Missed opportunities: Arrest and court touchpoints for individuals who fatally overdosed in Philadelphia in 2016.

BACKGROUND: Many studies document high risk of fatal overdose after incarceration. Few explore earlier touchpoints in criminal justice processes, like arrests and court hearings. Understanding these touchpoints is important for several reasons. Arrest and adjudicatory processes are harmful even when not resulting in incarceration. Arrests and criminal hearings also may reflect changes in overdose-related risk factors like transitions in employment and housing stability. Moreover, knowledge about these touchpoints contextualizes debate about the implementation of court-based programs like Drug Treatment Courts. This study described the incidence and accumulation of touchpoints for people who fatally overdosed in Philadelphia in 2016, and depicted how touchpoint incidence and characteristics interface with court-program eligibility. METHODS: Criminal court documents were obtained for all individuals who fatally overdosed in Philadelphia in 2016 from the Philadelphia Medical Examiner's Office. The characteristics of arrests and court hearings were abstracted to compile lifetime criminal histories. Latent class analysis was performed to identify whether these histories followed observably distinct patterns. RESULTS: In 2016, 907 people fatally overdosed in Philadelphia. Of these, 605 had at least one or more of 3,926 arrests and 3,822 hearings over their lifetime. There were 488 arrests and 533 hearings in the two years before death, with public disorder charges especially common closer to death. Less than 20% of these hearings resulted in custodial sentences. Of individuals with touchpoints, only nine participated in Drug Treatment Court, consistent with findings that most individuals were ineligible. Latent class analysis suggested five distinguishable patterns in age, timing, and characteristics of touchpoints. CONCLUSIONS: The type and frequency of touchpoints preceding fatal overdose reflect a period of complex vulnerability. Few individuals qualified for court-based programming, underscoring the limitations of supporting this population in specialized court settings. Reducing incidence and improving the health impact of criminal justice touchpoints remain important public health priorities.

Understanding vaccine knowledge, attitudes, and decision-making through college student interviews.

Objective: We aimed to explore knowledge, attitudes, and beliefs about vaccines required for college-entry and vaccine-related behaviors among college students. Participants: Thirty-three full-time undergraduate students, ≥ 18 years old, enrolled at public (2) and private (3) colleges and universities in metropolitan Philadelphia in fall 2016. Methods: We conducted semistructured interviews, which were double-coded with 5,015 comments overall and 99.3% intercoder reliability (κ = 0.779) using NVivo 11 software. Results: Six key themes emerged: (1) low knowledge about vaccines and requirements; (2) mixed attitudes about required vs. recommended vaccines; (3) high trust in medical professionals; (4) low perceived risk for vaccine-preventable disease outbreaks; (5) substantial parental influence on students' decision-making; and (6) low utilization of Student Health Services. Conclusions: This study revealed lack of knowledge about and low prioritization of vaccination despite overall positive attitudes towards vaccines. Prematriculation education of college students is critical to increasing vaccine knowledge and use.