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Eneanya ND, Boulware LE, Tsai J, Bruce MA, Ford CL, Harris C, Morales LS, Ryan MJ, Reese PP, Thorpe RJ, Morse M, Walker V, Arogundade FA, Lopes AA, Norris KC. Health inequities and the inappropriate use of race in nephrology. Nat Rev Nephrol 2022; 18:84-94. [PMID: 34750551 PMCID: PMC8574929 DOI: 10.1038/s41581-021-00501-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/13/2022]
Abstract
Chronic kidney disease is an important clinical condition beset with racial and ethnic disparities that are associated with social inequities. Many medical schools and health centres across the USA have raised concerns about the use of race - a socio-political construct that mediates the effect of structural racism - as a fixed, measurable biological variable in the assessment of kidney disease. We discuss the role of race and racism in medicine and outline many of the concerns that have been raised by the medical and social justice communities regarding the use of race in estimated glomerular filtration rate equations, including its relationship with structural racism and racial inequities. Although race can be used to identify populations who experience racism and subsequent differential treatment, ignoring the biological and social heterogeneity within any racial group and inferring innate individual-level attributes is methodologically flawed. Therefore, although more accurate measures for estimating kidney function are under investigation, we support the use of biomarkers for determining estimated glomerular filtration rate without adjustments for race. Clinicians have a duty to recognize and elucidate the nuances of racism and its effects on health and disease. Otherwise, we risk perpetuating historical racist concepts in medicine that exacerbate health inequities and impact marginalized patient populations.
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Affiliation(s)
- Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer Tsai
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Marino A Bruce
- Program for Research on Faith, Justice, and Health, Department of Behavioral and Social Sciences, University of Houston College of Medicine, Houston, TX, USA
| | - Chandra L Ford
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Christina Harris
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Leo S Morales
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Michael J Ryan
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Roland J Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michelle Morse
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Valencia Walker
- Department of Paediatrics, Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Antonio A Lopes
- Clinical Epidemiology and Evidence-Based Medicine Unit of the Edgard Santos University Hospital and Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil
| | - Keith C Norris
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Callaghan RC, Vander Heiden J, Sanches M, Asbridge M, Hathaway A, Kish SJ. Impacts of Canada's cannabis legalization on police-reported crime among youth: early evidence. Addiction 2021; 116:3454-3462. [PMID: 34085338 DOI: 10.1111/add.15535] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/26/2020] [Accepted: 04/21/2021] [Indexed: 12/01/2022]
Abstract
AIMS Canada's 2018 Cannabis Act allows youth (age 12-17 years) to possess up to 5 g of dried cannabis (or equivalent) for personal consumption/sharing. This study assessed whether the Cannabis Act was associated with changes in police-reported cannabis offences among youth in Canada. DESIGN Time series model using national daily criminal incident data from January 1, 2015-December 31, 2018 from the Canadian Uniform Crime Reporting Survey (UCR-2). Seasonal autoregressive integrated moving average time series models, stratified by sex, assessed the relations between legalization and youth cannabis-related offences. SETTING Canada, 2015-2018. CASES Police-reported cannabis-related offenses among youth age 12-17 years (male, n = 32 178; female, n = 9001). MEASUREMENTS Outcomes: police-reported cannabis-related crimes, property crimes, and violent crimes. Covariate: calendar-month. FINDINGS For females, legalization was associated with a step-effect decrease of 4.56 (95% confidence interval [CI] = 3.32, 5.81; P < 0.001) police-reported cannabis-related criminal offences per day, an effect equivalent to a 64.6% (standard error [SE] = 33.5%) reduction. For males, legalization was associated with a drop of 12.73 (95% CI = 8.82, 16.64; P < 0.001) cannabis-related offences per day, equaling a decrease of 57.7% (SE = 22.6%). Results were inconclusive as to whether there were associations between cannabis legalization and patterns of property crimes or violent crimes. CONCLUSIONS Implementation of the Cannabis Act in Canada in 2018 appears to have been associated with decreases of 55%-65% in cannabis-related crimes among male and female youth.
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Affiliation(s)
- Russell C Callaghan
- Northern Medical Program, University of Northern British Columbia, Prince George, Canada.,Human Brain Laboratory, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, Canada
| | - Julia Vander Heiden
- Northern Medical Program, University of Northern British Columbia, Prince George, Canada.,Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, Canada
| | - Marcos Sanches
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Andrew Hathaway
- College of Social and Applied Human Sciences, University of Guelph, Guelph, Canada
| | - Stephen J Kish
- Human Brain Laboratory, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
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Abstract
Police violence in the United States represents a pressing public health crisis impacting youth, particularly youth of color. This article reviews the recent epidemiology of police executions and conflicts involving children, adolescents, and young adults. The roles of social determinants of health and centuries-long history of white supremacy and racism as root causes of adverse policing are emphasized. The article summarizes the evidence as to how direct and vicarious experiences of police violence impact youth academic, behavioral, and health outcomes. Recommendations are provided for pediatricians to address this public health crisis through clinical practice, education, advocacy, and research.
