A Generational Shift: Race and the Declining Lifetime Risk of Imprisonment.

Mass incarceration fundamentally altered the life course for a generation of American men, but sustained declines in imprisonment in recent years raise questions about how incarceration is shaping current generations. This study makes three primary contributions to a fuller understanding of the contemporary landscape of incarceration in the United States. First, we assess the scope of decarceration. Between 1999 and 2019, the Black male incarceration rate dropped by 44%, and notable declines in Black male imprisonment were evident in all 50 states. Second, our life table analysis demonstrates marked declines in the lifetime risks of incarceration. For Black men, the lifetime risk of incarceration declined by nearly half from 1999 to 2019. We estimate that less than 1 in 5 Black men born in 2001 will be imprisoned, compared with 1 in 3 for the 1981 birth cohort. Third, decarceration has shifted the institutional experiences of young adulthood. In 2009, young Black men were much more likely to experience imprisonment than college graduation. Ten years later, this trend had reversed, with Black men more likely to graduate college than go to prison. Our results suggest that prison has played a smaller role in the institutional landscape for the most recent generation compared with the generation exposed to the peak of mass incarceration.

Reasonable Accommodation and Disparate Impact: Clean Shave Policy Discrimination in Today's Workplace.

This article examines Bey v. City of New York - a recent Second Circuit case where four Black firefights suffering from Pseudofolliculitis Barbae (a skin condition causing irritation when shaving which mostly affects Black men) challenged the New York City Fire Department's Clean Shave Policy - with an intersectional approach utilizing legal theories of racial, disability, and religious discrimination.

COVID-19 amplified racial disparities in the US criminal legal system.

The criminal legal system in the USA drives an incarceration rate that is the highest on the planet, with disparities by class and race among its signature features1-3. During the first year of the coronavirus disease 2019 (COVID-19) pandemic, the number of incarcerated people in the USA decreased by at least 17%-the largest, fastest reduction in prison population in American history4. Here we ask how this reduction influenced the racial composition of US prisons and consider possible mechanisms for these dynamics. Using an original dataset curated from public sources on prison demographics across all 50 states and the District of Columbia, we show that incarcerated white people benefited disproportionately from the decrease in the US prison population and that the fraction of incarcerated Black and Latino people sharply increased. This pattern of increased racial disparity exists across prison systems in nearly every state and reverses a decade-long trend before 2020 and the onset of COVID-19, when the proportion of incarcerated white people was increasing amid declining numbers of incarcerated Black people5. Although a variety of factors underlie these trends, we find that racial inequities in average sentence length are a major contributor. Ultimately, this study reveals how disruptions caused by COVID-19 exacerbated racial inequalities in the criminal legal system, and highlights key forces that sustain mass incarceration. To advance opportunities for data-driven social science, we publicly released the data associated with this study at Zenodo6.

Thurgood Marshall, Hero of American Medicine.

One of the heroes in American history, Associate Supreme Court Justice Thurgood Marshall (1908-1993) sought legal remedies against racial discrimination in education and health care. As director of the Legal Defense Fund (LDF) of NAACP from 1940 to 1961, his success in integrating law schools in Texas led to the first black medical student admitted to a state medical school in the South. Representing doctors and dentists needing a facility to perform surgery, the LDF brought cases before the courts in North Carolina that moved the country toward justice in health care. His ultimate legal victory came in 1954, Brown v. Board of Education of Topeka, the decision that declared racial segregation in public schools unconstitutional. In 1964, the LDF under Jack Greenberg, Marshall's successor as director, won Simkins v. Moses H. Cone Memorial Hospital, a decision that held that hospitals accepting federal funds had to admit black patients. The two decisions laid the judicial foundation for the laws and administrative acts that changed America's racial history, the Civil Rights Act of 1964 and the Social Security Act Amendments of 1965 that established Medicare and Medicaid. His achievements came during the hottest period of the American civil rights movement of the 1950s and 1960s. Well past the middle of the twentieth century, black Americans were denied access to the full resources of American medicine, locked in a "separate-but-equal" system woefully inadequate in every respect. In abolishing segregation, Marshall initiated the long overdue remedy of the unjust legacies of slavery and Jim Crow.

