Debra Furr-Holden
Debra Furr-Holden
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Professor of Epidemiology
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Professional overview
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Debra M. Furr-Holden is an epidemiologist and passionate advocate for health equity. A public health professional with broad expertise in health disparities and policy-level interventions toward health equity, her scholarship encompasses a range of topics including drug and alcohol dependence epidemiology, psychiatric epidemiology, and prevention science.
Dean Furr-Holden hails from Michigan State University, where she was the C.S. Mott Endowed Professor of Public Health and associate dean for public health integration. In announcing her appointment, effective July 2022, NYU President Andrew Hamilton noted Dr. Furr-Holden’s extensive experience working with local and national policymakers, her skill at team-building and success as a mentor, and her exceptional talent as a communicator on public health and health equity issues.
Indeed, it is Dean Furr-Holden’s action-oriented research and commitment to training the next generation of public health practitioners that dovetails perfectly with GPH’s mission to use data-driven interventions and cutting-edge innovation to identify and implement equitable solutions to both domestic and international public health challenges.
In addition to her endowed professorship at MSU, Dr. Furr-Holden served as director of the NIH-funded Flint Center for Health Equity Solutions at the College of Human Medicine. During the Covid-19 pandemic she was appointed to the Michigan Coronavirus Task Force on Racial Disparities, the Greater Flint Coronavirus Task Force on Racial Inequity, and the New York City African American Covid-19 Task Force. Most notably, in Michigan and Flint the racial disparity in Covid-19 cases and deaths among African Americans was eliminated.
Prior to her appointments at MSU Dr. Furr-Holden was an assistant (2007) and later associate (2011) professor at Johns Hopkins’ Bloomberg School of Public Health, where she retains an appointment as an adjunct professor. Before Johns Hopkins, she was a research scientist at the Pacific Institute for Research and Evaluation and a faculty member at Morgan State University.
Dean Furr-Holden is a widely published scholar whose writings include more than 120 peer-reviewed papers in high impact journals. In 2021 she published a seminal article in Addiction that highlighted racial disparities in opioid overdose deaths over the past two decades, and she was recently quoted in an exclusive article in The New York Times examining the demography of deaths nationwide from Covid-19.
Dean Furr-Holden is the recipient of numerous awards and honors, including the White House Presidential Early Career Award for Scientists and Engineers; the Michigan State University College of Human Medicine Junior Faculty Mentoring Award; and the Meeting the Moment for Public Health Award, recognizing the Michigan Coronavirus Task Force on Racial Disparities, of which she is a founding member.
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Education
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BA, Johns Hopkins University Krieger School of Arts & Sciences, Baltimore, MAPhD, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MA
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Publications
Publications
Impact of Alcohol Tax Increase on Maryland College Students' Alcohol-Related Outcomes
AbstractSmart, M. J., Yearwood, S. S., Hwang, S., Thorpe, R. J., & Furr-Holden, C. D. (n.d.).Publication year
2018Journal title
Substance Use and MisuseVolume
53Issue
6Page(s)
1015-1020AbstractObjective: This study A) assessed whether levels of alcohol-related disciplinary actions on college campuses changed among MD college students after the 2011 Maryland (MD) state alcohol tax increase from 6% to 9%, and B) determined which school-level factors impacted the magnitude of changes detected. Method: A quasi-experimental interrupted time series (ITS) analysis of panel data containing alcohol-related disciplinary actions on 33 MD college campuses in years 2006–2013. Negative binomial regression models were used to examine whether there was a statistically significant difference in counts of alcohol-related disciplinary actions comparing time before and after the tax increase. Results: The ITS anaysis showed an insignificant relationship between alcohol-related disciplinary actions and tax implementation (β = −.27; p =.257) but indicated that alcohol-related disciplinary actions decreased significantly over the time under study (β = −.05; p =.022). Discussion: Alcohol related disciplinary actions did decrease over time in the years of study, and this relationship was correlated with several school-level characteristics, including school price, school funding type, types of degrees awarded, and specialty. School price may serve as a proxy mediator or confounder of the effect of time on disciplinary actions.Intercorrelation of Alcohol and Other Drug Use Disorders among a National Sample of Drivers
AbstractScherer, M., Canham, S., Voas, R. B., & Furr-Holden, C. D. (n.d.).Publication year
2018Journal title
Journal of Psychoactive DrugsVolume
50Issue
2Page(s)
