Coming home from jail: the social and health consequences of community reentry for women, male adolescents, and their families and communities

Reframing reentry: Understanding how reentry programming affects the well-being and quality of life of returning citizens

This study examined the experiences returning citizens (RCs) have in participating in different reentry programs and how these experiences may lead to improved well-being and quality of life (QOL). We conducted 14 semi-structured interviews with RCs participating in employment-oriented reentry programs. The interviews focused on participants' reentry programming experience and areas affecting their well-being (e.g., housing, education, financial stability). QOL was enhanced for RCs when they were able to access stable housing, develop supportive relationships, have a job that permitted them the resources needed to live independently, and increase their perceptions of self-efficacy and social capital. While reentry programs maintain a focus on employment for RCs, housing, healthy relationships, and opportunities for increasing self-efficacy and social capital are tied to well-being and QOL among RCs. Reentry programs have the potential to influence a variety of factors at multiple levels that shape well-being and QOL, and in turn employment and recidivism, among RCs.

"A Friendly Conversation." Developing an eHealth Intervention to Increase COVID-19 Testing and Vaccination Literacy Among Women with Criminal and Legal System Involvement

Many women leaving jails are ill-prepared to follow recommended COVID-19 mitigation practices, including testing and vaccination. Low COVID-19-related health literacy, exposure to disinformation, and mistrust in authorities put women at increased risk. Research on this population has shown significant use of mobile devices for communication and web access and public Wi-fi for the internet. Using inductive (formative empirical research with the community) and deductive (theory-based) practices, we designed, developed, and pilot-tested a multimedia, culturally tailored web-based electronic health (eHealth) application to increase COVID-19-specific health literacy and promote testing and vaccination among women with criminal and legal system involvement (CLSI). The intervention included a serialized animated multimedia component and a telenovela-style series, complementing each other and addressing knowledge needs identified in the formative research phase of the project. The eHealth intervention was pilot-tested with 13 CLSI women by using online activity logs and semi-structured telephone interviews. Findings confirmed that eHealth interventions employing multimodal information delivery had increased chances of engaging audiences, especially when developed with input from the target population and are culturally tailored. In addition, using a web-based delivery optimized for mobile made the intervention accessible on various devices and decreased the risk of technical problems.

Barriers and facilitators to health during prison reentry to Miami, FL

BACKGROUND

People face numerous barriers to reentry and community integration following incarceration, and these obstacles manifest themselves as barriers to economic stability, housing security, healthcare, community acceptance, and educational attainment, ultimately leading to poor health. This study aims to understand healthcare needs of reentrants post release within the unique political and service context of Miami Dade County, FL, and seeks to uncover the structural facilitators and barriers to sustaining health during reentry.

METHODS

We report on a subset of data from a larger reentry asset mapping project. We conducted a qualitative thematic analysis based on 12 semi-structured interviews with community stakeholders, including reentrants who were released in the past year (n = 5) and with community providers who have provided support services to returning citizens for at least one year (n = 7). Narratives were coded through an iterative process using NVivo software and were analyzed using the general inductive approach.

RESULTS

Three themes emerged from the analysis: (1) social and structural barriers and facilitators to health during reentry, (2) challenges with medical care following release, and (3) long-term impacts of receiving poor healthcare in prison. Reentrants describe the carceral environment as non-conducive to health and cite an urgent need for systemic change within correctional institutions to promote their well-being. Respondents identified substance use disorder (SUD) treatment, trauma informed therapy, and chronic disease management as the primary healthcare needs of reentrants, and cite social support, stable housing, education, and employment as the key social and structural needs upon release.

CONCLUSION

This study identifies prevalent resource gaps in Miami Dade County during reentry. Respondents advocate for more inclusive governmental housing programs, Medicaid expansion, and more holistic reentry programs to support reentrants. Understanding the barriers and facilitators to health during reentry can inform future interventions to better support reentrants in their transition post-incarceration.

Health Insurance and Mental Health Treatment Use Among Adults With Criminal Legal Involvement After Medicaid Expansion

OBJECTIVE

Individuals with criminal legal involvement have high rates of substance use and other mental disorders. Before implementation of the Affordable Care Act's Medicaid expansion, they also had low health insurance coverage. The objective of this study was to assess the impact of Medicaid expansion on health insurance coverage and use of treatment for substance use or other mental disorders in this population.

METHODS

The authors used restricted data (2010-2017) from the National Survey on Drug Use and Health (NSDUH). Using a difference-in-differences approach, the authors estimated the impact of Medicaid expansion on health insurance coverage and treatment for substance use or other mental disorders among individuals with recent criminal legal involvement.

RESULTS

The sample consisted of 9,910 NSDUH respondents who were ages 18-64 years, had a household income ≤138% of the federal poverty level, and reported past-year criminal legal involvement. Medicaid expansion was associated with an 18 percentage-point increase in insurance coverage but no change in receipt of substance use treatment among individuals with substance use disorder. Individuals with any other mental illness had a 16 percentage-point increase in insurance coverage but no change in receipt of mental health treatment.

CONCLUSIONS

Despite a large increase in health insurance coverage among individuals with criminal legal involvement and substance use or other mental disorders, Medicaid expansion was not associated with a significant change in treatment use for these conditions. Insurance access alone appears to be insufficient to increase treatment for substance use or other mental disorders in this population.

Durable Viral Suppression Among Young Adults Living with HIV Receiving Ryan White Services in New York City

Identifying factors associated with durable viral suppression (DVS) can inform interventions to support young adults living with HIV (YALWH) in sustaining optimal health. We examined associations between client characteristics and DVS among YALWH aged 18-29 who completed an intake assessment and received ≥ 1 Ryan White Part A service in New York City from 1/2017 to 12/2019. Individuals were classified as achieving DVS at least once if they had ≥ 2 suppressed viral load test results ≥ 90 days apart with: (a) no intervening unsuppressed viral load test results in a 12-month period; and (b) no unsuppressed viral load test results after achieving DVS in that 12-month period. Of 2208 YALWH, 92.1% (n = 2034) had sufficient data in the New York City HIV Surveillance Registry to ascertain DVS status. Of these, 68% achieved DVS at least once. Controlling for ART prescription status at intake, YALWH with higher incomes were significantly more likely to achieve DVS at least once. YALWH with lifetime and recent histories of incarceration and/or drug use were significantly less likely to achieve DVS. Our findings underscore the potential role of tailored harm reduction and post-incarceration programs in reducing health inequities among YALWH.

