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McNamara C, Cook S, Brown LM, Palta M, Look KA, Westergaard RP, Burns ME. Prompt access to outpatient care post-incarceration among adults with a history of substance use: Predisposing, enabling, and need-based factors. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209277. [PMID: 38142041 PMCID: PMC11060918 DOI: 10.1016/j.josat.2023.209277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/30/2023] [Accepted: 12/15/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION As expanded Medicaid coverage reduces financial barriers to receiving health care among formerly incarcerated adults, more information is needed to understand the factors that predict prompt use of health care after release among insured adults with a history of substance use. This study's aim was to estimate the associations between characteristics suggested by the Andersen behavioral model of health service use and measures of health care use during the immediate reentry period and in the presence of Medicaid coverage. METHODS In this retrospective cohort study, we linked individual-level data from multiple Wisconsin agencies. The sample included individuals aged 18-64 released from a Wisconsin State Correctional Facility between April 2014 and June 2017 to a community in the state who enrolled in Medicaid within one month of release and had a history of substance use. We grouped predictors of outpatient care into variable domains within the Andersen model: predisposing- individual socio-demographic characteristics; enabling characteristics including area-level socio-economic resources, area-level health care supply, and characteristics of the incarceration and release; and need-based- pre-release health conditions. We used a model selection algorithm to select a subset of variable domains and estimated the association between the variables in these domains and two outcomes: any outpatient visit within 30 days of release from a state correctional facility, and receipt of medication for opioid use disorder within 30 days of release. RESULTS The size and sign of many of the estimated associations differed for our two outcomes. Race was associated with both outcomes, Black individuals being 12.1 p.p. (95 % CI, 8.7-15.4, P < .001) less likely than White individuals to have an outpatient visit within 30 days of release and 1.3 p.p. (95 % CI, 0.48-2.1, P = .002) less likely to receive MOUD within 30 days of release. Chronic pre-release health conditions were positively associated with the likelihood of post-release health care use. CONCLUSIONS Conditional on health insurance coverage, meaningful differences in post-incarceration outpatient care use still exist across adults leaving prison with a history of substance use. These findings can help guide the development of care transition interventions including the prioritization of subgroups that may warrant particular attention.
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Affiliation(s)
- Cici McNamara
- School of Economics, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Steven Cook
- Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI, USA.
| | - Lars M Brown
- Division of Medicaid Services, Wisconsin Department of Health Services, Madison, WI, USA.
| | - Mari Palta
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA.
| | - Kevin A Look
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
| | - Ryan P Westergaard
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
| | - Marguerite E Burns
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
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Ramezani N, Taylor BG, Balawajder EF, MacLean K, Pollack HA, Schneider JA, Taxman FS. Predictors of mental health among U.S. adults during COVID-19 early pandemic, mid- pandemic, and post-vaccine eras. BMC Public Health 2024; 24:643. [PMID: 38424510 PMCID: PMC10902933 DOI: 10.1186/s12889-024-17781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 01/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND A collective trauma like COVID-19 impacts individuals differently due to socio-contextual and individual characteristics. Younger adults, minorities, affiliates of certain political parties, and residents of some regions of the United States reported experiencing poorer mental health during the pandemic. Being diagnosed with COVID-19, or losing a friend/family to it, was related to more adverse mental health symptoms. While the negative impact of COVID-19 on health outcomes has been studied, mental health changes during this pandemic need further exploration. METHODS In a study of 8,612 U.S. households, using three surveys collected from a nationally representative panel between May 2020 and October 2021, using a repeated cross-sectional design, a linear mixed effect regression model was performed to investigate factors associated with the mental health status, based on the Mental Health Inventory-5, of individuals throughout different phases of the COVID-19 pandemic, and whether an improvement over time, especially after vaccines became available, was observed. RESULTS An overall improvement in mental health was observed after vaccines became available. Individuals with no COVID-related death in their household, those not wearing masks, those identifying as members of the Republican Party, race/ethnicities other than Asian, men, older adults, and residents of the South were less likely than others to report mental health challenges. CONCLUSIONS Our results highlight the need for widespread mental health interventions and health promotion to address challenges during the COVID-19 pandemic and beyond. Due to the worse mental health observed among Asians, younger adults, women, low-income families, those with a higher level of concern for COVID-19, people who lost someone to COVID-19, and/or individuals with histories of opioid use disorder and criminal legal involvement, over the period of this study, targeted attention needs to be given to the mental health of these groups.
