Debra Furr-Holden
Debra Furr-Holden
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Professor of Epidemiology
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Professional overview
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Debra M. Furr-Holden is an epidemiologist and passionate advocate for health equity. A public health professional with broad expertise in health disparities and policy-level interventions toward health equity, her scholarship encompasses a range of topics including drug and alcohol dependence epidemiology, psychiatric epidemiology, and prevention science.
Dean Furr-Holden hails from Michigan State University, where she was the C.S. Mott Endowed Professor of Public Health and associate dean for public health integration. In announcing her appointment, effective July 2022, NYU President Andrew Hamilton noted Dr. Furr-Holden’s extensive experience working with local and national policymakers, her skill at team-building and success as a mentor, and her exceptional talent as a communicator on public health and health equity issues.
Indeed, it is Dean Furr-Holden’s action-oriented research and commitment to training the next generation of public health practitioners that dovetails perfectly with GPH’s mission to use data-driven interventions and cutting-edge innovation to identify and implement equitable solutions to both domestic and international public health challenges.
In addition to her endowed professorship at MSU, Dr. Furr-Holden served as director of the NIH-funded Flint Center for Health Equity Solutions at the College of Human Medicine. During the Covid-19 pandemic she was appointed to the Michigan Coronavirus Task Force on Racial Disparities, the Greater Flint Coronavirus Task Force on Racial Inequity, and the New York City African American Covid-19 Task Force. Most notably, in Michigan and Flint the racial disparity in Covid-19 cases and deaths among African Americans was eliminated.
Prior to her appointments at MSU Dr. Furr-Holden was an assistant (2007) and later associate (2011) professor at Johns Hopkins’ Bloomberg School of Public Health, where she retains an appointment as an adjunct professor. Before Johns Hopkins, she was a research scientist at the Pacific Institute for Research and Evaluation and a faculty member at Morgan State University.
Dean Furr-Holden is a widely published scholar whose writings include more than 120 peer-reviewed papers in high impact journals. In 2021 she published a seminal article in Addiction that highlighted racial disparities in opioid overdose deaths over the past two decades, and she was recently quoted in an exclusive article in The New York Times examining the demography of deaths nationwide from Covid-19.
Dean Furr-Holden is the recipient of numerous awards and honors, including the White House Presidential Early Career Award for Scientists and Engineers; the Michigan State University College of Human Medicine Junior Faculty Mentoring Award; and the Meeting the Moment for Public Health Award, recognizing the Michigan Coronavirus Task Force on Racial Disparities, of which she is a founding member.
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Education
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BA, Johns Hopkins University Krieger School of Arts & Sciences, Baltimore, MAPhD, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MA
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Publications
Publications
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
2021Volume
46Issue
5Page(s)
878-879Right Sizing Flint’s Infrastructure in the Wake of the Flint Water Crisis Would Constitute an Additional Environmental Injustice
AbstractSadler, R. C., Furr-Holden, D., Greene-Moton, E., Larkin, B., Timlin, M., Walling, D., & Wyatt, T. (n.d.).Publication year
2021Journal title
Journal of the American Planning AssociationVolume
87Issue
3Page(s)
424-432AbstractRight 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
AbstractHines, C. J., Smart, M., Delellis, N., Remington Sprague, F., & Furr-Holden, D. (n.d.).Publication year
2020Journal title
Progress in Community Health Partnerships: Research, Education, and ActionVolume
14Issue
3Page(s)
307-313AbstractObjectives: 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
2020Journal title
Health EquityVolume
4Issue
1Page(s)
150-157Alcohol Advertising and Violence
AbstractTrangenstein, P. J., Greene, N., Eck, R. H., Milam, A. J., Furr-Holden, C. D., & Jernigan, D. H. (n.d.).Publication year
2020Journal title
American journal of preventive medicineVolume
58Issue
3Page(s)
343-351AbstractIntroduction: 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.Are Clinicians Contributing to Excess African American COVID-19 Deaths? Unbeknownst to Them, They May Be
AbstractMilam, A. J., Furr-Holden, D., Edwards-Johnson, J., Webb, B., Patton, J. W., Ezekwemba, N. C., Porter, L., Davis, T. M., Chukwurah, M., Webb, A. J., Simon, K., Franck, G., Anthony, J., Onuoha, G., Brown, I. M., Carson, J. T., & Stephens, B. C. (n.d.).Publication year
2020Journal title
Health EquityVolume
4Issue
1Page(s)
