Emily Goldmann
Emily Goldmann
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Clinical Associate Professor of Epidemiology
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Professional overview
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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.
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Education
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BA, Economics (Honors), Columbia University, New York, NYMPH, Epidemiology, University of Michigan, Ann Arbor, MIPhD, Epidemiologic Sciences, University of Michigan, Ann Arbor, MI
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Areas of research and study
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EpidemiologyMental HealthSocial BehaviorsSocial Determinants of Health
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Publications
Publications
Gender, Social Networks, and Stroke Preparedness in the Stroke Warning Information and Faster Treatment Study
AbstractMadsen, T. E., Roberts, E. T., Kuczynski, H., Goldmann, E., Parikh, N. S., & Boden-Albala, B. (n.d.).Publication year
2017Journal title
Journal of Stroke and Cerebrovascular DiseasesVolume
26Issue
12Page(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?
AbstractMooney, 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. (n.d.).Publication year
2017Journal title
American Journal of EpidemiologyVolume
186Issue
3Page(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 ) study
AbstractGoldmann, E., Roberts, E. T., Parikh, N. S., Lord, A. S., & Boden-Albala, B. (n.d.).Publication year
2016Journal title
Ethnicity and DiseaseVolume
26Issue
1Page(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 methods
AbstractLord, A. S., Carman, H. M., Roberts, E. T., Torrico, V., Goldmann, E., Ishida, K., Tuhrim, S., Stillman, J., Quarles, L. W., & Boden-Albala, B. (n.d.).Publication year
2015Journal title
International Journal of StrokeVolume
10Page(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 Soldiers
AbstractHoggatt, K. J., Prescott, M. R., Goldmann, E., Tamburrino, M., Calabrese, J. R., Liberzon, I., & Galea, S. (n.d.).Publication year
2015Journal title
Traffic Injury PreventionVolume
16Issue
1Page(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 disasters
AbstractGoldmann, E., & Galea, S. (n.d.).Publication year
2014Journal title
Annual Review of Public HealthVolume
35Page(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.Epigenetic signatures may explain the relationship between socioeconomic position and risk of mental illness: Preliminary findings from an urban community-based sample
AbstractUddin, M., Galea, S., Chang, S. C., Koenen, K. C., Goldmann, E., Wildman, D. E., & Aiello, A. E. (n.d.).Publication year
2013Journal title
Biodemography and Social BiologyVolume
59Issue
1Page(s)
68-84AbstractLow socioeconomic position (SEP) has previously been linked to a number of negative health indicators, including poor mental health. The biologic mechanisms linking SEP and mental health remain poorly understood. Recent work suggests that social exposures influence DNA methylation in a manner salient to mental health. We conducted a pilot investigation to assess whether SEP, measured as educational attainment, modifies the association between genomic methylation profiles and traumatic stress in a trauma-exposed sample. Results show that methylation × SEP interactions occur preferentially in genes pertaining to nervous system function, suggesting a plausible biological pathway by which SEP may enhance sensitivity to stress and, in turn, risk of posttraumatic stress disorder.[Supplementary materials are available for this article. Go to the publisher's online edition of Biodemography and Social Biology for the following free supplemental resource: Supplementary tables of full model and functional annotation clustering results.]Child maltreatment increases sensitivity to adverse social contexts: Neighborhood physical disorder and incident binge drinking in Detroit
AbstractKeyes, K. M., McLaughlin, K. A., Koenen, K. C., Goldmann, E., Uddin, M., & Galea, S. (n.d.).Publication year
2012Journal title
Drug and alcohol dependenceVolume
122Issue
1Page(s)
