Clinical Associate Professor of Epidemiology
Emily Goldmann is a Clinical Associate Professor in the Department of Epidemiology at the School of Global Public Health. She holds a BA in Economics from Columbia University and an MPH and PhD in Epidemiology from the University of Michigan.
Trained as a psychiatric and social epidemiologist, Dr Goldmann's research focuses on the social determinants of common mental disorders, substance use, behavioral health surveillance, and physical-mental health comorbidity. She is also interested in the development of pedagogical approaches for teaching epidemiology and public health to diverse audiences. Previous work has centered on the role of neighborhoods, socioeconomic status and social support in posttraumatic stress disorder in urban areas, as well as the mental health consequences of disasters and other potentially traumatic events.
Prior to joining NYU, Dr. Goldmann conducted health economics outcomes research on various health conditions at a consulting firm and worked as an epidemiologist at the New York City Department of Health and Mental Hygiene in the Bureau of Adult Mental Health, where she conducted behavioral health surveillance among New Yorkers. Dr. Goldmann received the NYU GPH Excellence in Public Health Faculty Award for the academic year 2016-2017.
BA, Economics (Honors), Columbia University, New York, NYMPH, Epidemiology, University of Michigan, Ann Arbor, MIPhD, Epidemiologic Sciences, University of Michigan, Ann Arbor, MI
EpidemiologyMental HealthSocial BehaviorsSocial Determinants of Health
Coronavirus Disease (COVID-19) Related Discrimination and Mental Health in Five U.S. Southern CitiesLe, P. T. D., Misra, S., Hagen, D., Wang, S. M., Li, T., Brenneke, S. G., Yang, L. H., & Goldmann, E.
Journal titleStigma and HealthAbstractEvidence is mounting that stigma and discrimination related to coronavirus disease (COVID-19) disproportionately impact racial/ethnic minority groups, and that these experiences can worsen mental health. The present study sought to examine multiple types of COVID-related discrimination and their associations with mental health outcomes among racial/ethnic groups in the U.S. South, a region characterized by high levels of racial polarization and increasingly large numbers of undocumented immigrants.We used the cross-sectional, population-based COVID-19 Southern Cities Study (5/26/20–6/6/20) of n = 1,688 adults in Atlanta-GA, Austin-TX, Dallas-TX, Houston-TX, and New Orleans-LA. Three adapted scales (Everyday Discrimination, Major Discrimination, Heightened Vigilance) assessed self-reported COVID-related discrimination. Mental health outcomes included psychological distress, sleep troubles, physical reactions, and self-rated worsened mental health. Bivariable comparisons and adjusted logistic regression models were conducted. The study found that major discrimination was more common (p < .001) among Hispanic and non-Hispanic Black than non-Hispanic Asian and non-Hispanic White respondents. All racial/ethnic minority groups experienced more everyday discrimination (p = .004) and heightened vigilance due to anticipated discrimination (p < .001) than non-Hispanic White respondents. All discrimination types were associated with all mental health outcomes (Odds Ratio; OR range: 1.63–2.61) except everyday and major discrimination with sleep troubles. Results showing greater COVID-related discrimination for racial/ethnic minority groups confirm that these discrimination experiences are not solely about the infectious disease itself, but also entrenched with persistent racism. Responses to COVID-related discrimination should also consider long-lasting impacts on mental health for racial/ethnic minority groups even after the immediate pandemic ends.
Acculturation and Depressive Symptoms Among Dominicans in New York City
An examination of racial and ethnic disparities in mental health during the Covid-19 pandemic in the U.S. SouthGoldmann, E., Hagen, D., Khoury, E. E., Owens, M., Misra, S., & Thrul, J.
Journal titleJournal of Affective Disorders
Page(s)471-478AbstractBackground: The mental health of racial/ethnic minority groups in the United States may be disproportionately impacted by the COVID-19 pandemic due to greater experience of peri-pandemic stressors. Yet, few studies have systematically examined racial/ethnic differences in mental health outcomes in this context. Methods: Data came from the COVID-19 Southern Cities Study, a probability-based, cross-sectional study conducted in May/June 2020 among adults living in the metropolitan statistical areas of Atlanta, Austin, Dallas, Houston, and New Orleans. Unadjusted and adjusted associations between racial/ethnic identity and past-week depression and/or anxiety symptoms (Patient Health Questionnaire-2 score ≥ 3 or Generalized Anxiety Disorder-2 score ≥ 3), trouble sleeping, physical reactions when thinking about COVID-19, and self-rated worsened mental health due to the pandemic were estimated in separate logistic regression models. Results: Over 30% of respondents reported depression and/or anxiety symptoms, 21% reported physical reactions, 25% had trouble sleeping, and 33% worsened mental health since the pandemic began. Adjusting for sociodemographic and health-related characteristics and pandemic-related stressors, odds of anxiety symptoms (odds ratio (OR) 0.53, 95% confidence interval (CI) 0.30–0.95) and worsened mental health (OR 0.58, 95% CI 0.36–0.94) were lower among non-Hispanic Black vs. non-Hispanic white respondents. Limitations: No diagnostic assessments were used, and results may not be generalizable to later phases of the pandemic and the entire U.S. South. Conclusions: Despite greater pandemic-related stressor experience, poor mental health outcomes were not more common among racial/ethnic minority individuals. However, interventions to reduce disparities in stressor experience and promote mental health are needed.