Anti-black Attitudes Are a Threat to Health Equity in the United States.

OBJECTIVES: To assess the extent to which persistent racism shapes perspectives on public health policies aimed at improving health equity in the United States. Specifically we evaluate the relationship between implicit and explicit anti-black attitudes and support for the ACA at the beginning of the Trump administration. METHODS: We use bivariate statistics to examine views toward the ACA, anti-black attitudes, and demographic variables. Using logistic regression, we examine how anti-black attitudes and demographic variables relate to participants stating that the ACA has worsened the quality of health care services in the United States. SURVEY POPULATION: Data for this study come from the American National Election Studies 2016 Time Series Study, which targets US citizens age 18 and older currently living in the United States (N = 3245). RESULTS: Implicit anti-black attitudes, particularly among whites, are strongly associated with negative feelings toward the ACA. A measure of explicit racial prejudice has the opposite relationship among whites. These results suggest that whites are most critical of the ACA when they hold positive attitudes toward blacks but hold negative stereotypes about blacks' work ethic and reject policies to eliminate racial inequalities. CONCLUSIONS: Anti-black racial attitudes are a critical barrier to enacting health policies that stand to improve health equity in the United States. Public health practitioners and policymakers should consider racism as an essential barrier to overcome in the push for greater health equity in the United States.

Racial differences in the relationship between alcohol/pregnancy policies and birth outcomes and prenatal care utilization: A legal epidemiology study.

OBJECTIVES: State policies regarding alcohol use during pregnancy (alcohol/pregnancy policies) have been in effect for more than 40 years. Previous research finds some policies increase adverse birth outcomes and decrease prenatal care utilization. This research examines whether effects of alcohol/pregnancy policies vary by race; the general hypothesis is that health benefits of policies are concentrated among White women and health harms of policies are concentrated among Black women. METHODS: This study uses 1972-2015 Vital Statistics data and policy data from NIAAA's Alcohol Policy Information System and original legal research. The dataset includes more than 150 million singleton births. Outcomes are preterm birth (PTB), low birthweight (LBW), and prenatal care utilization. Logistic regression models include raceXpolicy interaction terms as main predictors, adjust for individual- and state-level controls, include fixed effects for state, year and state-specific time trends, and account for clustering by state. RESULTS: The impact of alcohol/pregnancy policies varied by race for preterm birth, varied in a few cases for low birthweight, and generally did not vary for prenatal care utilization. The hypothesis regarding the direction of differential effects was not supported. Six policies had an adverse impact on PTB and/or LBW for White women. Findings differed for Black women; for Black women, four policies had a beneficial impact for PTB and one had an adverse impact for LBW. CONCLUSIONS: The impact of alcohol/pregnancy policies on birth outcomes varies by race. Future research should explore why some policies appear to have opposite effects for White v. Black women.

African American cultural history and reflections on Jung in the African Diaspora.

