The adverse effects of policing on population health: A conceptual model

Epidemiology of drug arrests in the United States: Evidence from the national survey on drug use and health, 2015-2019

OBJECTIVE

Following changes to drug criminalization policies, we re-examine the epidemiology of drug arrests among people who use drugs (PWUD) in the U.S.

METHODS

Serial cross-sectional data from the National Survey on Drug Use and Health (2015-2019) were utilized. Past-year illicit drug use (excluding cannabis) and drug arrests were described by year, area of residence, drug use characteristics and participant demographics. Adjusted associations between race and drug arrest were estimated using multivariable logistic regression.

RESULTS

Past-year illicit drug use remained consistent over time and was highest among non-Hispanic (NH) white respondents. Of those reporting past-year illicit drug use (n = 25,429), prevalence of drug arrests remained stable over time overall and in metro areas while increasing in non-metro areas. Arrests were elevated among NH Black participants and those with lower income, unemployment, housing transience, non-metro area residence, polysubstance use, history of drug injection, substance use dependence and past-year drug selling. Adjusted odds of drug arrest remained significantly higher among NH Black individuals [aOR 1.92, 95% CI 1.30, 2.84].

CONCLUSION

Despite recent shifts away from punitive drug policies, we detected no reduction in drug arrests nationally and increasing prevalence in non-metro areas. Despite reporting the lowest level of illicit substance use and drug selling, NH Black individuals had significantly increased odds of arrest across years. Findings highlight the need for further examination of policy implementation and policing practices in different settings, with more research focused non-metro areas, to address enduring structural racism in drug enforcement and its consequences for health.

Police Violence Exposure and Traumatic Stress Among Youth: A Systematic Review

Youth exposure to violence increases the risk of poor mental and physical health outcomes lasting into adulthood. Traumatic stress is an outcome of particular concern as the physiological stress response impacts the developing brain. Recently, youth exposure to police violence has been conceptualized as an adverse childhood experience that may impact traumatic stress. To examine this possibility, we conducted a systematic review, drawing upon five databases to gather the existing quantitative and qualitative peer-reviewed research on exposure to police violence and traumatic stress in youth. Searches yielded 27 relevant articles utilizing various study designs: thirteen quantitative, thirteen qualitative, and one mixed method. Twenty-six of the 27 studies found evidence of a relationship between police violence exposure and traumatic stress in youth. Police violence was associated with youth traumatic stress across three types of exposures: direct, vicarious, and anticipated. Studies also explored differential impacts by race and gender. The review revealed current gaps in the literature, such as a lack of data on select sociodemographic groups (e.g., rural youth, LGBTQ+ youth) and potential protective factors (e.g., resilience and school connectedness). In line with the findings, we put forth a research agenda as well as policy and practice recommendations to improve police interactions with youth and mental health services for youth who have been exposed to police violence. Recommendations include improving systematic data collection to track all types of police violence exposure, creating spaces for positive police interactions with youth, and training mental health practitioners to support youth exposed to police violence.

Community experiences with police and implications for public health: A focus group study

Interactions with the police can impact an individual's short and long-term physical, mental, and social wellbeing, as well as levels of violence and unrest within a community. As such, this study aimed to explore experiences with the police among individuals experiencing socioeconomic disadvantages in Edmonton, Canada. For this qualitative study, participants (n = 39) were recruited from an emergency shelter for women, a drop-in community organization supporting individuals experiencing socioeconomic disadvantages, and a centre providing settlement support for newcomers to Canada. During the recruitment process, the research information sheet, including the scope and goals of the study, was presented, and participants who had any experience with the police were recruited. Each participant joined one of seven focus groups, during which experiences with the police were discussed; data from the focus groups were analyzed utilizing thematic analysis. Factors that contributed to satisfactory experiences with the police included the police demonstrating responsiveness and compassion, as well as an individual's understanding of police work. Factors that contributed to unsatisfactory experiences included the experiences of discrimination, stigmatization, and disrespect during interactions with the police. Participants suggested that community-police relationships could be improved by police being less judgemental and suspicious in their approach, undergoing regular training in sociocultural sensitivity, and being more open in their communication and community outreach. Overall, adopting a less discriminatory and more empathetic approach within a police force is essential for creating and maintaining a positive community-police relationship. By considering the socioeconomic context of people's behaviours and actions, police can better support the health and wellbeing of individuals and communities.

