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1.
Proc Natl Acad Sci U S A ; 121(32): e2310073121, 2024 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-39074266

RESUMO

In the realm of climate policy, issues of environmental justice (EJ) are often treated as second-order affairs compared to overarching sustainability goals. We argue that EJ is in fact critical to successfully addressing our national and global climate challenges; indeed, centering equity amplifies the voices of the diverse constituencies most impacted by climate change and that are needed to build successful coalitions that shape and advance climate change policy. We illustrate this perspective by highlighting the experience of California and the contentious processes by which EJ became integrated into the state's climate action efforts. We examine the achievements and shortcomings of California's commitment to climate justice and discuss how lessons from the Golden State are influencing the evolution of current federal climate change policy.

2.
Proc Natl Acad Sci U S A ; 121(25): e2321441121, 2024 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-38861597

RESUMO

Legacy effects describe the persistent, long-term impacts on an ecosystem following the removal of an abiotic or biotic feature. Redlining, a policy that codified racial segregation and disinvestment in minoritized neighborhoods, has produced legacy effects with profound impacts on urban ecosystem structure and health. These legacies have detrimentally impacted public health outcomes, socioeconomic stability, and environmental health. However, the collateral impacts of redlining on wildlife communities are uncertain. Here, we investigated whether faunal biodiversity was associated with redlining. We used home-owner loan corporation (HOLC) maps [grades A (i.e., "best" and "greenlined"), B, C, and D (i.e., "hazardous" and "redlined")] across four cities in California and contributory science data (iNaturalist) to estimate alpha and beta diversity across six clades (mammals, birds, insects, arachnids, reptiles, and amphibians) as a function of HOLC grade. We found that in greenlined neighborhoods, unique species were detected with less sampling effort, with redlined neighborhoods needing over 8,000 observations to detect the same number of unique species. Historically redlined neighborhoods had lower native and nonnative species richness compared to greenlined neighborhoods across each city, with disparities remaining at the clade level. Further, community composition (i.e., beta diversity) consistently differed among HOLC grades for all cities, including large differences in species assemblage observed between green and redlined neighborhoods. Our work spotlights the lasting effects of social injustices on the community ecology of cities, emphasizing that urban conservation and management efforts must incorporate an antiracist, justice-informed lens to improve biodiversity in urban environments.


Assuntos
Animais Selvagens , Biodiversidade , Cidades , Animais , California , Ecossistema , Humanos , Conservação dos Recursos Naturais
3.
Proc Natl Acad Sci U S A ; 121(8): e2306729121, 2024 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-38349877

RESUMO

Wildfires have become more frequent and intense due to climate change and outdoor wildfire fine particulate matter (PM2.5) concentrations differ from relatively smoothly varying total PM2.5. Thus, we introduced a conceptual model for computing long-term wildfire PM2.5 and assessed disproportionate exposures among marginalized communities. We used monitoring data and statistical techniques to characterize annual wildfire PM2.5 exposure based on intermittent and extreme daily wildfire PM2.5 concentrations in California census tracts (2006 to 2020). Metrics included: 1) weeks with wildfire PM2.5 < 5 µg/m3; 2) days with non-zero wildfire PM2.5; 3) mean wildfire PM2.5 during peak exposure week; 4) smoke waves (≥2 consecutive days with <15 µg/m3 wildfire PM2.5); and 5) mean annual wildfire PM2.5 concentration. We classified tracts by their racial/ethnic composition and CalEnviroScreen (CES) score, an environmental and social vulnerability composite measure. We examined associations of CES and racial/ethnic composition with the wildfire PM2.5 metrics using mixed-effects models. Averaged 2006 to 2020, we detected little difference in exposure by CES score or racial/ethnic composition, except for non-Hispanic American Indian and Alaska Native populations, where a 1-SD increase was associated with higher exposure for 4/5 metrics. CES or racial/ethnic × year interaction term models revealed exposure disparities in some years. Compared to their California-wide representation, the exposed populations of non-Hispanic American Indian and Alaska Native (1.68×, 95% CI: 1.01 to 2.81), white (1.13×, 95% CI: 0.99 to 1.32), and multiracial (1.06×, 95% CI: 0.97 to 1.23) people were over-represented from 2006 to 2020. In conclusion, during our study period in California, we detected disproportionate long-term wildfire PM2.5 exposure for several racial/ethnic groups.