Racism is defined as a psychopathology and the ground in which the covenant of whiteness is rooted and mirrored in the system of apartheid structured by American Constitutional Jurisprudence between 1857 and 1954. This historical period overshadowed Carl Jung's visit to America between 1909 and 1937. The spirit of the times and practices of racism coloured Jung's views, attitudes, and theories about African Americans, just as colonialism coloured his attitudes toward Africa and Africans. Consequently Jung failed to see the African Diaspora and the extraordinary intellectual and artistic period of the Harlem Renaissance (1919-1929). Its introduction here foregrounds the exceptionalism of African Americans and the cultural continuity of African ancestry. This exceptionalism was not seen by Jung and there have been no attempts to redress its omission from analytical psychology and other sub-disciplines of Western psychology. Jung's theories of personality and psychoanalysis and his negative projections about primitivism among Africans and African American 'Negroes' would have been mediated by knowledge of a legislated American apartheid and the Harlem Renaissance which occurred within the barriers of apartheid. In this paper I posit that culture, kinship libido, and the African principle of Ubuntu are healing modalities that play a critical role in instinct and the relational ground of human psychology and biology, from which culture as an environmental expression constellates around common goals of the human species. Cultural equivalencies and expressions within the wisdom traditions and mythologies of the Africa Diaspora are considered. Specifically, the Bantu principle of Ubuntu or 'humanity' is identified as the relational ground in African cultures, while the Kemetic-Egyptian deity Maat, as an archetypal anima figure and the religio-mythology offer a transcendent position from which to critique the inequities and constitutional jurisprudence that structured American apartheid. Maat is the personification of truth, justice, balance and weighing of the heart in orderly judicial processes. In her we find the alignment of the spirit and matter in the law and judgement. The paper concludes with reflections on pathways toward healing the psychopathology of racism and recommendations to enhance clinical training and practice.

Le racisme est défini en tant que psychopathologie et le terrain dans lequel s'enracine l'alliance entre blancs, qui est reflétée dans le système d'apartheid structuré par la Jurisprudence Constitutionnelle Américaine entre 1857 et 1954. Cette période historique domine la visite de Carl Jung en Amérique entre 1909 et 1937. L'esprit de l'époque et le racisme ambiant ont teinté les perspectives de Jung, ses attitudes et ses théories sur les Afro-Américains. Tout comme le colonialisme a teinté ses attitudes à l'égard de l'Afrique et des Africains. De ce fait Jung n'a pas pris en compte la Diaspora Africaine, et l'extraordinaire période artistique et intellectuelle de la Renaissance de Harlem (1919-1929). Sa présentation ici met en premier plan l'exceptionnalisme des Afro-Américains et la continuité culturelle de l'héritage Africain. Cet exceptionnalisme ne fut pas remarqué par Jung et il n'y a pas eu de tentatives de la part de la psychologie analytique ou d'autres disciplines associées, pour remédier à cette omission. Les théories de Jung sur la personnalité et la psychanalyse et ses projections négatives sur le primitivisme chez les Africains et les « Nègres ¼ Afro-Américains auraient été arbitrées par la connaissance d'un apartheid Américain inscrit dans la loi, et de la Renaissance de Harlem qui se produisit à l'intérieur des barrières de cet apartheid. Dans cet article j'avance l'idée que la culture, la libido de parenté, et le principe Africain d'Ubuntu sont des modalités porteuses de guérison et qui jouent un rôle critique dans l'instinct et le terrain relationnel de la psychologie et la biologie humaine, à partir desquelles la culture en tant qu'expression de l'environnement se voit constellée autour de buts commun à l'espèce humaine. L'article examine des équivalences et des expressions culturelles dans des traditions de sagesse et mythologies de la Diaspora Africaine. Tout particulièrement le principe Bantou d'Ubuntu - ou « humanité ¼ - est identifié comme le terrain relationnel dans les cultures Africaines. Et la déité Khémite-Egyptienne Maât - en tant que figure archétypale de l'anima - et la mythologie religieuse offrent une position transcendante à partir de laquelle on peut faire la critique des inégalités et de la jurisprudence constitutionnelle qui structuraient l'apartheid Américain. Maât est la personnification de la vérité, de la justice, de l'équilibre, et de la pondération du cœur dans les processus de justice harmonieux. En elle nous trouvons l'alignement de l'esprit et de la matière dans la loi et le jugement. L'article se conclut par des réflexions sur les chemins permettant la guérison de la psychopathologie du racisme, et des recommandations pour améliorer la formation et la pratique cliniques.

