Highlights • We review multiple youth participatory approaches relevant for the promotion of health equity. • We identify commonalities and distinctions on processes including power and level of impact. • We review evidence for impact and consider illustrative cases for addressing health inequities. • We identify research directions for advancing youth participation and health equity.
Criminalizing young people, particularly Black- and Brown-identified young people, has increasingly been a feature of US rhetoric, policies, and practices. Thus, the domains in which young people are exposed to the legal system have continued to expand, encompassing their communities, schools, and homes. Importantly, public health researchers have begun exploring links between legal system exposure and health, although this literature is primarily focused at the interpersonal level and assesses associations within a single domain or in adulthood. Using critical race theory and ecosocial theory of disease distribution, we identified potential policy-level determinants of criminalization and briefly summarized the literature on downstream health outcomes among young people. Our analysis suggests that policy decisions may facilitate the targeting of structurally marginalized young people across domains. Future research should (1) position these legislative decisions as primary exposures of interest to understand their association with health among young people and inform institutional-level intervention, (2) measure the totality of exposure to the criminal legal system across domains, and (3) use theory to examine the complex ways racism operates institutionally to shape inequitable distributions of associated health outcomes.
Background: Evidence suggests education is an important lifecourse determinant of health, but few studies examine differential returns to education by sociodemographic subgroup. Methods: Using National Longitudinal Survey of Youth 1979 (N=6,158) cohort data, we evaluate education attained by age 25 and mental (MCS) and physical (PCS) health component summary scores at age 50. Race/ethnicity, sex, geography, immigration status, and childhood socioeconomic status (cSES) were evaluated as effect modifiers in birth-year adjusted linear regression models. Results: The association between education and PCS was large among high cSES respondents (β=0.81 per year of education, 95%CI: 0.67,0.94), and larger among low cSES respondents (interaction β=0.39, 95%CI: 0.06,0.72). The association between education and MCS was imprecisely estimated among White men (β =0.44; 95%CI: −0.03,0.90), while, Black women benefited more from each year of education (interaction β =0.91; 95%CI: 0.19,1.64). Similarly, compared to socially advantaged groups, low cSES Blacks, and low and high cSES women benefited more from each year of education, while immigrants benefited less from each year of education. Conclusions: If causal, increases in educational attainment may reduce some social inequities in health.
Background People incarcerated in US prisons have been disproportionately harmed by the COVID-19 pandemic. That prisons are such efficient superspreading environments can be attributed to several known factors: small, communal facilities where people are confined for prolonged periods of time; poor ventilation; a lack of non-punitive areas for quarantine/medical isolation; and staggeringly high numbers of people experiencing incarceration, among others. While health organizations have issued guidance on preventing and mitigating COVID-19 infection in carceral settings, little is known about if, when, and how recommendations have been implemented. We examined factors contributing to containment of one of the first California prison COVID-19 outbreaks and remaining vulnerabilities using an adapted multi-level determinants framework to systematically assess infectious disease risk in carceral settings. Methods Case study employing administrative data; observation; and informal discussions with: people incarcerated at the prison, staff, and county public health officials. Results Outbreak mitigation efforts were characterized by pre-planning (e.g., designation of ventilated, single-occupancy quarantine) and a quickly mobilized inter-institutional response that facilitated systematic, voluntary rapid testing. However, several systemic- and institutional-level vulnerabilities were unaddressed hindering efforts and posing significant risk for future outbreaks, including insufficient decarceration, continued inter-facility transfers, incomplete staff cohorting, and incompatibility between built environment features (e.g., dense living conditions) and public health recommendations. Conclusions Our adapted framework facilitates systematically assessing prison-based infectious disease outbreaks and multi-level interventions. We find implementing some recommended public health strategies may have contributed to outbreak containment. However, even with a rapidly mobilized, inter-institutional response, failure to decarcerate created an overreliance on chance conditions. This left the facility vulnerable to future catastrophic outbreaks and may render standard public health strategies - including the introduction of effective vaccines - insufficient to prevent or contain those outbreaks.
Background: Exposure to fatal police violence may play a role in population-level inequities in risk for preterm delivery.Objective: To evaluate whether exposure to fatal police violence during pregnancy affects the hazard of preterm delivery and whether associations differ by race/ethnicity and fetal sex. Methods:We leveraged temporal variation in incidents of fatal police violence within census tracts to assess whether occurrence of fatal police violence in a person's tract during pregnancy was associated with increased hazard of extremely (20-27 weeks), early (28-31 weeks), moderate (32-33 weeks), and late (32-36 weeks) preterm delivery in California from 2007 to 2015. We used both death records and the Fatal Encounters database to identify incidents of fatal police violence. We estimated hazard ratios (HR) using time-varying Cox proportional hazard models stratified by census tract, controlling for age, race/ethnicity, educational attainment, health insurance type, parity, and the year and season of conception. We further stratified by race/ ethnicity and infant sex to evaluate whether there were differential effects by these characteristics.
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