Debra Furr-Holden

Debra Furr-Holden
Debra Furr-Holden
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Dean of the School of Global Public Health

Professor of Epidemiology

Professional overview

The NYU School of Global Public Health begins a new chapter along its path to excellence in education, research, policy and practice with the appointment of C. Debra M. Furr-Holden, an epidemiologist and passionate advocate for health equity, as Dean of GPH and Professor of Epidemiology. 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.

Education

BA, Johns Hopkins University Krieger School of Arts & Sciences, Baltimore, MA
PhD, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MA

Publications

Publications

Racial and Ethnic Disparities in Perioperative Health Care Among Patients Undergoing Cardiac Surgery: JACC State-of-the-Art Review

Milam, A. J., Ogunniyi, M. O., Faloye, A. O., Castellanos, L. R., Verdiner, R. E., Stewart, J. W., Chukumerije, M., Okoh, A. K., Bradley, S., Roswell, R. O., Douglass, P. L., Oyetunji, S. O., Iribarne, A., Furr-Holden, D., Ramakrishna, H., & Hayes, S. N. (n.d.).

Publication year

2024

Journal title

Journal of the American College of Cardiology

Volume

83

Issue

4

Page(s)

530-545
Abstract
Abstract
There has been little progress in reducing health care disparities since the 2003 landmark Institute of Medicine's report Unequal Treatment. Despite the higher burden of cardiovascular disease in underrepresented racial and ethnic groups, they have less access to cardiologists and cardiothoracic surgeons, and have higher rates of morbidity and mortality with cardiac surgical interventions. This review summarizes existing literature and highlights disparities in cardiovascular perioperative health care. We propose actionable solutions utilizing multidisciplinary perspectives from cardiology, cardiac surgery, cardiothoracic anesthesiology, critical care, medical ethics, and health disparity experts. Applying a health equity lens to multipronged interventions is necessary to eliminate the disparities in perioperative health care among patients undergoing cardiac surgery.

Development of a systematic social observation tool for monitoring use of harm reduction supplies

Nesoff, E. D., Aronowitz, S. V., Milam, A. J., & Furr-Holden, C. D. M. (n.d.).

Publication year

2023

Journal title

International Journal of Drug Policy

Volume

122
Abstract
Abstract
Background: Harm reduction services such as safer injection supply distribution are essential to reducing morbidity and mortality among people who use drugs (PWUD); however, local use of harm reduction supplies (e.g., tourniquets, saline solution) is difficult to routinely and systematically monitor. The purpose of this study was to develop and validate a systematic social observation tool designed to assess use of harm reduction supplies at the street block level. Methods: Data collection took place on a random sample of 150 blocks located throughout the Kensington neighborhood of North Philadelphia from November 2021 to January 2022. We measured inter-rater reliability by two-way mixed-effects intra-class correlation coefficients (ICC) with the consistency agreement definition and internal consistency reliability using Cronbach's alpha and McDonald's omega. Exploratory factor analysis with principal component extraction and promax rotation assessed internal consistency. We validated scales against locations of public syringe disposal boxes, a proxy measure for areas of concentrated drug use, using logistic regression. Results: Naloxone canisters, syringe caps, saline and sterile water solution bottles showed the highest reliability (ICC≥0.7). Items also showed high internal consistency (alpha, omega>0.7). Exploratory factor analysis identified one, three-item scale with high internal consistency: syringe caps, vials, and baggies (alpha = 0.85; omega = 0.85)—all supplies used concurrently with drug injection but not discarded in syringe disposal boxes. Drug use (OR = 1.78, 95 % CI = (1.48, 2.23)), harm reduction (OR = 3.53, 95 % CI = (2.20, 6.12)), and EFA scales (OR = 1.85, 95 %CI = (1.51, 2.34)) were significantly and positively associated with being within walking distance (≤0.25 miles or 0.4 km) of a syringe disposal box. Conclusion: This study provides an efficient tool with high reliability and validity metrics to assess community uptake of harm reduction supplies designed for use by community organizations, policy makers, or other groups providing resources to PWUD.

Establishing the Relative Accuracy of Using City Directories as Proxies to Define and Reconstruct Historical Alcohol Environments

Sadler, R. C., Trangenstein, P., Harris, A., Buchalski, Z., Wojciechowski, T. W., & Furr-Holden, C. D. (n.d.).

