Skip to main content

David Abramson

David Abramson

David Abramson

Clinical Associate Professor of Global Public Health

Professional overview

Dr. David Abramson’s passion for disaster preparedness and response took root early in his career when he was both a paramedic and a writer for such magazines as Rolling Stone, Esquire, and Outside. What fascinates him most is how the health of a body--at the individual or population level--can dramatically improve or decline along with the severity of the damage inflicted by disaster, and then recover.

Dr. Abramson is the lead investigator on the Sandy Child and Family Health Study, a major representative population study of 1 million New Jersey residents living in Superstorm Sandy's path. He also dove into disaster research in Louisiana immediately after Hurricane Katrina, as well as spearheaded several studies following the Deepwater Horizon Spill.

The premise underlying Dr. Abramson’s research program – Population Impact, Recovery, and Resiliency (PiR2) – is the application of social science theory and methodology to complex population health issues associated with disaster-related or stressor-related recovery and resiliency.

Out of his research, Dr. Abramson has built a number of unique courses designed just for public health scholars, including “Public Health Emergency Preparedness and Response - A Global Perspective” and “Disasters, Complex Systems, and the Social Ecology of Health.” Using a number of disaster case studies, students analyze ecological and infrastructural systems as well as the role of social and behavioral determinants of health in disaster policy, practice, and research.

 

Education
BA, English (High Honors), Queens College, New York, NY
MPH, Sociomedical Sciences, Columbia University, New York, NY
PhD, Sociomedical Sciences/Political Science, Columbia University, New York, NY
Honors and awards
Columbia University Alumni Association Scholarship (2003)
Eugene Litwak Prize for best doctoral dissertation proposal, Mailman School of Public Health (2002)
Columbia University School of Public Health Alumni Association Scholarship Award (1982)
Nyack Hospital Paramedic Program Valedictorian (1989)
Areas of research and study
Community Health
Disaster Impact and Recovery
Population Health
Public Health Systems
Social Behaviors
Publications

Crisis Decision-Making During Hurricane Sandy: An Analysis of Established and Emergent Disaster Response Behaviors in the New York Metro Area

Chandler, T., Abramson, D., Panigrahi, B., Schlegelmilch, J., & Frye, N.

Publication year

2016

Journal title

Disaster Medicine and Public Health Preparedness

Page(s)

1-7
10.1017/dmp.2016.68
Abstract

Objective: This collective case study examined how and why specific organizational decision-making processes transpired at 2 large suburban county health departments in lower New York State during their response to Hurricane Sandy in 2012. The study also examined the relationships that the agencies developed with other emerging and established organizations within their respective health systems. Methods: In investigating these themes, the authors conducted in-depth, one-on-one interviews with 30 senior-level public health staff and first responders; reviewed documentation; and moderated 2 focus group discussions with 17 participants. Results: Although a natural hazard such as a hurricane was not an unexpected event for these health departments, they nevertheless confronted a number of unforeseen challenges during the response phase: prolonged loss of power and fuel, limited situational awareness of the depth and breadth of the storm’s impact among disaster-exposed populations, and coordination problems with a number of organizations that emerged in response to the disaster. Conclusions: Public health staff had few plans or protocols to guide them and often found themselves improvising and problem-solving with new organizations in the context of an overburdened health care system (Disaster Med Public Health Preparedness. 2016;page 1 of 7).

Foreword

Fothergill, A., Peek, L.A., Abramson, D., & Redlener, I.

Publication year

2015

The Medical Home and Care Coordination in Disaster Recovery: Hypothesis for Interventions and Research

Kanter, R.K., Abramson, D., Redlener, I., & Gracy, D.

