Baltimore Research Articles

Redefining low-threshold buprenorphine access in an integrated mobile clinic program: Factors associated with treatment retention

IntroductionThe Spot mobile clinic provides low-threshold buprenorphine integrated with clinical and social services in Baltimore City, MD. In 2021, The Spot modified practices to improve engagement including providing extended prescriptions, reducing frequency of toxicology testing, giving up to six months to stabilize on medication, offering maximum doses (up to 32 mg total) daily, and utilizing telemedicine. This study characterizes care retention by examining both the total time in care and the percentage of time with buprenorphine prescription coverage during these practice changes, and examines factors associated with retention. MethodsThis retrospective cohort study includes patients (n = 341) who received a buprenorphine prescription who initiated care on The Spot mobile clinic from September 2021 to October 2022, with follow-up through October 2023. We utilized the Cox proportional hazards model and Kaplan-Meier survival analyses to assess differences in care retention by the factors of patient demographics and clinical characteristics. Additionally, we performed sensitivity analyses using Poisson regression to examine differences between patients with 80 % or greater time with active prescription coverage versus <80 % of time with active prescription coverage. ResultsAfter practice setting changes, retention in care at 90 days was 60 %. Patients whose maximum daily buprenorphine dose was 28 to 32 mg were 80 % less likely to discontinue treatment over the study period than those prescribed ≤16 mg (adjusted hazard ratio of discontinuation: 0.2 [95 % CI: 0.1–0.3]). Engaging in wound care or hepatitis C treatment was associated with higher retention in care, and individuals experiencing homelessness remained engaged at rates comparable to stably housed patients. ConclusionPractice changes aimed to improve access to patient-centered, low-threshold buprenorphine treatment may increase retention in care. Notably, higher doses of buprenorphine and integrated treatment with wound care and hepatitis C treatment were associated with increased retention. Due to gaps in patient care, retention metrics should incorporate total time in care as well as percentage of time with an active buprenorphine prescription.

Challenges and Opportunities for Treating Hepatitis C Amongst People Who Use Drugs: Experience of an Integrated Mobile Clinic in Baltimore City.

Progress in treating chronic hepatitis C virus (HCV) infection has been slow amongst people who use drugs (PWUD). This study describes the HCV treatment cascade amongst people accessing a mobile clinic offering integrated low-threshold buprenorphine and infectious disease services in Baltimore City. From May 1, 2021, to December 31, 2022, 560 people had a rapid HCV antibody test, of whom 201 (36%) had a positive result and amongst those, 117 (58%) had an HCV RNA test performed, 81 (40%) had a documented positive RNA, 45 (22%) were prescribed medication, 42 (21%) started medication, 32 (16%) completed medication, 22 (11%) had blood work to assess for sustained virologic response and 20 (10%) had a documented cure. Challenges including housing instability, insurance barriers and lack of venous access limit progress in this cascade. Providing integrated care models to meet the needs of PWUD in the community is necessary but not sufficient to make progress in improving HCV treatment. Removal of insurance restrictions, availability of point-of-care HCV RNA testing, development of rapid HCV treatment guidelines and development of long-acting injectable HCV treatment are needed to move towards a same-day, one-time test and treat model of care.

Community Member Perceptions of Dollar Stores in Baltimore City, Maryland: "They are Not Progressive for the Communities".

Dollar stores are the fastest-growing type of food retailer in the United States, prompting policy action across the country related to their perceived negative impact on the communities they serve. However, there is little existing research that explores community member perceptions of dollar stores, which is critical to inform new, equitable policies. To address this gap in Baltimore City, Maryland, where dollar store density is high, we aimed to describe community member perceptions of dollar stores in terms of their role in the broader community. We used thematic analysis to construct themes from community member in-depth interviews (n = 16) and one community member workshop (n = 21) to understand how dollar stores are viewed in the context of the broader Baltimore City community. Six key themes were generated: (1) dollar stores contribute to neighborhood "blight," (2) better retail is needed, (3) dollar stores meet certain community needs, (4) dollar stores do not invest enough in the community, (5) dollar stores vary in location and stock depending on race-based neighborhood qualities, and (6) product quality is low. Overall, participants acknowledged that dollar stores meet certain needs in communities in which there are few alternative retail options, but many did not view them as a benefit and desired to have other retailers instead. Participants also discussed the lack of dollar store investment in the communities they serve, and the low quality of food and non-food products offered. Future policy development should include community member perspectives to understand local context and align policies with community priorities.