Rapid Behavioral Health Assessment Post-disaster: Developing and Validating a Brief, Structured ModuleGoldmann, E., Abramson, D. M., Piltch-Loeb, R., Samarabandu, A., Goodson, V., Azofeifa, A., Hagemeyer, A., Al-Amin, N., & Lyerla, R.
Journal titleJournal of Community Health
Page(s)982-991AbstractTo develop and validate a brief, structured, behavioral health module for use by local public health practitioners to rapidly assess behavioral health needs in disaster settings. Data were collected through in-person, telephone, and web-based interviews of 101 individuals affected by Hurricanes Katrina (n = 44) and Sandy (n = 57) in New Orleans and New Jersey in April and May 2018, respectively. Questions included in the core module were selected based on convergent validity, internal consistency reliability, test–retest reliability across administration modes, principal component analysis (PCA), question comprehension, efficiency, accessibility, and use in population-based surveys. Almost all scales showed excellent internal consistency reliability (Cronbach’s alpha, 0.79–0.92), convergent validity (r > 0.61), and test–retest reliability (in-person vs. telephone, intra-class coefficient, ICC, 0.75–1.00; in-person vs. web-based ICC, 0.73–0.97). PCA of the behavioral health scales yielded two components to include in the module—mental health and substance use. The core module has 26 questions—including self-reported general health (1 question); symptoms of posttraumatic stress disorder, depression, and anxiety (Primary Care PTSD Screen, Patient Health Questionnaire-4; 8 questions); drinking and other substance use (Alcohol Use Disorders Identification Test-Concise, AUDIT-C; Drug Abuse Screening Test, DAST-10; stand-alone question regarding increased substance use since disaster; 14 questions); prior mental health conditions, treatment, and treatment disruption (3 questions)—and can be administered in 5–10 minutes through any mode. This flexible module allows practitioners to quickly evaluate behavioral health needs, effectively allocate resources, and appropriately target interventions to help promote recovery of disaster-affected communities.
Student-led research team-building program may help junior faculty increase productivity in competitive biomedical research environmentBragg, M., Arshonsky, J., Pageot, Y., Eby, M., Tucker, C. M., Yin, S., Goldmann, E., & Jay, M.
Journal titleBMC Medical Education
Issue1AbstractBackground: Interdisciplinary research teams can increase productivity among academic researchers, yet many junior investigators do not have the training or financial resources to build productive teams. We developed and tested the acceptability and feasibility of three low-cost services to help junior faculty build and maintain their own research teams. Methods: At an urban academic medical centre, we implemented three types of consultation services: 1) giving talks on evidence-based best practices for building teams; 2) providing easy-to-use team building resources via email; and 3) offering a year-long consultation service—co-led by students—that taught faculty to build and maintain research teams. Our primary outcome was the number of faculty who used each service. For the yearlong consultation service, we asked faculty participants to complete three online self-assessments to rate their leadership confidence, the team’s performance, and which of the consultation components were most helpful. We used descriptive statistics to evaluate faculty assessment scores at three timepoints by comparing median scores and interquartile ranges. Results: We gave 31 talks on team building to 328 faculty and postdoctoral fellows from 2014 to 2020. Separately, 26 faculty heard about our research team building expertise and requested materials via email. For the consultation service, we helped build or enhance 45 research teams from 2014 to 2020. By the end of the consultation, 100% of the faculty reported they were still maintaining their team. In the initial survey, the majority of participants (95.7%, n = 22) reported having no or few experiences in building teams. Further, when asked to rate their team’s performance at 12-months, faculty highly rated many elements of both teamwork and taskwork, specifically their team’s productivity (6/7 points), morale (6/7 points), and motivation (6/7 points). By the end of the program, faculty participants also highly rated two components of the consultation program: recruitment assistance (7/10 points) and provision of team management tools (7/10 points). Conclusions: For participating faculty, our program provided valued guidance on recruitment assistance and team management tools. The high demand for team-building resources suggests that junior faculty urgently need better training on how to develop and manage their own team.