77-85AbstractIntroduction: Exposure to child maltreatment is associated with elevated risk for behavioral disorders in adulthood. One explanation for this life-course association is that child maltreatment increases vulnerability to the effects of subsequent stressors; however, the extent to which maltreatment increases sensitivity to social context has never been examined. We evaluated whether the association between neighborhood physical disorder and binge drinking was modified by child maltreatment exposure. Methods: Data were drawn from the Detroit Neighborhood Health Study, a prospective representative sample of predominately African Americans in the Detroit population. Neighborhood physical disorder was measured via systematic neighborhood assessment. Child maltreatment indicators included self-reported physical, sexual, and emotional abuse. Incident binge drinking was defined as at least one episode of ≥5 drinks (men) or ≥4 drinks (women) in the past 30-day period among those with no binge drinking at baseline (N=1013). Results: Child maltreatment and neighborhood physical disorder interacted to predict incident binge drinking (B=0.16, p=0.02) and maximum number of past 30-day drinks (B=0.15, p=0.04), such that neighborhood physical disorder predicted problematic alcohol use only among individuals with high exposure to child maltreatment. Conclusion: The results add to the growing literature that African Americans in the US are exposed to an array of stressors that have pernicious consequences for problematic alcohol use. Our results document the need for increased attention to the potential for at-risk alcohol use among populations with a high degree of stress exposure.Potentially Modifiable Pre-, Peri-, and Postdeployment Characteristics Associated With Deployment-Related Posttraumatic Stress Disorder Among Ohio Army National Guard Soldiers
AbstractGoldmann, E., Calabrese, J. R., Prescott, M. R., Tamburrino, M., Liberzon, I., Slembarski, R., Shirley, E., Fine, T., Goto, T., Wilson, K., Ganocy, S., Chan, P., Serrano, M. B., Sizemore, J., & Galea, S. (n.d.).Publication year
2012Journal title
Annals of EpidemiologyVolume
22Issue
2Page(s)
71-78AbstractPurpose: To evaluate potentially modifiable deployment characteristics-predeployment preparedness, unit support during deployment, and postdeployment support-that may be associated with deployment-related posttraumatic stress disorder (PTSD). Methods: We recruited a sample of 2616 Ohio Army National Guard (OHARNG) soldiers and conducted structured interviews to assess traumatic event exposure and PTSD related to the soldiers' most recent deployment, consistent with DSM-IV criteria. We assessed preparedness, unit support, and postdeployment support by using multimeasure scales adapted from the Deployment Risk and Resilience Survey. Results: The prevalence of deployment-related PTSD was 9.6%. In adjusted logistic models, high levels of all three deployment characteristics (compared with low) were independently associated with lower odds of PTSD. When we evaluated the influence of combinations of deployment characteristics on the development of PTSD, we found that postdeployment support was an essential factor in the prevention of PTSD. Conclusions: Results show that factors throughout the life course of deployment-in particular, postdeployment support-may influence the development of PTSD. These results suggest that the development of suitable postdeployment support opportunities may be centrally important in mitigating the psychological consequences of war.Pervasive exposure to violence and posttraumatic stress disorder in a predominantly African American Urban Community: The Detroit neighborhood health study
AbstractGoldmann, E., Aiello, A., Uddin, M., Delva, J., Koenen, K., Gant, L. M., & Galea, S. (n.d.).Publication year
2011Journal title
Journal of Traumatic StressVolume
24Issue
6Page(s)
747-751AbstractExposure to traumatic events is common, particularly among economically disadvantaged, urban African Americans. There is, however, scant data on the psychological consequences of exposure to traumatic events in this group. We assessed experience with traumatic events and posttraumatic stress disorder (PTSD) among 1,306 randomly selected, African American residents of Detroit. Lifetime prevalence of exposure to at least 1 traumatic event was 87.2% (assault = 51.0%). African Americans from Detroit have a relatively high burden of PTSD; 17.1% of those who experienced a traumatic event met criteria for probable lifetime PTSD. Assaultive violence is pervasive and is more likely to be associated with subsequent PTSD than other types of events. Further efforts to prevent violence and increase access to mental health treatment could reduce the mental health burden in economically disadvantaged urban areas.PTSD comorbidity and suicidal ideation associated with PTSD within the Ohio Army National Guard
AbstractCalabrese, J. R., Prescott, M., Tamburrino, M., Liberzon, I., Slembarski, R., Goldmann, E., Shirley, E., Fine, T., Goto, T., Wilson, K., Ganocy, S., Chan, P., Serrano, M. B., Sizemore, J., & Galea, S. (n.d.).Publication year
2011Journal title
Journal of Clinical PsychiatryVolume
72Issue
8Page(s)