Gonorrhea and early syphilis treatment practices among community healthcare providers in Baltimore City, Maryland.

Substantial gaps in reporting gonorrhea treatment and prompt ES treatment were observed. Practice-level interventions to facilitate reporting gonorrhea treatment and provide prompt ES treatment are needed.

Collaboration to Reduce Sudden Unexpected Infant Death With Child Fatality Review and Outreach.

Sudden unexpected infant death (SUID) is the leading cause of postneonatal infant mortality in the United States, with disproportionately high rates in Baltimore City and Baltimore County in Maryland. This Advocacy Case Study describes the collaboration between the City and County Child Fatality Review teams to decrease infant mortality. B'more for Healthy Babies, formed in 2009 by the Bureau of Maternal Child Health in Baltimore City with the goal of reducing infant mortality through policy change, service improvements, community mobilization, and behavior change has had a sustained effort to respond to SUID. Recognizing that infants born in Baltimore City often reside in Baltimore County (and vice versa), collaboration with Baltimore County has been essential to increasing B'more for Healthy Babies' scope, reach, and effectiveness. Public health messaging campaigns, creation, and dissemination of a "SLEEP SAFE" testimonial video, and Safe Sleep Summits have involved caregivers, healthcare providers, and community partners. Outcomes of this ongoing collaboration demonstrate a decrease in sleep-related infant mortality rates. Our findings also highlight the need for continued, real time monitoring of sleep-related infant mortality trends with a coordinated, multidisciplinary, and crossjurisdictional response. This initiative can serve as a model of cross-sector communication that can be replicated in other similar geographic locations to further reduce SUID.

Baseline Characteristics and Clinical Outcomes of Patients Seen Through the Free Diabetes Screening (FDS) Program.

To characterize the baseline characteristics and clinical outcomes of patients seen through the Free Diabetic Screening (FDS) program, a free diabetic retinopathy screening program for uninsured patients, in the ophthalmology resident clinic at the Wilmer Eye Institute. This retrospective longitudinal cohort study included uninsured patients ≥18 years with diabetes mellitus seen through the FDS clinic from 2013 to 2023. Data extraction was performed using manual chart review of the first FDS visit, and automated extraction of the data warehouse related to all other office visits. Patient demographic and clinical characteristics at presentation, treatments, and follow-ups were collected. A total of 422 patients were included in this study (mean age 52 years; 59% female; 47% Hispanic; 49% Spanish as primary language). One-third of patients had some form of diabetic retinopathy or diabetic macular edema, and 12% had vision-threatening diabetic retinopathy at presentation. In all, nearly 10% of patients were referred for further specialty care, and 71% of these patients completed at least one follow-up visit. The majority of patients (55%) returned for care as recommended and were followed for a mean length of 200weeks and 10 office visits. The FDS clinic provided much needed diabetic retinopathy screening and treatment for uninsured patients in Baltimore City and surrounding areas. This study highlights the need for strong integration between initial screening and downstream services, as nearly 10% of patients require further sub-specialty intervention or care.

Hierarchy, class, race and PPE in an American hospital in the early days of COVID-19: What the pandemic stress test can teach us about building equitable health systems

Because hospitals are spaces where life and death are routinely at stake, social hierarchies, pressures, and cultural norms are heightened. This was particularly true in the early days of the COVID-19 pandemic. Examining the dynamics in that era can provide insight into the nature of race and hierarchy in hospital structures.In the large literature on the experiences of hospital staff in the COVID-19 era, class and racial dynamics in hospitals are often sidestepped. In addition, the experiences of service staff such as environmental service workers and food service workers are severely under-represented.Here, we explore hierarchy, class, race and risk in two hospitals in the city of Baltimore in the first months of the pandemic in 2020, through the lens of availability of PPE. We draw on a survey of 403 staff in two Baltimore hospitals, and semi-structured interviews with 57 of those staff. Respondents worked in a variety of roles, from administration to clinical to service staff.A large majority of non-clinical service staff identified as Black, in contrast to a small minority of clinical staff with advanced degrees. The experience of access to PPE in the early pandemic differed across cadres of workers. Everyone in the hospital had to ration PPE, but many service staff felt that they were not prioritized in the same ways as clinical staff. PPE availability took on powerful symbolic resonance as a demonstration of how different cadres of workers were valued.The COVID-19 pandemic threw social and class dynamics within the hospital into relief, shedding light on what so often ran below the surface. Thus, it could also potentially be an impetus to examine these fault lines, and to push hospital structures a bit more in the direction of justice.

