Louis County Research Articles

A place-based spatial analysis of racial inequities in overdose in St. Louis County Missouri, United States

ObjectiveThe objective of this study was to identify place features associated with increased risk of drug-involved fatalities and generate a composite score measuring risk based on the combined effects of features of the built environment. MethodsWe conducted a geospatial analysis of overdose data from 2022 to 2023 provided by the St. Louis County Medical Examiner's Office to test whether drug-involved deaths were more likely to occur near 54 different place features using Risk Terrain Modeling (RTM). RTM was used to identify features of the built environment that create settings of heightened overdose risk. Risk was estimated using Relative Risk Values (RRVs) and a composite score measuring Relative Risk Scores (RRS) across the county was produced for drugs, opioids, and stimulants, as well as by Black and White decedents. ResultsIn the model including all drugs, deaths were more likely to occur in close proximity to hotels/motels (RRV=39.65, SE=0.34, t-value=10.81 p<.001), foreclosures (RRV=4.42, SE=0.12, t-value = 12.80, p<.001), police departments (RRV=3.13, SE=0.24, t-score=4.86, p<.001), and restaurants (RRV=2.33, SE=0.12, t-value=7.16, p<.001). For Black decedents, deaths were more likely to occur near foreclosures (RRV=9.01, SE=0.18, t-value =11.92, p<.001), and places of worship (RRV= 2.51, SE=0.18, t-value = 11.92, p<.001). For White decedents, deaths were more likely to occur in close proximity to hotels/motels (RRV=38.97, SE=0.39, t-value=9.30, p<.001) foreclosures (RRV=2.57, SE=0.16, t-value =5.84, p<.001), restaurants (RRV=2.52, SE=0.17, t-value=5.33, p<.001) and, auto painting/repair shops (RRV=0.04, SE=0.18, t-value =3.39, p<.001). ConclusionThese findings suggest that places of worship, the hospitality industry, and housing authorities may be physical features of the environment that reflect social conditions that are conducive to overdose. The scaling up of harm reduction strategies could be enhanced by targeting places where features are co-located.

An interrupted time series analysis of fentanyl, naloxone, and opioid-involved deaths in five counties in Eastern Missouri

IntroductionRates of opioid overdose deaths (OOD) have increased since the introduction of illicitly manufactured fentanyl in the U.S. drug supply. Though community-based naloxone distribution efforts have been found to effectively reduce OOD, no studies to date have examined their effects during the fentanyl era, nor in the epicenter of a state's overdose crisis. Thus, the current study assessed the impacts of both fentanyl and of subsequent grant-funded community-based naloxone distribution on OOD across Missouri's St. Louis region. MethodsMedical examiner data includes individuals who died within one of the five study counties (St. Louis City, St. Louis County, and Franklin, Jefferson, St. Charles counties [combined as “Collar Counties”]) between 2011 and 2022 due to an opioid overdose (N = 6799). Naloxone distribution date and location data came from Missouri's university-based naloxone distribution team. We conducted a controlled interrupted time series using an autoregressive model via proc. ARIMA to examine changes over time in the rate of OOD associated with the introduction of fentanyl (defined to be present in 25 % of opioid overdose deaths; June 2015) and the start of naloxone distribution for each location (August 2017, October 2017, and January 2018, respectively). ResultsThe introduction of fentanyl into the drug supply of St. Louis City was associated with an increased rate of OOD over time (p < .001). Naloxone distribution in the City was associated with an immediate decrease in OOD (p < .001) followed by a slowed increase in OOD (p < .001). These findings were not replicated in St. Louis County nor the Collar Counties. ConclusionsThe effects of fentanyl and naloxone on OOD varied by region in Eastern Missouri. Specifically, fentanyl and naloxone effects were only found in a high-need urban area with existing harm reduction and street outreach programs, but not in surrounding suburban or rural areas. State-level naloxone distribution decision-makers should prioritize funding harm reduction services in both urban and non-urban settings to help increase targeted naloxone distribution to those actively using drugs. Additionally, interventions tailored for people who engage in solitary drug use - such as safe consumption spaces and overdose detection technologies - should receive increased investment and implementation, particularly in rural areas where harm reduction infrastructure is more scarce.