El racismo es definido como una psicopatología y el fundamento sobre el cual se fundamenta el pacto del blanco, espejado en el sistema de apartheid por la Jurisprudencia Constitucional Americana entre 1857 y 1954. Este período histórico eclipsa la visita de Carl G. Jung a América entre 1909 y 1937. El espíritu del tiempo y las prácticas racistas colorean las perspectivas, actitudes y teorías de Jung sobre la población Afro Americana, tanto como el colonialismo coloreó sus actitudes hacia África y la población Africana. Consecuentemente, Jung no pudo percibir la Diáspora Africana y el extraordinario período artístico e intelectual del Renacimiento en Harlem (1919-1929). Su introducción aquí destaca la excepcionalidad de los Afro Americanos y la continuidad cultural del África ancestral. Esta excepcionalidad no ha sido considerada por Jung y no ha habido intentos de dar cuenta de dicha omisión desde la Psicología Analítica y otras subdisciplinas de la psicología Occidental. Las teorías de Jung sobre la personalidad, el psicoanálisis y las proyecciones negativas sobre el primitivismo entre Africanos, y Afro-Americanos 'negros' pudo haber sido mediada a través del conocimiento del apartheid legislado en América y el Renacimiento de Harlem el cual ocurrió dentro de las fronteras de dicho apartheid. En el presente trabajo propongo que la cultura, la libido de parentesco, y el principio Africano de Ubuntu son modalidades de sanación que juegan un rol crítico en el instinto y en el fundamento relacional de la psicología humana y la biología, desde el cual, la cultura como expresión del medio ambiente se constela alrededor de metas comunes de la especie humana. Se consideran equivalencias y expresiones culturales dentro de las sabias tradiciones y mitologías de la Diáspora Africana. Específicamente, el principio Bantu de Ubuntu o 'humanidad' es identificado como el fundamento relacional en las culturas Africanas, mientras que la deidad Kemetica- Egipcia Maat, como una figura arquetípica del ánima y la mitología religiosa ofrecen una posición trascendente desde la cual criticar las inequidades y la jurisprudencia constitucional que estructuran el apartheid Americano. Maat es la personificación de la verdad, la justicia, el balance y ponderación de corazón en los procesos ordenados judicialmente. En ella encontramos la alineación del espíritu y la materia en la ley y el juicio. El trabajo concluye con reflexiones acerca de posibles vías hacia la sanación de la psicopatología del racismo y recomendaciones para mejorar la formación y práctica clínica.

Explaining continuity in substance use: The role of criminal justice system involvement over the life course of an urban African American prospective cohort.

BACKGROUND: African Americans are disproportionately burdened by substance use consequences and criminal justice system involvement, yet their interrelationship over the life course is not well understood. This study aimed to assess how substance use, crime, and justice system involvement may influence one another from adolescence to midlife. METHODS: Data come from a community cohort of urban African Americans first assessed in childhood and followed up into midlife (n = 1242, 606 males, 636 females). We draw on interview data and local, state, and federal criminal records. Participants were assessed at ages 6, 16, 32, and 42, with additional record retrieval at age 52. Utilizing structural equation modeling, we estimate pathways between substance use, criminal behavior, and arrests over time by gender. RESULTS: For males, significant paths were found between childhood behavioral problems and adolescent substance use, delinquency, and police interactions. For females, a significant path was found between childhood behavioral problems and only adolescent delinquency. We observed continuity between substance use and between arrest constructs from adolescence through midlife for men only. Direct paths were found between substance use and later arrests for both males and females. Paths were also observed between arrests and later substance use for both genders. CONCLUSIONS: Findings of reciprocal relationships highlight the critical need to break the cycle of substance use and crime and point to specific times in the life course when intervention is necessary. Findings introduce the potential role of the criminal justice system as a key intervention agent in redirecting substance use careers.

Improving graduation rates for African Americans in drug court: Importance of human relationships and barriers to gaining and sustaining employment.