Positive health beliefs and blood pressure reduction in the deserve studyGoldmann, E., Jacoby, R., Finfer, E., Appleton, N., Parikh, N. S., Roberts, E. T., & Boden-Albala, B.
Journal titleJournal of the American Heart Association
Issue9AbstractBACKGROUND: There is growing recognition that positive health beliefs may promote blood pressure (BP) reduction, which is critical to stroke prevention but remains a persistent challenge. Yet, studies that examine the association between positive health beliefs and BP among stroke survivors are lacking. METHODS AND RESULTS: Data came from the DESERVE (Discharge Educational Strategies for Reduction of Vascular Events) study, a randomized controlled trial of a skills-based behavioral intervention to reduce vascular risk in a multiethnic cohort of 552 transient ischemic attack and mild/moderate stroke patients in New York City. The exposure was perception that people can protect themselves from having a stroke (ie, prevention self-efficacy) at baseline. The association between systolic BP (SBP) reduction at 12-month follow-up and self-efficacy was examined using linear regression adjusted for key confounders, overall and stratified by age, sex, race/ethnicity, and intervention trial arm. Approximately three quarters endorsed self-efficacy. These participants had, on average, 5.6 mm Hg greater SBP reduction compared with those who did not endorse it (95% CI, 0.5–10.7 mm Hg; P=0.032). Self-efficacy was significantly associated with greater SBP reduction, particularly among female versus male, younger versus older, and Hispanic versus non-Hispanic white patients. Sensitivity analysis adjusting for baseline SBP instead of elevated BP yielded no association between self-efficacy and SBP reduction, but showed sex differences in this association (women: β=5.3; 95% CI, −0.2 to 10.8; P=0.057; men: β=−3.3; 95% CI, −9.4 to 2.9; P=0.300; interaction P=0.064). CONCLUSIONS: Self-efficacy was linked with greater SBP reduction among female stroke survivors. Targeted strategies to improve health beliefs after stroke may be important for risk factor management.
Psychological Impact of Anti-Asian Stigma Due to the COVID-19 Pandemic: A Call for Research, Practice, and Policy ResponsesMisra, S., Le, P. T. D., Goldmann, E., & Yang, L. H.
Journal titlePsychological Trauma: Theory, Research, Practice, and PolicyAbstractThe COVID-19 pandemic is linked to a rise in stigma and discrimination against Chinese and other Asians, which is likely to have a negative impact on mental health, especially when combined with additional outbreak-related stressors. We discuss the need to consider the potential harms of these anti-Asian sentiments during both the height of the pandemic and longer-term recovery through (a) research-examining how it affects mental health and recovery; (b) practice-implementing evidencebased stigma reduction initiatives; and (c) policy-coordinating federal response to anti-Asian racism including investment in mental health services and community-based efforts.
Efficacy of a Discharge Educational Strategy vs Standard Discharge Care on Reduction of Vascular Risk in Patients with Stroke and Transient Ischemic Attack: The DESERVE Randomized Clinical TrialBoden-Albala, B., Goldmann, E., Parikh, N. S., Carman, H., Roberts, E. T., Lord, A. S., Torrico, V., Appleton, N., Birkemeier, J., Parides, M., & Quarles, L.
Journal titleJAMA Neurology
Page(s)20-27AbstractImportance: Despite secondary prevention strategies with proven efficacy, recurrent stroke rates remain high, particularly in racial/ethnic minority populations who are disproportionately affected by stroke. Objective: To determine the efficacy of a culturally tailored skills-based educational intervention with telephone follow-up compared with standard discharge care on systolic blood pressure reduction in a multiethnic cohort of patients with mild/moderate stroke/transient ischemic attack. Design, Setting, and Participants: Randomized clinical trial with 1-year follow-up. Participants were white, black, and Hispanic patients with mild/moderate stroke/transient ischemic attack prospectively enrolled from 4 New York City, New York, medical centers during hospitalization or emergency department visit between August 2012 and May 2016. Through screening of stroke admissions and emergency department notifications, 1083 eligible patients were identified, of whom 256 declined to participate and 275 were excluded for other reasons. Analyses were intention to treat. Interventions: The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) intervention is a skills-based, culturally tailored discharge program with follow-up calls delivered by a community health coordinator. This intervention was developed using a community engagement approach. Main Outcomes and Measures: The primary outcome was systolic blood pressure reduction at 12 months postdischarge. Results: A total of 552 participants were randomized to receive intervention or usual care (281 women [51%]; mean [SD] age, 64.61 [2.9] years; 180 Hispanic [33%], 151 non-Hispanic white [27%], and 183 non-Hispanic black [33%]). At 1-year follow-up, no significant difference in systolic blood pressure reduction was observed between intervention and usual care groups (β = 2.5 mm Hg; 95% CI, -1.9 to 6.9). Although not powered for subgroup analysis, we found that among Hispanic individuals, the intervention arm had a clinically and statically significant 9.9 mm Hg-greater mean systolic blood pressure reduction compared with usual care (95% CI, 1.8-18.0). There were no significant differences between arms among non-Hispanic white (β = 3.3; 95% CI, -4.1 to 10.7) and non-Hispanic black participants (β = -1.6; 95% CI, -10.1 to 6.8). Conclusions and Relevance: Few behavioral intervention studies in individuals who have had stroke have reported clinically meaningful reductions in blood pressure at 12 months, and fewer have focused on a skills-based approach. Results of secondary analyses suggest that culturally tailored, skills-based strategies may be an important alternative to knowledge-focused approaches in achieving sustained vascular risk reduction and addressing racial/ethnic stroke disparities; however, these findings should be tested in future studies. Trial Registration: ClinicalTrials.gov identifier: NCT01836354.
