Revisiting the role of the urban environment in substance use: the case of analgesic overdose fatalities.

Objectives: We examined whether neighborhood social characteristics (income distribution and family fragmentation) and physical characteristics (clean sidewalks and dilapidated housing) were associated with the risk of fatalities caused by analgesic overdose.

Methods: In a case-control study, we compared 447 unintentional analgesic opioid overdose fatalities (cases) with 3436 unintentional nonoverdose fatalities and 2530 heroin overdose fatalities (controls) occurring in 59 New York City neighborhoods between 2000 and 2006.

Results: Analgesic overdose fatalities were less likely than nonoverdose unintentional fatalities to have occurred in higher-income neighborhoods (odds ratio [OR] = 0.

Prescription opioid mortality trends in New York City, 1990-2006: examining the emergence of an epidemic.

Background: The drug overdose mortality rate tripled between 1990 and 2006; prescription opioids have driven this epidemic. We examined the period 1990-2006 to inform our understanding of how the current prescription opioid overdose epidemic emerged in urban areas.

Methods: We used data from the Office of the Chief Medical Examiner to examine changes in demographic and spatial patterns in overdose fatalities induced by prescription opioids (i.

Navigating non-positivity in neighbourhood studies: an analysis of collective efficacy and violence.

Background: In multilevel studies, strong correlations of neighbourhood exposures with individual and neighbourhood confounders may generate problems with non-positivity (ie, inferences that are 'off-support'). The authors used propensity restriction and matching to (1) assess the utility of propensity restriction to ensure analyses are 'on-support' and (2) examine the relation between collective efficacy and violence in a previously unstudied city.

Methods: Associations between neighbourhood collective efficacy and violent victimisation were estimated in data from New York City in 2005 (n=4000) using marginal models and propensity matching.

Race/Ethnic-Specific Homicide Rates in New York City: Evaluating the Impact of Broken Windows Policing and Crack Cocaine Markets.

The current study evaluated a range of social influences including misdemeanor arrests, drug arrests, cocaine consumption, alcohol consumption, firearm availability, and incarceration that may be associated with changes in gun-related homicides by racial/ethnic group in New York City (NYC) from 1990 to 1999. Using police precincts as the unit of analysis, we used cross-sectional, time series data to examine changes in Black, White, and Hispanic homicides, separately. Bayesian hierarchical models with a spatial error term indicated that an increase in cocaine consumption was associated with an increase in Black homicides.

Policing and risk of overdose mortality in urban neighborhoods.

Background: Accidental drug overdose is a major cause of mortality among drug users. Fears of police arrest may deter witnesses of drug overdose from calling for medical help and may be a determinant of drug overdose mortality. To our knowledge, no studies have empirically assessed the relation between levels of policing and drug overdose mortality.

Investigating the effect of social changes on age-specific gun-related homicide rates in New York City during the 1990s.

Objectives: We assessed whether New York City's gun-related homicide rates in the 1990s were associated with a range of social determinants of homicide rates.

Methods: We used cross-sectional time-series data for 74 New York City police precincts from 1990 through 1999, and we estimated Bayesian hierarchical models with a spatial error term. Homicide rates were estimated separately for victims aged 15-24 years (youths), 25-34 years (young adults), and 35 years or older (adults).

Ambient temperature and risk of death from accidental drug overdose in New York City, 1990-2006.

Background: Mortality increases as ambient temperature increases. Because cocaine affects core body temperature, ambient temperature may play a role in cocaine-related mortality in particular. The present study examined the association between ambient temperature and fatal overdoses over time in New York City.

Misdemeanor policing, physical disorder, and gun-related homicide: a spatial analytic test of "broken-windows" theory.

Background: Homicide contributes substantially to the burden of death in the US and remains a key contributor to the gap in white-black life expectancy. It has been hypothesized that "broken-windows" policing is associated with lower homicide rates and that physical disorder may mediate this association. However, the empiric evidence is limited and conflicting.

Epidemiology of subway-related fatalities in New York City, 1990-2003.

Problem: Subway transit is a relatively safe mode of transportation, yet compared to all other forms of mass transit in the United States (U.S.), subways have the highest fatality rate.

Resource document on the use of restraint and seclusion in correctional mental health care.

This resource document discusses the use of seclusion or restraint for purposes of mental health intervention in correctional facilities. Correctional mental health standards essentially state that seclusion or restraint, when used for health care purposes, should be implemented in a manner consistent with current community practice. The community practice was significantly impacted and revised during July 1999, after the Health Care Financing Administration defined rules for the use of seclusion and restraint in facilities that participate in Medicare and Medicaid.

"Gray murder": characteristics of elderly compared with nonelderly homicide victims in New York City.

Objectives: We compared characteristics of homicides among New York City residents aged 18 years and older from 1990 to 1998 to determine differences in demographics, cause and place of death, and presence of illicit drugs and alcohol in the deceased's system.

Methods: All medical examiner-certified homicides among New York City residents aged 18 years and older from 1990 to 1998 were studied (n = 11,850). Nonelderly (aged 18 to 64 years) and elderly (aged 65 years and older) victims were compared by gender, race/ethnicity, cause of death, place of death, and presence of illicit drugs or alcohol.

What explains the association between neighborhood-level income inequality and the risk of fatal overdose in New York City?

Accidental drug overdose is a substantial cause of mortality for drug users. Using a multilevel case-control study we previously have shown that neighborhood-level income inequality may be an important determinant of overdose death independent of individual-level factors. Here we hypothesized that the level of environmental disorder, the level of police activity, and the quality of the built environment in a neighborhood mediate this association.

Drug and alcohol use as determinants of New York City homicide trends from 1990 to 1998.

In this population-level study, we analyzed how well changes in drug and alcohol use among homicide victims explained declining homicide rates in New York City between 1990 and 1998. Victim demographics, cause of death, and toxicology were obtained for all homicide (N = 12573) and accidental death victims (N = 6351) between 1990 and 1998 from the Office of the Chief Medical Examiner of New York (OCME). The proportion of homicide and accident decedents positive for cocaine fell between 1990 and 1998 (13% and 9% respectively); the proportion of homicide and accident decedents positive for opiates and/or alcohol did not change significantly.

Opiates, cocaine and alcohol combinations in accidental drug overdose deaths in New York City, 1990-98.

Aims: Accidental drug overdose contributes substantially to mortality among drug users. Multi-drug use has been documented as a key risk factor in overdose and overdose mortality in several studies. This study investigated the contribution of multiple drug combinations to overdose mortality trends.