Extreme Heat and Suicide Watch Incidents Among Incarcerated Men

A Critical Gap in Addressing Mental Health in Heat-Health Action Plans Worldwide

PURPOSE OF REVIEW

Extreme heat is associated with mental health conditions such as suicide, anxiety, and substance use disorders. However, the integration of mental health in heat-health planning remains limited and no comprehensive assessment of its inclusion exists to date. This review aims to (1) identify and categorize mental health-related content in heat-health action plans globally; and (2) analyze the gaps in included interventions related to extreme heat and mental health.

RECENT FINDINGS

A review of 83 heat-health action plans from 24 countries revealed that while 75.9% of plans mentioned mental health, only 31.3% acknowledged its specific impacts and 21.7% included targeted interventions. These plans covered approximately 2.2 billion people, representing about 26% of the 2024 global population. Most interventions were directed at the societal level, with limited attention to individual or community-level support. Individuals with mental illness were commonly grouped with other vulnerable populations without tailored support. Low-income countries were not represented, while 44 plans (53.0%) came from high- and upper-middle-income countries. Among lower-middle-income countries, most plans originated from India (35; 89.7%). Despite recognition of the impacts of extreme heat on mental health, heat-health action plans lack comprehensive strategies to address these risks. The findings highlight a broader challenge within climate adaptation policies, where the recognition of mental health risks is often not matched by necessary resources, planning, and interventions. Given the critical gaps in mental health inclusion, greater efforts and resources are needed to integrate targeted mental health strategies into heat-health plans and policies.

Associations Between Temperature and Location of Injury or Condition Among Heat-Related Emergency Department Visits

High ambient temperature poses significant health risk globally. However, the relative importance of different exposure pathways leading to health risks remains unclear. For 9 US states during 2016-2018, ED visit records for heat exhaustion and heat stroke (HEAT), fluid and electrolyte imbalance (FEI), volume depletion (VD), and acute kidney injury (AKI) were identified via diagnosis codes. Co-diagnosed Y92 subcodes (Y codes) were used to categorize the patient's location at the time of injury or condition. Logistic regressions were used to estimate nonlinear associations between same-day temperature and Y codes for 11 non-residential versus residential locations among heat-related ED visits, including stratified analyses by patient age, race, and ethnicity. Odds ratios (OR) were calculated between the 95th versus 50th percentile of temperature. Overall, higher temperature was associated with increased risks of ED visits with Y codes for non-residential locations. HEAT ED visits were more likely to have Y codes for streets compared to residential locations (OR:1.68, 95% CI: 1.12-2.51). Similarly, VD visits were more likely to have Y codes for industrial area (OR: 2.68, 95% CI: 1.98-3.63), farms (OR:7.66, 95% CI: 4.05-14.50), recreation areas (OR:2.25, 95% CI: 1.78-2.84), and streets (OR:1.54, 95% CI: 1.39-1.70), but were less likely to have Y codes for public places (OR: 0.89, 95% CI: 0.84, 0.94). Similar associations were observed for FEI and AKI ED visits. Locations associated with higher heat risks may be due to exposure outdoor temperature and activities, supporting the need to develop strategies and interventions that minimize heat exposure in these areas.

The Intersection of Climate Justice and Criminal Justice: Extreme Heat and Health Inequities in Carceral Facilities

This Viewpoint discusses the ways in which incarcerated individuals are negatively impacted by the consequences of climate change and steps carceral facilities and policymakers can take to mitigate extreme heat risks.

Cold-related Mortality in US State and Private Prisons: A Case-Crossover Analysis

BACKGROUND

Cold temperatures are associated with increased risk for cardiovascular and respiratory disease mortality. Due to limited temperature regulation in prisons, incarcerated populations may be particularly vulnerable to cold-related mortality.

METHODS

We analyzed mortality data in US prisons from 2001 to 2019. Using a case-crossover approach, we estimated the association of a 10 °F decrease in cold temperature and extreme cold (days below the 10th percentile) with the risk of total mortality and deaths from heart disease, respiratory disease, and suicide. We assessed effect modification by personal, facility, and regional characteristics.

