The Carceral State, Social Disorganization, and Firearm Homicides in Chicago.

Importance: Black and other racially minoritized groups are overrepresented among those who experience firearm homicide. There has been a stark increase in incarcerated populations in the US since the 1980s, largely due to differential drug sentencing, of which racially minoritized individuals are also overrepresented; social disorganization theory postulates that community and family instability resulting from incarceration can further worsen crime. Objective: To understand the association of race-specific incarceration with race-specific firearm violence rates in Chicago, Illinois, through the lens of social vulnerability and family instability. Design, Setting, and Participants: This cross-sectional study with a retrospective cohort design utilized homicide data for the city of Chicago from January 1, 2001, to August 31, 2019. Demographic data at the census block level was obtained from the 2010 decennial census. Incarceration rates were obtained by race and ethnicity at the census tract level from the Opportunity Atlas. Data analysis occurred from January to June 2023. Exposure: Race-specific incarceration rates were the primary exposures of interest. The Social Vulnerability Index and single-parent households were studied as mediators. Main Outcomes and Measures: Race-specific firearm homicide rates were the outcomes of interest. Structural equation modeling was used to understand the mediating effect of social vulnerability and single-parent households on the association of incarceration with firearm homicides. Results: A total of 46 312 census blocks were evaluated. Black-specific incarceration rates were found to be associated with Black-specific firearm homicides (incidence rate ratio [IRR], 1.70; 95% CI, 1.50-1.94), but there was no association for Hispanic incarceration rates (IRR, 0.98; 95% CI, 0.75-1.28) or White incarceration rates (IRR, 1.13; 95% CI, 0.39-1.16). In the association of Black incarceration rates with Black firearm homicide rates, social vulnerability did not mediate the interaction, but the percentage of single-parent households mediated 23% of the interaction. Conclusions and Relevance: This study found that higher rates of incarceration were associated with increased rates of firearm homicides among Black communities alone; this association was found to be mediated partially through the density of single-parent households in these areas, suggesting that social disorganization resulting from mass incarceration may perpetuate firearm homicides. Targeted policies addressing mass incarceration and the disparities therein may be a means of reducing urban firearm homicides.

Changes in Economic Hardships Arising During the COVID-19 Pandemic: Differences by Nativity and Race.

Hardships in early childhood impact health. Few longitudinal studies have examined pandemic-related hardships among families with young children by race/ethnicity or nativity. We used prospective longitudinal data from 1,165 caregivers of children < 4 years surveyed in English and Spanish face-to-face in 5 urban hospitals 1/2018 to 3/2020 (pre-pandemic) and again by telephone 9/2020 to 3/2021 (during pandemic). Caregivers reported hardships (household food insecurity [HFI], child food insecurity [CFI]), behind on rent [BOR]) and maternal race/ethnicity and nativity. During the pandemic vs pre-pandemic, families with immigrant mothers had greater increases in HFI [aOR = 2.15 (CI 1.49-3.09)] than families with US-born mothers [aOR = 1.44 (CI 1.09-1.90)] and greater increases in BOR [families with immigrant mothers aOR = 4.09 (CI 2.78-6.01) vs. families with US-born mothers aOR = 2.19 (CI 1.68-2.85)]. CFI increases for all groups did not vary by nativity nor race/ethnicity. HFI and BOR increases during COVID were significantly greater in families with Latina mothers and those with immigrant mothers than other groups.

Deconstructing Racism, Hierarchy, and Power in Medical Education: Guiding Principles on Inclusive Curriculum Design.

In the context of current U.S. racial justice movements, analysis of racism in medicine within medical education is a critical task for all institutions. To educate the next generation of physicians about racism in medicine and out of concern that the curriculum required critical assessment and change, a group of students and faculty at Boston University School of Medicine (BUSM) initiated a longitudinal curricular analysis through a vertical integration group, commissioned by the Medical Education Committee, from May 2019 to June 2020. The curriculum analysis and the major outcomes and guiding principles that emerged from it are described as a path forward, toward a more inclusive curriculum. The major elements of this analysis included a comprehensive internal curricular assessment and an external assessment of peer institutions that led to the development of key curricular recommendations and overarching equity and specific racially focused equity competencies. The curricular recommendations fall into the following domains: (1) challenging the persistence of biological/genetic notions of race, (2) embedding structural practices in medical education to dismantle racism in medicine, and (3) promoting institutional climate change. Initial steps to implement these recommendations are described. The authors believe that the historic and present reality of racism in America and in medicine has impacted medical education specifically, and more broadly, the practice of medicine, trainee experience, and patient outcomes. The key findings of the BUSM analysis are transferable to other medical education institutions, and the described review process can support peer institutions as they engage in the imperative work of institutional reflection and addressing the salient ideas and practices that uphold racism in medicine.

Housing and Neighborhoods as Root Causes of Child Poverty.

Understanding how housing inequities among families with children are rooted in structural racism is important for identifying opportunities to engage in ongoing and collective work as pediatricians to lift children out of poverty. This article discusses the complex mechanisms between housing and child and family health outcomes, and offers potential solutions linking housing, health programs, and policy solutions. Beginning with a review of historical antecedents of housing policy and their impact on health inequities, the authors outlines policies and structures directly linked to disproportionate housing instability and inequities in health outcomes among children. This article examines four key domains of housing - affordability, stability, quality, and neighborhood - and their relationship to child and family health. Finally, the authors present multidimensional solutions for advancing health equity.