Sustainability of a dual language program during and beyond COVID-19 challenges

ABSTRACT This study evaluates the Dual Language Program (DLP) implemented at a Title I public school in Baltimore City during the 2019–2020 and 2020–2021 school years. Building on previous research, the DLP's implementation, sustainability, and effects on students’ learning outcomes were examined. Utilizing a mixed-methods approach, the study’s second phase included participants from the school’s mainstream, English-only program (MP), enriching the overall understanding of the school community’s perception of the program. Data were collected through surveys, classroom observations, and standardized assessments—the DIBELS and the iReady Diagnostic assessments. Findings showed challenges with curriculum standardization and prevalent misconceptions about bilingualism. Nevertheless, the program's successes were evident in DLP students’ enhanced engagement, parental involvement, and community support. Despite the challenges of the COVID-19 pandemic, the DLP demonstrated its capacity for scaleability and sustainability. During the 2020–2021 school year, regardless of virtual learning, DLP students not only maintained but, in the case of Cohort 1, showed greater growth in reading skills compared to MP students, with Cohort 3 DLP students improving to reach statistically similar performance levels to their MP peers. Findings indicate that the DLP has the potential to serve as a sustainable educational program, fostering both dual language proficiency and academic outcomes.

Characterization of pesticide exposures and their associations with asthma morbidity in a predominantly low-income urban pediatric cohort in Baltimore City

BackgroundPesticides may impact respiratory health, yet evidence of their impact on pediatric asthma morbidity is limited, particularly among urban children. ObjectiveTo characterize pesticide biomarker concentrations and evaluate their associations with pediatric asthma morbidity among predominantly low-income, Black children in Baltimore City, USA. MethodsWe measured urinary concentrations of 10 biomarkers for pyrethroid insecticides (cyfluthrin:4F-3PBA, permethrin:3PBA), organophosphate insecticides (chlorpyrifos:TCPY, malathion:MDA, parathion:PNP, diazinon:IMPY), and herbicides (glyphosate:AMPA, GPS; 2,4-dicholorphenoxyacetic acid:2,4-D; 2,4,5-tricholorphenoxyacetic acid:2,4,5-T) among 148 children (5–17 years) with established asthma. Urine samples and asthma morbidity measures (asthma symptoms, healthcare utilization, lung function and inflammation) were collected every three months for a year. Generalized estimating equations were used to examine associations between pesticide biomarker concentrations and asthma morbidity measures, controlling for age, sex, race, caregiver education, season, and environmental tobacco smoke. In sensitivity analyses, we assessed the robustness of our results after accounting for environmental co-exposures. ResultsFrequently detected (≥90% detection) pesticide biomarker concentrations (IMPY, 3PBA, PNP, TCPY, AMPA, GPS) varied considerably within children over the follow-up period (intraclass correlation coefficients: 0.1–0.2). Consistent positive significant associations were observed between the chlorpyrifos biomarker, TCPY, and asthma symptoms. Urinary concentrations of TCPY were associated with increased odds of coughing, wheezing, or chest tightness (adjusted Odds Ratio, aOR, TCPY:1.60, 95% Confidence Interval, CI:1.17–2.18). Urinary concentrations of TCPY were also associated with maximal symptom days (aOR:1.38, CI:1.02–1.86), exercise-related symptoms (aOR:1.63, CI:1.09–2.44), and hospitalizations for asthma (aOR:2.84, CI:1.08–7.43). We did not observe consistent evidence of associations between the pesticide exposures assessed and lung function or inflammation measures. ConclusionAmong predominantly Black children with asthma, we found evidence that chlorpyrifos is associated with asthma morbidity. Further research is needed to assess the contribution of pesticide exposures to pediatric respiratory health and characterize exposure sources among vulnerable populations to inform targeted interventions against potentially harmful pesticide exposures.