139-141AbstractAfrican Americans are overrepresented among reported coronavirus disease 2019 (COVID-19) cases and deaths. There are a multitude of factors that may explain the African American disparity in COVID-19 outcomes, including higher rates of comorbidities. While individual-level factors predictably contribute to disparate COVID-19 outcomes, systematic and structural factors have not yet been reported. It stands to reason that implicit biases may fuel the racial disparity in COVID-19 outcomes. To address this racial disparity, we must apply a health equity lens and disaggregate data explicitly for African Americans, as well as other populations at risk for biased treatment in the health-care system.Discrepancies in Local, State, and National Alcohol Outlet Listings: Implications for Research and Interventions
AbstractMilam, A. J., Barajas, C. B., Buchalski, Z., Wang, L., Sadler, R. C., & Furr-Holden, C. D. M. (n.d.).Publication year
2020Journal title
Substance Use and MisuseVolume
55Issue
14Page(s)
2348-2356AbstractBackground: The availability of local, state, and national data on alcohol outlet density have important implications for policies and interventions aiming to reduce alcohol-related problems. High-quality data on locations of alcohol outlets is important to accurately inform community interventions and public health initiatives, but such data is often not maintained, readily available, or of sufficient quality. Objectives: This study aims to examine the discrepancies between alcohol outlet databases and how neighborhood characteristics (i.e. income, majority racial population, urbanicity) are associated with the discrepancies between databases. Methods: Data was collected from national (n = 1), local (n = 2), and state databases (n = 3). Negative binomial regression models were used to assess discrepancies in alcohol outlet count at the ZIP code level based on the data source. Results: The average density of alcohol outlets (per 1000 residents) ranged from 0.71 to 2.17 in Maryland, 1.65 to 5.17 in Wisconsin, and 1.09 to 1.22 in Oregon based on different sources of data. Findings suggest high income areas (>200% poverty level) have fewer discrepancies (IR = 0.775, p < 0.01), low income areas (below poverty level) have greater discrepancies (IR = 4.990, p < 0.01), and urban areas tend to have fewer discrepancies (IR = 0.378, p < 0.01) between datasets. Conclusion: Interventions and policies depend on valid and reliable data; researchers, policymakers, and local agencies need to collaborate to develop methods to maintain accurate and accessible data.Expanding Tools for Investigating Neighborhood Indicators of Drug Use and Violence: Validation of the NIfETy for Virtual Street Observation
AbstractNesoff, E. D., Milam, A. J., Barajas, C. B., & Furr-Holden, C. D. M. (n.d.).Publication year
2020Journal title
Prevention ScienceVolume
21Issue
2Page(s)
203-210AbstractA growing body of evidence suggests that characteristics of the neighborhood environment in urban areas significantly impact risk for drug use behavior and exposure to violent crime. Identifying areas of community need, prioritizing planning projects, and developing strategies for community improvement require inexpensive, easy to use, evidence-based tools to assess neighborhood disorder that can be used for a variety of research, urban planning, and community needs with an environmental justice frame. This study describes validation of the Neighborhood Inventory for Environmental Typology (NIfETy), a neighborhood environmental observational assessment tool designed to assess characteristics of the neighborhood environment related to violence, alcohol, and other drugs, for use with Google Street View (GSV). GSV data collection took place on a random sample of 350 blocks located throughout Baltimore City, Maryland, which had previously been assessed through in-person data collection. Inter-rater reliability metrics were strong for the majority of items (ICC ≥ 0.7), and items were highly correlated with in-person observations (r ≥ 0.6). Exploratory factor analysis and constrained factor analysis resulted in one, 14-item disorder scale with high internal consistency (alpha = 0.825) and acceptable fit indices (CFI = 0.982; RMSEA = 0.051). We further validated this disorder scale against locations of violent crimes, and we found that disorder score was significantly and positively associated with neighborhood crime (IRR = 1.221, 95% CI = (1.157, 1.288), p < 0.001). The NIfETy provides a valid, economical, and efficient tool for assessing modifiable neighborhood risk factors for drug use and violence prevention that can be employed for a variety of research, urban planning, and community needs.Measurement of Social Processes at the Neighborhood Level in Baltimore City
AbstractWilliams, S. C., Milam, A. J., Furr-Holden, C. D. M., & Salgado, C. C. (n.d.).Publication year
2020Journal title
American journal of community psychologyVolume
66Issue
1Page(s)
