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If you think your child Symptoms has Pertussis: Your child may first have a runny nose proven 5 mg proscar prostate cancer young man, sneezing order generic proscar online androgen hormone 2nd, mild cough, and possibly fever. Childcare and School: If your child has been infected, it may take 5 to 21 days (usually 7 to 10 days) for symptoms to start. If staff or children are not Contagious Period treated, they need to stay From the time of the first cold-like symptoms until 21 home until 21 days after days after coughing begin. Call your Healthcare Provider If someone in your home has: ♦ had a cough 7 or more days. Antibiotics will reduce the contagious period, but may do little to relieve your child’s cough. Also, if public health has recommended that antibiotics are needed because of an exposure. Age appropriate pertussis vaccine should be administered in the absence of documented laboratory confirmed disease. Pinworms are most often found in preschool and school-aged children and their parents. These small worms are found in the human intestine and crawl out of the rectum at night to lay eggs on the anal area. Spread can also occur when infected people do not wash their hands well after scratching the anal area and then touch food or other objects, which are then eaten or touched by an uninfected person. Wash hands thoroughly with soap and warm running water after using the toilet, after contact with the anal area, handling bedding or underclothing, and before eating or preparing food. If you think your child Symptoms has Pinworms: Your child may have itching of the anal area, especially  Tell your childcare at night. Prevention  Wash hands after using the toilet or changing diapers and before preparing food or eating. Pneumococcal disease is an infection caused by a type of bacteria called Streptococcus pneumoniae (pneumococcus). There are different types of pneumococcal disease, such as pneumococcal pneumonia, bacteremia, meningitis, and otitis media. More serious pneumococcal infections include lung infection (pneumonia), bloodstream infection (septicemia), and infection of the brain (meningitis). Spread may occur when a “carrier” of the pneumococcus bacteria coughs or sneezes the bacteria into the air and another person breathes them in. By touching the secretions from the nose and mouth of an infected/colonized person then touching your eyes, nose, or mouth. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth. Infection If you think your child has Symptoms a Pneumococcal Infection: Your child may have fever, ear pain, or pull on their  Tell your childcare ear. Call your Healthcare Provider ♦ If your child has a high fever or ear pain that does not stop. Smoke increases the risk for serious respiratory infections and middle ear infections. Pneumonia can be a complication of other illnesses and can occur throughout the year. Infants and young children who experience common respiratory viruses and are exposed to second-hand tobacco smoke are at increased risk of developing bronchiolitis, bronchitis, pneumonia, and middle ear infections. Most of these viruses or bacteria can cause other illnesses, and not all persons exposed to them will develop pneumonia. Spread may also occur by touching the hands, tissues, or other items soiled with nose and mouth secretions from an infected person and then touching your eyes, nose, or mouth. Wash hands thoroughly with soap and warm running water after touching the secretions from the nose or mouth. If you think your child Symptoms has Pneumonia: Your child may have a runny nose, cough, fever, rapid  Tell your childcare breathing, and chest pain. Childcare and School: Yes, until fever is gone Contagious Period and your child is healthy enough for routine Shortly before and while your child has symptoms. Antibiotics do not work for illnesses caused by a virus, including colds and certain respiratory infections. Smoke increases the risk for serious respiratory infections and middle ear infections. Infants and young children who experience common respiratory infections and are also exposed to second-hand tobacco smoke are at increased risk of developing bronchiolitis, bronchitis, pneumonia, and middle ear infections. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth. Infection If you think your child has Symptoms a Respiratory Infection: Symptoms may include a runny nose, chills, muscle aches, and a sore throat. Your child may sneeze and  Tell your childcare cough and be more tired than usual. Antibiotics do not work for illnesses caused by a virus, including colds and respiratory infections. Smoke increases the risk for serious respiratory infections and middle ear infections. It is the most common cause of bronchiolitis and pneumonia in infants and children under 2 years of age. Infants infected during the first few weeks of life may only show tiredness, irritability, and loss of appetite and may have episodes where they stop breathing for short time periods (apnea) with few other respiratory signs. However, severe lower respiratory tract disease may occur at any age, especially in the elderly or those with heart, lung, or immune system problems. By touching the secretions from the nose and mouth of an infected person and also by touching hands, tissues, or other items soiled with these secretions and then touching your eyes, nose, or mouth. The virus can live on hands for one-half hour or more and on environmental surfaces for several hours. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth. Yes, until fever is gone If your child is infected, it may take 2 to 8 days for and the child is healthy symptoms to start. Infants who are hospitalized may be treated with a special medication called an antiviral drug. The scalp infection is most common in children, whereas infection of the feet is more common in adolescents and adults. It often begins as a small scaly patch on the scalp and may progress to larger areas of scaling. Serious problems can include bacterial skin infection (cellulitis) and fungal infections of the toenails. Any child with ringworm should not participate in gym, swimming, and other close contact activities that are likely to expose others until after treatment has begun or the lesions can be completely covered. Sports: Follow athlete’s healthcare provider’s recommendations and the specific sports league rules for return to practice and competition. Oral medications may need to be taken for 6 to 8 weeks for severe or recurring problems. If the pet has ringworm, children should not be allowed to have contact with the pet until the rash has been treated and heals.

Doppler studies demonstrate thickening purchase 5 mg proscar with amex mens health positions, shrinkage buy generic proscar 5 mg on-line prostate cancer va disability compensation, perforation or a tear in the and quantify the regurgitation. Causes include rheumatic heart disease (now itor the clinical effect of the valve lesion is to measure rare in the United Kingdom), infective endocarditis the left ventricular dimension. An end systolic dimen- occurring on a previously damaged or bicuspid aor- sion of over 5 cm indicates decompensation. Causes include se- infective endocarditis should be administered when vere hypertension, dissecting aneurysm and Marfan’s appropriate. It is only when volume overload is heart size or diminishing left ventricular function are excessive and chronic that the left ventricle fails. The indications for surgical intervention usually by valve first sign of this decompensation is a reduction in the replacement. There is also reduced coronary artery perfusion with associated increased risk of myocardial ischaemia. Prognosis Mild or moderate aortic regurgitation has a relatively good prognosis and thus surgical intervention is not Clinical features required. However, it is important to perform surgical Aortic regurgitation is asymptomatic until left ventricu- correction before irreversible left ventricular failure lar failure develops. Onexamination there is a large volume pulse, which is collapsing in char- acter (see page 27). The blood pressure has a wide pulse Aortic stenosis pressure (high systolic and low diastolic pressure). Various signs of the high-velocity blood flow Aortic stenosis is a pathological narrowing of the aortic have been described but are rare. There is however turbulent r Echocardiography is diagnostic, often showing cusp flow across these valves, which become thickened and thickening and calcification. Severe stenosis may develop over a period of the degree of stenosis and can measure left ventricular 20–30 years. It may lead to thicken- r Treatment includes management of angina and car- ing and calcification of the aortic valve, which is often diac failure. This pres- r Severe stenosis (pressure gradient over 60 mmHg) or sure overload results in left ventricular hypertrophy and symptomatic stenosis are indications for surgery (see arelative ischaemia of the myocardium with associ- page 30). As the stenosis becomes more severe, re- but this is increased if coronary artery bypass is also duced coronary artery perfusion exacerbates myocardial required. Balloon valvuloplasty may be used in pa- ischaemia even if the coronary arteries are normal. Im- tients unfit for surgery or to improve cardiac function paired left ventricular emptying is most apparent dur- prior to surgery. Ischaemia and hypertrophy of the left ventricle may lead