Distress about social problems and tobacco and cannabis use outcomes among young adults in Los Angeles County

OBJECTIVE

To examine associations of concern, worry, and stress about discrimination, shootings/violence, and police brutality and exclusive and dual tobacco and cannabis use among young adults.

METHODS

A prospective, racially/ethnically diverse cohort of young adults (n = 1960) living in Los Angeles, California completed a baseline survey in 2020 (age range: 19-23) and a follow-up survey in 2021. Exploratory factor analysis (EFA) was employed on nine variables assessing levels of concern, worry, and stress about societal discrimination, societal shootings/violence, and community police brutality at baseline. Past 30-day tobacco and cannabis use at follow-up was categorized as current exclusive tobacco, exclusive cannabis, and dual tobacco and cannabis (vs never/former) use based on eleven use variables. Multinomial logistic regressions estimated adjusted associations between each factor score (translated to standard deviation units) with exclusive and dual tobacco and cannabis use.

RESULTS

The EFA produced four factor scores representing concern/worry/stress (i.e., distress) about community police brutality (F1), distress about societal shootings/violence (F2), and distress about societal discrimination (F3), as well as generalized stress about police brutality, shootings/violence, and discrimination (F4). F1, F2, and F3 were associated with subsequent exclusive current cannabis use, with F1 having the strongest association (OR: 1.35, 95% CI: 1.18-1.55), while only F1 (OR: 1.51, 95% CI: 1.27-1.78) was associated with dual tobacco and cannabis use. None of the factors were associated with exclusive tobacco use.

CONCLUSIONS

Young adult concern, worry, and/or stress about social problems may increase risk of cannabis use with or without concurrent tobacco use 6-12 months later.

Organized abandonment under racial capitalism: Measuring accountable actors of structural racism for public health research and action

Understanding the shifting nature of structural racism historically and across institutions is vital for effective action towards racial health equity. While public health research on structural racism is rapidly increasing, most studies are missing the interdependence of policies and institutional practices over time that shape power imbalances and lead to entrenched health inequities. Here, we discuss Ruth Wilson Gilmore's concept of organized abandonment - the intentional disinvestment in communities which, in turn, creates opportunities for extraction, revenue generation, and carceral enforcement to fill the cracks of a compromised social infrastructure - to encourage action-oriented public health research that is grounded in history and an understanding of racial capitalism. We present a case example using publicly-available data on redlining, gentrification and policing in Seattle, Washington. We mapped the intersections of redlining and gentrification and estimated their neighborhood-level association with police activity using Bayesian spatial Poisson regression models. We found that histories of racist housing policies like redlining and processes of gentrification are interdependent and shape contemporary neighborhood racial and economic segregation and police activity. Compared to structurally advantaged neighborhoods, police stops were higher in neighborhoods that were 1) historically disinvested (i.e. redlined) and remain low-income and structurally disadvantaged and 2) formerly industrial and business districts that were not redlined and are now gentrified. Notably, we found that policing practices were significantly more intensive in neighborhoods that were both high redlined and gentrified. Together, these findings illustrate how the place-based racialized processes of dispossession, displacement and policing are deeply intertwined to maintain racial capitalism. Our findings also highlight the importance of examining multiple racialized processes simultaneously to fill critical gaps in the existing literature that are necessary for sustainable solutions to address structural racism.

Structural Racism, Mass Incarceration, and Racial and Ethnic Disparities in Severe Maternal Morbidity

Importance

Racial and ethnic inequities in the criminal-legal system are an important manifestation of structural racism. However, how these inequities may influence the risk of severe maternal morbidity (SMM) and its persistent racial and ethnic disparities remains underinvestigated.

Objective

To examine the association between county-level inequity in jail incarceration rates comparing Black and White individuals and SMM risk in California.

Design, Setting, and Participants

This population-based cross-sectional study used state-wide data from California on all live hospital births at 20 weeks of gestation or later from January 1, 1997, to December 31, 2018. Data were obtained from hospital discharge and vital statistics records, which were linked with publicly available county-level data. Data analysis was performed from January 2022 to February 2023.

Exposure

Jail incarceration inequity was determined from the ratio of jail incarceration rates of Black individuals to those of White individuals and was categorized as tertile 1 (low), tertile 2 (moderate), tertile 3 (high), with mean cutoffs across all years of 0 to 2.99, 3.00 to 5.22, and greater than 5.22, respectively.

Main Outcome and Measures

This study used race- and ethnicity-stratified mixed-effects logistic regression models with birthing people nested within counties and adjusted for individual- and county-level characteristics to estimate the odds of non-blood transfusion SMM (NT SMM) and SMM including blood transfusion-only cases (SMM; as defined by the Centers for Disease Control and Prevention SMM index) associated with tertiles of incarceration inequity.

Results

This study included 10 200 692 births (0.4% American Indian or Alaska Native, 13.4% Asian or Pacific Islander, 5.8% Black, 50.8% Hispanic or Latinx, 29.6% White, and 0.1% multiracial or other [individuals who self-identified with ≥2 racial groups and those who self-identified as "other" race or ethnicity]). In fully adjusted models, residing in counties with high jail incarceration inequity (tertile 3) was associated with higher odds of SMM for Black (odds ratio [OR], 1.14; 95% CI, 1.01-1.29 for NT SMM; OR, 1.20, 95% CI, 1.01-1.42 for SMM), Hispanic or Latinx (OR, 1.24; 95% CI, 1.14-1.34 for NT SMM; OR, 1.20; 95% CI, 1.14-1.27 for SMM), and White (OR, 1.02; 95% CI, 0.93-1.12 for NT SMM; OR, 1.09; 95% CI, 1.02-1.17 for SMM) birthing people, compared with residing in counties with low inequity (tertile 1).

Conclusions and Relevance

The findings of this study highlight the adverse maternal health consequences of structural racism manifesting via the criminal-legal system and underscore the need for community-based alternatives to inequitable punitive practices.

Racial Disparities in Drug Arrest Before and After De Facto Decriminalization in Baltimore

INTRODUCTION

To mitigate the harms of arrest and incarceration on health and racial equity, jurisdictions are increasingly enacting reforms to decriminalize drug possession through prosecutorial discretion (de facto). Impacts on health outcomes rely on whether this policy can reduce exposure to the carceral system among people who use drugs; however, data evaluating effects on arrest are lacking. This study explores the possible impacts of Baltimore City's enactment of de facto decriminalization on arrests by race.

METHODS

Police and court records were used to explore the possible impacts of Baltimore City's de facto decriminalization on street arrests and (processed) arrests advancing through the courts among people who use drugs. Interrupted time series models were used to compare pre-policy (January 2018-March 2020) trends with post-policy (April 2020-December 2021) trends in arrests for possession of drugs/paraphernalia and estimate racial disparities in street arrests (Black versus other races). Analyses were performed in February-May 2022.

RESULTS

The policy was associated with a significant and immediate decline in street and processed arrests for possession, which was not seen for other crime categories. Although declines were concentrated in the Black community, disparities in arresting persisted after the policy.

CONCLUSIONS

De facto decriminalization may be a promising strategy to reduce exposure to the carceral system, an established risk factor for overdose and other drug-related sequelae and a driver of racial disparities in the U.S. Further research is needed to elucidate the drivers of persisting racial disparities and disentangle policy effects from pandemic-related closures.

Racial Slurs by Police and Posttraumatic Stress Symptoms: Intrusive Policing and Perceived Injustice

Using the Future of Families and Child Wellbeing Study (N = 785), this article considers the ramifications of police use of racial slurs, a type of intrusive behavior, toward minority youth for posttraumatic stress (PTS). We also examine whether other intrusive police behaviors exacerbate this relationship and test whether perceptions of injustice mediate it. Results indicated that hearing a police officer use a racial slur was positively associated with PTS after controlling for intrusive police behaviors and other covariates. Intrusive policing tended to co-occur with the use of racial slurs and was positively associated with PTS. The association between hearing a racial slur and PTS did not vary by the number of intrusive behaviors exhibited by police. The association between hearing a slur and PTS was partially mediated by perceived procedural injustice. Overall, the use of racial slurs by police may do harm to minority adolescents by putting them at risk for posttraumatic stress disorder. Our results are consistent with prior research that racial slurs may contribute to PTS by eroding the bounds of what is considered just and fair. Interestingly, the association between racial slurs and PTS was independent of other intrusive policing behaviors. Mental health screeners should ask not only about being stopped by police but the characteristics of that encounter as well - including those imbued with racial animus.

Lethal use of force surveillance: practical considerations for open-source database linkage

Currently, there remains no reliable and timely government tracking in the USA of deaths caused by law enforcement. Federal efforts to track these events are insufficient, generally missing as many as half of community deaths that occur annually because of law enforcement's lethal use of force. The dearth of accurate data on these events limits the ability to accurately quantify their burden and effectively identify opportunities for intervention and policy change. The most reliable data sources on law enforcement related deaths among community members in the USA are publicly run (such as those run by the Washington Post and The Guardian newspapers) or crowdsourced systems, such as Fatal Encounters and Mapping Police Violence, which draw on both traditional and non-traditional sources of reporting and provide open-source access to users. We used successive deterministic and probabilistic linkage to merge these four databases. After exclusions, we found a total of 6333 deaths identified from 2013 to 2017. While most cases were identified by multiple databases, each database also found unique cases during their years of operation. The methodology described here emphasises the importance of these non-traditional data sources and can serve as a helpful resource to improve data accessibility and timeliness for public health agencies and others seeking to expand their study, understanding and response to this growing public health crisis.

Race, criminalization and urban mental health in the United States

PURPOSE OF REVIEW

As efforts to increase policing and roll back criminal legal system reforms in major U.S. cities rise, the collateral consequences of increased criminalization remain critical to document. Although the criminalization of mental illness has been well studied in the U.S., the mental health effects of criminalization are comparatively under-researched. In addition, despite extreme racial disparities in U.S. policing, there is limited understanding of how criminalization may contribute to racial disparities in mental health.

RECENT FINDINGS

Literature included in this review covers various types of criminalization, including direct and indirect impacts of incarceration, criminalization of immigration, first-hand and witnessed encounters with police, and the effects of widely publicized police brutality incidents. All forms of criminalization were shown to negatively impact mental health (depression, anxiety and suicidality), with evidence suggestive of disproportionate impact on Black people.

SUMMARY

There is evidence of significant negative impact of criminalization on mental health; however, more robust research is needed to address the limitations of the current literature. These limitations include few analyses stratified by race, a lack of focus on nonincarceration forms of criminalization, few longitudinal studies limiting causal inference, highly selected samples limiting generalizability and few studies with validated mental health measures.

Racial resentment and support for decriminalization of drug possession in the United States

Drug criminalization creates significant barriers to prevention and treatment of substance use disorders and racial equity objectives, and removal of criminal penalties for drug possession is increasingly being endorsed by health and justice advocates. We present empirical data estimating the share of U.S. adults who support eliminating criminal penalties for possession of all illicit drugs, and examine factors associated with public support. Data from the Johns Hopkins COVID-19 Civic Life and Public Health Survey, a probability-based nationally representative sample of 1222 U.S. adults, was collected from November 11-30, 2020. Support for decriminalizing drug possession was assessed overall and by sociodemographic factors and attitudes towards politics and race. Correlates of support were examined using multivariable logistic regression. Thirty-five percent of adults supported eliminating criminal penalties for drug possession in the U.S. In adjusted regression models, respondents who were younger or identified as politically liberal were more likely to support decriminalization relative to other groups, and respondents who were Hispanic or identified strongly with their religious beliefs were less likely to support decriminalization. Among white respondents, greater racial resentment was strongly associated with reduced support for drug decriminalization. Support for drug decriminalization varies considerably by beliefs about politics and race, with racial resentment among white Americans potentially comprising a barrier to drug policy reform. Findings can inform communication and advocacy efforts to promote drug policy reform in the United States.

Violence and the Carceral State: A Public Health Continuum

This Viewpoint reports the disproportionate rate of firearm-related deaths in US Black communities; emphasizes the urgency of addressing this issue; and details the causes of these deaths in the context of community, law enforcement, and in custody.

Change in distress about police brutality and substance use among young people, 2017-2020

BACKGROUND

It is unknown whether increasing attention to police brutality is a source of stress associated with substance use risk among young people.

METHODS

A longitudinal racially/ethnically diverse cohort from Los Angeles, California (n = 1797) completed baseline (2017; mean age: 17.9) and follow-up (2020; mean age: 21.2) surveys assessing level of concern, worry, and stress about police brutality (range: 0 'not at all' - 4 'extremely') and past 30-day nicotine, cannabis, alcohol, other drug, and number of substances used (0-19). Regression models, adjusted for demographic characteristics and baseline substance use, evaluated whether changes in distress about police brutality from 2017 to 2020 were associated with substance use in 2020 overall and stratified by race/ethnicity.

RESULTS

Distress about police brutality increased between 2017 (mean: 1.59) and 2020 (mean: 2.43) overall. Black/African American and Hispanic/Latino respondents consistently had the highest mean distress levels at both timepoints. In the full sample, each one-unit greater increase in distress about police brutality from 2017 to 2020 was associated with 11% higher odds of cannabis use, 13% higher odds of alcohol use, and 8% higher risk of using an additional substance for the number of substances used outcome. Race/ethnicity-stratified models indicated that greater increases in distress from 2017 to 2020 was associated with substance use among Black/African American, Hispanic, and multiracial respondents in 2020, but not Asian American/Pacific Islander and White respondents.

CONCLUSIONS

Distress about police brutality may be associated with substance use, particularly among certain racial/ethnic minority young people. Further investigation of whether police brutality affects health in disparity populations is needed.

Psychophysiological and affective reactivity to vicarious police violence

Little is known about how vicarious police violence, or instances of police violence observed but not directly experienced, impacts health among Black individuals. Using a lab-based paradigm in a sample of young adults (N = 101), this study examined: (a) psychophysiological reactivity to instances of vicarious police violence, particularly the assault and shooting of Black individuals; (b) affective reactivity to instances of vicarious police violence; and (c) how racial identity, one important moderator, influences psychophysiological and affective responses to vicarious police violence. Using electrocardiography and impedance cardiography, participants' cardiac sympathetic and parasympathetic physiological responses were continuously monitored. Three sets of high-quality color photographs (neutral, non-violent distress, violence) were viewed on a computer. Participants rated their affect after each set using the Positive and Negative Affect Schedule (PANAS). Following this task, racial identity was assessed using the Multidimensional Inventory of Black Identity-Short Form. Findings indicated that vicarious police violence was associated with greater sympathetic reactivity and negative affect relative to the neutral and non-violent distress conditions. Additionally, higher levels of racial centrality exacerbated the association between vicarious police violence and negative affect. Findings suggest that Black individuals may wish to limit their consumption of media depicting the assault and shooting of other Black individuals, with the caveat that the best solution is ultimately the cessation of police violence.

Neighborhood Police Encounters, Health, And Violence In A Southern City

The disproportionate rates of police surveillance and encounters in many communities in the US may be contributing to inequities in health and violence. Frequent policing in communities, which may often also be aggressive policing, has been associated with diminished health and well-being. This study adds to the growing body of research on this issue by examining the relationships between neighborhood police stop-and-frisk encounters and both health outcomes and violence rates in New Orleans, Louisiana, in an ecological, cross-sectional study using local police report, Centers for Disease Control and Prevention, and census data. The average rate of police stop-and-frisk encounters was more than three times higher for Black adults compared with their White counterparts. Even after we accounted for concentrated disadvantage (a high percentage of residents of lower socioeconomic status) and residential racial and income segregation, neighborhoods with higher rates of encounters had significantly higher prevalence rates of smoking, physical inactivity, and poor physical health, and they experienced significantly more violent crime (18.35 more per 1,000) and domestic violence (49.91 more per 1,000) events than neighborhoods with lower levels of police encounters. There is a need for strengthened policy focused on the relationship between frequent policing and health and violence outcomes.

Development and validation of police mental health ability scale

OBJECTIVES

Police officers are generally under long-term occupational stress. Good mental health ability enables them to better deal with emergencies and enhance their combat effectiveness. We aimed to develop the Police Mental Health Ability Scale (PMHAS) to provide a reference for police selection and ability training.

METHODS

Through literature analysis, individual interviews, half-open and half-closed questionnaire surveys, and expert consultations, the components of police mental health ability (PMHA) were theoretically constructed. Then, we enrolled 824 in-service police officers who participated in the training in Chongqing City and Sichuan Province from November 2018 to January 2019 and recovered 767 valid questionnaires (recovery rate, 93.08%).

RESULTS

Exploratory factor analysis generated five factors for PMHAS, including cognitive intelligence, emotional catharsis, swift decisiveness, behavioral drive, and reward pursuit, accounting for 58.904% of the variance. Confirmatory factor analysis demonstrated that the model fit well (χ2/df = 1.117, RMSEA = 0.020, GFI = 0.948, CFI = 0.990, IFI = 0.990, TLI = 0.987). The correlation coefficients of factors (r = -0.023 ~ 0.580) were lower than that of each factor and total score (r = 0.477 ~ 0.819). The Cronbach's α coefficients of PMHAS and its factors were 0.606-0.863, and the test-retest reliabilities were 0.602-0.732.

CONCLUSION

These results suggest that PMHAS is reliable and valid enough for measuring PMHA, which shows that it is a potentially valuable tool for assessing the mental health ability of police officers.