COVID-19 vaccine deliberation in individuals directly impacted by incarceration

Delays in vaccinating communities of color to COVID-19 have signaled a need to investigate structural barriers to vaccine uptake, with mass incarceration demanding greater characterization as a potential factor. In a nationally representative survey from February-March 2021 (N = 1,157), exposure to the criminal legal system, defined as having been incarcerated in prison or jail or having had a family member or close friend incarcerated, was associated with higher odds for COVID-19 vaccine deliberation. Individuals with criminal legal system exposure reported lower confidence in physician recommendation as a reason to get vaccinated. They were also more likely to decline vaccination out of fear it would cause COVID-19 infection, and that the vaccine might be promoted as a political tool. Our analysis suggests that populations impacted by the criminal legal system would benefit from targeted vaccine outreach by trusted community members who can address distrust during current and future pandemics.

Race, criminalization and urban mental health in the United States

PURPOSE OF REVIEW

As efforts to increase policing and roll back criminal legal system reforms in major U.S. cities rise, the collateral consequences of increased criminalization remain critical to document. Although the criminalization of mental illness has been well studied in the U.S., the mental health effects of criminalization are comparatively under-researched. In addition, despite extreme racial disparities in U.S. policing, there is limited understanding of how criminalization may contribute to racial disparities in mental health.

RECENT FINDINGS

Literature included in this review covers various types of criminalization, including direct and indirect impacts of incarceration, criminalization of immigration, first-hand and witnessed encounters with police, and the effects of widely publicized police brutality incidents. All forms of criminalization were shown to negatively impact mental health (depression, anxiety and suicidality), with evidence suggestive of disproportionate impact on Black people.

SUMMARY

There is evidence of significant negative impact of criminalization on mental health; however, more robust research is needed to address the limitations of the current literature. These limitations include few analyses stratified by race, a lack of focus on nonincarceration forms of criminalization, few longitudinal studies limiting causal inference, highly selected samples limiting generalizability and few studies with validated mental health measures.

Qualitative Analysis of Multiple Sources and Dimensions of Stigma Among Older Adults Living With HIV Infection Released From Corrections

While sources of stigma associated with HIV, incarceration, and aging have been explored separately, the concurrent effects of these multiple sources have been understudied. We conducted in-depth interviews with 48 older adults over 50 years of age with HIV infection who were returning from correctional settings concerning their experiences of stigma. Participants described HIV-related stigma substantially more often than incarceration-related stigma and a greater number of stigma experiences as time passed from release. Anticipated stigma experiences were frequently associated with HIV. Enacted stigma was often related to incarceration. Internalized stigma was associated with both HIV and incarceration. However, participants often described aging as a positive experience of gaining wisdom and control over their life. The findings indicated that multiple sources of stigma affect different dimensions of stigma. Postrelease interventions may benefit from addressing increasing experiences of stigma in the rapidly growing population of older adults living with HIV with a history of incarceration.

Inequalities in Cancer Stage at Diagnosis Among Incarcerated Individuals Undergoing Radiation Therapy at a Large Safety-Net Hospital

INTRODUCTION

There is a dearth of data on cancer care in the incarcerated population, despite being the leading cause of illness-related death in United states' prisons. We retrospectively reviewed the demographic and clinicopathologic characteristics of incarcerated individuals who received radiation therapy at a large safety-net hospital.

METHODS

Following IRB approval, we identified 80 incarcerated patients who presented for radiation therapy between January 2003 and May 2019. Descriptive statistics on the patients, tumor types and stage, treatment factors, and follow-up rates were analyzed.

RESULTS

80 individuals with 82 cancer diagnoses presented for radiation oncology consultation over the study period. The median age was 54 years (range, 46-64). Patients of White, Black, and "other" races comprised 61.3% (n=49), 28.8% (n=23), and 10% (n=8), respectively. Most patients were male (n=75, 93.8%) and English speakers (n=76, 95%). Moreover, 50% (n=40) had a substance use disorder history and 75% (n=60) had a smoking history. The three most common cancer types were prostate (n=12, 14.6%), gastrointestinal (n=14, 17.1%), thoracic (n=17, 20.7%), and head and neck (n=21, 25.6%). The distribution of tumor stage (AJCC) was I (n=12, 14.6%), II (n=12, 14.6%), III (n=14, 17.1%), IV (n=38, 46.3%), and unknown/unavailable (n=6, 7.3%). Of the cohort, 65 patients with 66 cancers (80.5%) received radiation. Among them, the 6-month, 1-year, and 5-year follow-up rates were 41.5%, 27.7%, and 3.1%, respectively. Subset analysis limited to stage I-III patients (n=30) revealed 6-month, 1-year and 5-year follow-up rates of 41.9%, 22.6%, and 3.2%, respectively.

CONCLUSIONS

This study highlights inequalities in cancer stage at diagnosis among a vulnerable patient population that is largely excluded from clinical research. Majority of the incarcerated patients presented with stage III & IV cancers and have poor follow up rates even among those with early-stage disease. Efforts to understand and mitigate persistent health inequalities among incarcerated patients are warranted.

Enhancing community integration after incarceration: findings from a prospective study of an intensive peer support intervention for veterans with an historical comparison group

BACKGROUND

The transition to the community after incarceration presents challenges for returning citizens, including the immediate need to secure housing, employment, and income. Additionally, health care is essential for this population due to high rates of chronic physical health and mental health problems and substance use disorders. There is growing recognition of the need for interventions that support returning citizens as they navigate community reintegration while simultaneously tending to physical and behavioral health needs. We developed and pilot tested a peer support intervention designed to provide social, emotional, and logistic support and promote linkage and engagement in healthcare for returning citizens. We tested the intervention with US military veterans in Massachusetts who were being released from prison and jail. Outcomes related to linkage to and engagement in healthcare were evaluated using an historical comparison group. Engagement in peer support, housing status, and reincarceration rates were monitored for the intervention group.

RESULTS

There were 43 veterans in the intervention group, and 36 in the historical comparison group. For linkage to primary care within 90 days of release, there were no statistically significant differences between the intervention and comparison groups (58% versus 67%). Intervention participants were significantly more likely to receive substance use treatment than the comparison group (86% versus 19%, p < .0001) and the mean monthly substance use visits was greater in the intervention group (0.96 versus 0.34, p < .007). Engagement in mental health services was greater for the intervention group than the comparison group (93% versus 64%, p < .003). There were no significant differences between groups for emergency department use and hospitalization. At the end of the study period, the majority of intervention participants who had been released for over a year were living in permanent housing (84%). Recidivism among the was low, with 7% re-arrested during the study period.

CONCLUSIONS

Augmenting reentry support through intensive peer support appears to have substantial benefits for veterans in terms of engaging them in health care and contributing to their longer-term stability, including housing and recidivism. Flexible reentry support such as this intervention may be well suited to meet the widely varying needs of returning citizens.

Policy Solutions to End Gaps in Medicaid Coverage during Reentry after Incarceration in the United States: Experts' Recommendations

Aims

We sought to gather experts' perspectives on Medicaid coverage gaps during reentry to identify high-yield policy solutions to improve the health of justice-involved individuals in the United States.