Publication year

2015

Journal title

Disaster Medicine and Public Health Preparedness

Volume

9

Page(s)

337-343
10.1017/dmp.2015.22
Abstract

In postdisaster settings, health care providers encounter secondary surges of unmet primary care and mental health needs that evolve throughout disaster recovery phases. Whatever a community's predisaster adequacy of health care, postdisaster gaps are similar to those of any underserved region. We hypothesize that existing practice and evidence supporting medical homes and care coordination in primary care for the underserved provide a favorable model for improving health in disrupted communities. Elements of medical home services can be offered by local or temporary providers from outside the region, working out of mobile clinics early in disaster recovery. As repairs and reconstruction proceed, local services are restored over weeks or years. Throughout recovery, major tasks include identifying high-risk patients relative to the disaster and underlying health conditions, assisting displaced families as they transition through housing locations, and tracking their evolving access to health care and community services as they are restored. Postdisaster sources of financial assistance for the disaster-exposed population are often temporary and evolving, requiring up-to-date information to cover costs of care until stable services and insurance coverage are restored. Evidence to support disaster recovery health care improvement will require research funding and metrics on structures, processes, and outcomes of the disaster recovery medical home and care coordination, based on adaptation of standard validated methods to crisis environments.

Preparedness and emergency response research centers: Early returns on investment in evidence-based public health systems research

Qari, S.H., Abramson, D., Kushma, J.A., & Halverson, P.K.

Publication year

2014

Journal title

Public Health Reports

Volume

129

Page(s)

1-4

School interventions after the Joplin tornado

Kanter, R.K., & Abramson, D.

Publication year

2014

Journal title

Prehospital and Disaster Medicine

Volume

29

Page(s)

214-217
10.1017/S1049023X14000181
Abstract

Background/Objective To qualitatively describe interventions by schools to meet children's needs after the May 2011 Joplin, Missouri tornado. Methods Qualitative exploratory study conducted six months after the tornado. Key informant interviews with school staff (teachers, psychologists, guidance counselor, nurse, principal), public health official, and physicians. Report After the tornado, school staff immediately worked to contact every enrolled child to provide assistance and coordinate recovery services. Despite severe damage to half of the city's schools, the decision was made to reopen schools at the earliest possible time to provide a safe, reassuring environment and additional services. An expanded summer school session emphasized child safety and emotional wellbeing. The 2011-2012 school year began on time, less than three months after the disaster, using temporary facilities. Displaced children were bused to their usual schools regardless of their new temporary residence locations. In just-in-time training sessions, teachers developed strategies to support students and staff experiencing anxiety or depression. Certified counselors conducted school-based, small-group counseling for students. Selective referrals were made to community mental health providers for children with greatest needs. Conclusions Evidence from Joplin adds to a small body of empirical experience demonstrating the important contribution of schools to postdisaster community recovery. Despite timely and proactive services, many families and children struggled after the tornado. Improvements in the effectiveness of postdisaster interventions at schools will follow from future scientific evidence on optimal approaches.

The Resilience Activation Framework: a Conceptual Model of How Access to Social Resources Promotes Adaptation and Rapid Recovery in Post-disaster Settings

Abramson, D., Grattan, L.M., Mayer, B., Colten, C.E., Arosemena, F.A., Bedimo-Rung, A., & Lichtveld, M.

Publication year

2014

Journal title

Journal of Behavioral Health Services and Research

Volume

42

Page(s)

42-57
10.1007/s11414-014-9410-2
Abstract

A number of governmental agencies have called for enhancing citizens’ resilience as a means of preparing populations in advance of disasters, and as a counterbalance to social and individual vulnerabilities. This increasing scholarly, policy, and programmatic interest in promoting individual and communal resilience presents a challenge to the research and practice communities: to develop a translational framework that can accommodate multidisciplinary scientific perspectives into a single, applied model. The Resilience Activation Framework provides a basis for testing how access to social resources, such as formal and informal social support and help, promotes positive adaptation or reduced psychopathology among individuals and communities exposed to the acute collective stressors associated with disasters, whether human-made, natural, or technological in origin. Articulating the mechanisms by which access to social resources activate and sustain resilience capacities for optimal mental health outcomes post-disaster can lead to the development of effective preventive and early intervention programs.

The Science and Practice of Resilience Interventions for Children Exposed to Disasters

Wizemann, T.M., Snair, M.R., Altevogt, B.M., , & Abramson, D.

