First Responder Assertive Linkage Programs: A Scoping Review of Interventions to Improve Linkage to Care for People Who Use Drugs.

CONTEXT: In response to the drug overdose crisis, first responders, in partnership with public health, provide new pathways to substance use disorder (SUD) treatment and other services for individuals they encounter in their day-to-day work. OBJECTIVE: This scoping review synthesizes available evidence on first responder programs that take an assertive approach to making linkages to care. RESULTS: Seven databases were searched for studies published in English in peer-reviewed journals between January 2000 and December 2019. Additional articles were identified through reference-checking and subject matter experts. Studies were selected for inclusion if they sufficiently described interventions that (1) focus on adults who use drugs; (2) are in the United States; (3) involve police, fire, or emergency medical services; and (4) assertively link individuals to SUD treatment. Twenty-two studies met inclusion criteria and described 34 unique programs, implementation barriers and facilitators, assertive linkage strategies, and linkage outcomes, including unintended consequences. CONCLUSIONS: Findings highlight the range of linkage strategies concurrently implemented and areas for improving practice and research, such as the need for more linkages to evidence-based strategies, namely, medications for opioid use disorder, harm reduction, and wraparound services.

The Interaction of Race and Gender as a Significant Driver of Racial Arrest Disparities for African American Men.

The mass incarceration of African Americans is both a driver of racial health inequalities in the USA. Systemic social biases which associate African American men with criminality, violence, and as a particular threat to white women may partially explain their over-representation in the criminal justice system. We combined data from the Washington, DC Metro Police Department (MPD) and the American Community Survey to test whether neighborhood-level gender, race, and economic makeup were associated with elevated drug-related arrest disproportions for African American men. We found that African American men were significantly overrepresented in all drug-related arrests across the District, and that this arrest disproportion was significantly higher in neighborhoods that had a higher percentage of white female residents. The association between race and gender was somewhat attenuated, but not completely eliminated, when we introduced socio-economic variables to our model. Addressing the social determinants of criminal justice disparities must account for the intersection of race, gender, and economics, rather than considering race in isolation.

The relationship between commercial sexual exploitation of children (CSEC) and childhood sexual abuse (CSA) among boys and girls in Haiti.

To test the hypothesis that childhood sexual abuse (CSA) is a risk factor for commercial sexual exploitation of children (CSEC), we analysed data from the Haiti Violence Against Children Survey (VACS), a population-based sample of adolescents and young adults ages 13-24 (1459 males and 1457 females). Twenty-one percent of males and 25% of females reported CSA; 6% of males and 4% of females reported CSEC. The adjusted odds ratios (AORs) for CSEC based on exposure to CSA were 5.6 (95% confidence interval/CI: 3.1-10.2) for males and 5.9 (CI: 2.6-13.0) for females. For each year earlier that males first experienced CSA, the odds of CSEC increased 60% (AOR 1.6, CI 1.2-2.0). In this first nationally-representative study of lifetime CSEC, both boys and girls victimised by CSA in Haiti were more likely to have also experienced CSEC than other youth, with children who experienced CSA at younger ages at the greatest risk.