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Ian Rockett

West Virginia University, Epidemiology, Faculty Member

University of Rochester, Psychiatry, Adjunct

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I am an epidemiologist and demographer by training. My principal research interests are injury epidemiology, mortality, and suicide misclassification.
Address: Morgantown, United States

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Kent State University

Eric S . Kim (UBC)

University of British Columbia

École Normale Supérieure de Lyon

Michael J. Gonzalez

Universidad de Puerto Rico Rio

Hungarian Academy of Sciences

Hela Ouaili-Mallek

Ecole Supérieure de la Statistique et de l'Analyse de l'Information

Srinivasa Rao Gadde

The University of Dodoma, Tanzania

Garumma T Feyissa

Drexel University

Alberto N Ramos Jr

Universidade Federal do Ceará

Universidad de Sevilla

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Papers by Ian Rockett

Variable Circumstances of Suicide Among Racial/Ethnic Groups by Sex and Age: A National Violent-Death Reporting System Analysis

Archives of Suicide Research, 2019

Suicide rates vary by race/ethnicity, but little is known about how the circumstances that contri... more Suicide rates vary by race/ethnicity, but little is known about how the circumstances that contribute to suicide differ across racial/ethnic groups. This study investigated suicide circumstances among non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic Asian/Pacific Islanders, non-Hispanic Native American/Alaskan Natives, and Hispanics by sex and age. Using de-identified National Violent Death Reporting System (NVDRS) Restricted Access Database files from 2006-2015, we examined proximal circumstances of suicide among decedents aged 10 years and older. Hierarchical logistic regression analysis revealed racial/ethnic differentials in non-alcohol substance abuse problem, intimate partner problem, and physical health problem across sex and age, controlling for potential confounders. Study findings highlight priority areas for suicide interventions.

Overcoming the limitations of ‘accident’ as a manner of death for drug overdose mortality: case for a death certificate checkbox

Injury Prevention, 2020

Collectively, the epidemic increases in the United States of opioid-related deaths and suicides d... more Collectively, the epidemic increases in the United States of opioid-related deaths and suicides during the first two decades of the 21st century have exposed shortcomings in current forensic and epidemiological approaches for determining and codifying manner of death—a vital function fulfilled by medical examiners, coroners and nosologists—the foundation for the National Violent Death Reporting System (NVDRS), an incident-based surveillance system providing individual-level information on decedent characteristics, manner, cause and circumstances of suicide, homicide and other violent injury deaths. Drug intoxication deaths are generally classified as ‘accidents’ or unintentional, a fundamental mischaracterisation; most arose from repetitive self-harm behaviours related to substance acquisition and misuse. Moreover, given the burden of affirmative evidence required to determine suicide, many of these ‘accidents’ likely reflected unrecognised intentional acts—that is, suicides. Additi...

Real-world, anti-tobacco environmental impact upon priceinduced smoking reduction among urban Chinese men: Evidence from China’s 2015 cigarette tax increase

Tobacco Induced Diseases

INTRODUCTION Raising the price of cigarettes via taxation has been promoted by the World Health O... more INTRODUCTION Raising the price of cigarettes via taxation has been promoted by the World Health Organization as an important tobacco control strategy. Price elasticity of cigarettes is not uniform and is dependent upon individual and environmental determinants. Many studies have examined the determinants of price-induced smoking, taking into account sociodemographic characteristics and consumption patterns. Little research has been conducted on the association between anti-smoking environments and price-induced smoking behavior. This study addresses the deficit within the Chinese context. METHODS Participants were 2852 male smokers identified through a multi-stage survey sampling process encompassing 6 cities in China between July and December 2016. A standardized questionnaire tapped price-induced smoking reduction and related information. Both unadjusted and adjusted logistic regression methods were applied in the analyses. RESULTS In all, 25.5% (95% CI: 22.5-27.9) of smokers in this study decreased their smoking expenditures following the 2015 excise tax increase. The adjusted logistic regression analysis showed that increased exposures to an anti-smoking information environment (AOR=1.39; 95% CI: 1.10-1.79), restricted smoking in their home (AOR=1.67; 95% CI: 1.32-2.08) and workplace (AOR=1.43; 95% CI: 1.09-1.85) were more likely to report diminished cigarette smoking following the tax increases. CONCLUSIONS This study adds to understanding price-induced smoking behavior among urban male Chinese smokers. Strengthening of excise tax policies needs to intensify environmental smoking restrictions and public education campaigns to increase the sensitivity of cigarette price changes among smokers.