Mental health service use among asian americans five to six years after exposure to the world trade center attack
Suicidal ideation is associated with cardiovascular disease in a large, urban cohort of adults in the Southern Cone of Latin AmericaDaray, F. M., Goldmann, E., Gutierrez, L., Ponzo, J., Lanas, F., Mores, N., Calandrelli, M., Poggio, R., Watkins, B. X., & Irazola, V.
Journal titleGeneral Hospital Psychiatry
Page(s)34-40AbstractIntroduction: To examine the relationship between suicidal ideation (SI) and cardiovascular disease (CVD) in the general adult population of four cities in the Southern Cone of Latin America (Argentina, Uruguay, Chile) and the role that depression, stressful life events (SLEs) and physical functional impairment may play in this association. Methods: A population-based cross-sectional study was conducted among 7524 adults between 35 and 74 years old, randomly selected. History of CVD included acute myocardial infarction, stroke and central or peripheral revascularization. SI in the past two weeks was measured using the last item of the Patient Health Questionnaire (PHQ-9), quality of life was assessed with the 12-item Short Form Survey (SF-12), and having experience of a SLE was determined by asking participants whether they had experienced at least one of a list of events in the past year. Multiple logistic regression was used to examine the association between SI and CVD overall and by sex. Results: The prevalence of SI was 8.3% (95% CI = 7.5, 9.0) and twice as high among women than men (11.1% vs. 5.1%). History of CVD was associated with almost twice the odds of SI (OR = 1.9, 95% CI = 1.5, 2.4). This association remained strong and significant after adjusting for potential confounders (OR = 1.8, 95% CI = 1.2, 2.7). Three additional models were tested to further adjust for depression severity, functional impairment, and SLEs separately. Adjustment for depression severity yielded no association between CVD and SI (OR = 1.1, 95% CI = 0.6, 1.7), adjustment for functional impairment yielded a marginal statistically significant association (OR = 1.5; 95% CI = 1.0, 2.4) and adjustment for SLE didn't modify either the magnitude or the statistical significance of the association. Conclusions: There is a significant association between SI and CVD, particularly among women, which may be driven, at least in part, by depression and physical functional impairment.
Unmet mental health care needs among Asian Americans 10–11 years after exposure to the world trade center attackKung, W. W., Wang, X., Liu, X., Goldmann, E., & Huang, D.
Journal titleInternational journal of environmental research and public health
Issue7AbstractThis study investigated the prevalence of unmet mental health care needs (UMHCN) and their associated factors among 2344 Asian Americans directly exposed to the World Trade Center (WTC) attack 10–11 years afterwards. Given the pervasive underutilization of mental health services among Asians, their subjective evaluation of unmet needs could provide more nuanced information on disparities of service. We used the WTC Health Registry data and found that 12% of Asian Americans indicated UMHCN: 69% attributing it to attitudinal barriers, 36% to cost barriers, and 29% to access barriers. Among all the factors significantly related to UMHCN in the logistic model, disruption of health insurance in the past year had the largest odds ratio (OR = 2.37, 95% confidence interval: 1.61–3.48), though similar to functional impairment due to mental disorders. Post-9/11 mental health diagnosis, probable mental disorder and ≥14 poor mental health days in the past month were also associated with greater odds of UMHCN, while greater social support was associated with lower odds. Results suggest that continued outreach efforts to provide mental health education to Asian communities to increase knowledge about mental illness and treatment options, reduce stigmatization of mental illness, and offer free mental health services are crucial to address UMHCN.
