Important New Findings on Drug Overdose Trends, Syndromic Surveillance, Consumption of PCB-Laden Fish in Academy???s Journal

NEW YORK CITY, June 19 - Research examining an array of important urban issues???including consumption of PCB-contaminated fish in East Harlem, the effectiveness of needle exchange programs at curtailing HIV transmission and the differences in drug overdose death rates among races???can be found in the June issue of the Journal of Urban Health: Bulletin of The New York Academy of Medicine. A richly informative special supplement to the Journal examines the potential and challenges of ???syndromic surveillance,??? an emerging system for early-stage detection of bioterrorism and disease outbreaks. Some intriguing studies in this issue include:

Racial/ethnic disparities in overdose mortality trends in New York City, 1990-98: Death rates from drug overdose have been consistently higher among blacks and Latinos than among whites in New York City throughout the 1990s, according to a study authored by scientists from the Academy and Cornell University Medical College. The overdose death rate among blacks was about one and a half times higher than among whites, said lead author Sandro Galea, M.D., M.P.H., Associate Director of the Academy???s Center for Urban Epidemiologic Studies. ???Although racial disparities in health have been decreasing, rate of overdose death continues to be higher among blacks than among other racial groups,??? said Galea, a medical epidemiologist. This research is one of 12 studies in the Journal???s feature section on drug overdose deaths and prevention.

Galea and colleagues examined all 7,451 accidental drug overdose deaths occurring in New York City from 1990-98 in adults aged 15-64, reviewing medical records at the Office of the Chief Medical Examiner. The authors explain that the racial differences in overdose mortality may reflect a preference by certain races to use drugs alone, which would leave no one to help should something go wrong. The differences may also reflect a greater reluctance among some races to call for emergency medical help, perhaps out of fear of criminal prosecution.

Consumption of fish from polluted waters by East Harlem women and children: Some low-income East Harlem women and their children continue to eat fish from polluted waters surrounding New York City despite state Health Department warnings of the danger, according to a study by researchers from the Mount Sinai School of Medicine. The state publishes annual advisories alerting the public not to eat certain fish from designated water bodies tainted by polychlorinated biphenyls (PCBs), mercury and other contaminants.

???Some of children???s problems with learning and behavior may be prevented by reducing their exposure to PCBs and other contaminants,??? said lead author Laura Anne Bienenfeld, M.D., M.Sc., of the Mount Sinai School of Medicine. The message is not being heeded even by those who realize the risk, the authors said, perhaps because the locally caught fish are free and therefore quite appealing to fixed-income families.

The research team interviewed more than 200 pregnant women and mothers at three East Harlem locations of the federal WIC program, a food and nutrition program for low-income families. Ninety-one percent of the women reported eating fish or shellfish. Among them, 11 percent consumed noncommercial fish caught in local waters and fed the fish to their children. More than half of those eating the dangerous fish said they knew of the health advisories. ???Further education may help inform these men and women of the long-term effect on their child???s development, behavior and learning,??? Bienenfeld said.

Bioterrorism detection using syndromic surveillance: A special supplement includes 14 papers and dozens of abstracts exploring syndromic surveillance, a rapidly emerging tool for early detection of community-wide disease and bioterrorism outbreaks. This is the first issue of any journal exclusively devoted to this surveillance technique, which involves monitoring and then rapidly analyzing health indicators based on real-time electronic data. A rash of particular symptoms treated in emergency rooms would be picked up by this system and could be quickly investigated, for example, as could spikes in certain medication sales or trends in ambulance dispatches.

Syndromic surveillance is like a health ???smoke detector??? providing advance warning of outbreaks, writes Farzad Mostashari, M.D., Assistant Commissioner with the New York City Department of Health and Mental Hygiene, in an editorial accompanying the supplement. ???[Syndromic surveillance] is still in its infancy, but has the potential of dramatically improving the ability of public health officials to identify and intervene in outbreaks,??? Mostashari said. The approach was virtually unknown just a few years ago and is still largely untested, he said. For syndromic surveillance to reach full potential on local and national levels, health agencies must become equipped to provide prompt response to potential alarms, create regulations to protect patients??? privacy, and adopt data standards.

The impact of needle-exchange programs on the spread of HIV among injection drug users: Needle exchange programs ???significantly??? reduce the spread of HIV among injection drugs users, finds a new study in the Journal. The study was based on a sophisticated computer simulation of the needle-sharing behaviors and infection rates among 10,000 simulated drug users during a 16-year period.

???Many opponents of needle exchange programs claim they do more harm than good because they provide an opportunity for injection drug users to meet new needle-sharing partners,??? said lead author Dr. Janet Raboud of the University of Toronto???s Division of Infectious Disease. ???Our work has shown that even if this were the case, needle exchange programs are still effective at reducing the spread of HIV.??? The study determined that HIV would be less prevalent if needle-exchange programs were in place, because infected and uninfected injection drug users would be less likely to share needles. The analysis found that even if drug-users made new drug-using friends at the needle-exchange program, and even if the exchange program were poorly attended, the spread of HIV would still be better contained than if no exchange program existed.

The Journal of Urban Health is published quarterly by The New York Academy of Medicine. The Academy is a non-profit institution founded in 1847 that is dedicated to enhancing the health of the public through research, education and advocacy, with a particular focus on urban populations, especially the disadvantaged.

Posted on June 19, 2003

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