Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-30 (of 31 Records) |
Query Trace: Houry D [original query] |
---|
Integrating public health and health care - protecting health as a team sport
Wong CA , Houry D , Cohen MK . N Engl J Med 2024 |
Protecting the mental health and well-being of the nation's health workforce
Howard J , Houry D . Am J Public Health 2024 114 137-141 |
Social determinants of health-an approach taken at CDC
Hacker K , Auerbach J , Ikeda R , Philip C , Houry D . J Public Health Manag Pract 2022 28 (6) 589-594 In the last decade, there has been an increasing awareness of the importance of addressing the social determinants of health (SDOH), the nonmedical conditions that influence health outcomes,1 as a systemic strategy for improving health, particularly among groups that are disproportionally affected by SDOH.2 While health care is important, it is estimated that these conditions, ranging from structural racism to socioeconomic factors, drive as much as 50% of health outcomes.3 |
Collaborative partnerships are key to address the overdose crisis: Public health and public safety
Houry D . J Public Health Manag Pract 2022 28 S273-s274 In 2021, an estimated more than 108 000 drug overdose deaths occurred in the United States, the highest number of overdose deaths predicted for a calendar year, according to recent provisional data from the Centers for Disease Control and Prevention (CDC.) The drug overdose crisis, previously driven by heroin and prescription opioids, since 2013 has been driven by synthetic opioids (primarily, illicit manufactured fentanyl). From 2020 to 2021, drug overdose deaths involving synthetic opioids increased by nearly 25%, and in 2021, nearly 70% of all drug overdose deaths involved these highly potent and lethal opioids. |
Social Needs and Social Determinants: The Role of the Centers for Disease Control and Prevention and Public Health.
Hacker K , Houry D . Public Health Rep 2022 137 (6) 333549221120244 The COVID-19 pandemic has been a long and tragic public health crisis. More than 1 million people have died in the United States. Some segments of our population, including those who are African American, Hispanic, American Indian/Alaska Native, and living in low socioeconomic areas, have borne a disproportionate burden of morbidity and mortality. 1 Preexisting health disparities have been exacerbated as people delayed care, deferred prevention, and isolated at home. |
Firearm Homicide and Suicide During the COVID-19 Pandemic: Implications for Clinicians and Health Care Systems.
Houry DE , Simon TR , Crosby AE . JAMA 2022 327 (19) 1867-1868 Firearm-related violence is a significant public health problem that requires a comprehensive approach to prevention that includes engagement and action by clinicians and health care systems. The effects of firearm-related violence on health care include immediate treatment for injuries, long-term care (eg, for spinal cord injuries and trauma), and a substantial toll on clinicians related to secondary traumatic stress. Firearms are the method of injury for most homicides and suicides (79% and 53%, respectively, in 2020).1 The circumstances of 2020, including the COVID-19 pandemic and community–law enforcement tensions related to law enforcement use of force, have potentially contributed to increased risks for homicide and suicide, including exacerbating the social and structural factors that drive racial and ethnic inequities.1 |
Methamphetamine use in the United States: epidemiological update and implications for prevention, treatment, and harm reduction
Jones CM , Houry D , Han B , Baldwin G , Vivolo-Kantor A , Compton WM . Ann N Y Acad Sci 2021 1508 (1) 3-22 Recent attention has focused on the growing role of psychostimulants, such as methamphetamine in overdose deaths. Methamphetamine is an addictive and potent stimulant, and its use is associated with a range of physical and mental health harms, overdose, and mortality. Adding to the complexity of this resurgent methamphetamine threat is the reality that the increases in methamphetamine availability and harms are occurring in the midst of and intertwined with the ongoing opioid overdose crisis. Opioid involvement in psychostimulant-involved overdose deaths increased from 34.5% of overdose deaths in 2010 to 53.5% in 2019-an increase of more than 50%. This latest evolution of the nation's overdose epidemic poses novel challenges for prevention, treatment, and harm reduction. This narrative review synthesizes what is known about changing patterns of methamphetamine use with and without opioids in the United States, other characteristics associated with methamphetamine use, the contributions of the changing illicit drug supply to use patterns and overdose risk, motivations for couse of methamphetamine and opioids, and awareness of exposure to opioids via the illicit methamphetamine supply. Finally, the review summarizes illustrative community and health system strategies and research opportunities to advance prevention, treatment, and harm reduction policies, programs, and practices. |
Adverse childhood experiences and stimulant use disorders among adults in the United States
Tang S , Jones CM , Wisdom A , Lin HC , Bacon S , Houry D . Psychiatry Res 2021 299 113870 Recent data indicate a resurgence of stimulant use and harms in the United States; thus, there is a need to identify risk factors to inform development of effective prevention strategies. Prior research suggests adverse childhood experiences (ACEs) are common among individuals using stimulants and may be an important target for prevention. National Epidemiological Survey on Alcohol and Related Conditions was used to estimate prevalence of ACEs among U.S. adults using amphetamine-type stimulants (ATS), cocaine, or both. Multivariable logistic regression examined associations between ACEs and stimulant use and use disorders. Among adults reporting lifetime ATS use, 22.1% had ≥4 ACEs, 24.9% had 2-3 ACEs, 22.4% had 1 ACE, 30.6% reported no ACEs. Among adults with lifetime ATS use disorder, 29.3% reported ≥4 ACEs, 28.7% reported 2-3 ACEs, 21.6% reported 1 ACE, and 20.4% reported no ACEs. Multivariable logistic regression found a significant relationship between number of ACEs and stimulant use and use disorders. In conclusion, we found a strong relationship between increasing ACE exposures and stimulant use and use disorders. Advancing comprehensive strategies to prevent ACEs and treating underlying trauma among those using stimulants holds great promise to reduce stimulant use and its health and social consequences in the United States. |
Trends in US Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes Before and During the COVID-19 Pandemic.
