Epidemiology of Incarceration: Characterizing Jail Incarceration for Public Health Research

The Unmet Health Care Needs of Indigenous People Incarcerated in Tribal Jails

This Viewpoint investigates the poor quality of health care provided to Indigenous peoples incarcerated in US tribal jails and proposes solutions to address health disparities and strengthen tribal sovereignty.

Does everyday discrimination account for the increased risk of vasomotor symptoms in Black women?: the Study of Women's Health Across the Nation (SWAN)

OBJECTIVES

Vasomotor symptoms (VMS), including hot flashes and night sweats, are hallmark symptoms of the menopause transition. Previous research has documented greater frequency, duration, and severity of VMS in Black women compared with women from other racial/ethnic groups, even after accounting for other factors. This analysis examined the association between discrimination and VMS and the extent to which discrimination accounts for the disproportionate burden of VMS in Black women.

METHODS

Using available discrimination and VMS data from the SWAN cohort study (n = 2,377, 48% White, 32% Black, 6% Japanese, 4% Chinese, and 9% Hispanic women) followed approximately yearly in midlife from premenopause (42-52 y) through postmenopause (~20 y), we assessed concurrent associations between discrimination and VMS frequency in the past 2 weeks using weighted generalized mixed models. We also assessed associations between chronic discrimination across first four visits and VMS trajectories from premenopause to postmenopause using weighted multinomial logistic regression. Models were adjusted for known risk factors for VMS.

RESULTS

Higher levels of discrimination were associated with concurrent reporting of any (odds ratio [OR], 1.57 [1.31-1.89]) and frequent (≥6 d) VMS (OR, 1.55 [1.21-1.99]). After adjustment, associations remained significant for any (OR, 1.30 [1.09-1.54]) but not frequent VMS. For any VMS trajectories, chronic discrimination was associated with "continuously high" (OR, 1.69 [1.03-2.77]) and "high pre-FMP-decline post-FMP" (OR, 1.70 [1.01-2.88]) versus "FMP-onset low" trajectories. After adjusting for discrimination, odds of reporting any, frequent, and of being in the "continuously high" any VMS trajectory remained elevated for Black versus White women.

CONCLUSIONS

Discrimination is associated with greater concurrent risk of any (but not frequent) VMS, and chronic discrimination is associated with a continuously high reporting of any VMS over time, independent of known risk factors. Adjusting for discrimination attenuates but does not eliminate the increased risk of VMS for Black women.

A novel use of HIV surveillance and court data to understand and improve care among a population of people with HIV experiencing criminal charges in North Carolina 2017-2020

Objectives Objectives

To enumerate the population of people with HIV (PWH) with criminal charges and to estimate associations between charges and HIV outcomes.

Methods

We linked statewide North Carolina criminal court records to confidential HIV records (both 2017-2020) to identify a population of defendants with diagnosed HIV. We used generalized estimating equations to examine changes in viral suppression (outcome) pre-post criminal charges (exposure), adjusting for other demographic and legal system factors.

Results

9,534 PWH experienced criminal charges. Compared to others with charges, PWH were more likely to be male and report Black race. The median duration of unresolved charges was longer for PWH. When adjusting for demographic factors, the period following resolution of charges was modestly associated with an increased risk of viral suppression (aRR 1.03 (95% confidence interval 1.02-1.04) compared to the pre-charge period.

Conclusions

A significant portion of PWH in NC had criminal charges during a three-year period, and these charges went unresolved for a longer time than those without HIV. These preliminary findings raise questions regarding whether PWH have appropriate access to legal services.

Provision of health care services related to substance use disorder in southern U.S. jails

INTRODUCTION

The U.S. jail population has more than tripled since the 1980s, and today, one out of every three incarcerated individuals is being held in a county or city jail. Substance use disorders (SUD) are overrepresented in incarcerated populations; however, little recent research has examined the availability and quality of SUD-related health care services in jail settings. Incarcerated individuals may engage with a variety of SUD-related health care services, including: screening and withdrawal management at entry, SUD treatment or other brief health care interventions while they are being held, and overdose prevention education and reentry planning at release.

METHODS

We conducted a thematic analysis of qualitative data from 34 interviews conducted with 38 personnel from a purposive sample of jails that varied in size and rurality within a five-state study area. The goals of the analyses were to: 1) describe jail health care services for SUD and barriers to service provision, 2) compare current practices to best practice recommendations, and 3) provide context by describing factors at the jail and community level that influence service provision, such as access to resources.