53-64AbstractAbstract : Small-area ecological research is critical to inform place-based interventions at the neighborhood level; however, objective measurement of the social context has been limited. The current study extends the application of the Neighborhood Inventory for Environmental Typology (NIfETy) through the development and evaluation of measures of social context for a longer period of observation (3 years) and at a larger area of aggregation (census tract clusters) compared to previous studies using measures at the block-face level from a single observation. Observations from the 172-item inventory were collected from a random sample of block faces (n = 793) in Baltimore City annually over a three-year period. Through a multistep process including replication of previous measures, data reduction, and factor analysis, six unique neighborhood-level indices were generated to describe the environmental context: drug and alcohol use, violence, physical disorder, epicenter, youth activity, and improvements. An assessment of measurement consistency and validity provided support for some indices, while others had notable limitations. These indices can assist local policymakers and public health practitioners assessing the needs of individual neighborhoods and evaluating the effectiveness of place-based interventions designed to improve the neighborhood environment and population health outcomes.Neighborhood Profiles and Associations with Coping Behaviors among Low-Income Youth
AbstractRabinowitz, J. A., Powell, T., Sadler, R., Reboussin, B., Green, K., Milam, A., Smart, M., Furr-Holden, D., Latimore, A., & Tandon, D. (n.d.).Publication year
2020Journal title
Journal of Youth and AdolescenceVolume
49Issue
2Page(s)
494-505AbstractExtant research has typically examined neighborhood characteristics in isolation using variable-centered approaches; however, there is reason to believe that perceptions of the neighborhood environment influence each other, requiring the use of person-centered approaches to study these relationships. The present study sought to determine profiles of youth that differ in their perceptions of their neighborhoods and objective neighborhood characteristics, and whether these profiles are associated with youth coping. Participants were low-income, African American youth (N= 733; 51.0% female, M age = 18.76 years, SD = 1.71) from a metropolitan city who were originally recruited for the Youth Opportunity program in Baltimore, Maryland. A latent profile analysis was conducted which included self-reported neighborhood social cohesion, collective efficacy, disorder, violence, and disadvantage derived from census data. Coping behaviors, specifically positive cognitive restructuring, problem-focused coping, distraction strategies, and avoidant behaviors were assessed via self-reported questionnaires. Four neighborhood profiles were identified: highest disorder (20.0%); highest violence/highest disadvantage (5.2%); high violence (26.6%); and highest cohesion/lowest disorder (48.2%). Individuals in the highest violence/highest disadvantage profile reported higher positive cognitive restructuring and problem-focused coping than the other profiles. These findings warrant an investigation into the individual assets and contextual resources that may contribute to more positive coping behaviors among youth in more violent and disadvantaged neighborhoods, which has the potential to improve resilient outcomes among youth in similar at-risk settings.The Impact of COVID-19 on African American Communities in the United States
AbstractCyrus, E., Clarke, R., Hadley, D., Bursac, Z., Trepka, M. J., Dévieux, J. G., Bagci, U., Furr-Holden, D., Coudray, M., Mariano, Y., Kiplagat, S., Noel, I., Ravelo, G., Paley, M., & Wagner, E. F. (n.d.).Publication year
2020Journal title
Health EquityVolume
4Issue
1Page(s)
476-483AbstractPurpose: The purpose of this ecological study was to understand the impact of the density of African American (AA) communities on coronavirus disease 2019 (COVID-19) prevalence and death rate within the three most populous counties in each U.S. state and territory (n=152). Methods: An ecological design was employed for the study. The top three most populous counties of each U.S. state and territory were included in analyses for a final sample size of n=152 counties. Confirmed COVID-19 cases and deaths that were accumulated between January 22, 2020 and April 12, 2020 in each of the three most populous counties in each U.S. state and territory were included. Linear regression was used to determine the association between AA density and COVID-19 prevalence (defined as the percentage of cases for the county population), and death rate (defined as number of deaths per 100,000 population). The models were adjusted for median age and poverty. Results: There was a direct association between AA density and COVID-19 prevalence; COVID-19 prevalence increased 5% for every 1% increase in county AA density (p<0.01). There was also an association between county AA density and COVID-19 deaths; the death rate increased 2 per 100,000 for every percentage increase in county AA density (p=0.02). Conclusion: These findings indicate that communities with a high AA density have been disproportionately burdened with COVID-19. To help develop effective interventions and programs that address this disparity, further study is needed to understand social determinants of health driving inequities for this community.The violence prevention potential of reducing alcohol outlet access in Baltimore, Maryland
AbstractTrangenstein, P. J., Eck, R. H., Lu, Y., Webster, D., Jennings, J. M., Latkin, C., Milam, A. J., Furr-Holden, D., & Jernigan, D. H. (n.d.).Publication year
2020Journal title
Journal of Studies on Alcohol and DrugsVolume
81Issue
1Page(s)
