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BackgroundUsing data from syndromic surveillance, the New York City Department of Health and Mental Hygiene (DOHMH) identified an increase in the number of emergency department (ED) visits related to synthetic cannabinoids. Syndromic surveillance data were used to target community-level interventions and assess the real-time impact of control measures in reducing synthetic cannabinoid (“K2”)-related morbidity.MethodsFrom April 2015 through September 2015, DOHMH implemented 3 separate interventions to reduce K2-related morbidity by limiting the availability of K2 products. Difference-in-difference analyses compared pre- and post-intervention differences in cannabinoid-related ED visit rates between neighborhoods and controls for Interventions A and B. City-wide count data were used to compare K2-related ED visits before and after Intervention C.ResultsSyndromic data showed a reduction in K2-related ED visits following the 3 interventions. Respective decreases in rates of synthetic cannabinoid-related ED visits of 33 and 38% were detected at the neighborhood-level due to Interventions A and B, respectively. A decrease of 29% was calculated at the city level following Intervention C.ConclusionsIn addition to identifying emerging public health concerns, syndromic data can provide valuable real-time evidence on the effectiveness of public health interventions.

The misuse of prescription painkillers is a major contributor to the ongoing drug overdose epidemic. This study investigated variability in non-medical use of prescription painkillers (NMUPP) by race and early-life socioeconomic status (SES) in a sample now at increased risk for opioid overdose. Data from two waves of the National Longitudinal Study of Adolescent to Adult Health (n = 11,602) were used to calculate prevalence of reported NMUPP by Wave 4 (2008; mean age 28), and to assess variation by race and by equivalized household family income at Wave 1 (1994/5). Predicted values for prevalence of NMUPP were modelled, adjusting for age, sex, parental education, and region. Race and SES in adolescence were associated with later reported NMUPP. A gradient was seen in prevalence by SES (adjusted: family income quartile 1 = 13.3%; quartile 2 = 13.8%; quartile 3 = 14.8%; quartile 4 = 16.0%; trend p-value = 0.007). Prevalence was higher among males. Racial/ethnic differences in prevalence were seen (non-Hispanic white (NHW) = 18.5%; non-Hispanic black (NHB) = 5.8%; Hispanic = 10.5%; Other = 10.0%). SES differences were less pronounced upon stratification, with trend tests significant only among females (p = 0.004), and marginally significant among Hispanic males (p = 0.06). Early-life SES was associated with reported lifetime NMUPP: the higher the family income in adolescence, the greater the likelihood of NMUPP by young adulthood. Variations in NMUPP by income paled in comparison with racial/ethnic differences. Results point to a possible long-enduring association between SES and NMUPP, and a need to examine underlying mechanisms.

The landmark 1973 Roe v. Wade decision in the United States established a woman's legal right to abortion before fetal viability. Despite this constitutional right, abortion access has become increasingly difficult, as state legislatures have since enacted more than 1000 restrictive laws and regulations. The recent tilt of the US Supreme Court to a more hostile position on the right to choose has emboldened some states to propose legislation not only restricting access to abortion services but also prohibiting abortion outright. The Supreme Court later this year will hear a case concerning a Mississippi law that would ban most abortions after 15 weeks, a direct challenge to the 1973 Roe decision. The court's ruling on the Mississippi case could alter or even overturn the constitutional right established by Roev. Wade.A reversal of this right would have public health consequences and would widen existing social and health inequities. Stripped of the right to choose termination of pregnancy, individuals face difficult options and negative consequences. For example, they might resort to illegal and dangerous abortions, or stay in unhealthy relationships, sometimes sustaining long-lasting psychological and physical harm. Findings from the study by Vilda et al. (p. 1696), included in this issue, underscore the importance of a woman's right to make sexual and reproductive health decisions and the potentially lethal impact the removal of that right could have.

Objectives: Since the US Supreme Court′s 1973 Roe v. Wade decision legalizing abortion, states have enacted laws restricting access to abortion services. Previous studies suggest that restricting access to abortion is a risk factor for adverse maternal and infant health. The objective of this investigation is to study the relationship between the type and the number of state-level restrictive abortion laws and infant mortality risk. Methods: We used data on 11,972,629 infants and mothers from the US Cohort Linked Birth/Infant Death Data Files 2008–2010. State-level abortion laws included Medicaid funding restrictions, mandatory parental involvement, mandatory counseling, mandatory waiting period, and two-visit laws. Multilevel logistic regression was used to determine whether type or number of state-level restrictive abortion laws during year of birth were associated with odds of infant mortality. Results: Compared to infants living in states with no restrictive laws, infants living in states with one or two restrictive laws (adjusted odds ratio (AOR) = 1.08; 95% confidence interval [CI] = 0.99–1.18) and those living in states with 3 to 5 restrictive laws (AOR = 1.10; 95% CI = 1.01–1.20) were more likely to die. Separate analyses examining the relationship between parental involvement laws and infant mortality risk, stratified by maternal age, indicated that significant associations were observed among mothers aged ≤19 years (AOR = 1.09, 95% CI = 1.00–1.19), and 20 to 25 years (AOR = 1.10, 95% CI = 1.03–1.17). No significant association was observed among infants born to older mothers. Conclusion: Restricting access to abortion services may increase the risk for infant mortality.