Association between anxiety, depression, and post-traumatic stress disorder and outcomes after ischemic strokeStein, L. A., Goldmann, E., Zamzam, A., Luciano, J. M., Messé, S. R., Cucchiara, B. L., Kasner, S. E., & Mullen, M. T.
Journal titleFrontiers in Neurology
Volume9AbstractBackground: Stroke patients are known to be at risk of developing anxiety, depression, and post-traumatic stress disorder (PTSD). Objective: To determine the overlap between anxiety, depression, and PTSD in patients after stroke and to determine the association between these disorders and quality of life, functional status, healthcare utilization, and return to work. Methods: A cross-sectional telephone survey was conducted to assess for depression, anxiety, PTSD, and health-related outcomes 6-12 months after first ischemic stroke in patients without prior psychiatric disease at a single stroke center. Results: Of 352 eligible subjects, 55 (16%) completed surveys. Seven subjects (13%) met criteria for probable anxiety, 6 (11%) for PTSD, and 11 for depression (20%). Of the 13 subjects (24%) who met criteria for any of these disorders, 6 (46%) met criteria for more than one, and 5 (39%) met criteria for all three. There were no significant differences in baseline characteristics, including stroke severity or neurologic symptoms, between those with or without any of these disorders. Those who had any of these disorders were less likely to be independent in their activities of daily living (ADLs) (54 vs. 95%, p < 0.001) and reported significantly worse quality of life (score of 0-100, median score of 50 vs. 80, p < 0.001) compared to those with none of these disorders. Conclusions: Anxiety, depression, and PTSD are common after stroke, have a high degree of co-occurrence, and are associated with worse outcomes, including quality of life and functional status.
Health Issues Associated with Commercial Sexual Exploitation and Sex Trafficking of Children in the United States: A Systematic ReviewLe, P. T. D., Ryan, N., Rosenstock, Y., & Goldmann, E.
Journal titleBehavioral Medicine
Page(s)219-233AbstractThis article reviews studies examining health issues associated with commercial sexual exploitation and sex trafficking (CSE/ST) of children in the United States. We searched five health and social sciences databases for peer-reviewed articles published in English between January 1990 and April 2017. After independent screening of the records, we identified 27 studies that met the inclusion criteria. Descriptions of the included studies and their definitions of CSE/ST are provided. Most of the studies sampled children and youth in urban, metropolitan areas and employed cross-sectional surveys or reviewed case files and medical records of convenience samples. Studies differed widely in their operationalization of CSE/ST, which limit systematic comparison across studies and the generalizability of findings. Qualitative analysis of the included studies shows that among commercially sexually exploited/trafficked children, there are elevated burdens of substance use and abuse, mental health disorders such as depression, PTSD, suicidal behaviors, and sexual and reproductive health issues including STIs, HIV, and pregnancy. This review underscores the need for more empirical studies, to guide an evidence-based understanding of and response to the range and complexity of the health issues in this population. Of particular utility are studies that address some of the methodological limitations of prior research in this field (e.g., cross-sectional, convenience samples) and those that assess overlooked health issues (e.g., malnutrition, eating disorders, post-trauma growth, and long-term health consequences).
Posttraumatic stress disorder in the short and medium term following the World Trade Center attack among Asian AmericansKung, W. W., Liu, X., Goldmann, E., Huang, D., Wang, X., Kim, K., Kim, P., & Yang, L. H.
Journal titleJournal of Community Psychology
Page(s)1075-1091AbstractThis study investigated patterns of probable posttraumatic stress disorder (PTSD) and their predictors among 2,431 Asian American and 31,455 non-Hispanic White World Trade Center (WTC) Registry participants 2–3 years and 5–6 years after the WTC attack. Participants were divided into four PTSD pattern groups: resilient, remitted, delayed onset, and chronic. Asians had a lower proportion in the resilient group (76.5% vs. 79.8%), a higher proportion in the chronic (8.6% vs. 7.4%) and remitted (5.9% vs. 3.4%) groups, and a similar proportion in the delayed onset group (about 9%) compared to Whites. In multinomial logistic regression analyses, disaster exposure, immigrant status, lower income, pre-attack depression/anxiety, and lower respiratory symptoms were associated with increased odds of chronic and delayed onset PTSD (vs. resilience) among both races. Education and employment were protective against chronic and delayed onset PTSD among Whites only. These results can inform targeted outreach efforts to enhance prevention and treatment for Asians affected by future events.
Teaching Epidemiology at the Undergraduate Level: Considerations and ApproachesGoldmann, E., Stark, J. H., Kapadia, F., & McQueen, M. B.