A perspective on integration and outreach: Guiding concepts in the evolution of health informatics

BackgroundThe National Library of Medicine’s Integrated Academic/Advanced Information Management Systems (IAIMS) initiative played a central role in the evolution of health informatics over the project’s lifetime (1983–2009) and continues to do so. AimOur objective is to demonstrate how IAIMS and two key IAIMS concepts, integration and outreach, have functioned at very different times during this evolutionary process. ApproachUsing a framework drawn from Lorenzi and Stead’s 2021 history of IAIMS, we examine the role of integration and outreach in work at the University of Maryland Baltimore (UMB) in the early 1980s and at the University of Texas Arlington (UTA) in 2020. ResultsGuided by these concepts, UMB implemented a campus-wide information utility, while UTA established a center to accelerate research and innovation. ConclusionsOutreach and integration have been formative in the evolution of health informatics and will continue to hold their power.

"Life Is Either You're Going into a Storm, Going through a Storm, or Coming out of One": Narrative Interviews with Younger Adults on Dialysis in Baltimore City

"Life Is Either You're Going into a Storm, Going through a Storm, or Coming out of One": Narrative Interviews with Younger Adults on Dialysis in Baltimore City

Police Avoidance Among Black Youth

ObjectivesPolice violence is a public health crisis that disproportionately impacts youth of color, particularly Black youth. These disparities may also compel Black youth to engage in police avoidance (i.e., efforts to circumvent police contact and surveillance). Even so, research on Black youths’ engagement in police avoidance is lacking. The present study is the first to investigate factors that may underpin police avoidance among Black youth. MethodsData come from the Survey of Police-Adolescent Contact Experiences (SPACE), a recent, cross-sectional, non-probability survey of Black youth (~52% male) aged 12-21 in Baltimore City (n = 345). ResultsFindings indicate that youth 1) identifying as bisexual or queer, 2) perceiving lower safety at home and in their neighborhoods, 3) reporting more negative attitudes about police, and 4) engaging in delinquent behaviors reported significantly greater police avoidance. Furthermore, youth who reported a greater number of known persons stopped by the police (e.g., family members, friends, neighbors) and had personally experienced officer intrusion during direct or witnessed stops (e.g., harsh language, threats of force, use of force) also exhibited greater police avoidance. ConclusionsLGBQ identity, reduced perceptions of environmental safety, negative attitudes about police, delinquent behaviors, and multiple types of police exposure may shape police avoidance among Black youth. Findings have the potential to inform targeted strategies to mitigate racial and LGBQ disparities in adolescent well-being. Clinical Trial RegistrationNone.

Polymetamorphism and metastability in Paleozoic schists of the central Appalachian Baltimore Terrane, USA

Metapelitic assemblages are often considered highly reactive during prograde metamorphism, such that they effectively record a history of tectono-metamorphic processes. Across eastern North America, metamorphosed rift-to-drift stratigraphy has been central to disentangling the terminal history of Appalachian convergence. We report results from a single metapelitic outcrop in the Loch Raven Schist of Maryland's Baltimore Terrane, where regional metamorphism is historically interpreted to have derived only from the Ordovician Taconic orogeny. An aluminum-rich litho-horizon alludes to two phases of metamorphism: an early, low/medium-pressure (P) sillimanite-stabilizing phase largely overprinted by a subsequent medium/high-P kyanite-stabilizing event, terminating at c. 391–383 Ma. This provides evidence of substantial crustal disturbances in the central Appalachians during Avalonian collision of comparable timing to equivalent events in the north. In a subordinate and aluminum-poor litho-horizon, large (2–3.5 cm) garnet provides geochronological evidence only for a protracted phase of metamorphism at 440–424 Ma. We interpret this age as recording the early, low/medium-P phase of metamorphism that either: (a) extends the duration of the Taconic event; or (b) provides new evidence for metamorphism associated with Silurian tectonism and/or extension in the Central Appalachians. However, this assemblage appears to have been metamorphically unresponsive during Devonian overprinting, despite peak metamorphic conditions of ∼670 °C and ∼8 kbar. We suggest that a potential combination of the paucity of fluid, limited strain accumulation, and coarse refractive assemblages stabilized a kinetically sluggish and metastable composition.

