Policing and Population Health: Past, Present, and Future.

Policy Points A growing body of research suggests that policing, as a form of state-sanctioned racial violence, operates as a social determinant of population health and racial or ethnic health disparities. A lack of compulsory, comprehensive data on interactions with police has greatly limited our ability to calculate the true prevalence and nature of police violence. While innovative unofficial data sources have been able to fill these data gaps, compulsory and comprehensive data reporting on interactions with police, as well as considerable investments in research on policing and health, are required to further our understanding of this public health issue.

Racial and Ethnic Disparities in Housing Instability During the COVID-19 Pandemic: the Role of Assets and Income Shocks.

Stable and adequate housing is critical to sound public health responses in the midst of a pandemic. This study explores the disproportionate impact of the COVID-19 pandemic on housing-related hardships across racial/ethnic groups in the USA as well as the extent to which these disparities are mediated by households' broader economic circumstances, which we operationalized in terms of prepandemic liquid assets and pandemic-related income losses. Using a longitudinal national survey with more than 23,000 responses, we found that Black and Hispanic respondents were more vulnerable to housing-related hardships during the pandemic than white respondents. These impacts were particularly pronounced in low- and moderate-income households. We found that liquid assets acted as a strong mediator of the housing hardship disparities between white and Black/Hispanic households. Our findings imply that housing became less stable for minority groups as a result of the pandemic, particularly those households with limited liquid assets. Such housing-related disparities demonstrate the need for policies and practices that target support to economically marginalized groups and families of color in particular.

Implementing a Social Determinants of Health Curriculum in Undergraduate Medical Education: A Qualitative Analysis of Faculty Experience.

PURPOSE: Following shifts that broadened the medical profession's conceptualization of the underlying drivers of health, medical schools are required to integrate curricula on health disparities and the social context of medicine into undergraduate medical education. Although previous research has focused on student experiences and outcomes in these curricula, less attention has been paid to the experiences of the physician-faculty involved. This study aimed to capture faculty insights to improve understanding of the challenges and opportunities of implementing this curricular reform. METHOD: In-depth, semistructured interviews were conducted with 10 faculty members at one U.S. medical school in spring 2019 to capture their experiences designing and teaching a new curriculum related to the social determinants of health and health disparities. Study design, including interview guide development, was informed by the critical pedagogy perspective and social constructionist approaches to curriculum implementation. With the use of a constructivist grounded theory approach, interview transcripts were analyzed using open, thematic, and axial coding techniques. Primary themes were categorized as professional, organizational, interactional, or intrapersonal and organized into the final model. RESULTS: Participants processed their experiences at 4 concentric levels: professional, organizational, interactional, and intrapersonal. Faculty generally embraced the movement to incorporate more discussion of social context as a driver of health outcomes. However, they struggled with the shortcomings of their training and navigating structural constraints within their school when developing and delivering content. When confronted with these limitations, faculty experienced unexpected tension in the classroom setting that catalyzed self-reflection and reconstruction of their teaching approach. CONCLUSIONS: Findings highlight the challenges that faculty encounter when integrating social determinants of health and related curricula into undergraduate medical education. They also speak to the need for a broader conceptualization of relevant expertise and have implications for how medical schools select, train, and support medical educators in this work.

Neither mad nor bad? The classification of antisocial personality disorder among formerly incarcerated adults.

Using the National Comorbidity Survey, this study explores the presence and symptoms of antisocial personality disorder (ASPD) among people with varying degrees of contact with the criminal justice system. The study finds an elevated prevalence of ASPD among formerly incarcerated persons, but also that ASPD is not a simple linear function of actual or potential contact with the criminal justice system. For example, among people who have been arrested the prevalence of ASPD is not much greater than among those who committed a crime but were never arrested. Furthermore, the difference in prevalence between those who were incarcerated and those who were arrested but not incarcerated is small. Moreover, the prevalence is highly sensitive to the elimination of one particular symptom among seven: failure to conform to social norms, as indicated by having been arrested. Eliminating this single symptom reduces the prevalence of ASPD by more than 50%, even among formerly incarcerated persons. Additional analyses reveal that, among formerly incarcerated persons who meet the diagnostic threshold for ASPD, their set of symptoms is perhaps driven more by their circumstance than their personality. For example, while formerly incarcerated persons frequently report failing to fulfill their promises, fewer than one in ten report a lack of remorse for having mistreated others. These findings suggest the need to further contextualize ASPD symptomatology, particularly among populations with frequent contact with the criminal justice system.