Subject and Methods

We interviewed 28 experts at the intersection of Medicaid and criminal justice via telephone between November 2018 and April 2019. Interviewees included Medicaid administrators, health and justice officials, policy makers, and health policy researchers. We performed thematic analysis of semi-structured interview transcripts to identify emergent themes and distill policy recommendations.

Results

Three themes emerged: 1) Medicaid coverage gaps during reentry contribute to poor health outcomes and recidivism, 2) Excessive burden on justice-involved people to re-activate Medicaid leads to coverage gaps, and 3) Scalable policy solutions exist to eliminate Medicaid coverage gaps during reentry. Policy recommendations centered on ending the federal "inmate exclusion," delaying Medicaid de-activation at intake, and promoting re-activation by reentry. Experts viewed coverage gaps as problematic, viewed current approaches as inefficient and burdensome to families and systems, and recommended several policy solutions.

Conclusion

By pursuing strategies to eliminate Medicaid gaps during reentry, policymakers can improve health outcomes and efficiency of government spending on healthcare, and may reduce cycles of incarceration.

"It was there when I came home": young adults and jail reentry in the context of COVID-19

In this study, the authors explore how young adults navigated the dual challenges of the COVID-19 pandemic and jail reentry in a large urban environment. Fifteen young adults (aged 18-25) participated in up to nine monthly semi-structured interviews to discuss their experiences of reentry during the height of the COVID-19 pandemic (i.e., spring and summer 2020). Participants held mixed attitudes and beliefs about COVID-19. Several participants viewed the pandemic as a hoax, while others took the pandemic more seriously, particularly if their friends and family members had contracted the virus. Yet nearly all participants viewed the pandemic as having a relatively minimal impact on their lives compared to the weight of their reentry challenges and probation requirements. Young adults described COVID-19 stay-at-home orders as limiting their exposure to negative influences and facilitating compliance with probation requirements. However, resource closures due to COVID-19, including schools, employment programs, and social services presented barriers to reentry success. The authors draw upon these findings to pose implications for interventions supporting young adult reentry.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12103-022-09683-8.

"A Catch-22": A Firsthand Account of Barriers and Facilitators to Accessing Health Care During Reentry

Although a history of incarceration is associated with poor long-term health status, the experience of seeking health care access during reentry is complex. Semistructured open-ended interviews were conducted among individuals with a recent history of incarceration (N = 20). The majority of participants were male (90%) and African American (80%). The majority (55%) had one or more chronic medical conditions, 40% reported active substance addiction, and 75% reported having a chronic psychiatric condition. In qualitative analysis, participants described the three biggest facilitators to accessing health care as eligibility for Medicaid, support through reentry organizations, and online resources. Participants said the major barriers to accessing health care were multiple and competing priorities, limitations of Medicaid, and lack of access to health records. Ensuring individuals with a history of incarceration are connected to the public assistance programs for which they are eligible is an important public health initiative and may facilitate successful reintegration.

Scoping review of interventions to link individuals to substance use services at discharge from jail

INTRODUCTION

Individuals with substance use disorders (SUD) must be linked to community-based SUD treatment and other services upon their release from jail, given their high service needs and risks for relapse, recidivism, and opioid-related overdose following release.

METHOD

This scoping review identified 14 studies (28 affiliated publications) that used experimental or quasi-experimental designs to evaluate jail re-entry interventions for individuals with SUD. The team coded intervention components, study characteristics, and study outcomes based on a service continuum for treatment linkage and retention and for post-release substance use and criminal justice outcomes.

RESULTS

This review included 4 randomized controlled trials (RCT) for linkage to treatment with medications for opioid use disorder (MOUD); 4 RCTs and 4 quasi-experimental studies for linkage to non-specific SUD treatment; and 2 RCTs for linkage to HIV + SUD services. Most studies (9/14) used case management and/or peer or patient navigation as the core intervention; 2 studies provided medical management for MOUD induction and/or facilitated referral to MOUD in the community; and 3 studies used motivational-based linkage interventions. A qualitative analysis of study outcomes found evidence to support the effectiveness of a diverse range of interventions to link individuals to community-based SUD treatment, MOUD, and other services at re-entry, but limited support for intervention effects on longer-term outcomes, including treatment retention, medication adherence, recidivism, and substance use.

CONCLUSION

Future controlled trials and implementation studies should help to unpack and examine core components of jail re-entry interventions and their successful implementation to enhance treatment retention and improve post-release outcomes.

Characteristics and Factors Associated With Intimate Partner Violence-Related Homicide Post-Release From Jail or Prison

Intimate partner violence (IPV) victimization and perpetration are common experiences among incarcerated people. Despite knowledge regarding the challenges of re-integrating post-release from jail or prison, including an increased risk of homicide victimization, there is a dearth of research focused on IPV-related homicides post-release from a correctional facility. To address this gap, the current study used 2003-2015 data from the National Violent Death Reporting System from 27 states to examine the characteristics and circumstances surrounding IPV-related homicides soon after the homicide victim was released from jail or prison. Of the 126 post-release homicides, 13.5% were related to IPV. Post-release homicides involving either a female victim or perpetrator were more likely to be IPV-related. In the case of many of the IPV-related homicides, there was evidence of prior IPV as well as potential bystanders (including formal and informal supports) who were aware of the risk for IPV escalation and possible lethality. Compared with non-IPV post-release homicides, those related to IPV were more likely to occur in the victim's home, have been immediately preceded by a physical fight, and have occurred by means other than firearm. These findings highlight the importance of enhancing the capacity of correctional facilities and community-based services to assess for and respond to risk of IPV and IPV-related lethality for individuals leaving correctional institutions.

Inpatient early intervention for serious mental illnesses and post-discharge criminal involvement in a high-volume psychiatric hospital setting

Individuals with serious mental illness (SMI) are at increased risk for arrest and incarceration relative to the same-community population without SMI. Publicly-funded inpatient psychiatric hospitals usually feature short lengths of stay and limited opportunities for extended services that might impact criminal justice involvement after discharge. This study examined the influence of an early intervention program for SMI at a high-volume public psychiatric hospital on involvement in the criminal justice system post-discharge. The Early Onset Treatment Program (EOTP) is an extended service intervention program for uninsured patients who are within 5 years of SMI onset. Criminal justice records (number of arrests with conviction, days of incarceration) were obtained for EOTP participants (n = 164) and comparison patients (n = 164) matched on demographics, diagnosis, and discharge date via propensity score matching. Data were zero-inflated and analyzed using hurdle models, controlling for prior arrests. The EOTP group was less likely to be convicted of at least one crime post-discharge (0 arrests vs. > 0, p < .001), and spent fewer days incarcerated (if incarcerated ≥1 day, p < .03). Participation in the EOTP service was linked to reduced likelihood of post-discharge arrest and days incarcerated. Several alternative variables may contribute to this preliminary observation, including length of stay, medication adherence, longer environmental stability, and individual patient characteristics.

