Descriptive Epidemiology for Community-wide Naloxone Administration by Police Officers and Firefighters Responding to Opioid Overdose.

Recently implemented New York State policy allows police and fire to administer intranasal naloxone when responding to opioid overdoses. This work describes the geographic distribution of naloxone administration (NlxnA) by police and fire when responding to opioid overdoses in Erie County, NY, an area of approximately 920,000 people including the City of Buffalo. Data are from opioid overdose reports (N = 800) filed with the Erie County Department of Health (July 2014-June 2016) by police/fire and include the overdose ZIP code, reported drug(s) used, and NlxnA. ZIP code data were geocoded and mapped to examine spatial patterns of NlxnA. The highest NlxnA rates (range: 0.01-84.3 per 10,000 population) were concentrated within the city and first-ring suburbs. Within 3 min 27.3% responded to NlxnA and 81.6% survived the overdose. The average individual was male (70.3%) and 31.4 years old (SD = 10.3). Further work is needed to better understand NlxnA and overdose, including exploring how the neighborhood environment creates a context for drug use, and how this context influences naloxone use and overdose experiences.

Social inequalities in the occurrence of suicidal ideation among older primary care patients.

OBJECTIVES: To examine whether there is an association between area socioeconomic status and the experience of suicidal ideation among older adults. DESIGN: Secondary analyses of data from a prospective study of naturalistic outcomes of depressive symptoms. SETTING: Monroe County, NY. PARTICIPANTS: A cohort of older adults (≥65 years, N = 515) attending primary care settings. MEASUREMENTS: Area socioeconomic status was based on the median household incomes of the census tracts (CTs) in which participants lived. At 6- and 12-month follow-up, the longitudinal interval follow-up evaluation was used to assess weekly depressive symptom status over the previous 6 months, which was used to construct a measure of any suicidal ideation during the study. RESULTS: Residents of CTs with median household incomes of less than $30,000/yr were more likely to experience suicidal ideation than residents of higher income CTs (unadjusted odds ratio [OR], 4.60; 95% confidence interval [CI], 1.64-12.86). Adjustment for demographic and baseline clinical factors did not eliminate the association (OR, 5.44; 95% CI, 1.71-17.24). Subsequent models that adjusted for medical, functional, and psychosocial variables did not explain this association either. CONCLUSIONS: There is a robust association between lower CT income and the occurrence of suicidal ideation in a primary care cohort of older adults over 1 year. These findings indicate the need for more research into how social worlds come to influence the emotional well being of older adults and whether social factors such as CT income can be used to identify individuals at increased risk for suicidal behavior.

A Longitudinal Study of Gun Violence Attitudes: Role of Childhood Aggression and Exposure to Violence, and Early Adolescent Bullying Perpetration and Victimization.

This prospective study examined the effects of early childhood physical aggression and violence exposure on bullying victimization/perpetration and attitudes toward guns and violence in early adolescence (EA) in a high-risk sample. Participants included 216 mother-child dyads from an ongoing longitudinal study using multi-method assessments (e.g., classroom observations, laboratory assessment, parent-, teacher-, and child self-reports). Results supported a developmental pathway from early adversity (i.e., prenatal substance use) to aggression at kindergarten age to bullying perpetration and gun violence attitudes (aggressive responses to shame) in EA. Higher peer victimization was also associated with aggressive responses to shame in EA. Results are discussed in light of the complexity of the motives for aggression and the need for prevention and early intervention.

Geographic Information Systems.