Assuntos
Poluentes Atmosféricos , Incêndios Florestais , Humanos , Material Particulado/efeitos adversos , Fumaça/efeitos adversos , California , Grupos Raciais , Exposição Ambiental , Poluentes Atmosféricos/efeitos adversos
4.
Proc Natl Acad Sci U S A ; 120(26): e2217124120, 2023 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-37339204

RESUMO

The United States government has indicated a desire to advance environmental justice through climate policy. As fossil fuel combustion produces both conventional pollutants and greenhouse gas (GHG) emissions, climate mitigation strategies may provide an opportunity to address historical inequities in air pollution exposure. To test the impact of climate policy implementation choices on air quality equity, we develop a broad range of GHG reduction scenarios that are each consistent with the US Paris Accord target and model the resulting air pollution changes. Using idealized decision criteria, we show that least cost and income-based emission reductions can exacerbate air pollution disparities for communities of color. With a suite of randomized experiments that facilitates exploration of a wider climate policy decision space, we show that disparities largely persist despite declines in average pollution exposure, but that reducing transportation emissions has the most potential to reduce racial inequities.

5.
Proc Natl Acad Sci U S A ; 120(2): e2210467120, 2023 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-36595690

RESUMO

Studying ∼200,000 evictions filed against ∼300,000 Philadelphians from 2005 to 2021, we focus on the role of transit to court in preventing tenants from asserting their rights. In this period, nearly 40% of tenants facing eviction were ordered to leave their residences because they did not show up to contest cases against them and received a default judgment. Controlling for a variety of potential confounds at the tenant and landlord level, we find that residents of private tenancies with longer transit travel time to the courthouse were more likely to default. A 1-h increase in estimated travel time increases the probability of default by between 3.8% and 8.6% points across different model specifications. The effect holds after adjusting for direct distance to the court, unobserved landlord characteristics, and even baseline weekend travel time. However, it is absent in public housing evictions, where timing rules are significantly laxer, and during the COVID-19 pandemic, when tenants had the opportunity to be present virtually. We estimate that had all tenants been equally able to get to the court in 10 min, there would have been 4,000 to 9,000 fewer default evictions over the sample period. We replicate this commuting effect in another dataset of over 800,000 evictions from Harris County, Texas. These results open up a new way to study the physical determinants of access to justice, illustrating that the location and accessibility of a courthouse can affect individual case outcomes. We suggest that increased use of video technology in court may reduce barriers to justice.


Assuntos
COVID-19 , Pessoas Mal Alojadas , Humanos , Pandemias , COVID-19/epidemiologia , Habitação , Texas
6.
Proc Natl Acad Sci U S A ; 120(23): e2301990120, 2023 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-37252970

RESUMO

Risk assessment instruments (RAIs) are widely used to aid high-stakes decision-making in criminal justice settings and other areas such as health care and child welfare. These tools, whether using machine learning or simpler algorithms, typically assume a time-invariant relationship between predictors and outcome. Because societies are themselves changing and not just individuals, this assumption may be violated in many behavioral settings, generating what we call cohort bias. Analyzing criminal histories in a cohort-sequential longitudinal study of children, we demonstrate that regardless of model type or predictor sets, a tool trained to predict the likelihood of arrest between the ages of 17 and 24 y on older birth cohorts systematically overpredicts the likelihood of arrest for younger birth cohorts over the period 1995 to 2020. Cohort bias is found for both relative and absolute risks, and it persists for all racial groups and within groups at highest risk for arrest. The results imply that cohort bias is an underappreciated mechanism generating inequality in contacts with the criminal legal system that is distinct from racial bias. Cohort bias is a challenge not only for predictive instruments with respect to crime and justice, but also for RAIs more broadly.