Social determinants are receiving renewed attention as research demonstrates the effects of social factors on individuals’ physical and mental health and elucidates the biological and psychological mechanisms underlying those effects. Through spheres of influence from policy and regulation development to direct service provision, state mental health agencies are in a unique position to lead primary and secondary prevention efforts aimed at addressing social determinants with both client-level and structural-level interventions. A survey of social determinants-related activity was sent to the Medical Directors of the state offices of mental health in all 50 states. The survey results suggest consensus among respondents as to the importance of addressing specific social determinants. However, few state mental health agencies have taken on a comprehensive and intentional approach to addressing social determinants as a unique area of activity. Specific activities are reviewed, and implications for future work is discussed.

BackgroundCompared to other Organisation for Economic Co-operation and Development (OECD) nations, US infant mortality rates (IMRs) are particularly high. These differences are partially driven by racial disparities, with non-Hispanic black having IMRs that are twice those of non-Hispanic white. Income inequality (the gap between rich and poor) is associated with infant mortality. One proposed way to decrease income inequality (and possibly to improve birth outcomes) is to increase the minimum wage. We aimed to elucidate the relationship between state-level minimum wage and infant mortality risk using individual-level and state-level data. We also determined whether observed associations were heterogeneous across racial groups.MethodsData were from US Vital Statistics 2010 Cohort Linked Birth and Infant Death records and the 2010 US Bureau of Labor Statistics. We fit multilevel logistic models to test whether state minimum wage was associated with infant mortality. Minimum wage was standardised using the z-transformation and was dichotomised (high vs low) at the 75th percentile. Analyses were stratified by mother's race (non-Hispanic black vs non-Hispanic white).ResultsHigh minimum wage (adjusted OR (AOR)=0.93, 95% CI 0.83 to 1.03) was associated with decreased odds of infant mortality but was not statistically significant. High minimum wage was significantly associated with reduced infant mortality among non-Hispanic black infants (AOR=0.80, 95% CI 0.68 to 0.94) but not among non-Hispanic white infants (AOR=1.04, 95% CI 0.92 to 1.17).ConclusionsIncreasing the minimum wage might be beneficial to infant health, especially among non-Hispanic black infants, and thus might decrease the racial disparity in infant mortality.

Objectives While ecological studies indicate that high levels of structural racism within US states are associated with elevated infant mortality rates, studies using individual-level data are needed. To determine whether indicators of structural racism are associated with the individual odds for infant mortality among white and black infants in the US. Methods We used data on 2,163,096 white and 590,081 black infants from the 2010 US Cohort Linked Birth/Infant Death Data Files. Structural racism indicators were ratios of relative proportions of blacks to whites for these domains: electoral (registered to vote and voted; state legislature representation), employment (civilian labor force; employed; in management; with a bachelor’s degree), and justice system (sentenced to death; incarcerated). Multilevel logistic regression was used to determine whether structural racism indicators were risk factors of infant mortality. Results Compared to the lowest tertile ratio of relative proportions of blacks to whites with a bachelor’s degree or higher—indicative of low structural racism—black infants, but not whites, in states with moderate (OR = 1.12, 95% CI = 0.94, 1.32) and high tertiles (OR = 1.25, 95% CI = 1.03, 1.51) had higher odds of infant mortality. Conclusions Educational and judicial indicators of structural racism were associated with infant mortality among blacks. Decreasing structural racism could prevent black infant deaths.

Individuals with mental illnesses experience disproportionately high rates of social adversities, chronic medical conditions, and early mortality. We analyzed a large, statewide dataset to explore associations between four social adversities and the presence of one or more, and then two or more, chronic medical conditions among individuals in treatment for mental illnesses in New York State. In Poisson regression models adjusting for multiple covariates (e.g., gender, age, smoking status, alcohol use), the presence of one or more adversities was associated with the presence of at least one medical condition (prevalence ratio (PR) = 1.21) or two or more medical conditions (PR = 1.46), and two or more adversities was associated with at least one medical condition (PR = 1.25) or two or more medical conditions (PR = 1.52) (all significant at p < .0001). Greater attention to primary, secondary, and tertiary prevention of chronic medical conditions is needed in mental health treatment settings, especially among those experiencing social adversities.