Prevalence, demographic variation and psychological correlates of exposure to police victimisation in four US cities

Police Violence Experienced by Black Gay and Bisexual Men: The Effects on HIV Care Engagement and Medication Adherence

Black men face high rates of police violence, including direct victimization and indirect exposure to or knowledge of harmful policing. This violence can result in death and physical harm, as well as in numerous poor mental health outcomes. There has been little research examining experiences of police violence experienced by Black gay and bisexual men or the effects of police brutality on HIV continuum of care outcomes. To address this important gap, in this exploratory study, we examined the effects of police brutality on engagement in HIV care and adherence to antiretroviral medications. Cross-sectional survey data were collected from 107 Black gay and bisexual men living with HIV. The path analysis showed that men with greater exposure to police violence had increased symptoms of post-traumatic stress disorder and were more likely to have missed HIV care appointments in the past year. Additionally, there was a significant indirect effect of exposure to police violence on missed medication doses via PTSD symptoms.

Prevalence and Correlates of Exposure (Direct and Indirect) to Perceived Racism-Based Police Violence among Black Emerging Adult College Students

A growing body of evidence makes plain that exposure to perceived racism-based events, particularly for Black emerging adults aged 18-29, represents a major public health concern in the United States given its widespread prevalence and documented association with adverse health outcomes. However, research on the prevalence and correlates of exposure to perceived racism-based police violence (RPV) for Black emerging adults is scant. The current study examines the prevalence and correlates of RPV exposure among a sample of 300 Black emerging adult college students, utilizing computer-assisted surveys. Univariate, bivariate, and multiple linear regression analyzes were conducted. We found moderately low rates for direct RPV exposure (Mean = 5.85) and moderately high rates (Mean = 10.4) for indirect exposure. Being younger and having incomes greater than $10,000 were significant predictors of direct RPV exposure, whereas being female and older were significant predictors of indirect RPV exposure. Our findings provide implications for future research and underscore the need for social work clinicians to include the RPV scales during their assessments for traumatic experiences.

The Relationship of Anti-Transgender Discrimination, Harassment, and Violence to Binge Drinking among Transgender Adults

Purpose: Using a minority stress paradigm, this paper examines the relationship between anti-transgender discrimination, harassment, and violence among transgender adults. Methods: Data from the 2015 U.S. National Transgender Survey were used to examine twenty types of anti-transgender experiences/problems (e.g., harassment at work, problems with police officials, verbal and physical assaults) in a sample of 27,715 transgender Americans aged 18 or older. Binge drinking during the previous month was the dependent variable, and eight control measures were examined in the multivariate analysis. Results: Experiencing any of the twenty types of anti-transgender discrimination, harassment, or violence increased the odds of binge drinking by 48%. Experiencing many such problems increased the odds of binge drinking by 104%. Multivariate analysis showed that anti-transgender discrimination, harassment, and violence remains a predictor of binge drinking even when other key measures are taken into account. Younger people, racial minority group members, and persons who were not married or "involved" were at particularly great risk. Conclusions: Consistent with the minority stress paradigm, the more different types of anti-transgender experiences people had, the more likely they were to engage in binge drinking. Targeted intervention needs to help transgender persons to avoid anti-transgender discrimination, harassment, and violence to the greatest extent possible, and to develop resiliency skills whenever they are victimized. This is particularly true for transgender persons who are younger, minority, and not "involved" in a relationship.

Multilevel experiences of carceral violence in Los Angeles, California: first-hand accounts from a racially diverse sample of transgender women

Transgender women face a disproportionate burden of carceral violence, or violence related to policing and the criminal legal system, with transgender women of colour experiencing even greater disparities. Several frameworks conceptualise the mechanisms through which violence impacts transgender women. However, none of them directly explore the role of carceral violence, particularly as it is experienced by transgender women themselves. Sixteen in-depth interviews were conducted with a racially/ethnically diverse sample of transgender women in Los Angeles between May and July 2020. Participants were between 23 - 67 years old. Participants identified as Black (n = 4), Latina (n = 4), white (n = 2), Asian (n = 2), and Native American (n = 2). Interviews assessed experiences of multilevel violence, including from police and law enforcement. Deductive and inductive coding methods were used to identify and explore common themes concerning carceral violence. Experiences of law enforcement-perpetrated interpersonal violence were common and included physical, sexual and verbal abuse. Participants also highlighted structural violence, including misgendering, the non-acceptance of transgender identities, and police intentionally failing to uphold laws that could protect transgender women. These results demonstrate the pervasive, multilevel nature of carceral violence perpetrated against transgender women and suggest avenues for future framework development, trans-specific expansions of carceral theory, and system-wide institutional change.

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.

Racial Inequities in Police Transport for Patients to the Emergency Department: A Multicenter Analysis

INTRODUCTION

Police involvement in patient transport to emergency medical care has increased over time, yet studies assessing racial inequities in transport are limited. This study evaluated the relationship between race and police transport to the emergency department for adult patients.

METHODS

This cross-sectional study evaluated adult (aged ≥18 years) visits at 13 different emergency departments across two regional hospital systems in the Southeastern and Northeastern U.S. from 2015 to 2022. Data were extracted from electronic health records. This analysis evaluated the association between race and transport by police transport using generalized linear multivariable mixed model with a binary logistic link for presence of police transport. Data were nested by patient and adjusted for site, demographics, and diagnostic visit characteristics.

RESULTS

Of 4,291,809 adult emergency department visits, 25,901 (0.6%) involved transport by police. Of the 25,901 visits in police-involved encounters, 10,513 (40.6%) patients were Black, and 9,827 (37.9%) were White. The adjusted model showed that Black patients were at higher odds of transport by police than White patients (AOR=1.64; 95% CI=1.57-1.72). Male sex, younger age (18-35 years), history of behavioral health diagnosis, and emergency department psychiatric or substance use disorders were independently associated with increased odds of police transport.

CONCLUSIONS

This analysis revealed racial inequities in police-involved transport to emergency medical care, highlighting an urgent need to evaluate drivers of inequities and the ways in which police transport influences clinical outcomes.

Transgender Incarceration and Law Enforcement as a Source of Harm: Upstream and Primordial Prevention Perspectives

In the United States (US), transgender individuals are more likely to experience violence and sexual assault in jails and prisons compared with cisgender peers. Harms of incarceration on transgender individuals include limited access to medical care and hormone therapy, as well as being housed in facilities based on biological sex instead of gender identity. However, there has been insufficient research on addressing factors that lead to transgender individuals being incarcerated in the first place. In this article, we argue the need to focus on law enforcement interactions with transgender individuals in the US to reduce incarceration-related harms. Using the perspectives of primordial prevention and focusing on upstream factors that create health-related harms, we assert that focusing on law enforcement is a necessary component in addressing how the criminal justice system harms transgender individuals.