24-33AbstractObjective: There are few cost-effectiveness analyses that model alcohol outlet zoning policies. This study determines the potential decreases in homicides, disability-adjusted life years (DALYs), and victim and criminal justice costs associated with four policy options that would reduce the alcohol outlet access in Baltimore. Method: This cost-effectiveness analysis used associations between on-premise (incidence rate ratio [IRR] = 1.41), off-premise (IRR = 1.76), and combined on-and off-premise outlet density (IRR = 1.07) and homicide in Baltimore. We determined the potential change in the level of homicide that could occur with changes in the density of alcohol outlets, assuming that 50% of the association was causal. Results: Reducing alcohol outlet density in Baltimore City by one quintile was associated with decreases of 51 homicides per year, $63.7 million, and 764 DALYs. Removing liquor stores in residential zones was associated with 22 fewer homicides, which would cost $27.5 million and lead to 391 DALYs. Removing bars/ taverns operating as liquor stores was associated with a decrease of one homicide, $1.2 million, and 17 DALYs. Removing both the liquor stores in residential zones and the bars/taverns operating as liquor stores was associated with 23 fewer homicides, which translated to $28.7 million and 409 DALYs. Conclusions: For preventing homicides, the strategy of removing liquor stores in residential zones was preferred because it was associated with substantial reductions in homicides without closing unacceptably high numbers of outlets. It is possible that policies that close the bars/taverns operating as liquor stores would be associated with decreases in other types of violent crime.Using Zoning as a Public Health Tool to Reduce Alcohol Outlet Oversaturation, Promote Compliance, and Guide Future Enforcement: a Preliminary Analysis of Transform Baltimore
AbstractFurr-Holden, C. D. M., Milam, A. J., Nesoff, E. D., Linton, S., Reboussin, B., Sadler, R. C., & Leaf, P. J. (n.d.).Publication year
2020Journal title
Journal of Urban HealthVolume
97Issue
4Page(s)
568-582AbstractAlcohol outlet oversaturation often exacerbates negative public health outcomes. Recently, Baltimore City passed an extensive zoning rewrite (“TransForm Baltimore”) that sought to give local government and residents a tool to reduce alcohol outlet oversaturation through land use regulation. The present investigation evaluated the outlet and neighborhood characteristics of stores impacted by two components of TransForm Baltimore: (1) a requirement that taverns licensed for on-premise consumption in addition to off-premise, carryout sales generate at least 50% of their business from on-premise sales, and (2) a requirement to close, repurpose, or relocate all package stores (i.e., off-premise alcohol outlets) that have been operating as “non-conforming” in residential zones since 1971. Research assistants visited every off-premise alcohol outlet in the city (n = 685) to complete an observational assessment. Approximately 77% (n = 530) of these off-premise alcohol outlets were open, including 292 taverns and 238 package stores. t tests and chi-square tests were used to compare neighborhood characteristics (neighborhood disadvantage, median household income, and racial segregation) of sham taverns (i.e., taverns with less than 50% space dedicated for on-premise sales that were primarily operating as a package store) and non-conforming package stores. Of the 292 taverns accessible during the study, the remainder were chronically closed (n = 130); 24 (8.2%) were deemed sham taverns. Sham taverns were more likely to be located in communities with more economic disadvantage and lower median household income (t test; p < 0.05). Compared to taverns, a lower proportion of sham taverns had visible dance floor space, patrons drinking, and menus available (chi-square test; p < 0.001). There were 80 residentially zoned, non-conforming alcohol outlets. These non-conforming alcohol outlets were disproportionately distributed in predominately poor and African American communities (t test; p < 0.05). As compared to conforming alcohol outlets, more non-conforming alcohol outlets sold sex paraphernalia and healthy foods (chi-square test; p < 0.05). With active enforcement, TransForm Baltimore offers the opportunity for local government and residents to improve public health and increase health equity in vulnerable and marginalized neighborhoods.Community-engaged development of a GIS-based healthfulness index to shape health equity solutions
AbstractSadler, R. C., Hippensteel, C., Nelson, V., Greene-Moton, E., & Furr-Holden, C. D. (n.d.).Publication year
2019Journal title
Social Science and MedicineVolume
227Page(s)
63-75AbstractAddressing health disparities requires both community engagement and an understanding of the social determinants of health. Although elements of the built environment can influence behavior change in public health interventions, such determinants have not been explicitly teased out via participatory mapping. An opportunity exists to integrate community voice in the development of such metrics. To fill this gap and inform the deployment of public health interventions in the Flint (USA) Center for Health Equity Solutions (FCHES), we created a means of assessing spatially-varying community needs and assets in a geographic information system (GIS), what we refer to as a healthfulness index. We engaged community and academic partners in their expert opinions on features of Flint's built environment that may promote or inhibit healthy behaviors via a multiple-criteria decision analysis framework. Experts selected from and ranked 29 