Monique Jindal

OBJECTIVE: To provide a research agenda and recommendations to address inequities in access to health care. DATA SOURCES AND STUDY SETTING: The Agency for Healthcare Research and Quality (AHRQ) organized a Health Equity Summit in July 2022 to evaluate what equity in access to health care means in the context of AHRQ's mission and health care delivery implementation portfolio. The findings are a result of this Summit, and subsequent convenings of experts on access and equity from academia, industry, and the government. STUDY DESIGN: Multi-stakeholder input from AHRQ's Health Equity Summit, author consensus on a framework and key knowledge gaps, and summary of evidence from the supporting literature in the context of the framework ensure comprehensive recommendations. DATA COLLECTION/EXTRACTION METHODS: Through a stakeholder-engaged process, themes were developed to conceptualize access with a lens toward health equity. A working group researched the most appropriate framework for access to care to classify limitations identified during the Summit and develop recommendations supported by research in the context of the framework. This strategy was intentional, as the literature on inequities in access to care may itself be biased. PRINCIPAL FINDINGS: The Levesque et al. framework, which incorporates multiple dimensions of access (approachability, acceptability, availability, accommodation, affordability, and appropriateness), is the backdrop for framing research priorities for AHRQ. However, addressing inequities in access cannot be done without considering the roles of racism and intersectionality. Recommendations include funding research that not only measures racism within health care but also tests burgeoning anti-racist practices (e.g., co-production, provider training, holistic review, discrimination reporting, etc.), acting as a convener and thought leader in synthesizing best practices to mitigate racism, and forging the path forward for research on equity and access. CONCLUSIONS: AHRQ is well-positioned to develop an action plan, strategically fund it, and convene stakeholders across the health care spectrum to employ these recommendations.

OBJECTIVES: Adverse childhood experiences (ACEs) are prevalent in the population and yield several adverse consequences for child health and development as they accumulate. The objective of the current study is to examine the association between ACEs and adolescent police contact using a national, longitudinal study of adolescents born in the United Kingdom. METHODS: Data come from a sample of 11 313 adolescents who participated in the UK Millennium Cohort Study (MCS), which is a national, longitudinal study of adolescents born in the United Kingdom between 2000 and 2002. Accumulating ACEs were measured at ages 5 and 7 years and reports of police contact were measured at age 14 years, including being stopped and questioned, warned/cautioned, and arrested. RESULTS: Accumulating ACEs at ages 5 and 7 years are associated with a significant increase in the odds of experiencing police stops by age 14 years, with 3 or more ACEs corresponding to a 100% increase in the odds of police stops. Additional analyses reveal that behavioral health factors at age 11 years explain 58.5% to 78.1% of the association between ACEs and adolescent police stops, with externalizing behavior explaining the largest portion of the association. Finally, accumulating ACEs were most relevant to being warned/cautioned or arrested by police. CONCLUSIONS: A history of accumulating ACEs during early childhood elevates the likelihood of police contact by age 14 years, in part by undermining behavioral health. Findings highlight the potential for early interventions in the lives of ACE-exposed adolescents to curtail justice system involvement.

Youth-police encounters reflect a pivotal point for intervention to improve police-community relations. Data from 454 youths (M = 15.1 years) included brief written descriptions of positive and negative experiences with a police officer and perceptions of police using Likert-scale items. Participating youths described both positive (46%) and negative (60%) experiences with police. Besides decidedly positive experiences, youths also responded to the positive experiences prompt with ambiguous situations (46%) that involved the arrest of the youth or their family (procedural or distributive justice). Examples of ambiguous self-described positive experiences included, "Restraining order," "My dad went to prison," and "When I was arrested in location redacted, the officer was kind and didn't put me in cuffs." Results from regressions indicated youths' perceptions of police were more often associated with the absence of positive experiences than specific positive or negative experiences. Study findings have implications for police trainings and future research on youth-police encounters.