Publication year

2023

Journal title

Journal of Studies on Alcohol and Drugs

Volume

84

Issue

1

Page(s)

158-170
Abstract
Abstract
Objective: Research on alcohol environments has established that poorer and minoritized communities are frequently overburdened by off-premise outlets (e.g., liquor stores). These outlets have more associated harms, including increased alcohol consumption and crime rates. Little, if any, research has shown how these socio-spatial disparities in exposure have grown or shifted over time, and no studies have established a method for re-creating historical alcohol environments. Method: In this article, we establish a method for defining outlets that sell alcohol (on-and off-premise) by comparing state databases to city directories for 2012 and 2016, and then using historical directories to assign probability of selling alcohol to outlets dating back to 1950. Using this metric, we then use geographic information systems to model shifts in alcohol availability by race and socioeconomic status in 10-year in- tervals from 1950 to 2010. Results: Our results suggest that in our study city of Flint, MI, disparities in the alcohol environment have narrowed since 1950. Although liquor stores are still more likely to be located in poorer and more heavily African American neighborhoods, the pattern has become insignificant over time. Furthermore, the number of alcohol outlets per capita has declined. Thus, although the city remains more overburdened with alcohol outlets than its suburbs, the disparity has shrunk. Conclusions: This work has implications for those working in alcohol prevention and policy, as well as in urban planning. Practitioners and researchers can use this method to model alcohol availability over time in their own communities, which helps better inform the discussion on disparities experienced in poor and minoritized neighborhoods.

In Reply to Yung and Morris

Milam, A. J., McDougle, L., & Furr-Holden, D. (n.d.). In Academic Medicine (1–).

Publication year

2023

Volume

98

Issue

1

Page(s)

9

Linking Historical Discriminatory Housing Patterns to the Contemporary Alcohol Environment

Sadler, R. C., Wojciechowski, T. W., Trangenstein, P., Harris, A., Buchalski, Z., & Furr-Holden, D. (n.d.).

Publication year

2023

Journal title

Applied Spatial Analysis and Policy

Volume

16

Issue

2

Page(s)

561-581
Abstract
Abstract
Research on alcohol outlet density consistently shows greater disparities in exposure in disinvested communities. Likewise, structural racism via discriminatory housing practices has created many of the issues that beset contemporary disinvested neighborhoods. Little work, however, has examined the relationship between housing practices and alcohol outlet disparities. The central premise of our work is that these discriminatory and inequitable practices create distinctions in the alcohol environment, and that such disparities have implications for work on alcohol policy. Here we link alcohol outlet density with a spatial database examining redlining, blockbusting, and gentrification in Baltimore, Maryland, and Flint, Michigan (two cities with common experiences of urban disinvestment over the last 50 years). Standard measures are used to account for the impacts of neighborhood racial, socioeconomic, and housing composition in a multilevel model. Our findings highlight that gentrification and redlining are strongly associated with alcohol outlet density, while blockbusting is not. Gentrification and redlining also frequently co-occur in inner-urban areas, while the more suburban phenomenon of blockbusting rarely overlaps with either. These findings further contextualize nascent work on structural racism in housing that illustrates important disparities along the lines of these distinct practices. Future work should consider how legacy impacts of discriminatory housing patterns impact our communities today.

Organizational Leaders Perceptions of Barriers to Accessing Behavioral Health Services in a Low-Resource Community

Montgomery, B. W., Maschino, L. D., Felton, J. W., Young, K., Furr-Holden, C. D., & Stoddard, S. A. (n.d.).

Publication year

2023

Journal title

Journal of Behavioral Health Services and Research

Volume

50

Issue

1

Page(s)

36-48
Abstract
Abstract
Little is known about how to effectively implement behavioral health programs in low-resource communities. Leaders from 20 community-serving behavioral health organizations in Flint, MI, were asked about their organizations and the barriers that they, and the populations they serve, face in providing and accessing behavioral health services. Barriers are reported using a mixed-methods analysis, reporting the number and percentage of organizations that experienced the barrier along with example quotations from the organization leaders. The most frequently reported barrier to providing services was finding adequate funding (50%) while the most frequently reported barrier for accessing services was finding adequate and reliable transportation (30%). Comparisons of these findings with barriers reported by providers in different settings and those seeking services are discussed. These comparisons may provide an important next step in identifying areas where providers perceptions and the needs of the population are misaligned and for systemic improvements more broadly.

Peer Recovery Coaches Perceptions of Their Work and Their Implications for Training, Support and Personal Recovery

Felton, J. W., Abidogun, T. M., Senters, K., Maschino, L. D., Montgomery, B. W., Tyson, R., Furr-Holden, C. D., & Stoddard, S. A. (n.d.).