Observational Studies in Suicide Research

Hogrefe Publishing eBooks, 2021

Contextual Influences on Deliberate Self-harm Among Chinese University Undergraduates: A Representative Nationwide Study

Background: Numerous studies have identified factors associated with deliberate self-harm (DSH), ... more Background: Numerous studies have identified factors associated with deliberate self-harm (DSH), but environmental influences have been largely neglected. This study explored regional and university contextual factors impacting DSH among undergraduate students in China. Methods: In this observational cross-sectional study, subjects were 5,016 undergraduate students, who were identified through multistage survey sampling in 22 Chinese universities. Individual-level data were obtained through a self-administered questionnaire, and environmental variables were extracted from the National Bureau of Statistics database. Multilevel logistic regression models were used to examine regional correlates of DSH.Results: The overall prevalence of self-reported DSH in the study sample was 7.5% (95% CI: 4.1%, 10.9%). The full multilevel logistic model showed university rank and city size were inversely associated with DSH prevalence (OR: 0.24 and 0.55). Regional unemployment rates were positively ...

Escalating costs of self-injury mortality in the 21st century United States: an interstate observational study

BMC Public Health

Background Estimating the economic costs of self-injury mortality (SIM) can inform health plannin... more Background Estimating the economic costs of self-injury mortality (SIM) can inform health planning and clinical and public health interventions, serve as a basis for their evaluation, and provide the foundation for broadly disseminating evidence-based policies and practices. SIM is operationalized as a composite of all registered suicides at any age, and 80% of drug overdose (intoxication) deaths medicolegally classified as ‘accidents,’ and 90% of corresponding undetermined (intent) deaths in the age group 15 years and older. It is the long-term practice of the United States (US) Centers for Disease Control and Prevention (CDC) to subsume poisoning (drug and nondrug) deaths under the injury rubric. This study aimed to estimate magnitude and change in SIM and suicide costs in 2019 dollars for the United States (US), including the 50 states and the District of Columbia. Methods Cost estimates were generated from underlying cause-of-death data for 1999/2000 and 2018/2019 from the US Ce...

Using natural language processing to improve suicide classification requires consideration of race

Suicide and Life-Threatening Behavior

OBJECTIVES To improve the accuracy of classification of deaths of undetermined intent and to exam... more OBJECTIVES To improve the accuracy of classification of deaths of undetermined intent and to examine racial differences in misclassification. METHODS We used natural language processing and statistical text analysis on restricted-access case narratives of suicides, homicides, and undetermined deaths in 37 states collected from the National Violent Death Reporting System (NVDRS) (2017). We fit separate race-specific classification models to predict suicide among undetermined cases using data from known homicide cases (true negatives) and known suicide cases (true positives). RESULTS A classifier trained on an all-race dataset predicts less than half of these cases as suicide. Importantly, our analysis yields an estimated suicide rate for the Black population comparable with the typical detection rate for the White population, indicating that misclassification excess is endemic for Black suicide. This problem may be mitigated by using race-specific data. Our findings, based on the statistical text analysis, also reveal systematic differences in the phrases identified as most predictive of suicide. CONCLUSIONS This study highlights the need to understand the reasons underlying suicide rate differences and for further testing of strategies to reduce misclassification, particularly among people of color.

Suicidal motivations among opioid overdose survivors: Replication and extension

Drug and Alcohol Dependence

BACKGROUND Several studies suggest suicidal motivation may contribute to opioid overdose fataliti... more BACKGROUND Several studies suggest suicidal motivation may contribute to opioid overdose fatalities in people with opioid use disorder. In this study, we sought to replicate and extend prior findings suggesting that a desire to die is common prior to nonfatal opioid overdose in people with opioid use disorder. METHODS Adults receiving inpatient detoxification and stabilization who reported a history of opioid overdose (N = 60) completed questions about suicidal cognition prior to their most recent overdose. RESULTS Approximately 45% reported some desire to die prior to their most recent overdose, with 20% reporting they had some intention to die. The correlation between these ratings was of a moderate magnitude (ρ = 0.58). Almost 40% of the sample perceived no risk of overdose prior to their most recent overdose event, suggesting a significant underestimation of risk in this population. CONCLUSIONS Desire to die was common in adults with opioid use disorder prior to nonfatal opioid overdose events, and 1 in 5 people with a history of opioid overdose reported intention to die prior to their most recent opioid overdose. Careful assessment of suicidal cognition in this population may improve prevention of opioid overdose deaths.