A Tale of Two Counties: A Study of Vote Centers in Fresno County and St. Louis County

A Tale of Two Counties: A Study of Vote Centers in Fresno County and St. Louis County

Serosurveillance and the first detection of Bourbon virus RNA in a wildlife host.

Bourbon virus (BRBV) is an emerging pathogen that can cause severe and fatal disease in humans. BRBV is vectored by Amblyomma americanum (lone star ticks), which are widely distributed across the central, southern, and eastern United States. Wildlife species are potentially important for the maintenance and transmission of BRBV, but little is known about which species are involved, and what other factors play a role in the exposure to BRBV. To assess the exposure risk to BRBV among wildlife in the St. Louis area, we collected sera from 98 individuals, representing 6 different mammalian species from two locations in St. Louis County: Tyson Research Center (TRC) and WildCare Park (WCP) from fall 2021 to spring 2023. The sera were used in a BRBV neutralization assay to detect neutralizing antibodies and RT-qPCR for viral RNA analysis. We also sampled and compared the abundance of A. americanum ticks at the two locations and modeled which factors influenced BRBV seropositivity across species. In TRC, we observed a high rate of seropositivity in raccoons (Procyon lotor, 23/25), and white-tailed deer (Odocoileus virginianus, 18/27), but a low rate in opossums (Didelphis virginiana, 1/18). Neutralizing antibodies were also detected in sampled TRC bobcats (Lynx rufus, 4/4), coyotes (Canis latrans, 3/3), and a red fox (Vulpes vulpes, 1/1). The virological analysis identified BRBV RNA in one of the coyote serum samples. In contrast to TRC, all sera screened from WCP were negative for BRBV-specific neutralizing antibodies, and significantly fewer ticks were collected at WCP (31) compared to TRC (2,316). Collectively, these findings suggest that BRBV circulates in multiple wildlife species in the St. Louis area and that tick density and host community composition may be important factors in BRBV ecology.

Neighborhood Context as a Barrier to Sport Participation for Girls: Evidence From a Sport Diversity Index.

Evidence suggests neighborhood contexts play a vital role in shaping the availability and diversity of youth sport and participation rates, especially for African American or Black girls. Currently, no index captures interscholastic sport opportunities (eg, sport diversity) within and across school districts and specifically applied to African American or Black girls. To visualize the inequalities present in interscholastic sport opportunities for girls across school districts using a novel index in a selected study area of St Louis City and County, Missouri, and discuss the implications for African American or Black girls. Cross-sectional study. Database secondary analysis. Data for 47 public high schools in the 23 St Louis City and County school districts. We gathered data from the 2014-2018 American Community Survey and Missouri State High School Activities Association. We assessed sport diversity for girls by constructing a sport diversity index (SDI) that uses an entropy index as its foundation. Census-tract data were used to examine the association with neighborhood demographics and contributors to school district income and sport diversity. Descriptive spatial statistics were calculated to evaluate distributions in St Louis City and County, with the bivariate local indicator of spatial autocorrelation used to determine any correlations between variables of interest. The St Louis City school district, which has areas with high rates of renter-occupied housing and poverty and high percentages of non-Hispanic African American or Black students, had the lowest SDI for girls, contrasted with the school districts in St Louis County, which showed an inverse pattern on average. The SDI for girls was correlated with the percentages of renter-occupied housing and poverty. The SDI for girls was also correlated with race: an increasing presence of the non-Hispanic African American or Black population was associated with decreased sport diversity for girls. The SDI for girls demonstrated a spatial association with neighborhood-level determinants of sport-opportunity availability for non-Hispanic African American or Black girls in St Louis. The role of social and political determinants of health in shaping community context and resultant health in athletic training research, policy, and practice should be considered.