RESULTS

Interviewees described wide variability in both availability and comprehensiveness of SUD-related health care services. Most adhered to federal guidance for supervising withdrawal from alcohol and benzodiazepines, but not opioids. Medication for addiction treatment was most widely available for pregnant women and rarely for other individuals. Roughly one third of the jails in our sample provided behavioral group or individual therapy with a licensed counselor and roughly one quarter offered self-help groups. Very few jails provided comprehensive re-entry planning and support. Jail staff reported specific barriers to providing each type of service, as well as limiting contextual factors. Despite observed increases in case volume, jail health care staff did not necessarily receive any additional funding or staff members. Overall, lack of investment in mental and behavioral health care contributed to recidivism and feelings of hopelessness among staff.

CONCLUSIONS

This study identified several areas where jails could improve SUD-related health care services. Many of the barriers to improvement-organizational buy-in, cost/budgeting, staffing, logistics-were not under the control of health care staff. Implementing changes will require support from local governments, jails administrators, private health care companies, and other local health care providers.

Jail Healthcare Staffing in the US Southeast: a Cross-Sectional Survey

BACKGROUND

Jails annually incarcerate millions of people with health problems, yet jail healthcare services have not been well described.

OBJECTIVE

To describe jail healthcare staffing.

DESIGN

Phone-administered survey conducted October 2020 to May 2021.

SETTING

County jails in North Carolina, South Carolina, Georgia, and Alabama.

PARTICIPANTS

Jail personnel "most knowledgeable" about jail healthcare.

MAIN MEASURES

Weekly on-site healthcare coverage rate (hours per 100 incarcerated person-weeks [IPWs]) by personnel type; telemedicine rates and detention officers' healthcare duties.

KEY RESULTS

Survey response rate was 73% (254/346). Among surveyed jails, 71% had on-site non-psychiatric providers (e.g., physicians, physician assistants) (median of 3.3 h per 100 IPWs); 90% had on-site nursing (median of 57.0 h per 100 IPWs) including 50% with on-site registered nurses (median of 25 h per 100 IPWs) and 70% with on-site licensed practical nurses (median of 52 h per 100 IPWs); 9% had on-site psychiatric providers (median of 1.6 h per 100 PWs). Telemedicine was used for primary care in 13% of jails (median 2.1 h per 100 IPW); for mental healthcare in 55% (median 2.1 h per 100 IPW); and for other specialties in 5% (median 1.0 h per 100 IPW). In 81% of jails, officers conducted medical intake and in 58% assessed urgency of medical requests (i.e., "sick call"). The number of officers' healthcare responsibilities increased inversely with weekly nursing coverage.

CONCLUSIONS

Nearly 30% of surveyed jails routinely lacked on-site healthcare providers and in most other jails providers' on-site presence was modest. Jails relied heavily on LPNs and officers for care, resulting in missed opportunities for care and potentially endangering incarcerated persons.

The role of detention officers in the provision of jail healthcare in the Southeastern United States

Jailed individuals have considerable healthcare needs, yet jail healthcare resources are often limited. We interviewed staff from 34 Southeastern jails about strategies that jails use to deliver healthcare. One of the most prominent strategies was the use of detention officers to provide or facilitate the provision of healthcare. Officers' roles included assessing the need for medical clearance, conducting medical intake screenings, monitoring for suicide/withdrawal, transporting patients to medical appointments, medication administration, monitoring blood glucose and blood pressure, responding to medical emergencies, and communication with healthcare personnel. Several participants reported that due to officer shortages, conflicting priorities, and lack of adequate training, officers' healthcare roles can compromise privacy, delay access to care, and result in inadequate monitoring and safety. Findings suggest the need for training and standardized guidelines for officers' involvement in jail healthcare delivery and reassessment of the scope of officers' healthcare responsibilities.

Changes in sleep quality and housing status among individuals incarcerated in jail

OBJECTIVE

To investigate sleep quality among individuals incarcerated in a rural county jail, by housing status before incarceration.

METHODS

Using cross-sectional survey methods, 194 individuals incarcerated in jail reported sleep quality prior to and during incarceration on a Likert scale and pre-incarceration housing status (ie, house, apartment, motel, group living, or homeless). Prevalence ratios (PR) were estimated using log binomial regression to determine associations between housing status before incarceration and changes in sleep quality.

RESULTS

Participants in non-permanent housing before incarceration had a lower prevalence of worsening sleep quality while incarcerated (compared to stable or improving) compared to those in permanent housing before incarceration (PR = 1.69, 95% CI: 1.03, 2.77).

CONCLUSIONS

Pre-incarceration housing is associated with change in sleep quality among individuals incarcerated in jail. Jail may be an important point of intervention to improve sleep quality during incarceration and through connecting individuals to more stable living conditions.