143-150AbstractThis study examined the relationship between alcohol, marijuana, cocaine, and painkiller use disorders in a sample of drivers. We studied nighttime drivers aged 16 to 87 (n = 4,277) from the 2007 National Roadside Survey who reported substance use behaviors and provided breath tests for alcohol. Logistic regression analyses assessed the relationships between (1) substance (i.e., alcohol/marijuana/cocaine/pain killer) use disorders; (2) demographic characteristics; and (3) BAC levels. Overall, 13.2% of participants met criteria for marijuana use disorder, 7% met criteria for cocaine use disorder, and 15.4% met criteria for extra-medicinal painkiller use disorder. When self-report data were analyzed, three reciprocal associations emerged: (1) marijuana use disorders and alcohol use disorders were correlated; (2) marijuana use disorders and cocaine use disorders were correlated; and (3) cocaine use disorders and painkiller use disorders were correlated. BAC data revealed that marijuana and cocaine use disorders were both associated with positive BAC levels, but only cocaine use disorders were associated with BAC levels over the legal limit. Results suggest significant poly-substance use disorders in a sample of nighttime drivers, with variations by demographic characteristics. The individual and public health consequences of multiple substance use disorders among drivers are significant.Managing Conflicts in Urban Communities: Youth Attitudes Regarding Gun Violence
AbstractMilam, A. J., Furr-Holden, C. D., Leaf, P., & Webster, D. (n.d.).Publication year
2018Journal title
Journal of Interpersonal ViolenceVolume
33Issue
24Page(s)
3815-3828AbstractGun violence remains a pressing public health concern, especially in high-risk urban environments. Community-level violence intervention efforts are being mounted in cities across the United States to prevent and reduce the most severe forms of violence. There is growing evidence to suggest the effectiveness of the Safe Streets Program/Cure Violence as a community-based intervention to reduce homicides and shootings. The mechanism underlying the reductions in community violence is theorized to be linked with changes in attitudes toward violence as well as shifts in social norms related to violence and retaliation, but there are few tools to assess these domains. This preliminary investigation sought to establish the metric properties of the Survey on Attitudes About Guns and Shootings (SAGAS) with the goal of providing an empirical measure of attitudes and community-level norms. Males aged 18 to 24 were surveyed using the SAGAS in two high-violence communities in Baltimore, Maryland, using street intercept methodology. We found acceptable reliability and validity metrics for the SAGAS. Reliability and validity of the SAGAS were assessed using internal consistency and a latent class analysis with violent behavior outcomes. The internal consistency of the total scale was in the extensive range (α =.70-.79) and the internal consistency of the factors was in the exemplary range (α ≥.80). In addition, latent classes of attitudes were predictive of being arrested or being shot. Future studies will examine if rates of violence decrease in neighborhoods targeted by the Safe Streets Program and the mediating role of attitudes toward gun violence using the SAGAS.Novel Methods for Environmental Assessment of Pedestrian Injury: Creation and Validation of the Inventory for Pedestrian Safety Infrastructure
AbstractNesoff, E. D., Milam, A. J., Pollack, K. M., Curriero, F. C., Bowie, J. V., Gielen, A. C., & Furr-Holden, D. M. (n.d.).Publication year
2018Journal title
Journal of Urban HealthVolume
95Issue
2Page(s)
208-221AbstractNationally, 80% of pedestrian fatalities occur in urban environments, yet the distribution of injuries across urban areas is not uniform. Identifying street-level risk factors for pedestrian injury is essential for urban planning and improvement projects, as well as targeted injury prevention efforts. However, creating and maintaining a comprehensive database of a city’s traffic safety infrastructure can be cumbersome and costly. The purpose of this study was to create and validate a neighborhood environmental observational assessment tool to capture evidence-based pedestrian safety infrastructure using Google Street View (GSV)—The Inventory for Pedestrian Safety Infrastructure (IPSI). We collected measures in-person at 172 liquor stores in Baltimore City from June to August 2015 to assess the tool’s reliability; we then collected IPSI measures at the same 172 locations using GSV from February to March 2016 to assess IPSI reliability using GSV. The majority of items had good or excellent levels of inter-rater reliability (ICC ≥ 0.8), with intersection features showing the highest agreement across raters. Two scales were also developed using exploratory factor analysis, and both showed strong internal consistency (Cronbach’s alpha ≥ 0.6). The IPSI provides a valid, economically efficient tool for assessing pedestrian safety infrastructure that can be employed for a variety of research and urban planning needs. It can also be used for in-person or GSV observation. Reliable and valid measurement of pedestrian safety infrastructure is essential to effectively prevent future pedestrian injuries.Reducing cardiovascular disparities through community-engaged implementation research: A national heart, lung, and blood institute workshop report
AbstractMensah, G. A., Cooper, R. S., Siega-Riz, A. M., Cooper, L. A., Smith, J. D., Hendricks Brown, C., Westfall, J. M., Ofili, E. O., Price, L. N., Arteaga, S., Green Parker, M. C., Nelson, C. R., Newsome, B. J., Redmond, N., Roper, R. A., Beech, B. M., Brooks, J. L., Furr-Holden, D., Gebreab, S. Y., … Pérez-Stable, E. J. (n.d.).Publication year
2018Journal title
Circulation researchVolume
122Issue
2Page(s)