Right to counsel? A mixed‐methods evaluation of the St. Louis County initial appearance program

AbstractResearch summaryLegal representation is a critical right in the criminal legal process, yet it is unclear when representation is guaranteed. Further, many individuals find obtaining legal representation difficult and expensive. The current study is an evaluation of an initial appearance program implemented in St. Louis County, Missouri. This mixed‐methods study focuses on understanding if and how providing counsel at initial appearance affects the bond amount, release type, and length of pretrial detention. Data from official court records and interviews with project staff and stakeholders suggest that early, free representation at arraignment can facilitate release on recognizance and lowered bail amounts. Results from a series of interaction models suggest that this type of programming may be able to help reduce some racial disparities. Our thematic analysis indicates that courtroom stakeholders see value in the program for the defendants, the criminal process, and the courtroom workgroup dynamics during pretrial stages.Policy implicationsThe results reflect the need for early representation in the legal process. Representation can potentially reduce some of the racial and ethnic disparities in case processing, which are relatively stark and can lead to downstream effects like a greater likelihood of recidivism and conviction. Currently, most funding for public defenders is inequitable to that of the prosecutor's office, and this work speaks to the necessity of providing representation that begins with the initial appearance and continues throughout the life of the case. This work also highlights how outside funding can be used to support more equitable and fair case processing in the criminal legal system.

The Saint Louis bridges program: A mental health network of more than one hundred churches and the mental health community

This article describes the history and development of a faith-based mental health network of over one hundred Black churches in North St Louis City and County. The Bridges to Care and Recovery (BCR) program is a joint effort of the Black faith community, three community hospitals, local universities, a school of medicine and funding from the city /state departments of mental health. The mission of BCR is to improve the fragmented mental health services to the Black community and to address the stigma of mental illness. This innovative program provides a blueprint for other metropolitan areas to emulate. The present paper is a detailed description of the key elements and services of the Bridges program.

The effect of economic conditions on poverty perception in Minnesota

The paper analyzes subjective poverty in St. Louis County, Minnesota, with the methods of systematic data collection in 2020 and makes a diachronic comparison using the results of a similar survey from 2010. The paper identifies the most important poverty-related items and compares the precise meanings of the results of the 2010 and 2020 surveys. It also aims to find out how the recovery after the recession of 2008 modified perceptions of poverty. It is revealed that poverty in 2020 is mainly associated with items related to material needs. Many of the items mentioned in relation to poverty are related to financial issues, to basic human needs, or to physical safety. The paper concludes that in spite of the economic recovery, subjective poverty did not change significantly in the examined period.

Vote at Any Polling Place: A Case Study of St. Louis County, Missouri

Vote at Any Polling Place: A Case Study of St. Louis County, Missouri

When do people increase COVID-19 protective behaviors? A longitudinal analysis of the impact of infections among close contacts and in the community

Studies examining individual-level changes in protective behaviors over time in association with community-level infection and self or close-contact infection with SARS-CoV-2 are limited. We analyzed overall and demographic specific week-to-week changes in COVID-19 protective behaviors and their association with COVID-19 infections (regional case counts and self or close contacts). Data were collected through 37 consecutive weekly surveys from 10/17/2021 – 6/26/2022. Our survey panel included 212 individuals living or working in St. Louis City and County, Missouri, U.S.A. Frequency of mask-wearing, handwashing, physical distancing, and avoiding large gatherings was self-reported (more/the same/less than the prior week). Close contact with COVID-19 was reported if the panel member, their household member, or their close contact tested positive, got sick, or was hospitalized for COVID-19 in the prior week. Regional weekly COVID-19 case counts were matched to the closest survey administration date. We used generalized linear mixed models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations. Evidence for effect modification was assessed using the likelihood ratio test. Increased protective behaviors were positively associated with COVID-19 case counts (ORhighest vs. lowest case count category = 4.39, 95% CI 3.35–5.74) and with participant-reported self or close contacts with COVID-19 (OR = 5.10, 95% CI 3.88–6.70). Stronger associations were found for White vs. Black panel members (p <.0001). Individuals modulated their protective behaviors in association with regional COVID-19 case counts and self or close contact infection. Rapid reporting and widespread public awareness of infectious disease rates may help reduce transmission during a pandemic by increasing protective behaviors.