First weeks out: Social support stability and health among formerly incarcerated men

RATIONALE

Social support has a lasting and robust impact on individuals' health, wellness, and longevity. Having social support and a reliable social network is especially important for individuals returning from prison. Upon release, individuals are often left with fragmented, if any, interpersonal relationships, which influences their overall health. When a released person's support network becomes erratic or unstable, they may be unlikely to successfully reintegrate. Additionally, the impediments and stressors associated with community reentry-particularly after a long prison sentence-impact released persons' ability to preserve their physical and mental health.

OBJECTIVE

The current study examines the effects of the stability of social support on physical and mental health in a sample of recently released men in Texas.

METHODS

Data are from the LoneStar Project, a longitudinal study of men released from prison, to examine the crucial nature of social support stability on health in a unique sample of reentering persons. Regression models are employed to examine the effect of diverse domains of social support stability on self-rated physical and mental health in the first few weeks after prison release.

RESULTS

Findings indicate that emotional and instrumental social support stability from family and friends is essential to positive self-assessments of mental health, but not physical health, among a group of recently incarcerated men.

CONCLUSIONS

Results regarding the intricacies of the pathway between various stable support types and mental health are discussed. Relevant practical implications include the need for quality mental health care that must begin during the prison term to minimize stressors associated with psychological health upon reentry. Policy-related ramifications comprise a push to establish support programs for families to develop positive support outcomes for the released person during the reentry process, enabling family members to attain practical skills to increase family and individual well-being long term.

Effectiveness of interpersonal psychotherapy for community living depressed women involved with the justice system

BACKGROUND

Despite the prevalence of depression among women in the justice system, and its potentially significant consequences, there is a dearth of studies investigating psychological treatments for depression in this context, especially outside prison.

AIMS

Our aim was to gather preliminary data on whether individual interpersonal psychotherapy (IPT) is an acceptable and effective treatment for depression in women at an early stage in the justice system.

METHOD

In this pilot study, IPT was offered to 24 depressed women following their first or second contact with the justice system. The women were assessed using a range of scales to quantify depression, anxiety, post-traumatic stress disorder (PTSD) and social support. Multilevel models were used to explore interactions between change in depression and other features given the multiplicity and complexity of problems. Details on engagement and attrition were also collected.

RESULTS

Therapy attrition was low, despite challenging life-circumstances and depression scores followed a linear trajectory with scores significantly decreasing over the time (β = -0.59, SE = 0.07, p < 0.001). Participants with more adverse life events, attachment related anxiety and lower social support had poorer outcomes.

CONCLUSIONS AND IMPLICATIONS

Results are encouraging. More than half of the hard-to-reach women who were eligible did engage, and retention rates suggest the therapy was acceptable to them. Depression scores improved, and potential factors affecting treatment outcome were identified. A randomised controlled trial is now warranted, ensuring adequate supplementary support for women with dependants living on their own and without employment.

HIV Risk-Related Behaviors and Willingness to Use Pre-Exposure Prophylaxis Among Black Americans with an Arrest History

OBJECTIVE

Black individuals in the USA are arrested and incarcerated at a significantly higher rate than White individuals, and incarceration is associated with increased HIV vulnerability. Pre-exposure prophylaxis (PrEP) reduces the risk for HIV transmission, but little is known about the relationship between HIV risk behavior and willingness to use PrEP among Black individuals with an arrest history.

METHOD

A total of 868 individuals completed a nationally representative survey and provided baseline data on sexual risk. Participants were grouped as those with a history of arrest (N = 226) and those with no history of arrest (N=619) based on self-reported arrest history. Our study examined HIV risk behaviors associated with willingness to use PrEP between those with arrest history and those without arrest history.

RESULTS

Participants with an arrest history were more likely to have a lifetime history of anal sex (p<0.0001) and sexually transmitted diseases (p=0.0007). A history of multiple sexual partners in the past 3 months was associated with PrEP willingness in individuals with an arrest history [aPR 2.61 (1.77, 3.85), p<0.0001], adjusting for other covariates in the model.

CONCLUSIONS

Differences in risk behavior and willingness to use PrEP exist by arrest history. Understanding these risk behaviors are necessary to increase access to PrEP. PrEP uptake and adherence interventions, when recommended and made available for individuals at substantive risk of HIV infection at the time of arrest and during incarceration, are essential to reducing the spread of HIV in correctional facilities and in communities to which they return.

Undoing resilience: immigrant status and poor health following incarceration

BACKGROUND

In the United States, foreign-born persons often have better health outcomes than their native-born peers, despite exposure to adversity. Nevertheless, it is unclear whether this pattern extends to the consequences of life events, such as incarceration, that separate immigrants from their supportive networks and increase exposure to adversity. Accordingly, using four waves of data from the National Longitudinal Study of Adolescent to Adult Health, hierarchical generalized linear models were used to examine within-individual changes in self-rated health following first incarceration (N = 31,202 person-waves).

RESULTS

The results showed that incarceration was associated with modest health declines that were similar in magnitude for immigrant and native-born persons. Supplemental analyses revealed that these effects did not vary by immigrant race or ethnicity, or by age at immigration. The only exception was for immigrants from low- and middle-income countries, who were marginally less likely to experience health declines following incarceration.

CONCLUSIONS

In general, incarceration appears to be similarly health damaging for immigrants and non-immigrants. These findings raise important questions about how incarceration is linked to health declines for foreign- and native-born populations and emphasize the importance of access to healthcare for individuals released from correctional facilities. More research is needed, however, to further examine the cumulative impacts of incarceration on immigrants' health across the life course, and to assess a broader spectrum of health outcomes.

“Traditions Are Not for Me”: Curriculum, Alternative Schools, and Formerly Incarcerated Young Black Men’s Academic Success

Literature suggests that culturally promotive curricula can counter the effect of anti-Blackness in United States (U.S.) schools by cultivating Black students’ cultural, social, and academic development and fostering learning environments in which they feel respected, connected, and invested in their school communities. However, Black students, especially young Black men, who return to school following a period of incarceration, face discrimination and numerous barriers to school reentry and engagement. While some enroll in alternative schools as a last option to earn a diploma, little is known about how curricula in these educational settings can facilitate positive school reentry experiences and outcomes among this population. As such, this intrinsic qualitative case study explored how one alternative school’s culturally promotive curriculum fosters and cultivates educational resilience among formerly incarcerated young Black men. Data collection included observations, interviews, and document reviews, and utilized a thematic analytic approach that included grounded theory techniques. Results indicate that teaching content that formerly incarcerated young Black men perceived as truthful and relevant to their lived experiences augmented their school engagement. The young men reported feeling empowered by the school’s curriculum structure and culture that allowed them to self-direct learning goals and course content toward themes that affirmed their cultural and social identities. The curriculum also appeared to facilitate positive relationships with the instructors, leading to the development of a positive school climate where the young men felt safe, appreciated, and supported. These findings highlight the important role space, place, and relationships can play in bolstering formerly incarcerated young Black men’s educational resilience through a culturally promotive curriculum in the context of an alternative school.