Mobile laboratory measurements of air pollutants in Baltimore, MD elucidate issues of environmental justice

ABSTRACT The City of Baltimore, MD has a history of problems with environmental justice (EJ), air pollution, and the urban heat island (UHI) effect. Current chemical transport models lack the resolution to simulate concentrations on the scale needed, about 100 m, to identify the neighborhoods with anomalously high air pollution levels. In this paper we introduce the capabilities of a mobile laboratory and an initial survey of several pollutants in Baltimore to identify which communities are exposed to disproportionate concentrations of air pollution and to which species. High concentrations of black carbon (BC) stood out at some locations – near major highways, downtown, and in the Curtis Bay neighborhood of Baltimore. Results from the mobile lab are confirmed with longer-term, low-cost monitoring. In Curtis Bay, higher concentrations of BC were measured along Pennington Ave. (mean [5th to 95th percentiles] = 2.08 [2.0–10.9] μg m−3) than along Curtis Ave. just ~ 150 m away (0.67[0.1 – 1.8] μg m−3). Other species, including criteria pollutants ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and fine particulate matter (PM2.5), showed little gradient. Observations with high spatial and temporal resolution help isolate the mechanisms leading to locally high pollutant concentrations. The difference in BC appears to result not from heavier truck traffic or slower dispersion but from the interruptions in traffic flow. Pennington Ave. has three stoplights while Curtis Ave. has none. As heavy-duty diesel-powered vehicles accelerate, they experience turbo-lag and the resulting rich air-fuel mixture exacerbates BC emissions. Immediate mediation might be achieved through smoother traffic flow, and the long-term solution through replacing heavy-duty trucks with electric vehicles. Implications: We present results documenting the locations within Baltimore of high concentrations of Black Carbon pollution and identify the likely source – diesel exhaust emissions exacerbated by stop-and-go traffic and associated turbo-lag. This suggests solutions (smoother traffic, retrofit particulate filters, replacement of diesel with electric vehicles) that would enhance Environmental Justice (EJ) and could be applied to other cities with EJ problems. Synopsis: This paper presents observations of atmospheric black carbon aerosol showing impacts on environmental justice, then identifies causes and suggests solutions.

Abstract A050: The impact of air pollution on aggressive breast cancer prognoses in women of African descent

Abstract Significance. Breast cancer (BC) is the most diagnosed cancer among women in the US. Though highly heterogeneous, different subtypes can be characterized by the expression of membrane receptors on the cell surface: ER+, HER2+, PR+, or basal-like which does not express any of the three receptors. Basal-like triple-negative breast cancer (TNBC) is a highly aggressive subtype of BC that represents about 15% of overall BC cases. Black women disproportionately experience higher rates of early-onset TNBC phenotypes and worse prognoses when compared to White women. Though genetics is a key factor in oncogenesis and cancer progression, it is now widely recognized that differences in cancer outcomes are influenced, also, by various environmental, social, and lifestyle factors known collectively as the social determinants of health (SDOH). For example, air pollution has consistently been shown to be associated with an increased risk of breast cancer, however, little is known about how air pollution alters biological and molecular mechanisms impacting breast cancer progression. Elucidating these influential factors is critical to understanding and addressing disparate outcomes. We are interested in understanding how air pollution impacts immune-oncology related proteins in breast cancer, specifically for Black and White women living in Baltimore City, Maryland. Methods. In a cohort of 217 women (142 Black, 75 White), we performed statistical analyses to determine the correlation between particulate matter 2.5 (PM2.5) with breast cancer subtype and oncogenic molecular drivers within the tumor and its microenvironment. PM2.5 concentration for Census year 2000 was measured using the EPA Downscale Model. Concentrations at the census-tract level were then linked to each participant's geocoded residential address at study baseline. Results. [BJ1] Our data reveal that a higher exposure to PM2.5 is correlated with breast cancer subtypes incidences[BJ2] (p- value[BJ3] =0.051), specifically for hormone receptor positive (ER+ and/or PR+) and TNBC subtypes (p-value=0.035). Elevated air pollution is also associated with estrogen-receptor status overall (p-value=0.002) and in Black (p-value=0.043) and White (p-value=0.008) women in the stratified analysis. Serum protein measurements in this cohort also revealed significant relationships between elevated air pollution and immune-oncology related proteins, including PD-L1, CAIX, CXCL9, and MCP-2.Discussion. Our preliminary evidence reveals an association between air pollution, breast cancer subtypes, and immune-oncology related proteins, with some of these relationships affecting Black and White populations differently. We will continue to interrogate these differences and begin to reveal the underlying mechanisms exacerbating breast cancer disparities. Citation Format: Kayla S. Ingram, Brittany Jenkins-Lord. The impact of air pollution on aggressive breast cancer prognoses in women of African descent [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A050.