RESULTS

There were 18,578 deaths during cold months. The majority were male (96%) and housed in a state-operated prison (96%). We found a delayed association with mortality peaking 3 days after and remaining positive until 6 days after cold exposure. A 10 °F decrease in temperature averaged over 6 days was associated with a 5.1% (95% confidence interval [CI]: 2.1%, 8.0%) increase in total mortality. The 10-day cumulative effect of an extreme cold day was associated with an 11% (95% CI: 2.2%, 20%) increase in total mortality and a 55% (95% CI: 11%, 114%) increase in suicides. We found the greatest increase in total mortality for prisons built before 1980, located in the South or West, and operating as a dedicated medical facility.

CONCLUSIONS

Cold temperatures were associated with an increased risk of mortality in prisons, with marked increases in suicides. This study contributes to the growing evidence that the physical environment of prisons affects the health of the incarcerated population.

Heat Waves and Adverse Health Events Among Dually Eligible Individuals 65 Years and Older

Importance

Extensive research has found the detrimental health effects of heat waves. However, a critical gap exists in understanding their association with adverse health events among older dually eligible individuals, who may be particularly susceptible to heat waves.

Objective

To assess the association between heat waves and adverse health events among dually eligible individuals 65 years and older.

Design, Setting, and Participants

This retrospective time-series study assessed the association between heat waves in warm months from 2016 to 2019 and zip code tabulation area (ZCTA)-day level adverse health events. Dually eligible individuals 65 years and older who were continuously enrolled in either a Medicare fee-for-service plan or a Medicare Advantage plan with full Medicaid benefits from May to September in any given year were identified. All ZCTAs in the US with at least 1 dually eligible individual in each study year were included. Data were analyzed from September 2023 to August 2024.

Exposure

Heat waves, defined as 3 or more consecutive extreme heat days (ie, days with a maximum temperature of at least 90 °F [32.2 °C] and in the 97th percentile of daily maximum temperatures for each ZCTA during the study period).

Main Outcomes and Measures

Daily counts of heat-related emergency department visits and heat-related hospitalizations for each ZCTA.

Results

The study sample included 5 448 499 beneficiaries 65 years and older in 28 404 ZCTAs across 50 states and Washington, DC; the mean (SD) proportion of female beneficiaries and beneficiaries 85 years and older in each ZCTA was 66% (7%) and 20% (8%), respectively. The incidence rate for heat-related emergency department visits was 10% higher during heat wave days compared to non-heat wave days (incidence rate ratio [IRR], 1.10; 95% CI, 1.08-1.12), and the incidence rate of heat-related hospitalizations was 7% higher during heat wave days (IRR, 1.07; 95% CI, 1.04-1.09). There were similar patterns in other adverse health events, including a 4% higher incidence rate of death during heat wave days (IRR, 1.04; 95% CI, 1.01-1.07). The magnitude of these associations varied across some subgroups. For example, the association between heat waves and heat-related emergency department visits was statistically significant only for individuals in 3 of 9 US climate regions: the Northwest, Ohio Valley, and the West.

Conclusions and Relevance

In this time-series study, heat waves were associated with increased adverse health events among dually eligible individuals 65 years and older. Without adaptation strategies to address the health-related impacts of heat, dually eligible individuals are increasingly likely to face adverse outcomes.