Publication year

2023

Journal title

Community mental health journal

Volume

59

Issue

5

Page(s)

962-971
Abstract
Abstract
The peer recovery workforce, including individuals in sustained recovery from substance use, has grown rapidly in the previous decades. Peer recovery coaches represent a scalable, resource-efficient, and acceptable approach to increasing service delivery, specifically among individuals receiving substance use services in low-resource communities. Despite the potential to improve access to care in traditionally underserved settings, there are a number of barriers to successfully integrating peer recovery coaches in existing recovery services. The current study presents results from two focus groups composed of peer recovery coaches. Findings suggest that peer recovery coaches report discordance between their perceived role and their daily responsibilities and experience both inter- and intrapersonal challenges that impact their own recovery processes. These results point to several promising policy and structural changes that may support and enhance this growing workforce.

An Evaluation Framework of a Transdisciplinary Collaborative Center for Health Equity Research

Ellington, R., Barajas, C. B., Drahota, A., Meghea, C., Uphold, H., Scott, J. B., Lewis, E. Y., & Furr-Holden, C. D. (n.d.).

Publication year

2022

Journal title

American Journal of Evaluation
Abstract
Abstract
Over the last few decades, there has been an increase in the number of large federally funded transdisciplinary programs and initiatives. Scholars have identified a need to develop frameworks, methodologies, and tools to evaluate the effectiveness of these large collaborative initiatives, providing precise ways to understand and assess the operations, community and academic partner collaboration, scientific and community research dissemination, and cost-effectiveness. Unfortunately, there has been limited research on methodologies and frameworks that can be used to evaluate large initiatives. This study presents a framework for evaluating the Flint Center for Health Equity Solutions (FCHES), a National Institute of Minority Health and Health Disparities (NIMHD)-funded Transdisciplinary Collaborative Center (TCC) for health disparities research. This report presents a summary of the FCHES evaluation framework and evaluation questions as well as findings from the Year-2 evaluation of the Center and lessons learned.

Experiences of Discrimination, Institutional Responses to Seminal Race Events, and Depressive Symptoms in Black U.S. Medical Students

Milam, A. J., Brown, I., Edwards-Johnson, J., McDougle, L., Sousa, A., & Furr-Holden, D. (n.d.).

Publication year

2022

Journal title

Academic Medicine

Volume

97

Issue

6

Page(s)

876-883
Abstract
Abstract
PURPOSE: To examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students.METHOD: This study collected data from a convenience sample of Black U.S. medical students via an anonymous electronic questionnaire in August 2020 that was distributed through the Student National Medical Association and Organization of Student Representatives listservs and an author's social media accounts. It included questions on demographics, institutional responses to seminal race events, experiences of discrimination, and symptoms of depression. Path models were used to examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students.RESULTS: Of the 750 students completing the survey, 733 (97.7%) were Black. Experiences of discrimination and a lack of institutional responses to seminal race events were associated with more depressive symptoms (b = 0.19, 95% CI: 0.11, 0.26; P < .001 and b = 0.12, 95% CI: 0.04, 0.20; P = .01). After controlling for gender and clinical diagnosis of depression or anxiety before medical school, there was a relationship between experiences of discrimination and institutional responses to seminal race events such that students who reported more experiences of discrimination were more likely to report that their institution did not respond to seminal race events (b = 0.41, 95% CI: 0.34, 0.48; P < .001). Experiences of discrimination moderated the relationship between institutional responses to seminal race events and depressive symptoms (i.e., the relationship between a lack of institutional responses to seminal race events and depressive symptoms was stronger among students who reported more frequent experiences of discrimination).CONCLUSIONS: Institutions dedicated to supporting Black medical student wellness must be diligent in cultivating a culture intolerant of discrimination and deft in their responses to seminal race events in the larger culture.

Mission, Organization, and Future Direction of the Serological Sciences Network for COVID-19 (SeroNet) Epidemiologic Cohort Studies

Figueiredo, J. C., Hirsch, F. R., Kushi, L. H., Nembhard, W. N., Crawford, J. M., Mantis, N., Finster, L., Merin, N. M., Merchant, A., Reckamp, K. L., Melmed, G. Y., Braun, J., Mcgovern, D., Parekh, S., Corley, D. A., Zohoori, N., Amick, B. C., Du, R., Gregersen, P. K., … Skarbinski, J. (n.d.).