213-230AbstractCardiovascular disparities remain pervasive in the United States. Unequal disease burden is evident among population groups based on sex, race, ethnicity, socioeconomic status, educational attainment, nativity, or geography. Despite the significant declines in cardiovascular disease mortality rates in all demographic groups during the last 50 years, large disparities remain by sex, race, ethnicity, and geography. Recent data from modeling studies, linked micromap plots, and small-Area analyses also demonstrate prominent variation in cardiovascular disease mortality rates across states and counties, with an especially high disease burden in the southeastern United States and Appalachia. Despite these continued disparities, few large-scale intervention studies have been conducted in these high-burden populations to examine the feasibility of reducing or eliminating cardiovascular disparities. To address this challenge, on June 22 and 23, 2017, the National Heart, Lung, and Blood Institute convened experts from a broad range of biomedical, behavioral, environmental, implementation, and social science backgrounds to summarize the current state of knowledge of cardiovascular disease disparities and propose intervention strategies aligned with the National Heart, Lung, and Blood Institute mission. This report presents the themes, challenges, opportunities, available resources, and recommended actions discussed at the workshop.Differences in Obesity Among Men of Diverse Racial and Ethnic Background
AbstractHill, S. E., Bell, C., Bowie, J. V., Kelley, E., Furr-Holden, D., LaVeist, T. A., & Thorpe, R. J. (n.d.).Publication year
2017Journal title
American Journal of Men's HealthVolume
11Issue
4Page(s)
984-989AbstractRacial/ethnic disparities exist in obesity prevalence among men, with Hispanic men exhibiting the highest prevalence compared with non-Hispanic White and non-Hispanic Black men. Most studies do not parse out Hispanic groups; therefore, it is unclear whether the increases in obesity rates among Hispanic men applies to all groups or if there are particular groups of Hispanic men that are driving the increase. The goal of this study is to examine the variations in obesity among men of diverse racial/ethnic backgrounds and determine if obesity is affected by nativity. The data used in this study were from 11 years (2002-2012) of the National Health Interview Survey. Logistic regression was used to examine the relationship between race/ethnicity, obesity, and nativity. After adjusting for covariates, there are differences in obesity prevalence, with the largest prevalence among Puerto Rican men and Mexican American men. Consistent with previous literature, it has been suggested that men born in the United States are more likely to be obese than men born outside the United States. This study underscores the importance of distinguishing Hispanic groups when examining obesity, and provides information for future, targeted intervention strategies related to obesity among high-risk groups.The Effects of Discrimination Are Associated With Cigarette Smoking Among Black Males
AbstractParker, L. J., Hunte, H., Ohmit, A., Furr-Holden, D., & Thorpe, R. J. (n.d.).Publication year
2017Journal title
Substance Use and MisuseVolume
52Issue
3Page(s)
383-391AbstractPrevious research has demonstrated that experiencing interpersonal discrimination is associated with cigarette smoking. Few studies have examined the relationship between the effects of physical and emotional discrimination and cigarette usage, and none have examined this relationship among Black men. The aim of this study was to examine the association between the effects of physical and emotional discrimination and cigarette smoking. Methods: Data from the Indiana Black Men's Health Study, a community-based sample of adult Black men, was used to conduct multivariate logistic regression to examine the relationship between the physical and emotional effects of discrimination and smoking, net of healthcare and workplace discrimination, age, education, household income, and being married. Results: After adjusting for having an emotional response to discrimination, health care and workplace discrimination, age, education, household income, and being married, males who had a physical response to discrimination (e.g., upset stomach or headache) had higher odds of cigarette use (odds ratio (OR): 1.95, 95% confidence interval (CI): 1.15–3.30) than men who did not have a physical response to discrimination. Conclusion: Findings from the study suggest that Black males may use cigarette smoking as a means to mitigate the stress associated with experiences of discrimination. Future research is needed further to explore if and how Black males use cigarette smoking to cope with unfair treatment.Tobacco policies and on-premise smoking in bars and clubs that cater to young African Americans following the Maryland Clean Indoor Air Act of 2007
AbstractNesoff, E. D., Milam, A. J., Bone, L. R., Stillman, F. A., Smart, M. J., Hoke, K. S., & Furr-Holden, C. D. M. (n.d.).Publication year
2017Journal title
Journal of Ethnicity in Substance AbuseVolume
16Issue
3Page(s)
328-343AbstractAfrican American young adults ages 18–25 smoke less than their Caucasian peers, yet the burden of tobacco-related illness is significantly higher in African Americans than in Caucasians across the lifespan. Little is known about how clean indoor air laws affect tobacco smoking among African American young adults. We conducted a systematic observation of bars and clubs with events targeted to African American adults 18–25 in Baltimore City at two timepoints (October and November of 2008 and 2010) after enforcement of the Maryland Clean Indoor Air Act (CIAA). Twenty venues—selected on the basis of youth reports of popular venues—were rated during peak hours. All surveillance checklist items were restricted to what was observable in the public domain. There was a significant decrease in observed indoor smoking after CIAA enforcement. Observed outdoor smoking also decreased, but this change was not significant. Facilities for smoking outdoors increased significantly. The statewide smoking ban became effective February 1, 2008, yet measurable changes in smoking behavior in bars were not evident until the City engaged in stringent enforcement of the ban several months later.ALCOHOL OUTLETS AND SUBSTANCE USE AMONG HIGH SCHOOLERS
AbstractMilam, A. J., Johnson, S. L., Furr-Holden, C. D. M., & Bradshaw, C. P. (n.d.).Publication year
2016Journal title
Journal of Community PsychologyVolume
44Issue
7Page(s)