Indiana's Section 1115 Medicaid Waiver And Interagency Coordination Improve Enrollment For Justice-Involved Adults

Timely access to Medicaid coverage offers many potential benefits to justice-involved adults reentering the community. In 2015 Indiana's Section 1115 Medicaid waiver (the Healthy Indiana Plan [HIP]) expanded eligibility for low-income adults. To expedite coverage for justice-involved adults, Indiana subsequently improved interagency coordination in two ways. First, the Indiana Department of Correction began initiating Medicaid applications for those in custody. Second, Medicaid began temporarily suspending coverage for people while they were incarcerated instead of discontinuing it. Prison release data from the Indiana Department of Correction linked to Medicaid enrollment data indicate that before HIP was implemented, approximately 9 percent of justice-involved adults received Medicaid coverage within 120 days of release. After HIP implementation, coverage rates increased by 9 percentage points. After both interagency coordination policies were implemented, an additional 29-percentage-point increase in coverage occurred. Furthermore, coverage effective within seven days of release increased by 14 percentage points after the interagency coordination policies went into effect. These findings support the notion that policies and procedures encouraging interagency coordination are beneficial in increasing timely access to Medicaid coverage for justice-involved people.

A Systematic Evaluation of Barriers and Facilitators to the Provision of Services for Justice-Involved Women

The community health delivery system (CHDS) are vital agencies to the success of integration and the provision of services to improve the health and well-being of justice-involved women. Many agencies face barriers and challenges in providing services to vulnerable populations, such as justice-involved women, and, as a result, often offer individual rather than coordinator care. Thus, it is necessary to explore CHDS systemic barriers and challenges to identify opportunities for coordinated care. We conducted semi-structured interviews with 26 CHDS directors or designees to identify systemic barriers and challenges, organizational processes, experiences with vulnerable populations, services and programs, and care coordination and perceived women's barriers and challenges to the provision of services including decision-making processes and access. Qualitative analyses were used to construct thematic descriptions in five areas: (1) mental health as an unmet need, (2) financial constraints, (3) limited organizational capacity, (4) implicit bias, and (5) minimal cultural support of vulnerable populations.

The heterogeneous effect of marijuana decriminalization policy on arrest rates in Philadelphia, Pennsylvania, 2009-2018

BACKGROUND

Marijuana decriminalization holds potential to reduce health inequities. However, limited attention has focused on assessing the impact of decriminalization policies across different populations. This study aims to determine the differential effect of a marijuana decriminalization policy change in Philadelphia, PA on marijuana arrests by demographic characteristics.

METHODS

Using a comparative interrupted time series design, we assessed whether the onset of marijuana decriminalization in Philadelphia County was associated with reduction in arrests rates from 2009 to 2018 compared to Dauphin County. Stratified models were used to describe the differential impact of decriminalization across different demographic populations.

RESULTS

Compared to Dauphin, the mean arrest rate for all marijuana-related crimes in Philadelphia declined by 19.9 per 100,000 residents (34.9% reduction), 17.1 per 100,000 residents (43.1% reduction) for possession, and 2.8 per 100,000 resident (15.9% reduction) for sales/manufacturing. Arrest rates also differed by demographic characteristics post-decriminalization. Notably, African Americans had a greater absolute/relative reduction in possession-based arrests than Whites. However, relative reductions for sales/manufacturing-based arrests was nearly 3 times lower for African Americans. Males had greater absolute/relative reduction for possession-based arrests, but lower relative reduction for sales/manufacturing-based arrests compared to females. There were no substantial absolute differences by age; however, youths (vs. adults) experienced higher relative reduction in arrest rates.

CONCLUSIONS

Findings suggest an absolute/relative reduction for possession-based arrests post-decriminalization; however, relative disparities in sales/manufacturing-based arrests, specifically for African Americans, increased. More consideration towards the heterogeneous effect of marijuana decriminalization are needed given the unintended harmful effects of arrest on already vulnerable populations.

Carbon Capture, Employment, and Coming Home from Prison

Finding and securing employment is a huge challenge for those who have been released from prison. In this paper, we argue that carbon capture technology carries the unique potential to positively impact employment opportunities for those who are undergoing the reentry process. Notably, these careers exist nearly entirely in industries which already employ ex-felons. If carbon capture technology were implemented throughout the United States, our estimates suggest that ex-felons would be eligible for nearly 3.6 million careers. Many of these jobs would be created in industries which directly or indirectly support natural resource extraction, ethanol production, electricity generation, and iron, steel, and cement production. In addition to benefiting the economy, these careers would provide returning individuals with financial security and supportive, prosocial peer relationships. Accordingly, carbon capture carries the unique ability to promote environmental justice while simultaneously providing relief to a tremendously overburdened criminal justice system.

Weathering Probation and Parole: The Protective Role of Social Support on Black Women’s Recent Stressful Events and Depressive Symptoms

Despite an overrepresentation of Black women in the criminal justice system, Black women’s mental health at the precarious intersection of race, gender, and community-based correctional supervision has been underresearched. Building on weathering theory, this study conceptualized criminal justice involvement as a social inequality that negatively affects Black women’s mental health. This study investigated the relationships between recent stressors, forms of social support, and depression through moderated regression analyses with a sample of 169 Black women on probation and parole. Almost half of the women met criteria for clinical levels of depression. Distinct forms of social support served as statistically significant protective factors between stressors and depression symptoms. Our findings highlight the importance of studying the mental health of Black women under correctional surveillance and bolstering multiple forms of support to promote their well-being. The impact of criminal justice involvement and institutional racism on Black women’s mental health requires further research.

Narrative Inquiry Into Shelter-Seeking by Women With a History of Repeated Incarceration: Research and Nursing Practice Implications

Nurses who provide care in the community to women with a history of repeated incarceration may struggle to understand the full extent of the barriers faced by this population and as a result risk giving suboptimal care to an already underserved group. This narrative inquiry study of stories told by 10 women with histories of repeated incarceration fulfilled 2 purposes: to demonstrate how women's shelter-seeking stories exposed uniquely complex patterns of health opportunity and risk and to demonstrate how storytelling might serve as an informative mode of nursing health assessment for this population.

Halfway Out: An Examination of the Effects of Halfway Houses on Criminal Recidivism

Halfway houses are a form of community supervision and correctional programming that have become a staple intervention in recent years. Despite the ingrained belief in their benefits with respect to successful reintegration, this assumption may not be justified based on the existing literature. The current study provides a systematic review and meta-analysis of nine studies examining the effects of halfway houses on recidivism. Overall, the findings suggest that halfway houses are an effective correctional strategy for successful reentry (log odds ratio [LOR] = 0.236, z = 9.27, p < .001). Further work is needed to determine best practices for programming and meeting the needs of different participants.

