Racial disparities in health conditions among prisoners compared with the general population

Opioid use, prescribing and fatal overdose patterns among racial/ethnic minorities in the United States: A scoping review and conceptual risk environment model

ISSUES

To date, there has been no synthesis of research addressing the scale and nuances of the opioid epidemic in racial/ethnic minority populations in the United States that considers the independent and joint impacts of dynamics such as structural disadvantage, provider bias, health literacy, cultural norms and various other risk factors.

APPROACH

Using the "risk environment" framework, we conducted a scoping review on PubMed, Embase and Google Scholar of peer-reviewed literature and governmental reports published between January 2000 and February 2024 on the nature and scale of opioid use, opioid prescribing patterns, and fatal overdoses among racial/ethnic minorities in the United States, while also examining macro, meso and individual-level risk factors.

KEY FINDINGS

Results from this review illuminate a growing, but fragmented, literature lacking standardisation in racial/ethnic classification and case reporting, specifically in regards to Indigenous and Asian subpopulations. This literature broadly illustrates racial/ethnic minorities' increasing nonmedical use of opioids, heightened burdens of fatal overdoses, specifically in relation to polydrug use and synthetic opioids, with notable elevations among Black/Latino subgroups, in addition uneven opioid prescribing patterns. Moreover, the literature implicates a variety of unique risk environments corresponding to dynamics such as residential segregation, provider bias, overpolicing, acculturative stress, patient distrust, and limited access to mental health care services and drug treatment resources, including medications for opioid use disorder.

IMPLICATIONS

There has been a lack of rigorous, targeted study on racial/ethnic minorities who use opioids, but evidence highlights burgeoning increases in usage, especially polydrug/synthetic opioid use, and disparities in prescriptions and fatal overdose risk-phenomena tied to multi-level forms of entrenched disenfranchisement.

CONCLUSION

There is a need for further research on the complex, overlapping risk environments of racial/ethnic minorities who use opioids, including deeper inclusion of Indigenous and Asian individuals, and efforts to generate greater methodological synergies in population classification and reporting guidelines.

Access to Healthcare Among Young Adult Probationers Participating in a Pilot Health-Focused Reentry Program

Justice-involved adults experience disparities in healthcare access. This pilot study examines healthcare access among young adult probationers (n = 66) receiving 6-months of Service Navigation and Health Coaching support implemented between 2017 and 2021. Data are from baseline, 6-month follow-up and satisfaction surveys. Between baseline and follow-up, the proportion of insured young adult participants (66%-88%; p < .001) and those using healthcare services (36%-71%; p < .001) increased significantly; report of unmet physical healthcare needs decreased significantly (44%-26%; p = .003). Satisfaction data revealed increased self-efficacy, motivation, focus, and improved organizational, goal setting, and communication skills. The program improved healthcare access by increasing health insurance and recent use of healthcare services. Longitudinal studies are needed to assess maintenance of these outcomes and potential impacts on disparities in health status and access to care indicators. Integrating navigation and coaching supports to advance the well-being of justice-involved young adults is a promising mechanism to facilitate healthcare access.

Does the immigrant health advantage extend to incarcerated immigrants?

•Existing immigrant health research does not include institutionalized populations.•The immigrant health advantage does not extend to all incarcerated immigrant groups.•Differences in health exist by race/ethnicity, U.S. citizenship, and health outcome.•The incarcerated immigrant population has unique health profiles and needs.

Promoting anti-racism in the legal system: an application of the STYLE framework

Racism is a critical social problem, and we present a framework to guide professionals in engaging in anti-racist practices. Professionals on the frontlines in psychology and related fields such as social work and public health have a responsibility to engage in anti-racist practices. Part of the professional role must be to advocate for justice through increased proximity to the issues and engagement in anti-oppressive practices. The current discourse introduces a framework through which people working in psychology and other related professions can promote anti-racism work, highlighting the legal system for illustrative purposes. While some professionals in psychology may not have direct experience with the legal system, many of the individuals served by psychologists do (e.g., clients/patients, students, community members). Our framework is represented by the acronym STYLE (Self-examination, Talk about racism, Yield time to anti-racism work, Learn about structural racism, Evaluate policies and practices). The goal of STYLE is to expand anti-racism science and practice within psychology and related fields. We describe new roles for professionals in dismantling health inequities and offer specific pathways to develop critical partnerships toward this aim. STYLE explicitly encourages active, intentional involvement of affected community members in the development and evaluation of approaches to health services. To achieve equity and to promote individual and organizational growth in anti-racism and ultimately anti-oppression work, professionals must focus on changing their STYLE.