Changing trends of excess self-protective behavior, and association with belief in prevention myths during the COVID-19 epidemic in China: A panel study

Objective This prospective observational study examined changing trends of excess self-protective... more Objective This prospective observational study examined changing trends of excess self-protective behavior (EPB), and its association with perceived risk, severity and belief in prevention myths during the Chinese COVID-19 epidemic. Methods The study employed a longitudinal design. Participants were recruited for an online panel survey from chat groups on social media platforms. Descriptive statistics and the CATMOD program were used for data analysis. Findings Participants numbered 150 for the linkable baseline survey and 102 for the final survey. There were 5 waves of interviews. The prevalence of participants perceiving a personal risk of contracting COVID-19, and severe consequences of the disease, was 18.6% and 25.5%, respectively. Their prevalence had declined to 4.9% and 17.6%, respectively, by the last observation point. The 5 selected EPBs also manifested a decreasing trend. Belief in COVID-19 prevention myths trended upwards. Perceived risk was positively associated with e...

Suicidal motivations reported by opioid overdose survivors: A cross-sectional study of adults with opioid use disorder

Drug and Alcohol Dependence, 2019

Background: Prior studies in heroin use disorder reported low rates (10%) of suicidal intention w... more Background: Prior studies in heroin use disorder reported low rates (10%) of suicidal intention with non-fatal opioid overdose but did not assess dimensional ratings of suicidal ideation. This study aims to quantify the frequency and intensity of ratings of desire to die and perceived overdose risk proximal to the most recent opioid overdose event among individuals admitted for opioid use disorder detoxification/stabilization. Methods: Cross-sectional study (June 2017-July 2018) assessing patterns of opioid use and variables related to overdose history was conducted in a not-for-profit psychiatric hospital. Adults (>18 years) with opioid use disorder were eligible and 120 of 122 participants completed all measures. Forty-one percent were women and 85% self-identified as white. Participants' perceptions of the likelihood of overdose and their suicidal motivations (defined as desire to die)

Association of smoking with poor health-related quality of life among health-profession students in China: A 31-university multilevel, multivariable analysis

Tobacco Induced Diseases

INTRODUCTION While many studies have confirmed that smoking is causally associated with various d... more INTRODUCTION While many studies have confirmed that smoking is causally associated with various diseases, some have found an association between smoking and human functional impairment. Relationships between smoking and poor healthrelated quality of life (HRQoL) have been investigated in general populations. However, these studies have examined only individual-level correlates. This study examined the association between smoking and poor HRQoL, at both the individual and contextual levels, in university settings across China. METHODS Large-scale survey sampling was conducted among 11659 healthprofession students from 31 Chinese universities. HRQoL was measured by the EQ-5D instrument. This multilevel, multivariable analysis utilized unadjusted and adjusted methods. RESULTS Prevalence of poor HRQoL in this study was 2.7% (95% CI: 1.9-3.5). Multilevel logistic regression analysis revealed that frequent (OR=3.18; 95% CI: 2.35-4.33) and occasional smokers (OR=2.73; 95% CI: 1.61-4.65) and universities with high (OR=2.68; 95% CI: 1.34-5.35) and medium smoking prevalence (OR=1.49; 95% CI: 0.95-5.35) had excess odds of poor HRQoL compared to their respective referents, non-smokers and universities with a low smoking prevalence. CONCLUSIONS This multilevel study provides new evidence that smoking is associated with poor HRQL. Findings underscore the importance of alerting the populace that functional impairment is linked to smoking.

Adjusted odds ratios<sup>a</sup> and 95% confidence intervals for suicide versus undetermined manner of death classification by injury mechanism/cause according to documentation of a suicide note and other selected psychological/psychiatric characteristics: 17 National Violent Death Reporting Sys...

<p>Adjusted odds ratios<a href="http://www.plosone.org/article/info:doi/10.1371/jou... more

Percent suicide by method and selected demographic characteristics: 17 National Violent Death Reporting System States and the United States, 2011–2013<sup>a</sup>

<p>Percent suicide by method and selected demographic characteristics: 17 National Violent ... more

Review Article Metabolic Syndrome Is Associated with Increased Breast Cancer Risk: A Systematic Review with Meta-Analysis

Copyright © 2014 Ruchi Bhandari et al.This is an open access article distributed under the Creati... more Copyright © 2014 Ruchi Bhandari et al.This is an open access article distributed under the Creative CommonsAttribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Although individual metabolic risk factors are reported to be associated with breast cancer risk, controversy surrounds risk of breast cancer from metabolic syndrome (MS). We report the first systematic review and meta-analysis of the association between MS and breast cancer risk in all adult females. Methods. Studies were retrieved by searching four electronic reference databases [PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and ProQuest through June 30, 2012] and cross-referencing retrieved articles. Eligible for inclusion were longitudinal studies reporting associations between MS and breast cancer risk among females aged 18 years and older. Relative risks and 95 % confidence...