Holland KM , Jones C , Vivolo-Kantor AM , Idaikkadar N , Zwald M , Hoots B , Yard E , D'Inverno A , Swedo E , Chen MS , Petrosky E , Board A , Martinez P , Stone DM , Law R , Coletta MA , Adjemian J , Thomas C , Puddy RW , Peacock G , Dowling NF , Houry D . JAMA Psychiatry 2021 78 (4) 372-379 IMPORTANCE: The coronavirus disease 2019 (COVID-19) pandemic, associated mitigation measures, and social and economic impacts may affect mental health, suicidal behavior, substance use, and violence. OBJECTIVE: To examine changes in US emergency department (ED) visits for mental health conditions (MHCs), suicide attempts (SAs), overdose (OD), and violence outcomes during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the Centers for Disease Control and Prevention's National Syndromic Surveillance Program to examine national changes in ED visits for MHCs, SAs, ODs, and violence from December 30, 2018, to October 10, 2020 (before and during the COVID-19 pandemic). The National Syndromic Surveillance Program captures approximately 70% of US ED visits from more than 3500 EDs that cover 48 states and Washington, DC. MAIN OUTCOMES AND MEASURES: Outcome measures were MHCs, SAs, all drug ODs, opioid ODs, intimate partner violence (IPV), and suspected child abuse and neglect (SCAN) ED visit counts and rates. Weekly ED visit counts and rates were computed overall and stratified by sex. RESULTS: From December 30, 2018, to October 10, 2020, a total of 187 508 065 total ED visits (53.6% female and 46.1% male) were captured; 6 018 318 included at least 1 study outcome (visits not mutually exclusive). Total ED visit volume decreased after COVID-19 mitigation measures were implemented in the US beginning on March 16, 2020. Weekly ED visit counts for all 6 outcomes decreased between March 8 and 28, 2020 (March 8: MHCs = 42 903, SAs = 5212, all ODs = 14 543, opioid ODs = 4752, IPV = 444, and SCAN = 1090; March 28: MHCs = 17 574, SAs = 4241, all ODs = 12 399, opioid ODs = 4306, IPV = 347, and SCAN = 487). Conversely, ED visit rates increased beginning the week of March 22 to 28, 2020. When the median ED visit counts between March 15 and October 10, 2020, were compared with the same period in 2019, the 2020 counts were significantly higher for SAs (n = 4940 vs 4656, P = .02), all ODs (n = 15 604 vs 13 371, P < .001), and opioid ODs (n = 5502 vs 4168, P < .001); counts were significantly lower for IPV ED visits (n = 442 vs 484, P < .001) and SCAN ED visits (n = 884 vs 1038, P < .001). Median rates during the same period were significantly higher in 2020 compared with 2019 for all outcomes except IPV. CONCLUSIONS AND RELEVANCE: These findings suggest that ED care seeking shifts during a pandemic, underscoring the need to integrate mental health, substance use, and violence screening and prevention services into response activities during public health crises. |
Monitoring sexual violence trends in emergency department visits using syndromic data from the National Syndromic Surveillance Program - United States, January 2017-December 2019
D'Inverno AS , Idaikkadar N , Houry D . Am J Public Health 2021 111 (3) e1-e9 Objectives. To report trends in sexual violence (SV) emergency department (ED) visits in the United States.Methods. We analyzed monthly changes in SV rates (per 100 000 ED visits) from January 2017 to December 2019 using Centers for Disease Control and Prevention's National Syndromic Surveillance Program data. We stratified the data by sex and age groups.Results. There were 196 948 SV-related ED visits from January 2017 to December 2019. Females had higher rates of SV-related ED visits than males. Across the entire time period, females aged 50 to 59 years showed the highest increase (57.33%) in SV-related ED visits, when stratified by sex and age group. In all strata examined, SV-related ED visits displayed positive trends from January 2017 to December 2019; 10 out of the 24 observed positive trends were statistically significant increases. We also observed seasonal trends with spikes in SV-related ED visits during warmer months and declines during colder months, particularly in ages 0 to 9 years and 10 to 19 years.Conclusions. We identified several significant increases in SV-related ED visits from January 2017 to December 2019. Syndromic surveillance offers near-real-time surveillance of ED visits and can aid in the prevention of SV. (Am J Public Health. Published online ahead of print January 21, 2021: e1-e9. https://doi.org/10.2105/AJPH.2020.306034). |
Investigation of optimal dose of early intervention to prevent posttraumatic stress disorder: A multiarm randomized trial of one and three sessions of modified prolonged exposure
