An Examination of Racial Disparities in Misdemeanor Marijuana Possession Arrests Following Reforms in Four U.S. Jurisdictions

Using data from New York, NY; Los Angeles, CA; Prince George’s County, MD; and Louisville, KY, we examine trends in racial disparities in the enforcement of misdemeanor marijuana possessionbefore and after marijuana reforms. In these jurisdictions, we find that changes to marijuana enforcement were associated with reductions in arrest rates for Black, Hispanic, and White people, though the rate of decline varied by jurisdiction. Black people were arrested at the highest rates in relation to their proportion of the population. In three of the four jurisdictions where issuing criminal citations was an enforcement option, racial/ethnic disparities in arrest rates increased post-reforms; legalization and the option to issue a civil citation were associated with reductions in racial/ethnic disparities. Trends in this study provide policymakers with information to implement effective reforms that target racial disparities in marijuana possession arrests.

Shifting Peaks and Cumulative Consequences: Disqualifying Convictions in High-security Jobs

Objectives: Disqualifying conviction lists (DCLs) bar applicants with certain convictions within specified timeframes from employment. Using proposed federal legislative changes in the aviation sector as a case study, we examine whether convictions under the existing policy are associated with subsequent arrest. Then we consider the implications of proposed expansions—arrests instead of convictions and a longer look-back window—on employment restrictions. Methods: Since DCLs exclude ineligible applicants with conviction records, we use a large, single-state sample of diverse criminal histories. We compare subsequent arrest rates across offense types, consider variations in hazard patterns, and project exclusion estimates based on current and anticipated policy reforms. Results: Only half of the disqualifying offenses have consistently higher recidivism rates than non-disqualifying offense types. Over 20 percent of the sample would be barred from employment, policy extensions double this estimate, and exclusions are age-graded, shifting a peak conviction age of 20 years old to a peak “consequence age” of 28. Conclusions: Including a narrower set of offenses would reduce those automatically disqualified in our study context by nearly 20 percent, or 39,000 individuals. Instead of expanding the DCL scope, successful criteria should be both effective in prediction and narrow in application.

Racial demographics explain the link between racial disparities in traffic stops and county-level racial attitudes

Disparities in the treatment of Black and White Americans in police stops are pernicious and widespread. We examine racial disparities in police traffic stops by leveraging data on traffic stops from hundreds of U.S. counties from the Stanford Open Policing Project and corresponding county-level data on implicit and explicit racial attitudes from the Project Implicit research website. We find that Black-White traffic stop disparities are associated with county-level implicit and explicit racial attitudes and that this association is attributable to racial demographics: counties with a higher proportion of White residents had larger racial disparities in police traffic stops. We also examined racial disparities in several post-stop outcomes (e.g., arrest rates) and found that they were not systematically related to racial attitudes, despite evidence of disparities. These findings indicate that racial disparities in counties’ traffic stops are reliably linked to counties’ racial attitudes and demographic compositions.

Comparative Effectiveness of Implantable Defibrillators for Asymptomatic Brugada Syndrome: A Decision‐Analytic Model

Background Optimal management of asymptomatic Brugada syndrome (BrS) with spontaneous type I electrocardiographic pattern is uncertain. Methods and Results We developed an individual‐level simulation comprising 2 000 000 average‐risk individuals with asymptomatic BrS and spontaneous type I electrocardiographic pattern. We compared (1) observation, (2) electrophysiologic study (EPS)‐guided implantable cardioverter‐defibrillator (ICD), and (3) upfront ICD, each using either subcutaneous or transvenous ICD, resulting in 6 strategies tested. The primary outcome was quality‐adjusted life years (QALYs), with cardiac deaths (arrest or procedural‐related) as a secondary outcome. We varied BrS diagnosis age and underlying arrest rate. We assessed cost‐effectiveness at $100 000/QALY. Compared with observation, EPS‐guided subcutaneous ICD resulted in 0.35 QALY gain/individual and 4130 cardiac deaths avoided/100 000 individuals, and EPS‐guided transvenous ICD resulted in 0.26 QALY gain and 3390 cardiac deaths avoided. Compared with observation, upfront ICD reduced cardiac deaths by a greater margin (subcutaneous ICD, 8950; transvenous ICD, 6050), but only subcutaneous ICD improved QALYs (subcutaneous ICD, 0.25 QALY gain; transvenous ICD, 0.01 QALY loss), and complications were higher. ICD‐based strategies were more effective at younger ages and higher arrest rates (eg, using subcutaneous devices, upfront ICD was the most effective strategy at ages 20–39.4 years and arrest rates >1.37%/year; EPS‐guided ICD was the most effective strategy at ages 39.5–51.3 years and arrest rates 0.47%–1.37%/year, and observation was the most effective strategy at ages >51.3 years and arrest rates <0.47%/year). EPS‐guided subcutaneous ICD was cost‐effective ($80 508/QALY). Conclusions Device‐based approaches (with or without EPS risk stratification) can be more effective than observation among selected patients with asymptomatic BrS. BrS management should be tailored to patient characteristics.