This is an open-access article, free of all

Objectives: To compare stress levels among residents in large Chinese cities between 2001 and 200... more Objectives: To compare stress levels among residents in large Chinese cities between 2001 and 2008. Methods: Survey data were collected in three mainland Chinese capital cities in two waves, in 2001 and 2008, respectively. Participants were recruited through a multi-stage stratified sampling process. Stress was assessed using the Perceived Stress Scale, Chinese version (CPSS). Descriptive methods were used to estimate mean stress levels and associated 95 % confidence intervals. Estimates were adjusted by post-stratification weights. Results: Indicating stable stress levels, respective adjusted mean stress scores for the combined samples of study participants were 23.90 (95%CI: 23.68–24.12) in 2001 and 23.69 (95%CI: 23.38–24.01) in 2008. A lower stress level in 2008 than in 2001 manifested among residents who were under 25 years of age; female; with a college or higher level education; divorced, widowed, or separated; members of the managerial and clerical group; students or army per...

New Edition Population and Health : An Introduction to Epidemiology by

Epidemiologists search for the who, when, where, and why of health problems. Health surveys have ... more Epidemiologists search for the who, when, where, and why of health problems. Health surveys have the capacity to access hard-to-reach populations. Epidemiologic research gauges whether specific medicines or behaviors prevent disease. Founded in 1929, the Population Reference Bureau is the leader in providing timely, objective information on U.S. and international population trends and their implications. PRB informs policymakers, educators, the media, and concerned citizens working in the public interest around the world through a broad range of activities including publications, information services , seminars and workshops, and technical support. PRB is a nonprofit, nonadvocacy organization. Our efforts are supported by government contracts, foundation grants, individual and corporate contributions, and the sale of publications. PRB is governed by a Board of Trustees representing diverse community and professional interests. The Population Bulletin is published four times a year a...

Incidence and Lethality of Suicidal Overdoses by Drug Class

JAMA Network Open, 2020

IMPORTANCE Prior lethality analyses of suicide means have historically treated drug poisoning oth... more

Adjusted odds ratios<sup>a</sup> and 95% confidence intervals for suicide versus undetermined manner of death classification according to injury mechanism/cause and documentation of a suicide note and other selected psychological/psychiatric characteristics: 17 National Violent Death Reporting Sy...

<p>Adjusted odds ratios<a href="http://www.plosone.org/article/info:doi/10.1371/jou... more

Assessing Substance Abuse Treatment Need: A

Results: Thirty-one percent (95% confidence interval [CI] 27.3% to 34.7%) of screened ED patients... more Results: Thirty-one percent (95% confidence interval [CI] 27.3% to 34.7%) of screened ED patients (n=1,330) had positive test results for substance use. Their prevalence of denial of use in the 30 days before the survey ranged from 10% for alcohol (95% CI 5.7% to 14.3%) to 100% for phencyclidine. One percent of all ED patients (n=1,502) had a recorded diagnosis of substance abuse. By contrast, as many as 27% (95% CI 23.3% to 31.8%) were assessed as needing substance abuse treatment on the basis of a comprehensive case definition that accounted for denial and positive test results. A sensitivity analysis using other case definitions is also presented. For example, 4% (95% CI 2.8% to 5.3%) of patients met the very strict definition of DSM-IV current drug dependence only. Under the comprehensive case definition, TennCare patients (adjusted odds ratio [OR] 1.63; 95% CI 1.30 to 2.05) and Medicare patients (adjusted OR 2.50; 95% CI 1.34 to 4.65) showed excess treatment need relative to th...

Feasibility and acceptability of safety screening among patients receiving addiction treatment

Journal of Substance Abuse Treatment, 2020

INTRODUCTION Premature mortality associated with opioid-related overdose and suicide is a signifi... more INTRODUCTION Premature mortality associated with opioid-related overdose and suicide is a significant public health problem in the United States. Approximately 20-30% of individuals with opioid use disorder (OUD) have a history of both suicide attempt and unintentional opioid overdose. The objective of this study is to evaluate the feasibility of a standardized screen for suicide and overdose among patients receiving addiction treatment. METHODS We conducted a cross-sectional study using a convenience sample of patients (n = 113) recruited from two inpatient treatment programs. We used a modified version of the Patient Safety Screener (mPSS) to screen for suicidal ideation, suicide attempt, and overdose. Study staff administered the screen in-person during treatment, and we linked results to administrative clinical data. Subjects (n = 108) and members of their clinical care team (n = 20) completed a screening acceptability survey. We recorded a positive mPSS if a patient reported suicidal ideation in the past two weeks, a suicide attempt, and/or an overdose in the past six months. RESULTS Fifty-eight percent of subjects had a positive mPSS screen, and 30.3% reported suicidal ideation, suicide attempt, and overdose. Subjects and clinical staff reported that it was acceptable to screen for suicide attempt(s) and overdose(s). About a third of the clinical staff reported concerns about administration time (n = 7) and impact on workflow (n = 6). CONCLUSIONS Both suicide and overdose are important patient safety factors that should be incorporated into addiction treatment and discharge planning. This study's findings support simultaneously screening for suicide and overdose in OUD inpatient treatment settings. Future research needs to determine whether screening improves provision of services and reduces self-injurious behavior.