variables in 6 categories (including amenities, environment, greenspace, housing, infrastructure, and social issues) using the analytic hierarchy process. The resulting matrices of expert opinions were aggregated and appended as weights for each variable's corresponding map layer. When combined through map algebra, composite scores yield spatially-varying healthfulness indices which signal any neighborhood's relative health promoting qualities (along a 0–100 scale). Results varied substantially across Flint, with the middle belt scoring highest and older neighborhoods in the northeast and north center of the city scoring lowest. Scores were aggregated to 38 Flint neighborhoods; for each of two project-specific indices, these ranged from lows of 38.7 (Hilborn Park) and 41.8 (Columbia Heights) to highs of 52.9 (College Cultural) and 58.0 (University Ave Corridor). We hypothesize that—even when controlling for individual-level factors—we will measure better and more sustained behavior change among participants living in neighborhoods with high healthfulness scores. Future work will examine this hypothesis and determine the importance of such indices in other similar communities.Coping, Discrimination, and Physical Health Conditions Among Predominantly Poor, Urban African Americans: Implications for Community-Level Health Services
AbstractBarajas, C. B., Jones, S. C., Milam, A. J., Thorpe, R. J., Gaskin, D. J., LaVeist, T. A., & Furr-Holden, C. D. M. (n.d.).Publication year
2019Journal title
Journal of Community HealthVolume
44Issue
5Page(s)
954-962AbstractAfrican Americans and ethnic minorities experience racial discrimination in a variety of settings. Racial discrimination is a potent stressor that has been linked to psychosocial stress and poor physical health. To cope with discriminatory experiences and daily life event stressors, African Americans frequently use the concept of John Henryism (a high effort coping strategy with prolonged exposure to stress). This cross-sectional analysis explored the relationship between racism/discrimination, John Henryism, and health problems in a predominately African American sample. Data were collected through health care screenings for hypertension, diabetes, and obesity and a self-report survey to assess experiences of discrimination and use of John Henryism. Logistic and linear regression models were used to assess the relationship between the John Henryism score, racism/discrimination score, and health problems among 352 participants. John Henryism was associated with a decrease in systolic blood pressure (b = − 12.50, 95% CI = − 23.05, − 1.95) among men, after adjusting for experiences of racism/discrimination and demographic characteristics. Experiences of racism/discrimination were associated with an increase in systolic blood pressure (b = 11.23, 95% CI = 0.38, 22.09) among men, after adjusting for John Henryism and demographic characteristics. Among women, there was no association found between John Henryism and experiences of racism/discrimination with systolic blood pressure. No association was found between John Henryism and experiences of racism/discrimination with being overweight/obese in women nor men. The study found that John Henryism was positively associated with the health of men, while experiences of racism/discrimination were negatively associated with their health. Limitations of the study are discussed, and recommendations are made to guide future research exploring the concept of John Henryism as a relevant factor between stress, racial discrimination and poor health.Does Tobacco Outlet Inequality Extend to High-White Mid-Atlantic Jurisdictions? A Study of Socioeconomic Status and Density
AbstractFakunle, D. O., Thorpe, R. J., Furr-Holden, C. D. M., Curriero, F. C., & Leaf, P. J. (n.d.).Publication year
2019Journal title
Journal of Racial and Ethnic Health DisparitiesVolume
6Issue
2Page(s)
409-418AbstractTobacco outlet density research has evolved to require a more refined examination of socioeconomic status’ influence beyond median household income. This study investigates the effects of SES on census-tract-level tobacco outlet density in five predominantly White Maryland jurisdictions. Tobacco license addresses and demographic data were analyzed via t tests and spatial lag modeling. Results showed that higher SES jurisdictions had lower tobacco outlet density than lower SES jurisdictions despite similar White populations and that median household income had consistent associations with tobacco outlet density. This study corroborates findings that differences in SES correlate with differences in tobacco outlet density between racially similar areas.Individual and Neighborhood Factors Associated with Sexual Behavior Classes in an Urban Longitudinal Sample
AbstractGreen, K. M., Matson, P. A., Reboussin, B. A., Milam, A. J., Furr-Holden, C. D. M., Rabinowitz, J. A., Powell, T. W., & Ialongo, N. S. (n.d.).Publication year
2019Journal title
Sexually Transmitted DiseasesVolume
46Issue
2Page(s)