819-832AbstractFew studies have considered the potential role of the built environment in increasing adolescent substance use. The current study explored the relationship between alcohol outlets, a potential malleable component of the neighborhood environment, and adolescent behavioral outcomes. Specifically, we investigated the relationship between alcohol outlet density, perceived alcohol, tobacco, and other drugs (ATOD) availability, perception of substance use as a problem at the school, and self-reported ATOD use. Data come from Maryland Safe and Supportive Schools (MDS3) Initiative, a statewide project focused on measuring and improving school climate. The sample includes 25,308 adolescents from 58 high schools (Grades 9–12) across 12 counties. Multilevel path models indicated a positive relationship between the count of alcohol outlets and perceived availability of ATOD among girls but not boys. Perceived availability was associated with increased ATOD use at both individual and school levels as well as other students’ ATOD use. Findings provide support for the potential role of the built environment in adolescent risk for substance use, particularly among girls.Association Between Any Major Discrimination and Current Cigarette Smoking Among Adult African American Men
AbstractParker, L. J., Kinlock, B. L., Chisolm, D., Furr-Holden, D., & Thorpe, R. J. (n.d.).Publication year
2016Journal title
Substance Use and MisuseVolume
51Issue
12Page(s)
1593-1599AbstractBackground: Findings from previous research has demonstrated a positive relationship between interpersonal discrimination and cigarette smoking. Cigarette smoking is proposed to be an externalizing coping mechanism used to alleviate discrimination. At the national level, it is unclear if discrimination is associated with cigarette smoking among African American men. Objective: The aim of the study was to examine the association between discrimination and cigarette smoking among a national sample of African American men. Methods: Using data from the National Survey of American Life (n = 1,271), multivariable logistic regression was used to examine the relationship between discrimination and cigarette smoking. Results: Thirty-two percent of the men were current smokers. Controlling for everyday discrimination, major discrimination, major stress, depressive symptoms, age, being married, household income, and education, African American men who experienced major discrimination had a higher odd of being a current smoking (odds ratio: 1.11, 95% confidence interval: 1.02–1.21) than African American men who did not experience major discrimination. Conclusion/Importance: Findings suggest that African American men may use cigarette smoking as a mechanism to alleviate the experiences of discrimination. Future studies should continue to examine factors associated with African American men's smoking behavior in efforts to inform culturally relevant interventions.Changes in Attitudes toward Guns and Shootings following Implementation of the Baltimore Safe Streets Intervention
AbstractMilam, A. J., Buggs, S. A., Furr-Holden, C. D. M., Leaf, P. J., Bradshaw, C. P., & Webster, D. (n.d.).Publication year
2016Journal title
Journal of Urban HealthVolume
93Issue
4Page(s)
609-626AbstractAmong youth 15 to 24 years of age, homicide and nonfatal shootings are the leading causes of mortality and morbidity. Urban youth’s attitudes and perceptions about the use of gun violence to resolve conflict present a major barrier to efforts to reduce gun homicides and nonfatal shootings. The current investigation extends the existing literature on attitudes toward guns and shootings among high-risk youth ages 18 to 24 by measuring perceived norms and viewpoints regarding gun violence in two analogous Baltimore City neighborhoods pre-implementation and 1-year post-implementation of the Safe Streets intervention (adapted from the CeaseFire/Cure Violence intervention). The Safe Streets intervention is designed for communities with high rates of gun violence and utilizes outreach workers to identify and build trusting relationships with youth ages 15 to 24 who are at greatest risk of being involved in gun violence. The outreach workers also position themselves in the community so that they can rapidly intervene in disputes that have the potential to lead to gun violence. Chi-squared tests and exploratory structural equation modeling (ESEM) were used to examine changes in attitudes toward gun violence 1 year after the implementation of the Safe Streets intervention. There was a statistically significantly improvement in 43 % of the attitudes assessed in the intervention community post-intervention compared to 13 % of the attitudes in the control community. There was a statistically significant improvement in the violent attitudes toward personal conflict resolution scale after implementation of the intervention in both the intervention (b = −0.522, p < 0.001) and control community (b = −0.204, p < 0.032). Exposure to the intervention (e.g., seeing stop shooting signs in your neighborhood) was also associated with the nonviolent attitudes toward conflict scale. Overall, the study found greater improvement in attitudes toward violence in the intervention community following the implementation of the Safe Streets program. These findings offer promising insights into future community violence prevention efforts.Classifying substance use disorder treatment facilities with co-located mental health services: A latent class analysis approach
AbstractMauro, P. M., Furr-Holden, C. D., Strain, E. C., Crum, R. M., & Mojtabai, R. (n.d.).Publication year
2016Journal title
Drug and alcohol dependenceVolume
163Page(s)