Prognosis to arrhythmias and left ventricular failure. Clinical features Patients are asymptomatic until there is severe steno- sis when they present with exercise-induced syncope, Pulmonary stenosis angina or dyspnoea. Narrowing of the pulmonary valve, resulting in pressure On examination the pulse is low volume and slow ris- overload of the right ventricle. On palpation there may be an aortic systolic thrill felt in the right second intercostal space. Aetiology The apex is slow and thrusting in nature but not dis- This is almost invariably a congenital lesion either as an placed. On auscultation there may be a systolic ejection isolated lesion or as part of the tetralogy of Fallot. Rarely click, followed by a mid-systolic ejection murmur heard itmaybeanacquiredlesionsecondarytorheumaticfever best in the right second intercostal space and radiating or the carcinoid syndrome. The murmur is best heard with the patient leaning forward with breath held in expiration. Pathophysiology The obstruction to right ventricular emptying results Investigations in right ventricular hypertrophy and hence decreased r Chest X-ray may show a post-stenotic dilation of the ventricular compliance, which leads to right atrial ascending aorta and left ventricular hypertrophy. If severe, the condition leads to right Chapter 2: Rheumatic fever and valve disease 47 ventricular failure, often with accompanying regurgita- Aetiology tion of the tricuspid valve and signs of right-sided heart Tricuspid regurgitation can be divided into functional, failure. Patients with mild r Organic tricuspid regurgitation occurs with rheuma- pulmonary stenosis are asymptomatic (diagnosed inci- tic mitral valve disease, infective endocarditis and the dentally from the presence of a murmur or the presence carcinoid syndrome. Patients the tricuspid valve is seen particularly in intravenous mayhavenon-specificsymptomssuchasfatigueordysp- drug abusers. Syncope is a sign of critical stenosis, which requires plasia of the tricuspid valve with abnormal valve urgent treatment. Auscultation reveals a click and harsh Pathophysiology mid-systolic ejection murmur heard best on inspiration Regurgitation of blood into the right atrium during sys- in the left second intercostal space often associated with tole results in high right atrial pressures and hence right a thrill. A left parasternal heave may also be felt due to atrial hypertrophy and dilatation. In the chronic un- cases intervention is required before decompensation of treated patient there can be hepatic cirrhosis from the the right ventricle occurs. Echocardiography is diagnostic and is also essential to assess right ventricular function. Tricuspid regurgitation Definition Management Retrograde blood flow from the right ventricle to the Functional tricuspid regurgitation usually resolves with rightatrium during systole. Severe organic tricuspid 48 Chapter 2: Cardiovascular system regurgitation or refractory functional regurgitation may Sinus nodal arrhythmias require operative repair (or rarely replacement). Cardiac arrhythmias A cardiac arrhythmia is a disturbance of the nor- Aetiology mal rhythm of the heart. Tachycardias are also subdivided according to their Clinical features origin: Most patients are asymptomatic but occasionally post- r Sinustachycardia. If bradycardia is episodic and severe, syncope r Ventricular tachyarrhythmias such as ventricular may occur. However, in patients with bundle branch block Most cases do not require treatment other than with- and in cases where the rapid rate of supraventricu- drawal of drugs or treatment of any underlying cause. Chapter 2: Cardiac arrhythmias 49 Sinus tachycardia rate may be regular, bradycardic, tachycardic or variable with pauses. Carotid sinus massage typically leads to a Definition sudden and sometimes prolonged sinus pause. Aetiology/pathophysiology Sinustachycardia is a physiological response to main- tain tissue perfusion and oxygenation. Causes include Complications exercise, fever, anaemia, hypovolaemia, hypoxia, heart The most important complication is cardiac syncope, as failure, hyperthyroidism, pulmonary embolism, drugs in other forms of bradycardia. Clinical features Investigations Palpitations with an associated rapid, regular pulse rate. In addition anti-arrhythmic drugs may be required to Management controlanytachycardia. Atrial arrhythmias Sinus node disease Atrial ectopic beats Definition Sinusnode disease or sick sinus syndrome is a tachy- Definition cardia/bradycardia resulting from damage to the sinus Atrial ectopic beats include extrasystoles and premature node. Aetiology/pathophysiology Aetiology Sinusnode disease is relatively common in the elderly Atrial ectopics are common in normal individuals.

