Prioritization of carceral spending in U.S. cities: Development of the Carceral Resource Index (CRI) and the role of race and income inequality.

BACKGROUND: Policing, corrections, and other carceral institutions are under scrutiny for driving health harms, while receiving disproportionate resources at the expense of prevention and other services. Amidst renewed interest in structural determinants of health, roles of race and class in shaping government investment priorities are poorly understood. METHODS: Based on the Social Conflict Model, we assessed relationships between city racial/ economic profiles measured by the Index of Concentration at the Extremes (ICE) and budgetary priorities measured by the novel Carceral Resource Index (CRI), contrasting investments in carceral systems with funding for health and social support across the 50 most populous cities in the United States (U.S.). Bivariate correlations, and unadjusted and adjusted polynomial regression models were used to assess the relationship between budgetary investments and population concentration at extremes in terms of income, racial/ethnic composition, and education, controlling for other demographic characteristics. RESULTS: In our sample, median CRI was -0.59 (IQR -0.64, -0.45), with only seven cities exhibiting positive CRI values. This indicates that most large U.S. cities spend more on carceral systems than on health and supportive services, combined. Adjusted polynomial models showed a convex relationship between the CRI and ICE-Education, and ICE-Race(White vs. Black)+Income, with quadratic terms that were positive and significant at p<0.05. After controlling for age, the strongest prioritization of carceral systems was observed in cities where the proportion of low-income Black residents approached or exceeded that of high-income white residents. CONCLUSIONS: Municipal prioritization of carceral investments over health and social support is pervasive in the U.S and exacerbated by racial and economic disparities. The CRI offers new opportunities to understand the role of government investments as a structural determinant of health and safety. Longitudinal research is warranted to examine the relationship between budget priorities, structural racism, and health outcomes.

"Nobody Knows How You're Supposed to Interpret it:" End-user Perspectives on Prescription Drug Monitoring Program in Massachusetts.

OBJECTIVES: America's overdose crisis spurred rapid expansion in the number and scope of prescription drug monitoring programs (PDMPs). As their public health impact remains contested, little is known about PDMP user experiences and perspectives. We explore perspectives of PDMP end-users in Massachusetts. METHODS: Between 2016 and 2017, we conducted semi-structured qualitative interviews on overdose crisis dynamics and PDMP experiences with a purposive sample of 18 stakeholders (prescribers, pharmacists, law enforcement, and public health regulators). Recordings were transcribed and double-coded using a grounded hermeneutic approach. RESULTS: Perspectives on prescription monitoring as an element of overdose crisis response differed across sectors, but narratives often critiqued PDMPs as poorly conceived to serve end-user needs. Respondents indicated that PDMP: (1) lacked clear orientation towards health promotion; (2) was not optimally configured or designed as a decision support tool, resulting in confusion over interpreting data to guide health care or law enforcement actions; and, (3) problematized communication and relationships between prescribers, pharmacists, and patients. CONCLUSIONS: User insights must inform design, programmatic, and policy reform to maximize PDMP benefits while minimizing harm.

Fentanyl panic goes viral: The spread of misinformation about overdose risk from casual contact with fentanyl in mainstream and social media.

BACKGROUND: Fueled by misinformation, fentanyl panic has harmed public health through complicating overdose rescue while rationalizing hyper-punitive criminal laws, wasteful expenditures, and proposals to curtail vital access to pain pharmacotherapy. To assess misinformation about health risk from casual contact with fentanyl, we characterize its diffusion and excess visibility in mainstream and social media. METHODS: We used Media Cloud to compile and characterize mainstream and social media content published between January 2015 and September 2019 on overdose risk from casual fentanyl exposure. RESULTS: Relevant content appeared in 551 news articles spanning 48 states. Misinformed media reports received approximately 450,000 Facebook shares, potentially reaching nearly 70,000,000 users from 2015-2019. Amplified by erroneous government statements, misinformation received excess social media visibility by a factor of 15 compared to corrective content, which garnered fewer than 30,000 shares with potential reach of 4,600,000 Facebook users. CONCLUSION: Health-related misinformation continues to proliferate online, hampering responses to public health crises. More evidence-informed tools are needed to effectively challenge misinformed narratives in mainstream and social media.

Correlates of bushmeat in markets and depletion of wildlife.