108-115AbstractBackground: The Affordable Care Act calls for increased integration and coordination of behavioral health services, as people with co-occurring disorders (CODs), meeting criteria for both substance use and psychiatric disorders, are overrepresented in treatment samples. Nationwide estimates of mental health (MH) service co-location in substance use disorder (SUD) treatment facilities are needed. We empirically derived a multiple-indicator categorization of services for CODs in SUD treatment facilities. Methods: We used latent class analysis to categorize 14,037 SUD treatment facilities in the United States and territories included in the 2012 National Survey of Substance Abuse Treatment Services. Latent class indicators included MH screening and diagnosis, MH support services, psychiatric medications, groups for CODs, and psychosocial approaches. Multinomial logistic regression compared facility-identified primary focus (i.e., SUD, MH, mix of SUD-MH, and general/other) and other facility characteristics across classes. Results: A four-class solution was chosen with the following classes: Comprehensive MH/COD Services (25%), MH without COD Services (25%), MH Screening Services (21%), and Limited MH Services (29%). The former two classes with co-located MH services were less likely to report a SUD-primary focus than the latter classes reporting only MH screening or Limited MH Services. Only the Comprehensive MH/COD Services class also had a high probability of providing special groups for CODs. Conclusions: Approximately half of SUD treatment facilities were in classes with co-located mental health services, but only a quarter provided comprehensive COD services. Future studies should assess differences in patient experiences and treatment outcomes across facilities with and without COD services.Clustering of Black Adolescent Marijuana Use in Low-Income, Urban Neighborhoods
Reboussin, B. A., Milam, A. J., Green, K. M., Ialongo, N. S., & Furr-Holden, C. D. M. (n.d.).Publication year
2016Journal title
Journal of Urban HealthVolume
93Issue
1Page(s)
109-116Evaluating nighttime observational measures of neighborhood disorder: Validity of the nighttime NIfETy assessment
AbstractMilam, A. J., Johnson, R. M., Nesoff, E. D., Reboussin, B. A., & Furr-Holden, C. D. (n.d.).Publication year
2016Journal title
Journal of Environmental PsychologyVolume
45Page(s)
97-102AbstractWhile there are a growing number of observational instruments to assess the built and social dimensions of the neighborhood environment, there are few reliable and validated instruments; there are no instruments that assess the neighborhood environment during nighttime hours, a potential peak period of health and safety risk. The purpose of this investigation is to establish the metric properties of Neighborhood Inventory for Environmental Typology (NIfETy) Instrument nighttime ratings. Reliability of the scale was measured by internal consistency reliability and test re-test correlation. Validity was evaluated through correlation with the daytime NIfETy rating and regression models with local violent crime data. The nighttime items had good internal consistency (α = 0.81-0.82) for the total scale and acceptable internal consistency for a seven-item nighttime disorder scale (α = 0.66-0.71). Future investigations will examine the nighttime NIfETy and its association with specific risk behaviors to evaluate changes in neighborhood environment.Not in my back yard: A comparative analysis of crime around publicly funded drug treatment centers, liquor stores, convenience stores, and corner stores in one Mid-Atlantic City
AbstractFurr-Holden, C. D. M., Milam, A. J., Nesoff, E. D., Johnson, R. M., Fakunle, D. O., Jennings, J. M., & Thorpe, R. J. (n.d.).Publication year
2016Journal title
Journal of Studies on Alcohol and DrugsVolume
77Issue
1Page(s)
17-24AbstractObjective: This research examined whether publicly funded drug treatment centers (DTCs) were associated with violent crime in excess of the violence happening around other commercial businesses. Method: Violent crime data and locations of community entities were geocoded and mapped. DTCs and other retail outlets were matched based on a Neighborhood Disadvantage score at the census tract level. Street network buffers ranging from 100 to 1,400 feet were placed around each location. Negative binomial regression models were used to estimate the relationship between the count of violent crimes and the distance from each business type. Results: Compared with the mean count of violent crime around drug treatment centers, the mean count of violent crime (M = 2.87) was significantly higher around liquor stores (M = 3.98; t test; p < .01) and corner stores (M = 3.78; t test; p < .01), and there was no statistically significant difference between the count around convenience stores (M = 2.65; t test; p = .32). In the adjusted negative binomial regression models, there was a negative and significant relationship between the count of violent crime and the distance from drug treatment centers (β = -.069, p < .01), liquor stores (β = -.081, p < .01), corner stores (β = -.116, p < .01), and convenience stores (β = -.154, p < .01). Conclusions: Violent crime associated with drug treatment centers is similar to that associated with liquor stores and is less frequent than that associated with convenience stores and corner stores.Racial differences and the role of neighborhood in the sequencing of marijuana and tobacco initiation among urban youth
AbstractGreen, K. M., Johnson, R. M., Milam, A. J., Furr-Holden, D., Ialongo, N. S., & Reboussin, B. A. (n.d.).Publication year
2016Journal title
Substance AbuseVolume
37Issue
4Page(s)