Effectiveness and implementation of decentralized, community- and primary care-based strategies in promoting hepatitis B testing uptake: a systematic review and meta-analysis

Expanding chronic hepatitis B (CHB) testing through effective implementation strategies in primary- and community-care setting is crucial for elimination. Our study aimed to determine the effectiveness of all available strategies in the literature and evaluate their specifications and implementation outcomes, thereby informing future programming and policymaking. We conducted a systematic review and meta-analysis (PROSPERO CRD42023455781), searching Scopus, Embase, PubMed, and CINAHL databases up to June 05, 2024, for randomized controlled trials investigating primary- and community-care-based implementation strategies to promote CHB testing. Studies were screened against a priori eligibility criteria, and their data were extracted using a standardized protocol if included. ROB-2 was used to assess the risk of bias. Implementation strategies' components were characterized using the Behavior Change Wheel (BCW) framework. Random-effect models were applied to pool the effectiveness estimate by strategy. Mixed-effect meta-regression was employed to investigate if effectiveness varied by the number of strategy's BCW components. 7146 unique records were identified. 25 studies were eligible for the review, contributing 130,598 participants. 19 studies were included in the meta-analysis. No studies were conducted in low-and-middle-income countries. Implementation outcomes were reported in only ten studies (40%). Community-based strategies included lay health workers-led education (Pooled Risk Difference=27.9% [95% Confidence Interval=3.4-52.4], I2=99.3%) or crowdsourced education on social media (3.1% [-2.2 to 8.4], 0.0%). Primary care-based strategies consisted of electronic alert system (8.4% [3.7-13.1], 95.0%) and healthcare providers-led education (HCPs, 62.5% [53.1-71.9], 27.5%). The number of BCW-framework-driven strategy components showed a significant dose-response relationship with effectiveness. HCPs-led education stands out, and more enriched multicomponent strategies had better effectiveness. Future implementation strategies should consider critical contextual factors and policies to achieve a sustainable impact towards hepatitis B elimination targets. Tran Dolch Post-Doctoral Fellowship in Hepatology, Johns Hopkins University School of Medicine, Baltimore MD, USA.

The horizontal tensor complementarity problem

This article explores a new type of nonlinear complementarity problem, namely the horizontal tensor complementarity problem (HTCP), which is a natural extension of the horizontal linear complementarity problem studied in Sznajder [Degree-theoretic analysis of the vertical and horizontal linear complementarity problems [Ph.D. Thesis]. University of Maryland Baltimore County; 1994]. We extend the concepts of R 0 , R and P pairs from a pair of linear transformations given in Chi et al. [The weighted horizontal linear complementarity problem on a Euclidean Jordan algebra. J Global Optim. 2019;73:153–169] to a pair of tensors. When a given pair of tensors has these properties, we use degree-theoretic tools to discuss the existence and boundedness of solutions to the HTCP. Finally, we study a uniqueness result of the solution of the HTCP.