182 Examining the Feasibility and Acceptability of Data-Driven Outreach Using Geographic Information Systems to Address Racial Disparities in Fatal Opioid Overdose

OBJECTIVES/GOALS: This project examines the initial feasibility, acceptability, and appropriateness of using population-health data and geospatial information systems (GIS) technology to guide opioid overdose prevention in a Black community facing increasing racial inequities in fatal overdose since 2016. METHODS/STUDY POPULATION: We applied a mixed-methods approach, using GIS to examine hot spots of fatal opioid overdose among Black, adult decedents in St. Louis City and County, Missouri, derived from cause-of-death data from the Medical Examiner’s Offices from 2016-2021 (N = 1,612). Hot spot analysis was conducting using the Getis-Ord Gi* statistic. We then conducted a focus group with community-based providers in Black neighborhoods (N = 8) to assess the acceptability and appropriateness of mapping overdose data and to determine the utility of GIS for guiding decision-making in outreach activities aimed at overdose prevention. The focus group was recorded and transcribed for analysis to extract themes. RESULTS/ANTICIPATED RESULTS: Among 340 census tracts in the St. Louis region, 41 were statistically significant hot spots, indicating high clustering of fatal overdose. All hot spots were clustered together in North St. Louis, an area characterized by high racial and income segregation. Focus group participants reported potential pitfalls of GIS, including data inaccuracy for Black individuals and unwanted attention in hot spot areas (e.g., increased policing). Potential benefits included improved care coordination between organizations, assessing effectiveness of outreach interventions, and improving community-level awareness. Hyper-local neighborhood rather than regional maps were perceived as useful for outreach. DISCUSSION/SIGNIFICANCE: Artifacts of structural racism that drive Black opioid overdose deaths limit the utility of GIS to guide outreach in communities facing this systemic disinvestment. However, neighborhood-level GIS may serve as a tool for communities to build awareness and collaboration toward overdose prevention.

Race and Subprime Lending Frequency: Understanding Subprime Lending's Role in the St. Louis Vacancy Crisis

Using loan-level data, this analysis considers the intersection of race, subprime home loans, and the current vacancy crisis in St. Louis, Missouri. Borrowers in Black areas in the north of St. Louis City and St. Louis County received subprime home loans at higher frequencies during the subprime boom period of 2003–2007 than those in White areas, with differences in balloon loans especially stark. Specifically, borrowers in Black neighborhoods received subprime loans more frequently than those with equal FICO scores in White neighborhoods. As a result of these differential loan terms, North City and inner ring “First Suburb” areas saw more foreclosure and borrower payment delinquency, which in turn were highly associated with home vacancy, controlling for other risk factors. However, foreclosure was no longer a significant predictor of home vacancy after controlling for demographic factors and FICO score, indicating that the unequal loan terms may have driven much of the increase in home vacancy in the St. Louis area since the Great Recession.

The effectiveness of an ICWA Court at achieving improved ICWA implementation and outcomes: A pre‐post intervention study

AbstractThis article presents findings from a quasi‐experimental study of the St. Louis County (Duluth, Minnesota) ICWA Court examining its effectiveness at achieving improved ICWA implementation and a better case process and outcomes for Indian families. Using a case file review method, cases prior to implementing the ICWA Court were compared to post‐ICWA Court cases on demographics, case characteristics, application of ICWA requirements, presence of parties at hearings, achievement of child permanency outcomes, and permanency timeliness. Compared to pre‐ICWA Court, this study found several statistically significant improvements in the ICWA Court's handling of cases, including taking less time to confirm the case as an ICWA case, greater appearance of tribal representatives by the Dispositional review hearing stage, more active efforts findings, more placements with relatives at earlier stages of the case, more placement with relative outcomes when reunifications were not possible, and timelier permanency.

Looking for a system with its head and heart in balance: Using institutional analysis to assess Indian child welfare act implementation in Saint Louis County, Minnesota

AbstractSince the passage of the Indian Child Welfare Act (ICWA), state and county human service systems have struggled to implement its provisions in a manner that incorporates the spirit and the letter of the law. This article provides a descriptive overview of a jurisdictionally specific tribal‐state partnership team's adaptation of Institutional Analysis, a needs assessment methodology developed by Praxis International, as an alternative methodology to compliance measurement and to identify needs in ICWA implementation. We share a description of our process and experience, our theory of change for human services systems seeking to improve their treatment of American Indian families, and provide some lessons from our experience.

