Inequalities in US Life Expectancy by Area Unemployment Level, 1990-2010

This study examined the association between unemployment and life expectancy in the United States during 1990-2010. 

Census-based unemployment rates were linked to US county-level mortality data. Life expectancies were calculated by age, sex, race, and unemployment level during 1990-2010. Differences in life expectancy were decomposed by age and cause of death. 

Life expectancy was consistently lower in areas with higher unemployment rates. In 2006-2010, those in areas with high unemployment rates (≥9%) had a life expectancy of 76.9 years, compared with 80.7 years for those in areas with low unemployment rates (<3%). The association between unemployment and life expectancy was stronger for men than for women. 

Life expectancy ranged from 69.9 years among black men in high unemployment areas to 90.0 years among Asian/Pacific Islander women in low unemployment areas. Disparities persisted over time. In 1990-1992, life expectancy was 4.7 years shorter in high unemployment than in low unemployment areas. In 2006-2010, the life expectancy difference between the lowest and highest unemployment areas decreased to 3.8 years. Heart disease, cancer, homicide, unintentional injuries, diabetes, HIV/AIDS, and liver cirrhosis contributed most to the lower life expectancy in high unemployment areas. High unemployment areas recorded larger gains in life expectancy than low unemployment areas, contributing to the narrowing gap during 1990-2010.

Below:  Life expectancy at birth by sex and area unemployment level, United States, 1990–2010

Below:  Survivorship by age, race, and unemployment level, United States, 1990–2010

Below:  Conditional probability of survival between ages of 25 and 64 years by unemployment level, United States, 1990–2010

Full article at:   http://goo.gl/FI27Gt

By:  Singh GK1, Siahpush M2.

• 1US Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857, USA.
• 2Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE 68198-4365, USA.
• Scientifica (Cairo). 2016;2016:8290435. doi: 10.1155/2016/8290435. Epub 2016 Mar 17. 

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Stakeholder Perceptions & Operational Barriers in the Training & Distribution of Take-Home Naloxone within Prisons in England

BACKGROUND:

The aim of the study was to assess potential barriers and challenges to the implementation of take-home naloxone (THN) across ten prisons in one region of England.

METHODS:

Qualitative interviews deploying a grounded theory approach were utilised over a 12- to 18-month period that included an on-going structured dialogue with strategic and operational prison staff from the ten prisons and other key stakeholders (n = 17). Prisoner perceptions were addressed through four purposive focus groups belonging to different establishments (n = 26). Document analysis also included report minutes and access to management information and local performance reports. The data were thematically interpreted using visual mapping techniques.

RESULTS:

The distribution and implementation of THN in a prison setting was characterised by significant barriers and challenges. As a result, four main themes were identified: a wide range of negative and confused perceptions of THN amongst prison staff and prisoners; inherent difficulties with the identification and engagement of eligible prisoners; the need to focus on individual prison processes to enhance the effective distribution of THN; and the need for senior prison staff engagement.

CONCLUSIONS:

The distribution of THN within a custodial setting requires consideration of a number of important factors which are discussed...

Since I’ve come to this jail, everyone [has been] banging on about getting myself sorted and off the drugs and everything you know. It’s taken a while and I’m in the right place to move forward for once, no more gear – nothing. I’m done with that life….. I’m clean now with no intention of using, so why do I need this? [Male prisoner, Prison 5]

What’ll happen is that I will leave here and as soon I get my feet on the ground the police will stop me, as always, and say…..’What’s this? You must be using again - you’re nicked [arrested]'. [Male prisoner, Prison 2]

Many of my staff understand what we are trying to do here which is get prisoners off drugs and abstinent by the time they leave here…if not abstinent entirely then at least in a positon to consider an abstinent life. For many staff, and it’s not just uniformed staff [prison officers], just handing out Naloxone give out the wrong message that says it’s alright now you can keep on using. I don’t agree with this view myself but I know they [staff] think it. [Healthcare Manager, Naloxone Action Group]

I am very concerned that Naloxone could be given out by prison officers or anyone else without healthcare input. The risks will be too great if something went wrong and the wrong person got hold of it. [Healthcare nurse, Naloxone Action Group] 

Full article at:   http://goo.gl/588N9e

By:   Sondhi A1, Ryan G2, Day E3.

• 1Therapeutic Solutions (Addictions) Communications House, 26 York Street, London, W1U 6PZ, UK. arun.sondhi@therapeutic-solutions.org.uk.
• 2Public Health England, 2nd Floor Skipton House London Road Elephant & Castle, London, SE1 6LH, UK.
• 3Addiction Psychiatry, Addictions Department, National Addiction Centre, Addiction Sciences Building, 4 Windsor Walk, Denmark Hill, London, SE5 8AF, UK.
• Harm Reduct J. 2016 Feb 3;13(1):5. doi: 10.1186/s12954-016-0094-1. 

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“There's Nothing Here”: Deindustrialization as Risk Environment for Overdose

Applying the “risk environment” approach proposed by ( Rhodes, 2002; Rhodes, 2009 ), this study considers the diverse contextual factors contributing to drug overdose in a deindustrialized region of the United States. 

The Monongahela Valley of Pennsylvania, once a global center of steel production, has suffered a mass exodus of jobs, residents, and businesses since a national manufacturing crisis erupted in the early 1980s; more recently, it has seen a dramatic uptick in accidental drug poisoning deaths. 

Where recent local and national media attention to overdose has focused on suburban areas and middle class victims, this study concentrates instead on the deteriorating mill city of McKeesport, Pennsylvania. Eighteen clients of the city's sole drug treatment facility participated in in-depth interviews concerning their direct experience with accidental overdose. Specifically, participants were asked to describe their own most recent overdose event and/or the last overdose they had personally witnessed. They were also asked to speculate upon the roots of the local overdose epidemic, while venturing possible remedies. 

In relating their overdose experiences, participants characterized a micro-level risk environment that was hidden behind closed doors, and populated by unprepared, ambivalent overdose “assistants.” Tasked with explaining a geographic concentration of overdose in and around McKeesport, interviewees referenced the hopelessness of the area and its lack of opportunity as driving the use of heroin, with many explicitly suggesting the need for jobs and community reinvestment to reduce fatalities. 

While state and county efforts to ameliorate overdose mortality have focused upon creating an open market in naloxone, this study suggests the need for interventions that address the poverty and social isolation of opiate users in the post-industrial periphery.

Purchase full article at:   http://goo.gl/N6yTvy

By:  Katherine McLean

The Pennsylvania State University - Greater Allegheny, 4000 University Drive, McKeesport, PA, 15131, United States

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