Stigma as a fundamental hindrance to the United States opioid overdose crisis response.

Alexander Tsai and co-authors discuss the role of stigma in responses to the US opioid crisis

The Case for Gun Policy Reforms in America

Debates about gun control often drift towards general arguments about whether guns make us safer or less safe, and gun control is equated with restricting gun ownership. However, with recent Supreme Court decisions overturning laws which ban firearm possession in the District of Columbia and Chicago, current gun control policies in the U.S. do not disarm lawabiding adults over the age of 21. Rather, gun control laws today focus on one or more of four general objectives. These laws aim to:Define conditions that prohibit a person from possessing firearms;Implement regulations to prevent prohibited persons from possessing firearms;Restrict carrying of concealed firearms outside the home; andRegulate the design of firearms to enhance public and personal safety.In this report we draw upon research evidence to suggest how improvements in each of these types of gun policies could enhance public safety in the United States

Firearms on College Campuses: Research Evidence nad Policy Implications

This report reviews the evidence surrounding the relationship between civilian gun carrying and violent crime and mass shootings and factors that are unique to public safety on college campuses. Policies removing restrictions on civilian gun carrying are based on claims or assumptions about civilian gun use, the impact of state Right-to-Carry (RTC) laws, and the nature of mass shootings that are not supported by or are contrary to the best available research. The incidence of civilian self-defensive gun use (SDGU) is difficult to discern as available data are based on self-report, and distinguishing aggressor from victim in interpersonal altercations can be highly subjective. Nonetheless, data from the National Crime Victimization Survey indicate that SDGU is relatively rare (about 102,000 self-reported incidents per year affecting 0.9% of all violent crime victimizations) and is no more effective in reducing victims' risk of injury than other victim responses to attempted violent crimes. Research led by John Lott, author of More Guns, Less Crime, suggesting that RTC laws prevent violent crime has important flaws that biased his findings. The most recent and rigorous research on RTC laws that corrects for these flaws consistently finds that RTC laws are associated with more violent crime. These findings may seem counterintuitive because concealed-carry permit holders have, as a group, low rates of criminal offending and must pass a background check to ensure that they do not have any condition, such as a felony conviction, that prohibits firearm ownership. But, in states with low standards for legal gun ownership, legal gun owners account for the majority of persons incarcerated for committing violent crimes with firearms

Bringing an Effective Behavioral Weight Loss Intervention for People With Serious Mental Illness to Scale

People with serious mental illnesses (SMIs) die 10–20 years earlier than the general population, mainly due to cardiovascular disease. Obesity is a key driver of cardiovascular risk in this group. Because behavioral weight loss interventions tailored to the needs of people with SMI have been shown to lead to clinically significant weight loss, achieving widespread implementation of these interventions is a public health priority. In this Perspective, we consider strategies for scaling the ACHIEVE behavioral weight loss intervention for people with SMI, shown to be effective in a randomized clinical trial (RCT), to mental health programs in the U.S. and internationally. Given the barriers to high-fidelity implementation of the complex, multi-component ACHIEVE intervention in often under-resourced mental health programs, we posit that substantial additional work is needed to realize the full public health potential of this intervention for people with SMI. We discuss considerations for successful “scale-up,” or efforts to expand ACHIEVE to similar settings and populations as those included in the RCT, and “scale-out,” or efforts to expand the intervention to different mental health program settings/sub-populations with SMI. For both, we focus on considerations related (1) intervention adaptation and (2) implementation strategy development, highlighting four key domains of implementation strategies that we believe need to be developed and tested: staff capacity building, leadership engagement, organizational change, and policy strategies. We conclude with discussion of the types of future research needed to support ACHIEVE scale-up/out, including hybrid trial designs testing the effectiveness of intervention adaptations and/or implementations strategies

Need for Cardiovascular Risk Reduction in Persons With Serious Mental Illness: Design of a Comprehensive Intervention

Persons with serious mental illness (SMI) comprise a high-risk group for cardiovascular disease (CVD)-related mortality with rates at least twice those of the overall US. Potentially modifiable CVD risk behaviors (tobacco smoking, obesity, physical inactivity, unhealthy diet) and risk factors (hypertension, diabetes, dyslipidemia) are all markedly elevated in persons with SMI. Evaluations of programs implementing integrated medical care into specialty mental health settings have not shown meaningful effects on CVD risk factor reduction. Rigorously tested, innovative interventions are needed to address the large burden of CVD risk in populations with SMI. In this article, we describe the design of a comprehensive 18-month intervention to decrease CVD risk that we are studying in a randomized clinical trial in a community mental health organization with psychiatric rehabilitation programs. The individual-level intervention incorporated health behavior coaching and care coordination/care management to address all seven CVD risk behaviors and risk factors, and is delivered by a health coach and nurse. If successful, the intervention could be adopted within current integrated care models and significantly improve the physical health of persons with SMI

The stigma turbine:A theoretical framework for conceptualizing and contextualizing marketplace stigma

Stigmas, or discredited personal attributes, emanate from social perceptions of physical characteristics, aspects of character, and “tribal” associations (e.g., race; Goffman 1963). Extant research emphasizes the perspective of the stigma target, with some scholars exploring how social institutions shape stigma. Yet the ways stakeholders within the socio-commercial sphere create, perpetuate, or resist stigma remain overlooked. We introduce and define marketplace stigma as the labeling, stereotyping, and devaluation by and of commercial stakeholders (consumers, companies and their employees, stockholders, institutions) and their offerings (products, services, experiences). We offer the Stigma Turbine (ST) as a unifying conceptual framework that locates marketplace stigma within the broader sociocultural context, and illuminates its relationship to forces that exacerbate or blunt stigma. In unpacking the ST, we reveal the critical role market stakeholders can play in (de)stigmatization, explore implications for marketing practice and public policy, and offer a research agenda to further our understanding of marketplace stigma and stakeholder welfare