We used data on number of carcasses of wildlife species sold in 79 bushmeat markets in a region of Nigeria and Cameroon to assess whether species composition of a market could be explained by anthropogenic pressures and environmental variables around each market. More than 45 mammal species from 9 orders were traded across all markets; mostly ungulates and rodents. For each market, we determined median body mass, species diversity (game diversity), and taxa that were principal contributors to the total number of carcasses for sale (game dominance). Human population density in surrounding areas was significantly and negatively related to the percentage ungulates and primates sold in markets and significantly and positively related to the proportion of rodents. The proportion of carnivores sold was higher in markets with high human population densities. Proportion of small-bodied mammals (<1 kg) sold in markets increased as human population density increased, but proportion of large-bodied mammals (>10 kg) decreased as human population density increased. We calculated an index of game depletion (GDI) for each market from the sum of the total number of carcasses traded per annum and species, weighted by the intrinsic rate of natural increase (rmax ) of each species, divided by individuals traded in a market. The GDI of a market increased as the proportion of fast-reproducing species (highest rmax ) increased and as the representation of species with lowest rmax (slow-reproducing) decreased. The best explanatory factor for a market's GDI was anthropogenic pressure-road density, human settlements with >3000 inhabitants, and nonforest vegetation. High and low GDI were significantly differentiated by human density and human settlements with >3000 inhabitants. Our results provided empirical evidence that human activity is correlated with more depleted bushmeat faunas and can be used as a proxy to determine areas in need of conservation action.

Mapping hotspots of threatened species traded in bushmeat markets in the Cross-Sanaga rivers region.

Bushmeat markets exist in many countries in West and Central Africa, and data on species sold can be used to detect patterns of wildlife trade in a region. We surveyed 89 markets within the Cross-Sanaga rivers region, West Africa. In each market, we counted the number of carcasses of each taxon sold. During a 6-month period (7594 market days), 44 mammal species were traded. Thirteen species were on the International Union for Conservation of Nature (IUCN) Red List or protected under national legislation, and at least 1 threatened species was traded in 88 of the 89 markets. We used these data to identify market groups that traded similar species assemblages. Using cluster analyses, we detected 8 market groups that were also geographically distinct. Market groups differed in the diversity of species, evenness of species, and dominant, prevalent, and characteristic species traded. We mapped the distribution of number of threatened species traded across the study region. Most threatened species were sold in markets nearest 2 national parks, Korup National Park in Cameroon and Cross River in Nigeria. To assess whether the threatened-species trade hotspots coincided with the known ranges of these species, we mapped the overlap of all threatened species traded. Markets selling more threatened species overlapped with those regions that had higher numbers of these. Our study can provide wildlife managers in the region with better tools to discern zones within which to focus policing efforts and reduce threats to species that are threatened by the bushmeat trade.

Association of body mass with price of bushmeat in Nigeria and Cameroon.

Spatially extensive patterns of bushmeat extraction (and the processes underlying these patterns) have not been explored. We used data from a large sample (n= 87) of bushmeat trading points in urban and rural localities in Nigeria and Cameroon to explore extraction patterns at a regional level. In 7,594 sample days, we observed 61,267 transactions involving whole carcasses. Rural and urban trading points differed in species for sale and in meat condition (fresh or smoked). Carcass price was principally associated with body mass, with little evidence that taxonomic group (primate, rodent, ungulate, or mammalian carnivore) affected price. Moreover, meat condition was not consistently associated with price. However, some individual species were more expensive throughout the region than would be expected for their size. Prices were weakly positively correlated with human settlement size and were highest in urban areas. Supply did not increase proportionally as human settlement size increased, such that per capita supply was significantly lower in urban centers than in rural areas. Policy options, including banning hunting of more vulnerable species (those that have low reproductive rates), may help to conserve some species consumed as bushmeat because carcass prices indicate that faster breeding, and therefore the more sustainable species, may be substituted and readily accepted by consumers.

Resumen: Los patrones espacialmente extensivos de extracción de carne silvestre (y los procesos relacionados con esos patrones) no han sido explorados. Utilizamos datos de una muestra grande (n =87) de puntos de venta de carne silvestre en localidades urbanas y rurales en Nigeria y Camerún para explorar los patrones de extracción a nivel regional. En 7,594 días de muestreo observamos 61,267 transacciones involucrando cuerpos completos. Los puntos de venta rurales y urbanos difirieron en especies en venta y condición de la carne (fresca o ahumada). El precio del cuerpo se asoció principalmente con la masa corporal, con poca evidencia de que el grupo taxonómico (primate, roedor, ungulado o mamífero carnívoro) afectara el precio. Mas aun, la condición de la carne no se asoció consistentemente con el precio. Sin embargo, algunas especies individuales en la región fueron más caras de lo esperado por su tamaño. Los precios se correlacionaron positiva y débilmente con el tamaño del asentamiento humano y fueron más altos en áreas urbanas. La oferta no incrementó proporcionalmente a medida que incrementó el tamaño del asentamiento, tanto que la oferta per cápita fue significativamente menor en centros urbanos que en áreas urbanas. Opciones de políticas, incluyendo la prohibición de la caza de especies más vulnerables (aquellas que tienen bajas tasas reproductivas), pueden ayudar a conservar algunas especies consumidas como carne silvestre porque los precios indican que especies de reproducción más rápida, y por lo tanto más sustentables, pueden ser sustituidas y aceptadas de buena gana por los consumidores.