Publication year

2022

Journal title

Open Forum Infectious Diseases

Volume

9

Issue

6
Abstract
Abstract
Background: Global efforts are needed to elucidate the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the underlying cause of coronavirus disease 2019 (COVID-19), including seroprevalence, risk factors, and long-Term sequelae, as well as immune responses after vaccination across populations and the social dimensions of prevention and treatment strategies. Methods: In the United States, the National Cancer Institute in partnership with the National Institute of Allergy and Infectious Diseases, established the SARS-CoV-2 Serological Sciences Network (SeroNet) as the nation's largest coordinated effort to study coronavirus disease 2019. The network comprises multidisciplinary researchers bridging gaps and fostering collaborations among immunologists, epidemiologists, virologists, clinicians and clinical laboratories, social and behavioral scientists, policymakers, data scientists, and community members. In total, 49 institutions form the SeroNet consortium to study individuals with cancer, autoimmune disease, inflammatory bowel diseases, cardiovascular diseases, human immunodeficiency virus, transplant recipients, as well as otherwise healthy pregnant women, children, college students, and high-risk occupational workers (including healthcare workers and first responders). Results: Several studies focus on underrepresented populations, including ethnic minorities and rural communities. To support integrative data analyses across SeroNet studies, efforts are underway to define common data elements for standardized serology measurements, cellular and molecular assays, self-reported data, treatment, and clinical outcomes. Conclusions: In this paper, we discuss the overarching framework for SeroNet epidemiology studies, critical research questions under investigation, and data accessibility for the worldwide scientific community. Lessons learned will help inform preparedness and responsiveness to future emerging diseases.

Symptoms of Depression and Anxiety Among Black Medical Students: the Role of Peer Connectedness and Perceived Discrimination

Milam, A. J., Oboh, O., Brown, Z., Edwards-Johnson, J., Terry, A., Barajas, C. B., Simon, K. M., & Furr-Holden, C. D. M. (n.d.).

Publication year

2022

Journal title

Journal of Racial and Ethnic Health Disparities

Volume

9

Issue

6

Page(s)

2180-2187
Abstract
Abstract
This study examined the association between discrimination, peer connectedness, and mental health symptoms among Black medical students. Data were collected from a convenience sample of Black medical students via an anonymous electronic questionnaire (n = 733) in year 2020. The Patient-Reported Outcomes Measurement Information System Depression and Anxiety forms were used to measure depression and anxiety symptoms. Structural equation modeling was used to examine the association between discrimination, peer connectedness, and mental health symptoms (Mplus 7.3). The majority of the participants were female (80%), approximately 40% were third or fourth year medical school students, and 13% had a clinical diagnosis of depression/anxiety before medical school. About half of the students reported being watched more closely than their classmates, and 66% reported feeling the need to work twice as hard as others to get the same treatment or evaluation. The majority of students reported that their peers were supportive of their academic success (60.7%), and 53% reported that students often or always invited them to social outings. The mean T-score for depressive symptoms was 53.6 (SD = 7.8), and the mean T-score for anxiety symptoms was 58.6 (SD = 8.4). Overall, findings indicated a high prevalence of anxiety and depression symptoms among Black medical students, and increased discrimination was associated with more mental health symptoms among males. Additionally, increased peer connectedness was associated with fewer symptoms of anxiety among males and females and fewer depressive symptoms among females. Addressing discrimination among medical students may improve mental health among Black medical students.

Trajectory Modeling of Spatio-Temporal Trends in COVID-19 Incidence in Flint and Genesee County, Michigan

Wojciechowski, T. W., Sadler, R. C., Buchalski, Z., Harris, A., Lederer, D., & Furr-Holden, C. D. (n.d.).

Publication year

2022

Journal title

Annals of Epidemiology

Volume

67

Page(s)

29-34
Abstract
Abstract
Purpose: : The establishment of community-academic partnerships to digest data and create actionable policy and advocacy steps is of continuing importance. In this paper, we document COVID-19 racial and geographic disparities uncovered via a collaboration between a local health department and university research center. Methods: : We leverage individual level data for all COVID-19 cases aggregated to the census block group level, where group-based trajectory modeling was employed to identify latent patterns of change and continuity in COVID-19 diagnoses. Results: : Linking with socioeconomic data from the census, we identified the types of communities most heavily affected by each of Michigan's two waves (in spring and fall of 2020). This includes a geographic and racial gap in COVID-19 cases during the first wave, which is largely eliminated during the second wave. Conclusions: : Our work has been extremely valuable for community partners, informing community-level response toward testing, treatment, and vaccination. In particular, identifying and conducting advocacy on the sizeable racial disparity in COVID-19 cases during the first wave in spring 2020 helped our community nearly eliminate disparities throughout the second wave in fall 2020.