Are Asian foods healthier than Western foods: Evidence collected from St. Louis area grocery stores

Diets vary substantially across different ethnic groups while also having a significant and long-term impact on general health and well-being. Common perceptions are that the overconsumption of Western-style foods drives the increase in non-communicable diseases in Western society and that Asian-style foods are more nutritious and healthier than Western-style foods. Therefore, our research goal was to identify differences in the nutrient content of Asian-style foods and Western-style foods offered in grocery stores available to the general population in St. Louis County, Missouri. We hypothesized that the nutrient content in foods available at Western grocery stores would not differ from the similar foods available at Asian grocery stores. We hand-collected 648 food items randomized by store and food category in three Asian grocery stores and one Western supermarket in St. Louis and documented their nutritional information. We then characterized and compared the nutrient content of the collected foods at the store and food category levels. We found that foods from Asian stores had statistically significantly lower protein (p &amp;lt; 0.01), higher sodium (p = 0.10), and similar energy, total carbohydrates, cholesterol, total fat, and sugar content compared to Western stores. Also, we found that foods available in Asian stores had a significantly longer “Time-to-Expiration” period (p &amp;lt; 0.01). These findings challenge the common perception that foods from Asian stores are healthier than Western stores and contribute to our understanding of associations between ethnicity, diet, and health.

1906. Impact of Mask Mandate Timing on Community Transmission of SARS-CoV-2 in the St. Louis Metropolitan Area

Abstract Background Mask mandates have been a widely used public health tool during the COVID-19 pandemic, but how to optimize their impact in the setting of concurrent but spontaneous population-level behavior changes due to rising case counts is not known. This study aimed to examine how earlier or later mask mandate implementation in the context of spontaneous behavior change would have affected transmission of SARS-CoV-2 and severe COVID-19 outcomes in the St. Louis, Missouri area. Methods Our model utilized aggregated hospitalization and death data for St. Louis city and county residents admitted to nearly all hospitals in the metropolitan area. We first fit a real-life model to estimate changes in transmission after the July 3, 2020 mask mandate, and then created counterfactual scenarios in which 1) 10%, 25%, and 50% of the changes were attributed to the mandate (as opposed to spontaneous behavior change) and 2) the mandate was implemented 3 or 7 days earlier, or 7 or 14 days later. We used an SEIR (Susceptible-Exposed-Infectious-Recovered) model framework and fit models in R. Results Assuming that 50% of increased masking was due to the mandate, implementing a mandate 7 days earlier was associated with a reduction from 12,685 (IQR: 10,463-16,560) to 12,294 (10,296-15,205) cumulative hospitalizations by September 30, while a 2-week delay was associated with an increase to 13,277 (10,808-17,908) hospitalizations. Trends were similar, but with reduced magnitude, when assuming that 10% or 25% of increased masking was due to the mandate (Figure). Depending on whether 10%, 25%, or 50% of increased masking was due to the mandate, implementing the mandate 1 week early was associated with a return to baseline (June 26) hospital census 1-7 days earlier, while delaying the mandate by 2 weeks led to a 2-12 day delay in return to baseline. Hospital census and cumulative deaths in the real-life (baseline) model and under 12 counterfactual scenarios which vary mask mandate timing (3 or 7 days earlier, or 7 or 14 days delayed) and percentage of increase in masking that is attributed to the mask mandate (Panels A-B: 10%, Panels C-D: 25%, and Panels E-F: 50%). As more of the increase in masking is attributed to the mandate, the costs of delaying the mandate and the benefits of earlier implementation increase. While differences in hospital census are most apparent several weeks after the mandate, differences in deaths gradually become more apparent over time. Conclusion Impact of a mask mandate depends on both timing and percent of increased masking that is attributed to the mandate. Implementing a mandate even a few days earlier is associated with fewer cumulative hospitalizations and earlier return to baseline, but the overall duration of implementation is slightly longer. Given wide variations in public behavior, locally-tailored models are essential for estimating the impact of interventions and informing the local public health response. Disclosures All Authors: No reported disclosures.

Overcoming Barriers to Voter Mobilization during the COVID-19 Pandemic: A Case Study of St. Louis, Missouri.