Maples-Keller JL , Post LM , Price M , Goodnight JM , Burton MS , Yasinski CW , Michopoulos V , Stevens JS , Hinrichs R , Rothbaum AO , Hudak L , Houry D , Jovanovic T , Ressler K , Rothbaum BO . Depress Anxiety 2020 37 (5) 429-437 BACKGROUND: Posttraumatic stress disorder (PTSD) is linked to a specific event, providing the opportunity to intervene in the immediate aftermath of trauma to prevent the development of this disorder. A previous trial demonstrated that trauma survivors who received three sessions of modified prolonged exposure therapy demonstrated decreased PTSD and depression prospectively compared to assessment only. The present study investigated the optimal dosing of this early intervention to test one versus three sessions of exposure therapy in the immediate aftermath of trauma. METHODS: Participants (n = 95) recruited from a Level 1 Trauma Center were randomly assigned in a 1.5:1.5:1 ratio in a parallel-group design to the three conditions: one-session exposure therapy, three-session exposure therapy, and assessment only. Follow-up assessments were conducted by study assessors blind to study condition. RESULTS: Mixed-effects model results found no significant differences in PTSD or depression symptoms between the control condition and those who received one or three exposure therapy sessions across 1-12-month follow-up assessment. Results indicate that the intervention did not interfere with natural recovery. Receiver operating characteristic curve analyses on the screening measure used for study inclusion (Predicting PTSD Questionnaire; PPQ) in the larger sample from which the treatment sample was drawn (n = 481) found that the PPQ was a poor predictor of likely PTSD at all follow-up time points (Area under the curve's = 0.55-0.62). CONCLUSIONS: This likely impacted study results as many participants demonstrated natural recovery. Recommendations for future early intervention research are reviewed, including strategies to identify more accurately those at risk for PTSD and oversampling more severe trauma types. |
Trends in intentional and unintentional opioid overdose deaths in the United States, 2000-2017
Olfson M , Rossen LM , Wall MM , Houry D , Blanco C . JAMA 2019 322 (23) 2340-2342 This study used data from the National Vital Statistics System Mortality to evaluate trends in US drug overdose deaths involving opioids certified as unintentional, suicide, or undetermined intent. |
Identifying and preventing adverse childhood experiences: Implications for clinical practice
Jones CM , Merrick MT , Houry DE . JAMA 2019 323 (1) 25-26 Adverse childhood experiences, commonly referred to as ACEs, are potentially traumatic events that occur in childhood and adolescence, such as experiencing physical, emotional, or sexual abuse; witnessing violence in the home; having a family member attempt or die by suicide; and growing up in a household with substance use, mental health problems, or instability due to parental separation, divorce, or incarceration.1 Since the publication of the ACES Study by the Centers for Disease Control and Prevention and Kaiser Permanente in 1998,2 more than 2 decades of research have documented the association of ACEs with health and well-being across the life span.1-3 |
Severe pulmonary disease associated with electronic-cigarette-product use - interim guidance
Schier JG , Meiman JG , Layden J , Mikosz CA , VanFrank B , King BA , Salvatore PP , Weissman DN , Thomas J , Melstrom PC , Baldwin GT , Parker EM , Courtney-Long EA , Krishnasamy VP , Pickens CM , Evans ME , Tsay SV , Powell KM , Kiernan EA , Marynak KL , Adjemian J , Holton K , Armour BS , England LJ , Briss PA , Houry D , Hacker KA , Reagan-Steiner S , Zaki S , Meaney-Delman D . MMWR Morb Mortal Wkly Rep 2019 68 (36) 787-790 On September 6, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). As of August 27, 2019, 215 possible cases of severe pulmonary disease associated with the use of electronic cigarette (e-cigarette) products (e.g., devices, liquids, refill pods, and cartridges) had been reported to CDC by 25 state health departments. E-cigarettes are devices that produce an aerosol by heating a liquid containing various chemicals, including nicotine, flavorings, and other additives (e.g., propellants, solvents, and oils). Users inhale the aerosol, including any additives, into their lungs. Aerosols produced by e-cigarettes can contain harmful or potentially harmful substances, including heavy metals such as lead, volatile organic compounds, ultrafine particles, cancer-causing chemicals, or other agents such as chemicals used for cleaning the device (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis, or other drugs; for example, "dabbing" involves superheating substances that contain high concentrations of THC and other plant compounds (e.g., cannabidiol) with the intent of inhaling the aerosol. E-cigarette users could potentially add other substances to the devices. This report summarizes available information and provides interim case definitions and guidance for reporting possible cases of severe pulmonary disease. The guidance in this report reflects data available as of September 6, 2019; guidance will be updated as additional information becomes available. |
Emergency physicians and opioid overdoses: A call to aid