The "triple whammy": Serious psychological distress, suicidal ideation, and substance misuse among transgender persons

PURPOSE

This paper examines the conjoint effects of serious psychological distress, suicidal ideation, and substance abuse among transgender adults. The principal aims are to determine the prevalence of this "triple whammy," identify the factors underlying the co-occurrence of all three problems, and to determine if there is evidence of syndemic effects underlying the "triple whammy."

METHODS

Data from the 2015 U.S. National Transgender Survey were used to examine the "triple whammy" relationship in a sample of 27,715 transgender Americans aged 18 or older. Odds ratios and multivariate logistic regression were performed to examine the data.

RESULTS

13.3 % of the study participants reported experiencing serious psychological distress, suicidal ideation, and substance abuse. The most potent predictors of the "triple whammy" were younger age, a greater number of anti-transgender experiences, and not reaching various transition milestones. Strong evidence emerged to indicate the presence of syndemic effects in operation.

CONCLUSIONS

Experiencing the combination of adverse mental health and substance abuse was not uncommon in this population of transgender adults. Being young, experiencing a larger variety of types of anti-transgender discrimination, harassment, and violence, and not reaching specific transition milestones all had a significant impact on the odds that people would experience the "triple whammy." This was particularly true when these measures were examined in conjunction with one another, because of strong syndemic effects.

Examining the Relationship between Anti-Black Racism, Community and Police Violence, and COVID-19 Vaccination

In 2020, the COVID-19 pandemic emerged against a backdrop of long-standing racial inequities that contributed to significant disparities in COVID-19 mortality, morbidity, and eventually, vaccination rates. COVID-19 also converged with two social crises: anti-Black racism and community and police violence. The goal of this study was to examine the associations between community violence, police violence, anti-Black racism, and COVID-19 vaccination. Survey data were collected from a sample of 538 Black residents of Chicago between September 2021 and March 2022. Structural equation modeling was used to test associations between neighborhood violence, police violence, racism, medical mistrust, trust in COVID-related information, depressive symptoms, and having received a COVID-19 vaccination. In line with predictions, neighborhood violence had a significant indirect effect on vaccination via trust in COVID-related information from a personal doctor. Additionally, racism had a significant indirect effect on vaccination via trust in COVID-related information from a personal doctor, as well as via medical mistrust and trust in COVID-related information from a personal doctor. These findings add to the growing body of literature demonstrating the importance of medical mistrust when examining COVID-19 vaccination disparities. Furthermore, this study highlights the importance of considering how social and structural factors such as violence and racism can influence medical mistrust.

Prevalence and Correlates of Adverse Mental Health Outcomes among Male and Female Black Emerging Adults with a History of Exposure (Direct versus Indirect) to Police Use of Force

Anxiety, depression, and psychological distress are public health concerns for Black emerging adults ages 18-29, given their prevalence in this population. However, we have scant empirical research investigating the prevalence and correlates of negative mental outcomes among Black emerging adults with a history of exposure to police use of force. Thus, the current study examined the prevalence and correlates of depression, anxiety, and psychological well-being and how they vary among a sample of Black emerging adults with a history of direct or indirect exposure to police use of force. Computer-assisted surveys were administered to a sample of Black emerging adults (N = 300). Univariate, bivariate, and multiple linear regression analyses were conducted. Black women with a history of direct or indirect exposure to police use of force had significantly less favorable scores on the depression and anxiety scales compared with Black men. Study findings suggest that Black emerging adults, particularly women, with a history of exposure to police use of force are at risk of experiencing adverse mental health outcomes. Future research with a larger and ethnically diverse sample of emerging adults that examines the prevalence and correlates of adverse mental health outcomes and how they vary by gender, ethnicity, and exposure to police use of force is warranted.

Secondary Institutional Betrayal: Implications for Observing Mistreatment of Sexual Assault Survivors Secondhand

Institutional betrayal has been used to describe the experiences of sexual assault survivors who are harmed by institutions which they rely on for safety or survival. This concept has primarily been studied in the context of survivors' direct relationships with institutions they are members of (e.g., universities, churches, military) and how the said institutions either failed to protect them or were unsupportive following their disclosure. Institutional betrayal can exacerbate negative mental and physical health outcomes for survivors, highlighting a need to hold institutions accountable for harm they cause. A limitation to this conceptualization is that many adults in the general public are not proximally connected to institutions (as they have historically been defined), and the majority of survivors do not formally report. Drawing on semi-structured interviews conducted with young women survivors (n = 12), the present study aims to address this gap by abstracting the conceptualization to a more macro level, proposing the term secondary institutional betrayal. Secondary institutional betrayal refers to survivors' feelings of mistrust and disillusionment toward institutions they are distally connected to which are not directly involved in their own assault (e.g., the media, U.S. government, U.S. criminal legal system, their university), yet still have influence over their personal safety and survival. This sense of betrayal stems from secondhand observations, through the news media, of how other survivors are treated by these institutions. Many survivors in the present study reported their secondhand observations of institutional betrayal would likely deter them from reporting future assaults. Establishing research in this area is important to understand how survivors in the general public are impacted by news stories which highlight institutional betrayal, particularly in the context of ongoing social movements (e.g., #MeToo) which amplify public discourse about sexual assault.

"We (still) charge genocide": A systematic review and synthesis of the direct and indirect health consequences of police violence in the United States

Building on historical and contemporary efforts to eliminate police and other forms of state violence, and on the understanding that police violence is a social determinant of health, we conducted a systematic review in which we synthesize the existing literature around 1) racial disparities in police violence; 2) health impacts of direct exposure to police violence; and 3) health impacts of indirect exposure to police violence. We screened 336 studies and excluded 246, due to not meeting our inclusion criteria. Forty-eight additional studies were excluded during the full text review, resulting in a study sample size of 42 studies. Our review showed that Black people in the US are far more likely than white people to experience a range of forms of police violence: from fatal and nonfatal shootings, to assault and psychological violence. Exposure to police violence increases risk of multiple adverse health outcomes. Moreover, police violence may operate as a vicarious and ecological exposure, producing consequences beyond those directly assaulted. In order to successfully eliminate police violence, scholars must work in alignment with social justice movements.