Drug courts have been an important part of the criminal justice system since 1989. They continue to expand throughout the United States because nearly three decades of research has shown that they are more effective than other interventions, such as traditional probation. There is a pattern, though, in some drug courts where African Americans are less likely to graduate than their Caucasian counterparts. This qualitative study explores this phenomenon by asking African American participants (n = 31) their views on the most helpful aspects of drug court and how drug court could be more helpful in supporting them in graduating the program. Participants felt that the respect and compassion they received from the drug court judge and their case managers, as well as the camaraderie they developed with other participants, was an aspect of drug court that supported them in graduating the program. Next, participants felt that graduation rates would improve if drug court better supported them in gaining employment or sustaining the employment they already had. Implications for drug court practice are discussed.

Black Lives Matter, but What About Our Health?

In the setting of the current social and political climate, the focus on protection of Black lives in America has come to the forefront. We evaluate how health in the Black community should be a paramount concern that can be addressed in three ways: 1. Connecting the medical community to the Black community, empowering patients with knowledge, and diversifying the medical workforce. These three initiatives will help to decrease the health disparities seen in Black health.

Racial and Ethnic Disparities in Meeting MTM Eligibility Criteria Based on Star Ratings Compared with the Medicare Modernization Act.

BACKGROUND: Previous research found racial and ethnic disparities in meeting medication therapy management (MTM) eligibility criteria implemented by the Centers for Medicare & Medicaid Services (CMS) in accordance with the Medicare Modernization Act (MMA). OBJECTIVE: To examine whether alternative MTM eligibility criteria based on the CMS Part D star ratings quality evaluation system can reduce racial and ethnic disparities. METHODS: This study analyzed the Beneficiary Summary File and claims files for Medicare beneficiaries linked to the Area Health Resource File. Three million Medicare beneficiaries with continuous Parts A, B, and D enrollment in 2012-2013 were included. Proposed star ratings criteria included 9 existing medication safety and adherence measures developed mostly by the Pharmacy Quality Alliance. Logistic regression and the Blinder-Oaxaca approach were used to test disparities in meeting MMA and star ratings eligibility criteria across racial and ethnic groups. Multinomial logistic regression was used to examine whether there was a disparity reduction by comparing individuals who were MTM-eligible under MMA but not under star ratings criteria and those who were MTM-eligible under star ratings criteria but not under the MMA. Concerning MMA-based MTM criteria, main and sensitivity analyses were performed to represent the entire range of the MMA eligibility thresholds reported by plans in 2009, 2013, and proposed by CMS in 2015. Regarding star ratings criteria, meeting any 1 of the 9 measures was examined as the main analysis, and various measure combinations were examined as the sensitivity analyses. RESULTS: In the main analysis, adjusted odds ratios for non-Hispanic blacks (backs) and Hispanics to non-Hispanic whites (whites) were 1.394 (95% CI = 1.375-1.414) and 1.197 (95% CI = 1.176-1.218), respectively, under star ratings. Blacks were 39.4% and Hispanics were 19.7% more likely to be MTM-eligible than whites. Blacks and Hispanics were less likely to be MTM-eligible than whites in some sensitivity analyses. Disparities were not completely explained by differences in patient characteristics based on the Blinder-Oaxaca approach. The multinomial logistic regression of each main analysis found significant adjusted relative risk ratios (RRR) between whites and blacks for 2009 (RRR = 0.459, 95% CI = 0.438-0.481); 2013 (RRR = 0.449, 95% CI = 0.434-0.465); and 2015 (RRR = 0.436, 95% CI = 0.425-0.446) and between whites and Hispanics for 2009 (RRR = 0.559, 95% CI = 0.528-0.593); 2013 (RRR = 0.544, 95% CI = 0.521-0.569); and 2015 (RRR = 0.503, 95% CI = 0.488-0.518). These findings indicate a significant reduction in racial and ethnic disparities when using star ratings eligibility criteria; for example, black-white disparities in the likelihood of meeting MTM eligibility criteria were reduced by 55.1% based on star ratings compared with MMA in 2013. Similar patterns were found in most sensitivity and disease-specific analyses. CONCLUSIONS: This study found that minorities were more likely than whites to be MTM-eligible under the star ratings criteria. In addition, MTM eligibility criteria based on star ratings would reduce racial and ethnic disparities associated with MMA in the general Medicare population and those with specific chronic conditions. DISCLOSURES: Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under award number R01AG049696. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Cushman reports an Eli Lilly grant and uncompensated consulting for Takeda Pharmaceuticals outside this work. The other authors have no potential conflicts of interest to report. Study concept and design were contributed by Wang and Shih, along with Wan, Kuhle, Spivey, and Cushman. Wang, Qiao, and Wan took the lead in data collection, with assistance from the other authors. Data interpretation was performed by Wang, Kuhle, and Qiao, with assistance from the other authors. The manuscript was written by Spivey and Qiao, along with the other authors, and revised by Cushman, Dagogo-Jack, and Chisholm-Burns, along with the other authors.