Spatiotemporal Facility-Level Patterns of Summer Heat Exposure, Vulnerability, and Risk in United States Prison Landscapes

Heat is associated with increased risk of morbidity and mortality. People who are incarcerated are especially vulnerable to heat exposure due to demographic characteristics and their conditions of confinement. Evaluating heat exposure in prisons, and the characteristics of exposed populations and prisons, can elucidate prison-level risk to heat exposure. We leveraged a high-resolution air temperature data set to evaluate short and long-term patterns of heat metrics for 1,614 prisons in the United States from 1990 to 2023. We found that the most heat-exposed facilities and states were mostly in the Southwestern United States, while the prisons with the highest temperature anomalies from the historical record were in the Pacific Northwest, the Northeast, Texas, and parts of the Midwest. Prisons in the Pacific Northwest, the Northeast, and upper Midwest had the highest occurrences of days associated with an increased risk of heat-related mortality. We also estimated differences in heat exposure at prisons by facility and individual-level characteristics. We found higher proportions of non-white and Hispanic populations in the prisons with higher heat exposure. Lastly, we found that heat exposure was higher in prisons with any of nine facility-level characteristics that may modify risk to heat. This study brings together distinct measures of exposure, vulnerability, and risk, which would each inform unique strategies for heat-interventions. Community leaders and policymakers should carefully consider which measures they want to apply, and include the voices of directly impacted people, as the differing metrics and perspectives will have implications for who is included in fights for environmental justice.

Health equity for people living in correctional facilities: Addressing bias, stigma, and dehumanization

Individuals living in carceral systems oftentimes are not prioritized in ways that ensure that their rights and dignity are protected. Many families and communities have been and continue to be separated and negatively impacted by disparities in judges’ sentencing practices resulting in inequities in treatment and outcomes. As we continue our series on learning the language of health equity, we elucidate health inequities for justices-involved individuals in correctional facilities. This paper contributes to systematically identifying the role of nurse researchers in eliminating health inequities for adults living in correctional health settings to improve health outcomes. It is our determined belief that only through heightening the awareness of nurses on workforce and public biases about people living in prison and their deservedness of compassionate care; advocating for the elimination of stigmatizing and dehumanizing care practices that are regularly levied on them across settings; and including them in health-related research, that we can achieve health equity for this population.

The Joint Effects of Thunderstorms and Power Outages on Respiratory-Related Emergency Visits and Modifying and Mediating Factors of This Relationship

BACKGROUND

While limited studies have evaluated the health impacts of thunderstorms and power outages (POs) separately, few have assessed their joint effects. We aimed to investigate the individual and joint effects of both thunderstorms and POs on respiratory diseases, to identify disparities by demographics, and to examine the modifications and mediations by meteorological factors and air pollution.

METHODS

Distributed lag nonlinear models were used to examine exposures during three periods (i.e., days with both thunderstorms and POs, thunderstorms only, and POs only) in relation to emergency department visits for respiratory diseases (2005-2018) compared to controls (no thunderstorm/no PO) in New York State (NYS) while controlling for confounders. Interactions between thunderstorms and weather factors or air pollutants on health were assessed. The disparities by demographics and seasons and the mediative effects by particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ) and relative humidity (RH) were also evaluated.

RESULTS

Thunderstorms and POs were independently associated with total and six subtypes of respiratory diseases in NYS [highest risk ratio (RR) = 1.12; 95% confidence interval (CI): 1.08, 1.17], but the impact was stronger when they co-occurred (highest RR = 1.44; 95% CI: 1.22, 1.70), especially during grass weed, ragweed, and tree pollen seasons. The stronger thunderstorm/PO joint effects were observed on chronic obstructive pulmonary diseases, bronchitis, and asthma (lasted 0-10 d) and were higher among residents who lived in rural areas, were uninsured, were of Hispanic ethnicity, were 6-17 or over 65 years old, and during spring and summer. The number of comorbidities was significantly higher by 0.299-0.782/case. Extreme cold/heat, high RH, PM 2.5 , and ozone concentrations significantly modified the thunderstorm-health effect on both multiplicative and additive scales. Over 35% of the thunderstorm effects were mediated by PM 2.5 and RH.

CONCLUSION

Thunderstorms accompanied by POs showed the strongest respiratory effects. There were large disparities in thunderstorm-health associations by demographics. Meteorological factors and air pollution levels modified and mediated the thunderstorm-health effects. https://doi.org/10.1289/EHP13237.