Police stops to reduce crime: A systematic review and meta-analysis

BACKGROUND

Police-initiated pedestrian stops have been one of the most widely used crime prevention tactics in modern policing. Proponents have long considered police stops to be an indispensable component of crime prevention efforts, with many holding them responsible for the significant reductions in violent crime observed across major US cities in recent decades. Critics, however, have taken issue with the overuse of pedestrian stops, linking them to worsening mental and physical health, attitudes toward the police, and elevated delinquent behavior for individuals directly subject to them. To date, there has been no systematic review or meta-analysis on the effects of these interventions on crime and individual-level outcomes.

OBJECTIVES

To synthesize the existing evaluation research regarding the impact of police-initiated pedestrian stops on crime and disorder, mental and physical health, individual attitudes toward the police, self-reported crime/delinquency, violence in police-citizen encounters, and police misbehavior.

SEARCH METHODS

We used the Global Policing Database, a repository of all experimental and quasi-experimental evaluations of policing interventions conducted since 1950, to search for published and unpublished evaluations of pedestrian stop interventions through December of 2019. This overarching search was supplemented by additional searches of academic databases, gray literature sources, and correspondence with subject-matter experts to capture eligible studies through December 2021.

SELECTION CRITERIA

Eligibility was limited to studies that included a treatment group of people or places experiencing pedestrian stops and a control group of people or places not experiencing pedestrian stops (or experiencing a lower dosage of pedestrian stops). Studies were required to use an experimental or quasi-experimental design and evaluate the intervention using an outcome of area-level crime and disorder, mental or physical health, individual or community-level attitudes toward the police, or self-reported crime/delinquency.

DATA COLLECTION AND ANALYSIS

We adopted standard methodological procedures expected by the Campbell Collaboration. Eligible studies were grouped by conceptually similar outcomes and then analyzed separately using random effects models with restricted maximum likelihood estimation. Treatment effects were represented using relative incident rate ratios, odds ratios, and Hedges' g effect sizes, depending on the unit of analysis and outcome measure. We also conducted sensitivity analyses for several outcome measures using robust variance estimation, with standard errors clustered by each unique study/sample. Risk of bias was assessed using items adapted from the Cochrane randomized and non-randomized risk of bias tools.

RESULTS

Our systematic search strategies identified 40 eligible studies corresponding to 58 effect sizes across six outcome groupings, representing 90,904 people and 20,876 places. Police-initiated pedestrian stop interventions were associated with a statistically significant 13% (95% confidence interval [CI]: -16%, -9%, p < 0.001) reduction in crime for treatment areas relative to control areas. These interventions also led to a diffusion of crime control benefits, with a statistically significant 7% (95% CI: -9%, -4%, p < 0.001) reduction in crime for treatment displacement areas relative to control areas. However, pedestrian stops were also associated with a broad range of negative individual-level effects. Individuals experiencing police stops were associated with a statistically significant 46% (95% CI: 24%, 72%, p < 0.001) increase in the odds of a mental health issue and a 36% (95% CI: 14%, 62%, p < 0.001) increase in the odds of a physical health issue, relative to control. Individuals experiencing police stops also reported significantly more negative attitudes toward the police (g = -0.38, 95% CI: -0.59, -0.17, p < 0.001) and significantly higher levels of self-reported crime/delinquency (g = 0.30, 95% CI: 0.12, 0.48, p < 0.001), equating to changes of 18.6% and 15%, respectively. No eligible studies were identified measuring violence in police-citizen encounters or officer misbehavior. While eligible studies were often considered to be at moderate to high risk of bias toward control groups, no significant differences based on methodological rigor were observed. Moderator analyses also indicated that the negative individual-level effects of pedestrian stops may be more pronounced for youth, and that significant differences in effect sizes may exist between US and European studies. However, these moderator analyses were limited by a small number of studies in each comparison, and we were unable to compare the effects of police stops across racial groupings.

AUTHORS' CONCLUSIONS

While our findings point to favorable effects of pedestrian stop interventions on place-based crime and displacement outcomes, evidence of negative individual-level effects makes it difficult to recommend the use of these tactics over alternative policing interventions. Recent systematic reviews of hot spots policing and problem-oriented policing approaches indicate a more robust evidence-base and generally larger crime reduction effects than those presented here, often without the associated backfire effects on individual health, attitudes, and behavior. Future research should examine whether police agencies can mitigate the negative effects of pedestrian stops through a focus on officer behavior during these encounters.

Unintended reductions in assaults near sobriety checkpoints: A longitudinal spatial analysis

BACKGROUND

Sobriety checkpoints are a form of proactive policing in which law enforcement officers concentrate at a point on the roadway to systematically perform sobriety tests for all passing drivers. We investigated whether sobriety checkpoints unintentionally reduce assaults in surrounding areas.

METHODS

Exposures of interest were sobriety checkpoints conducted by the Los Angeles Police Department between 2012 and 2017. Comparison units were matched 1:2 to sobriety checkpoints, selected as the same point location temporally lagged by exactly ±168 hours. The outcome was the density of police-reported assaults around the checkpoint location.

RESULTS

In mixed effects regression analyses, assault incidence was lower when sobriety checkpoints were in operation compared to the same location ±168 hours [b= -0.0108, 95% CI: (-0.0203, -0.0012)].

CONCLUSIONS

Sobriety checkpoints were associated with decreased assault incidence, but estimated effect sizes were small and effects did not endure long after checkpoints ended.

Police and Transgender and Gender Diverse People in the United States: A Brief Note on Interaction, Harassment, and Violence

Transgender and gender diverse (TGD) people in the United States continue to face dire rates of police violence and harassment. However, little research has examined this phenomenon using large-scale nationwide data. The current study utilized data from the United States Transgender Survey to examine the prevalence and correlates of police interaction, harassment, and violence among TGD people in the United States. Police harassment and violence types examined included reported incidences of (a) officers using the wrong pronouns, (b) officers asking about an individual's transition, (c) verbal harassment, (d) physical attack, (e) forcing sex to avoid arrest, and (f) unwanted sexual contact from an officer. Results from a weighted sample of 22,456 TGD people revealed that 40.3% reported having interacted with the police in the past year. Among those who interacted with the police in the past year, 45.7% reported experiencing at least one incident of police verbal harassment and 6.1% reported at least one incidence of police physical/sexual violence in the past year. Engaging in sex work was one of the most consistent predictors of police interaction, harassment, and violence. Notably, sex workers were approximately 11 times more likely to report being forced to engage in sex with the police to avoid arrest when compared to non-sex workers. Overall, people of color also reported significantly higher rates of police harassment and violence compared to their White counterparts. Additional correlates included income, educational attainment, and participation in other illegal work. Taken together, the findings of the current study highlight the urgent need for additional examination, intervention, and advocacy to eliminate police harassment and violence against members of the TGD community in the United States.