Houry D , Adams J . Ann Emerg Med 2019 74 (3) 436-438 Despite encouraging news, our country remains amidst an opioid overdose epidemic, and emergency physicians have a front line view and opportunity to continue progress in reducing overdoses. Although recent data in the United States indicate a slowing in overdose fatalities1, decreased opioid prescribing and opioid misuse2,3, and a decreased number of people initiating heroin use3, it is too early to declare success. Although initially linked to prescription opioids, the opioid overdose epidemic now is largely fueled by highly potent illicit agents such as illicitly manufactured fentanyl and various fentanyl analogs; alongside of this are increases in psychostimulant and cocaine overdoses4. What does all of this mean for emergency physicians? We seek to highlight successes achieved in recent years, but also call for more ongoing action by emergency physicians with specific patient-centered actions. |
Emergency department implementation of the Centers for Disease Control and Prevention Pediatric Mild Traumatic Brain Injury Guideline Recommendations
Lumba-Brown A , Wright DW , Sarmiento K , Houry D . Ann Emerg Med 2018 72 (5) 581-585 From 2005 to 2009, children made more than 2 million outpatient visits and almost 3 million emergency department (ED) visits for mild traumatic brain injury.1 The actual number of mild traumatic brain injury cases is difficult to assess because patients may seek treatment in a variety of medical or school settings, or not at all. However, there is evidence that these numbers are increasing; in 2007, there were 461,000 ED visits for traumatic brain injury among children aged 14 years and younger; by 2013, that number had increased to 642,000.2,3 |
Opportunities for prevention and intervention of opioid overdose in the emergency department
Houry DE , Haegerich TM , Vivolo-Kantor A . Ann Emerg Med 2018 71 (6) 688-690 Consider “Jane,” a 30-year-old female patient brought in by emergency medical services (EMS) to the emergency department (ED), reflecting just one of more than 100,000 opioid overdose patients treated in EDs each year. Naloxone, an opioid antagonist and overdose reversal drug, was administered in the field by EMS; however, additional rounds of naloxone were required in the ED because of high opioid potency. Once she was stabilized, a quick review of her chart revealed several recent visits for opioid-related overdoses. A review of her history revealed that she was prescribed opioids initially in the ED 5 years earlier after sustaining minor injuries in a motor vehicle crash. She began misusing prescription opioids during the following year, receiving prescriptions from multiple providers in primary care clinics and EDs. Yet, because a check of the state’s prescription drug monitoring program was not completed before any prescription, her use of multiple providers and high dosages was not identified, and opioids continued to be prescribed in different clinical settings for pain management. Soon thereafter, Jane initiated heroin use and presented to the ED several times with cellulitis from injection drug use, as well as after an overdose of prescription and illicit opioids. Each time, she was discharged without a referral to substance use treatment or without a naloxone kit. |
Underlying factors in drug overdose deaths
Dowell D , Noonan RK , Houry D . JAMA 2017 318 (23) 2295-2296 Drug overdose accounted for 52 404 deaths in the United States in 2015,1 which are more deaths than for AIDS at its peak in 1995. Provisional data from the US Centers for Disease Control and Prevention (CDC) indicate drug overdose deaths increased again from 2015 to 2016 by more than 20% (from 52 898 deaths in the year ending in January 2016 to 64 070 deaths in the year ending in January 2017).2 Increases are greatest forover-doses related to the category including illicitly manufactured fentanyl (ie, synthetic opioids excluding methadone), which more than doubled, accounting for more than 20 000 overdose deaths in 2016 vs less than 10 000 deaths in 2015. This difference is enough to account for nearly all the increase in drug overdose deaths from 2015 to 2016.2 | Since 2010, overdose deaths involving predominantly illicit opioids (heroin, synthetic nonmethadone opioids, or both) have increased by more than 200% (Figure). Why have overdose deaths related to illicit opioids increased so substantially? Data from the National Survey on Drug Use and Health reveal moderate increases in people reporting past-year heroin use from 2010 to 2015 (Figure). Increasing numbers of individuals who use heroin are younger, might be less experienced, and might use heroin in riskier ways that are difficult to measure (eg, using it alone, using more heroin, using it more often, or combining drugs). |
Physical Abuse of Children