Journal titleAmerican Journal of Epidemiology
Page(s)1143-1148AbstractThe rapid growth in undergraduate public health education has offered training in epidemiology to an increasing number of undergraduate students. Epidemiology courses introduce undergraduate students to a population health perspective and provide opportunities for these students to build essential skills and competencies such as ethical reasoning, teamwork, comprehension of scientific methods, critical thinking, quantitative and information literacy, ability to analyze public health information, and effective writing and oral communication. Taking a varied approach and incorporating active learning and assessment strategies can help engage students in the material, improve comprehension of key concepts, and further develop key competencies. In this commentary, we present examples of how epidemiology may be taught in the undergraduate setting. Evaluation of these approaches and others would be a valuable next step.
The experiences of providing caregiving for patients with schizophrenia in the Ghanaian context
The New York City Mental Health Needs Assessment Study (MHNAS): Objectives, design, and methodsNorman, C. C., McDonald, K., Schneider, A. E., Malinovsky, I., Goldmann, E., Blauschild, M. K., & Driver, C.
Journal titleInternational Journal of Methods in Psychiatric Research
Issue2AbstractObjectives: This paper describes the objectives, design, and methods of the Mental Health Needs Assessment Study (MHNAS). The objective of the MHNAS was to assess the needs of individuals transitioning to the community following psychiatric hospitalization and again 3–5 months later to inform community service planning. Needs were defined broadly to include domains like housing, employment, treatment, and social support. Methods: The MHNAS used a 2-stage clustered sampling approach where the primary sampling units were hospitals and secondary sampling units were patients. The study included an in-person patient interview, an assessment of need from a key hospital worker, and a follow-up telephone interview 3–5 months after discharge. Results: One thousand one hundred twenty-nine patients from 8 randomly selected hospitals participated. The overall response rate was 54.3% with a cooperation rate of 71.8%. The sample was similar to the overall population of psychiatric patients with respect to several key demographics. Conclusion: The MHNAS demonstrates the feasibility of conducting a needs assessment with a random sample of psychiatric inpatients in a large urban setting. Results from this study may improve community service planning to better meet individuals' needs, with the ultimate goal of reducing rehospitalization and promoting recovery.
Age-related differences in antihypertensive medication adherence in hispanics: A cross-sectional community-based survey in New York City, 2011-2012Bandi, P., Goldmann, E., Parikh, N. S., Farsi, P., & Boden-Albala, B.
Journal titlePreventing Chronic Disease
Issue7AbstractIntroduction US Hispanics, particularly younger adults in this population, have a higher prevalence of uncontrolled hypertension than do people of other racial/ethnic groups. Little is known about the prevalence and predictors of antihypertensive medication adherence, a major determinant of hypertension control and cardiovascular disease, and differences between age groups in this fast-growing population. Methods The cross-sectional study included 1,043 community-dwelling Hispanic adults with hypertension living in 3 northern Manhattan neighborhoods from 2011 through 2012. Age-stratified analyses assessed the prevalence and predictors of high medication adherence (score of 8 on the Morisky Medication Adherence Scale [MMAS-8]) among younger (< 60 y) and older (≥60 y) Hispanic adults. Results Prevalence of high adherence was significantly lower in younger versus older adults (24.5% vs 34.0%, P = .001). In younger adults, heavy alcohol consumption, a longer duration of hypertension, and recent poor physical health were negatively associated with high adherence, but poor self-rated general health was positively associated with high adherence. In older adults, advancing age, higher education level, high knowledge of hypertension control, and private insurance or Medicare versus Medicaid were positively associated with high adherence, whereas recent poor physical health and health-related activity limitations were negatively associated with high adherence. Conclusion Equitable achievement of national hypertension control goals will require attention to suboptimal antihypertensive medication adherence found in this study and other samples of US Hispanics, particularly in younger adults. Age differences in predictors of high adherence highlight the need to tailor efforts to the life stage of people with hypertension.
Chronic Physical Illness Burden and Suicidal Ideation Among Dominicans in New York CityGoldmann, E., Roberts, E. T., Parikh, N. S., & Boden-Albala, B.
Journal titleJournal of Immigrant and Minority Health
Page(s)616-622AbstractLittle is known about the association between chronic illness and suicidal ideation (SI) among Dominicans living in the United States. This study used data from a community survey of 2753 Dominican adults in New York City. SI included thoughts of self-harm or being better off dead in the past month. Chronic physical illness burden was categorized as having 0, 1, or 2+ diagnosed conditions. Adjusted logistic regressions evaluated the association between number of conditions and SI, overall and stratified by sex and age. Adjusted models yielded a strong association between chronic illness burden and SI among men [odds ratio (OR) 5.57, 95 % confidence interval (CI) 2.19–14.18] but not women (OR 0.80, 95 % CI 0.50–1.29; interaction p = 0.011). The association of interest did not differ significantly between younger and older adults. Screening for SI in health care practice, particularly among Dominican men with multiple chronic health conditions, may be warranted.