507-510AbstractBackground: With patterns of initiation of tobacco and marijuana changing, there is increasing evidence that marijuana use may serve as an antecedent to tobacco use among adolescents. However, studies have not fully characterized the prevalence of these patterns among vulnerable youth and have rarely examined the factors that predict the sequencing of onset of tobacco and marijuana use. Methods: Utilizing longitudinal data from a sample of urban youth followed from age 6 to age 18, the authors identify the sequencing of initiation of tobacco and marijuana and test whether race and 5 neighborhood factors (i.e., perceived disorder, drug activity, drug access, exposure to violence, and exposure to violent victimization) predict onset sequencing. Results: Various sequencing patterns were observed, with 12.4% of the sample initiating marijuana use before tobacco use was initiated. In adjusted logistic regression models, black youth were 2.66 times as likely as whites to initiate marijuana before tobacco compared with initiating tobacco before marijuana (P =.032). Youth with greater exposure to violent victimization were 3.89 times as likely to initiate marijuana first than initiate tobacco first (P =.002). Other neighborhood factors were not statistically significantly associated with sequencing. Conclusions: Black youth and youth with greater exposure to victimization had an increased risk of initiating marijuana before tobacco, which suggests that this pattern may be rooted in specific risk factors. Substance use prevention efforts should consider taking into account that marijuana use may put certain youth at risk of initiating tobacco. Future research needs to monitor sequencing, as well as risk factors for and consequences of the various patterns, particularly since marijuana use and the mixing of tobacco and marijuana use are gaining acceptability in general populations.The inequitable distribution of tobacco outlet density: the role of income in two Black Mid-Atlantic geopolitical areas
AbstractFakunle, D. O., Milam, A. J., Furr-Holden, C. D., Butler, J., Thorpe, R. J., & LaVeist, T. A. (n.d.).Publication year
2016Journal title
Public HealthVolume
136Page(s)
35-40AbstractObjectives Studies have shown that communities with higher concentrations of low-income racial and ethnic minorities correlate with a greater presence of tobacco outlets. Community-level income has consistently been among the strongest predictors of tobacco outlet density. This study analyzes two Maryland geopolitical areas with similar racial concentrations yet differing income levels in an attempt to disentangle the race–income relationship with tobacco outlet density. Study design In this cross-sectional examination of tobacco outlet and census tract-level sociodemographic data, Baltimore City, Maryland, and Prince George's County, Maryland, were geocoded to determine tobacco outlet density. Methods Tobacco outlet density was defined as the mean number of tobacco outlets per 1000 persons per census tract. Comparisons of tobacco outlet density and sociodemographic variables were analysed via two-sample t-tests, and the direct effect of sociodemographic variables on tobacco outlet density for each area was analysed via spatial lag regressions. Results Prince George's County, the area with the higher income level ($77,190 vs $43,571), has a significantly lower tobacco outlet density than Baltimore City (P < 0.001). Prince George's County has a 67.5% Black population and an average of 3.94 tobacco outlets per 1000 persons per tract. By contrast, Baltimore City has a 65.3% Black population and an average of 7.95 tobacco outlets per 1000 persons per tract. Spatial lag regression model results indicate an inverse relationship between income and tobacco outlet density in Baltimore City and Prince George's County (β = −0.03, P < 0.01 & β = −0.01, P = 0.02, respectively), and a significant interaction term indicating a greater magnitude in the relationship between income and tobacco outlet density in Baltimore City (β = −0.05, P < 0.01). Conclusion Results suggest that higher socio-economic status, even in primarily underrepresented racial and ethnic geopolitical areas, is linked to lower tobacco outlet density.The influence of neighborhood context on exposure to and use of substances among Urban African American children
AbstractCooley-Strickland, M., Bynum, L., Otte, K., Tang, L., Griffin, R. S., Quille, T. J., & Furr-Holden, D. (n.d.). In Drug Use Trajectories Among Minority Youth (1–).Publication year
2016Page(s)
233-269AbstractSubstance use is a widespread problem among adolescents. According to the 2008 Monitoring the Future survey, almost half (45 %) of American youth have smoked cigarettes by the end of high school, 21 % of whom had tried them before the beginning of eighth grade; 72 % have consumed alcohol by the end of high school, with 39 % having done so by eighth grade; and half (47 %) of American children have tried an illicit drug by the time they leave high school (Johnston et al. 2009). However, most of the research on adolescent substance use has been conducted on primarily Caucasian samples (Lambert et al. 2004), leaving a paucity of research on substance use among ethnic minority adolescents (De La Rosa et al. 1993; Wallace et al. 1999). It is important to investigate substance use among ethnic minorities because racial and ethnic minority groups exhibit disproportionately adverse social outcomes associated with drug use, including poverty, violence, crime and arrest (REF). Prior research has shown that African American adolescents are less likely to smoke cigarettes (Felton et al. 1999; Kann et al. 1996) and consume alcohol (Blum et al. 2000) than their Caucasian peers. However, prevalence rates for drug use initiation by race/ethnicity indicate that while African Americans are less likely than Caucasians to initiate smoking tobacco and drinking by age 13, they are at greater risk of initiating cocaine and marijuana use at earlier ages (i.e., 17.2 %, 11.1 %, and 1.3 % for smoking, marijuana, and cocaine initiation before 13 years of age respectively (Kann et al. 1996).The Moderating Role of Gender in the Relationship Between Tobacco Outlet Exposure and Tobacco Use Among African American Young Adults
AbstractBrown, Q., Milam, A. J., Bowie, J. V., Ialongo, N. S., Gaskin, D. J., & Furr-Holden, D. (n.d.).Publication year
2016Journal title
Prevention ScienceVolume
17Issue
3Page(s)
338-346AbstractTobacco outlet exposure is a correlate of tobacco use with potential differences by gender that warrant attention. The aim of this study is to explore the moderating role of gender in the relationship between tobacco outlet exposure and past month tobacco use among African American young adults 21 to 24 years old. This cross-sectional study (n = 283) used geospatial methods to determine the number of tobacco outlets within walking distance (i.e., a quarter mile) of participants’ homes and distance to the nearest outlet. Logistic regression models were used to test interactions between gender and tobacco outlet exposure (i.e., density and proximity). Tobacco outlets were classified based on whether or not they were licensed to sell tobacco only (TO outlets) or tobacco and alcohol (TA outlets). Neither density nor proximity was associated with past month tobacco use in the pooled models. However, gender modified the relationship between TO outlet density and tobacco use, and this relationship was significant only among women (OR = 1.02; p < 0.01; adjusted OR = 1.01; p < 0.05). This study underscores the importance of reducing tobacco outlet density in residential neighborhoods, especially TO outlets, as well as highlights potential gender differences in the relationship between tobacco outlet density and tobacco use.The Role of Stress and Spirituality in Adolescent Substance Use
AbstractDebnam, K., Milam, A. J., Furr-Holden, C. D., & Bradshaw, C. (n.d.).Publication year
2016Journal title
Substance Use and MisuseVolume
51Issue
6Page(s)
733-741AbstractBackground: Substance use can occur as a result of coping with stress. Within the school context, youth are exposed to stressors related to school achievement and peer-relationships. Protective factors, such as spirituality, may moderate adolescents' engagement in substance use. Objective: The current study investigated the role of spirituality in the association between stress and substance use, in an effort to test the hypothesis that spirituality moderates the association between stress and substance use. Methods: This study used data from youth in grades 6-8 attending 40 parochial private schools. A total of 5,217 students participated in the web-based survey administered in Spring 2013. Multilevel structural equation models were used to examine the association between stress, spirituality, and substance use, while accounting for the nested nature of the data (i.e., students within schools). Results: Higher stress was significantly associated with increased alcohol, tobacco, and other drug use among youth (b =.306, p <.001). In addition, lower spiritual beliefs were associated with greater substance use (b =.349, p <.001). Spiritual beliefs did not moderate the relationship between stress and substance use. Conclusions/Importance: Implications for increasing students' adaptive coping when confronted with school-related stressors and the role of school climate are discussed.Triangulating syndemic services and drug treatment policy: Improving drug treatment portal locations in Baltimore City
AbstractFurr-Holden, C. D. M., Milam, A. J., Nesoff, E. D., Garoon, J., Smart, M. J., Duncan, A., & Warren, G. C. (n.d.).Publication year
2016Journal title
Progress in Community Health Partnerships: Research, Education, and ActionVolume
10Issue
2Page(s)
319-327AbstractThe Problem: The prevalence of injection drug use (IDU) and incidence of human immunodeficiency virus (HIV) remain high in Baltimore, where IDU is a primary HIV risk factor. Substance use disorders and HIV are related syndemically— their causes and consequences interact synergistically. Baltimore is increasingly considering the syndemic relationship of substance use disorders, IDU, and HIV in making decisions about drug treatment funding and location. Purpose of Article: Our goal was to empirically identify the optimal location of new drug treatment programs through the development and application of a novel, practical tool. Key Points: Syndemic triangles were constructed to measure and visualize unmet need for drug treatment services. These data were used to determine priority zones for new treatment centers. Conclusions: The application of this tool helped inform strategies for locating drug treatment services in Baltimore, and its successful use suggests its potential value in other metropolitan areas.Past 15-year trends in adolescent marijuana use: Differences by race/ethnicity and sex
AbstractJohnson, R. M., Fairman, B., Gilreath, T., Xuan, Z., Rothman, E. F., Parnham, T., & Furr-Holden, C. D. M. (n.d.).Publication year
2015Journal title
Drug and alcohol dependenceVolume
155Page(s)
8-15AbstractBackground: The potential for increases in adolescent marijuana use is an important concern given recent changes in marijuana policy. The purpose of this study was to estimate trends in marijuana use from 1999 to 2013 among a national sample of US high school students. We examine changes over time by race/ethnicity and sex. Methods: Data are from the National Youth Risk Behavior Survey (YRBS), which involves biennial, school-based surveys that generate nationally representative data about 9th-12th grade students in the United States. Students self-reported sex, race/ethnicity, and marijuana use (i.e., lifetime use, past 30-day use, any use before age 13). We generated national estimates of the prevalence of marijuana use for the time period, and also tested for linear and quadratic trends (. n=. 115,379). Results: The prevalence of lifetime marijuana use decreased modestly from 1999 to 2009 (44% to 37%), and has increased slightly since 2009 (41%). Other marijuana use variables (e.g., past 30-day use) followed a similar pattern over time. The prevalence of past 30-day use from 1999 to 2013 for all groups and both sexes was 22.5%, and it was lowest among Asians and highest among American Indian/Alaska Natives. Although boys have historically had a higher prevalence of marijuana use, results indicate that male-female differences in marijuana use decreased over time. Conclusion: Despite considerable changes in state marijuana policies over the past 15 years, marijuana use among high school students has largely declined. Continued surveillance is needed to assess the impact of policy changes on adolescent marijuana use.The role of neighborhood in urban black adolescent marijuana use