Assuntos
Crime , Direito Penal , Criança , Humanos , Adolescente , Adulto Jovem , Adulto , Estudos Longitudinais , Estudos de Coortes , Medição de Risco
7.
Proc Natl Acad Sci U S A ; 120(16): e2208450120, 2023 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-37036985

RESUMO

Average ambient concentrations of nitrogen dioxide (NO2), an important air pollutant, have declined in the United States since the enactment of the Clean Air Act. Despite evidence that NO2 disproportionately affects racial/ethnic minority groups, it remains unclear what drives the exposure disparities and how they have changed over time. Here, we provide evidence by integrating high-resolution (1 km × 1 km) ground-level NO2 estimates, sociodemographic information, and source-specific emission intensity and location for 217,740 block groups across the contiguous United States from 2000 to 2016. We show that racial/ethnic minorities are disproportionately exposed to higher levels of NO2 pollution compared with Whites across the United States and within major metropolitan areas. These inequities persisted over time and have worsened in many cases, despite a significant decrease in the national average NO2 concentration over the 17-y study period. Overall, traffic contributes the largest fraction of NO2 disparity. Contributions of other emission sources to exposure disparities vary by location. Our analyses offer insights into policies aimed at reducing air pollution exposure disparities among races/ethnicities and locations.


Assuntos
Poluição do Ar , Disparidades nos Níveis de Saúde , Dióxido de Nitrogênio , Estados Unidos/etnologia , Dióxido de Nitrogênio/toxicidade , Disparidades Socioeconômicas em Saúde , Análise Espaço-Temporal , Grupos Raciais , Etnicidade , Fatores de Tempo , Humanos
8.
Proc Natl Acad Sci U S A ; 120(18): e2215262120, 2023 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-37094159

RESUMO

Land conservation efforts throughout the United States sustain ecological benefits while generating wealth in the housing market through capitalization of amenities. This paper estimates the benefits of conservation that are capitalized into proximate home values and quantifies how those benefits are distributed across demographic groups. Using detailed property and household-level data from Massachusetts, we estimate that new land conservation led to $62 million in new housing wealth equity. However, houses owned by low-income or Black or Hispanic households are less likely to be located near protected areas, and hence, these populations are less likely to benefit financially. Direct study of the distribution of this new wealth from capitalized conservation is highly unequal, with the richest quartile of households receiving 43%, White households receiving 91%, and the richest White households receiving 40%, which is nearly 140% more than would be expected under equal distribution. We extend our analysis using census data for the entire United States and observe parallel patterns. We estimate that recent land conservation generated $9.8 billion in wealth through the housing market and that wealthier and White households benefited disproportionately. These findings suggest regressive and racially disparate incidence of the wealth benefits of land conservation policy.


Assuntos
Conservação dos Recursos Naturais , Status Econômico , Habitação , Humanos , Características da Família , Hispânico ou Latino , Pobreza , Estados Unidos , Negro ou Afro-Americano , Brancos
9.
Am J Respir Crit Care Med ; 210(2): 178-185, 2024 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-38412262

RESUMO

Rationale: The share of Black or Latinx residents in a census tract remains associated with asthma-related emergency department (ED) visit rates after controlling for socioeconomic factors. The extent to which evident disparities relate to the within-city heterogeneity of long-term air pollution exposure remains unclear. Objectives: To investigate the role of intraurban spatial variability of air pollution in asthma acute care use disparity. Methods: An administrative database was used to define census tract population-based incidence rates of asthma-related ED visits. We estimate the associations between census tract incidence rates and 1) average fine and coarse particulate matter, nitrogen dioxide (NO2), and sulfur dioxide (SO2), and 2) racial and ethnic composition using generalized linear models controlling for socioeconomic and housing covariates. We also examine for the attenuation of incidence risk ratios (IRRs) associated with race/ethnicity when controlling for air pollution exposure. Measurements and Main Results: Fine and coarse particulate matter and SO2 are all associated with census tract-level incidence rates of asthma-related ED visits, and multipollutant models show evidence of independent risk associated with coarse particulate matter and SO2. The association between census tract incidence rate and Black resident share (IRR, 1.51 [credible interval (CI), 1.48-1.54]) is attenuated by 24% when accounting for air pollution (IRR, 1.39 [CI, 1.35-1.42]), and the association with Latinx resident share (IRR, 1.11 [CI, 1.09-1.13]) is attenuated by 32% (IRR, 1.08 [CI, 1.06-1.10]). Conclusions: Neighborhood-level rates of asthma acute care use are associated with local air pollution. Controlling for air pollution attenuates associations with census tract racial/ethnic composition, suggesting that intracity variability in air pollution could contribute to neighborhood-to-neighborhood asthma morbidity disparities.


