The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States.

Introduction: Several studies have measured health outcomes in the United States, but none have provided a comprehensive assessment of patterns of health by state. Objective: To use the results of the Global Burden of Disease Study (GBD) to report trends in the burden of diseases, injuries, and risk factors at the state level from 1990 to 2016. Design and Setting: A systematic analysis of published studies and available data sources estimates the burden of disease by age, sex, geography, and year. Main Outcomes and Measures: Prevalence, incidence, mortality, life expectancy, healthy life expectancy (HALE), years of life lost (YLLs) due to premature mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 333 causes and 84 risk factors with 95% uncertainty intervals (UIs) were computed. Results: Between 1990 and 2016, overall death rates in the United States declined from 745.2 (95% UI, 740.6 to 749.8) per 100 000 persons to 578.0 (95% UI, 569.4 to 587.1) per 100 000 persons. The probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC from 1990 to 2016. In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference. Minnesota had the highest HALE at birth (70.3 years), and West Virginia had the lowest (63.8 years), a 6.5-year difference. The leading causes of DALYs in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, while the third leading cause in 1990 was low back pain, and the third leading cause in 2016 was chronic obstructive pulmonary disease. Opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5% (95% UI, 42.8% to 93.9%) change. In 2016, each of the following 6 risks individually accounted for more than 5% of risk-attributable DALYs: tobacco consumption, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure. Across all US states, the top risk factors in terms of attributable DALYs were due to 1 of the 3 following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states). Conclusions and Relevance: There are wide differences in the burden of disease at the state level. Specific diseases and risk factors, such as drug use disorders, high BMI, poor diet, high fasting plasma glucose level, and alcohol use disorders are increasing and warrant increased attention. These data can be used to inform national health priorities for research, clinical care, and policy.

What Is Wrong with Monetary Sanctions? Directions for Policy, Practice, and Research.

Monetary sanctions are an integral and increasingly debated feature of the American criminal legal system. Emerging research, including that featured in this volume, offers important insight into the law governing monetary sanctions, how they are levied, and how their imposition affects inequality. Monetary sanctions are assessed for a wide range of contacts with the criminal legal system ranging from felony convictions to alleged traffic violations with important variability in law and practice across states. These differences allow for the identification of features of law, policy, and practice that differentially shape access to justice and equality before the law. Common practices undermine individuals' rights and fuel inequality in the effects of unpaid monetary sanctions. These observations lead us to offer a number of specific recommendations to improve the administration of justice, mitigate some of the most harmful effects of monetary sanctions, and advance future research.

Institutional Castling: Military Enlistment and Mass Incarceration in the United States.

The military is a major state provider of employment, occupational training, and educational subsidies. Yet military downsizing and its increased selectivity during penal expansion may have cleaved off employment opportunities for disadvantaged men. We show how institutional castling-the shifting prominence of competing institutions in the lives of specific demographic groups-has affected the underlying risk of military employment and penal confinement. Black veterans who have dropped out of high school are less likely to be incarcerated than their nonveteran counterparts, and declines in the employment rates of military servicemembers with less than a high school education are associated with large increases in incarceration rates. The military's critical role in providing institutional protection from the penal system has eroded for young, undereducated African American men.

Monetary Sanctions: Legal Financial Obligations in US Systems of Justice.

This review assesses the current state of knowledge about monetary sanctions, e.g., fines, fees, surcharges, restitution, and any other financial liability related to contact with systems of justice, which are used more widely than prison, jail, probation, or parole in the United States. The review describes the most important consequences of the punishment of monetary sanctions in the United States, which include a significant capacity for exacerbating economic inequality by race, prolonged contact and involvement with the criminal justice system, driver's license suspension, voting restrictions, damaged credit, and incarceration. Given the lack of consistent laws and policies that govern monetary sanctions, jurisdictions vary greatly in their imposition, enforcement, and collection practices of fines, fees, court costs, and restitution. A review of federally collected data on monetary sanctions reveals that a lack of consistent and exhaustive measures of monetary sanctions presents a unique problem for tracking both the prevalence and amount of legal financial obligations (LFOs) over time. We conclude with promising directions for future research and policy on monetary sanctions.

Cruel Intentions? HIV Prevalence and Criminalization During an Age of Mass Incarceration, U.S. 1999 to 2012.

A 2014 U.S. Department of Justice Best Practices Report advocates that states eliminate HIV-specific criminal penalties except under 2 conditions: when a human immunodeficiency virus (HIV)-positive person intentionally commits a sex crime or transmits the virus by engaging in behavior that poses a significant risk of transmission, regardless of actual transmission. We assess the premise of these exceptions to understand whether these best practices are based on scientific evidence about the population at risk of infection and the risk of sexual violence by HIV-positive individuals. We employ nationally representative, cross-sectional survey data from the Current Population Survey (CPS), the Survey of Inmates in State, Federal, and Local Jails (SISFLJ), and the National Health and Nutrition Survey (NHANES). Data from the CPS, SISFLJ, and NHANES are weighted and combined to analyze bias in the population at risk of HIV. Linear probability models are employed to estimate the likelihood that HIV-positive inmates are incarcerated for violent or sexual offenses, net of socioeconomic factors. We find significant measurement bias in HIV prevalence rates. The selection of national surveys for population denominators distorts contemporary estimates of HIV prevalence by 7% to 20%. Our findings also illustrate that HIV-positive inmates are 10 percentage-points less likely to be incarcerated for violent offenses than HIV-negative inmates. National best practice guidelines may undermine effective social policy that aims to curtail stigma within HIV-positive communities because scientific evidence neither include inmates into prevalence denominators (as a measure of the population at risk) nor assess the likelihood that HIV-positive inmates commit violent or sexual crimes.