Houry D . N Engl J Med 2017 377 (4) 399 As an emergency physician who has treated the types of injuries described by Berkowitz too many times, I appreciate the clinical review regarding physical abuse in children. However, clinical presentations represent only a small fraction of the child abuse and neglect that occur in the United States. Self-reported survey data from children and caregivers indicate that one in seven children were victims of abuse or neglect in the preceding year.1 Each adverse childhood experience can result in lifelong health issues, such as obesity, depression, drug abuse, and suicide. The Centers for Disease Control and Prevention (CDC) recently released the guide Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities, which provides effective strategies for preventing violence against children.2 Several model medical programs are highlighted, such as enhanced primary care programs that identify and address risk factors for child abuse and neglect, early childhood homevisitation programs that provide caregiver training, and trauma-focused cognitive behavioral therapy to lessen the harms of abuse. Although diagnosis and treatment are crucial, physicians also play a critical role in the prevention of child abuse and adverse childhood experiences. |
New data on opioid use and prescribing in the United States
Schuchat A , Houry D , Guy GP Jr . JAMA 2017 318 (5) 425-426 The United States is in the midst of an opioid overdose epidemic. Between 1999 and 2010, prescription opioid–related overdose deaths increased substantially in parallel with increased prescribing of opioids.1 In 2015, opioid-involved drug overdoses accounted for 33 091 deaths, approximately half involving prescription opioids.2 Additionally, an estimated 2 million individuals in the United States have opioid use disorder (addiction) associated with prescription opioids, accounting for an estimated $78.5 billion in economic costs annually.3 Proven strategies are available to manage chronic pain effectively without opioids, and changing prescribing practices is an important step in addressing the opioid overdose epidemic and its adverse effects on US communities. | On July 6, 2017, the US Centers for Disease Control and Prevention reported that between 2006 and 2015 the amount of opioids prescribed in the United States peaked in 2010 at 782 morphine milligram equivalents (MME) per capita and then decreased each year through 2015 to 640 MME per capita. Prescribing rates increased from 72.4 to 81.2 prescriptions per 100 persons between 2006 and 2010, were constant between 2010 and 2012, and then declined to 70.6 per 100 persons from 2012 to 2015, a 13.1% decline.1 Yet the amount of opioids prescribed in 2015 remains more than 3 times higher than in 1999, when the amount prescribed was 180 MME per capita, and is nearly 4 times higher than in Europe in 2015. |
Saving lives and protecting people from injuries and violence
Houry D . Inj Prev 2016 22 (3) 230 Injury is the leading cause of death for people aged 1–44 in the USA. CDC’s National Center for Injury Prevention and Control—the Injury Center—is uniquely poised to measure the toll of injury and violence on the lives of Americans and reduce factors that increase their risk. For more than 20 years, Injury Center scientists and partners in the field have tracked trends in injury and violence burden, investigated risk factors through surveillance and research and translated findings into evidence-based strategies and interventions. | | The Injury Center has two CDC agency-wide priorities: (1) motor vehicle injury and (2) prescription drug overdose, and has identified the topics of child abuse and neglect, older adult falls, sexual violence, and youth sports concussion as important growth areas. In 2015, the Injury Center updated its research priorities in these areas to help guide intramural and extramural investments to accelerate impact at the population level over the next 3–5 years. | | CDC funds 10 Injury Control Research Centers (ICRCs) at universities and medical centres to form a national network of academic, public health, and community partners to conduct prevention research, train the next generation of injury prevention researchers and practitioners, and develop and evaluate violence and injury interventions. |
The National Violent Death Reporting System: Past, present, and future
Crosby AE , Mercy JA , Houry D . Am J Prev Med 2016 51 S169-s172 Each and every day in the U.S., more than 160 people die as a result of violence due to homicides and suicides.1 These violent deaths constitute an urgent public health problem. Homicide and suicide, taken together, were the fourth leading cause of years of potential life lost in the U.S. in 2014.2 Each year, more than 55,000 people die in the U.S. as a result of violence-related injuries.3 In 2014, suicide was the tenth leading cause of death, claiming more than 42,000 lives1 and resulting in an economic cost estimated to be $53.2 billion, largely associated with lost work productivity.4,5 From 2005 to 2014, the national suicide rate rose for 9 straight years from 10.9 per 100,000 in 2005 to 13.0 per 100,000 in 2014, an increase of more than 18%,6 and now ranks as the second leading cause of death among adolescents and young adults.7,8 Homicide rates in the U.S. have declined over the long term, but are still a major problem resulting in an economic cost estimated at $26.4 billion.2,5 