Publication year

2014

Hurricane Sandy: Lessons learned, again

Abramson, D., & Redlener, I.

Publication year

2012

Journal title

Disaster Medicine and Public Health Preparedness

Volume

6

Page(s)

328-329
10.1001/dmp.2012.76

Measuring the impact of hurricane katrina on access to a personal healthcare provider: The use of the national survey of children's health for an external comparison group

Stehling-Ariza, T., Park, Y.S., Sury, J.J., & Abramson, D.

Publication year

2012

Journal title

Maternal and Child Health Journal

Volume

16

Page(s)

170-177
10.1007/s10995-012-1006-y
Abstract

This paper examined the effect of Hurricane Katrina on children's access to personal healthcare providers and evaluated the use of propensity scoremethods to compare a nationally representative sample of children, as a proxy for an unexposed group, with a smaller exposed sample. 2007 data from the Gulf Coast Child and Family Health (G-CAFH) Study, a longitudinal cohort of households displaced or greatly impacted by Hurricane Katrina, were matched with 2007 National Survey of Children's Health (NSCH) data using propensity score techniques. Propensity scores were created using poverty level, household educational attainment, and race/ethnicity, with and without the addition of child age and gender. The outcome was defined as having a personal healthcare provider. Additional confounders (household structure, neighborhood safety, health and insurance status)were also examined. All covariates except gender differed significantly between the exposed (G-CAFH) and unexposed (NSCH) samples. Fewer G-CAFH children had a personal healthcare provider (65 %) compared to those from NSCH (90 %). Adjusting for all covariates, the propensity score analysis showed exposed children were 20 %less likely to have a personal healthcare provider compared to unexposed children in the US (OR = 0.80, 95 % CI 0.76, 0.84), whereas the logistic regression analysis estimated a stronger effect (OR = 0.28, 95 % CI 0.21, 0.39). Two years after Hurricane Katrina, children exposed to the storm had significantly lower odds of having a personal health care provider compared to unexposed children. Propensity score matching techniques may be useful for combining separate data samples when no clear unexposed group exists. © Springer Science+Business Media, LLC 2012.

Persistence of mental health needs among children affected by hurricane Katrina in New Orleans

Olteanu, A., Arnberger, R., Grant, R., Davis, C., Abramson, D., & Asola, J.

Publication year

2011

Journal title

Prehospital and Disaster Medicine

Volume

26

Page(s)

3-6
10.1017/S1049023X10000099
Abstract

Background: Hurricane Katrina made landfall in August 2005 and destroyed the infrastructure of New Orleans. Mass evacuation ensued. The immediate and long-lasting impact of these events on the mental health of children have been reported in survey research. This study was done to describe the nature of mental health need of children during the four years after Hurricane Katrina using clinical data from a comprehensive healthcare program. Medical and mental health services were delivered on mobile clinics that traveled to medically underserved communities on a regular schedule beginning immediately after the hurricane. Patients were self-selected residents of New Orleans. Most had incomes below the federal poverty level and were severely affected by the hurricane. Methods: Paper charts of pediatric mental health patients were reviewed for visits beginning with the establishment of the mental health program from 01 July 2007 through 30 June 2009 (n = 296). Demographics, referral sources, presenting problems, diagnoses, and qualitative data describing Katrina-related traumatic exposures were abstracted. Psychosocial data were abstracted from medical charts. Data were coded and processed for demographic, referral, and diagnostic trends. Results: Mental health service needs continued unabated throughout this period (two to nearly four years post-event). In 2008, 29% of pediatric primary care patients presented with mental health or developmental/learning problems, including the need for intensive case management. The typical presentation of pediatric mental health patients was a disruptive behavior disorder with an underlying mood or anxiety disorder. Qualitative descriptive data are presented to illustrate the traumatic post-disaster experience of many children. School referrals for mental health evaluation and services were overwhelmingly made for disruptive behavior disorders. Pediatric referrals were more nuanced, reflecting underlying mood and anxiety disorders. Histories indicated that many missed opportunities for earlier identification and intervention. Conclusions: Mental health and case management needs persisted four years after Hurricane Katrina and showed no signs of abating. Many children who received mental health services had shown signs of psychological distress prior to the hurricane, and no causal inferences are drawn between disaster experience and psychiatric disorders. Post-disaster mental health and case management services should remain available for years post-event. To ensure timely identification and intervention of child mental health needs, pediatricians and school officials may need additional training. © 2014 World Association for Disaster and Emergency Medicine.