Opioids, Race, Context, and Journeys to Crime: Analyzing Black–White Differences in Travel Associated With Opioid Possession Offenses

Journeys to crime, or distances traveled from residences to places of alleged crimes, describe how people enter into the criminal justice system. Race, as an ascribed characteristic of individuals and a determinant of community conditions, introduces disparities in journeys to crime. Use of opioids among nonurban, White populations and changing law enforcement responses prompt inquiry into how race affects journeys to crime associated with opioid possession. This study evaluates Black–White differences in travel among persons arrested for opioid possession in Delaware. It applies race and rationality theory to assess the effects of race and racialized context on travel patterns. Multilevel models reveal travel to possess opioids is greater for White relative to Black Delawareans. Community conditions such as marijuana possession arrest rates and concentrated disadvantage have varying impacts on travel from various geographic areas. Racial–spatial differences in travel show persistent disparities in drug law enforcement amid efforts to curb opioid misuse.

Reduction of in-hospital cardiac arrest with sequential deployment of rapid response team and medical emergency team to the emergency department and acute care wards

Purpose This study aimed to determine if sequential deployment of a nurse-led Rapid Response Team (RRT) and an intensivist-led Medical Emergency Team (MET) for critically ill patients in the Emergency Department (ED) and acute care wards improved hospital-wide cardiac arrest rates. Methods In this single-center, retrospective observational cohort study, we compared the cardiac arrest rates per 1000 patient-days during two time periods. Our hospital instituted a nurse-led RRT in 2012 and added an intensivist-led MET in 2014. We compared the cardiac arrest rates during the nurse-led RRT period and the combined RRT-MET period. With the sequential approach, nurse-led RRT evaluated and managed rapid response calls in acute care wards and if required escalated care and co-managed with an intensivist-led MET. We specifically compared the rates of pulseless electrical activity (PEA) in the two periods. We also looked at the cardiac arrest rates in the ED as RRT-MET co-managed patients with the ED team. Results Hospital-wide cardiac arrests decreased from 2.2 events per 1000 patient-days in the nurse-led RRT period to 0.8 events per 1000 patient-days in the combined RRT and MET period (p-value = 0.001). Hospital-wide PEA arrests and shockable rhythms both decreased significantly. PEA rhythms significantly decreased in acute care wards and the ED. Conclusion Implementing an intensivist-led MET-RRT significantly decreased the overall cardiac arrest rate relative to the rate under a nurse-led RRT model. Additional MET capabilities and early initiation of advanced, time-sensitive therapies likely had the most impact.

Demanding Reduction: A County-level Analysis Examining Structural Determinants of Human Trafficking Arrests in Florida

Academic literature has placed increased focus on understanding the complexities of human trafficking cases, but a gap in literature persists on assessing structural determinants that may impact the number of identified human trafficking arrests. As such, using administrative data on human trafficking arrests from 2013 to 2017, in the present study we examine the influence that macro-level social disorganization indicators, physical characteristics, and criminality rates have on human trafficking arrests in the state of Florida. Results reveal that counties with a higher number of human trafficking arrests were associated with higher levels of residential instability, a greater count of police agencies, as well as, lower levels of concentrated disadvantage and drug arrest rates. We close with directions for future research and anti-trafficking policy recommendations.

Fiscal Pressures and Discriminatory Policing: Evidence from Traffic Stops in Missouri

This paper provides evidence of racial variation in traffic enforcement responses to local government budget stress using data from policing agencies in the state of Missouri from 2001 through 2012. Like previous studies, we find that local budget stress is associated with higher citation rates; we also find an increase in traffic-stop arrest rates. However, we find that these effects are concentrated among White (rather than Black or Latino) drivers. The results are robust to the inclusion of a range of covariates and a variety of model specifications, including a regression discontinuity examining bare budget shortfalls. Considering potential mechanisms, we find that targeting of White drivers is higher where the White-to-Black income ratio is higher, consistent with the targeting of drivers who are better able to pay fines. Further, the relative effect on White drivers is higher in areas with statistical over-policing of Black drivers: when Black drivers are already getting too many fines, police cite White drivers from whom they are presumably more likely to be able to raise the needed extra revenue. These results highlight the relationship between policing-as-taxation and racial inequality in policing outcomes.