98-104AbstractBackground This study aimed to increase understanding of the clustering of sexual behaviors in an urban sample of emerging adults, and the individual and neighborhood factors associated with sexual behavior patterns to provide insight into reducing the disproportionate burden of poor sexual outcomes among urban African Americans. Methods We draw on 2 cohorts of urban, predominantly African American youth first assessed at age 6 years and follow-up to emerging adulthood (mean age, 20 years; n = 1618). Latent class analyses by gender identified co-occurrence of sexual behavior. Results We found 3 classes for both males and females: high-risk (13% of males, 15% of females), low-risk (54% of males, 56% of females) and no-risk (33% of males, 29% of females). Membership in the high-risk class was associated with school dropout, a substance use disorder diagnosis, having a criminal arrest, pregnancy, and sexually transmitted diseases for both males and females. High-risk females also had higher rates of depression. Low-risk males and females also had elevated risk of pregnancy and parenthood. Neighborhood factors distinguished the high- and no-risk classes for males and females, including the neighborhood environment scale, which assessed poverty, safety, drug activity, and crime/violence in the neighborhood. Neighborhood religiosity was inversely associated with membership in the high-risk class compared with the no-risk class for females only. Neighborhood racism distinguished those in the high-risk class compared with the no-risk class for males. Conclusions Future work should take into account the clustering of sexual risk behaviors. Specific neighborhood factors could be addressed to reduce sexual health disparities.Neighbourhood alcohol environment and injury risk: A spatial analysis of pedestrian injury in Baltimore City
AbstractNesoff, E. D., Milam, A. J., Pollack, K. M., Curriero, F. C., Bowie, J. V., Knowlton, A. R., Gielen, A. C., & Furr-Holden, D. M. (n.d.).Publication year
2019Journal title
Injury PreventionVolume
25Issue
5Page(s)
350-356AbstractOBJECTIVES: The purpose of this study was to investigate the contribution of neighbourhood disorder around alcohol outlets to pedestrian injury risk.METHODS: A spatial analysis was conducted on census block groups in Baltimore City. Data included pedestrian injury EMS records from 1 January 2014 to 15 April 2015 (n=858), off-premise alcohol outlet locations for 2014 (n=693) and neighbourhood disorder indicators and demographics. Negative binomial regression models were used to determine the relationship between alcohol outlet count and pedestrian injuries at the block group level, controlling for other neighbourhood factors. Attributable risk was calculated by comparing the total population count per census block group to the injured pedestrian count.RESULTS: Each one-unit increase in the number of alcohol outlets was associated with a 14.2% (95% CI 1.099 to 1.192, P<0.001) increase in the RR of neighbourhood pedestrian injury, adjusting for traffic volume, pedestrian volume, population density, per cent of vacant lots and median household income. The attributable risk was 10.4% (95% CI 7.7 to 12.7) or 88 extra injuries. Vacant lots was the only significant neighbourhood disorder indicator in the final adjusted model (RR=1.016, 95% CI 1.007 to 1.026, P=0.003). Vacant lots have not been previously investigated as possible risk factors for pedestrian injury.CONCLUSIONS: This study identifies modifiable risk factors for pedestrian injury previously unexplored in the literature and may provide evidence for alcohol control strategies (eg, liquor store licencing, zoning and enforcement).Racial discrimination, John Henryism coping, and behavioral health conditions among predominantly poor, urban African Americans: Implications for community-level opioid problems and mental health services
AbstractJones, S. C., Brooks, J. H., Milam, A. J., Barajas, C. B., LaVeist, T. A., Kane, E., & Furr-Holden, C. D. M. (n.d.).Publication year
2019Journal title
Journal of Community PsychologyVolume
47Issue
5Page(s)
1032-1042AbstractThe current study examined the relationship between John Henryism Active Coping (JHAC), experiences of racial discrimination, and behavioral health outcomes in a community sample of 319 Black adults. Assessments included primary health care screenings as well as self-reported survey questions to assess JHAC, experiences of discrimination, and self-reported behavioral health. Logistic regression models, adjusted for control variables, found a significant relationship between JHAC and having an opioid problem (odds ratio [OR] = 0.95, p = 0.003) and needing mental health services (OR = 0.95, p < 0.001), such that higher levels of coping were associated with lower odds of reporting an opioid problem and needing mental health services. Notably, racial discrimination was not significantly independently associated with behavioral health. Implications for interventions and community programming are discussed.Social influences on drinking trajectories from adolescence to young adulthood in an urban minority sample
AbstractReboussin, B. A., Furr-Holden, D. M., Green, K. M., Ialongo, N. S., Rabinowitz, J. A., Matson, P. A., Maher, B., Nelson, V., & Milam, A. J. (n.d.).Publication year
2019Journal title
Journal of Studies on Alcohol and DrugsVolume
80Issue
2Page(s)