Rural and suburban population surge following detonation of an improvised nuclear device: A new model to estimate impact

Meit, M., Redlener, I., Briggs, T.W., Kwanisai, M., Culp, D., & Abramson, D.

Publication year

2011

Journal title

Disaster Medicine and Public Health Preparedness

Volume

5
10.1001/dmp.2011.20
Abstract

Background: The objective of the study was to model urban evacuation into surrounding communities after the detonation of an improvised nuclear device (IND) to assist rural and suburban planners in understanding and effectively planning to address the effects of population surges. Methods: Researchers developed parameters for how far evacuees would travel to escape disasters and factors that would influence choice of destination from studies of historical evacuations, surveys of citizens' evacuation intentions in hypothetical disasters, and semistructured interviews with key informants and emergency preparedness experts. Those parameters became the inputs to a "push-pull" model of how many people would flee in the 4 scenarios and where they would go. Results: The expanded model predicted significant population movements from the New York City borough of Manhattan and counties within 20 km of Manhattan to counties within a 150-mi radius of the assumed IND detonation. It also predicted that even in some communities located far from Manhattan, arriving evacuees would increase the population needing services by 50% to 150%. Conclusions: The results suggest that suburban and rural communities could be overwhelmed by evacuees from their center city following an IND detonation. They also highlight the urgency of educating and communicating with the public about radiation hazards to mitigate panic and hysteria, anticipating the ways in which a mass exodus may disrupt or even cripple rescue and response efforts, and devising creative ways to exercise and drill for an event about which there is great denial and fatalism. © 2011 American Medical Association.

Children as bellwethers of recovery: Dysfunctional systems and the effects of parents, households, and neighborhoods on serious emotional disturbance in children after Hurricane Katrina

Abramson, D., Park, Y.S., Stehling-Ariza, T., & Redlener, I.

Publication year

2010

Journal title

Disaster Medicine and Public Health Preparedness

Volume

4
10.1001/dmp.2010.7
Abstract

Background: Over 160 000 children were displaced from their homes after Hurricane Katrina. Tens of thousands of these children experienced the ongoing chaos and uncertainty of displacement and transiency, as well as significant social disruptions in their lives. The objectives of this study were to estimate the long-term mental health effects of such exposure among children, and to elucidate the systemic pathways through which the disaster effect operates. Methods: The prevalence of serious emotional disturbance was assessed among 283 school-aged children in Louisiana and Mississippi. These children are part of the Gulf Coast Child & Family Health Study, involving a longitudinal cohort of 1079 randomly sampled households in the two states, encompassing a total of 427 children, who have been interviewed in 4 annual waves of data collection since January 2006. The majority of data for this analysis was drawn from the fourth round of data. Results: Although access to medical care for children has expanded considerably since 2005 in the region affected by Hurricane Katrina, more than 37% of children have received a clinical mental health diagnosis of depression, anxiety, or behavior disorder, according to parent reports. Children exposed to Hurricane Katrina were nearly 5 times as likely as a pre-Katrina cohort to exhibit serious emotional disturbance. Path analyses confirm the roles played by neighborhood social disorder, household stressors, and parental limitations on children's emotional and behavioral functioning. Conclusions: Children and youth are particularly vulnerable to the effects of disasters. They have limited capacity to independently mobilize resources to help them adapt to stressful postdisaster circumstances, and are instead dependent upon others to make choices that will influence their household, neighborhood, school, and larger social environment. Children's mental health recovery in a postdisaster setting can serve as a bellwether indicator of successful recovery or as a lagging indicator of system dysfunction and failed recovery. ©2010 American Medical Association. All rights reserved.

Emergency response and public health in Hurricane Katrina: What does it mean to be a public health emergency responder?

Van Devanter, N., Leviss, P., Abramson, D., Moon-Howard, J., & Honoré, P.A.

Publication year

2010

Journal title

Journal of Public Health Management and Practice

Volume

16
10.1097/PHH.0b013e3181d8bbb2
Abstract

Since 9/11, federal funds directed toward public health departments for training in disaster preparedness have dramatically increased, resulting in changing expectations of public health workers' roles in emergency response. This article explores the public health emergency responder role through data collected as part of an oral history conducted with the 3 health departments that responded to Hurricane Katrina in Mississippi and Louisiana. The data reveals a significant change in public health emergency response capacity as a result of federal funding. The role is still evolving, and many challenges remain, in particular, a clear articulation of the public health role in emergency response, the integration of the public health and emergency responder cultures, identification of the scope of training needs and strategies to maintain new public health emergency response skills, and closer collaboration with emergency response agencies. Copyright © 2010 Wolters Kluwer Health |Lippincott Williams & Wilkins.

Experiences of Public health workers in responding to Hurricane Katrina: Voices from the storm

Moon-Howard, J., VanDevanter, N., Abramson, D., Leviss, P., & Honoré, P.A.

Publication year

2010

Journal title

Journal of Public Health Management and Practice

Measuring individual disaster recovery: A socioecological framework

Abramson, D., Stehling-Ariza, T., Park, Y.S., Walsh, L., & Culp, D.

Publication year

2010

Journal title

Disaster Medicine and Public Health Preparedness

Volume

4
10.1001/dmp.2010.14
Abstract

Background: Disaster recovery is a complex phenomenon. Too often, recovery is measured in singular fashion, such as quantifying rebuilt infrastructure or lifelines, without taking in to account the affected population's individual and community recovery. A comprehensive framework is needed that encompasses a much broader and far-reaching construct with multiple underlying dimensions and numerous causal pathways; without the consideration of a comprehensive framework that investigates relationships between these factors, an accurate measurement of recovery may not be valid. This study proposes a model that encapsulates these ideas into a single framework, the Socio-Ecological Model of Recovery. Methods: Using confirmatory factor analysis, an operational measure of recovery was developed and validated using the five measures of housing stability, economic stability, physical health, mental health, and social role adaptation. The data were drawn from a sample of displaced households following Hurricane Katrina. Measures of psychological strength, risk, disaster exposure, neighborhood contextual effects, and formal and informal help were modeled to examine their direct and indirect effects on recovery using a structural equation model. Findings: All five elements of the recovery measure were positively correlated with a latent measure of recovery, although mental health and social role adaptation displayed the strongest associations. An individual's psychological strength had the greatest association with positive recovery, followed by having a household income greater than $20 000 and having informal social support. Those factors most strongly associated with an absence of recovery included the time displaced since the hurricane, being disabled, and living in a community with substantial social disorder. Discussion: The socio-ecological framework provides a robust means for measuring recovery, and for testing those factors associated with the presence or absence of recovery. ©2010 American Medical Association. All rights reserved.

Recovery research, Katrina's fifth anniversary, and lessons relearned

Redlener, I., & Abramson, D.

Publication year

2010

Journal title

Disaster Medicine and Public Health Preparedness

Volume

4
10.1001/dmp.2010.1001

Lessons from Katrina – What Went Wrong, What Was Learned, Who’s Most Vulnerable

Abramson, D., Redlener, I., & Garfield, R.

Publication year

2009

Journal title

Cardozo Journal of Law and Gender

Volume

14

Page(s)

783 - 790

Analyzing postdisaster surveillance data: The effect of the statistical method

Di Maggio, C., Abramson, D., & Galea, S.