Using trajectory modeling of spatio-temporal trends to illustrate disparities in COVID-19 death in flint and Genesee County, Michigan

Sadler, R. C., Wojciechowski, T. W., Buchalski, Z., Harris, A., Lederer, D., Peters, M., Hackert, P., & Furr-Holden, C. D. (n.d.).

Publication year

2022

Journal title

Spatial and Spatio-temporal Epidemiology

Volume

43
Abstract
Abstract
COVID-19′s rapid onset left many public health entities scrambling. But establishing community-academic partnerships to digest data and create advocacy steps offers an opportunity to link research to action. Here we document disparities in COVID-19 death uncovered during a collaboration between a health department and university research center. We geocoded COVID-19 deaths in Genesee County, Michigan, to model clusters during two waves in spring and fall 2020. We then aggregated these deaths to census block groups, where group-based trajectory modeling identified latent patterns of change and continuity. Linking with socioeconomic data, we identified the most affected communities. We discovered a geographic and racial gap in COVID-19 deaths during the first wave, largely eliminated during the second. Our partnership generated added and immediate value for community partners, including around prevention, testing, treatment, and vaccination. Our identification of the aforementioned racial disparity helped our community nearly eliminate disparities during the second wave.

Adolescent Development in Context: A Decade Review of Neighborhood and Activity Space Research

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Publication year

2021

Journal title

Journal of Research on Adolescence

Volume

31

Issue

4

Page(s)

944-965
Abstract
Abstract
Over the last decade, two lines of inquiry have emerged from earlier investigations of adolescent neighborhood effects. First, researchers began incorporating space-time geography to study adolescent development within activity spaces or routine activity locations and settings. Second, cultural-developmental researchers implicated neighborhood settings in cultural development, to capture neighborhood effects on competencies and processes that are salient or normative for minoritized youth. We review the decade’s studies on adolescent externalizing, internalizing, academic achievement, health, and cultural development within neighborhoods and activity spaces. We offer recommendations supporting decompartmentalization of cultural-developmental and activity space scholarship to advance the science of adolescent development in context.

Alcohol outlets, drug paraphernalia sales, and neighborhood drug overdose

Nesoff, E. D., Milam, A. J., Morrison, C., Weir, B. W., Branas, C. C., Furr-Holden, D. M., Knowlton, A. R., & Martins, S. S. (n.d.).

Publication year

2021

Journal title

International Journal of Drug Policy

Volume

95
Abstract
Abstract
Background: Alcohol outlets have been associated with various forms of injury and may contribute to neighborhood disparities in drug overdose. Few studies have examined the associations between alcohol outlets and drug overdose. This study investigated whether alcohol outlets were associated with the neighborhood drug overdose rate and whether the sale of drug paraphernalia contributes to this association. Methods: A cross-sectional ecological spatial analysis was conducted within census block groups in Baltimore City (n = 653). Outcomes were counts of EMS calls for any drug overdose in 2015 (n = 3,856). Exposures of interest were counts of alcohol outlets licensed for off-premise and on-premise consumption and the proportion of off-premise outlets selling drug paraphernalia (e.g., blunt wrappers, baggies, pipes). Negative binomial regression was used to assess the relationship between outlet count and overdose rate, and if paraphernalia sales altered this relationship, controlling for other neighborhood factors. Spatial autocorrelation was assessed and regression inference adjusted accordingly. Results: Each additional off-premise alcohol outlet was associated with a 16.6% increase in the neighborhood overdose rate (IRR=1.17, 95%CI=(1.11, 1.23)), adjusted for other neighborhood variables. On-premise alcohol outlets were not significantly associated with overdose rate when adjusting for off-premise alcohol outlets (IRR=1.01, 95% CI=(0.97, 1.06)). The proportion of off-premise outlets that sold drug paraphernalia was negatively associated with overdose rate (IRR=0.55, 95% CI=(0.41, 0.74)) and did not alter the relationship between off-premise outlets and overdose. Conclusion: This study provides preliminary public health evidence for informing policy decisions about alcohol outlet licensing and zoning. Alcohol outlets could be potential community partners for harm reduction strategies such as health communication in identifying overdose symptoms or Good Samaritan Laws.

An NIH investment in health equity - the economic impact of the Flint Center for Health Equity Solutions

Meghea, C. I., Montgomery, B. W., Ellington, R., Wang, L., Barajas, C., Lewis, E. Y., Yeary, S. T., Van Egeren, L. A., & Furr-Holden, D. (n.d.).

Publication year

2021

Journal title

BMC public health

Volume

21

Issue

1
Abstract
Abstract
Background: Health disparities are pervasive and are linked to economic losses in the United States of up to $135 billion per year. The Flint Center for Health Equity Solutions (FCHES) is a Transdisciplinary Collaborative Center for health disparities research funded by the National Institute of Minority Health and Health Disparities (NIMHD). The purpose of this study was to estimate the economic impact of the 5-year investment in FCHES in Genesee County, Michigan. Methods: The estimated impacts of FCHES were calculated using a U.S.-specific input/output (I/O) model, IMPLAN, from IMPLAN Group, LLC., which provides a software system to access geographic specific data regarding economic sector interactions from a variety of sources. This allowed us to model the cross-sector economic activity that occurred throughout Genesee County, Michigan, as a result of the FCHES investment. The overall economic impacts were estimated as the sum of three impact types: 1. Direct (the specific expenditures impact of FCHES and the Scientific Research and Development Services sector); 2. Indirect (the impact on suppliers to FCHES and the Scientific Research and Development Services sector); and 3. Induced (the additional economic impact of the spending of these suppliers and employees in the county economy). Results: The total FCHES investment amounted to approximately $11 million between 2016 and 2020. Overall, combined direct, indirect, and induced impacts of the total FCHES federal investment in Genesee County included over 161 job-years, over $7.6 million in personal income, and more than $19.2 million in economic output. In addition, this combined economic activity generated close to $2.3 million in state/local and federal tax revenue. The impact multipliers show the ripple effect of the FCHES investment. For example, the overall output of over $19.2 million led to an impact multiplier of 1.75 – every $1 of federal FCHES investment led to an additional $.75 of economic output in Genesee County. Conclusions: The FCHES research funding yields significant direct economic impacts above and beyond the direct NIH investment of $11 million. The economic impact estimation method may be relevant and generalizable to other large research centers such as FCHES.

Black, white, or green? The effects of racial composition and socioeconomic status on neighborhood-level tobacco outlet density

Fakunle, D. O., Curriero, F. C., Leaf, P. J., Furr-Holden, D. M., & Thorpe, R. J. (n.d.).

Publication year

2021

Journal title

Ethnicity and Health

Volume

26

Issue

7

Page(s)

1012-1027
Abstract
Abstract
Objective: To compare predominantly-Black and predominantly-White Maryland areas with similar socioeconomic status to examine the role of both race and socioeconomic status on tobacco outlet availability and tobacco outlet access. Design: Maryland tobacco outlet addresses were geocoded with 2011–2015 American Community Survey sociodemographic data. Two-sample t-tests were conducted comparing the mean values of sociodemographic variables and tobacco outlet density per Census Tract, and spatial lag based regression models were conducted to analyze the direct association between covariables and tobacco outlet density while accounting for spatial dependence between and within jurisdictions. Results: Predominantly-White jurisdictions had lower tobacco outlet availability and access than predominantly-Black jurisdictions, despite similar socioeconomic status. Spatial lag model results showed that median household income and vacant houses had consistent associations with tobacco outlet density across most of the jurisdictions analyzed, and place-based spatial lag models showed direct associations between predominantly-Black jurisdictions and tobacco outlet availability and access. Conclusion: Predominantly-White areas have lower levels of tobacco outlet density than predominantly-Black areas, despite both areas having similar socioeconomic statuses.

Evaluation of a local ordinance to prevent any underage purchases in liquor stores: The need for enforcement

Milam, A. J., Furr-Holden, C. D. M., Nesoff, E. D., & Trangenstein, P. J. (n.d.).

Publication year

2021

Journal title

Journal of Studies on Alcohol and Drugs

Volume

82

Issue

2

Page(s)

219-227
Abstract
Abstract
Objective: In June 2012, Baltimore City, MD, enacted legislation (commonly referred to as the Mosby Bill) prohibiting all liquor stores (outlets that primarily sell alcoholic beverages) from selling “any food, goods, wares, supplies, or other merchandise to any person under the age of 18.” Three years after enactment, we evaluated the impact of this legislation on non-alcohol product sales among youth. Method: Research assistants (RAs) ages 16–20 were trained in using a standardized observational tool to quantify and record characteristics of the outlets, including products sold. A trained pair comprising one RA age 16 to 20 and one RA exactly age 18 were sent into every liquor store (i.e., packaged goods stores and bar/taverns with packaged goods sales) in Baltimore to conduct the assessment and make a non-alcohol purchase. Since the research was not conducted in concert with the police, the 18-year-old RA made the purchase attempt while the other (age 16 to 20) RA completed the assessment. Results: Purchase attempts were made at 502 liquor stores, and 352 of those attempts were suc-cessful (able to make purchase without being asked for identification or age; noncompliance rate = 68.1%). Noncompliance was highest among packaged goods stores compared with bar/taverns, and in neighborhoods with a lower median household income and a higher proportion of African American residents (p < .050). Noncompliant outlets were also located closer to public schools (p < .050). Conclusions: This evaluation demonstrates that, in the absence of enforcement, ordinances are neither likely to be honored nor to achieve the intended public health benefits.

Health Data Disparities in Opioid-Involved Overdose Deaths From 1999 to 2018 in the United States

Milam, A. J., Furr-Holden, D., Wang, L., & Simon, K. M. (n.d.).

Publication year

2021

Journal title

American journal of public health

Volume

111

Issue

9

Page(s)

E1627-E1635
Abstract
Abstract
Objectives. To examine temporal trends in the classification of opioid-involved overdose deaths (OODs) and racial variation in the classification of specific types of opioids used. Methods. We analyzed OODs coded as other or unspecified narcotics from 1999 to 2018 in the United States using data from the National Vital Statistics System and the Centers for Disease Control and Prevention. Results. The total proportion of OODs from unspecified narcotics decreased from 32.4% in 1999 to 1.9% in 2018. The proportion of OODs from unspecified narcotics among African American persons was approximately 2-fold greater than that of non-Hispanic White persons until 2012. Similarly, the proportion of OODs from unspecified narcotics among Hispanic persons was greater than that of White persons until 2015. After we controlled for death investigation system, African American persons had a higher incidence rate of OODs from unspecified narcotics compared with White persons. Conclusions. There have been significant improvements in the specification OODs over the past 20 years, and there has been significant racial disparity in the classification of OODs until about 2015. The findings suggest a health data disparity; the excessive misclassification of OODs is likely attributable to the race/ ethnicity of the decedent.

Linking historical discriminatory housing patterns to the contemporary food environment in Baltimore

Sadler, R. C., Bilal, U., & Furr-Holden, C. D. (n.d.).

Publication year

2021

Journal title

Spatial and Spatio-temporal Epidemiology

Volume

36
Abstract
Abstract
Food access literature links disinvested communities with poor food access. Similarly, links are made between discriminatory housing practices and contemporary investment. Less work has examined the relationship between housing practices and food environment disparities. Our central premise is that these practices create distinctions in food environment quality, and that these disparities may have implications for food system advocacy and policymaking. In this paper, we link an objective food environment assessment with a spatial database highlighting redlining, blockbusting, and gentrification in Baltimore, Maryland, USA. Standard socioeconomic and housing characteristics are used to control for race, income, and housing composition in a multivariate regression analysis. Our findings highlight that blockbusting—rather than redlining—most strongly shapes poor food access. Redlining and gentrification, meanwhile, are associated with better food access. These findings raise important points about future policy discussions, which should instead be focused on ameliorating more contemporary patterns of housing inequality.

Reply to Drs. Hart and Cadet: we agree—the challenges of increasing equity, diversity and inclusion include societal issues and actions now are vital

Henningfield, J. E., Fields, S., Anthony, J. C., Brown, L. S., Bolaños-Guzmán, C. A., Comer, S. D., De La Garza, R., Furr-Holden, D., Garcia-Romeu, A., Hatsukami, D., Raznahan, A., & Zarate, C. A. (n.d.). In Neuropsychopharmacology (1–).

Publication year

2021

Volume

46

Issue

5

Page(s)

878-879

Right Sizing Flint’s Infrastructure in the Wake of the Flint Water Crisis Would Constitute an Additional Environmental Injustice

Sadler, R. C., Furr-Holden, D., Greene-Moton, E., Larkin, B., Timlin, M., Walling, D., & Wyatt, T. (n.d.).