1072-1078AbstractObjective: To study the relation between posttraumatic stress disorder (PTSD) psychiatric comorbidity and suicidal ideation in a representative sample of Ohio Army National Guard soldiers. Method: Using retrospective data collected on the telephone from a random sample of 2,616 National Guard soldiers who enrolled in a 10-year longitudinal study (baseline data collected November 2008-November 2009), we examined (1) the prevalence of other psychopathologies among those with DSM-IV-diagnosed PTSD compared to those without PTSD and (2) the association between PTSD comorbidity and suicidal ideation (reporting thoughts of being better off dead or hurting themselves). All analyses were carried out using logistic regression. Results: Of guard members with PTSD in the last year, 61.7% had at least 1 other psychopathology; 20.2% had at least 2 other co-occurring conditions. The most common co-occurring psychopathology was depression. While those with PTSD overall were 5.4 (95% CI, 3.8-7.5) times more likely to report suicidality than those without PTSD, those who had at least 2 additional conditions along with PTSD were 7.5 (95% CI, 3.0-18.3) times more likely to report suicidal ideation at some point in their lifetime than those with PTSD alone. Conclusions: Soldiers with PTSD were at increased risk for suicidality, and, among those with PTSD, those with at least 2 additional conditions were at the highest risk of suicidal ideation. Future research should address the mechanisms that contribute to multimorbidity in this population and the appropriate treatment methods for this high-risk group.SLC6A4 methylation modifies the effect of the number of traumatic events on risk for posttraumatic stress disorder
AbstractKoenen, K. C., Uddin, M., Chang, S. C., Aiello, A. E., Wildman, D. E., Goldmann, E., & Galea, S. (n.d.).Publication year
2011Journal title
Depression and AnxietyVolume
28Issue
8Page(s)
639-647AbstractBackground: Posttraumatic stress disorder (PTSD) is a common and debilitating mental disorder that occurs following exposure to a traumatic event. However, most individuals do not develop PTSD following even a severe trauma, leading to a search for new variables, such as genetic and other molecular variation, associated with vulnerability and resilience in the face of trauma exposure. Method: We examined whether serotonin transporter (SLC6A4) promoter genotype and methylation status modified the association between number of traumatic events experienced and PTSD in a subset of 100 individuals from the Detroit Neighborhood Health Study. Results: Number of traumatic events was strongly associated with risk of PTSD. Neither SLC6A4 genotype nor methylation status was associated with PTSD in main effects models. However, SLC6A4 methylation levels modified the effect of the number of traumatic events on PTSD after controlling for SLC6A4 genotype. Persons with more traumatic events were at increased risk for PTSD, but only at lower methylation levels. At higher methylation levels, individuals with more traumatic events were protected from this disorder. This interaction was observed whether the outcome was PTSD diagnosis, symptom severity, or number of symptoms. Conclusions: Gene-specific methylation patterns may offer potential molecular signatures of increased risk for and resilience to PTSD. Depression and Anxiety, 2011.Social and environmental influences on population mental health
Goldmann, E., & Galea, S. (n.d.). In Population Mental Health (1–).Publication year
2011Page(s)
51-68Epigenetic and immune function profiles associated with posttraumatic stress disorder
AbstractUddin, M., Aiello, A. E., Wildman, D. E., Koenen, K. C., Pawelec, G., De Los Santos, R., Goldmann, E., & Galea, S. (n.d.).Publication year
2010Journal title
Proceedings of the National Academy of Sciences of the United States of AmericaVolume
107Issue
20Page(s)
9470-9475AbstractThe biologic underpinnings of posttraumatic stress disorder (PTSD) have not been fully elucidated. Previous work suggests that alterations in the immune system are characteristic of the disorder. Identifying the biologic mechanisms by which such alterations occur could provide fundamental insights into the etiology and treatment of PTSD. Here we identify specific epigenetic profiles underlying immune system changes associated with PTSD. Using blood samples (n = 100) obtained froman ongoing, prospective epidemiologic study in Detroit, theDetroit Neighborhood Health Study, we applied methylation microarrays to assay CpG sites from more than 14,000 genes among 23 PTSD-affected and 77 PTSD-unaffected individuals. We show that immune system functions are significantly over represented among the annotations associated with genes uniquely unmethylated among those with PTSD. We further demonstrate that genes whose methylation levels are significantly and negatively correlated with traumatic burden show a similar strong signal of immune function among the PTSD affected. The observed epigenetic variability in immune function by PTSD is corroborated using an independent biologic marker of immune response to infection, CMV - a typically latent herpes virus whose activity was significantly higher among those with PTSD. This report of peripheral epigenomic and CMV profiles associated with mental illness suggests a biologic model of PTSD etiology in which an externally experienced traumatic event induces down stream alterations in immune function by reducing methylation levels of immune-related genes.Investigating the effect of social changes on age-specific gun-related homicide rates in New York City during the 1990s
AbstractCerdá, M., Messner, S. F., Tracy, M., Vlahov, D., Goldmann, E., Tardiff, K. J., & Galea, S. (n.d.).Publication year
2010Journal title
American journal of public healthVolume
100Issue
6Page(s)
1107-1115AbstractObjectives. We assessed whether New York City's gun-related homicide rates in the 1990s were associated with a range of social determinants of homicide rates. Methods. We used cross-sectional time-series data for 74 New York City police precincts from 1990 through 1999, and we estimated Bayesian hierarchical models with a spatial error term. Homicide rates were estimated separately for victims aged 15-24 years (youths), 25-34 years (young adults), and 35 years or older (adults). Results. Decreased cocaine consumption was associated with declining homicide rates in youths (posterior median [PMJ=0.25; 95% Bayesian confidence interval [BCI]=0.07, 0.45) and adults (PM=0.07; 95% BCI=0.02, 0.12), and declining alcohol consumption was associated with fewer homicides in young adults (PM=0.14; 95% BCI=0.02, 0.25). Receipt of public assistance was associated with fewer homicides for young adults (PM =-104.20; 95% BCI=-182.0, -26.14) and adults (PM=-28.76; 95% BCI=-52.65, -5.01). Misdemeanor policing was associated with fewer homicides in adults (PM =-0.01; 95% BCI=-0.02, -0.001). Conclusions. Substance use prevention policies and expansion of the social safety net may be able to cause major reductions in homicide among age groups that drive city homicide trends.Borrowing and selling to pay for health care in low- and middle-income countries
AbstractKruk, M. E., Goldmann, E., & Galea, S. (n.d.).Publication year
2009Journal title
Health AffairsVolume
28Issue
4Page(s)
1056-1066AbstractMany families around the world make sizable out-of-pocket payments for health care. We calculated the frequency of borrowing money or selling assets to buy health services in forty low- and middle-income countries and estimated how various factors are associated with these coping strategies. The data represented a combined population of 3.66 billion, or 58 percent of the world's population. On average, 25.9 percent of households borrowed money or sold items to pay for health care. The risk was higher among the poorest households and in countries with less health insurance. Health systems in developing countries are failing to protect families from the financial risks of seeking health care.City living and mental health in history
Loue, S., Sajatovic, M., Goldmann, E., Galea, S., & Maxwell, A. (n.d.). In Determinants of minority mental health and wellness (1–).Publication year
2009Epidemiology
Reyes, G., Elhai, J. D., Ford, J. D., Goldmann, E., & Galea, S. (n.d.). In The encyclopedia of psychological trauma (1–).Publication year
2008Longitudinal determinants of posttraumatic stress in a population-based cohort study
AbstractGalea, S., Ahern, J., Tracy, M., Hubbard, A., Cerda, M., Goldmann, E., & Vlahov, D. (n.d.).Publication year
2008Journal title
EpidemiologyVolume
19Issue
1Page(s)
47-54AbstractBACKGROUND: Posttraumatic stress disorder is a prevalent and disabling psychologic pathology. Longitudinal research on the predictors of posttraumatic stress symptomatology is limited. METHODS: We recruited 2752 participants to a prospective, population-based cohort study by conducting a telephone survey of adult residents of the New York City metropolitan area in 2002; participants completed 3 follow-up interviews over a 30-month period. Censoring weights were estimated to account for potential bias. We used generalized estimating equation logistic regression models with bootstrapped confidence intervals to assess the predictors of posttraumatic stress over time in multivariable models. RESULTS: Predictors of posttraumatic stress over time included ongoing stressors (odds ratio [OR] = 1.91 per 1 unit increase in number of stressors, [95% confidence interval = 1.55-2.36]) and traumatic events (OR = 1.92 per 1 unit increase in number of traumatic events [CI = 1.71-2.22]), social support (compared with high levels, OR = 1.71 for medium [1.09-2.52]; OR = 1.57 for low [1.08-2.35]), low income (OR = 0.87 per $10,000 increase [0.81-0.92]), female sex (1.60 [1.11-2.23]), and Latino ethnicity (compared with white, OR = 1.74 [1.05-2.97]). CONCLUSIONS: These findings suggest that ongoing stressors play a central role in explaining the trajectory of posttraumatic stress over time, and that factors beyond the experience of stressors and traumas may account for sex and ethnic differences in posttraumatic stress risk. Interventions that focus on reducing ongoing adversity may help mitigate the consequences of traumatic events.