SARS-CoV-2 Mitigation Strategies, Testing, and Cases at 254 Jails in the US Southeast, October 2020 to May 2021

Objectives. To characterize severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mitigation strategies, testing, and cases across county jails in the Southeastern United States, examining variability by jail characteristics. Methods. We administered a 1-time telephone survey to personnel of 254 jails in Alabama, Georgia, North Carolina, and South Carolina between October 2020 and May 2021. Results. Some SARS-CoV-2 mitigation strategies (e.g., screening at intake, isolation and masking for symptomatic persons) were commonly reported (≥ 75% of jails). Other measures, such as masking regardless of symptoms (52%) and screening at release (26%), were less common and varied by jail state or population size. Overall, 41% of jails reported no SARS-CoV-2 testing in the past 30 days. Jails with testing (59%) tested a median of 6 per 100 incarcerated persons; of those jails, one third reported 1 or more cases of positive tests. Although most jails detected no cases, in the 20% of all jails with 1 or more case in the past 30 days, 1 in 5 tests was positive. Conclusions. There was low testing coverage and variable implementation of SARS-CoV-2 mitigation strategies in Southeastern US jails during the first year of the COVID-19 pandemic. (Am J Public Health. 2022;112(11):1589-1598. https://doi.org/10.2105/AJPH.2022.307012).

Nutritional adequacy of meals and commissary items provided to individuals incarcerated in a southwest, rural county jail in the United States

BACKGROUND

Poor diet may contribute to deleterious chronic health among individuals incarcerated. Yet, limited research has evaluated the nutritional content of menus and commissary items provided in jails. Thus, this study assessed the macronutrient distribution, caloric composition, and diet quality of the seven-day cycle menu and commissary items provided in a southwest, rural county jail in the United States.

METHODS

Daily and mean availability of calories and macronutrients for the seven-day cycle menu and commissary items were estimated using NutritionCalc Plus®. Diet quality (i.e., Healthy Eating Index-2015 [HEI-2015]) was assessed. Macronutrients and calories were compared to the Acceptable Macronutrient Distribution Range (AMDR) and the 2020-2025 Dietary Guidelines for Americans (DGA). Protein and carbohydrate were compared to the Dietary Reference Intake (DRI). HEI-2015 was compared to the average U.S. diet.

RESULTS

Daily caloric provisions exceeded DGA recommendations. Daily available (16.2%-25.2% kcal/day) and mean protein met the AMDR recommendations, yet exceeded the DRI. Mean protein with commissary packs exceeded the AMDR recommendations and DRI. Daily available carbohydrate met AMDR recommendations for all but two days of the seven-day cycle menu, which exceeded recommendations (52.5%-66.4% kcal/day). Mean carbohydrate met the AMDR recommendations and exceeded the DRI, and with the commissary packs, exceeded the AMDR recommendations and DRI. Daily available total fat for the seven-day cycle menu (79.5-146.7 g), mean total fat alone and with the commissary packs exceeded AMDR recommendations. Daily available saturated fat for the seven-day cycle menu (16.7-47.7 g) exceeded AMDR recommendations for all but one day of the seven-day cycle menu, while mean saturated fat alone and with the commissary packs exceeded AMDR recommendations. Daily available added sugars for the seven-day cycle menu (8.4-14.2 g), mean added sugars alone and with the commissary packs all met AMDR recommendations. HEI-2015 scores for the seven-day cycle menu ranged from 49.3-74.5 (mean = 62.2, SD = 9.4), and increased with the commissary packs.

CONCLUSIONS

Exceeding caloric and saturated fat recommendations may contribute to weight gain, regardless of high diet quality. Increasing nutrient-dense foods available in jail may reduce chronic disease among incarcerated populations.

Nutrition availability for those incarcerated in jail: Implications for mental health

PURPOSE

Using a seven-day cycle menu and commissary items at a rural county jail, this study aims to describe provisions of micronutrients known to be associated with mental health disorders and if they meet dietary guidelines.

DESIGN/METHODOLOGY/APPROACH

The nutritional content of a seven-day cycle menu and four available commissary food packs were evaluated using NutritionCalc® Plus software (McGraw-Hill Education version 5.0.19) and compared to Dietary Reference Intakes (DRI).

FINDINGS

Menu mean values of Vitamin B6, Vitamin B12, Vitamin C and zinc met DRI recommendations. However, Vitamin D (for men and women), magnesium (for men only) and omega-3s (for men only) did not meet the DRI recommendations.