The Mobility of Youth in the Justice System: Implications for Recidivism.

Both residential mobility and community disadvantage have been shown to be associated with negative outcomes for adolescents generally and juvenile offenders specifically. The current study examines the effects of moving among a large sample (n = 13,096) of previously adjudicated youth (31.6 % female, 41.2 % Black, 16.5 % Hispanic). Additionally, we examine whether moving upward to a more affluent neighborhood, moving downward to an area of greater disadvantage, or moving laterally to a similar neighborhood tempers the effects of residential mobility. We use a combination of analytical techniques, including propensity score matching to untangle the effects of mobility sans pre-existing conditions between movers and non-movers. Results show relocation increases recidivism, irrespective of the direction of the move with regard to socioeconomic context. Moving upward has the most detrimental impact for adjudicated male adolescents, while downward relocations evidenced the largest effect for female youth. Implications for policy and future research needs are discussed.

Tobacco policies and on-premise smoking in bars and clubs that cater to young African Americans following the Maryland Clean Indoor Air Act of 2007.

African American young adults ages 18-25 smoke less than their Caucasian peers, yet the burden of tobacco-related illness is significantly higher in African Americans than in Caucasians across the lifespan. Little is known about how clean indoor air laws affect tobacco smoking among African American young adults. We conducted a systematic observation of bars and clubs with events targeted to African American adults 18-25 in Baltimore City at two timepoints (October and November of 2008 and 2010) after enforcement of the Maryland Clean Indoor Air Act (CIAA). Twenty venues-selected on the basis of youth reports of popular venues-were rated during peak hours. All surveillance checklist items were restricted to what was observable in the public domain. There was a significant decrease in observed indoor smoking after CIAA enforcement. Observed outdoor smoking also decreased, but this change was not significant. Facilities for smoking outdoors increased significantly. The statewide smoking ban became effective February 1, 2008, yet measurable changes in smoking behavior in bars were not evident until the City engaged in stringent enforcement of the ban several months later.

Stigma, sexual risks, and the war on drugs: Examining drug policy and HIV/AIDS inequities among African Americans using the Drug War HIV/AIDS Inequities Model.

The relationship between drug policy and HIV vulnerability is well documented. However, little research examines the links between racial/ethnic HIV disparities via the Drug War, sexual risk, and stigma. The Drug War HIV/AIDS Inequities Model has been developed to address this dearth. This model contends that inequitable policing and sentencing promotes sexual risks, resource deprivation, and ultimately greater HIV risk for African-Americans. The Drug War also socially marginalizes African Americans and compounds stigma for incarcerated and formerly incarcerated persons living with HIV/AIDS. This marginalization has implications for sexual risk-taking, access to health-promoting resources, and continuum of care participation. The Drug War HIV/AIDS Inequities Model may help illuminate mechanisms that promote increased HIV vulnerability as well as inform structural intervention development and targeting to address racial/ethnic disparities.

Interaction between Red Meat Intake and NAT2 Genotype in Increasing the Risk of Colorectal Cancer in Japanese and African Americans.