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Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www order 5mg proscar free shipping prostate zoloft. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www cheap 5mg proscar fast delivery prostate questions. Table 5-2 provides guidance on the interpreta- tion of hepatitis B serologic test results. Cost-effectiveness data on the use of laboratory testing in particular at- risk populations are available. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Reactivations have also been reported to occur with other types of immunosuppressives, notably anti–tumor- necrosis factor therapy for rheumatoid arthritis and infammatory bowel disease (Esteve et al. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Research to develop a vaccine for hepatitis C continues although it is unlikely that a vaccine will be developed and licensed in the near future. Given the com- plexity of the issues surrounding vaccination of children and adults, this report devotes a separate chapter (Chapter 4) to immunization. Support for abstinence is an element of harm reduction but is not a requirement for participation in harm-reduction programs. Harm reduction focuses on providing information about safer practices (for ex- ample, how to inject without exposing oneself to contaminated blood), providing materials for engaging in safer practices (such as needle syringes and condoms), and offering hepatitis B vaccination. Because harm reduc- tion does not condemn illicit-drug use and instead seeks practical solutions to mitigate its harmful consequences, these programs can be controversial (Des Jarlais et al. The guidelines are updated regularly to refect advances in care and should be referred to as the basis of appropri- ate medical management. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. In addition, any pa- tient who has stigmata of liver disease—ascites, enlarged spleen, jaundice, or encephalopathy—or a platelet count below 100,000 (which is a sign of possible splenomegaly) should be referred immediately to a specialist. The primary care provider should take a his- tory and perform a physical examination with emphasis on symptoms and signs of liver disease. Patients found to have signs or symptoms of liver disease or a low platelet count (below 100,000) should be referred to a specialist who has experience in managing persons with advanced hepatitis C. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. For genotype 1 patients, it may be preferable frst to do a liver biopsy to determine the degree of liver involvement and scarring before making a decision about whether treatment should be considered sooner rather than later. Finally, primary care providers should counsel patients to abstain from, or at least limit, alcohol consumption be- cause heavy alcohol use is the greatest contributor to the rate of progressive liver fbrosis. Because patient characteristics that are associated with not responding to treatment generally are associated with not receiving treatment, it is diffcult to ascertain from available research fndings the degree to which lower up- take into treatment represents discrimination against minority populations or appropriate implementation of treatment guidelines. For example, in another study of veterans, less treatment was received by minority-groups members and by persons who were older, who had a history of drug and alcohol use, or who had comorbid illnesses (Butt et al. However, researchers found that in a large national cohort of veterans less than one-fourth of the patients who began treatment for chronic hepatitis C completed a 48-week course. The major predictors of treatment noncompletion were pretreatment anemia and depression (Butt et al. For example, a study found that Hispanic patients were more likely to be candidates for treatment but were Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Another study found that blacks and Hispanics were 24–27% less likely than whites to receive surgi- cal therapy (Sonnenday et al. Once researchers controlled for receipt of treatment, the difference in mortality in black patients was no longer signifcant (Davila and El-Serag, 2006). Those data on racial and ethnic disparities in the outcomes of and treatments for chronic hepatitis underscore the need for additional research to understand the biologic and societal basis of the disparities. They also indicate the