Spatial Heterogeneity in Fatal Overdose Rate Trends in Mexican Cities: 2005-2021.

Objectives. To describe national and city-level fatal drug overdose trends between 2005 and 2021 in Mexico. Methods. We calculated fatal overdose rates at the city level in 3-year periods from 2005 to 2021 and annually at the national level for people aged 15 to 64 years in Mexico. We calculated rate differences and rate ratios for each city between periods. Results. The national fatal overdose rate was 0.53 overdose deaths per 100 000 population and was almost twice as high in urban than in nonurban areas. The national fatal overdose rate was stable over the period 2005 to 2014 and increased monotonically to a peak in 2021. Fatal overdose rates varied across cities. Cities with the 8 highest fatal overdose rates in the period were all in states along the US-Mexico border. Conclusions. Fatal overdoses have doubled over the past 15 years in Mexico. Overdose rates are particularly high and increasing in cities close to the US-Mexico border. Public Health Implications. There is a need for enhanced overdose surveillance data and coordinated harm reduction strategies, particularly in the northern border region of Mexico. (Am J Public Health. 2024;114(7):705-713. https://doi.org/10.2105/AJPH.2024.307650).

Associated factors to non-medical and medical use of psychoactive medication among Mexican adolescents and adults in a national household survey.

BACKGROUND: Non-medical use of psychoactive medication is a public health problem. Studies in other contexts indicate that individual sociodemographic characteristics are associated with non-medical use, but these associations have not been assessed in the Mexican context. OBJECTIVES: To estimate the prevalence non-medical and medical use of psychoactive medication among Mexican adolescents and adults' medication users and to estimate the associations between sociodemographic characteristics and non-medical use of psychoactive medication, using data from a nationally representative sample. METHODS: Secondary analysis of data collected from the National Survey of Drug, Alcohol, and Tobacco Consumption (ENCODAT) 2016 to 2017. The analytical sample included people aged 12 to 65 years. The sample was stratified into two age categories: adolescents (12-17 years) and adults (18-65 years). Sub-analyses were performed to describe prevalence of use and non-medical use of psychoactive medication at the state-level. Descriptive statistics and multinomial logistic regression models were used to estimate associations between sociodemographic characteristics and medical, non-medical, and non-use of psychoactive medication in adolescents and adults. RESULTS: Among Mexican medication users in 2016, the national prevalence of non-medical use of psychoactive drugs was 19.6%; 22.2% among adolescents and 19.4% among adults. States adjacent to the US-Mexico border reported the highest levels of non-medical use of psychoactive medication. Illicit drug consumption was associated with non-medical use. Sociodemographic characteristics associated with non-medical use varied between adolescents and adults. CONCLUSIONS: There is a high proportion of non-medical use of psychoactive drugs among Mexican medication users, especially among young people. Understanding factors associated with the misuse of psychoactive medications in Mexico can inform policy for prevention and treatment.

Evaluating the health effects of place-based slum upgrading physical environment interventions: A systematic review (2012-2018).

Rapid urbanization in low- and middle-income countries (LMIC) is associated with increasing population living in informal settlements. Inadequate infrastructure and disenfranchisement in settlements can create environments hazardous to health. Placed-based physical environment upgrading interventions have potential to improve environmental and economic conditions linked to health outcomes. Summarizing and assessing evidence of the impact of prior interventions is critical to motivating and selecting the most effective upgrading strategies moving forward. Scientific and grey literature were systematically reviewed to identify evaluations of physical environment slum upgrading interventions in LMICs published between 2012 and 2018. Thirteen evaluations that fulfilled inclusion criteria were reviewed. Quality of evaluations was assessed using an adapted Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Findings were then pooled with those published prior to 2012. Narrative analysis was performed. Of thirteen evaluations, eight used a longitudinal study design ("primary evaluations"). All primary evaluations were based in Latin America and included two housing, two transportation, and four comprehensive intervention evaluations. Three supporting evaluations assessed housing interventions in Argentina and South Africa; two assessed a comprehensive intervention in India. Effects by intervention-type included improvements in quality of life and communicable diseases after housing interventions, possible improvements in safety after transportation and comprehensive interventions, and possible non-statistically significant effects on social capital after comprehensive interventions. Effects due to interventions may vary by regional context and intervention scope. Limited strong evidence and the diffuse nature of comprehensive interventions suggests a need for attention to measurement of intervention exposure and analytic approaches to account for confounding and selection bias in evaluation. In addition to health improvements, evaluators should consider unintended health consequences and environmental impact. Understanding and isolating the effects of place-based interventions can inform necessary policy decisions to address inadequate living conditions as rapid urban growth continues across the globe.

US Mayors' and Health Commissioners' Opinions About Health Disparities in Their Cities.

OBJECTIVES: To characterize US mayors' and health commissioners' opinions about health disparities in their cities and identify factors associated with these opinions. METHODS: We conducted a multimodal survey of mayors and health commissioners in fall-winter 2016 (n = 535; response rate = 45.2%). We conducted bivariate analyses and multivariable logistic regression. RESULTS: Forty-two percent of mayors and 61.1% of health commissioners strongly agreed that health disparities existed in their cities. Thirty percent of mayors and 8.0% of health commissioners believed that city policies could have little or no impact on disparities. Liberal respondents were more likely than were conservative respondents to strongly agree that disparities existed (mayors: odds ratio [OR] = 7.37; 95% confidence interval [CI] = 3.22, 16.84; health commissioners: OR = 5.09; 95% CI = 3.07, 8.46). In regression models, beliefs that disparities existed, were avoidable, and were unfair were independently associated with the belief that city policies could have a major impact on disparities. CONCLUSIONS: Many mayors, and some health commissioners, are unaware of the potential of city policies to reduce health disparities. Ideology is strongly associated with opinions about disparities among these city policymakers. Public Health Implications: Information about health disparities, and policy strategies to reduce them, needs to be more effectively communicated to city policymakers.