Variable Circumstances of Suicide Among Racial/Ethnic Groups by Sex and Age: A National Violent-Death Reporting System Analysis

Archives of Suicide Research, 2019

Suicide rates vary by race/ethnicity, but little is known about how the circumstances that contri... more Suicide rates vary by race/ethnicity, but little is known about how the circumstances that contribute to suicide differ across racial/ethnic groups. This study investigated suicide circumstances among non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic Asian/Pacific Islanders, non-Hispanic Native American/Alaskan Natives, and Hispanics by sex and age. Using de-identified National Violent Death Reporting System (NVDRS) Restricted Access Database files from 2006-2015, we examined proximal circumstances of suicide among decedents aged 10 years and older. Hierarchical logistic regression analysis revealed racial/ethnic differentials in non-alcohol substance abuse problem, intimate partner problem, and physical health problem across sex and age, controlling for potential confounders. Study findings highlight priority areas for suicide interventions.

Overcoming the limitations of ‘accident’ as a manner of death for drug overdose mortality: case for a death certificate checkbox

Injury Prevention, 2020

Collectively, the epidemic increases in the United States of opioid-related deaths and suicides d... more Collectively, the epidemic increases in the United States of opioid-related deaths and suicides during the first two decades of the 21st century have exposed shortcomings in current forensic and epidemiological approaches for determining and codifying manner of death—a vital function fulfilled by medical examiners, coroners and nosologists—the foundation for the National Violent Death Reporting System (NVDRS), an incident-based surveillance system providing individual-level information on decedent characteristics, manner, cause and circumstances of suicide, homicide and other violent injury deaths. Drug intoxication deaths are generally classified as ‘accidents’ or unintentional, a fundamental mischaracterisation; most arose from repetitive self-harm behaviours related to substance acquisition and misuse. Moreover, given the burden of affirmative evidence required to determine suicide, many of these ‘accidents’ likely reflected unrecognised intentional acts—that is, suicides. Additi...

Real-world, anti-tobacco environmental impact upon priceinduced smoking reduction among urban Chinese men: Evidence from China’s 2015 cigarette tax increase

Tobacco Induced Diseases

INTRODUCTION Raising the price of cigarettes via taxation has been promoted by the World Health O... more INTRODUCTION Raising the price of cigarettes via taxation has been promoted by the World Health Organization as an important tobacco control strategy. Price elasticity of cigarettes is not uniform and is dependent upon individual and environmental determinants. Many studies have examined the determinants of price-induced smoking, taking into account sociodemographic characteristics and consumption patterns. Little research has been conducted on the association between anti-smoking environments and price-induced smoking behavior. This study addresses the deficit within the Chinese context. METHODS Participants were 2852 male smokers identified through a multi-stage survey sampling process encompassing 6 cities in China between July and December 2016. A standardized questionnaire tapped price-induced smoking reduction and related information. Both unadjusted and adjusted logistic regression methods were applied in the analyses. RESULTS In all, 25.5% (95% CI: 22.5-27.9) of smokers in this study decreased their smoking expenditures following the 2015 excise tax increase. The adjusted logistic regression analysis showed that increased exposures to an anti-smoking information environment (AOR=1.39; 95% CI: 1.10-1.79), restricted smoking in their home (AOR=1.67; 95% CI: 1.32-2.08) and workplace (AOR=1.43; 95% CI: 1.09-1.85) were more likely to report diminished cigarette smoking following the tax increases. CONCLUSIONS This study adds to understanding price-induced smoking behavior among urban male Chinese smokers. Strengthening of excise tax policies needs to intensify environmental smoking restrictions and public education campaigns to increase the sensitivity of cigarette price changes among smokers.

Observational Studies in Suicide Research

Hogrefe Publishing eBooks, 2021

Contextual Influences on Deliberate Self-harm Among Chinese University Undergraduates: A Representative Nationwide Study

Background: Numerous studies have identified factors associated with deliberate self-harm (DSH), ... more Background: Numerous studies have identified factors associated with deliberate self-harm (DSH), but environmental influences have been largely neglected. This study explored regional and university contextual factors impacting DSH among undergraduate students in China. Methods: In this observational cross-sectional study, subjects were 5,016 undergraduate students, who were identified through multistage survey sampling in 22 Chinese universities. Individual-level data were obtained through a self-administered questionnaire, and environmental variables were extracted from the National Bureau of Statistics database. Multilevel logistic regression models were used to examine regional correlates of DSH.Results: The overall prevalence of self-reported DSH in the study sample was 7.5% (95% CI: 4.1%, 10.9%). The full multilevel logistic model showed university rank and city size were inversely associated with DSH prevalence (OR: 0.24 and 0.55). Regional unemployment rates were positively ...