Assuntos
Poluição do Ar , Asma , Serviço Hospitalar de Emergência , Material Particulado , Humanos , Asma/epidemiologia , Asma/etnologia , Poluição do Ar/efeitos adversos , Poluição do Ar/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Material Particulado/efeitos adversos , Masculino , Feminino , Hispânico ou Latino/estatística & dados numéricos , Adulto , Incidência , Negro ou Afro-Americano/estatística & dados numéricos , Características da Vizinhança/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , Dióxido de Enxofre , Pessoa de Meia-Idade , Exposição Ambiental/efeitos adversos , Exposição Ambiental/estatística & dados numéricos , Dióxido de Nitrogênio/efeitos adversos , Características de Residência/estatística & dados numéricos , Estados Unidos/epidemiologia
10.
Proc Natl Acad Sci U S A ; 119(27): e2123533119, 2022 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-35759671

RESUMO

High COVID-19 mortality among Black communities heightened the pandemic's devastation. In the state of Louisiana, the racial disparity associated with COVID-19 mortality was significant; Black Americans accounted for 50% of known COVID-19-related deaths while representing only 32% of the state's population. In this paper, we argue that structural racism resulted in a synergistic framework of cumulatively negative determinants of health that ultimately affected COVID-19 deaths in Louisiana Black communities. We identify the spatial distribution of social, environmental, and economic stressors across Louisiana parishes using hot spot analysis to develop aggregate stressors. Further, we examine the correlation between stressors, cumulative health risks, COVID-19 mortality, and the size of Black populations throughout Louisiana. We hypothesized that parishes with larger Black populations (percentages) would have larger stressor values and higher cumulative health risks as well as increased COVID-19 mortality rates. Our results suggest two categories of parishes. The first group has moderate levels of aggregate stress, high population densities, predominately Black populations, and high COVID-19 mortality. The second group of parishes has high aggregate stress, lower population densities, predominantly Black populations, and initially low COVID-19 mortality that increased over time. Our results suggest that structural racism and inequities led to severe disparities in initial COVID-19 effects among highly populated Black Louisiana communities and that as the virus moved into less densely populated Black communities, similar trends emerged.


Assuntos
Negro ou Afro-Americano , COVID-19 , Equidade em Saúde , Disparidades em Assistência à Saúde , COVID-19/mortalidade , Disparidades em Assistência à Saúde/etnologia , Humanos , Louisiana/epidemiologia , Densidade Demográfica , Fatores Raciais
11.
Proc Natl Acad Sci U S A ; 119(17): e2117776119, 2022 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-35446711

RESUMO

Research has made clear that neighborhoods impact the health and well-being of their residents. A related strand of research shows that neighborhood disadvantage is geographically clustered. Because the neighborhoods of low-income and minority populations tend to be more disadvantaged, neighborhood conditions help explain racial and socioeconomic inequalities. These strands of research restrict processes of neighborhood influence to operate only within and between geographically contiguous neighbors. However, we are underestimating the role of neighborhood conditions in explaining inequality if disadvantage extends beyond the residential and extralocal environments into a network of neighborhoods spanning the urban landscape based on where residents move within a city. I use anonymized mobile phone data to measure exposure to air pollution among residents of poor and minority neighborhoods in 88 of the most populous US cities. I find that residents from minority and poor neighborhoods travel to neighborhoods that have greater air pollution levels than the neighborhoods that residents from White and nonpoor neighborhoods visit. Hispanic neighborhoods exhibit the greatest overall pollution burden, Black/White and Asian/White disparities are greatest at the network than residential scale, and the socioeconomic advantage of lower risk exposure is highest for residents from White neighborhoods. These inequalities are notable given recent declines in segregation and air pollution levels in American cities.