Among high-income nations, the U.S. historically has the highest homicide rate.9 Homicides disproportionately affect boys and men, adolescents and young adults, and certain racial/ethnic groups, such as non-Hispanic blacks, non-Hispanic American Indian/Alaska Natives, and Hispanics.10 These groups have not experienced the same level of decline and, in some cases, rates have increased.11 Homicide is the third leading cause of death for 10- to 24-year-olds in the U.S. and the leading cause of death for male and female African Americans aged 10–34 years.1 Suicide and homicide are preventable, but to address this problem as efficiently and effectively as possible, practitioners need data that are both timely and provide information that is useful in guiding preventive actions. |
Announcing the CDC guideline for prescribing opioids for chronic pain
Houry D , Baldwin G . J Safety Res 2016 57 83-4 This guideline provides recommendations for primary care providers who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses: (a) when to initiate or continue opioids for chronic pain; (b) opioid selection, dosage, duration, follow-up, and discontinuation; and (c) assessing risk and addressing harms of opioid use. This guideline is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including abuse, dependence, overdose, and death. |
Saving lives and protecting people from injuries and violence
Houry D . Ann Emerg Med 2016 68 (2) 230-2 Emergency physicians witness the effects of injury and violence every day. Traumatic brain injury, assault-related trauma, motor vehicle crashes, and opioid overdoses make up only some of these injuries-many of which can be prevented and better understood. The Centers for Disease Control and Prevention's National Center for Injury Prevention and Control (Injury Center) is uniquely poised to measure the toll of injury and violence on the lives of Americans, to communicate this public health burden, and to reduce the factors that increase their risk. Injury is the leading cause of death for persons aged 1 to 44 years in the United States. The Injury Center seeks to prevent violence and injuries and to reduce their consequences. For more than 20 years, Injury Center researchers have investigated factors that put Americans at risk through surveillance and research and translated these findings into evidence-based strategies and interventions. Many of these efforts are directly relevant to emergency medicine through preventing injuries and violence to save lives. |
Reducing the risks of relief - the CDC opioid-prescribing guideline
Frieden TR , Houry D . N Engl J Med 2016 374 (16) 1501-4 The annual number of deaths from prescription-opioid overdose has quadrupled in the United States in the past 15 years, driving dramatic increases in mortality. Efforts to improve pain management resulted in a quadrupling of rates of opioid prescribing, which propelled a tightly correlated epidemic of addiction, overdose, and death from prescription opioids that is now further evolving to include increasing use and overdoses of heroin and illicitly produced fentanyl. | The pendulum of opioid use in pain management has swung back and forth several times over the past 100 years. Beginning in the 1990s, efforts to improve treatment of pain failed to adequately take into account opioids’ addictiveness, their low therapeutic ratio, and their lack of documented effectiveness in the treatment of chronic pain. Increased prescribing was also fueled by aggressive and sometimes misleading marketing of long-acting opioids to physicians.1 It has become increasingly clear that opioids carry substantial risks and uncertain benefits, especially as compared with other treatments for chronic pain. | On March 15, 2016, the Centers for Disease Control and Prevention (CDC) released a “Guideline for Prescribing Opioids for Chronic Pain” to chart a safer, more effective course.2 The guideline is designed to support clinicians caring for patients outside the context of active cancer treatment or palliative or end-of-life care. More research is needed to fill in critical evidence gaps regarding the effectiveness, safety, and economic efficiency of long-term opioid therapy. However, given what we know about the risks associated with long-term opioid therapy and the availability of effective nonpharmacologic and nonopioid pharmacologic treatment options, the guideline uses the best available scientific data to provide information and recommendations to support patients and clinicians in balancing the risks of addiction and overdose with limited evidence of benefits of opioids for chronic pain. |
Dating violence and injury among youth exposed to violence
