Understanding the Toxic Cycle: Expanding emergency care of Alcohol & Other Drugs

Project Director: Matthew Rehrer, MD
Principal Investigator: Harrison Alter, MS, MD; Colin Feeney, MD, PD

The emergency department (ED) is frequently the only source of care for patients with substance abuse and dependency problems.  We are using the social emergency medicine framework to understand how the ED can improve the care of these patients, particularly in the realms of referral to treatment, brief interventions, and refining clinical strategies for patients in acute withdrawal. We also hope soon to study the effect that these drugs have on other common ED problems, especially violence.


Effects of racial segregation on neighborhood violent injury rates

Project Director: Josh Berezin
Principal Investigator: Harrison Alter, MS, MD 

African Americans and Hispanics experience higher rates of violent injury and death than Whites. In 2004, homicide was the 21st leading cause of death for non-Hispanic Whites of all ages, but the 6th and 7th for African Americans and Hispanics respectively.  This disparity is particularly pronounced for young males. For example, among causes of death in males 20-24 years old, homicide accounted for 48.4% of deaths among African Americans, 25% of deaths among Hispanics, and 9.7% of deaths among Whites.

In attempting to explain these disparities, some scholars have examined the role of housing discrimination and its effect on communities. The United States has a long and ignominious history of racial residential segregation, which Douglas Massey defines as the “degree to which two or more groups live separately from one another, in different parts of the urban environment.”

A researcher associated with the Levitt Center, Josh Berezin, working with colleagues at UC Berkeley, performed a cross-sectional, ecological, neighborhood-level study of the relationship between diversity and violent injury in Oakland, California.  The methods involved determining the number of injuries in Oakland block groups, calculating a measure of diversity for those block groups, and analysis of the data.

Berezin and his co-investigators found that in block groups with at least one violent injury had a significant and inverse association between level of racial and ethnic diversity and rate of violent injury (IRR 0.22; 95% CI 0.10 – 0.48). They found a similar relationship for predominantly African American block groups (IRR 0.23; 95% CI 0.083 – 0.62) and predominantly Hispanic block groups (IRR 0.08; 95% CI 0.01 – 0.76).  Diversity was not significantly associated with violent injury in predominantly White or Asian block groups.


Stop Trafficking Now: Ending the Commercial Sexual Exploitation of Children

Project Director: Hillary Larkin, PA-C
Principal Investigator: Harrison Alter, MS, MD 

The Levitt Center is actively engaged with other agencies in the Bay Area, particularly the HEAT (Human Exploitation And Trafficking) Watch initiative, to fashion a coordinated response by the medical community for trafficked children.  We are also working with researchers at UCSF, Stanford and UC Berkeley to understand better what are the needs of this most vulnerable group, and how the emergency care system might respond to these needs.


Back to Current Projects