Gender, Social Networks, and Stroke Preparedness in the Stroke Warning Information and Faster Treatment StudyMadsen, T. E., Roberts, E. T., Kuczynski, H., Goldmann, E., Parikh, N. S., & Boden-Albala, B.
Journal titleJournal of Stroke and Cerebrovascular Diseases
Page(s)2734-2741AbstractBackground and Purpose The study aimed to investigate the effect of gender on the association between social networks and stroke preparedness as measured by emergency department (ED) arrival within 3 hours of symptom onset. Methods As part of the Stroke Warning Information and Faster Treatment study, baseline data on demographics, social networks, and time to ED arrival were collected from 1193 prospectively enrolled stroke/transient ischemic attack (TIA) patients at Columbia University Medical Center. Logistic regression was conducted with arrival to the ED ≤3 hours as the outcome, social network characteristics as explanatory variables, and gender as a potential effect modifier. Results Men who lived alone or were divorced were significantly less likely to arrive ≤3 hours than men who lived with a spouse (adjusted odds ratio [aOR]:.31, 95% confidence interval [CI]:.15-0.64) or were married (aOR:.45, 95% CI:.23-0.86). Among women, those who lived alone or were divorced had similar odds of arriving ≤3 hours compared with those who lived with a spouse (aOR: 1.25, 95% CI:.63-2.49) or were married (aOR:.73, 95% CI:.4-1.35). Conclusions In patients with stroke/TIA, living with someone or being married improved time to arrival in men only. Behavioral interventions to improve stroke preparedness should incorporate gender differences in how social networks affect arrival times.
Street Audits to Measure Neighborhood Disorder: Virtual or In-Person?Mooney, S. J., Bader, M. D., Lovasi, G. S., Teitler, J. O., Koenen, K. C., Aiello, A. E., Galea, S., Goldmann, E., Sheehan, D. M., & Rundle, A. G.
Journal titleAmerican Journal of Epidemiology
Page(s)265-273AbstractNeighborhood conditions may influence a broad range of health indicators, including obesity, injury, and psychopathology. In particular, neighborhood physical disorder - a measure of urban deterioration - is thought to encourage crime and high-risk behaviors, leading to poor mental and physical health. In studies to assess neighborhood physical disorder, investigators typically rely on time-consuming and expensive in-person systematic neighborhood audits. We compared 2 audit-based measures of neighborhood physical disorder in the city of Detroit, Michigan: One used Google Street View imagery from 2009 and the other used an in-person survey conducted in 2008. Each measure used spatial interpolation to estimate disorder at unobserved locations. In total, the virtual audit required approximately 3% of the time required by the in-person audit. However, the final physical disorder measures were significantly positively correlated at census block centroids (r = 0.52), identified the same regions as highly disordered, and displayed comparable leave-one-out cross-validation accuracy. The measures resulted in very similar convergent validity characteristics (correlation coefficients within 0.03 of each other). The virtual audit-based physical disorder measure could substitute for the in-person one with little to no loss of precision. Virtual audits appear to be a viable and much less expensive alternative to in-person audits for assessing neighborhood conditions.
Race/ethnic differences in post-stroke depr ession (PSD): Findings from the stroke warning information and faster treatment (SWIFT ) studyGoldmann, E., Roberts, E. T., Parikh, N. S., Lord, A. S., & Boden-Albala, B.
Journal titleEthnicity and Disease
Page(s)1-8AbstractObjectives: Post-stroke depression (PSD) is common and associated with poor stroke outcomes, but few studies have examined race/ethnic disparities in PSD. Given the paucity of work and inconsistent findings in this important area of research, our study aimed to examine race/ethnic differences in depression in a multi-ethnic cohort of stroke patients. Design: Longitudinal. Setting: Prospective trial of a post-stroke educational intervention. Patients or Participants: 1,193 mild/moderate ischemic stroke/transient ischemic attack (TIA) patients. Main Outcome Measures: We used the Center for Epidemiologic Studies Depression (CES-D) Scale to assess subthreshold (CES-D score 8-15) and full (CES-D score ≥ 16) depression at one month ("early") and 12 months ("late") following stroke. Multinomial logistic regression analyses examined the association between race/ethnicity and early and late PSD separately. Results: The prevalence of subthreshold and full PSD was 22.5% and 32.6% in the early period and 22.0% and 27.4% in the late period, respectively. Hispanics had 60% lower odds of early full PSD compared with non-Hispanic Whites after adjusting for other covariates (OR=.4, 95% CI: .2, .8). Race/ ethnicity was not significantly associated with late PSD. Conclusions: Hispanic stroke patients had half the odds of PSD in early period compared with Whites, but no difference was found in the later period. Further studies comparing trajectories of PSD between race/ ethnic groups may further our understanding of race/ethnic disparities in PSD and help identify effective interventions.