Publication year

2008

Journal title

Disaster Medicine and Public Health Preparedness

Volume

2

Page(s)

119-126
10.1097/DMP.0b013e31816c7475
Abstract

Data from existing administrative databases and ongoing surveys or surveillance methods may prove indispensable after mass traumas as a way of providing information that may be useful to emergency planners and practitioners. The analytic approach, however, may affect exposure prevalence estimates and measures of association. We compare Bayesian hierarchical modeling methods to standard survey analytic techniques for survey data collected in the aftermath of a terrorist attack. Estimates for the prevalence of exposure to the terrorist attacks of September 11, 2001, varied by the method chosen. Bayesian hierarchical modeling returned the lowest estimate for exposure prevalence with a credible interval spanning nearly 3 times the range of the confidence intervals (Cls) associated with both unadjusted and survey procedures. Bayesian hierarchical modeling also returned a smaller point estimate for measures of association, although in this instance the credible interval was tighter than that obtained through survey procedures. Bayesian approaches allow a consideration of preexisting assumptions about survey data, and may offer potential advantages, particularly in the uncertain environment of postterrorism and disaster settings. Additional comparative analyses of existing data are necessary to guide our ability to use these techniques in future incidents. (Disaster Med Public Health Preparedness. 2008;2:119-126). © 2008.

Prevalence and predictors of mental health distress post-katrina: Findings from the gulf coast child and family health study

Abramson, D., Stehling-Ariza, T., Garfield, R., & Redlener, I.

Publication year

2008

Journal title

Disaster Medicine and Public Health Preparedness

Volume

2

Page(s)

77-86
10.1097/DMP.0b013e318173a8e7
Abstract

Background: Catastrophic disasters often are associated with massive structural, economic, and population devastation; less understood are the long-term mental health consequences. This study measures the prevalence and predictors of mental health distress and disability of hurricane survivors over an extended period of recovery in a postdisaster setting. Methods: A representative sample of 1077 displaced or greatly affected households was drawn in 2006 using a stratified cluster sampling of federally subsidized emergency housing settings in Louisiana and Mississippi, and of Mississippi census tracts designated as having experienced major damage from Hurricane Katrina in 2005. Two rounds of data collection were conducted: a baseline face-to-face interview at 6 to 12 months post-Katrina, and a telephone follow-up at 20 to 23 months after the disaster. Mental health disability was measured using the Medical Outcome Study Short Form 12, version 2 mental component summary score. Bivariate and multivariate analyses were conducted examining socioeconomic, demographic, situational, and attitudinal factors associated with mental health distress and disability. Results: More than half of the cohort at both baseline and follow-up reported significant mental health distress. Self-reported poor health and safety concerns were persistently associated with poorer mental health. Nearly 2 years after the disaster, the greatest predictors of poor mental health included situational characteristics such as greater numbers of children in a household and attitudinal characteristics such as fatalistic sentiments and poor self-efficacy. Informal social support networks were associated significantly with better mental health status. Housing and economic circumstances were not independently associated with poorer mental health. Conclusions: Mental health distress and disability are pervasive issues among the US Gulf Coast adults and children who experienced long-term displacement or other serious effects as a result of Hurricanes Katrina and Rita. As time progresses postdisaster, social and psychological factors may play greater roles in accelerating or impeding recovery among affected populations. Efforts to expand disaster recovery and preparedness policies to include long-term social re-engagement efforts postdisaster should be considered as a means of reducing mental health sequelae. (Disaster Med Public Health Preparedness. 2008;2:77-86).

Children and Megadisasters: Lessons Learned in the New Millennium

Garrett, A.L., Grant, R., Madrid, P., Brito, A., Abramson, D., & Redlener, I.