Escalating costs of self-injury mortality in the 21st century United States: an interstate observational study

BMC Public Health

Background Estimating the economic costs of self-injury mortality (SIM) can inform health plannin... more Background Estimating the economic costs of self-injury mortality (SIM) can inform health planning and clinical and public health interventions, serve as a basis for their evaluation, and provide the foundation for broadly disseminating evidence-based policies and practices. SIM is operationalized as a composite of all registered suicides at any age, and 80% of drug overdose (intoxication) deaths medicolegally classified as ‘accidents,’ and 90% of corresponding undetermined (intent) deaths in the age group 15 years and older. It is the long-term practice of the United States (US) Centers for Disease Control and Prevention (CDC) to subsume poisoning (drug and nondrug) deaths under the injury rubric. This study aimed to estimate magnitude and change in SIM and suicide costs in 2019 dollars for the United States (US), including the 50 states and the District of Columbia. Methods Cost estimates were generated from underlying cause-of-death data for 1999/2000 and 2018/2019 from the US Ce...

Using natural language processing to improve suicide classification requires consideration of race

Suicide and Life-Threatening Behavior

OBJECTIVES To improve the accuracy of classification of deaths of undetermined intent and to exam... more OBJECTIVES To improve the accuracy of classification of deaths of undetermined intent and to examine racial differences in misclassification. METHODS We used natural language processing and statistical text analysis on restricted-access case narratives of suicides, homicides, and undetermined deaths in 37 states collected from the National Violent Death Reporting System (NVDRS) (2017). We fit separate race-specific classification models to predict suicide among undetermined cases using data from known homicide cases (true negatives) and known suicide cases (true positives). RESULTS A classifier trained on an all-race dataset predicts less than half of these cases as suicide. Importantly, our analysis yields an estimated suicide rate for the Black population comparable with the typical detection rate for the White population, indicating that misclassification excess is endemic for Black suicide. This problem may be mitigated by using race-specific data. Our findings, based on the statistical text analysis, also reveal systematic differences in the phrases identified as most predictive of suicide. CONCLUSIONS This study highlights the need to understand the reasons underlying suicide rate differences and for further testing of strategies to reduce misclassification, particularly among people of color.

Suicidal motivations among opioid overdose survivors: Replication and extension

Drug and Alcohol Dependence

BACKGROUND Several studies suggest suicidal motivation may contribute to opioid overdose fataliti... more BACKGROUND Several studies suggest suicidal motivation may contribute to opioid overdose fatalities in people with opioid use disorder. In this study, we sought to replicate and extend prior findings suggesting that a desire to die is common prior to nonfatal opioid overdose in people with opioid use disorder. METHODS Adults receiving inpatient detoxification and stabilization who reported a history of opioid overdose (N = 60) completed questions about suicidal cognition prior to their most recent overdose. RESULTS Approximately 45% reported some desire to die prior to their most recent overdose, with 20% reporting they had some intention to die. The correlation between these ratings was of a moderate magnitude (ρ = 0.58). Almost 40% of the sample perceived no risk of overdose prior to their most recent overdose event, suggesting a significant underestimation of risk in this population. CONCLUSIONS Desire to die was common in adults with opioid use disorder prior to nonfatal opioid overdose events, and 1 in 5 people with a history of opioid overdose reported intention to die prior to their most recent opioid overdose. Careful assessment of suicidal cognition in this population may improve prevention of opioid overdose deaths.

Changing trends of excess self-protective behavior, and association with belief in prevention myths during the COVID-19 epidemic in China: A panel study

Objective This prospective observational study examined changing trends of excess self-protective... more Objective This prospective observational study examined changing trends of excess self-protective behavior (EPB), and its association with perceived risk, severity and belief in prevention myths during the Chinese COVID-19 epidemic. Methods The study employed a longitudinal design. Participants were recruited for an online panel survey from chat groups on social media platforms. Descriptive statistics and the CATMOD program were used for data analysis. Findings Participants numbered 150 for the linkable baseline survey and 102 for the final survey. There were 5 waves of interviews. The prevalence of participants perceiving a personal risk of contracting COVID-19, and severe consequences of the disease, was 18.6% and 25.5%, respectively. Their prevalence had declined to 4.9% and 17.6%, respectively, by the last observation point. The 5 selected EPBs also manifested a decreasing trend. Belief in COVID-19 prevention myths trended upwards. Perceived risk was positively associated with e...