186-195AbstractObjective: Research on the heterogeneity in drinking patterns of urban minorities within a socioecological framework is rare. The purpose of this study was to explore multiple, distinct patterns of drinking from adolescence to young adulthood in a sample of urban minority youth and to examine the influence of neighborhood, family, and peers on these trajectories. Method: Data are from a longitudinal study of 584 (56% male) primarily Black (87%) youth who were first sampled in childhood based on their residence in low-income neighborhoods in Baltimore City and followed up annually through age 26. Data were analyzed using group-based trajectory modeling and multinomial logistic regression. Results: Modeling revealed six trajectories from ages 14 to 26: abstainer, experimenter, adult increasing, young adult increasing, adolescent limited, and adolescent increasing. Neighborhood disadvantage was a risk factor for drinking regardless of the timing of onset. Perceptions of availability, peer drinking, and parental approval for drinking were risk factors for underage drinking trajectories, whereas parental supervision was a significant protective factor. Positive social activities in neighborhoods was protective against increased drinking, whereas a decline in perceptions of peer drinking was associated with adolescent-limited drinking. Conclusions: Our findings uniquely highlight the importance of developing interventions involving parents for urban minority youth for whom family is particularly relevant in deterring underage drinking. Perhaps most importantly, our data suggest that interventions that support positive social activities in disadvantaged neighborhoods are protective against adolescent drinking and altering perceptions of peer drinking may reduce adolescent drinking among low-income, urban minority youth. (J. Stud. Alcohol Drugs, 80, 186–195, 2019).The continuum of community engagement in research: A roadmap for understanding and assessing progress
AbstractKey, K. D., Furr-Holden, D., Yvonne Lewis, E., Cunningham, R., Zimmerman, M. A., Johnson-Lawrence, V., & Selig, S. (n.d.).Publication year
2019Journal title
Progress in Community Health Partnerships: Research, Education, and ActionVolume
13Issue
4Page(s)
427-434AbstractBackground: The past two decades have been marked by increased community involvement in the research process. Community-engaged research (CEnR) is increasingly promoted in the literature, and academic programs with a community–academic partnership focus. Community-based participatory research (CBPR) is an approach to frame equitable community involvement in research and is a critical component of the CEnR continuum. As with CEnR, noted benefits of using CBPR expressed in the literature, which include enhancing the relevance and application of the research data, expertise to complex problems at all stages of research, overcoming community distrust, and improving community health. This article presents a community engagement (CE) model that includes seven defined designations for CEnR. In addition, this model includes equity indicators and contextual factors for consideration at the various levels of engagement along the continuum. Methods: The CE model described in this article combines the principles of CE and CBPR in conjunction with a continuum model. The continuum integrates a focus on health equity and contextual factors providing perspectives from both community and academic partners at each point of engagement. Conclusions: A broadly defined CEnR continuum will allow researchers, community members and organizations to readily identify 1) where they are on the continuum of CEnR, 2) appropriate access points to enter the continuum based on existing contextual factors, and 3) actions to promote progression on the continuum. Funders have the opportunity to specify the appropriate level of CE needed to accomplish the goals of their identified priorities.The epidemiology of opioid overdose in Flint and Genesee County, Michigan: Implications for public health practice and intervention
AbstractSadler, R. C., & Furr-Holden, D. (n.d.).Publication year
2019Journal title
Drug and alcohol dependenceVolume
204AbstractAs the opioid epidemic continues to worsen throughout the United States, researchers and practitioners require additional tools to help in efforts to address use and prevent overdose. Although opioids are increasingly of concern to all racial and socioeconomic groups, specific geographic regions and sub-populations remain more burdened by overdoses than others. The example of Flint, Michigan, is used to contextualize the landscape of opioid overdose death and understand geographic and demographic variation in risk. Kernel density analysis and spatial joins in ArcGIS were used to map opioid overdose death clusters, treatment availability, and neighborhood-level conditions to uncover factors related to overdose death. Spatial analysis revealed three geographic clusters in opioid overdose death in Flint. These neighborhoods tended to be somewhat poorer but also significantly Whiter than the average Flint neighborhood. Alternatively, opioid overdose death clusters did not occur in predominately African-American neighborhoods. As well, treatment sites were not coincident with the location of overdose death clusters, suggesting a potential need for geographically-targeted interventions. Of the 47 treatment sites, only 29 offered medication-assisted treatment, and expansion of these programs may therefore be warranted. This work is of great importance to ongoing prevention and treatment efforts in Flint, but also to other communities with a need for better tools to monitor and intervene in the opioid epidemic.The Impact of the Urban Neighborhood Environment on Marijuana Trajectories During Emerging Adulthood