Publication year

2007

Journal title

Advances in Pediatrics

Volume

54

Page(s)

189-214
10.1016/j.yapd.2007.03.011
Abstract

Many specific lessons were learned from recent megadisasters in the United States at the expense of children who suffered from a government and a citizenry that was desperately unprepared to respond to and recover from the disaster's short- and long-term effects. During the 9/11 attacks, the nation learned a new sense of vulnerability as the specter of terrorism was delivered repeatedly to our collective consciousness. As this article has emphasized, children experienced significant and widespread psychological effects from this event, and many did not receive adequate treatment. Hurricane Katrina exploited the weaknesses of an already strained child mental health system and vividly demonstrated the liability of poor preparedness and inadequate communication by both families and governments. The impact of Katrina continues to affect many thousands of children over a year later, as the systems that were intended to care for them have largely moved on. Indeed, there was no mention of Hurricane Katrina, the Gulf Coast, or the storm's survivors in the 2007 State of the Union address by the President. After 9/11 and the unprecedented federal spending that occurred to increase our nation's readiness, it is discouraging that the response to Hurricane Katrina fell so short of what had the potential to be the greatest disaster response and recovery story in the history of our nation. It is unlikely that further uncontained expenditures will solve the problems that were exposed in the Gulf Coast. There is not a solution that money can buy. One need only look a few hundred miles south to the Cuban disaster response system to appreciate where some of our shortfalls lie. Cuba has succeeded where the United States has not in part because its citizens are participants in their own preparedness. They engage their children and their families in preparedness planning and they rely upon other members of their community to strengthen their ability to survive as individuals. The American mentality of "dial 911 in an emergency and wait for help" works only as long as there are enough resources to match the need. In a disaster, this approach has proven to be inadequate over and over again. In America, we are well positioned to be leaders in responding to the needs of children affected by disaster. The resources of our government and the resourcefulness of our people should offer much promise for the future. By analyzing our past shortfalls and taking practical steps to mitigate the existing barriers to preparedness, our children, we hope, will fare much better the next time a megadisaster strikes. Box 7 includes suggestions for national priorities for child disaster care. © 2007 Elsevier Inc. All rights reserved.

Housing need, housing assistance, and connection to HIV medical care

Aidala, A.A., Lee, G., Abramson, D., Messeri, P., & Siegler, A.

Publication year

2007

Journal title

AIDS and Behavior

Volume

11
10.1007/s10461-007-9276-x
Abstract

HIV infection has become a chronic condition that for most persons can be effectively managed with regular monitoring and appropriate medical care. However, many HIV positive persons remain unconnected to medical care or have less optimal patterns of health care utilization than recommended by good clinical practice standards. This paper investigates housing status as a contextual factor affecting access and maintenance in appropriate HIV medical care. Data provided from 5,881 interviews conducted from 1994 to 2006 with a representative sample of 1,661 persons living with HIV/AIDS in New York City demonstrated a strong and consistent relationship between housing need and remaining outside of or marginal to HIV medical care. In contrast, housing assistance increased access and retention in medical care and appropriate treatment. The relationship between housing and medical care outcomes remain controlling for client demographics, health status, insurance coverage, co-occurring mental illness, and problem drug use and the receipt of supportive services to address co-occurring conditions. Findings provide strong evidence that housing needs are a significant barrier to consistent, appropriate HIV medical care, and that receipt of housing assistance has an independent, direct impact on improved medical care outcomes. © 2007 Springer Science+Business Media, LLC.

Patient satisfaction with different interpreting methods: A randomized controlled trial

Gany, F., Leng, J., Shapiro, E., Abramson, D., Motola, I., Shield, D.C., & Changrani, J.

Publication year

2007

Journal title

Journal of General Internal Medicine

Volume

22

Page(s)