Reidy DE , Kearns MC , Houry D , Valle LA , Holland KM , Marshall KJ . Pediatrics 2016 137 (2) e20152627 OBJECTIVES: To assess gender differences in the proportion of adolescents reporting teen dating violence (TDV) and the frequency of TDV at multiple age points across adolescence in a high-risk sample of youth with previous exposure to violence. METHODS: A cross-sectional, high-risk sample of boys and girls (n = 1149) ages 11 to 17 years completed surveys assessing TDV and self-defense. Indices of TDV included perpetration and victimization scales of controlling behaviors, psychological TDV, physical TDV, sexual TDV, fear/intimidation, and injury. RESULTS: More girls reported perpetrating psychological and physical TDV, whereas twice as many boys reported sexual TDV perpetration. More girls reported fear/intimidation victimization than boys. When comparing the frequency of TDV across adolescence, boys reported more sexual TDV victimization at younger ages, and girls demonstrated a trend toward more victimization at older ages. Likewise, younger boys reported more fear/intimidation and injury perpetration and injury victimization than younger girls. However, by age 17, girls reported more injury perpetration than boys, and reports of injury victimization and use of self-defense did not differ. Notably, despite potential parity in injury, girls consistently reported more fear/intimidation victimization associated with TDV. CONCLUSIONS: Contrary to data suggesting that girls experience far more sexual TDV and injury, these data suggest that at specific times during adolescence, boys among high-risk populations may be equally at risk for victimization. However, the psychological consequences (fear) are greater for girls. These findings suggest a need to tailor strategies to prevent TDV based on both age- and gender-specific characteristics in high-risk populations. |
In search of teen dating violence typologies
Reidy DE , Ball B , Houry D , Holland KM , Valle LA , Kearns MC , Marshall KJ , Rosenbluth B . J Adolesc Health 2015 58 (2) 202-7 PURPOSE: The goal of the present research was to identify distinct latent classes of adolescents that commit teen dating violence (TDV) and assess differences on demographic, behavioral, and attitudinal correlates. METHODS: Boys and girls (N = 1,149; Mage = 14.3; Grades 6-12) with a history of violence exposure completed surveys assessing six indices of TDV in the preceding 3 months. Indices of TDV included controlling behaviors, psychological TDV, physical TDV, sexual TDV, fear/intimidation, and injury. In addition, adolescents provided demographic and dating history information and completed surveys assessing attitudes condoning violence, relationship skills and knowledge, and reactive/proactive aggression. RESULTS: Latent class analysis indicated a three-class solution wherein the largest class of students was nonviolent on all indices ("nonaggressors") and the smallest class of students demonstrated high probability of nearly all indices of TDV ("multiform aggressors"). In addition, a third class of "emotional aggressors" existed for which there was a high probability of controlling and psychological TDV but low likelihood of any other form of TDV. Multiform aggressors were differentiated from emotional and nonaggressors on the use of self-defense in dating relationships, attitudes condoning violence, and proactive aggression. Emotional aggressors were distinguished from nonaggressors on nearly all measured covariates. CONCLUSIONS: Evidence indicates that different subgroups of adolescents engaging in TDV exist. In particular, a small group of youth engaging in multiple forms of TDV can be distinguished from a larger group of youth that commit acts of TDV restricted to emotional aggression (i.e., controlling and psychological) and most youth that do not engage in TDV. |
The CDC Injury Center's response to the growing public health problem of falls among older adults
Houry D , Florence C , Baldwin G , Stevens J , McClure R . Am J Lifestyle Med 2015 20 (10) 74-7 BACKGROUND: Older adult falls are a significant cause of morbidity and mortality in the United States. This leading cause of injury in adults aged 65 and older results in $35 billion in direct medical costs. OBJECTIVE: To project the number of older adult falls by 2030 and the associated lifetime medical cost. A secondary objective is to review what clinicians can do to incorporate falls screening and prevention into their practice for community-dwelling older adults. METHODS: Using the CDC's Web-based Injury Statistics Query and Reporting System and the US Census Bureau data, the number of older adults in 2030, fatal falls, and medical costs associated with fall injuries was projected. In addition, evidence-based interventions that can be integrated into clinical practice were reviewed. RESULTS: The number of older adult fatal falls is projected to reach 100,000 per year by 2030 with an associated cost of $100 billion. By integrating screening for falls risk into clinical practice, reviewing and modifying medications, and recommending Vitamin D supplementation, physicians can reduce future falls by nearly 25%. CONCLUSION: Falls in older adults will continue to rise substantially and become a significant cost to our health care system if we do not begin to focus on prevention in the clinical setting. |
Getting everyone to buckle up on every trip: what more can be done?