AbstractReboussin, B. A., Ialongo, N. S., Green, K. M., Furr-Holden, D. M., Johnson, R. M., & Milam, A. J. (n.d.).Publication year
2019Journal title
Prevention ScienceVolume
20Issue
2Page(s)
270-279AbstractAlthough there is little difference in rates of marijuana use between White and Black youth, Blacks have significantly higher rates of marijuana use and disorder in young adulthood. Theory suggests that factors tied to social disadvantage may explain this disparity, and neighborhood setting may be a key exposure. This study sought to identify trajectories of marijuana use in an urban sample during emerging adulthood, neighborhood contexts that predict these trajectories and social role transitions or “turning points” that may redirect them. Data are from a longitudinal cohort study of 378 primarily Black emerging adults who were first sampled in childhood based on their residence in low-income neighborhoods in Baltimore City and followed up annually. Group-based trajectory modeling identified three groups: No Use (68.8%), Declining Use (19.6%), and Chronic Use (11.7%). Living in close proximity to an alcohol outlet, and living in a neighborhood with more female-headed households and higher rates of violent crime increased the odds of membership in the Chronic Use group relative to No Use. Living in a neighborhood with more positive social activity increased the odds of membership in the Declining Use group relative to No Use. Not receiving a high school diploma or GED, pregnancy, and parenting also increased the odds of membership in the Declining Use group relative to No Use. These findings provide support that minority youth living in socially toxic and disordered neighborhoods are at increased risk of continuing on a trajectory of marijuana use during emerging adulthood while positive social activity in neighborhoods has the potential to redirect these negative trajectories. Besides taking on the responsibilities of parenting, emerging adults in the marijuana user groups had similar educational and family outcomes, suggesting that early marijuana use may have long-term implications.The population randomization observation process (PROP) assessment method: Using systematic habitation observations of street segments to establish household-level epidemiologic population samples
AbstractSmart, M., Sadler, R., Harris, A., Buchalski, Z., Pearson, A., & Debra Furr-Holden, C. (n.d.).Publication year
2019Journal title
International Journal of Health GeographicsVolume
18Issue
1AbstractBackground: Identifying and intervening on health disparities requires representative community public health data. For cities with high vacancy and transient populations, traditional methods of population estimation for refining random samples are not feasible. The aim of this project was to develop a novel method for systematic observations to establish community epidemiologic samples. Results: We devised a four-step population randomization observation process for Flint, Michigan, USA: (1) Use recent total population data for community areas (i.e., neighborhoods) to establish the proportional sample size for each area, (2) Randomly select street segments of each community area, (3) Deploy raters to conduct observations about habitation for each randomly selected segment, and (4) Complete observations for second and third street segments, depending on vacancy levels. We implemented this systematic observation process on 400 randomly selected street segments. Of these, 130 (32.5%) required assessment of secondary segments due to high vacancy. Among the 130 primary segments, 28 (21.5%) required assessment of tertiary (or more) segments. For 71.5% of the 400 primary street segments, there was consensus among raters on whether the dwelling inhabited or uninhabited. Conclusion: Houses observed with this method could have easily been considered uninhabited via other methods. This could cause residents of ambiguous dwellings (likely to be the most marginalized residents with highest levels of unmet health needs) to be underrepresented in the resultant sample.Understanding the relationship between alcohol outlet density and life expectancy in Baltimore City: The role of community violence and community disadvantage
AbstractFurr-Holden, C. D. M., Nesoff, E. D., Nelson, V., Milam, A. J., Smart, M., Lacey, K., Thorpe, R. J., & Leaf, P. J. (n.d.).Publication year
2019Journal title
Journal of Community PsychologyVolume
47Issue
1Page(s)
63-75AbstractThis research investigated the relationship between alcohol outlet density (AOD) and life expectancy, as mediated by community violence and community disadvantage. We used linear regression models to assess bivariate and multivariate relationships. There was a negative bivariate association between liquor store density and average life expectancy (β = −7.3370, p < 0.001). This relationship was partially attenuated when controlling for community disadvantage and fully attenuated when controlling for community violence. Bars/taverns (i.e., on-premise) were not associated with average life expectancy (β = −0.589, p = 0.220). Liquor store density is associated with higher levels of community disadvantage and higher rates of violence, both of which are associated with lower life expectancies. Future research, potential intervention, and current related policies are discussed.