ORIGINALITY/VALUE

As deficits of Vitamin D, magnesium and omega-3s are known to exacerbate bipolar disorder, anxiety and depression, small changes to food would increase the offerings and potential intake of nutrients that may improve mental health.

Barriers and facilitators to attending and being physically active during recreation time among women incarcerated

BACKGROUND

Most women incarcerated in jail are not physically active and do not attend recreation time (rec-time), a time dedicated to being physically active, outside. The purpose of this study was to determine barriers and facilitators to attending and being physically active during rec-time among women incarcerated in jail.

METHODS

We recruited and distributed a cross-sectional questionnaire to 100 women incarcerated at the Coconino County Detention Facility (CCDF) in Flagstaff, Arizona from March to July 2020. Women were asked about their experience with rec-time at CCDF, including if they had ever attended, how often they attended, if they exercised at rec-time, activities they participated in, and facilitators, barriers, and benefits to attend rec-time.

RESULTS

Among 99 women who completed the questionnaire, 89% had ever attended rec-time. Most women identified environmental- and health-related facilitators to attending rec-time including enjoying natural light (74%), getting fresh air (83%), a change in environment (62%), and to move around and exercise (72%). Many women indicated environmental-, equipment-, clothing, and motivation-related barriers to attending rec-time. Specifically, women believed there was a lack of equipment (56%) and limited access to proper footwear (49%).

CONCLUSIONS

As health and environment are important facilitators and barriers to being physically active among women incarcerated in jail, it is important to identify appropriate environmental and policy interventions to increase the use of rec-time and physical activity. If a correctional facility does not offer rec-time or a similar alternative, one should be established, accessible, and welcoming.

"Everything has changed": detention officer roles and recreation time changes due to COVID-19 policies at a Southwest County Jail

BACKGROUND

The COVID-19 pandemic responses in jails have forced detention officers to adjust how they approach the confinement and care of individuals while they are incarcerated. One aspect of incarceration affected was detention officers' roles. The aims of this research project were to determine how the COVID-19 pandemic has affected the general duties of detention officers at a Southwest County Jail. Detention officers were recruited via email to participate in an online questionnaire from October to December 2020. Participants answered Likert scale and open-ended questions regarding how the COVID-19 pandemic has affected their job duties. Descriptive statistics and thematic analysis were used to identify themes and patterns in the responses.

RESULTS

Among 24 detention officers, 87% indicated agreement that the COVID-19 pandemic has significantly changed the duties of detention officers at CCDF. The most discussed change was the introduction of a 14-day quarantine process for newly incarcerated individuals. The 14-day quarantine increased the workload of detention officers.

CONCLUSION

The COVID-19 pandemic responses in jail may have unintended negative consequences for the job duties of detention officers. Current and future pandemic response strategies in jails would benefit from taking staff perspectives into consideration as they are directly impacted by the COVID-19 response strategies put into place. Policy implications are discussed.

Childhood Environmental Instability and Social-Emotional Outcomes in Emerging Adults

Adverse childhood experiences (ACEs) can negatively affect social-emotional functioning. The association between individual and cumulative ACEs and social-emotional domains of self-esteem, loneliness, and negotiation in intimate partner relationships has not been explored in low-risk emerging adults, a gap this study aims to fill. An online survey was administered to undergraduate emerging adults, ages 18 to 25 years (M_age = 19.73, SD = 1.83; N = 436; 20.60% Hispanic; 63.80% female). The ACEs Survey, Child Abuse Potential Inventory, and Conflict Tactics Scale-2nd Edition were used. Three multivariate ordinary least squares regressions were run, each including predictors significant in bivariate analyses and outcomes of self-esteem, loneliness, and negotiation for each regression. Emotional abuse, B = -.20, p < .01; emotional neglect, B = -.21, p < .001; and substance using family member, B = -.12, p < .05, were negatively associated with self-esteem; emotional neglect, B = .11, p < .01, and cumulative ACEs, B = .16, p < .01, were positively associated with loneliness; and incarcerated family member was positively associated with negotiation, B = .12, p < .05. Overall, these findings suggest that individual ACEs associated with environmental instability (e.g., emotional abuse) are strong predictors of social-emotional outcomes, relative to ACEs associated with more direct physical harm (e.g., sexual abuse).

Patterns of Physical Activity Among Women Incarcerated in Jail

The physical and mental health benefits of physical activity in all populations are well established. In 2019, incarcerated women at a Southwest county jail were observed during "recreation time," a time when physical activity is encouraged, to identify the proportion of women who participated in recreation time and their physical activity levels. During observed recreation times, 28% of women attended; 56% were sedentary, 4% engaged in vigorous physical activity, and approximately 40% walked or performed similarly moderate physical activity. Future research should identify barriers to being physically active while incarcerated, leading to targeted interventions to promote physical activity.