Racial capitalism and firearm violence: Developing a theoretical framework for firearm violence research examining structural racism

Despite the early promise of centering structural racism in explanatory models of firearm violence, there are noticeable gaps in what's been produced thus far; in particular, a deeper and more serious engagement with long-standing theories of racism is needed to further enrich our understanding of how structural inequalities produce unequal burdens of firearm-related harms. Thus, building on theories and concepts from a range of academic fields and Black philosophical perspectives, we developed a theoretical framework to help explain the role of place-based structural racism on firearm violence disparities. A central component of our framework is the concept racial capitalism, which contends that racial exploitation and the accumulation of assets depend on and reinforce one another. In this article, we present our framework and highlight how two processes related to racial capitalism—racialized dispossession and racialized spatial stigma—are connected with geographic disparities in firearm violence. We also present the results of an ecological cross-sectional study that reveals a potential key association between racial capitalism and firearm violence disparities on the neighborhood-level. We used a structural intersectionality approach and descriptive epidemiological methods to highlight and quantitatively describe spatial firearm violence disparities that could potentially be linked to the varying exposure of two dimensions of racial capitalism—historical redlining and contemporary racialized subprime mortgage lending. We found that sustained disadvantaged census tracts (tracts that were historically redlined and experienced higher contemporary subprime lending) experienced the highest burden of firearm violence in Baltimore City between 2015 and 2019. Our research suggests that racial capitalism could potentially be a root cause of firearm violence disparities. A theoretical framework based on racial capitalism can inform the development and usage of indicators and analytic methods for racism-related firearm violence research. Moreover, this framework can identify factors to prioritize in equity-based violence prevention policies and programs.

Shaping Baltimore’s urban forests: past insights for present-day ecology

ContextLand use history of urban forests impacts present-day soil structure, vegetation, and ecosystem function, yet is rarely documented in a way accessible to planners and land managers.ObjectivesTo (1) summarize historical land cover of present-day forest patches in Baltimore, MD, USA across land ownership categories and (2) determine whether social-ecological characteristics vary by historical land cover trajectory.MethodsUsing land cover classification derived from 1927 and 1953 aerial imagery, we summarized present-day forest cover by three land cover sequence classes: (1) Persistent forest that has remained forested since 1927, (2) Successional forest previously cleared for non-forest vegetation (including agriculture) that has since reforested, or (3) Converted forest that has regrown on previously developed areas. We then assessed present-day ownership and average canopy height of forest patches by land cover sequence class.ResultsMore than half of Baltimore City’s forest has persisted since at least 1927, 72% since 1953. About 30% has succeeded from non-forest vegetation during the past century, while 15% has reverted from previous development. A large proportion of forest converted from previous development is currently privately owned, whereas persistent and successional forest are more likely municipally-owned. Successional forest occurred on larger average parcels with the fewest number of distinct property owners per patch. Average tree canopy height was significantly greater in patches of persistent forest (mean = 18.1 m) compared to canopy height in successional and converted forest patches (16.6 m and 16.9 m, respectively).ConclusionsHistorical context is often absent from urban landscape ecology but provides information that can inform management approaches and conservation priorities with limited resources for sustaining urban natural resources. Using historical landscape analysis, urban forest patches could be further prioritized for protection by their age class and associated ecosystem characteristics.

Officer gunpoint during police stops: Repercussions for youth mental health and perceived safety.

Youth-police contact is increasingly acknowledged as a stressor and a racialized adverse childhood experience that can undermine youths' mental health. The present study investigates a particularly distressing feature of youths' direct and witnessed in-person police stops-officer gunpoint (i.e., officers drawing of firearms and pointing them at youth, their peers, or other community members). We examine patterns of youths' officer gunpoint exposure and associations with youth mental health and safety perceptions. Data come from the Survey of Police-Adolescent Contact Experiences (SPACE), a cross-sectional survey of a community-based sample of Black youth ages 12-21 in Baltimore City, Maryland (n = 335), administered from August 2022 to July 2023. Findings indicate that ~33% of youth reporting in-person police stops had been exposed to officer gunpoint during stops. Officer gunpoint was significantly and positively associated with being male, unemployed, having an incarcerated parent, living in a neighborhood with greater disorder, and having been directly stopped by police, in addition to youth delinquency and impulsivity. Net of covariates, experiencing officer gunpoint was associated with a significantly higher rate of youth emotional distress during stops. Significant associations between officer gunpoint and youths' current police violence stress, police avoidance, and diminished safety perceptions also emerged and were largely explained by youths' heightened emotional distress at the time of police stops. Trauma-informed approaches are needed to mitigate the mental health harms of youth experiencing officer gunpoint.