How place and race drive the numbers of fatal police shootings in the US: 2015-2020

Place and race are two important predictors of fatal police shootings. We used Mapping Police Violence Data and the Washington Post Fatal Force Data to determine whether a county's deprivation status within communities influences the association between the number of fatal police shootings, and how the number of fatal police shootings differs by race and ethnicity. We categorized counties based on the Social Vulnerability Index (SVI) to three categories: low-, medium-, and high-SVI. The analytical sample included 3136 US counties between 2015 and 2020; during this time, 5525 individuals were fatally shot by police. Our findings show that place strongly impacts the number of fatal police shootings. Among all fatal shootings, 713 occurred in low-SVI counties, 1660 in middle-SVI, and 3152 in high-SVI counties. Race played a significant role; fatal shooting deaths increased by 2.3 times among White individuals, 9.6 times among Black individuals, and 15 times among Hispanic individuals between low- and high-SVI counties. The results of negative binomial regressions show a strong association between fatal police shootings and the counties' characteristics. In comparison with low-SVI counties, residents in counties with moderate and high-SVI are more likely to be fatally shot by police by 4.9 and 5.8 percentage points. In addressing violence and fatal police shootings, the vulnerability of counties and the population's racial composition play significant roles and need specific attention in addressing systemic racial disparities in the criminal justice system.

Latent Class Profiles of Police Violence Exposure in 4 US Cities and Their Associations with Anticipation of Police Violence and Mental Health Outcomes

While studying polyvictimization is well established within the broader violence literature and applied to other types of violence, it has yet to be documented whether polyvictimization also presents in patterns of police violence exposure (i.e., neglectful, psychological, physical, and sexual police violence). Our objective was to analyze latent patterns of co-occurring police contact and their associations with mental health. By applying latent class analysis (LCA) methods to the 2016 and 2017 Surveys of Police-Public Encounters (N = 2615), conducted in 4 Northeastern US cities, we identified classes of direct and vicarious police violence and compared sociodemographic characteristics among classes using multinomial regression. Classes were regressed on mental health outcomes. LCA identified four classes of police contact. Compared to Positive Police Contact (33.0%) class members, members of the (a) Extreme Police Violence (4.0%) class reported higher anticipation of future police victimization, psychological distress, and suicide ideations and attempts; they were more likely to be Black, cisgender men, and Latinx; (b) members of the High Police Violence (23.6%) class reported higher anticipation of future police victimization and psychological distress; they were more likely to be Black, Native American, and multiracial; members of the (c) Low Police Contact (39.5%) class had comparable mental health outcomes; they were more likely to report a household income < $19,999. Notably, no participants were unexposed to police contact. Polyvictimization presents in experiences of police violence and disproportionately impacts structurally marginalized people.

An Intersectional-Contextual Approach to Racial Trauma Exposure Risk and Coping Among Black Youth

Black youth experience racial discrimination at higher rates than other racial/ethnic groups in the United States. To identify how racism can simultaneously serve as a risk factor for adverse childhood experience (ACE) exposure, a discrete type of ACE, and a post-ACE mental health risk factor among Black youth, Bernard and colleagues (2021) proposed the culturally informed ACEs (C-ACE) model. While an important addition to the literature, the C-ACE model is framed around a single axis of race-based oppression. This paper extends the model by incorporating an intersectional and ecodevelopmental lens that elucidates how gendered racism framed by historical trauma, as well as gender-based socialization experiences, may have implications for negative mental health outcomes among Black youth. Clinical and research implications are discussed.

Trauma and Police Violence: Issues and Implications for Mental Health Professionals

In this piece, the authors present the case of a young Black American man who experienced symptoms of post-traumatic stress disorder after an episode of police violence. Through engagement with this case, the authors consider whether trauma-focused psychotherapies, particularly trauma-focused cognitive behavioral therapies (TF-CBT), are equipped to attend to contextual factors relevant to traumatic experiences of police violence. The authors suggest further research to determine for whom and in what contexts standard forms of psychotherapy as well as alternatives to TF-CBT are effective, and augmenting provider education to include advocacy strategies aimed at reducing police violence-advocacy that is relevant in the context of nationwide protests occurring after the officer-perpetrated killings of George Floyd, Breonna Taylor, and others.

Structural Racism and Inequities in Incidence, Course of Illness, and Treatment of Psychotic Disorders Among Black Americans

Psychotic disorders (e.g., schizophrenia, schizoaffective disorder) are a leading cause of morbidity and premature mortality and an overlooked health inequity in the United States. European data indicate inequities in incidence, severity, and treatment of psychotic disorders, particularly for Black communities, that appear to be primarily attributable to social adversities. The dominant US narrative is that any observed differences are primarily a result of clinician bias and misdiagnosis. We propose that employing the framework of structural racism will prompt European and US research to converge and consider the multifaceted drivers of inequities in psychotic disorders among Black Americans. In particular, we describe how historical and contemporary practices of (1) racialized policing and incarceration, and (2) economic exploitation and disinvestment, which are already linked to other psychiatric disorders, likely contribute to risks and experiences of psychotic disorders among Black Americans. This framework can inform new strategies to (1) document the role of racism in the incidence, severity, and treatment of psychotic disorders; and (2) dismantle how racism operates in the United States, including defunding the police, abolishing carceral systems, and redirecting funds to invest in neighborhoods, housing, and community-based crisis response and mental health care. (Am J Public Health. 2022;112(4):624-632. https://doi.org/10.2105/AJPH.2021.306631).