312-318
10.1007/s11606-007-0360-8
Abstract

BACKGROUND: Growth of the foreign-born population in the U.S. has led to increasing numbers of limited-English-proficient (LEP) patients. Innovative medical interpreting strategies, including remote simultaneous medical interpreting (RSMI), have arisen to address the language barrier. This study evaluates the impact of interpreting method on patient satisfaction. METHODS: 1,276 English-, Spanish-, Mandarin-, and Cantonese-speaking patients attending the primary care clinic and emergency department of a large New York City municipal hospital were screened for enrollment in a randomized controlled trial. Language-discordant patients were randomized to RSMI or usual and customary (U&C) interpreting. Patients with language-concordant providers received usual care. Demographic and patient satisfaction questionnaires were administered to all participants. RESULTS: 541 patients were language-concordant with their providers and not randomized; 371 were randomized to RSMI, 167 of whom were exposed to RSMI; and 364 were randomized to U&C, 198 of whom were exposed to U&C. Patients randomized to RSMI were more likely than those with U&C to think doctors treated them with respect (RSMI 71%, U&C 64%, p <0.05), but they did not differ in other measures of physician communication/care. In a linear regression analysis, exposure to RSMI was significantly associated with an increase in overall satisfaction with physician communication/care (β 0.10, 95% CI 0.02-0.18, scale 0-1.0). Patients randomized to RSMI were more likely to think the interpreting method protected their privacy (RSMI 51%, U&C 38%, p <0.05). Patients randomized to either arm of interpretation reported less comprehension and satisfaction than patients in language-concordant encounters. CONCLUSIONS: While not a substitute for language-concordant providers, RSMI can improve patient satisfaction and privacy among LEP patients. Implementing RSMI should be considered an important component of a multipronged approach to addressing language barriers in health care. © 2007 Society of General Internal Medicine.

Public health disaster research: surveying the field, defining its future.

Abramson, D., Morse, S.S., Garrett, A.L., & Redlener, I.

Publication year

2007

Journal title

Disaster Medicine and Public Health Preparedness

Volume

1

Page(s)

57-62
10.1097/DMP.0b013e318065b7e1

HIV-positive men sexually active with women: Sexual behaviors and sexual risks

Aidala, A.A., Lee, G., Moon-Howard, J., Caban, M., Abramson, D., & Messeri, P.

Publication year

2006

Journal title

Journal of Urban Health

Volume

83

Page(s)

637-655
10.1007/s11524-006-9074-1
Abstract

This study examines patterns of sexual behavior, sexual relating, and sexual risk among HIV-positive men sexually active with women. A total of 278 HIV-positive men were interviewed every 6-12 months between 1994 and 2002 and reported considerable variability in sexual behaviors over time. Many were not sexually active at all for months at a time; many continued to have multiple female and at times male partners. Over one-third of the cohort had one or more periods when they had engaged in unprotected sex with a female partner who was HIV-negative or status unknown (unsafe sex). Periods of unsafe sex alternated with periods of safer sex. Contextual factors such as partner relations, housing status, active drug use, and recently exchanging sex showed the strongest association with increased odds of unsafe sex. A number of predictors of unsafe sex among African American men were not significant among the Latino sub-population, suggesting race/ethnic differences in factors contributing to heterosexual transmission. Implications for prevention interventions are discussed. © 2006 The New York Academy of Medicine.

Antiretroviral therapy and declining AIDS mortality in New York City

Messeri, P., Gunjeong, L., Abramson, D., Aidala, A., Chiasson, M.A., & Jessop, D.J.

Publication year

2003

Journal title

Medical Care

Volume

41

Page(s)

512-521
10.1097/00005650-200304000-00007
Abstract

OBJECTIVE. This study estimates the impact of Highly Active Antiretroviral Therapy (HAART) and other antiretroviral therapy combinations on reducing mortality risk for a cohort of HIV-infected persons living in New York City. MATERIALS AND METHODS. Data for this study come from the CHAIN project, an ongoing multiwave longitudinal study of HIV-infected persons is living in New York City (n = 700) initiated in 1994. The study sample is drawn from the clients of 43 medical and social service agencies and is broadly representative of New York City residents, who were aware of their positive serostatus at time of enrollment. Occurrences of deaths were obtained through routine field tracking and searches of death certificates and an online death registry. Information on other study variables was obtained through in-person interviews. A Cox proportional hazard model was applied to estimate the effects of medication on mortality risk. RESULTS. Mortality rates for the CHAIN cohort dropped steadily from a high of 131 deaths per 1000 persons/year in 1995 to 31 deaths per 1000 persons/year in 1999, with the historically low mortality rates continuing through 2000. Current use of HAART was associated with a 50% reduction in mortality risk (hazard ratio = 0.51, P

Contact

da76@nyu.edu +1 (212) 992-6298 715/719 Broadway New York, NY 10003