Baldwin GT , Houry D . Ann Intern Med 2015 163 (3) 234-5 The Centers for Disease Control and Prevention (CDC) focuses on preventing illness, injury, disability, and death. To spotlight attention and focus activity, CDC Director Dr. Thomas Frieden has identified 7 public health “winnable battles.” These battles address public health issues in which judicious action and implementation of evidence-based and scalable interventions would have an immediate positive effect. | The prevention of motor vehicle injuries is a winnable battle, in part, because of the life-saving potential of seat belts and our opportunity to increase their use. The CDC aims to prevent deaths and injuries from motor vehicle crashes by focusing on modifiable behaviors through coordinated, sustained, and complementary actions with the U.S. Department of Transportation, especially the National Highway Traffic Safety Administration. | The most effective intervention to reduce injury of motor vehicle occupants in a crash is simple: Wear a seat belt. Seat belts reduce the risk for fatal injuries by approximately 45% and serious injuries by approximately 50% when worn in a motor vehicle crash (1). Seat belts are a critical and cross-cutting secondary prevention strategy. They protect persons regardless of who is at fault or the root cause of the crash, including those involved in crashes that result from the negligence of alcohol-impaired drivers and from distracted driving. Seat belts have saved the lives of 300 000 Americans since 1975, including more than 12 500 Americans in 2013 alone (1, 2). In that same year, approximately 2800 more Americans would be alive today if all unrestrained passenger vehicle occupants aged 5 years or older involved in a fatal crash had buckled up (2). |
Violence in the United States: status, challenges, and opportunities
Sumner SA , Mercy JA , Dahlberg LL , Hillis SD , Klevens J , Houry D . JAMA 2015 314 (5) 478-88 IMPORTANCE: Interpersonal violence, which includes child abuse and neglect, youth violence, intimate partner violence, sexual violence, and elder abuse, affects millions of US residents each year. However, surveillance systems, programs, and policies to address violence often lack broad, cross-sector collaboration, and there is limited awareness of effective strategies to prevent violence. OBJECTIVES: To describe the burden of interpersonal violence in the United States, explore challenges to violence prevention efforts and to identify prevention opportunities. DATA SOURCES: We reviewed data from health and law enforcement surveillance systems including the National Vital Statistics System, the Federal Bureau of Investigation's Uniform Crime Reports, the US Justice Department's National Crime Victimization Survey, the National Survey of Children's Exposure to Violence, the National Child Abuse and Neglect Data System, the National Intimate Partner and Sexual Violence Survey, the Youth Risk Behavior Surveillance System, and the National Electronic Injury Surveillance System-All Injury Program. RESULTS: Homicide rates have decreased from a peak of 10.7 per 100,000 persons in 1980 to 5.1 per 100,000 in 2013. Aggravated assault rates have decreased from a peak of 442 per 100,000 in 1992 to 242 per 100,000 in 2012. Nevertheless, annually, there are more than 16,000 homicides and 1.6 million nonfatal assault injuries requiring treatment in emergency departments. More than 12 million adults experience intimate partner violence annually and more than 10 million children younger than 18 years experience some form of maltreatment from a caregiver, ranging from neglect to sexual abuse, but only a small percentage of these violent incidents are reported to law enforcement, health care clinicians, or child protective agencies. Moreover, exposure to violence increases vulnerability to a broad range of mental and physical health problems over the life course; for example, meta-analyses indicate that exposure to physical abuse in childhood is associated with a 54% increased odds of depressive disorder, a 78% increased odds of sexually transmitted illness or risky sexual behavior, and a 32% increased odds of obesity. Rates of violence vary by age, geographic location, sex, and race/ethnicity, and significant disparities exist. Homicide is the leading cause of death for non-Hispanic blacks from age 1 through 44 years, whereas it is the fifth most common cause of death among non-Hispanic whites in this age range. Additionally, efforts to understand, prevent, and respond to interpersonal violence have often neglected the degree to which many forms of violence are interconnected at the individual level, across relationships and communities, and even intergenerationally. The most effective violence prevention strategies include parent and family-focused programs, early childhood education, school-based programs, therapeutic or counseling interventions, and public policy. For example, a systematic review of early childhood home visitation programs found a 38.9% reduction in episodes of child maltreatment in intervention participants compared with control participants. CONCLUSIONS AND RELEVANCE: Progress has been made in reducing US rates of interpersonal violence even though a significant burden remains. Multiple strategies exist to improve violence prevention efforts, and health care providers are an important part of this solution. |
- Page last reviewed:Feb 1, 2024
- Page last updated:Apr 29, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure