Do Police Encounters Increase the Risk for Cardiovascular Disease? Police Encounters and Framingham 30-Year Cardiovascular Risk Score.

INTRODUCTION: Despite increased attention to the societal consequences of aggressive policing, the focus on rarer instances of deaths/severe injuries fails to fully capture the day-to-day experiences that racially minoritized groups face during police encounters (PEs). We explored differential vulnerability by race/ethnicity in the relationship between PEs and cardiovascular disease (CVD) risk. METHODS: Using data from the National Longitudinal Study of Adolescent to Adult Health, we regressed the Framingham 30-Year CVD risk score on a high number of lifetime PEs (6 + among men and 2 + among women). To explore differential vulnerability by race, we added an interaction between PEs and race/ethnicity. We also examined sex- and race and sex-stratified models. RESULTS: We observed no association between PEs and CVD risk in the sample overall, but the interaction between PEs and race/ethnicity was statistically significant. In race stratified models, we found that higher PEs were associated with a lower CVD risk among Black respondents, whereas among White respondents there was no relationship. In the sex-stratified analysis, reporting higher PEs was associated with lower CVD risk among men, while among women there was no relationship. In sex- and race-stratified models, higher PEs was associated with lower CVD risk among Black men and higher CVD risk among White women, while there was no association among Black women and White men. CONCLUSION: The association between PEs and CVD risk depends on race/ethnicity and sex. More work is needed to understand the counterintuitive finding that high PEs are associated with lower CVD risk among Black men.

MICEAL Black and Latinx Perspectives on COVID-19 Vaccination: A Mixed-Methods Examination.

OBJECTIVES: To describe the differences and similarities in perceptions and attitudes regarding COVID-19 vaccination among Black and Latinx Michiganders. METHODS: Utilizing a convergent mixed-methods approach, forty interviews were conducted with 24 Black and 16 Latinx community members between December 2020 and June 2021 across four Michigan counties disproportionately affected by COVID-19. Survey data were collected from a representative sample of 1598 individuals living in Detroit between January and March 2021. RESULTS: Vaccine hesitancy was a more prevalent theme among Black interview participants than Latinx participants. Trust in experts and vaccine access were significantly more influential in the decision to vaccinate for Latinx residents compared to Black residents. Latinx individuals reported greater intention to receive a COVID-19 vaccine compared to Black respondents. Multinomial logit models revealed that 30% of Black participants expressed hesitancy about the COVID-19 vaccine compared to 10% of Latinx respondents. CONCLUSIONS AND IMPLICATIONS: This study provides a deeper understanding of key differences and similarities in vaccine acceptance/hesitancy across race/ethnicity. The findings can enhance health interventions and outcomes by informing the development of culturally responsive practices tailored to specific communities.

Resident Willingness to Participate in Digital Contact Tracing in a COVID-19 Hotspot: Findings From a Detroit Panel Study.

BACKGROUND: Digital surveillance tools and health informatics show promise in counteracting diseases but have limited uptake. A notable illustration of the limits of such tools is the general failure of digital contact tracing in the United States in response to COVID-19. OBJECTIVE: We investigated the associations between individual characteristics and the willingness to use app-based contact tracing in Detroit, a majority-minority city that experienced multiple waves of COVID-19 outbreaks and deaths since the start of the pandemic. The aim of this study was to examine variations among residents in the willingness to download a contact tracing app on their phones to provide public health officials with information about close COVID-19 contact during summer 2020. METHODS: To examine residents' willingness to participate in digital contact tracing, we analyzed data from 2 waves of the Detroit Metro Area Communities Study, a population-based survey of Detroit, Michigan residents. The data captured 1873 responses from 991 Detroit residents collected in June and July 2020. We estimated a series of multilevel logit models to gain insights into differences in the willingness to participate in digital contact tracing across a variety of individual attributes, including race/ethnicity, degree of trust in the government, and level of education, as well as interactions among these variables. RESULTS: Our results reflected widespread reluctance to participate in digital contact tracing in response to COVID-19, as less than half (826/1873, 44.1%) of the respondents said they would be willing to participate in app-based contact tracing. Compared to White respondents, Black (odds ratio [OR] 0.45, 95% CI 0.23-0.86) and Latino (OR 0.32, 95% CI 0.11-0.99) respondents were significantly less willing to participate in digital contact tracing. Trust in the government was positively associated with the willingness to participate in digital contact tracing (OR 1.17, 95% CI 1.07-1.27), but this effect was the strongest for White residents (OR 2.14, 95% CI 1.55-2.93). We found similarly divergent patterns of the effects of education by race. While there were no significant differences among noncollege-educated residents, White college-educated residents showed greater willingness to use app-based contact tracing (OR 6.12, 95% CI 1.86-20.15) and Black college-educated residents showed less willingness (OR 0.46, 95% CI 0.26-0.81). CONCLUSIONS: Trust in the government and education contribute to Detroit residents' wariness of digital contact tracing, reflecting concerns about surveillance that cut across race but likely arise from different sources. These findings point to the importance of a culturally informed understanding of health hesitancy for future efforts hoping to leverage digital contact tracing. Though contact tracing technologies have the potential to advance public health, unequal uptake may exacerbate disparate impacts of health crises.

Effect of vaccine effectiveness and safety on COVID-19 vaccine acceptance in Detroit, Michigan, July 2020.

This study examined whether future COVID-19 vaccine acceptance differed based on an experimental manipulation of the vaccine safety and effectiveness profile. Data come from the Detroit Metro Area Community Study, a population-based study conducted July 15-20, 2020. Participants were asked whether they would get a new COVID-19 vaccine after being randomly assigned information about the vaccine's effectiveness (50% or 95%) and chance of fever (5% or 20%). Among 1,117 Detroiters, 51.3% would accept a COVID-19 vaccine that is 50% effective and 77.1% would accept a vaccine that is 95% effective. Women and adults ≥65 were more accepting of a vaccine; Black Detroiters were less accepting. Believing vaccines to be important, effective, and safe was associated with higher acceptance. Uptake of a COVID-19 may be limited, depending on perceived vaccine effectiveness and general attitudes toward vaccines. Public health approaches to modifying these attitudes will be especially important in the Black community.

Mediators of Racial Differences in COVID-19 Vaccine Acceptance and Uptake: A Cohort Study in Detroit, MI.

Despite their disparate rates of infection and mortality, many communities of color report high levels of vaccine hesitancy. This paper describes racial differences in COVID-19 vaccine uptake in Detroit, and assesses, using a mediation model, how individuals' personal experiences with COVID-19 and trust in authorities mediate racial disparities in vaccination acceptance. The Detroit Metro Area Communities Study (DMACS) is a panel survey of a representative sample of Detroit residents. There were 1012 respondents in the October 2020 wave, of which 856 (83%) were followed up in June 2021. We model the impact of race and ethnicity on vaccination uptake using multivariable logistic regression, and report mediation through direct experiences with COVID as well as trust in government and in healthcare providers. Within Detroit, only 58% of Non-Hispanic (NH) Black residents were vaccinated, compared to 82% of Non-Hispanic white Detroiters, 50% of Hispanic Detroiters, and 52% of other racial/ethnic groups. Trust in healthcare providers and experiences with friends and family dying from COVID-19 varied significantly by race/ethnicity. The mediation analysis reveals that 23% of the differences in vaccine uptake by race could be eliminated if NH Black Detroiters were to have levels of trust in healthcare providers similar to those among NH white Detroiters. Our analyses suggest that efforts to improve relationships among healthcare providers and NH Black communities in Detroit are critical to overcoming local COVID-19 vaccine hesitancy. Increased study of and intervention in these communities is critical to building trust and managing widespread health crises.

The association of criminal justice supervision setting with overdose mortality: a longitudinal cohort study.

BACKGROUND AND AIMS: Despite the high prevalence of substance use among people in the US criminal justice system, little is known about the incidence of overdose mortality by use patterns, drug convictions and supervision setting. We examined the associations between these characteristics and overdose mortality. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Individuals sentenced to prison, jail, probation or jail plus probation for a felony conviction in Michigan, USA from 2003 to 2006. MEASUREMENTS: Using the National Death Index, we assessed overdose mortality to December 2012. We calculated overdose mortality rates by pre-sentence opioid use, drug convictions and supervision setting. Multivariable analyses were conducted using competing risks regression with time-varying covariates. FINDINGS: Among 140 266 individuals followed over a mean of 7.84 years [standard deviation (SD) = 1.52], 14.9% of the 1131 deaths were due to overdose (102.8 per 100 000 person-years). Over the follow-up, more than half of overdose deaths occurred in the community (57.7%), nearly a third (28.8%) on probation and 12.8% on parole. The adjusted risk of overdose death was lower on probation [hazard ratio (HR) = 0.71, 95% confidence interval (CI) = 0.60, 0.85] than in the community without probation or parole (HR = 1.00) but not significantly different on parole (HR = 1.13, 95% CI = 0.87, 1.47). Pre-sentence daily opioid use (HR = 3.54, 95% CI = 3.24, 3.87) was associated with an increased risk. Drug possession (HR = 1.11, 95% CI = 0.93, 1.31) and delivery convictions (HR = 0.92, 95% CI = 0.77, 1.09) were not significantly associated with overdose mortality. CONCLUSIONS: Based on the absolute or relative risk, parole, probation and community settings are appropriate settings for enhanced overdose prevention interventions. Ensuring that individuals with pre-sentence opioid use have access to harm reduction and drug treatment services may help to prevent overdose among people involved with the criminal justice system.

Author Correction: A natural experiment study of the effects of imprisonment on violence in the community.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

A natural experiment study of the effects of imprisonment on violence in the community.

One of the goals of imprisonment is to reduce violence1. Although imprisonment has risen dramatically since the 1970s, its effects on future violent crime are poorly understood2. This study's objective was to examine the effect of imprisonment on violent crime in the community among individuals on the policy margin between prison and probation sentences. Drawing on data from a population-based cohort of individuals convicted of a felony in Michigan between 2003 and 2006 (n = 111,110) and followed through June 2015, we compared the rates of commission of violent crime committed by individuals sentenced to prison with those of individuals sentenced to probation using a natural experiment based on the random assignment of judges to criminal cases. Being sentenced to prison had no significant effects on arrests or convictions for violent crimes after release from prison, but imprisonment modestly reduced the probability of violence if comparisons included the effects of incapacitation during imprisonment. These results suggest that for individuals on the current policy margin between prison and probation, imprisonment is an ineffective long-term intervention for violence prevention, as it has, on balance, no rehabilitative or deterrent effects after release.

Short- and long-term effects of imprisonment on future felony convictions and prison admissions.

A substantial contributor to prison admissions is the return of individuals recently released from prison, which has come to be known as prison's "revolving door." However, it is unclear whether being sentenced to prison itself has a causal effect on the probability of a subsequent return to prison or on criminal behavior. To examine the causal effect of being sentenced to prison on subsequent offending and reimprisonment, we leverage a natural experiment using the random assignment of judges with different propensities for sentencing offenders to prison. Drawing on data on all individuals sentenced for a felony in Michigan between 2003 and 2006, we compare individuals sentenced to prison to those sentenced to probation, taking into account sentence lengths and stratifying our analysis by race. Results show that being sentenced to prison rather than probation increases the probability of imprisonment in the first 3 years after release from prison by 18 percentage points among nonwhites and 19 percentage points among whites. Further results show that such effects are driven primarily by imprisonment for technical violations of community supervision rather than new felony convictions. This suggests that more stringent postprison parole supervision (relative to probation supervision) increases imprisonment through the detection and punishment of low-level offending or violation behavior. Such behavior would not otherwise result in imprisonment for someone who had not already been to prison or who was not on parole. These results demonstrate that the revolving door of prison is in part an effect of the nature of postprison supervision.

Trajectories of neighborhood attainment after prison.

A potentially important but understudied aspect of prisoner reentry is the neighborhood environments experienced by formerly incarcerated people. We know that many formerly incarcerated people return to very disadvantaged neighborhood environments and that returning to disadvantaged neighborhoods after prison increases the risk of recidivism and reduces employment. Yet very little is known about the social, economic, and institutional processes that sort formerly incarcerated people into different neighborhoods after release or their trajectories of neighborhood attainment over time. Motivated by a conceptualization of prisoner reentry and reintegration as a process that unfolds over time, we examine trajectories of neighborhood environments after release. Motivated by the literature on neighborhood attainment, social capital, and the role of criminal justice institutions in structuring the lives of former prisoners, we examine sources of variation in neighborhood attainment. We use administrative data from the Michigan Department of Corrections on formerly incarcerated people paroled in 2003 and followed for two years after release. Descriptive results from a latent class trajectory model show that most white and black formerly incarcerated people experience flat trajectories, with little upward or downward residential mobility over time. Findings from multi-level growth curve models suggest that institutional factors are particularly important for the neighborhood attainment of whites, while human capital and social ties are particularly important for blacks. Among both blacks and whites, pre-prison and first post-prison neighborhood conditions exhibit a strong association with post-prison neighborhood attainment, although these associations are larger for blacks than whites.

Narrative change, narrative stability, and structural constraint: The case of prisoner reentry narratives.

Cultural sociologists and other social scientists have increasingly used the concept of narrative as a theoretical tool to understand how individuals make sense of the links between their past, present, and future, how individuals construct social identities from cultural building blocks, and how culture shapes social action and individual behavior. Despite its richness, we contend that the narratives literature has yet to grapple with narrative change and stability when structural constraints or barriers challenge personal narratives and narrative identities. Particularly for marginalized groups, the potential incompatibility of personal narratives with daily experiences raises questions about the capacity of narratives to influence behavior and decision-making. In this study we draw on prospective longitudinal data on the reentry narratives and narrative identities of former prisoners to understand how narratives do and not change when confronted with contradictory experiences and structural constraints. We identify and describe the processes generating narrative change and stability among our subjects. These findings inform a framework for studying narrative change and stability based on four factors: the content of the narrative itself, the structural circumstances experienced by the individual, the institutional contexts in which the individual is embedded, and the social networks in which the individual is embedded.

Custodial Parole Sanctions and Earnings after Release from Prison.

Although the labor market consequences of incarceration in prison have been central to the literature on mass incarceration, punishment, and inequality, other components of the growing criminal justice system have received less attention from sociologists. In particular, the rise of mass incarceration was accompanied by an even larger increase in community supervision. In this paper, we examine the labor market effects of one frequently experienced aspect of post-prison parole, short-term custody for parole violations. Although such sanctions are viewed as an alternative to returning parole violators to prison, they have the potential to affect labor market outcomes in ways similar to imprisonment, including both adverse and positive effects on earnings. We estimate that parolees lost approximately 37 percent of their earnings in quarters during which they were in short-term custody. Although their earnings tended to increase in the quarter immediately following short-term custody-consistent with the stated intentions of such sanctions-parolees experienced further earnings loss over the longer term after such sanctions. In the third quarter following a short-term custody sanction, earnings are lowered by about 13 percent. These associations are larger for those who were employed in the formal labor market before their initial incarceration.

Health Insurance Trends and Access to Behavioral Healthcare Among Justice-Involved Individuals-United States, 2008-2014.

BACKGROUND: A large proportion of justice-involved individuals have mental health issues and substance use disorders (SUD) that are often untreated due to high rates of uninsurance. However, roughly half of justice-involved individuals were estimated to be newly eligible for health insurance through the Affordable Care Act (ACA). OBJECTIVE: We aimed to assess health insurance trends among justice-involved individuals before and after implementation of the ACA's key provisions, the dependent coverage mandate and Medicaid expansion, and to examine the relationship between health insurance and treatment for behavioral health conditions. DESIGN: Repeated and pooled cross-sectional analyses of data from the National Survey on Drug Use and Health (NSDUH). PARTICIPANTS: Nationally representative sample of 15,899 adults age 19-64 years between 2008 and 2014 with a history of justice involvement during the prior 12 months. MAIN MEASURES: Uninsurance rates between 2008 and 2014 are reported. Additional outcomes include adjusted treatment rates for depression, serious mental illness, and SUD by insurance status. KEY RESULTS: The dependent coverage mandate was associated with a 13.0 percentage point decline in uninsurance among justice-involved individuals age 19-25 years (p < 0.001). Following Medicaid expansion, uninsurance declined among justice involved individuals of all ages by 9.7 percentage points (p < 0.001), but remained 16.3 percentage points higher than uninsurance rates for individuals without justice involvement (p < 0.001). In pooled analyses, Medicaid, relative to uninsurance and private insurance, was associated with significantly higher treatment rates for illicit drug abuse/dependence and depression. CONCLUSION: Given the high prevalence of mental illness and substance use disorders among justice-involved populations, persistently elevated rates of uninsurance and other barriers to care remain a significant public health concern. Sustained outreach is required to reduce health insurance disparities between individuals with and without justice involvement. Public insurance appears to be associated with higher treatment rates, relative to uninsurance and private insurance, among justice-involved individuals.