Voter Registration and Jail-Incarcerated Women: Are Justice-Involved Women Civically Engaged?

Civic engagement, like the broader phenomenon of social engagement, seems out of keeping with the alienating ethos of incarceration. We sought to learn which demographic and contextual factors predicted one form of civic engagement, voter registration, in a jail-incarcerated female population. A 158-item survey was administered to 261 adult women incarcerated in three Midwestern jails, September 2014 to March 2016, as part of a parent intervention study for cervical cancer prevention. Chi-square comparisons between a voter registered and a non-registered group yielded significant differences in five demographic and social context indicators, and a model for voter registration was estimated using multiple logistic regression. Total time incarcerated, having personal health insurance, being stably housed, and identifying as a Black woman contributed significantly to voter registration. We suggest that in a justice-involved group the community's facilitation of access to basic resources may trigger a reciprocal engagement in civic life, and we speculate that Black women may find belonging and motivation for engagement in resilient, long-standing sources outside official institutions. Our findings support the notion that meeting the basic needs of individuals post-incarceration can create healthier, more engaged communities.

Medical nutrition therapy in Canadian federal correctional facilities

Background

Under- and over nutrition as well as nutrition risk factors such as communicable and non-communicable diseases are a common and major cause of morbidity and mortality in correctional facilities. Consequently, medical nutrition therapy (MNT), a spectrum of nutrition services aimed at optimizing individual well-being, is being recognized as integral to the health of people who experience incarceration. However, there is a paucity of research that explores the delivery of MNT in correctional facilities.

Methods

A scoping review combined with secondary analysis of qualitative data (field notes, in-depth stakeholder interviews) from a 2-year ethnographic study about food insecurity and incarceration was undertaken to gain insights about the delivery of corrections-based MNT in Canada. Thematic analysis of all documents was done using an interpretive framework.

Results

An understanding about MNT was developed within three themes: 1) specialized service provision in a unique environment; 2) challenges with the provision of MNT; and 3) consideration of corrections-based MNT alternatives. An incarcerated individual’s nutritional health was conceptualized as culminating from various factors that included dietary intake and health status, enabling environments, access to quality health services, and clinical nutrition services. Nutrition care practices, which range from health promotion to rehabilitation, are challenged by issues of access, visibility, adequacy, and environmental barriers. Their success is dependent on demand (e.g., ability of recipient to act) and factors that enable quality health and food services. Advancing corrections-based MNT will require policies that provide supportive food and health environments and creating sustainable services by integrating alternatives such as peer approaches and telehealth.

Conclusions

Professional associations, government, researchers and other stakeholders can help to strengthen corrections-based MNT by fostering shifts in thinking about the role of health practitioners in these contexts, preparing future health professionals with the specialized skills needed to work in these environments, generating evidence that can best inform practice, and cultivating collaborations aimed at crime prevention, successful societal reintegration, and the reduction of recidivism.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-3926-3) contains supplementary material, which is available to authorized users.

Understanding and Improving the Health of People Who Experience Incarceration: An Overview and Synthesis

The world prison population is growing at a rate that exceeds the rate of population growth. This issue of Epidemiologic Reviews comprises articles in which researchers summarize what is known about some of the key health issues facing people in prison, particularly in relation to human immunodeficiency virus and other blood-borne viral infections. A key recurring theme is that addressing the health needs of people in prison is important to reducing health inequalities at the population level—that prisoner health is public health. The reviews also highlight some critical evidence gaps, notably the lack of evidence from low- and middle-income countries, and the limited number of longitudinal studies in which health behaviors, health outcomes, or health service experiences after release from prison are documented. Despite growing evidence of the poor health of detained adolescents, none of the included reviews considered this population. Further research on the health of young people who cycle through juvenile detention should be a priority. Despite a rapidly growing literature on the health of people who experience incarceration, some critical health issues remain poorly understood, and there has been insufficient attention devoted to co-occurring health conditions and the consequent need for coordinated care. Key populations in custodial settings remain understudied, limiting capacity to develop targeted, evidence-based responses to their health needs. The quality of many studies is suboptimal, and although rigorous, independent research in correctional settings can be challenging, it is not impossible and is critical to laying the groundwork for evidence-based reform.

Effectiveness of Dialectical Behavioral Therapy on Reduction of Recidivism Among Recently Incarcerated Homeless Women: A Pilot Study

The purpose of this pilot randomized controlled trial (RCT) was to compare the 6-month outcomes of a Dialectical Behavioral Therapy-Corrections Modified (DBT-CM) program versus a Health Promotion (HP) program on mitigating recidivism among 130 female parolees/probationers between baseline and 6-month follow-up. The effect of DBT-CM on reducing recidivism was greater among those who expressed a desire for help (risk ratio [RR] = 0.40; 95% confidence interval [CI] = [0.16, 1.00]; p = .050) and among homeless female ex-offenders (HFOs) who were younger (<50 years of age; RR = 0.46; 95% CI = [0.19, 1.11]; p = .085) and participants with Desire for Help score > 35 (Model 3; RR = 0.40; 95% CI = [0.16, 1.00]; p = .050). Findings from this pilot study suggest that the DBT-CM intervention may be effective in reducing reincarceration rates among some HFOs during reentry. Larger RCTs are needed to validate our findings.

Life After: Examining the Relationship Between Sociobehavioral Factors and Mental Health Among African American Ex-Offenders

Mental health problems are 3 times higher among prisoners than the general population. After release, reentry barriers and other factors can exacerbate mental problems. This study of 250 African American ex-offenders examines the relationship between sociobehavioral factors and mental health. Independent variables included self-reported health, alcohol use, employment, and history of mental problems before prison. Covariates included the number of immediate family with mental problems and the number of serious conflicts with family members or friends. Analyses revealed that men who had serious conflicts, used alcohol more often, reported less than excellent health, and not employed were more likely to report being troubled by mental problems. Family mental health history was not statistically significant. The current study adds to the literature by identifying selected factors associated with the mental health of African American male, ex-offenders. Findings from this study can inform interventions to address mental health issues and reduce recidivism.

The Assets and Challenges of Formerly Incarcerated Latino Men's Social Support Networks in Promoting Healthy Behaviors

After being exposed to high-risk environments in correctional facilities, formerly incarcerated Latino men (FILM) encounter new risks upon reentering their community of residence including drug use and sexual risk behaviors. Families and close social support networks are critical in potentially mitigating the stressors and risks associated with reentry and reducing the likelihood of recidivism. We conducted a study to examine the material and cognitive assets that familial networks can use to provide support to FILM to engage in health-promoting practices. This analysis is based on linear and logistic regression modeling of cross-sectional data collected through a computer-administered survey with dyads of FILM (ages 18-49, who had been in jail or prison within the past 5 years) and their nominated social network (n = 130 dyads). We found that both male and female social supports (MSS and FSS) have significantly higher levels of structural resources (education and employment) than FILM. Though FSS reported higher self-efficacy on health-promoting practices than FILM, contrary to what we predicted, FILM and FSS/MSS reported similar levels of mental health and behavioral risks. Our results suggest a number of limitations in designing family-based intervention strategies, but they also provided insight into the specificities needed to enhance the social support networks of FILM.