Discharge educational strategies for reduction of vascular events (DESERVE): Design and methodsLord, A. S., Carman, H. M., Roberts, E. T., Torrico, V., Goldmann, E., Ishida, K., Tuhrim, S., Stillman, J., Quarles, L. W., & Boden-Albala, B.
Journal titleInternational Journal of Stroke
Page(s)151-154AbstractRationale: Stroke and vascular risk factors disproportionately affect minority populations, with Blacks and Hispanics experiencing a 2·5- and 2·0-fold greater risk compared with whites, respectively. Patients with transient ischemic attacks and mild, nondisabling strokes tend to have short hospital stays, rapid discharges, and inaccurate perceptions of vascular risk. Aim: The primary aim of the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial is to evaluate the efficacy of a novel community health worker-based multilevel discharge intervention vs. standard discharge care on vascular risk reduction among racially/ethnically diverse transient ischemic attack/mild stroke patients at one-year postdischarge. We hypothesize that those randomized to the discharge intervention will have reduced modifiable vascular risk factors as determined by systolic blood pressure compared with those receiving usual care. Sample size estimates: Given 300 subjects per group and alpha of 0·05, the power to detect a 6mmHg reduction in systolic blood pressure is 89%. Design: DESERVE trial is a prospective, randomized, multicenter clinical trial of a novel discharge behavioral intervention. Patients with transient ischemic attack/mild stroke are randomized during hospitalization or emergency room visit to intervention or usual care. Intervention begins prior to discharge and continues postdischarge. Study outcomes: The primary outcome is difference in systolic blood pressure reduction between groups at 12 months. Secondary outcomes include between-group differences in change in glycated hemoglobin, smoking rates, medication adherence, and recurrent stroke/transient ischemic attack at 12 months. Discussion: DESERVE will evaluate whether a novel discharge education strategy leads to improved risk factor control in a racially diverse population.
The Prevalence and Correlates of Risky Driving Behavior Among National Guard SoldiersHoggatt, K. J., Prescott, M. R., Goldmann, E., Tamburrino, M., Calabrese, J. R., Liberzon, I., & Galea, S.
Journal titleTraffic Injury Prevention
Page(s)17-23AbstractObjective: Previous studies have reported that risky driving is associated with deployment and combat exposure in military populations, but there is limited research on risky driving among soldiers in the National Guard and Reserves, a group increasingly deployed to active international conflicts. The goal of this analysis was to assess the prevalence of risky driving and its demographic, mental health, and deployment-related correlates among members of the Ohio Army National Guard (OHARNG).Methods: The study group comprised 2,616 eligible OHARNG soldiers enlisted as of June 2008, or who enlisted between June 2008 and February 2009. The main outcome of interest was the prevalence of risky driving behavior assessed using six questions: “How often do you use seat belts when you drive or ride in a car?”; “In the past 30 days, how many times have you driven when you've had perhaps too much to drink?”; “In the past year, have you ever become impatient with a slow driver in the fast lane and passed them on the right?”; “In the past year have you crossed an intersection knowing that the traffic lights have already changed from yellow to red?”; “In the past year have you disregarded speed limits late at night or early in the morning?”; and “In the past year have you underestimated the speed of an oncoming vehicle when attempting to pass a vehicle in your own lane?” We fit multiple logistic regression models and derived the adjusted prevalence of risky driving behavior for soldiers with mental health conditions, deployment experience, exposure to combat or trauma, and psychosocial stressors or supports.Results: The prevalence of risky driving was higher in soldiers with a history of mental health conditions, deployment to a conflict area, deployment-related traumatic events, and combat or post-combat stressors. In contrast, the prevalence of risky driving was lower for soldiers who reported high levels of psychosocial support.Conclusions: Efforts to mitigate risky driving in military populations may be more effective if they incorporate both targeted messages to remediate dangerous learned driving behaviors and psychosocial interventions to build resilience and address underlying stressors and mental health symptoms.
Mental health consequences of disastersGoldmann, E., & Galea, S.
Journal titleAnnual Review of Public Health
Page(s)169-183AbstractWe present in this review the current state of disaster mental health research. In particular, we provide an overview of research on the presentation, burden, correlates, and treatment of mental disorders following disasters. We also describe challenges to studying the mental health consequences of disasters and discuss the limitations in current methodologies. Finally, we offer directions for future disaster mental health research.