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Affiliation(s)
- Niloofar Ramezani
- Department of Biostatistics, Virginia Commonwealth University, Box 980032, One Capital Square, 830 East Main St, Richmond, VA, 23219, USA.
| | - Bruce G Taylor
- NORC at the University of Chicago, Public Health Department, 4350 East West Highway, 8th floor, Bethesda, MD, 20814, USA
| | - Elizabeth Flanagan Balawajder
- NORC at the University of Chicago, Public Health Department, 4350 East West Highway, 8th floor, Bethesda, MD, 20814, USA
| | - Kai MacLean
- NORC at the University of Chicago, Public Health Department, 4350 East West Highway, 8th floor, Bethesda, MD, 20814, USA
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, Department of Public Health Sciences, Urban Health Lab, University of Chicago, 969 E 60th St, Chicago, IL, 60637, USA
| | - John A Schneider
- Department of Medicine and Public Health Sciences, Crown Family School of Social Work, Policy, and Practice, University of Chicago, 5841 South Maryland Avenue MC 5065, Chicago, IL, 60637, USA
| | - Faye S Taxman
- Schar School of Policy and Government, George Mason University, 3351 Fairfax Drive Van Metre Hall, Arlington, VA, 22201, USA
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Jones AA, Strong-Jones S, Apsley HB. The role of polysubstance use on criminal justice involvement in the United States. Curr Opin Psychiatry 2023; 36:290-300. [PMID: 37191661 PMCID: PMC10280570 DOI: 10.1097/yco.0000000000000873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW Polysubstance use, broadly defined as using more than one type of substance, disproportionately impacts those involved in the criminal justice system (CJS). This review synthesizes recent findings on polysubstance use among those involved in the CJS and highlights areas of particular concern and interventions. RECENT FINDINGS We use 18 recent articles to identify the prevalence and types of criminal justice involvement and correlates of polysubstance use and criminal justice involvement. We highlight latent patterns of polysubstance use among various criminal justice populations (adults, pregnant women, and youth) and differential associations with adverse substance use and criminal justice outcomes. Lastly, we discuss substance use treatment in the justice system, the role of polysubstance use in treatment access and outcomes, and substance use-related services for previously incarcerated individuals reentering society. SUMMARY Current research provides further evidence of the syndemic nature of polysubstance use, criminal justice involvement, and adverse outcomes, which are complicated by significant barriers to accessing evidence-based treatment in justice settings. Yet, current research is limited due to methodological inconsistency and limited focus on the social determinants of health, racial/ethnic disparities, and interventions to increase treatment and reentry services.
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Affiliation(s)
- Abenaa A Jones
- Department of Human Development and Family Studies, Pennsylvania State University
- Consortium on Substance Use and Addiction, Pennsylvania State University
| | - Sienna Strong-Jones
- Department of Human Development and Family Studies, Pennsylvania State University
| | - Hannah B Apsley
- Department of Human Development and Family Studies, Pennsylvania State University
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Harris KN, Kulesza C. Exploring the Impact of Adult-use Cannabis Legalization on Legal System Referrals to Treatment for Cannabis Use: Do Age and Race Have a Moderating Effect? Clin Ther 2023; 45:599-615. [PMID: 37414510 DOI: 10.1016/j.clinthera.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Despite the progression of recreational cannabis legalization, the legal system remains the largest source of referral to treatment for cannabis use. The legal system's continued practice of requiring participation in cannabis treatment programs raises questions regarding the extent to which individuals who interact with the legal system are monitored for cannabis use post-legalization. This article presents trends in justice-system referrals to treatment for cannabis use in legal and nonlegal states for 2007-2019. The relationship between legalization and justice system treatment referrals for black, Hispanic/Latino, and white adults and juveniles was explored. Given that minority and youth populations are subject to disproportionate levels of cannabis enforcement, legalization is expected to have a weaker relationship with justice-system referral rates in white juveniles and black and Hispanic/Latino adults and juveniles compared to white adults. METHODS Using 2007-2019 data from the Treatment Episode Data Set-Admissions (TEDS-A), variables were created for state-level rates of legal system-referred treatment admissions for cannabis use in black, Hispanic/Latino, and white adults and juveniles. Rate trends were compared across populations and staggered difference-in-difference and event analyses were conducted to determine whether legalization is associated with a decline in justice-system referrals to treatment for cannabis use . FINDINGS For the study period, the mean rate of legal system-referred admissions in the total population was 2.75 per 10,000 residents. Black juveniles had the highest mean rate (20.16), followed by Hispanic/Latino juveniles (12.35), black adults (9.18), white juveniles (7.58), Hispanic/Latino adults (3.42), and white adults (1.66). Legalization did not have a significant impact on treatment-referral rates in any population of study. Events analyses indicated significant rate increases in black juveniles in legalized states compared to controls at 2 and 6 years after policy change, and in black and Hispanic/Latino adults at 6 years after policy change (all, P < 0.05). While racial/ethnic disparities in referral rates declined in absolute terms, the relative size of these disparities increased in legalized states. IMPLICATIONS TEDS-A captures only publicly funded treatment admissions and relies on the quality of individual-state reporting. Individual-level factors that may impact decisions regarding treatment referrals for cannabis use could not be controlled for. Despite limitations, the present findings suggest that for individuals who interact with the criminal legal system, cannabis use may still result in legal monitoring after reform. The upward trend in legal system referrals for black (but not white) adults and juveniles several years after states legalize cannabis warrants further examination and may reflect continued disparate treatment of these populations at multiple points along the legal-system continuum.