Assuntos
Poluição do Ar , Exposição Ambiental , População Urbana , Cidades , Humanos , Dinâmica Populacional , Características de Residência
12.
Proc Natl Acad Sci U S A ; 119(49): e2209078119, 2022 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-36445964

RESUMO

In the history of humanity, most conflicts within and between societies have originated from perceived inequality in resource distribution. How humans achieve and maintain distributive justice has therefore been an intensely studied issue. However, most research on the corresponding psychological processes has focused on inequality aversion and has been largely agnostic of other motives that may either align or oppose this behavioral tendency. Here we provide behavioral, computational, and neuroimaging evidence that distribution decisions are guided by three distinct motives-inequality aversion, harm aversion, and rank reversal aversion-that interact with each other and can also deter individuals from pursuing equality. At the neural level, we show that these three motives are encoded by separate neural systems, compete for representation in various brain areas processing equality and harm signals, and are integrated in the striatum, which functions as a crucial hub for translating the motives to behavior. Our findings provide a comprehensive framework for understanding the cognitive and biological processes by which multiple prosocial motives are coordinated in the brain to guide redistribution behaviors. This framework enhances our understanding of the brain mechanisms underlying equality-related behavior, suggests possible neural origins of individual differences in social preferences, and provides a new pathway to understand the cognitive and neural basis of clinical disorders with impaired social functions.


Assuntos
Motivação , Justiça Social , Humanos , Encéfalo , Ciências Humanas , Afeto
13.
Proc Natl Acad Sci U S A ; 119(30): e2118525119, 2022 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-35858404

RESUMO

In an environment that is high in racial justice saliency, how do identities inform motivation for supporting specific issues in the crowd? This study examines the role that intersectionality played in mobilizing participants to join the mass demonstrations sparked by the murder of George Floyd. Building on recent studies that show how protest participants connect issue-based concerns with their identities to boost support for movements, we analyze data collected through surveys with a random sample of activists participating in the protests after George Floyd's death in Washington, DC, in 2020. We find that intersectional motivations played a significant role in mobilizing protest participants. Analysis of these factors helps explain the diversity of the crowd and provides insights into how the movement may contribute to greater success for racial justice and the degree to which the movement has staying power.


Assuntos
Enquadramento Interseccional , Racismo , Justiça Social , Humanos , Motivação , Grupos Raciais , Inquéritos e Questionários
14.
Proc Natl Acad Sci U S A ; 119(44): e2205548119, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36279443

RESUMO

Air pollution levels in the United States have decreased dramatically over the past decades, yet national racial-ethnic exposure disparities persist. For ambient fine particulate matter ([Formula: see text]), we investigate three emission-reduction approaches and compare their optimal ability to address two goals: 1) reduce the overall population average exposure ("overall average") and 2) reduce the difference in the average exposure for the most exposed racial-ethnic group versus for the overall population ("national inequalities"). We show that national inequalities in exposure can be eliminated with minor emission reductions (optimal: ~1% of total emissions) if they target specific locations. In contrast, achieving that outcome using existing regulatory strategies would require eliminating essentially all emissions (if targeting specific economic sectors) or is not possible (if requiring urban regions to meet concentration standards). Lastly, we do not find a trade-off between the two goals (i.e., reducing overall average and reducing national inequalities); rather, the approach that does the best for reducing national inequalities (i.e., location-specific strategies) also does as well as or better than the other two approaches (i.e., sector-specific and meeting concentration standards) for reducing overall averages. Overall, our findings suggest that incorporating location-specific emissions reductions into the US air quality regulatory framework 1) is crucial for eliminating long-standing national average exposure disparities by race-ethnicity and 2) can benefit overall average exposures as much as or more than the sector-specific and concentration-standards approaches.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Estados Unidos , Humanos , Poluentes Atmosféricos/análise , Etnicidade , Exposição Ambiental/prevenção & controle , Exposição Ambiental/análise , Poluição do Ar/prevenção & controle , Poluição do Ar/análise , Material Particulado/análise
15.
Proc Natl Acad Sci U S A ; 119(14): e2118780119, 2022 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-35344441