urgency of new policies that ensure that optimal medical care is given to all without regard to race or ethnicity. Although treatment costs are high, some studies have found that treat- ment can be cost-effective. In particular, several studies compared the costs Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. There is evidence that people’s ability to pay affects whether they seek and receive appropriate medical care for chronic hepatitis B and hepatitis C. The committee recognizes that uncertainties in funding and health-care reform may make implementation of such a pro- gram challenging. General Population Various factors can lead to diffculties in accessing screening, preven- tion, testing, and care related to viral hepatitis. Obstacles to obtaining such services may be limitations in private or public insurance coverage and cost- sharing, lack of access to public health insurance, lack of public funding to support implementation of state viral hepatitis plans, lack of hepatitis awareness and health literacy, inadequacy of sites or practice settings where health-care services are received, transportation needs, social stigmas, fear of legal prosecution related to drug use and immigration, and such cultural factors as religious beliefs, beliefs about biologic products, health percep- tions, and language. Among those, however, the most important barriers to receipt of existing services are inadequacy of health-insurance coverage and lack of money to pay for services. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. As discussed in Chapter 4, health insurance must provide strong coverage for immunization, counseling services, medical treatment, and prescription drugs, or the insurance’s cost-sharing features will prevent use of services. High deductibles (amounts to be paid out of pocket before coverage begins) or beneft limits are common in insurance policies that are provided by medium and small employers or in-network plans (which provide different coverage in network from out of network). The current fragmentation of viral hepatitis services involving vaccina- tion, risk-factor screening, laboratory testing, and medical management is a major obstacle to the effective delivery of needed services and makes com- pliance more diffcult. The lack of coordination between services can inhibit use by requiring people to travel to multiple sites to obtain care, impairs the development of trusting relationships among multiple providers, and taxes a health system’s ability to transfer information where and when it is needed for good clinical care. One important consequence of the fragmentation of viral-hepatitis ser- vices is inconsistency in referral of people who have chronic viral hepatitis for appropriate medical care. That gap refects defciencies primary-care providers’ knowledge, and it can be substantial when there are barriers, such as physical barriers (that is, screening and testing services in a different location from medical-management services), economic barriers, and cultu- ral barriers. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. In addition, it traced the outcome of therapy and continued to follow those who did not respond.

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The belief that severe sentences were needed to restore law and order to America reflected a “perfect storm” (Austin et al order proscar 5mg without a prescription mens health cover. As Reinarman and Levine have noted buy proscar 5mg line prostate 30cc, crack was a “godsend to the Right,” as it offered the opportunity to reinvigorate a conservative moral and political agenda (Reinarman and Levine 1997, p. A punitive response to crack was in perfect harmony with a politically vigorous assertion of “traditional family values”—individual moral discipline and abstinence—and with the demand for serious consequences for those who failed to conform to them, including hippies, war protesters, and restive black youth. Subscriber: Univ of Minnesota - Twin Cities; date: 23 October 2013 Race and Drugs Democrats who were anxious and angry about their declining status in the post civil rights era. Avoiding explicit racial appeals to resentful whites, the strategy relied on racially coded messages about drugs, crime, and welfare (Beckett 1999; Tonry 2011). A “seemingly race- neutral concern over crime” became a vehicle to continue to fight racial battles (Loury 2008, p. Not to be outdone by