Police Violence and Public Health

Despite their enormous potential impact on population health and health inequities, police violence and use of excessive force have only recently been addressed from a public health perspective. Moving to change this state of affairs, this article considers police violence in the USA within a social determinants and health disparities framework, highlighting recent literature linking this exposure to mental health symptoms, physical health conditions, and premature mortality. The review demonstrates that police violence is common in the USA; is disproportionately directed toward Black, Latinx, and other marginalized communities; and exerts a significant and adverse effect on a broad range of health outcomes. The state-sponsored nature of police violence, its embedding within a historical and contemporary context of structural racism, and the unique circumstances of the exposure itself make it an especially salient and impactful form of violence exposure, both overlapping with and distinct from other forms of violence. We conclude by noting potential solutions that clinicaly psychology and allied fields may offer to alleviate the impact of police violence, while simultaneously recognizing that a true solution to this issue requires a drastic reformation or replacement of the criminal justice system, as well as addressing the broader context of structural and systemic racism in the USA. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Racial and ethnic disparities in "stop-and-frisk" experience among young sexual minority men in New York City

Although racial/ethnic disparities in police contact are well documented, less is known about other dimensions of inequity in policing. Sexual minority groups may face disproportionate police contact. We used data from the P18 Cohort Study (Version 2), a study conducted to measure determinants of inequity in STI/HIV risk among young sexual minority men (YSMM) in New York City, to measure across-time trends, racial/ethnic disparities, and correlates of self-reported stop-and-frisk experience over the cohort follow-up (2014–2019). Over the study period, 43% reported stop-and-frisk with higher levels reported among Black (47%) and Hispanic/Latinx (45%) than White (38%) participants. Stop-and-frisk levels declined over follow-up for each racial/ethnic group. The per capita rates among P18 participants calculated based on self-reported stop-and-frisk were much higher than rates calculated based on New York City Police Department official counts. We stratified respondents’ ZIP codes of residence into tertiles of per capita stop rates and observed pronounced disparities in Black versus White stop-and-frisk rates, particularly in neighborhoods with low or moderate levels of stop-and-frisk activity. YSMM facing the greatest economic vulnerability and mental disorder symptoms were most likely to report stop-and-frisk. Among White respondents levels of past year stop-and-frisk were markedly higher among those who reported past 30 day marijuana use (41%) versus those reporting no use (17%) while among Black and Hispanic/Latinx respondents stop-and-frisk levels were comparable among those reporting marijuana use (38%) versus those reporting no use (31%). These findings suggest inequity in policing is observed not only among racial/ethnic but also sexual minority groups and that racial/ethnic YSMM, who are at the intersection of multiple minority statuses, face disproportionate risk. Because the most socially vulnerable experience disproportionate stop-and-frisk risk, we need to reach YSMM with community resources to promote health and wellbeing as an alternative to targeting this group with stressful and stigmatizing police exposure.

Urban upbringing and psychiatric disorders in the United States: A racial comparison

BACKGROUND

Studies that link urbanicity to mental health are mixed depending on outcome and context. More research is needed to examine whether the urban upbringing effect holds true across racial populations in a large and diverse country like the United States.

METHODS

We analyzed two large datasets that were administered contemporaneously with similar methods: The National Comorbidity Survey-Replication (NCS-R, Whites) and the National Survey of American Life (NSAL, Blacks). We ran multivariable logistic regression models to examine the associations between area of upbringing (urban/large city, other, rural) and six psychiatric disorders, controlling for sex, age, years of education and income-to-poverty ratio (and ethnicity in the NSAL). We performed these analyses in both the NCS-R and the NSAL separately.

RESULTS

The majority (58.97%) of the White sample grew up in the 'other' category (i.e. small town, small city, or suburb of a large city), whereas a much larger percentage (39.89%) of the Black sample grew up in a large city. In the White sample, urban upbringing was not associated with any of the psychiatric disorders at a conventional level of statistical significance. In the Black sample, urban upbringing was associated with greater odds of having mood disorder, alcohol use disorder and drug use disorder, but was not significantly associated with anxiety disorders, PTSD, or eating disorders.

CONCLUSIONS

Urban upbringing was not associated with psychiatric disorders among Whites, but was associated with greater odds of mood disorders, alcohol us disorder and drug use disorder among Blacks. Future research can elucidate how differences in urban upbringing between Whites and Blacks are linked to differences in risk for psychiatric disorders.

Negative illness feedbacks: High-frisk policing reduces civilian reliance on ED services

OBJECTIVE

This paper demonstrates that localized and chronic stop-question-and-frisk (SQF) practices are associated with community members' utilization of emergency department (ED) resources. To explain this relationship, we explore the empirical applicability of a legal epidemiological framework, or the study of legal institutional influences on the distribution of disease and injury.

DATA AND STUDY DESIGN

Analyses are derived from merging data from the Philadelphia Vehicle and Pedestrians Investigation, the National Historical Geographic Information System, and the Southeastern Philadelphia Community Health database to zip code identifiers common to all datasets. Weighted multilevel negative binomial regressions measure the influence that local SQF practices have on ED use for this population. Analytic methods incorporate patient demographic covariates including household size, health insurance status, and having a doctor as a usual source of care.

PRINCIPAL FINDINGS

Findings reveal that both tract-level frisking and poor health are linked to more frequent use of hospital EDs, per respondent report. Despite their health care needs, however, reporting poor/fair health status is associated with a substantial decrease in the rate of emergency department visits as neighborhood frisk concentration increases (IRR = 0.923; 95% CI: 0.891, 0.957). Moreover, more sickly people in high-frisk neighborhoods live in tracts that have greater racial disparities in frisking-a pattern that accounts for the moderating role of neighborhood frisking in sick people's usage of the emergency room.

CONCLUSIONS

Findings indicating the robust association reported above interrogate the chronic incompatibility of local health and human service system aims. The study also provides an interdisciplinary theoretical lens through which stakeholders can make sense of these challenges and their implications.

Executions and Police Conflicts Involving Children, Adolescents and Young Adults

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.

Police harassment and psychosocial vulnerability, distress, and depressive symptoms among black men who have sex with men in the U.S.: Longitudinal analysis of HPTN 061

The mental health impact of exposure to police harassment is understudied, particularly among Black men who have sex with men (BMSM), a group at elevated risk of exposure to such discrimination. This study aimed to identify the associations among BMSM between recent police harassment and psychosocial vulnerability, psychological distress, and depression measured six months later. Data come from the HIV Prevention Trials Network (HPTN) 061 Study, a cohort study of BMSM recruited in 6 U.S. cities (Atlanta, GA, Boston, MA, Los Angeles, CA, New York, NY, San Francisco, CA, and Washington DC). Participants completed baseline, 6-month follow-up, and 12-month follow-up interviews. A convenience sample of 1553 BMSM was recruited between July 2009 and October 2010 of whom 1155 returned for a follow-up interview 12 months later. Accounting for previous police interaction, poverty, psychopathology, drug use, and alcohol use, we estimated associations between recent police harassment reported at the 6 month follow-up interview and 12 month outcomes including psychosocial vulnerability (elevated racial/sexual identity incongruence), psychological distress (being distressed by experiences of racism and/or homophobia), and depression. About 60% of men reported experiencing police harassment between the baseline and 6-month interview due to their race and/or sexuality. Adjusted analyses suggested police harassment was independently associated with a 10.81 (95% CI: 7.97, 13.66) point increase and 8.68 (95% CI: 6.06, 11.30) point increase in distress due to experienced racism and distress due to experienced homophobia scores, respectively. Police harassment perceived to be dually motivated predicted disproportionate levels of distress. Police harassment is prevalent and associated with negative influences on psychosocial vulnerability and psychological distress among BMSM. Reducing exposure to police harassment may improve the psychosocial health of BMSM.

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We examine the impact of police harassment on Black men who have sex with men.

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Data from the HPTN 061 Study show that police harassment is highly prevalent.

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Police harassment is associated with psychosocial vulnerability.

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Police harassment is associated with psychological distress.

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Harassment motivated by racism and homophobia is associated with added distress.

Incorporating Measures of Structural Racism into Population Studies of Reproductive Health in the United States: A Narrative Review

Purpose: Black women in the United States face poor outcomes across reproductive health measures-from pregnancy outcomes to gynecologic cancers. Racial health inequities are attributable to systemic racism, but few population studies of reproductive health outcomes integrate upstream measures of systemic racism, and those who do are limited to maternal and infant health outcomes. Advances in understanding and intervening on the pathway from racism to reproductive health outcomes are limited by a paucity of methodological guidance toward this end. We aim to fill this gap by identifying quantitative measures of systemic racism that are salient across reproductive health outcomes. Methods: We conducted a review of literature from 2000 to 2019 to identify studies that use quantitative measures of exposure to systemic racism in population reproductive health studies. We analyzed the catalog of literature to identify cohesive domains and measures that integrate data across domains. For each domain, we contextualize its use within population health research, describe metrics currently in use, and present opportunities for their application to reproductive health research. Results: We identified four domains of systemic racism that may affect reproductive health outcomes: (1) civil rights laws and legal racial discrimination, (2) residential segregation and housing discrimination, (3) police violence, and (4) mass incarceration. Multiple quantitative measures are available for each domain. In addition, a multidimensional measure exists and additional domains of systemic racism are salient for future development into distinct measures. Conclusion: There are quantitative measures of systemic racism available for incorporation into population studies of reproductive health that investigate hypotheses, including and beyond those related to maternal and infant health. There are also promising areas for future measure development, such as the child welfare system and intersectionality. Incorporating such measures is critical for appropriate assessment of and intervention in racial inequities in reproductive health outcomes.

Moderating Effects of Resilience on Depression, Psychological Distress, and Suicidal Ideation Associated With Interpersonal Violence

Resilience has been found to attenuate the effects of negative mental health symptomology associated with interpersonal victimization; however, existing research has largely focused on resilience traits, such as individual cognitive and environmental factors that promote resilience. In addition, empirical knowledge on the extent to which resilience mitigates suicidal symptomology associated with interpersonal violence victimization is particularly limited. This study assesses whether the relationship between interpersonal violence (i.e., IPV and nonpartner sexual violence) and mental health symptomology (i.e., depression, psychological distress, and suicidal ideation) is moderated by resilience using a general population sample of women (N = 932). A cross-sectional, observational survey was administered in four U.S. cities (Baltimore, New York City, Philadelphia, and Washington, D.C.). Bivariate results indicated that women exposed to interpersonal violence reported significantly higher rates of suicidal ideation, depression, and psychological distress compared with women without exposure to interpersonal violence. Regression models revealed significant positive associations between interpersonal violence and depression, distress, and suicidal ideation, adjusting for sociodemographics. Resilience did not significantly moderate the relationship between interpersonal violence victimization and any associated mental health outcomes. However, subgroup analyses reveal significant interaction effects between resilience and IPV within specific racial and ethnic minority subgroups, suggesting that attenuating effects of resilience on mental health symptoms (i.e., depression and psychological distress) associated with IPV likely vary across race and ethnicity. Implications for future research and clinical interventions focused on resilience among survivors of interpersonal violence are discussed.

Police Interactions, Perceived Respect, and Longitudinal Changes in Depression in African Americans

Introduction: We examined police exchanges' and feelings of discrimination's impact on changes in adolescent depression symptoms. Relative to other races, police speak more disrespectfully to African Americans and often exert unnecessary force. We investigated the impact of these exchanges on depression.

Methods: Adolescent Health Study data were analyzed. Latent growth curve modeling with mediation illustrated relationships between police exchanges, perceived discrimination, and depression changes.

Results: African American adolescents had significantly higher levels of initial depression than other racial/ethnic identity groups. For African Americans, police exchanges predicted depression changes. Perceived respect predicted levels and changes of depression for both groups, but mediated the relationship between police exchanges and depression changes only in the “other” racial/ethnic identity group.

Discussion: Police stoppings impacted depression changes for African Americans independent of perceived respect. Findings highlight a potentially unique relationship between depression and police exchanges among African Americans. Future studies may investigate roles of individual differences.

Effect of race on suspect injuries during encounters with police

OBJECTIVES

To estimate the effects of race and ethnicity on suspect injuries during use of force encounters with police in Tucson, Arizona.

METHODS

Data on all use of force cases recorded by the Tucson Police Department from January 2018 to March 2020 were analysed. Logistic regression was used to estimate the effects of race and ethnicity on the likelihood of suspect injuries controlling for a variety of other factors.

RESULTS

Overall, 28.5% of people who had force used against them by Tucson police were injured. Multivariate analyses reveal that among those who had force used against them, African-American suspects were significantly less likely than white suspects to be injured. The risk of injury for other racial and ethnic groups is about the same as the risk for white suspects. Resisting arrest and seeking to escape from police custody do not increase the risk of injury among suspects, but assaulting officers or other individuals does increase the risk of injury. Certain types of force, such as canines, firearms and TASERs, are associated with significantly elevated risks of injury among suspects.

CONCLUSIONS

Numerous interest groups have raised concerns about the police use of force against minorities. Using publicly available data, this analysis examined the effects of race and ethnicity on risk of injury during the use of force encounters with police in Tucson. The findings reveal that minorities are not injured at elevated rates relative to whites. To the contrary, African-American suspects are less likely to be injured than white suspects are.

“Return of the repressed”: Exposure to police violence increases protest and self-sacrifice intentions for the Yellow Vests

Worldwide, it is not uncommon to observe violent police reactions against social movements. These are often rationalized by decision makers as efficient ways to contain violence from protesters. In France for instance, the ongoing Yellow Vests protests have generated an unprecedented number of casualties, injuries, and convictions among protesters. But was this response efficient in diminishing violence stemming from the Yellow Vests? To this day, little is known about the psychological consequences of police violence in the context of protests. Combining insights from Significance Quest Theory and the Social Identity perspective on collective action, we predicted that exposure to police violence could “backfire” and lead to increased radicalization of protesters. A cross-sectional investigation of 523 Yellow Vests yielded evidence for this hypothesis. We found positive direct effects of exposure to police violence on intentions to attend future demonstrations and to self-sacrifice for the Yellow Vests. Moreover, these effects were serially mediated by perceived Loss of Significance and Identification with the Yellow Vests. Paradoxically, these results highlight for the first time the mechanism through which political repression may contribute to the formation of radical politicized identities. Thus, we recommend that decision makers privilege the use of de-escalation techniques in protest policing whenever possible.

Impact of Police Violence on Mental Health: A Theoretical Framework

Police violence has increasingly been recognized as a public health concern in the United States, and accumulating evidence has shown police violence exposure to be linked to a broad range of health and mental health outcomes. These associations appear to extend beyond the typical associations between violence and mental health, and to be independent of the effects of co-occurring forms of trauma and violence exposure. However, there is no existing theoretical framework within which we may understand the unique contributions of police violence to mental health and illness.This article aims to identify potential factors that may distinguish police violence from other forms of violence and trauma exposure, and to explore the possibility that this unique combination of factors distinguishes police violence from related risk exposures. We identify 8 factors that may alter this relationship, including those that increase the likelihood of overall exposure, increase the psychological impact of police violence, and impede the possibility of coping or recovery from such exposures.On the basis of these factors, we propose a theoretical framework for the further study of police violence from a public mental health perspective.

Impact of law enforcement-related deaths of unarmed black New Yorkers on emergency department rates, New York 2013-2016

BACKGROUND

Law enforcement-related deaths of unarmed black Americans may lead black communities to distrust public institutions. Our study quantifies the impact of law enforcement-related deaths of black New York residents on the use of hospital emergency departments (ED) during 2013-2016.

METHODS

We used regression discontinuity models stratified by race and time period (2013-2015 and 2015-2016) to estimate the impact of law enforcement-related deaths on ED rates. Dates of deaths and media reports were from the Mapping Police Violence database. We calculated the daily overall and condition-specific ED visit rates from the New York's Statewide Planning and Research Cooperative System.

RESULTS

There were 14 law enforcement-related deaths of unarmed black New York residents from 2013 to 2016. In 2013-2014, the ED rate among black New Yorkers decreased by 7.7 visits per 100 000 black New Yorkers (5% less than the average ED rate) using the date of media report as the cut-off with a 2-week exposure window. No changes in ED rates were noted for black New Yorkers in 2015-2016 or for white New Yorkers in either time period. Models using the date of death followed a similar pattern.

CONCLUSION

The decrease in ED rates among black New Yorkers immediately following media reports of law enforcement-related deaths involving unarmed black New Yorkers during 2013-2014 may represent potentially harmful delays in healthcare. Reforms implemented during 2015-2016 might have modified the impact of these deaths. Further investigation into the population health impacts of law enforcement-related deaths is needed.

"Can I Live": Black American Adolescent Boys' Reports of Police Abuse and the Role of Religiosity on Mental Health

State sanctioned violence aimed at Black individuals and communities is an issue that has pervaded American history and society since before the establishment of the United States. For Black males, anticipating and preparing for involuntary police contact, unfortunately, is an inevitable part of life. The purpose of this study is to examine the impact of reports of police abuse on mental health and perceived racial out-group perceptions and the protective role of religiosity among a nationally representative sample of Black American adolescent boys (Mage = 14.98). Linear multiple regression was used to determine the interactive effects of subjective religiosity and reported police abuse on Black American adolescent boys. Higher reports of subjective religiosity were associated with lower depressive symptomatology. Reports of police abuse were associated with lower public regard beliefs (belief that society views Black Americans less favorably). Results highlight the impact experiencing police abuse has on Black adolescent boys and we conclude with implications, areas for future research and intervention points.

Police Violence among Adults Diagnosed with Mental Disorders

Police violence is reportedly common among those diagnosed with mental disorders characterized by the presence of psychotic symptoms or pronounced emotional lability. Despite the perception that people with mental illness are disproportionately mistreated by the police, there is relatively little empirical research on this topic. A cross-sectional general population survey was administered online in 2017 to 1,000 adults in two eastern U.S. cities to examine the relationship between police violence exposure, mental disorders, and crime involvement. Results from hierarchical logistic regression and mediation analyses revealed that a range of mental health conditions are broadly associated with elevated risk for police violence exposure. Individuals with severe mental illness are more likely than the general population to be physically victimized by police, regardless of their involvement in criminal activities. Most of the excess risk of police violence exposure related to common psychiatric diagnoses was explained by confounding factors including crime involvement. However, crime involvement may necessitate more police contact, but does not necessarily justify victimization or excessive force (particularly sexual and psychological violence). Findings support the need for adequate training for police officers on how to safely interact with people with mental health conditions, particularly severe mental illness.

Gender-Based Violence Against Transgender People in the United States: A Call for Research and Programming

Gender-based violence (GBV) is an umbrella term for any harm that is perpetrated against a person's will and that results from power inequalities based on gender roles. Most global estimates of GBV implicitly refer only to the experiences of cisgender, heterosexually identified women, which often comes at the exclusion of transgender and gender nonconforming (trans) populations. Those who perpetrate violence against trans populations often target gender nonconformity, gender expression or identity, and perceived sexual orientation and thus these forms of violence should be considered within broader discussions of GBV. Nascent epidemiologic research suggests a high burden of GBV among trans populations, with an estimated prevalence that ranges from 7% to 89% among trans populations and subpopulations. Further, 165 trans persons have been reported murdered in the United States between 2008 and 2016. GBV is associated with multiple poor health outcomes and has been broadly posited as a component of syndemics, a term used to describe an interaction of diseases with underlying social forces, concomitant with limited prevention and response programs. The interaction of social stigma, inadequate laws, and punitive policies as well as a lack of effective GBV programs limits access to and use of GBV prevention and response programs among trans populations. This commentary summarizes the current body of research on GBV among trans populations and highlights areas for future research, intervention, and policy.

Mental Health Consequences of Sexual Misconduct by Law Enforcement and Criminal Justice Personnel among Black Drug-Involved Women in Community Corrections

This study examines the prevalence, correlates, and mental health consequences of sexual misconduct by law enforcement and criminal justice (LECJ) personnel. Baseline data for Project E-WORTH (Empowering African-American Women on the Road to Health) were collected between November 2015 and May 2018 from 351 drug-involved Black women from community corrections in New York City. LECJ sexual misconduct was self-reported and we measured mental health outcomes with the CESD-4 and the PTSD Checklist. Univariate and multivariable logistic regression analyses were performed. Approximately 14% of our sample had experienced LECJ sexual misconduct. Participants who reported multiple arrests, recent drug use, and having experienced childhood sexual victimization were more likely to have experienced LECJ sexual misconduct. Further, LECJ sexual misconduct was positively associated with depression and PTSD. These findings suggest that LECJ sexual misconduct is a previously unreported risk factor for adverse mental health outcomes among criminal-legal system-involved women. There is a need for recognition of LECJ sexual victimization among criminal-legal system-involved women. As such, prevention, treatment, and community corrections service delivery for this population should be trauma informed.

Police Stops Among At-Risk Youth: Repercussions for Mental Health

PURPOSE

The aim of the study was to examine the proximate mental health consequences of stressful and emotionally charged interactions with police officers among a national sample of at-risk youth who have been stopped by the police.

METHODS

A sample of 918 youth (average age 15 years) in the U.S. who reported being stopped by police in the most recent wave (2014-2017) of the Fragile Families & Child Wellbeing Study was used in the present study.

RESULTS

Although age at first stop was not associated with mental health outcomes, youth stopped by police more frequently were more likely to report heightened emotional distress and posttraumatic stress symptoms. Findings also indicate that being stopped at school and officer intrusiveness were potent predictors of these adverse emotional and mental health responses to the stop.

CONCLUSIONS

Under certain circumstances, the police stop can result in feelings of stigma and trauma among at-risk youth. Youth may benefit when school counselors or social workers provide mental health screenings and offer counseling care after police encounters, particularly when such encounters are intrusive and/or occur at school.

Police Interactions and the Mental Health of Black Americans: a Systematic Review

Black Americans comprise 13% of the US population, yet data suggests that they represent 23% of those fatally shot by police officers. Data on non-lethal encounters with police in the Black community is less available but can understandably result in emotional trauma, stress responses, and depressive symptoms. The aim of this systematic literature review is to assess if interactions with the police are associated with mental health outcomes among Black Americans. Following pre-defined inclusion criteria, 11 articles were reviewed. Using a quality assessment tool, eight studies received a fair quality rating, two studies a poor rating, and one study received a good rating. The types of police interaction reported among study participants included police use of force during arrest, police stops, police searches, exposure to police killings, and interactions with police in the court system and varied mental health outcomes. Most of the studies (6 of 11) reviewed found statistically significant associations between police interactions and mental health (psychotic experiences, psychological distress, depression, PTSD, anxiety, suicidal ideation and attempts), indicating a nearly twofold higher prevalence of poor mental health among those reporting a prior police interaction compared to those with no interaction. Although better quality studies are needed, findings suggest an association between police interactions and negative mental health outcomes. Changes in law enforcement policy, development and implementation of a validated instrument for police experiences, improved community outreach, a federally mandated review of policy and practice in police departments, and expanded police training initiatives could reduce the potential negative mental health impact of police interactions on Black Americans.

The thin blue line of health: Police contact and wellbeing in Europe

Increasing evidence suggests that even minor forms of contact with the criminal justice system-such as being stopped by police-may be implicated in poor health. Police use of force can increase the risk of physical injury, whereas interactions accompanied by abusive rhetoric or threats can lead to psychological and emotional harm. Police contact may also have no health consequences for individuals or even be linked to good health because of an increased sense of public safety and confidence in law enforcement. This is the first study that explores whether contact with law enforcement is related to health and wellbeing in Europe. We estimated multilevel models with data from 26 countries that participated in the 2010 round of the European Social Survey. Across all outcomes-self-rated health, functional limitations, happiness, loneliness, and emotional wellbeing-having been approached, stopped or contacted by police was associated with worse health and wellbeing, especially when police treatment was perceived as unsatisfactory.

Sexual orientation and mental health among adults in four U.S. cities

Sexual minorities have higher risk for psychological distress than heterosexual populations. However, this disparity remains under-studied in urban settings, and there likewise has been minimal prior research of potential interactions with gender and race/ethnicity. The present study aimed to examine mental health correlates of sexual minority identification in conjunction with gender and race/ethnicity. A community sample of 1,615 adults from four eastern cities in the United States was used. A series of regression analyses were conducted to examine differences in psychological distress and suicidal ideation across different sexual orientation populations. The results showed that only bisexual individuals had significantly higher psychological distress and risk for suicidal ideation than heterosexual individuals even after adjusting for age and income. The associations were consistent across gender and race/ethnicity. No significant differences between homosexual and heterosexual individuals were found. Health professionals working with people of bisexual orientation in urban settings should attend to potential psychological distress and recent suicidal ideation.

The mismeasure of Terry stops: Assessing the psychological and emotional harms of stop and frisk to individuals and communities

In Terry v. Ohio, the US Supreme Court relied on a balancing test to uphold the reasonableness of the practice known as "stop and frisk," balancing the contribution of the practice to effective crime prevention and detection against the nature and quality of the intrusion to individual rights. In recent years, statistics have been powerfully deployed by legal scholars, jurists, and policymakers to challenge the assumption that stop and frisk leads to frequent discovery of contraband or other criminal behavior, and to address stark racial and ethnic disparities in the deployment of stop and frisk. However, the other side of the Terry equation-the nature and quality of the intrusion-has received far less attention from the legal community. With few exceptions, Terry jurisprudence portrays the Terry frisk simply as a brief pat-down of the outer clothing and treats each Terry stop as an isolated encounter for purposes of measuring the harm involved. Yet there is a robust social science literature on the effects of stop and frisk on individuals, including data on its effects on individuals from marginalized or vulnerable groups, on individuals over time, and on communities as a whole. Moreover, stop and frisk in the current era has evolved from a tool in the arsenal of individual officers to a systematic, widely deployed strategy. This article argues that the failure to grapple with the application of modern knowledge to modern policing practices leads to a mismeasurement on both sides of the Terry equation. Not only does stop and frisk cause a wide range of emotional and psychological harms; these harms may also interfere with the ability of law enforcement to prevent and investigate crime. Even apart from any legal doctrinal implications for stop and frisk jurisprudence, recognizing the flawed assumptions described in this article should encourage all the relevant stakeholders to re-evaluate the consequences of the Terry regime.