RESUMO

SignificanceOur study is a randomized trial in policing confirming that intensive training in procedural justice (PJ) can lead to more procedurally just behavior and less disrespectful treatment of people at high-crime places. The fact that the PJ intervention reduced arrests by police officers, positively influenced residents' perceptions of police harassment and violence, and also reduced crime provides important guidance for police reform in a period of strong criticism of policing. This randomized trial points to the potential for PJ training not simply to encourage fair and respectful policing but also to improve evaluations of the police and crime prevention effectiveness.


Assuntos
Polícia , Justiça Social , Crime/prevenção & controle , Humanos , Aplicação da Lei , Violência/prevenção & controle
16.
Artigo em Inglês | MEDLINE | ID: mdl-39151477

RESUMO

Atopic dermatitis (AD) is a complex disease characterized by dry, pruritic skin and significant atopic and psychological sequelae. Although AD has always been viewed as multifactorial, early research was dominated by overlapping genetic determinist views of either innate barrier defects leading to inflammation or innate inflammation eroding skin barrier function. However, the incidence of AD in the US has increased since 1970 at a pace that far exceeds genetic drift and thus suggests a modern, environmental etiology. Another implicated factor is Staphylococcus aureus; however, a highly contagious microorganism is unlikely to be the primary etiology of a non-communicable disease. Recently, the roles of the skin and gut microbiomes have received greater attention as potentially targetable drivers of AD. Here too however, dysbiosis on a population scale would require induction by an environmental factor. In this review, we describe the evidence supporting the environmental hypothesis of AD etiology and detail the molecular mechanisms of each AD-relevant toxins. We also outline how a pollution focused paradigm demands earnest engagement with environmental injustice if the field is to meaningfully address racial and geographic disparities. Identifying specific toxins and their mechanisms can also inform in-home and national mitigation strategies.

17.
Circulation ; 148(13): 1061-1069, 2023 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-37646159

RESUMO

The evolution of the electronic health record, combined with advances in data curation and analytic technologies, increasingly enables data sharing and harmonization. Advances in the analysis of health-related and health-proxy information have already accelerated research discoveries and improved patient care. This American Heart Association policy statement discusses how broad data sharing can be an enabling driver of progress by providing data to develop, test, and benchmark innovative methods, scalable insights, and potential new paradigms for data storage and workflow. Along with these advances come concerns about the sensitive nature of some health data, equity considerations about the involvement of historically excluded communities, and the complex intersection of laws attempting to govern behavior. Data-sharing principles are therefore necessary across a wide swath of entities, including parties who collect health information, funders, researchers, patients, legislatures, commercial companies, and regulatory departments and agencies. This policy statement outlines some of the key equity and legal background relevant to health data sharing and responsible management. It then articulates principles that will guide the American Heart Association's engagement in public policy related to data collection, sharing, and use to continue to inform its work across the research enterprise, as well as specific examples of how these principles might be applied in the policy landscape. The goal of these principles is to improve policy to support the use or reuse of health information in ways that are respectful of patients and research participants, equitable in impact in terms of both risks and potential benefits, and beneficial across broad and demographically diverse communities in the United States.