Suicidal motivations reported by opioid overdose survivors: A cross-sectional study of adults with opioid use disorder

Drug and Alcohol Dependence, 2019

Background: Prior studies in heroin use disorder reported low rates (10%) of suicidal intention w... more Background: Prior studies in heroin use disorder reported low rates (10%) of suicidal intention with non-fatal opioid overdose but did not assess dimensional ratings of suicidal ideation. This study aims to quantify the frequency and intensity of ratings of desire to die and perceived overdose risk proximal to the most recent opioid overdose event among individuals admitted for opioid use disorder detoxification/stabilization. Methods: Cross-sectional study (June 2017-July 2018) assessing patterns of opioid use and variables related to overdose history was conducted in a not-for-profit psychiatric hospital. Adults (>18 years) with opioid use disorder were eligible and 120 of 122 participants completed all measures. Forty-one percent were women and 85% self-identified as white. Participants' perceptions of the likelihood of overdose and their suicidal motivations (defined as desire to die)

Association of smoking with poor health-related quality of life among health-profession students in China: A 31-university multilevel, multivariable analysis

Tobacco Induced Diseases

INTRODUCTION While many studies have confirmed that smoking is causally associated with various d... more INTRODUCTION While many studies have confirmed that smoking is causally associated with various diseases, some have found an association between smoking and human functional impairment. Relationships between smoking and poor healthrelated quality of life (HRQoL) have been investigated in general populations. However, these studies have examined only individual-level correlates. This study examined the association between smoking and poor HRQoL, at both the individual and contextual levels, in university settings across China. METHODS Large-scale survey sampling was conducted among 11659 healthprofession students from 31 Chinese universities. HRQoL was measured by the EQ-5D instrument. This multilevel, multivariable analysis utilized unadjusted and adjusted methods. RESULTS Prevalence of poor HRQoL in this study was 2.7% (95% CI: 1.9-3.5). Multilevel logistic regression analysis revealed that frequent (OR=3.18; 95% CI: 2.35-4.33) and occasional smokers (OR=2.73; 95% CI: 1.61-4.65) and universities with high (OR=2.68; 95% CI: 1.34-5.35) and medium smoking prevalence (OR=1.49; 95% CI: 0.95-5.35) had excess odds of poor HRQoL compared to their respective referents, non-smokers and universities with a low smoking prevalence. CONCLUSIONS This multilevel study provides new evidence that smoking is associated with poor HRQL. Findings underscore the importance of alerting the populace that functional impairment is linked to smoking.

Adjusted odds ratios<sup>a</sup> and 95% confidence intervals for suicide versus undetermined manner of death classification by injury mechanism/cause according to documentation of a suicide note and other selected psychological/psychiatric characteristics: 17 National Violent Death Reporting Sys...

<p>Adjusted odds ratios<a href="http://www.plosone.org/article/info:doi/10.1371/jou... more

Percent suicide by method and selected demographic characteristics: 17 National Violent Death Reporting System States and the United States, 2011–2013<sup>a</sup>

<p>Percent suicide by method and selected demographic characteristics: 17 National Violent ... more

Review Article Metabolic Syndrome Is Associated with Increased Breast Cancer Risk: A Systematic Review with Meta-Analysis

Copyright © 2014 Ruchi Bhandari et al.This is an open access article distributed under the Creati... more Copyright © 2014 Ruchi Bhandari et al.This is an open access article distributed under the Creative CommonsAttribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Although individual metabolic risk factors are reported to be associated with breast cancer risk, controversy surrounds risk of breast cancer from metabolic syndrome (MS). We report the first systematic review and meta-analysis of the association between MS and breast cancer risk in all adult females. Methods. Studies were retrieved by searching four electronic reference databases [PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and ProQuest through June 30, 2012] and cross-referencing retrieved articles. Eligible for inclusion were longitudinal studies reporting associations between MS and breast cancer risk among females aged 18 years and older. Relative risks and 95 % confidence...

This is an open-access article, free of all

Objectives: To compare stress levels among residents in large Chinese cities between 2001 and 200... more Objectives: To compare stress levels among residents in large Chinese cities between 2001 and 2008. Methods: Survey data were collected in three mainland Chinese capital cities in two waves, in 2001 and 2008, respectively. Participants were recruited through a multi-stage stratified sampling process. Stress was assessed using the Perceived Stress Scale, Chinese version (CPSS). Descriptive methods were used to estimate mean stress levels and associated 95 % confidence intervals. Estimates were adjusted by post-stratification weights. Results: Indicating stable stress levels, respective adjusted mean stress scores for the combined samples of study participants were 23.90 (95%CI: 23.68–24.12) in 2001 and 23.69 (95%CI: 23.38–24.01) in 2008. A lower stress level in 2008 than in 2001 manifested among residents who were under 25 years of age; female; with a college or higher level education; divorced, widowed, or separated; members of the managerial and clerical group; students or army per...