Exploring Lifetime Accumulation of Criminal Justice Involvement and Associated Health and Social Outcomes in a Community-Based Sample of Women who Use Drugs

Among people who use illegal drugs, engagement with the criminal justice (CJ) system often involves an ongoing, intermittent series of arrests, incarcerations, and periods of community supervision. The potential associations between the lifetime accumulation of CJ involvement and social and health outcomes is largely unexplored. In a cross-sectional sample of women who use crack, heroin, and/ or methamphetamine recruited from communities in Oakland, CA (N = 624), we developed an approach to characterize CJ accumulation. We used latent class analysis (LCA), a multivariate person-centered method that assumes an unobserved categorical variable that divides a population into a small number of mutually exclusive and exhaustive classes. Using observed measures of incarceration and community supervision as indicator variables, we developed a model of CJ accumulation that elucidates patterns of involvement as lived by the women in the sample. Based on model fit statistics, we selected a three-class model and labeled the classes "low," "medium," and "high." We then explored associations between the classes of CJ accumulation and health and health-related outcomes using logistic regression. The odds of homelessness (p for trend = 0.004), transience (p for trend = 0.017), and recent victimization (p for trend = 0.023) were higher among women in higher accumulation classes. Higher class of CJ accumulation was associated with higher odds of reporting unmet need for physical health care (p for trend < 0.001) and mental health care (p for trend = 0.002). The odds of physical health conditions, such as hepatitis C infection (p for trend < 0.001) and mental health conditions, such as depression (p for trend = 0.003), also increased with higher class of accumulation. While the findings described here are limited by the cross-sectional nature of the study, they suggest that CJ accumulation is a potentially meaningful concept for assessing associations between the CJ system and health-related issues.

Assessment of Cardiovascular Health among Community-Dwelling Men with Incarceration History

Returning to the community after incarceration is a particularly vulnerable time with significantly increased risk of death in the first 2 weeks. The elevated risk of death persists as long as 2 years, with cardiovascular disease (CVD) among the leading causes. African-Americans, especially African-American men, have higher rates of incarceration and community supervision (e.g., probation and parole) and an earlier onset of hypertension compared to Whites. Few studies have objectively assessed the cardiovascular health profile of criminal justice involved individuals. This study is designed to determine the cardiovascular health profile among men in community corrections and/or transitional housing, identify the prevalence of key CVD risk factors, and assess if risk varies by race/ethnicity. We recruited 100 adult men (mean age = 42.7, SD = 11.35, 60% White, 40% non-Hispanic White) with a history of incarceration in jail or prison of ≥ 6 months during their most recent incarceration and enrolled in a community corrections program. Using the American Heart Association's Life's Simple 7™ (LS-7), measures of each of the LS-7 components (body mass index, blood pressure, lipids, blood glucose, smoking, diet, and physical activity) were obtained, and LS-7 scores were generated for each measure using AHA-defined categories of poor (1 point), intermediate (2 points), and ideal (3 points) and summed to yield a total score ranging from poor for all (7 points) to ideal for all (21 points). Mann-Whitney U tests were performed to assess differences in LS-7 scores (poor, intermediate, ideal) by race/ethnicity. Additionally, an independent samples t test was conducted for race/ethnicity and LS-7 total score. Mann-Whitney U tests for LS-7 categories and race/ethnicity indicated a greater number of non-Whites had poor blood pressure (p < .01) and diet (p < .05) as compared to Whites. The independent samples t test demonstrated significantly lower LS-7 scores for non-Whites compared to Whites. To our knowledge, this is the first study to evaluate cardiovascular health among individuals with a history of incarceration using the LS-7 metric, which included objective measures for four of the seven LS-7 metrics. Non-Whites, which included African-Americans, Hispanics, and American Indians, were more likely than Whites to fall into the poor category for both diet and blood pressure and had significantly lower total LS-7 scores than Whites, indicating they have worse scores across all seven of the LS-7 measures. Similar to what is found among non-incarcerated samples, non-Whites with incarceration histories are at elevated risk for cardiovascular events relative to their White peers.

Changes in Community Integration From Pre- to Post-incarceration: The Influence of Psychological and Criminal Justice Factors

Research on changes in community integration from pre- to postincarceration has primarily focused on employment and is mixed, showing both deterioration and improvement. Research is needed to examine change in other areas, as well as predictive individual-level factors. We assessed changes in jail inmates' (n = 334) employment, source of income, residential stability, marital status, and volunteerism from pre- to post-incarceration, and analyzed individual-level predictors of change. On average, more inmates improved than deteriorated in community integration, with education and low criminal thinking predicting the greatest improvement. Across multiple areas, inmates' community integration does not appear to deteriorate from pre- to post-incarceration. Apparent improvements may reflect that people become incarcerated during times of crisis, regressing to baseline by 1 year postrelease.

"Improving Native American elder access to and use of health care through effective health system navigation"

BACKGROUND

Public insurance reforms of the past two decades have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older. Historically, this population is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other United States aging populations, representing a neglected group within the healthcare system. Despite the pervasive belief that the Indian Health Service will address all their health-related needs, American Indian elders are negatively affected by gaps in insurance and lack of access to health care. While the 2010 Patient Protection and Affordable Care Act included provisions to ameliorate disparities for American Indians, its future is uncertain. In this context, American Indian elders with variable health literacy must navigate a complex and unstable healthcare system, regardless of where they seek care.

METHODS

This community-driven study features a mixed-method, participatory design to examine help-seeking behavior and healthcare experiences of American Indian elders in New Mexico, in order to develop and evaluate a tailored intervention to enhance knowledge of, access to, and use of insurance and available services to reduce healthcare disparities. This study includes qualitative and quantitative interviews combined with concept mapping and focus groups with American Indian elders and other key stakeholders.

DISCUSSION

The information gathered will generate new practical knowledge, grounded in actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of health care by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on this population, and will offer a replicable model for enhancing the effects of such initiatives on other underserved groups affected by healthcare inequities.

TRIAL REGISTRATION

This protocol does not include the collection of health outcome data. Clinicaltrials.gov, NCT03550404 . Registered June 6, 2018.

Sociodemographic and psychopathological predictors of criminal behavior in women with gambling disorder

INTRODUCTION

Women have been underrepresented in the empirical research of gambling disorder (GD), a psychiatric condition included in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5). More specifically, no studies to date have been carried out exploring the clinical phenotype of women with GD who have committed gambling-related illegal acts.