the Republicans, the Democrats became equally fervent apostles of tough-on-crime policies. With little debate or reflection, the federal and state governments responded to crack specifically and drug use more generally with soaring law enforcement budgets and ever more punitive laws and policies that increased arrests of low-level drug offenders, the likelihood of a prison sentence upon conviction of a drug offense, and the lengths of prison sentences. The federal Anti-Drug Abuse Act of 1986 and the Anti-Drug Abuse Act of 1988 imposed far higher penalties for the sale of crack cocaine than for powder cocaine. Under the notorious federal 100-1 law governing powder and crack sentences, federal defendants with 5 grams of crack cocaine received the same mandatory minimum 5-year sentence imposed on defendants with 500 grams of powder cocaine. Fourteen states also imposed harsher sentences for crack compared to powder cocaine offenses (Porter and Wright 2011), and all states ratcheted up sentences for drug law violations regardless of the drug involved (Human Rights Watch 2000, 2008; Mauer 2006). Harsh penalties for crack were easily enacted because that drug was uniquely linked in the mainstream’s collective consciousness with dangerous, poor, minority inner-city dwellers who supposedly threatened white suburban America. Federal District Judge Clyde Cahill described the racial underpinnings of federal crack sentencing legislation: The fear of increased crime as a result of crack cocaine fed white society’s fear of the black male as a crack user and as a source of social disruption. The prospect of black crack migrating to the white suburbs led the legislators to reflexively punish crack violators more harshly than their white, suburban, powder cocaine dealing counterparts. Clary 1994) When public officials, legislators, and the media talked about crack in terms of addiction and violence, the subtext was understood to be race: [C]rack cocaine was perceived as a drug of the Black inner-city urban poor, while powder cocaine, with its higher costs, was a drug of wealthy whites…. This framing of the drug in class and race-based terms provides important context when evaluating the legislative response. Even so, the racial underpinnings of the war on drugs have changed little (Loury 2008). As Loury observed, “the racial subtext of our law and order political discourse over the last three decades has been palpable” (Loury 2007, p. When Americans are asked to envision a drug offender, they see black men in urban alleyways, not white college kids in their dorms (Tonry 2011). Heightened media and political attention to substance abuse and the drug trade in urban minority neighborhoods has promoted the erroneous public perception that illegal drugs are more prevalent there than in more affluent white neighborhoods. Katherine Beckett’s Seattle research suggests that current racial disparities in drug arrests and case outcomes reflect images and concerns embedded in the national psyche during the “crack epidemic” in the 1980s (Beckett et al. Michelle Alexander insists the conflation of blackness with drug crime continues to provide “a legitimate outlet to the expression of antiblack resentment and animus—a convenient release valve now that explicit forms of racial bias are strictly condemned” (Alexander 2010, pp. Arrests and Imprisonment The modern war on drugs has resulted in a steep rise in the number of Americans arrested and locked up on drug charges. Although the total number of arrests nationwide increased by only 31 percent from 1980 to 2009, the number of drug arrests grew by 186 percent and the drug arrest rate increased from 256 per 100,000 persons to 542 (Snyder and Mulako-Wangota 2012b). Between 1980 and 2003, the number of drug offenders in state prisons grew twelvefold. In 2009, nearly one- quarter of a million persons (242,200) were serving time under state jurisdiction for drug offenses, making up 17. Subscriber: Univ of Minnesota - Twin Cities; date: 23 October 2013 Race and Drugs 1985 811,400 557,696 245,149 8555 69 30 1 1986 824,100 543,521 273,377 7203 66 33 1 1987 937,400 604,032 325,381 7988 64 35 1 1988 1,155,200 696,399 448,623 10,178 60 39 1 1989 1,361,700 797,072 556,579 8049 59 41 1 1990 1,089,500 641,096 439,981 8423 59 40 1 1991 1,010,000 582,731 418,598 8670 58 41 1 1992 1,066,400 625,326 431,249 9825 59 40 1 1993 1,126,300 674,756 440,899 10,644 60 39 1 1994 1,351,400 