COVID-19 Vaccine Refusal and Medical Distrust Held by Correctional Officers

This study explores COVID-19 vaccine acceptance among prison security staff and the extent to which they trust varied sources of information about the vaccines. Cross-sectional survey data were obtained from a state-wide sample of corrections officers (COs, hereafter; n = 1208) in February 2021. Group differences, disaggregated by demographic characteristics, were examined using F-tests and t-tests. Despite the comparatively limited risk of contracting the virus, non-security staff reported they would accept a COVID-19 vaccine at no cost (74%), compared to their more vulnerable CO counterparts (49%). We observed vaccine refusal correlations between COs' reported gender, age, and length of time working as a CO, but none with their self-reported race. Vaccine refusal was more prevalent among womxn officers, younger officers, and those who had spent less time working as prison security staff. Our findings also suggest that the only trusted source of information about vaccines were family members and only for officers who would refuse the vaccine; the quality of trust placed in those sources, however, was not substantially positive and did not vary greatly across CO racial groups. By highlighting characteristics of the observed gaps in COVID-19 vaccine acceptance between COs and their non-security staff coworkers, as well as between corrections officers of varied demographic backgrounds, these findings can inform the development of responsive and accepted occupational health policies for communities both inside and intrinsically linked to prisons.

Collaborative Healthcare in Incarcerated Settings

A total of 2,162,400 adults were incarcerated in the United States in 2016. Sub-optimal health status, existing healthcare disparities, and fragmented healthcare delivery among incarcerated populations are concerning and warrant redress. This article highlights the need for and discusses the benefits of collaboration between healthcare professionals in incarcerated settings. The roles of primary care health professionals, pharmacists, and medical family therapists (MedFTs) in correctional facilities are outlined. Through integrated healthcare models, enhanced communication, improved continuity of care, and holistic treatment plans, existing gaps in healthcare delivery in correctional facilities can be filled. By working together and assuming nontraditional roles, medical professionals can help improve health outcomes of incarcerated individuals. Collaborative healthcare models in incarcerated settings can elevate public health in a cost-effective, yet positive manner.

Conditions of Confinement in U.S. Carceral Facilities During COVID-19: Individuals Speak-Incarcerated During the COVID-19 Epidemic

Objectives

We aimed to describe conditions of confinement among people incarcerated in the United States during the coronavirus disease 2019 (COVID-19) pandemic using a community-science data collection approach.

Methods

We developed a web-based survey with community partners to collect information on confinement conditions (COVID-19 safety, basic needs, support). Formerly incarcerated adults released after March 1, 2020, or nonincarcerated adults in communication with an incarcerated person (proxy) were recruited through social media from July 25, 2020 to March 27, 2021. Descriptive statistics were estimated in aggregate and separately by proxy or formerly incarcerated status. Responses between proxy and formerly incarcerated respondents were compared using Chi-square or Fisher's exact tests based on α=0.05.

Results

Of 378 responses, 94% were by proxy, and 76% reflected state prison conditions. Participants reported inability to physically distance (≥6 ft at all times; 92%), inadequate access to soap (89%), water (46%), toilet paper (49%), and showers (68%) for incarcerated people. Among those receiving prepandemic mental health care, 75% reported reduced care for incarcerated people. Responses were consistent between formerly incarcerated and proxy respondents, although responses by formerly incarcerated people were limited.

Conclusions

Our findings suggest that a web-based community-science data collection approach through nonincarcerated community members is feasible; however, recruitment of recently released individuals may require additional resources. Our data obtained primarily through individuals in communication with an incarcerated person suggest COVID-19 safety and basic needs were not sufficiently addressed within some carceral settings in 2020-2021. The perspectives of incarcerated individuals should be leveraged in assessing crisis-response strategies.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

Digital Health Experiences of Incarcerated Populations Using Telemedicine in North Carolina Prisons

More than 1.2 million adults are incarcerated in the United States and hence, require health care from prison systems. The current delivery of care to incarcerated individualss is expensive, logistically challenging, risk fragmenting care, and pose security risks. The purpose of this study was to evaluate the association of patient characteristics and experiences with the perceived telemedicine experiences of incarcerated individuals during the pandemic. We conducted a cross-sectional study of incarcerated individuals in 55 North Carolina prison facilities seeking medical specialty care via telemedicine. Data collection took place from June 1, 2020 to November 30, 2020. Of the 482 patient surveys completed, 424 (88%) were male, 257 (53.3%) were over 50 years of age, and 225 (46.7%) were Black or African American and 195 (40.5%) were White, and 289 (60%) no prior telemedicine experience. There were 3 strong predictors of how patients rated their telemedicine experience: personal comfort with telemedicine (P-value < .001), wait time (P-value < .001), and the clarity of the treatment explanation by the provider (P-value < .001). There was a relationship between telemedicine experiences and how patient rated their experience. Also, patients who were less satisfied with using telemedicine indicated their preference for an in-clinic visit for their next appointment.

Hepatitis C Virus Is Associated With Increased Mortality Among Incarcerated Hospitalized Persons in Massachusetts

Hepatitis C virus (HCV) is curable, but incarcerated populations face barriers to treatment. In a cohort of incarcerated hospitalized patients in Boston, Massachusetts, HCV infection was associated with increased mortality. Access to HCV treatment in carceral settings is crucial to avoid unnecessary death and to support HCV elimination efforts.

Health profiles and racial disparities among individuals on probation in Hennepin County, Minnesota, 2016: a cross-sectional study

OBJECTIVES

To estimate the health characteristics and racial/ethnic health disparities among a probation cohort in Hennepin County. We hypothesised the probation population would have higher health needs compared with the general population as well as significant racial/ethnic health disparities.

DESIGN

Cross-sectional study using linked administrative records.

PARTICIPANTS

Of 7992 eligible individuals, 5873 met inclusion criteria of 6 or more months of eligibility for a full-benefit Minnesota healthcare plan.

SETTING

Probation system in Hennepin County in 2016.

OUTCOMES

We compared health condition prevalence among our probation cohort with survey data from the general population and analysed by race/ethnicity. We also measured sociodemographic characteristics, including the use of safety-net services.

RESULTS

Individuals were predominantly male (80.5%), young (mean age: 35.5 years), and disproportionately black or African American (52.9%). A majority of individuals enrolled in Medicaid were eligible via Medicaid expansion (65.9%). Compared with the general population, individuals on probation had higher rates of substance use disorders (66.5% vs 8.1%), mental illness (55.3% vs 14.4%) and many physical conditions (eg, asthma: 17.0% vs 12.5%, chronic kidney disease: 5.8% vs 0.2%). White individuals on probation were significantly more likely than black or African American individuals to have a diagnosed substance use disorder (71.6% vs 62.0%) or mental health disorder (64.9% vs 48.5%), but fewer chronic physical health conditions (average: 0.52 vs 0.73 chronic physical conditions).

CONCLUSIONS

Individuals on probation have high health needs, which vary substantially by race/ethnicity. Without attention to this variation, interventions to address health conditions in this population could worsen racial/ethnic disparities.

Estimating the influence of adolescent delinquent behavior on adult health using sibling fixed effects

Despite the well-established link between juvenile delinquency and socioeconomic attainment in adulthood, less is known about whether engagement in delinquent behavior during adolescence shapes adult health outcomes. This study examines the association between juvenile delinquency and adult physical and mental health, and whether this association is confounded by unobserved family heterogeneity. Moreover, this study explores the potential underlying mechanisms through which juvenile delinquency shapes adult physical and mental health. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) 1994-1995 (Wave 1) and 2007-2008 (Wave 4), we adopted a sibling fixed effect approach to account for genetic factors, family environment, and childhood social contexts such as school and neighborhood effects. The conventional OLS results show that engagement in delinquent behavior during adolescence strongly predicts higher levels of Framingham cardiovascular disease (CVD) risk score and depressive symptoms in adulthood. Once we account for family-specific heterogeneity, however, the point estimates of the associations of delinquency with CVD risk score and depressive symptoms are attenuated by 33% and 45%, respectively. Despite this attenuation, the association of juvenile delinquency with adult health is robust: a one standard-deviation increase in juvenile delinquency is associated with approximately 8 and 6 percent of one standard-deviation increases in CVD risk and depressive symptoms, respectively. Our mediation analyses suggest that a combination of several mediating pathways jointly explain the association between juvenile delinquency with adult health. The most consistent and significant mediating pathways connecting juvenile delinquency to both physical and mental health included disruption in student-teacher relationship, smoking, criminal justice contact, and educational attainment. Moreover, while binge drinking explained part of the association between delinquency and CVD risk score, student-friend relationship partially mediated the association with depression.

Health Implications of Incarceration and Reentry on Returning Citizens: A Qualitative Examination of Black Men's Experiences in a Northeastern City

While a great deal of research captures the lived experiences of Black men as they navigate through the criminal legal system and onto reentry, very little research is grounded in how those processes are directly connected to their health. Although some research argues that mass incarceration is a determinant of poor health, there is a lack of qualitative analyses from the perspective of Black men. Black men face distinct pathways that lead them into the criminal legal system, and these same pathways await them upon reentry. This study aims to examine the health implications associated with incarceration and reentry of Black men. While adopting a phenomenological approach alongside interviews, our findings show both race- and gender-specific outcomes for the men in our sample. For example, health and wellness appears to be a significant theme that governs their (in)ability to matriculate society. Moreover, their contact with the criminal legal system appears to exacerbate health concerns and hindrances toward reentry. Other themes include mental health and the role of masculinity. We conclude with implications on policy and future research.

Incarceration as a Reason for US Alcohol and Drug Treatment Non-completion: a Multilevel Analysis of Racial/Ethnic and Sex Disparities

Incarceration may be an overlooked reason for treatment non-completion experienced disproportionately by African Americans. This study utilized multilevel logistic regression to model treatment non-completion due to incarceration using the 2015-2016 Treatment Episode Dataset-Discharges. Among a sample restricted to treatment non-completers (n = 306,008), 5% terminated treatment because they became incarcerated (n = 13,082), which varied widely by demographics and by state. In Idaho, 46% of African Americans terminated treatment because they became incarcerated. Women had lower odds of treatment non-completion than men, and the effect of sex was strongest among African Americans (adjusted odds ratio [aOR] = 0.30, 95% confidence interval [95% CI] = 0.26-0.34). Among men, all racial/ethnic minority groups demonstrated significantly higher odds of treatment non-completion due to incarceration compared with Whites, and the strongest effect was among African Americans (aOR = 1.37, 95% CI = 1.29-1.44). Incarceration as a reason for treatment non-completion disproportionately affects African Americans and men and varies by state. Interventions targeting incarceration alternatives should be availed to racial/ethnic minorities already participating in treatment.

Prevalence of Diabetes and Associated Risk Factors among a Group of Prisoners in the Yaoundé Central Prison

BACKGROUND

Diabetes is a public health problem worldwide, associated with increased morbidity and mortality. According to the International Diabetes Federation (IDF) 2017 data, around 425 million people worldwide suffer from diabetes. This number is expected to increase to 629 million in 2045. Various occidental studies reported the increased prevalence and lower control of diabetes among prisoners. However, there is no data on the characteristics of inmates with diabetes in sub-Saharan Africa.

METHODS

A cross-sectional study among incarcerated detainees from the Yaoundé Central Prison was conducted from January to July 2017. Diabetes was defined according to the American Diabetes Association (ADA) criteria. Analyzed variables included phenotypic characteristics, lifestyle, the reason for detention, the sentence severity, and the length of detention.

RESULTS

We recruited 437 inmates (344 men) with an average age of 37.0 (95% CI: 35.9-38.3) years. The most frequent age group was 20 to 39 years with 281 (64.7%) inmates, and the mean prison stay was 29.1 (95% CI: 25.7-32.8) months. The prevalence of diabetes in the Yaoundé Central Prison was 9.4%. The main cardiovascular risk factors were a sedentary lifestyle (91.1%), hypertension (39.6%), smoking (31.6%), and alcohol consumption (28.1%). Hypertension (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (.

CONCLUSION

Diabetes prevalence in the Yaoundé Central Prison was high, at 9.4%, compared to that in the general population. It was associated with other classical cardiovascular risk factors and factors linked to the sentence (minor and major crimes). This trial is registered with CE00617/CRERSHC/2016.

Cardiovascular risk factors in people deprived of their liberty: an integrative review

ABSTRACT Objective: To investigate the scientific evidence on the most frequent risk factors for cardiovascular disease in persons deprived of their liberty. Methods: An integrative literature review carried out in the CINAHL, Medline/Pubmed, Scopus, LILACS, CUIDEN, Web of Science and Virtual Health Library portal databases using the following keywords: cardiovascular diseases, risk factors, prisons, prisoners. Results: The final sample consisted of 17 primary articles published in English and Spanish. Overweight and obesity were the most cited cardiovascular risk factors besides diabetes, hypertension, smoking, dyslipidemia, consumption of alcohol and other drugs, physical inactivity, metabolic syndrome, anxiety, depression and unhealthy heart diet. Conclusions: The most frequent risk factors for cardiovascular disease in persons deprived of their liberty were those classified as modifiable. In the prison setting, these factors are enhanced due to an environment with little modification of these opportunities.

Criminal Justice Contact and Health Service Utilization among Women across Health Care Settings: Analyzing the Role of Arrest

BACKGROUND

It is well-established in the United States that incarceration negatively influences women's health, and researchers have called for examinations of the health effects of criminal justice contact more broadly. This study uses the behavioral model for vulnerable populations to document the prevalence of illness and health risks for recently arrested women, and examines potential ways that illness and health risks are associated with health service use across health care settings.

METHODS

We conducted a mediation analysis using pooled data from the National Survey on Drug Use and Health (2010-2014).

RESULTS

These findings reveal that recent arrest is associated with different types of health care use among women. Specifically, women recently arrested are hospitalized and seek care at the emergency department at higher rates than non-recently arrested women and this may be associated with their vulnerable mental and behavioral health status.

CONCLUSIONS

The findings suggest an increasing overlap between criminal justice and public health sectors. Increased access to appropriate health services is a necessary strategy to reduce resource intensive hospitalizations and emergency department use among women experiencing a recent arrest.

Education and Health Conditions among the Currently Incarcerated and the Non-Incarcerated Populations

Previous research has found a strong link between educational attainment and health, where the highly educated live longer and healthier lives than those with lower levels of education. Because such research has relied on samples of the non-institutionalized population, previous research has not explored the association between education and specific chronic and infectious health conditions among the currently incarcerated. Analyzing the relationship between education and health conditions among the incarcerated, whom tend to be less healthy and for whom many of the intermediate mechanisms between education and health are held relatively constant in prison, may yield new insights. Using the 2002-2004 National Health Interview Study (N=74,881), the 2004 Survey of Inmates in State and Federal Correctional Facilities (N=17,553), and interaction terms from logistic regression models, I compared the strength of the association between educational attainment and the presence of chronic and infectious health conditions among the incarcerated and non-incarcerated populations. These models indicated generally stronger negative associations between educational attainment and chronic conditions among the non-incarcerated, while the negative relationship between education and hepatitis was stronger for the incarcerated. These results suggest that while education may play a lesser role for chronic conditions for the incarcerated, it can still important for avoiding risky health behaviors.

Pharmacy Practice in the South Dakota Correctional System: Discovery of an Unconventional Experiential Practice Site

Pharmacists must be prepared to care for populations where health disparities are greatest and their services can best impact public health needs. Such preparation requires that students have access to practice experiences in underserved environments where pharmacy practice, cultural competence and knowledge of population health are experienced simultaneously. The correctional facility is such a place. The American Society of Health-System Pharmacists recommends that students receive preceptorship opportunities within the correctional system. The occasional collaboration or experiential opportunity, like Kingston's early model, has occurred between health professional schools and correctional facilities. However, to date, the correctional facility-experiential site remains an untapped opportunity, at least in a complete, coordinated, pharmaceutical care, patient management framework. Consequently, a short research study asked: To what extent is there potential for correctional facilities to serve as experiential practice sites for pharmacy students? The research objective was to identify pharmaceutical practices within South Dakota correctional system and compare those practices to the guidelines established by the Association of American College of Pharmacy's as optimal for student training. To understand medical and pharmaceutical practices in SDPS, three South Dakota Adult prison facilities were included in the exploratory study. Data was collected through a mixed methods approach designed to obtain perspectives about the SDPS health care system from individuals representing the numerous job levels and roles that exist within the health care continuum. Interviews and a web-based surveys were used to collect data. A review of a 36-page transcript along with 498 freeform survey comments revealed that while exact themes from the Exemplary Practice Framework may not have been evident, related words or synonyms for patient-centered care, informatics, public health, medication therapy management, and quality improvement appeared with great frequency.

Biological Risk and Infection Profiles of Young Adult Male Mexican American Gang Members

OBJECTIVES

Little research has examined the long-term health consequences of gang affiliation among Mexican Americans. The objectives of this study were to (1) measure biological indicators of cardiovascular and metabolic risk, as well as prevalence of sexually transmitted infections (STIs), in a sample of Mexican American men aged 25-40 who were affiliated with gangs as adolescents and (2) compare those indicators with a comparable national sample of Latino men.

METHODS

Using bivariate analyses, we compared blood pressure, body mass index, 4 metabolic and cardiovascular indicators, and 4 infections for 179 Mexican American formerly gang-affiliated men in San Antonio, Texas, and 155 Mexican American men from the National Health and Nutrition Examination Survey. We used multivariate models to estimate adjusted risk scores for each sample controlling for age, marital status, and education.

RESULTS

Compared with men in the national sample, the unadjusted results showed that men in the gang-affiliated sample had significantly higher mean systolic blood pressure (125.6 vs 120.0  mm Hg, P = .001), diastolic blood pressure (81.4 vs 71.1 mm Hg, P < .001), and C-reactive protein (5.9 vs 3.6 mg/L, P = .04), and a significantly lower mean total cholesterol (164.2 vs 205.5 mg/dL, P < .001) and low-density lipoprotein cholesterol (91.1 vs 120.1 mg/dL, P < .001). Compared with men in the national sample, more men in the gang-affiliated sample had herpes simplex virus type 2 (64/174 [36.8%] vs 18/147 [12.2%], P < .001), chlamydia (10/176 [5.7%] vs 1/135 [0.7%], P = .02), and hepatitis C virus (85/173 [49.1%] vs 0, P < .001). The gang-affiliated sample had a significantly higher adjusted risk score than the national sample (1.5 vs 1.1, P = .003).

CONCLUSIONS

Gang-affiliated Mexican American men had significant disparities in biological risk indicators and STIs, which can lead to long-term health implications and highlight the need for tailored prevention strategies. Long-term exposure to psychosocial stressors and subsequent systemic inflammation may also increase the risk for physiological and psychological dysregulation and detrimental chronic health conditions in this population.

The global burden of kidney disease and the sustainable development goals

Kidney disease has been described as the most neglected chronic disease. Reliable estimates of the global burden of kidney disease require more population-based studies, but specific risks occur across the socioeconomic spectrum from poverty to affluence, from malnutrition to obesity, in agrarian to post-industrial settings, and along the life course from newborns to older people. A range of communicable and noncommunicable diseases result in renal complications and many people who have kidney disease lack access to care. The causes, consequences and costs of kidney diseases have implications for public health policy in all countries. The risks of kidney disease are also influenced by ethnicity, gender, location and lifestyle.  Increasing economic and health disparities, migration, demographic transition, unsafe working conditions and environmental threats, natural disasters and pollution may thwart attempts to reduce the morbidity and mortality from kidney disease. A multisectoral approach is needed to tackle the global burden of kidney disease. The sustainable development goals (SDGs) emphasize the importance of a multisectoral approach to health. We map the actions towards achieving all of the SDGs that have the potential to improve understanding, measurement, prevention and treatment of kidney disease in all age groups. These actions can also foster treatment innovations and reduce the burden of such disease in future generations.

Mass Incarceration and Racial Inequality

Despite two decades of declining crime rates, the United States continues to incarcerate a historically and comparatively large segment of the population. Moreover, incarceration and other forms of criminal justice contact ranging from police stops to community supervision are disproportionately concentrated among African American and Latino men. Mass incarceration, and other ways in which the criminal justice system infiltrates the lives of families, has critical implications for inequality. Differential rates of incarceration damage the social and emotional development of children whose parents are in custody or under community supervision. The removal through incarceration of a large segment of earners reinforces existing income and wealth disparities. Patterns of incarceration and felony convictions have devastating effects on the level of voting, political engagement, and overall trust in the legal system within communities. Incarceration also has damaging effects on the health of families and communities. In short, the costs of mass incarceration are not simply collateral consequences for individuals but are borne collectively, most notably by African Americans living in acutely disadvantaged communities that experience high levels of policing and surveillance. In this article, we review racial and ethnic differences in exposure to the criminal justice system and its collective consequences.