AIMS

In this study, we sought to delineate the clinical, personality and psychopathological differences between treatment-seeking women with GD, with and without a criminal record. Furthermore, we aimed to identify the variables that best predict the presence of illegal acts in this clinical group.

MATERIAL AND METHODS

Data corresponded to n=273 treatment-seeking women who met criteria for GD. Two groups were compared: women with a history of criminal behavior (n=61, 22.34%) to those who did not (n=212, 77.66%) taking psychopathology, clinical and personality data into account.

RESULTS

Women who engaged in criminal acts were younger and endorsed higher psychopathology, GD severity, and novelty seeking levels than the other clinical group. Regarding the predictive model, women with higher levels of novelty seeking and lower levels of reward dependence were at higher risk of having a criminal record. DISCUSSION, CONCLUSIONS AND IMPLICATIONS FOR PRACTICE AND/OR POLICY: Our findings uphold that women with GD and a history of illegal acts are especially vulnerable in terms of comorbid psychopathology and dysfunctional personality traits. Therefore, this population could potentially benefit from public policies that target their mental health needs.

Stress, Substance Use, and Yoga in the Context of Community Reentry Following Incarceration

This field report provides a rationale for the potential of yoga to support reductions in stress and substance use among people returning to the community from jail or prison and describes an agency-based example of yoga classes offered in this context. People who have recently experienced incarceration face a multitude of stressors, which can heighten the risk of substance use and support the need to address stress reduction as a pathway to reduced substance use. One promising intervention is yoga, which has demonstrated significant stress-reduction effects among several populations. Feedback from participants in this field report's practice example reinforces the potential for yoga to decrease stress and complement substance use treatment in supporting health during the transition from incarceration to community return. Further scholarship is needed to explore the benefits and limitations of yoga in this context.

The Affordable Care Act and Changes in Insurance Coverage and Source of Health Care among High-risk Rural, Substance-using, Female Offenders Transitioning to the Community

PURPOSE

This study examines health care coverage and health care among rural, drug-involved female offenders under the Affordable Care Act (ACA) compared with pre-ACA and whether being insured is associated with having a usual source of care.

METHODS

This study involved random selection, screening, and face-to-face interviews with drug-using women in three rural Appalachian jails. Analyses focused on participants who had completed a three-month follow-up interview after release from jail (N=371).

RESULTS

Analyses indicated that women released after ACA implementation were more likely than those released pre-implementation to be insured. A multivariate logistic regression model showed that being insured was significantly related to having a usual health care source during community re-entry.

CONCLUSIONS

Results demonstrate the benefits of the ACA, signaling important implications for public health in rural communities and the criminal justice system, including targeting underserved groups during incarceration and providing information about and resources for health care enrollment.

The association between income and life expectancy revisited: deindustrialization, incarceration and the widening health gap

BACKGROUND

The health gap between the top and the bottom of the income distribution is widening rapidly in the USA, but the lifespan of America's poor depends substantially on where they live. We ask whether two major developments in American society, deindustrialization and incarceration, can explain variation among states in life expectancy of those in the lowest income quartile.

METHODS

Life expectancy estimates at age 40 of those in the bottom income quartile were used to fit panel data models examining the relationship with deindustrialization and incarceration between 2001 and 2014 for all US states.

RESULTS

A one standard deviation (s.d.) increase in deindustrialization (mean = 11.2, s.d. = 3.5) reduces life expectancy for the poor by 0.255 years [95% confidence interval (CI): 0.090-0.419] and each additional prisoner per 1000 residents (mean = 4.0, s.d. = 1.5) is associated with a loss of 0.468 years (95% CI: 0.213-0.723). Our predictors explain over 20% of the state-level variation in life expectancy among the poor and virtually the entire increase in the life expectancy gap between the top and the bottom income quartiles since the turn of the century.

CONCLUSIONS

In the USA between 2001 and 2014, deindustrialization and incarceration subtracted roughly 2.5 years from the lifespan of the poor, pointing to their role as major health determinants. Future research must remain conscious of the upstream determinants and the political economy of public health. If public policy responses to growing health inequalities are to be effective, they must consider strengthening industrial policy and ending hyper-incarceration.

Achieving Drug and Alcohol Abstinence Among Recently Incarcerated Homeless Women: A Randomized Controlled Trial Comparing Dialectical Behavioral Therapy-Case Management With a Health Promotion Program

BACKGROUND

Homeless female ex-offenders (homeless female offenders) exiting jail and prison are at a critical juncture during reentry and transitioning into the community setting.

OBJECTIVE

The purpose of the study was to compare the effect of a dialectical behavioral therapy-case management (DBT-CM) program with a health promotion (HP) program on achieving drug and alcohol abstinence among female parolees/probationers residing in the community.

METHODS

We conducted a multicenter parallel randomized controlled trial with 130 female parolees/probationers (aged 19-64 years) residing in the community randomly assigned to either DBT-CM (n = 65) or HP (n = 65). The trial was conducted in four community-based partner sites in Los Angeles and Pomona, California, from February 2015 to November 2016. Treatment assignment was carried out using a computer-based urn randomization program. The primary outcome was drug and alcohol use abstinence at 6-month follow up.

RESULTS

Analysis was based on data from 116 participants with complete outcome data. Multivariable logistic regression revealed that the DBT-CM program remained an independent positive predictor of decrease in drug use among the DBT-CM participants at 6 months (p = .01) as compared with the HP program participants. Being non-White (p < .05) and having higher depressive symptom scores (p < .05) were associated with lower odds of drug use abstinence (i.e., increased the odds of drug use) at 6 months.

DISCUSSION

DBT-CM increased drug and alcohol abstinence at 6-month follow-up, compared to an HP program.

Lessons Learned From the Implementation of Seek, Test, Treat, Retain Interventions Using Mobile Phones and Text Messaging to Improve Engagement in HIV Care for Vulnerable Populations in the United States

In the United States, little is known about interventions that rely on mobile phones and/or text messaging to improve engagement in HIV care for vulnerable populations. Domestic studies using these technologies as part of the National Institute on Drug Abuse "Seek, Test, Treat, Retain" research initiative were queried regarding intervention components, implementation issues, participant characteristics, and descriptive statistics of mobile phone service delivery. Across five studies with 1,135 predominantly male, minority participants, implementation challenges occurred in three categories: (1) service interruptions; (2) billing/overage issues, and; (3) the participant user experience. Response rules for automated text messages frequently frustrated participants. The inability to reload minutes/texting capacity remotely was a significant barrier to intervention delivery. No study encountered confidentiality breaches. Service interruption was common, even if studies provided mobile phones and plans. Future studies should attend to the type of mobile phone and service, the participant user experience, and human subjects concerns.