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Affiliation(s)
- Tiffani J Johnson
- Department of Emergency Medicine, University of California, Davis School of Medicine, 4150 V Street Suite 2100, Sacramento, CA 95817, USA.
| | - Joseph L Wright
- Pediatrics and Health Policy & Management, University of Maryland Schools of Medicine and Public Health, University of Maryland Capital Region Health, 3001 Hospital Drive, Executive Suite, Cheverly, MD 20785, USA
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Marijuana and Psychosis: Policy Implications for Treatment Providers. J Am Acad Child Adolesc Psychiatry 2018; 57:613-614. [PMID: 30071983 DOI: 10.1016/j.jaac.2018.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/02/2018] [Accepted: 06/11/2018] [Indexed: 01/03/2023]
Abstract
In 2017, the annual prevalence of marijuana use rose to 24% among 8th to 12th graders, despite decreases in rates of other illicit substance use.1 This is of concern, as increasing use is coupled with declining perception of harm among adolescents,1 increasing potency of cannabis,2 ease of adolescents' access to marijuana,1 and progressive medicalization and legalization of marijuana. Exposure to high levels of Δ-9-tetrahydrocannabinol through cannabis use triggers repeated activation of the endogenous mesolimbic dopaminergic system, desensitization, and progressive enhancement of acquired susceptibility to psychosis.3.
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Lamb RJ, Ginsburg BC. Addiction as a BAD, a Behavioral Allocation Disorder. Pharmacol Biochem Behav 2017; 164:62-70. [PMID: 28476485 DOI: 10.1016/j.pbb.2017.05.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/19/2017] [Accepted: 05/01/2017] [Indexed: 12/16/2022]
Abstract
Addiction is continued drug use despite its harm. As one always has alternatives, addiction can be construed as a decision to allocate behavior to drug use. While decision making is commonly discussed and studied as if it resulted from deliberative, evaluative processes, such processes are actually only rarely involved in behavior allocation. These deliberative processes are too slow, effortful and inefficient to guide behavior other than when necessary. Rather, most actions are guided by faster, more automatic processes, often labeled habits. Habits are mostly adaptive, and result from repeated reinforcement leading to over-learned behavior. Habitual behavior occurs rapidly in response to particular contexts, and the behavior occurring first is that which occurs, i.e., the behavior that is decided upon. Thus, as drug use becomes habitual, drug use is likely to be chosen over other available activities in that particular context. However, while drug use becoming habitual is necessary for addiction to develop, it is not sufficient. Typically, constraints limit even habitual drug use to safer levels. These constraints might include limiting occasions for use; and, almost always, constraints on amount consumed. However, in a minority of individuals, drug use is not sufficiently constrained and addiction develops. This review discusses the nature of these constraints, and how they might fail. These failures do not result from abnormal learning processes, but rather unfortunate interactions between a person and their environment over time. These accumulate in the maladaptive allocation of behavior to drug use. This Behavior Allocation Disorder (BAD) can be reversed; occasionally easily when the environment significantly changes, but more often by the arduous application of deliberative processes generally absent from decision making. These deliberative processes must continue until new more adaptive habits become the most probable behavior in the contexts encountered. As alternatives to drug use become the most probable behavior, relapse risk diminishes.
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Affiliation(s)
- R J Lamb
- Departments of Psychiatry and Pharmacology, University of Texas Health Science Center at San Antonio, United States.
| | - Brett C Ginsburg
- Departments of Psychiatry and Pharmacology, University of Texas Health Science Center at San Antonio, United States
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Tillson M, Strickland JC, Staton M. Age of First Arrest, Sex, and Drug Use as Correlates of Adult Risk Behaviors Among Rural Women in Jails. WOMEN & CRIMINAL JUSTICE 2017; 27:287-301. [PMID: 29033495 PMCID: PMC5640161 DOI: 10.1080/08974454.2017.1291392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Incarcerated women frequently report initiation of substance use and sexual encounters at an early age, and often engage in high-risk drug use and sexual behaviors as adults. This study examined the timing of first sex, drug use, and arrest, as well as their unique influences on specific risky behaviors in adulthood, among a high-risk population of rural women recruited from jails. Ages of initiation were all positively and significantly correlated, and each independently increased the likelihood of several risky behaviors in adulthood. Implications are discussed for screening, intervention, and treatment targeting high-risk women and girls in rural areas, particularly within criminal justice settings.
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Affiliation(s)
- Martha Tillson
- Center on Drug and Alcohol Research and College of Social Work, University of Kentucky, Lexington, Kentucky, USA
| | - Justin C Strickland
- Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Michele Staton
- Center on Drug and Alcohol Research and Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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