Publication year

2021

Journal title

Journal of the American Planning Association

Volume

87

Issue

3

Page(s)

424-432
Abstract
Abstract
Right sizing has become an essential talking point in discussing next steps for postindustrial and shrinking cities as they struggle to maintain outdated, outsized infrastructure. Yet the literature has been clear that balancing economic and social objectives must be a key part of the discussion, especially given that historical patterns of disinvestment have disproportionately affected socioeconomically disadvantaged and racial/ethnic minority populations. In this Viewpoint, we illuminate concerns on a recent article published in this journal on right sizing that Flint (MI) should have enacted in the wake of its catastrophic water crisis. We present the nature of decline in Flint, as well as evidence from Flint’s recent master plan and its history with urban renewal that demonstrates why recommending such a policy not only goes against common urban planning practice but misses the local context in Flint, which is marked by deep-seated apprehension of the inequitable underpinnings of historical urban planning practice.

A novel method for evaluating and comparing community health reports

Hines, C. J., Smart, M., Delellis, N., Remington Sprague, F., & Furr-Holden, D. (n.d.).

Publication year

2020

Journal title

Progress in Community Health Partnerships: Research, Education, and Action

Volume

14

Issue

3

Page(s)

307-313
Abstract
Abstract
Objectives: This study assessed the comprehensiveness and efficiency of existing Flint area public health community data using a novel method. One hundred thirty-eight community public health data reports were identified and screened for inclusion from Internet searches and community partner interviews. Methods: Forty-two Centers for Disease Control and Prevention (CDC)-based health metrics were adopted as a standard for unbiased comparison. For each report, a percentage “match-to-standard” was calculated (i.e., we calculated the percentage of CDC recommended metrics that were covered in the report). The two locally generated reports with the highest match-to-standard scores were compared for overlap. Results: There were 138 initially identified reports, and 110 unique reports remained after duplicates were removed. Twenty public health data reports met inclusion criteria and were included in the final sample. The top local public health data report yielded a 59.5% match-to-standard, indicating a 23.8% gap in current Flint area community data. Evaluation across all reports yielded an 89.3% match-to-standard with a 10.7% gap. An overlap of 70% exists between the two local reports with the highest match-to-standard scores. Conclusions: This research identified key health metrics not captured by current locally generated Flint public health reports. The 23.8% gap indicates an opportunity to improve local public health data report comprehensiveness. The 70% overlap across the two local reports with greatest match-tostandard scores generated locally, indicates potential duplication and an opportunity to improve efficiency.

Access to Care during a Global Health Crisis

Furr-Holden, D., Carter-Pokras, O., Kimmel, M., & Mouton, C. (n.d.).

Publication year

2020

Journal title

Health Equity

Volume

4

Issue

1

Page(s)

150-157

Alcohol Advertising and Violence

Trangenstein, P. J., Greene, N., Eck, R. H., Milam, A. J., Furr-Holden, C. D., & Jernigan, D. H. (n.d.).

Publication year

2020

Journal title

American journal of preventive medicine

Volume

58

Issue

3

Page(s)

343-351
Abstract
Abstract
Introduction: Numerous studies have found associations between alcohol outlet density and violence, but it is unknown whether alcohol advertisements visible outside outlets are also associated with violent crime. Baltimore City, MD enacted restrictions on retail alcohol establishment advertising practices as of June 5, 2017. This study examines the association between alcohol advertisements visible outside off-premise alcohol outlets and violent crime before this restriction. Methods: Outlet observations (n=683) were conducted in summer 2015, and violent crime data (n=24,085) were from June 5, 2015, through June 4, 2017. The number of violent crimes per square mile within 1,000 feet of outlets was summed using kernel density estimation. In 2018–2019, authors used mixed models with a Simes–Benjamini–Hochberg correction for multiple testing. Results: Roughly half (47%, n=267) of the outlets with complete data (n=572) had alcohol advertisements visible from the exterior. Outlets with alcohol advertisements had 15% more violent crimes per square mile within 1,000 feet (eβ=1.15, 95% CI=1.07, 1.25, q<0.001) after adjusting for neighborhood context. All associations between alcohol advertisements and specific types of violent crime were significant, with the association strongest for homicides (eβ=1.28, 95% CI=1.13, 1.46, q<0.001). There was no association between cigarette advertisements and violent crime (eB=1.08, 95% CI=0.92, 1.26, q=0.43). Conclusions: Alcohol advertisements visible outside off-premise outlets were associated with increased violent crime over and above the association between the outlets themselves and violent crime. Reducing alcohol advertising visible from the street may decrease risk of violent crime that is associated with alcohol outlets.

Contact

gph.dean@nyu.edu 708 Broadway New York, NY, 10003