New Edition Population and Health : An Introduction to Epidemiology by

Epidemiologists search for the who, when, where, and why of health problems. Health surveys have ... more Epidemiologists search for the who, when, where, and why of health problems. Health surveys have the capacity to access hard-to-reach populations. Epidemiologic research gauges whether specific medicines or behaviors prevent disease. Founded in 1929, the Population Reference Bureau is the leader in providing timely, objective information on U.S. and international population trends and their implications. PRB informs policymakers, educators, the media, and concerned citizens working in the public interest around the world through a broad range of activities including publications, information services , seminars and workshops, and technical support. PRB is a nonprofit, nonadvocacy organization. Our efforts are supported by government contracts, foundation grants, individual and corporate contributions, and the sale of publications. PRB is governed by a Board of Trustees representing diverse community and professional interests. The Population Bulletin is published four times a year a...

Incidence and Lethality of Suicidal Overdoses by Drug Class

JAMA Network Open, 2020

IMPORTANCE Prior lethality analyses of suicide means have historically treated drug poisoning oth... more

Adjusted odds ratios<sup>a</sup> and 95% confidence intervals for suicide versus undetermined manner of death classification according to injury mechanism/cause and documentation of a suicide note and other selected psychological/psychiatric characteristics: 17 National Violent Death Reporting Sy...

<p>Adjusted odds ratios<a href="http://www.plosone.org/article/info:doi/10.1371/jou... more

Assessing Substance Abuse Treatment Need: A

Results: Thirty-one percent (95% confidence interval [CI] 27.3% to 34.7%) of screened ED patients... more Results: Thirty-one percent (95% confidence interval [CI] 27.3% to 34.7%) of screened ED patients (n=1,330) had positive test results for substance use. Their prevalence of denial of use in the 30 days before the survey ranged from 10% for alcohol (95% CI 5.7% to 14.3%) to 100% for phencyclidine. One percent of all ED patients (n=1,502) had a recorded diagnosis of substance abuse. By contrast, as many as 27% (95% CI 23.3% to 31.8%) were assessed as needing substance abuse treatment on the basis of a comprehensive case definition that accounted for denial and positive test results. A sensitivity analysis using other case definitions is also presented. For example, 4% (95% CI 2.8% to 5.3%) of patients met the very strict definition of DSM-IV current drug dependence only. Under the comprehensive case definition, TennCare patients (adjusted odds ratio [OR] 1.63; 95% CI 1.30 to 2.05) and Medicare patients (adjusted OR 2.50; 95% CI 1.34 to 4.65) showed excess treatment need relative to th...

Feasibility and acceptability of safety screening among patients receiving addiction treatment

Journal of Substance Abuse Treatment, 2020

INTRODUCTION Premature mortality associated with opioid-related overdose and suicide is a signifi... more INTRODUCTION Premature mortality associated with opioid-related overdose and suicide is a significant public health problem in the United States. Approximately 20-30% of individuals with opioid use disorder (OUD) have a history of both suicide attempt and unintentional opioid overdose. The objective of this study is to evaluate the feasibility of a standardized screen for suicide and overdose among patients receiving addiction treatment. METHODS We conducted a cross-sectional study using a convenience sample of patients (n = 113) recruited from two inpatient treatment programs. We used a modified version of the Patient Safety Screener (mPSS) to screen for suicidal ideation, suicide attempt, and overdose. Study staff administered the screen in-person during treatment, and we linked results to administrative clinical data. Subjects (n = 108) and members of their clinical care team (n = 20) completed a screening acceptability survey. We recorded a positive mPSS if a patient reported suicidal ideation in the past two weeks, a suicide attempt, and/or an overdose in the past six months. RESULTS Fifty-eight percent of subjects had a positive mPSS screen, and 30.3% reported suicidal ideation, suicide attempt, and overdose. Subjects and clinical staff reported that it was acceptable to screen for suicide attempt(s) and overdose(s). About a third of the clinical staff reported concerns about administration time (n = 7) and impact on workflow (n = 6). CONCLUSIONS Both suicide and overdose are important patient safety factors that should be incorporated into addiction treatment and discharge planning. This study's findings support simultaneously screening for suicide and overdose in OUD inpatient treatment settings. Future research needs to determine whether screening improves provision of services and reduces self-injurious behavior.