Danielle C Ompad
Danielle C. Ompad
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Vice Dean for Academic Affairs
Professor of Epidemiology
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Professional overview
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Dr. Danielle Ompad is an epidemiologist whose work is focused in the areas of urban health, HIV, illicit drug use, and adult access to vaccines. With respect to illicit drug use, her work has spanned the entire natural history of addiction – from initiation to cessation, with particular attention paid to risk for infectious diseases such as HIV, hepatitis B and C, and STIs. She has primarily worked with people who use heroin, crack, cocaine, and/or club drugs.
In New York City, she has been examining heroin cessation among current, former, and relapsed heroin users. Working with Alliance for Public Health and the Ukrainian Institute on Public Health Policy, she analyzes harm reduction service utilization among people who inject drugs, in order to optimize service delivery in Ukraine. Since 2013, she has served as faculty for the Fogarty-funded New York State International Training and Research Program with the goal of building research capacity in Ukraine.
Dr. Ompad’s National Institute of Allergy and Infectious Diseases-funded study aims to determine if herpes simplex 1 and 2 infections explain racial disparities in HIV incidence among a cohort of young gay, bisexual, and other men who have sex with men (YMSM). In addition, Dr. Ompad and colleagues are assessing HPV infection prevalence, persistence, and clearance among this same cohort.
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Education
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BS, Biology, Bowie State University, Bowie, MDMHS, Epidemiology, Johns Hopkins University, Baltimore, MDPhD, Epidemiology, Johns Hopkins University, Baltimore, MD
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Honors and awards
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Excellence in Public Health Teaching Award, New York University (2014)Excellence in Public Health Teaching Award, New York University (2013)National Hispanic Science Network on Drug Abuse Scientific Development Travel Fellowship (2010)Delta Omega Honorary Society, Alpha Chapter (2002)
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Areas of research and study
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EpidemiologyHIV/AIDSInfectious DiseasesSocial Determinants of HealthSTIsSubstance AbuseVaccines
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Publications
Publications
Access to and use of health services among undocumented Mexican immigrants in a US urban area
AbstractNandi, A., Galea, S., Lopez, G., Nandi, V., Strongarone, S., & Ompad, D. C. (n.d.).Publication year
2008Journal title
American journal of public healthVolume
98Issue
11Page(s)
2011-2020AbstractObjectives. We assessed access to and use of health services among Mexican-born undocumented immigrants living in New York City in 2004. Methods. We used venue-based sampling to recruit participants from locations where undocumented immigrants were likely to congregate. Participants were 18 years or older, born in Mexico, and current residents of New York City. The main outcome measures were health insurance coverage, access to a regular health care provider, and emergency department care. Results. In multivariable models, living in a residence with fewer other adults, linguistic acculturation, higher levels of formal income, higher levels of social support, and poor health were associated with health insurance coverage. Female gender, fewer children, arrival before 1997, higher levels of formal income, health insurance coverage, greater social support, and not reporting discrimination were associated with access to a regular health care provider. Higher levels of education, higher levels of formal income, and poor health were associated with emergency department care. Conclusions. Absent large-scale political solutions to the challenges of undocumented immigrants, policies that address factors shown to limit access to care may improve health among this growing population.Correlates of illicit methadone use in New York City: A cross-sectional study
AbstractOmpad, D. C., Fuller, C. M., Chan, C. A., Frye, V., Vlahov, D., & Galea, S. (n.d.).Publication year
2008Journal title
BMC public healthVolume
8AbstractBackground. Despite growing concern about illicit methadone use in the US and other countries, there is little data about the prevalence and correlates of methadone use in large urban areas. We assessed the prevalence and examined correlates of lifetime and recent illicit methadone use in New York City (NYC). Methods. 1,415 heroin, crack, and cocaine users aged 15-40 years were recruited in NYC between 2000 and 2004 to complete interviewer-administered questionnaires. Results. In multivariable logistic regression, non-injection drug users who used illicit methadone were more likely to be heroin dependent, less than daily methamphetamine users and to have a heroin using sex partner in the last two months. Injection drug users who used illicit methadone were more likely to use heroin daily, share injection paraphernalia and less likely to have been in a detoxification program and to have not used marijuana in the last six months. Conclusion. The results overall suggest that illicit (or street) methadone use is likely not a primary drug of choice, but is instead more common in concert with other illicit drug use.Hunger and health among undocumented Mexican migrants in a US urban area
AbstractHadley, C., Galea, S., Nandi, V., Nandi, A., Lopez, G., Strongarone, S., & Ompad, D. (n.d.).Publication year
2008Journal title
Public Health NutritionVolume
11Issue
2Page(s)
151-158AbstractObjectives: To measure the occurrence and correlates of hunger and to evaluate the association between hunger and three health indicators among undocumented Mexican immigrants. Design: Non-probability cross-sectional sample. Setting: Neighbourhoods within New York City. Subjects: Four hundred and thirty-one undocumented Mexican immigrants living in the USA. Results: Hunger was indicated by approximately 28% of respondents. In a multivariate model, working as a day labourer was associated with hunger (odds ratio (OR) 3.33, 95% confidence interval (CI) 1.83-6.06) while receiving public assistance protected against hunger (OR 0.23, 95% CI 0.06-0.88). In multivariate models, respondents who reported experiencing hunger also reported poorer overall health (OR 1.69, 95% CI 0.95-3.02) and more days of poor mental (P = 0.045) and physical health (P < 0.0001). Greater amount of time lived in the USA was also associated with worse overall health (P = 0.054) and more days of poor mental and physical health (P < 0.01). Conclusions: The present study shows that food insecurity and hunger may be problems among undocumented migrants living in the USA. Uncertain and unpredictable work schedules and limited access to public assistance may contribute to high levels of hunger, which in turn may also negatively affect mental and physical health. Increasing amount of time lived in the USA is also associated with poorer health indicators. Programmes that provide undocumented migrants with emergency access to resources may reduce food insecurity and lead to improved health outcomes among this vulnerable population.Mortality risk among recent-onset injection drug users in five U.S. cities
AbstractVlahov, D., Wang, C., Ompad, D., Fuller, C. M., Caceres, W., Ouellet, L., Kerndt, P., Jarlais, D. C. D., & Garfein, R. S. (n.d.).Publication year
2008Journal title
Substance Use and MisuseVolume
43Issue
3Page(s)
413-428AbstractTo quantify the risk of death among recent-onset (< 5 years) injection drug users, we enrolled 2089 injection drug users (IDUs) age ≤ 35 years (minimum age = 18 years) between 1997 and 1999. Median age was 24 years, 62.4% were male, 54.5% were non-Hispanic White, mean duration of injecting was 3 years, and 45.4% injected daily within the prior 6 months. Using the National Death Index, we identified 68 deaths over a follow-up period through December 2002 with a mortality rate of 7.10/1000 person years. Using age-, sex-, and race-adjusted data to the census and mortality, we calculated standardized mortality ratios (SMRs) over time. The adjusted SMR (with national data as the reference) for IDUs was 3.66 for 1997, which increased to 9.78 by 1998, decreased slightly to 7.08 by 1999, and continuously declined to 2.54 by 2002. These data confirm considerable excess mortality among recent onset injection drug users compared to non-IDU peers in the general population and indicate need for interventions such as increased quality and accessibility to drug abuse** treatment and overdose prevention to prevent premature death among young IDUs.Predictors of influenza vaccination in an urban community during a national shortage
AbstractPhillips-Caesar, E., Coady, M. H., Blaney, S., Ompad, D. C., Sisco, S., Glidden, K., Vlahov, D., & Galea, S. (n.d.).Publication year
2008Journal title
Journal of health care for the poor and underservedVolume
19Issue
2Page(s)
611-624AbstractLittle is known about the impact of vaccine shortages on vaccination rates among disadvantaged populations in the United States. We compared factors associated with influenza vaccination rates during a vaccine shortage (2004-2005) and a non-shortage (2003-2004) year among adults in predominantly minority New York City neighborhoods. Thirty-one percent of participants received influenza vaccine during the non-shortage year compared with 18% during the shortage. While fewer people received the influenza vaccine during the shortage, a higher proportion of the vaccinated were in a high-risk group (68% vs. 52%, respectively). People were less likely to have been vaccinated during the shortage if they were Black. This study suggests that vaccination rates were lower during the shortage period among Blacks and those who are not explicitly a focus of national vaccination outreach campaigns. Such groups are less likely to be vaccinated when vaccines are scarce.Prevalence and correlates of previous hepatitis B vaccination and infection among young drug-users in New York City
AbstractAmesty, S., Ompad, D. C., Galea, S., Fuller, C. M., Wu, Y., Koblin, B., & Vlahov, D. (n.d.).Publication year
2008Journal title
Journal of Community HealthVolume
33Issue
3Page(s)
139-148AbstractHepatitis B (HBV) vaccination coverage remains low among drug users. In 1997, ACIP made hepatitis B vaccine available for persons aged 0-18 years and many states began requiring HBV vaccination for entry into middle school; these programs might affect HBV vaccination and infection rates in younger DUs. We were interested in determining correlates of immunization among younger (<25 years) and older (25 and older) DUs. Methods: A community-based sample of 1,211 heroin, crack, and cocaine users 18 or older was recruited from Harlem and the Bronx. We assessed previous HBV vaccination and infection and correlates using bivariate analyses. Results: The sample was predominantly male (74.0%), aged ≥25 years (67.1%) and Hispanic (59.9%). In terms of socioeconomic status, 57.1% had less than a high school education, 84.5% had been homeless in their lifetime, and 48.0% had an illegal main income source. Among 399 DUs younger than 25 years of age, 30% demonstrated serological evidence of previous vaccination, 49.9% were susceptible to HBV at baseline, and 20% showed evidence of infection. In our model, previous HBV infection and vaccination status were associated with being 22 years old or younger (AOR = 1.40 and 1.66). Compared to susceptible individuals, those vaccinated were significantly less likely to be born in other countries (AOR = 0.50). Among 812 DUs 25 and older, 10.6% demonstrated serological evidence of previous vaccination, 59.2% were susceptible to HBV at baseline, and 30.2% showed evidence of infection. Conclusion: Existing interventions to increase HBV vaccination among adolescents should target high risk groups.Project VIVA: A multilevel community-based intervention to increase influenza vaccination rates among hard-to-reach populations in New York City
AbstractCoady, M. H., Galea, S., Blaney, S., Ompad, D. C., Sisco, S., & Vlahov, D. (n.d.).Publication year
2008Journal title
American journal of public healthVolume
98Issue
7Page(s)
1314-1321AbstractObjectives. We sought to determine whether the work of a community-based participatory research partnership increased interest in influenza vaccination among hard-to-reach individuals in urban settings. Methods. A partnership of researchers and community members carried out interventions for increasing acceptance of influenza vaccination in disadvantaged urban neighborhoods, focusing on hard-to-reach populations (e.g., substance abusers, immigrants, elderly, sex workers, and homeless persons) in East Harlem and the Bronx in New York City. Activities targeted the individual, community organization, and neighborhood levels and included dissemination of information, presentations at meetings, and provision of street-based and door-to-door vaccination during 2 influenza vaccine seasons. Participants were recruited via multiple modalities. Multivariable analyses were performed to compare interest in receiving vaccination pre- and postintervention. Results. There was increased interest in receiving the influenza vaccine postintervention (P<.01). Being a member of a hard-to-reach population (P=.03), having ever received an influenza vaccine (P<.01), and being in a priority group for vaccination (P<.01) were also associated with greater interest in receiving the vaccine. Conclusions. Targeting underserved neighborhoods through a multilevel community-based participatory research intervention significantly increased interest in influenza vaccination, particularly among hard-to-reach populations. Such interventions hold promise for increasing vaccination rates annually and in pandemic situations.Sampling and recruitment in multilevel studies among marginalized urban populations: The IMPACT studies
AbstractOmpad, D. C., Galea, S., Marshall, G., Fuller, C. M., Weiss, L., Beard, J. R., Chan, C., Edwards, V., & Vlahov, D. (n.d.).Publication year
2008Journal title
Journal of Urban HealthVolume
85Issue
2Page(s)
268-280AbstractIllicit drug use in urban settings is a major public health problem. A range of individual level factors are known to influence drug use and its consequences, and a number of recent studies have suggested that the neighborhood in which an individual lives may also play a role. However, studies seeking to identify neighborhood-level determinants of drug use, particularly among marginalized urban populations, need to overcome significant challenges, particularly in the area of sampling and recruitment. One key issue is defining functional neighborhoods that are relevant to local residents. Another arises from the need to sample a representative or even a diverse population when studying marginalized groups such as illicit drug users. These are common problems that raise particular challenges when both need to be addressed in the same study. For example, many sampling approaches for neighborhood-level studies have included some form of random sample of households, but this may systematically overlook marginalized populations. On the other hand, the sampling approaches commonly used in studies of hidden populations such as chain referral, snow ball, and more recently, respondent-driven sampling, typically expand beyond a geographic "neighborhood." We describe the organization and rationale for the IMPACT Studies in New York City as a case illustration on how such issues may be addressed.Urban health issues
Boslaugh, S., Ompad, D., Galea, S., & Vlahov, D. (n.d.). In Encyclopedia of epidemiology (1–).Publication year
2008Volume
2Page(s)
1058-1063Urban health systems
AbstractOmpad, D. C., Galea, S., & Vlahov, D. (n.d.). In International Encyclopedia of Public Health: Overview (1–).Publication year
2008Page(s)
463-470AbstractUrban health is the study of urban characteristics that can influence health and disease in the urban context. These characteristics include features of the social and physical environment as well as of the urban resource infrastructure. Features of the social and physical environment and the urban resource infrastructure in turn are shaped by municipal, national, and global forces and trends. This article introduces the reader to urban health concepts, including the definition of 'urban,' features of the urban environment that may influence health, and a selection of methods for evaluating the impact of urban living on health. © 2008Access to influenza vaccine in East Harlem and the Bronx during a national vaccine shortage
AbstractOmpad, D. C., Galea, S., Blaney, S., Coady, M. H., Sisco, S., Glidden, K., & Vlahov, D. (n.d.).Publication year
2007Journal title
Journal of Community HealthVolume
32Issue
3Page(s)
195-202AbstractIn October 2004, one of the major producers of the U.S. influenza vaccine supply announced that their vaccine would not be available because of production problems, resulting in approximately half of the anticipated supply suddenly becoming unavailable. This study was part of a larger effort using community-based participatory research (CBPR) principles to distribute influenza vaccine to hard-to-reach populations. Given the extant literature suggesting economic and racial disparities in influenza vaccine access in times of adequate supply and our inability to distribute vaccine due to the shortage, we sought to examine vaccine access as well as awareness of the vaccine shortage and its impact on health-seeking behaviors in eight racially-diverse and economically-disadvantaged neighborhoods in New York City (NYC) during the shortage. In our study few people had been vaccinated, both among the general community and among high risk groups; vaccination rates for adults in priority groups and non-priority groups were 21.0% and 3.5%. Awareness of the 2004 vaccine shortage was widespread with over 90% being aware of the shortage. While most attributed the shortage to production problems, almost 20% said that it was due to the government not wanting to make the vaccine available. Many respondents said they would be more likely to seek vaccination during the current and subsequent influenza seasons because of the shortage. The target neighborhoods were significantly affected by the national influenza vaccine shortage. This study highlights the challenges of meeting the preventive health care needs of hard-to-reach populations in times of public health crisis.Convenience is the key to hepatitis A and B vaccination uptake among young adult injection drug users
AbstractCampbell, J. V., Garfein, R. S., Thiede, H., Hagan, H., Ouellet, L. J., Golub, E. T., Hudson, S. M., Ompad, D. C., & Weinbaum, C. (n.d.).Publication year
2007Journal title
Drug and alcohol dependenceVolume
91Page(s)
S64-S72AbstractBackground: Despite CDC recommendations to vaccinate injection drug users (IDUs) against hepatitis A virus (HAV) and hepatitis B virus (HBV) infections, coverage remains low. Vaccination programs convenient to IDUs have not been widely implemented or evaluated. We assessed whether convenience and monetary incentives influenced uptake of free vaccine by 18-30-year-old IDUs in five U.S. cities. Methods: IDUs recruited from community settings completed risk behavior self-interviews and testing for antibodies to HAV (anti-HAV) and hepatitis B core antigen (anti-HBc). Vaccine was offered presumptively at pre-test (except in Chicago); on-site availability and incentives for vaccination differed by site, creating a quasi-experimental design. Results: Of 3181 participants, anti-HAV and anti-HBc seroprevalence was 19% and 23%, respectively. Although 83% of participants were willing to be vaccinated, only 36% received ≥1 dose, which varied by site: Baltimore (83%), Seattle (33%), Los Angeles (18%), New York (17%), and Chicago (2%). Participation was highest when vaccine was available immediately on-site and lowest when offered only after receiving results. Monetary incentives may have increased participation when on-site vaccination was not available. Conclusion: IDUs were willing to be vaccinated but immediate, on-site availability was critical for uptake. Convenience should be a key consideration in designing strategies to increase vaccine coverage among IDUs.Defining Neighborhood Boundaries for Urban Health Research
AbstractWeiss, L., Ompad, D., Galea, S., & Vlahov, D. (n.d.).Publication year
2007Journal title
American journal of preventive medicineVolume
32Issue
6Page(s)
S154-S159AbstractAbstract: The body of literature exploring neighborhood effects on health has increased rapidly in recent years, yet a number of methodologic concerns remain, including preferred methods for identification and delineation of study neighborhoods. In research combining census or other publicly available data with surveys of residents and/or street-level observations, questions regarding neighborhood definition take on added significance. Neighborhoods must be identified and delineated in such a way as to optimize quality and availability of data from each of these sources. IMPACT (Inner-City Mental Health Study Predicting HIV/AIDS, Club and Other Drug Transitions), a multilevel study examining associations among features of the urban environment and mental health, drug use, and sexual behavior, utilized a multistep neighborhood definition process including development of census block group maps, review of land use and census tract data, and field visits and observation in each of the targeted communities. Field observations were guided by a preidentified list of environmental features focused on the potential for recruitment (e.g., pedestrian volume), characteristics commonly used to define neighborhood boundaries (e.g., obstructions to pedestrian traffic, changes in land use), and characteristics that have been associated in the literature with health behaviors and health outcomes (such as housing type and maintenance and use of open spaces). This process, implemented in February through July 2005, proved feasible and offered the opportunity to identify neighborhoods appropriate to study objectives and to collect descriptive information that can be used as a context for understanding study results.Identifying Injection Drug Users at Risk of Nonfatal Overdose
AbstractCoffin, P. O., Tracy, M., Bucciarelli, A., Ompad, D., Vlahov, D., & Galea, S. (n.d.).Publication year
2007Journal title
Academic Emergency MedicineVolume
14Issue
7Page(s)
616-623AbstractObjectives: Drug overdose is the second leading cause of accidental deaths among U.S. adults aged 15-64 years. Emergency physicians have a unique opportunity to provide overdose prevention interventions, because habitual drug users are in frequent need of medical care. The authors evaluated associations between individual-level risk factors and experiencing an overdose in the past six months to determine which characteristics and behaviors may be most predictive of overdose. Methods: The authors used data from a sample of street-recruited habitual drug users who participated in face-to-face interviews about overdose from November 2001 to February 2004. This analysis was restricted to 772 respondents who had been injecting for at least one year and who had injected heroin within the past two months. Results: A total of 16.6% of participants had overdosed in the past six months. Characteristics and behaviors that were independently associated with an increased risk of a recent overdose were having had a prior overdose (odds ratio [OR], 28.58; 95% confidence interval [CI] = 14.10 to 57.96), using cocaine/crack in the past six months (OR, 2.07; 95% CI = 1.25 to 3.45), using alcohol in the past six months (OR, 1.90; 95% CI = 1.01 to 3.57), experiencing serious withdrawal symptoms in the past two months (OR, 2.70; 95% CI = 1.58 to 4.61), and younger age. Conclusions: Drug users who have previously experienced a nonfatal overdose are at very high risk of experiencing future overdoses. Further longitudinal studies are needed to identify robust predictors of overdose risk over time in habitual drug users, but these data suggest that drug users who have overdosed warrant aggressive prevention efforts such as agonist maintenance treatment or provision of take-home naloxone.Impact of social network characteristics on high-risk sexual behaviors among non-injection drug users
AbstractPilowsky, D. J., Hoover, D., Hadden, B., Fuller, C., Ompad, D. C., Andrews, H. F., De Leon, C. L., Hoepner, L., Xia, Q., & Latkin, C. (n.d.).Publication year
2007Journal title
Substance Use and MisuseVolume
42Issue
11Page(s)
1629-1649AbstractSexually active non-injection drug users in New York City and their sexual partners or fellow drug users (N = 264) were recruited from 2002 to 2005, and associations between social network characteristics and sexual risk behaviors were examined. We assessed social networks, sexual practices, and drug use. Results suggest having a drug-centered social network, i.e., a network that includes a high proportion of individuals who provide, receive, or use drugs, increases the risk of engaging in high-risk sexual behaviors. The study's limitations are noted and longitudinal studies are needed to ascertain whether these associations are causal. Funding was provided by the National Institute on Drug Abuse.Pandemic preparedness and hard to reach populations.
Vlahov, D., Coady, M. H., Galea, S., Ompad, D. C., & Barondess, J. A. (n.d.).Publication year
2007Journal title
American journal of disaster medicineVolume
2Issue
6Page(s)
281-283Perceived stress among a workforce 6 months following hurricane Katrina
AbstractLeon, K. A., Hyre, A. D., Ompad, D., DeSalvo, K. B., & Muntner, P. (n.d.).Publication year
2007Journal title
Social psychiatry and psychiatric epidemiologyVolume
42Issue
12Page(s)
1005-1011AbstractTo determine stress levels among a workforce 6 months after hurricane Katrina made landfall, a web-based survey that included the four-item Perceived Stress Scale was administered to employees of the largest employer in New Orleans. An overall Perceived Stress Scale score was obtained by pooling responses for the four items. Among 1,542 adult respondents, 24.1% stated they felt that they were "fairly often" or "very often" unable to control the important things in their life and 21.4% considered that their difficulties were "fairly often" or "very often" piling up so high that they could not overcome them. Also, 6.1% reported that they "almost never" or "never" felt confident about their ability to handle their personal problems and 15.2% indicated that things were "almost never" or "never" going their way. The overall mean Perceived Stress Scale score was 6.3 (standard deviation = 3.1; range = 0-16). Higher stress scale scores, indicating more stress, were present for women, and for participants with lower income, displaced longer than 3 months, who were more afraid of losing their life during hurricane Katrina and its immediate aftermath, and who knew someone that died during the storm. Additionally, participants who were living in a relative of friend's house or in a temporary trailer at the time of the survey had higher stress scores compared to their counterparts who had returned to live in their pre-hurricane residence. There was a direct association between higher stress scores and symptoms of post-traumatic stress disorder. Employers and health care providers should be apprised of the need for monitoring stress and offering counseling opportunities for returning workforces following future large-scale disasters.Rapid vaccine distribution in nontraditional settings: lessons learned from project VIVA
AbstractCoady, M. H., Weiss, L., Galea, S., Ompad, D. C., Glidden, K., & Vlahov, D. (n.d.).Publication year
2007Journal title
Journal of Community Health NursingVolume
24Issue
2Page(s)
79-85AbstractWith growing fear of a worldwide influenza pandemic, programs that can rapidly vaccinate a broad range of persons are urgently needed. Vaccination rates are low among disadvantaged and hard-to-reach populations living within urban communities, and delivering vaccines to these groups may prove challenging. Project VIVA1 (Venue-Intensive Vaccination for Adults), staffed by teams of nurses and outreach workers, aimed to deliver vaccines rapidly within disadvantaged neighborhoods in New York City. Project VIVA nurses offered free influenza vaccine door-to-door and on street corners over 10 days in October, 2005. A total of 1,648 people were vaccinated, exceeding expectation. Careful selection and training of project staff, community involvement in project development, community outreach, and prioritizing street-based distribution may be key factors in an effective rapid vaccination program. In conclusion, this project may be replicated in other communities and utilized for annual vaccination campaigns and in the event of a pandemic.Risk factors for methadone outside treatment programs: Implications for HIV treatment among injection drug users
AbstractVlahov, D., O’Driscoll, P., Mehta, S. H., Ompad, D. C., Gern, R., Galai, N., & Kirk, G. D. (n.d.).Publication year
2007Journal title
AddictionVolume
102Issue
5Page(s)
771-777AbstractBackground: Diversion of methadone outside treatment programs occurs, yet reasons for use of 'street methadone' are characterized poorly. Self-medication for withdrawal symptoms is one plausible hypothesis. Among HIV-infected drug users, some antiretroviral medications can reduce potency of methadone, yet any association between such effects and the use of supplemental methadone sources remains undetermined. Objective: To estimate the frequency and risk factors for use of street methadone. Methods: Injection drug users (IDUs) recruited through extensive community outreach in 1988-89 and 1994 were followed semi-annually with questionnaires about health history, use of licit and illicit drugs including methadone and HIV-related assays. Analyses were performed using generalized estimating equation logistic regression. Results: Of 2811 IDUs enrolled and eligible for analysis, 493 people reported use of street methadone over 12 316 person-years of follow-up (4.0/100 person-years). In multivariate analyses, street methadone use was more common among women, whites, those 40-59 years old, those who reported withdrawal symptoms, past methadone program attendance (6-12 months before visit), recent heroin injection with or without cocaine (but not cocaine alone), smoking or sniffing heroin and reported trading sex. Street methadone was not associated with HIV infection or treatment. Conclusion: The results suggest that older IDUs still using heroin may be using street methadone to treat signs of withdrawal. The absence of a higher rate of street methadone use in HIV seropositive IDUs reveals that antiretroviral/ methadone interactions are not a primary determinant of use outside of treatment settings.Social determinants of the health of urban populations: Methodologic considerations
AbstractOmpad, D. C., Galea, S., Caiaffa, W. T., & Vlahov, D. (n.d.).Publication year
2007Journal title
Journal of Urban HealthVolume
84Page(s)
i42-i53AbstractA full understanding of the role of the urban environment in shaping the health of populations requires consideration of different features of the urban environment that may influence population health. The social environment is key to understanding the way in which cities affect the health of populations. Social determinants of health (SDH) are important, generally, yet can have different effects in different settings from urban to rural, between countries, between cities, and within cities. Failure to acknowledge, and more importantly, to understand the role of SDH in health and access to health and social services will hamper any effort to improve the health of the population. In this paper, we will briefly summarize a few key SDH and their measurement. We will also consider methodologic tools and some methodologic challenges. The concepts presented here are broadly applicable to a variety of settings: developed and developing countries, slum areas, inner cities, middle income neighborhoods, and even higher income neighborhoods. However, our focus will be on some of the more vulnerable urban populations who are most profoundly affected by SDH.Strategies for improving influenza immunization rates among hard-to-reach populations
AbstractVlahov, D., Coady, M. H., Ompad, D. C., & Galea, S. (n.d.).Publication year
2007Journal title
Journal of Urban HealthVolume
84Issue
4Page(s)
615-631AbstractWhereas considerable attention has been devoted to achieving high levels of influenza immunization, the importance of this issue is magnified by concern over pandemic influenza. Most recommendations for vaccine administration address high risk groups such as the elderly and those with chronic diseases, but coverage for hard-to-reach (HTR) populations has had less attention. HTR populations include minorities but also include other primarily urban groups such as undocumented immigrants, substance users, the homeless, and homebound elderly. Obstacles to the provision of immunization to HTR populations are present at the patient, provider, and structural levels. Strategies at the individual level for increasing immunization coverage include community-based educational campaigns to improve attitudes and increase motivation for receiving vaccine; at the provider level, education of providers to encourage immunizations, improving patient-provider interactions, broadening the provider base to include additional nurses and pharmacists, and adoption of standing orders for immunization administration; and at the structural level, promoting wider availability of and access to vaccine. The planning process for an influenza pandemic should include community engagement and extension of strategies beyond traditional providers to involve community-based organizations addressing HTR populations.Symptoms of posttraumatic stress disorder in a New Orleans workforce following Hurricane Katrina
AbstractDeSalvo, K. B., Hyre, A. D., Ompad, D. C., Menke, A., Tynes, L. L., & Muntner, P. (n.d.).Publication year
2007Journal title
Journal of Urban HealthVolume
84Issue
2Page(s)
142-152AbstractOn August 29, 2005, Hurricane Katrina made landfall resulting in catastrophic damage and flooding to New Orleans, LA, and the Gulf Coast, which may have had significant mental health effects on the population. To determine rates and predictors of symptoms consistent with a diagnosis of posttraumatic stress disorder (PTSD) in New Orleans residents following Hurricane Katrina, we conducted a web-based survey 6 months after Hurricane Katrina made landfall. Participants included 1,542 employees from the largest employer in New Orleans. The prevalence of PTSD symptoms was 19.2%. Predictors of PTSD symptoms in a multivariate-adjusted regression model included female sex, non-black race, knowing someone who died in the storm, not having property insurance, having had a longer evacuation, a much longer work commute compared to before Hurricane Katrina, and currently living in a newly purchased or rented house or in a temporary trailer. Despite universal health coverage and the benefits of an employee assistance program for all employees, only 28.5% of those with PTSD symptoms had talked to a health professional about the events of Hurricane Katrina or issues encountered since the storm. A significant burden of PTSD symptoms was present 6 months following Hurricane Katrina among a large group of adults who had returned to work in New Orleans. Given their key role in the economic redevelopment of the region, there is a tremendous need to identify those in the workforce with symptoms consistent with PTSD and to enhance treatment options. The strong relationship between displacement from ones' pre-Katrina residence and symptoms of PTSD suggests a need to focus resource utilization and interventions on individuals living in temporary housing.Urban as a determinant of health
AbstractVlahov, D., Freudenberg, N., Proietti, F., Ompad, D., Quinn, A., Nandi, V., & Galea, S. (n.d.).Publication year
2007Journal title
Journal of Urban HealthVolume
84Page(s)
i16-i26AbstractCities are the predominant mode of living, and the growth in cities is related to the expansion of areas that have concentrated disadvantage. The foreseeable trend is for rising inequities across a wide range of social and health dimensions. Although qualitatively different, this trend exists in both the developed and developing worlds. Improving the health of people in slums will require new analytic frameworks. The social-determinants approach emphasizes the role of factors that operate at multiple levels, including global, national, municipal, and neighborhood levels, in shaping health. This approach suggests that improving living conditions in such arenas as housing, employment, education, equality, quality of living environment, social support, and health services is central to improving the health of urban populations. While social determinant and multilevel perspectives are not uniquely urban, they are transformed when viewed through the characteristics of cities such as size, density, diversity, and complexity. Ameliorating the immediate living conditions in the cities in which people live offers the greatest promise for reducing morbidity, mortality, and disparities in health and for improving quality of life and well being.Urbanicity, urbanization, and the urban environment
AbstractOmpad, D. C., Galea, S., & Vlahov, D. (n.d.). In Macrosocial Determinants of Population Health (1–).Publication year
2007Page(s)
53-69AbstractWe live in an increasingly interconnected world, as some like to say, a "global village." As in any village, social, economic and biophysical environments shape individual action and interaction, which, in turn, influence the quality of life and the health of inhabitants. Technology, information, media, food, goods and services, as well as environmental pollution and diseases are shared among villages, cities, countries and continents. Not only are these exchanges great in scope, but the magnitude and speed of interaction among individuals and populations is also increasing. For example, international trade grew 8.6% per year during the decade 1990-1999 (World Trade Organization, 2000a, b), with an estimated US$1.7 trillion in daily global trading (Lee, 2000). An estimated 760 million people traveled to international destinations in 2004 (World Trade Organization, 2005), and circumnavigation of the globe is now possible in a mere 36 hours (Smolinski, Hamburg, & Lederberg, 2003). Immigration contributes to global exchanges, with an estimated 175 million individuals spending at least one year in another country (United Nations, 2002). Additionally, approximately 17 million refugees and internally displaced persons migrate from their homes every year (United Nations High Commissioner for Refugees, 2004). These trends of growing interactions on the global scale shape the environments in which we live and which influence our well-being and our health.Determinants of influenza vaccination in hard-to-reach urban populations
AbstractBryant, W. K., Ompad, D. C., Sisco, S., Blaney, S., Glidden, K., Phillips, E., Vlahov, D., & Galea, S. (n.d.).Publication year
2006Journal title
Preventive MedicineVolume
43Issue
1Page(s)
60-70AbstractObjective.: Influenza vaccination rates among disadvantaged minority and hard-to-reach populations are lower than in other groups. We assessed the barriers to influenza vaccination in disadvantaged urban areas. Methods.: We conducted a cross-sectional study, using venue-based sampling, collecting data on residents of eight neighborhoods throughout East Harlem and the Bronx, New York City. Results.: Of 760 total respondents, 461 (61.6%) had received influenza vaccination at some point in their life. In multivariable models, having access to routine medical care, receipt of health or social services, having tested positive for HIV, and current interest in receiving influenza vaccination were significantly associated with having received influenza vaccination in the previous year. Of participants surveyed, 79.6% were interested in receiving an influenza vaccination at the time of survey. Among participants who had never previously received influenza vaccination in the past, 73.4% were interested in being vaccinated; factors significantly associated with an interest in being vaccinated were minority race, lower annual income, history of being homeless, being uninsured/underinsured, and not having access to routine medical care. Conclusions.: Participants who are unconnected to health or social services or government health insurance are less likely to have been vaccinated in the past although these persons are willing to receive vaccine if it were available.