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Cannabis Legalization and the Decline of Cannabis Use Disorder (CUD) Treatment Utilization in the US. CURRENT ADDICTION REPORTS 2023. [DOI: 10.1007/s40429-022-00461-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Tolou-Shams M, Holloway ED, Ordorica C, Yonek J, Folk JB, Dauria EF, Lehn K, Ezimora I, Wiley HMF. Leveraging Technology to Increase Behavioral Health Services Access for Youth in the Juvenile Justice and Child Welfare Systems: a Cross-systems Collaboration Model. J Behav Health Serv Res 2022; 49:422-435. [PMID: 35835953 PMCID: PMC9282614 DOI: 10.1007/s11414-022-09808-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 01/07/2023]
Abstract
Behavioral health services access for justice- and child welfare-involved youth is limited despite significant need. Structural interventions to address limited access are nascent. Technology can advance access, but few interventions focus on system-impacted youth and their mental health needs and challenges. This article describes the development, process, and initial outcomes of the Youth Justice and Family Well-Being Technology Collaborative (JTC) that was formed to leverage technology within and across public health and justice-related systems to promote increased behavioral health services access. Cross-system considerations are identified for public health, court, and other key stakeholders to successfully integrate technology into practice to expand access to these critical services.
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Affiliation(s)
- Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General, University of California, 1001 Potrero Ave, Bldg. 5, 7M, San Francisco, CA, 94110, USA.
| | - Evan D. Holloway
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General, University of California, 1001 Potrero Ave, Bldg. 5, 7M, San Francisco, CA 94110 USA
| | - Catalina Ordorica
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General, University of California, 1001 Potrero Ave, Bldg. 5, 7M, San Francisco, CA 94110 USA
| | - Juliet Yonek
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General, University of California, 1001 Potrero Ave, Bldg. 5, 7M, San Francisco, CA 94110 USA
| | - Johanna B. Folk
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General, University of California, 1001 Potrero Ave, Bldg. 5, 7M, San Francisco, CA 94110 USA
| | - Emily F. Dauria
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA USA
| | - Kristiana Lehn
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General, University of California, 1001 Potrero Ave, Bldg. 5, 7M, San Francisco, CA 94110 USA
| | - Ifunanya Ezimora
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General, University of California, 1001 Potrero Ave, Bldg. 5, 7M, San Francisco, CA 94110 USA
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Rowell-Cunsolo TL, Bellerose M, Hart C. Access to Harm Reduction Treatment Among Formerly Incarcerated Individuals During the COVID-19 Era. Health Secur 2021; 19:S95-S101. [PMID: 34101494 PMCID: PMC8236556 DOI: 10.1089/hs.2021.0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tawandra L Rowell-Cunsolo
- Tawandra L. Rowell-Cunsolo, PhD, is an Assistant Professor, Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin. Meghan Bellerose, MPH, is a Graduate Student, Mailman School of Public Health; and Carl Hart, PhD, is a Professor, Department of Psychology; both at Columbia University, New York, NY
| | - Meghan Bellerose
- Tawandra L. Rowell-Cunsolo, PhD, is an Assistant Professor, Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin. Meghan Bellerose, MPH, is a Graduate Student, Mailman School of Public Health; and Carl Hart, PhD, is a Professor, Department of Psychology; both at Columbia University, New York, NY
| | - Carl Hart
- Tawandra L. Rowell-Cunsolo, PhD, is an Assistant Professor, Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin. Meghan Bellerose, MPH, is a Graduate Student, Mailman School of Public Health; and Carl Hart, PhD, is a Professor, Department of Psychology; both at Columbia University, New York, NY
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