Modeling the community-level effects of male incarceration on the sexual partnerships of men and women.

Men who have been incarcerated experience substantial changes in their sexual behavior after release from jail and prison, and high rates of incarceration may change sexual relationship patterns at a community level. Few studies, however, address how rates of incarceration affect community patterns of sexual behavior, and the implications of those patterns for HIV and STD risk. We describe a "proof of principle" computational model that tests whether rates of male incarceration could, in part, explain observed population-level differences in patterns of sexual behavior between communities with high rates of incarceration and those without. This validated agent-based model of sexual partnership among 20-25 year old heterosexual urban residents in the United States uses an algorithm that incarcerates male agents and then releases them back into the agent community. The results from these model experiments suggest that at rates of incarceration similar to those observed for urban African American men, incarceration can cause an increase in the number of partners at the community level. The results suggest that reducing incarceration and creating a more open criminal justice system that supports the maintenance of inmates' relationships to reduce instability of partnerships for men who are incarcerated may have important sexual health and public health implications. Incarceration is one of many social forces that affect sexual decision-making, and incarceration rates may have substantial effects on community-level HIV and STD risks.

Homelessness and Housing Insecurity Among Former Prisoners.

The United States has experienced dramatic increases in both incarceration rates and the population of insecurely housed or homeless persons since the 1980s. These marginalized populations have strong overlaps, with many people being poor, minority, and from an urban area. That a relationship between homelessness, housing insecurity, and incarceration exists is clear, but the extent and nature of this relationship is not yet adequately understood. We use longitudinal, administrative data on Michigan parolees released in 2003 to examine returning prisoners' experiences with housing insecurity and homelessness. Our analysis finds relatively low rates of outright homelessness among former prisoners, but very high rates of housing insecurity, much of which is linked to features of community supervision, such as intermediate sanctions, returns to prison, and absconding. We identify risk factors for housing insecurity, including mental illness, substance use, prior incarceration, and homelessness, as well as protective "buffers" against insecurity and homelessness, including earnings and social supports.

Romantic Relationships and Criminal Desistance: Pathways and Processes.

In dominant theories of criminal desistance, marital relationship formation is understood to be a key "turning point" away from deviant behavior. Empirical studies supporting this claim have largely focused on the positive role of marriage in men's desistance from crime, and relatively few studies have examined the role that non-marital relationships may play in desistance. Drawing on 138 longitudinal in-depth interviews with 22 men and women reentering society from prison, this paper extends the scope of desistance research by additionally considering the significance of more fleeting and fluid relationships, and the diverse processes through which romantic relationships of all sorts are linked with criminal behaviors. We present an empirically-based typology detailing six processes, grouped within three conceptual categories, through which romantic relationships had their effects. These pathways include material circumstances, social bonds and interactions, and emotional supports and stressors. We also consider gender differences in these processes. While more tenuous bonds to marginally conventional partners would seem to exert little effect, as one of the few relationships and social roles available to many former prisoners, we found that they wielded important influence, if not always in a positive direction.

Incarceration, Prisoner Reentry, and Communities.

Since the mid-1970s the United States has experienced an enormous rise in incarceration and accompanying increases in returning prisoners and in post-release community correctional supervision. Poor urban communities are disproportionately impacted by these phenomena. This review focuses on two complementary questions regarding incarceration, prisoner reentry, and communities:(1) whether and how mass incarceration has affected the social and economic structure of American communities, and (2) how residential neighborhoods affect the social and economic reintegration of returning prisoners. These two questions can be seen as part of a dynamic process involving a pernicious "feedback" loop, in which mass incarceration undermines the structure and social organization of some communities, thus creating more criminogenic environments for returning prisoners and further diminishing their prospects for successful reentry and reintegration.

Modeling the underlying dynamics of the spread of crime.

The spread of crime is a complex, dynamic process that calls for a systems level approach. Here, we build and analyze a series of dynamical systems models of the spread of crime, imprisonment and recidivism, using only abstract transition parameters. To find the general patterns among these parameters--patterns that are independent of the underlying particulars--we compute analytic expressions for the equilibria and for the tipping points between high-crime and low-crime equilibria in these models. We use these expressions to examine, in particular, the effects of longer prison terms and of increased incarceration rates on the prevalence of crime, with a follow-up analysis on the effects of a Three-Strike Policy.