This chapter presents an overview of the development, capabilities, and utilization of geographic information systems (GIS). There are nearly an unlimited number of applications that are relevant to GIS because virtually all human interactions, natural and man-made features, resources, and populations have a geographic component. Everything happens somewhere and the location often has a role that affects what occurs. This role is often called spatial dependence or spatial autocorrelation, which exists when a phenomenon is not randomly geographically distributed. GIS has a number of key capabilities that are needed to conduct a spatial analysis to assess this spatial dependence. This chapter presents these capabilities (e.g., georeferencing, adjacency/distance measures, overlays) and provides a case study to illustrate how GIS can be used for both research and planning. Although GIS has developed into a relatively mature application for basic functions, development is needed to more seamlessly integrate spatial statistics and models.The issue of location, especially the geography of human activities, interactions between humanity and nature, and the distribution and location of natural resources and features, is one of the most basic elements of scientific inquiry. Conceptualizations and physical maps of geographic space have existed since the beginning of time because all human activity takes place in a geographic context. Representing objects in space, basically where things are located, is a critical aspect of the natural, social, and applied sciences. Throughout history there have been many methods of characterizing geographic space, especially maps created by artists, mariners, and others eventually leading to the development of the field of cartography. It is no surprise that the digital age has launched a major effort to utilize geographic data, but not just as maps. A geographic information system (GIS) facilitates the collection, analysis, and reporting of spatial data and related phenomena. The capabilities of GIS are much more than just mapping, although map production is one of the most utilized features. GIS applications are relevant in a tremendous number of areas ranging from basic geographic inventories to simulation models.This chapter presents a general overview of geographic information system topics. The purpose is to provide the reader with a basic understanding of a GIS, the types of data that are needed, the basic functionality of these systems, the role of spatial analysis, and an example in the form of a case study. The chapter is designed to provide advanced students and experts outside of the field of GIS sufficient information to begin to utilize GIS and spatial analytic concepts, but it is not designed to be the sole basis for becoming a GIS expert. There is a tremendous level of sophistication related to the digital cartographic databases and manipulation of those databases underlying the display and use of GIS that is more appropriately a part of geographic information science (i.e., basic research issues associated with geographic data including technical as well as theoretical aspects such as the impact on society [1]) rather than being relevant to this chapter. The utilization of GIS for conducting spatial analysis is the guiding theme for the chapter.

Spatiotemporal Analysis and Epidemiology of Kawasaki Disease in Western New York: A 16-Year Review of Cases Presenting to a Single Tertiary Care Center.

BACKGROUND: Kawasaki disease (KD) is one of the leading causes of acquired heart disease in children in developed nations. Epidemiologic evidence suggests that KD is related to an infectious agent; however, the cause remains unknown. Yearly incidence in Japan has been steadily increasing, but few long-term databases of KD cases from North America have been reviewed. METHODS: We reviewed the epidemiology of local cases over a 16-year period to study incidence with time and temporal and geographic clustering of cases in a representative cohort in North America. RESULTS: The yearly incidence in cases per population <5 years old per 100,000 was 20.2 and 15.9, using International Classification of Disease, ninth revision and detailed chart review, respectively. Using International Classification of Disease, ninth revision alone overestimates our incidence by 27%. We show a distinct seasonality of cases with winter predominance. Applying Kulldorff's spatial scan statistic revealed no significant clustering of cases with either purely spatial or space-time analyses. On purely nonconstrained temporal SaTScan analysis, there was a significant clustering of cases in a 67- to 68-week period in 2000-2001. CONCLUSIONS: Our analysis reveals an apparent outbreak of KD in our region in 2000-2001. In contrast to Japan, for the last 14 years, the incidence in our region has been stable.

Clusters in irregular areas and lattices.

Geographic areas of different sizes and shapes of polygons that represent counts or rate data are often encountered in social, economic, health, and other information. Often political or census boundaries are used to define these areas because the information is available only for those geographies. Therefore, these types of boundaries are frequently used to define neighborhoods in spatial analyses using geographic information systems and related approaches such as multilevel models. When point data can be geocoded, it is possible to examine the impact of polygon shape on spatial statistical properties, such as clustering. We utilized point data (alcohol outlets) to examine the issue of polygon shape and size on visualization and statistical properties. The point data were allocated to regular lattices (hexagons and squares) and census areas for zip-code tabulation areas and tracts. The number of units in the lattices was set to be similar to the number of tract and zip-code areas. A spatial clustering statistic and visualization were used to assess the impact of polygon shape for zip- and tract-sized units. Results showed substantial similarities and notable differences across shape and size. The specific circumstances of a spatial analysis that aggregates points to polygons will determine the size and shape of the areal units to be used. The irregular polygons of census units may reflect underlying characteristics that could be missed by large regular lattices. Future research to examine the potential for using a combination of irregular polygons and regular lattices would be useful.