Heterocyclic aromatic amines formed in cooked meat may be an underlying mechanism for the red meat-colorectal cancer (CRC) association. These compounds require bioactivaction by N-acetyltransferase 2 (NAT2). An interaction effect between red meat consumption and NAT2 in increasing CRC risk has been inconsistently reported in whites. We investigated this interaction in two populations in which the high-activity rapid NAT2 phenotype is 10- and 2-fold more common than in whites. We meta-analyzed four studies of Japanese (2,217 cases, 3,788 controls) and three studies of African Americans (527 cases, 4,527 controls). NAT2 phenotype was inferred from an optimized seven-SNP genotyping panel. Processed and total red meat intakes were associated with an increased CRC risk in Japanese and in both ethnic groups combined (P's ≤ 0.002). We observed an interaction between processed meat intake and NAT2 in Japanese (P = 0.04), African Americans (P = 0.02), and in both groups combined (P = 0.006). The association of processed meat with CRC was strongest among individuals with the rapid NAT2 phenotype (combined analysis, OR for highest vs. lowest quartile: 1.62, 95% CI: 1.28-2.05; Ptrend = 8.0×10-5), intermediate among those with the intermediate NAT2 phenotype (1.29, 95% CI: 1.05-1.59; Ptrend = 0.05) and null among those with the slow phenotype (Ptrend = 0.45). A similar interaction was found for NAT2 and total red meat (Pinteraction = 0.03). Our findings support a role for NAT2 in modifying the association between red meat consumption and CRC in Japanese and African Americans.

Black Lives Matter: A Commentary on Racism and Public Health.

The recent nonindictments of police officers who killed unarmed Black men have incited popular and scholarly discussions on racial injustices in our legal system, racialized police violence, and police (mis)conduct. What is glaringly absent is a public health perspective in response to these events. We aim to fill this gap and expand the current dialogue beyond these isolated incidents to a broader discussion of racism in America and how it affects the health and well-being of people of color. Our goal is not only to reiterate how salient structural racism is in our society, but how critical antiracist work is to the core goals and values of public health.

Commercial sexual exploitation of children and the emergence of safe harbor legislation: implications for policy and practice.

Commercial sexual exploitation of children is an enduring social problem that has recently become the focus of numerous legislative initiatives. In particular, recent federal- and state-level legislation have sought to reclassify youth involved in commercial sexual exploitation as victims rather than as offenders. So-called Safe Harbor laws have been developed and centered on decriminalization of "juvenile prostitution." In addition to or instead of decriminalization, Safe Harbor policies also include diversion, law enforcement training, and increased penalties for adults seeking sexual contact with minors. The purpose of this paper is to review the underlying rationale of Safe Harbor laws, examine specific policy responses currently enacted by the states, and consider the effects of policy variations. Directions for future research and policy are addressed.

Black physicians and the struggle for civil rights: lessons from the Mississippi experience: part 1: the forces for and against change.

The roles of black physicians in the South in the period leading up to the Civil Rights Act of 1964 and the Voting Rights Act of 1965 have not been fully disclosed. In Mississippi and elsewhere in the South, it is a story of disenfranchised professionals who risked life, limb, and personal success to improve the lot of those they served. This first of 2 articles on the subject provides an overview of the forces for and against the struggle for civil rights and social justice in medicine in the South. We use newly available data from Mississippi as a prime example. An understanding of these forces is essential to an understanding of medical education and medical practice in this period and helps explain why the South remains in last place in most indicators of health today.

Black physicians and the struggle for civil rights: lessons from the Mississippi experience: part 2: their lives and experiences.

Little information is available on the lives and experiences of black physicians who practiced in the South during the Jim Crow era of legalized segregation. In Mississippi and elsewhere, it is a story of disenfranchised professionals who risked life, limb, and personal success to improve the lot of those they served. In this second article on this topic, we present the stories of some of the physicians who were leaders in the civil rights movement in Mississippi as examples. Because the health disparities they sought to address have, not of their own making, been passed on to the next generation of physicians, the lessons learned from their experience are worthy of consideration.