Voters in St. Louis, Missouri, faced unprecedented challenges amid two critical elections during the 2020 election season. Voters were to determine if the state should expand access to Medicaid as well as decide the next President of the United States. The lack of access to affordable health care, combined with a federal administration at odds with the Black Lives Matter movement, elevated the importance of electoral engagement within communities of color. The emergence COVID-19 complicated voter mobilization efforts as public health restrictions limited access to voters and shifting voting regulations confused voters. This study presents an in-depth qualitative case study of voter mobilization efforts in St. Louis by drawing on semi-structured interviews with 28 participants who engaged in voter mobilization within poverty-impacted communities in St. Louis City and St. Louis County. Subjects identified how they shifted tactics to allow for the health and safety of mobilizers and potential voters. Additionally, policies are identified that would eliminate administrative hurdles placed on voters and shift the burden of facilitating democratic elections to the State. Findings from this study highlight the widening structural barriers and administrative burdens that are inhibiting a straightforward process for voting and detail potential policy solutions.

Prevalence of Bourbon and Heartland viruses in field collected ticks at an environmental field station in St. Louis County, Missouri, USA

Heartland and Bourbon viruses are pathogenic tick-borne viruses putatively transmitted by Amblyomma americanum, an abundant tick species in Missouri. To assess the prevalence of these viruses in ticks, we collected 2778 ticks from eight sampling sites at Tyson Research Center, an environmental field station within St. Louis County and close to the City of St. Louis, from May - July in 2019 and 2021. Ticks were pooled according to life stage and sex, grouped by year and sampling site to create 355 pools and screened by RT-qPCR for Bourbon and Heartland viruses. Overall, 14 (3.9%) and 27 (7.6%) of the pools were positive for Bourbon virus and Heartland virus respectively. In 2019, 11 and 23 pools were positive for Bourbon and Heartland viruses respectively. These positives pools were of males, females and nymphs. In 2021, there were 4 virus positive pools out of which 3 were positive for both viruses and were comprised of females and nymphs. Five out of the 8 sampling sites were positive for at least one virus. This included a site that was positive for both viruses in both years. Detection of these viruses in an area close to a relatively large metropolis presents a greater public health threat than previously thought.

Common Bryophytes from the Sax-Zim Bog Important Bird Area in St. Louis County, Minnesota

We identified 68 bryophytes (4 liverworts, 64 mosses) during three days of sampling five Friends of Sax-Zim Bog (FOSZB) properties and five additional sites within the surrounding 147,000-acre Sax-Zim Bog Important Bird Area in St. Louis County, Minnesota. The landscape types surveyed are loosely categorized as upland, forested wetland, moderate-rich fen, poor fen, restored fen and bog. In total, this survey added 50 species (3 liverworts, 47 mosses) to a previous FOSZB bryophyte species list for a total of 78 bryophyte species (4 liverworts, 74 mosses) documented in the greater Sax-Zim Bog region. Over 20% of the bryophytes found were in the genus Sphagnum. Our updated list of common bryophytes will be used by FOSZB staff for educational purposes to inform FOSZB visitors about local bryoflora.

Public Health Information Seeking, Trust, and COVID-19 Prevention Behaviors: Cross-sectional Study.

BackgroundPreventative health measures such as shelter in place and mask wearing have been widely encouraged to curb the spread of the COVID-19 disease. People’s attitudes toward preventative behaviors may be dependent on their sources of information and trust in the information.ObjectiveThe aim of this study was to understand the relationship between trusting in COVID-19 information and preventative behaviors in a racially and politically diverse metropolitan area in the United States.MethodsWe conducted a web-based cross-sectional survey of residents in St. Louis City and County in Missouri. Individuals aged ≥18 years were eligible to participate. Participants were recruited using a convenience sampling approach through social media and email. The Health Belief Model and the Socioecological Model informed instrument development, as well as COVID-19–related questions from the Centers for Disease Control and Prevention. We performed an ordinary least squares linear regression model to estimate social distancing practices, perceptions, and trust in COVID-19 information sources.ResultsOf the 1650 eligible participants, the majority (n=1381, 83.7%) had sought or received COVID-19–related information from a public health agency, the Centers for Disease Control and Prevention, or both. Regression analysis showed a 1% increase in preventative behaviors for every 12% increase in trust in governmental health agencies. At their lowest levels of trust, women were 68% more likely to engage in preventative behaviors than men. Overall, those aged 18-45 years without vulnerable medical conditions were the least likely to engage in preventative behaviors.ConclusionsTrust in COVID-19 information increases an individual’s likelihood of practicing preventative behaviors. Effective health communication strategies should be used to effectively disseminate health information during disease outbreaks.