AbstractReboussin, B. A., Green, K. M., Milam, A. J., Furr-Holden, D. M., Johnson, R. M., & Ialongo, N. S. (n.d.).Publication year
2015Journal title
Drug and alcohol dependenceVolume
154Page(s)
69-75AbstractBackground: The present study examined the influence of neighborhood factors on transitions in marijuana involvement during adolescence in a sample of primarily low-income, urban Black youth. Methods: 556 Black adolescents were interviewed annually beginning in first grade as part of a longitudinal study. Latent class analysis (LCA) was used to examine stages of marijuana involvement from 6th to 9th grades. The influence of neighborhood disorder, drug activity, violent crime, safety and disadvantage on transitions in marijuana involvement was tested using latent transition analysis (LTA). Results: There was evidence for three stages of involvement: no involvement, offered, and use and problems. Involvement increased steadily during adolescence with a slightly greater risk to transition from offers to use between 6th and 7th grades. Neighborhood disorder (AOR = 1.04, CI = 1.00, 1.08), drug activity (AOR = 1.12, CI = 1.02, 1.22) and disadvantage (AOR = 1.44, CI = 1.10, 1.92) were associated with the transition from marijuana offers to use and problems. Neighborhood disorder (AOR = 1.07, CI = 1.02, 1.11), drug activity (AOR = 1.19, CI = 1.10, 1.29) and violent crime (AOR = 1.17, CI = 1.03, 1.32) were associated with transitioning rapidly from no involvement to use and problems. Conclusions: Understanding how neighborhoods could be organized and provided with supports to discourage marijuana use and promote non-drug using behaviors should be an important goal of any prevention program in low-income, urban Black neighborhoods. Enhancing citizen participation and mobilization to address the social processes of neighborhood disorder has the potential to reduce marijuana involvement in these neighborhoods.The School Assessment for Environmental Typology (SAfETy): An Observational Measure of the School Environment
AbstractBradshaw, C. P., Milam, A. J., Furr-Holden, C. D. M., & Lindstrom Johnson, S. (n.d.).Publication year
2015Journal title
American journal of community psychologyVolume
56Issue
3Page(s)
280-292AbstractSchool safety is of great concern for prevention researchers, school officials, parents, and students, yet there are a dearth of assessments that have operationalized school safety from an organizational framework using objective tools and measures. Such a tool would be important for deriving unbiased assessments of the school environment, which in turn could be used as an evaluative tool for school violence prevention efforts. The current paper presents a framework for conceptualizing school safety consistent with Crime Prevention through Environmental Design (CPTED) model and social disorganization theory, both of which highlight the importance of context as a driver for adolescents’ risk for involvement in substance use and violence. This paper describes the development of a novel observational measure, called the School Assessment for Environmental Typology (SAfETy), which applies CPTED and social disorganizational frameworks to schools to measure eight indicators of school physical and social environment (i.e., disorder, trash, graffiti/vandalism, appearance, illumination, surveillance, ownership, and positive behavioral expectations). Drawing upon data from 58 high schools, we provide preliminary data regarding the validity and reliability of the SAfETy and describe patterns of the school safety indicators. Findings demonstrate the reliability and validity of the SAfETy and are discussed with regard to the prevention of violence in schools.Neighborhood alcohol outlets and the association with violent crime in one mid-Atlantic City: The implications for zoning policy
AbstractJennings, J. M., Milam, A. J., Greiner, A., Furr-Holden, C. D. M., Curriero, F. C., & Thornton, R. J. (n.d.).Publication year
2014Journal title
Journal of Urban HealthVolume
91Issue
1Page(s)
62-71AbstractViolent crime such as homicide causes significant excess morbidity and mortality in US urban areas. A health impact assessment (HIA) identified zoning policy related to alcohol outlets as one way to decrease violent crime. The objectives were to determine the relationship between alcohol outlets including off-premise alcohol outlets and violent crime in one urban area to provide local public health evidence to inform a zoning code rewrite. An ecologic analysis of census tracts in Baltimore City was conducted from 2011 to 2012. The data included violent crimes (n = 51,942) from 2006 to 2010, licensed alcohol outlets establishments (n = 1,327) from 2005 to 2006, and data on neighborhood disadvantage, percent minority, percent occupancy, and drug arrests from 2005 to 2009. Negative binomial regression models were used to determine the relationship between the counts of alcohol outlets and violent crimes controlling for other factors. Spatial correlation was assessed and regression inference adjusted accordingly. Each one-unit increase in the number of alcohol outlets was associated with a 2.2 % increase in the count of violent crimes adjusting for neighborhood disadvantage, percent minority, percent occupancy, drug arrests, and spatial dependence (IRR = 1.022, 95 % CI = 1.015, 1.028). Off-premise alcohol outlets were significantly associated with violent crime in the adjusted model (IRR = 1.048, 95 % CI = 1.035, 1.061). Generating Baltimore-specific estimates of the relationship between alcohol outlets and violent crime has been central to supporting the incorporation of alcohol outlet policies in the zoning code rewrite being conducted in Baltimore City.