834,472 503,576 13,352 62 37 1 1995 1,476,100 910,293 550,247 15,559 62 37 1 1996 1,506,200 933,390 555,580 17,230 62 37 1 1997 1,583,600 988,840 575,274 19,485 62 36 1 1998 1,559,100 965,556 575,331 18,213 62 37 1 1999 1,557,100 982,494 555,636 18,971 63 36 1 2000 1,579,566 1,005,853 553,905 19,808 64 35 1 2001 1,586,902 1,014,107 552,382 20,413 64 35 1 2002 1,538,813 997,637 519,875 21,301 65 34 1 2003 1,678,192 1,097,610 557,171 23,411 65 33 1 2004 1,746,570 1,141,852 581,464 23,254 65 33 1 2005 1,846,351 1,202,924 617,744 25,683 65 33 1 2006 1,889,810 1,208,364 656,229 25,217 64 35 1 2007 1,841,182 1,179,813 636,337 25,032 64 35 1 2008 1,702,537 1,093,965 585,118 23,454 64 34 1 2009 1,663,582 1,086,003 554,105 23,475 65 33 1 Source: Snyder and Mulako‐Wangota 2012a. Arrests In 2010, the most recent year for which national drug arrest data are available, almost one in three drug arrestees was black (Federal Bureau of Investigation 2010). At no point since 1985 have blacks accounted for less than 30 percent of all drug arrests. Subscriber: Univ of Minnesota - Twin Cities; date: 23 October 2013 Race and Drugs Click to view larger Figure 1 Rates of Drug Arrests, by Race, 1980 to 2009 Note: National Estimated Source: Snyder and Mulako-Wangota 2012b. African Americans are arrested for drug offenses at much higher rates than whites, as Figure 1 shows. As of 2009, the ratio of black to white drug arrest rates was three to one (see Table 2). Between 1980 and 2009, the arrest rate for black Americans for drug law violations increased from 505 per 100,000 black population to 1,351. Drug Arrests by Race, 1980–2009 (Rates calculated per 100,000 residents of each race) Black rate White Rate Ratio of Black to White 1980 505 226 2. Subscriber: Univ of Minnesota - Twin Cities; date: 23 October 2013 Race and Drugs 2001 1,485 436 3. The preponderance of annual drug arrests since 1980 have been for drug possession, not sales (Human Rights Watch 2009). Black arrest rates for possession began at twice the white rate in 1980, and after rising and falling, were three times the white rate in 2009 (Snyder 2011). In 2009, the black arrest rate for sales was four times greater than the white rate (Snyder 2011). According to Human Rights Watch (2009), there was not a single state in the country in 2006 in which white arrest rates for drug charges equaled those for blacks. In nine states, blacks were arrested on drug charges at rates more than seven times white rates. In each of 43 cities examined by the Sentencing Project, blacks in 2003 were arrested at higher rates than whites, ranging from a high of 8. Between 1980 and 2003, the black-to-white ratio of drug arrests increased in all but five of the cities, and it doubled in 21 cities (King 2008, pp. Beckett, Nyrop, and Pfingst (2006) calculated black and white drug arrest rates and ratios in 18 mid-sized cities in 2000 and found ratios ranging from 1. In the 75 largest counties, 49 percent of felony drug defendants are non-Hispanic blacks and 26 percent are non- Hispanic whites (Cohen and Kyckelhahn 2010). Incarceration The racial disparity evident in drug arrests increases as cases wend their way through the criminal justice system. Black defendants constitute 44 percent and white defendants 55 percent of persons convicted of drug felonies in state courts. Among defendants convicted of drug felonies, 61 percent of whites and 70 percent of blacks are sentenced to incarceration. Whites sentenced to incarceration for drug felonies received a mean maximum sentence length of 29 months, compared with 34 months for blacks (Durose, Farole, and Rosenmerkel 2009). As Table 3 shows, the number of African Americans admitted to state prison as new court commitments on drug charges has consistently exceeded the number of whites during the past 10 years. Subscriber: Univ of Minnesota - Twin Cities; date: 23 October 2013 Race and Drugs Table 3 State Prison Admissions for Drug Offenses by Race, 2000–2009 White Black Other* 2000 28,784 49,714 723 2001 29,704 49,798 797 2002 33,777 52,275 869 2003 34,958 49,285 876 2004 34,377 42,859 879 2005 40,707 43,251 1,024 2006 40,519 45,217 1,079 2007 35,364 45,174 1,084 2008 32,459 43,259 1,036 2009 31,380 40,790 828 (*) Includes some persons of Hispanic origin; however, there are additional persons of Hispanic origin who are new court commitments who were not categorized as to race and who are not included in these figures.