Assuntos
American Heart Association , Disseminação de Informação , Humanos , Estados Unidos , Coleta de Dados
18.
Emerg Infect Dis ; 30(13): S94-S99, 2024 04.
Artigo em Inglês | MEDLINE | ID: mdl-38561870

RESUMO

The Medicaid Inmate Exclusion Policy (MIEP) prohibits using federal funds for ambulatory care services and medications (including for infectious diseases) for incarcerated persons. More than one quarter of states, including California and Massachusetts, have asked the federal government for authority to waive the MIEP. To improve health outcomes and continuation of care, those states seek to cover transitional care services provided to persons in the period before release from incarceration. The Massachusetts Sheriffs' Association, Massachusetts Department of Correction, Executive Office of Health and Human Services, and University of Massachusetts Chan Medical School have collaborated to improve infectious disease healthcare service provision before and after release from incarceration. They seek to provide stakeholders working at the intersection of criminal justice and healthcare with tools to advance Medicaid policy and improve treatment and prevention of infectious diseases for persons in jails and prisons by removing MIEP barriers through Section 1115 waivers.


Assuntos
Doenças Transmissíveis , Prisioneiros , Estados Unidos , Humanos , Medicaid , Prisões , Massachusetts/epidemiologia
19.
Emerg Infect Dis ; 30(13): S68-S74, 2024 04.
Artigo em Inglês | MEDLINE | ID: mdl-38561803

RESUMO

Preexposure prophylaxis (PrEP) is underused in persons who use drugs and justice-involved persons. In an ongoing randomized controlled trial in 4 US locations comparing patient navigation versus mobile health unit on time to initiation of HIV medication or PrEP for justice-involved persons who use stimulants or opioids and who are at risk for or living with HIV, we assessed HIV risk factors, perceived HIV risk, and interest in PrEP. Participants without HIV (n = 195) were 77% men, 65% White, 23% Black, and 26% Hispanic; 73% reported a recent history of condomless sex, mainly with partners of unknown HIV status. Of 34% (67/195) reporting injection drug use, 43% reported sharing equipment. Despite risk factors, many persons reported their risk for acquiring HIV as low (47%) or no (43%) risk, although 51/93 (55%) with PrEP indications reported interest in PrEP. Justice-involved persons who use drugs underestimated their HIV risk and might benefit from increased PrEP education efforts.


Assuntos
Infecções por HIV , Profilaxia Pré-Exposição , Feminino , Humanos , Masculino , Hispânico ou Latino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Fatores de Risco , Estados Unidos , Brancos , Negro ou Afro-Americano
20.
Emerg Infect Dis ; 30(13): S62-S67, 2024 04.
Artigo em Inglês | MEDLINE | ID: mdl-38561843

RESUMO

We reviewed data obtained in October 2021-May 2023 from youth who reported a history of sexual activity upon admission to 1 of 12 juvenile justice facilities in Utah, USA, that offered screening for Chlamydia trachomatis and Neisseria gonorrhoeae. Urinalysis revealed C. trachomatis positivity of 10.77%, N. gonorrhoeae positivity of 1.08%, and coinfection C. trachomatis N. gonorrhoeae) of 0.90%. Prevalence of infection was similar for youths in rural and urban facilities. A total of 12.01% of those identifying as male and 14.01% of those identifying as female tested positive for C. trachomatis, N. gonorrhoeae, or coinfection. Of young adults who tested positive, 74.65% received their results while incarcerated, all of whom accepted treatment. Our research underscores the feasibility of providing prompt C. trachomatis/N. gonorrhoeae screening and treatment in juvenile correctional facilities. The pervasiveness of infection emphasizes the urgent need for early identification and treatment for C. trachomatis and N. gonorrhoeae in incarcerated youth nationwide.


Assuntos
Infecções por Chlamydia , Coinfecção , Gonorreia , Adulto Jovem , Adolescente , Masculino , Feminino , Humanos , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Gonorreia/prevenção & controle , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Utah/epidemiologia , Coinfecção/epidemiologia , Neisseria gonorrhoeae , Chlamydia trachomatis , Estabelecimentos Correcionais , Prevalência , Programas de Rastreamento/métodos
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