution to estimate prevalence ratios (PRs) among adults with DSM-5 lifetime AUD. We included the following correlates: race/ethnicity, sex, age, personal annual income, marital status, education, urban/rural status, U.S. region, any illegal drug use disorder, nicotine use disorder, and select mood-, anxiety-, personality-, and trauma-related disorders. RESULTS Among AIAN, the prevalence of lifetime AUD was 46.6%. Among AIAN with lifetime AUD, 33.8% sought alcohol-related treatment. Among individuals with lifetime AUD, AIAN were associated with greater alcohol-related treatment-seeking compared to NHW (adjusted PR = 1.41 [95% CI 1.26 to 1.58]). Among AIAN with AUD, being male and age 35 to 64 were statistically significant correlates of seeking treatment or help for AUD. CONCLUSIONS A relatively higher proportion of AIAN than NHW with AUDs sought alcohol treatment. Among individuals with lifetime AUD, significant demographic and psychiatric disorder correlates of treatment are present, showing that certain groups are less likely to seek treatment or help for alcohol-related issues. Among AIAN with AUD, these correlates may reflect distinct patterns of seeking alcohol-related treatment, which can inform more effective treatment promotion efforts with this population.
Collapse
Affiliation(s)
- Marc A. Emerson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Roland S. Moore
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA
| | - Raul Caetano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA
| |
Collapse
|
9
|
Andreuccetti G, Cherpitel CJ, Carvalho HB, Leyton V, Miziara ID, Munoz DR, Reingold AL, Lemos NP. Alcohol in combination with illicit drugs among fatal injuries in Sao Paulo, Brazil: An epidemiological study on the association between acute substance use and injury. Injury 2018; 49:2186-2192. [PMID: 30270012 PMCID: PMC6289625 DOI: 10.1016/j.injury.2018.09.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 02/02/2023]
Abstract
Injury deaths have a major impact on public health systems, particularly in the Latin American region; however, little is known about how different drugs, in combination or not with alcohol, interact with each injury type. We tested an epidemiological protocol for investigating alcohol and other drug acute use among fatally injured victims taking into account the injury context for all injury causes in Sao Paulo, Brazil. Blood alcohol and drug content were fully screened and confirmed following a probability sample selection of decedents (n = 365) during 19 consecutive months (2014-2015). Drug concentrations, including benzodiazepines, cannabis, cocaine, and opioids were determined by gas chromatography-mass spectrometry (GC-MS) or liquid chromatography tandem mass spectrometry (LC-MS/MS). Toxicology data were interpreted in combination with injury context retrieved from police records regarding cause, place of injury, and victims' criminal history. More than half of all fatally injured victims studied were under the influence of at least one substance (55.3%). Alcohol was the leading substance consumed before a fatal injury event (30.1%), followed by cocaine (21.9%) and cannabis (14%). Illicit drug use (cocaine and cannabis) comprised more than two thirds of all drug-related deaths. Alcohol-positive deaths are over-represented among road traffic injuries, while drug-positive deaths are more prevalent among intentional injuries. Victims who had previous criminal convictions were significantly more likely to have used illicit drugs compared to those who did not have a criminal background. We estimated that one in every two fatal injuries in the city of Sao Paulo is associated with acute substance use by the victim. The health burden attributed to alcohol- and drug-related fatal injury events has reached significant higher levels in Latin American cities such as Sao Paulo compared globally.
Collapse
Affiliation(s)
- G Andreuccetti
- Department of Preventive Medicine, University of Sao Paulo Medical School, Brazil; Alcohol Research Group, Emeryville, CA, United States; Department of Legal Medicine, University of Sao Paulo Medical School, Brazil.
| | - C J Cherpitel
- Alcohol Research Group, Emeryville, CA, United States
| | - H B Carvalho
- Department of Preventive Medicine, University of Sao Paulo Medical School, Brazil
| | - V Leyton
- Department of Legal Medicine, University of Sao Paulo Medical School, Brazil
| | - I D Miziara
- Department of Legal Medicine, University of Sao Paulo Medical School, Brazil; Technical-Scientific Police Superintendency of the State of Sao Paulo, Sao Paulo, Brazil
| | - D R Munoz
- Department of Legal Medicine, University of Sao Paulo Medical School, Brazil
| | - A L Reingold
- School of Public Health, University of California, Berkeley, CA, United States
| | - N P Lemos
- Department of Laboratory Medicine, School of Medicine, University of California, San Francisco, CA, United States
| |
Collapse
|
10
|
Lee JP, Pagano A, Moore RS, Tilsen N, Henderson JA, Iron Shell A, Davids S, LeBeaux L, Gruenewald P. Impacts of alcohol availability on Tribal lands where alcohol is prohibited: A community-partnered qualitative investigation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 54:77-86. [PMID: 29414489 PMCID: PMC5899679 DOI: 10.1016/j.drugpo.2018.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 12/21/2017] [Accepted: 01/09/2018] [Indexed: 12/22/2022]
Abstract
On a Northern Plains reservation where alcohol was prohibited, we investigated community members' views on the impacts of alcohol availability. Our methods combined elements of Tribal community participatory research with qualitative inquiry to elicit these perspectives. We used rapid appraisal techniques to conduct confidential interviews with 31 key leaders representing 7 relevant major community systems, and representing a variety of perspectives. Topics included respondents' understandings of the current systems of alcohol availability and use on the reservation, the impacts of these systems on reservation residents, and possible ways to measure these impacts. Respondents reported impacts on individuals, families, and the tribe overall. Alcohol-related problems shaped and were shaped by a constellation of social-ecological conditions: kinship, housing, employment, public/social service capacity, and the supply of alcohol in nearby off-reservation areas, as well as inter-governmental relationships and the spiritual life of reservation residents. A variety of social-structural determinants magnified alcohol impacts, so that the problem drinking of a small number of individuals could have broad effects on their families and the entire community. Our participatory qualitative methods enabled us to directly include the voices as well as the personal experiences and expertise of community members in this presentation. These methods may be broadly applied within policy analysis to identify ways to reduce harms related to alcohol and other drugs for Indigenous communities.
Collapse
Affiliation(s)
- Juliet P Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue, Suite 1200, Oakland, CA, 94612, USA.
| | - Anna Pagano
- Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue, Suite 1200, Oakland, CA, 94612, USA
| | - Roland S Moore
- Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue, Suite 1200, Oakland, CA, 94612, USA
| | - Nick Tilsen
- Great Plains Local Community Development Corporation, Porcupine, SD, 57772, USA
| | - Jeffrey A Henderson
- Black Hills Center for American Indian Health, 701 St. Joseph Street, Suite 204, Rapid City, SD, 57701, USA
| | - Andrew Iron Shell
- Great Plains Local Community Development Corporation, Porcupine, SD, 57772, USA
| | - Sharice Davids
- Great Plains Local Community Development Corporation, Porcupine, SD, 57772, USA
| | - Lyle LeBeaux
- Great Plains Local Community Development Corporation, Porcupine, SD, 57772, USA
| | - Paul Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue, Suite 1200, Oakland, CA, 94612, USA
| |
Collapse
|