Adverse Childhood Experiences in relation to drug and alcohol use in the 30 days prior to incarceration in a county jail

Purpose

To characterize the relationship between adverse childhood experiences (ACEs) and substance use among people incarcerated in a county jail.

Design/methodology/approach

A questionnaire was administered to 199 individuals incarcerated in a Southwest county jail as part of a social-epidemiological exploration of converging co-morbidities in incarcerated populations. Among 96 participants with complete ACEs data, the authors determined associations between individual ACEs items and a summative score with methamphetamine (meth), heroin, other opiates, and cocaine use and binge drinking in the 30 days prior to incarceration using logistic regression.

Findings

People who self-reported use of methamphetamine, heroin, other opiates, or cocaine in the 30 days prior to incarceration had higher average ACEs scores. Methamphetamine use was significantly associated with living with anyone who served time in a correctional facility and with someone trying to make them touch sexually. Opiate use was significantly associated with living with anyone who was depressed, mentally ill, or suicidal; living with anyone who used illegal street drugs or misused prescription medications; and if an adult touched them sexually. Binge drinking was significantly associated with having lived with someone who was a problem drinker or alcoholic.

Originality

Significant associations between methamphetamine use and opiate use and specific adverse childhood experiences suggest important entry points for improving jail and community programming.

Social Implications

Our findings point to a need for research to understand differences between methamphetamine use and opiate use in relation to particular adverse experiences during childhood, and a need for tailored intervention for people incarcerated in jail.

Cardiovascular Risk Factors among Individuals Incarcerated in an Arizona County Jail

We aimed to estimate the prevalence of cardiovascular risk factors, including hypertension, diabetes, high cholesterol, cigarette smoking, alcohol consumption, and obesity among a sample of individuals incarcerated in an Arizona county jail and compare prevalence estimates to a matched non-institutionalized population. From 2017–2018, individuals housed at a county jail completed a cross-sectional health survey. We estimated the prevalence of hypertension, diabetes, cholesterol, overweight/obesity, cigarette smoking, binge drinking, and self-reported health among individuals incarcerated. We compared prevalence estimates of cardiovascular risk factors to a matched sample of 2017–2018 NHANES participants. Overall, 35.9%, 7.7%, and 17.8% of individuals incarcerated in jail self-reported hypertension, diabetes, and high cholesterol, respectively. Of individuals incarcerated, 59.6% were overweight or obese and 36.8% self-reported fair or poor general health. Over half of individuals incarcerated reported ever smoking cigarettes (72.3%) and binge drinking (60.7%). Compared to a matched sample of NHANES participants, individuals incarcerated in jail had a statistically higher prevalence of cigarette smoking and binge drinking. Screening of cardiovascular risk factors and providing preventive measures and interventions, such as healthy eating, physical activity, or pharmacological adherence interventions, while individuals are incarcerated may contribute to the prevention and management of cardiovascular risk factors and, eventually, cardiovascular disease.

Racial/Ethnic Differences in Drug- and Alcohol-Related Arrest Outcomes in a Southwest County From 2009 to 2018

Objectives. To estimate the association between race/ethnicity and drug- and alcohol-related arrest outcomes.Methods. We used multinomial logistic regression and general estimating equations to estimate the association between race/ethnicity and arrest outcomes in 36 073 drug- and alcohol-related arrests obtained from administrative records in a Southwest US county from 2009 to 2018. Results were stratified by charge type.Results. Among misdemeanor drug- and alcohol-related arrests, American Indian/Alaska Native (AI/AN; adjusted odds ratio [AOR] = 3.60; 95% confidence interval [CI] = 3.32, 3.90), Latino (AOR = 1.53; 95% CI = 1.35, 1.73), and Black persons (AOR = 1.28; 95% CI = 1.05, 1.55) were more likely than White persons to be booked into jail as opposed to cited and released. AI/AN (AOR = 10.77; 95% CI = 9.40, 12.35), Latino (AOR = 2.63; 95% CI = 2.12, 3.28), and Black persons (AOR = 1.84; 95% CI = 1.19, 2.84) also were more likely than White persons to be convicted and serve time for their misdemeanor charges. Results were similar for felony drug- and alcohol-related arrests aggregated and stratified.Conclusions. Our results suggest that race/ethnicity is associated with outcomes in drug-related arrests and that overrepresentation of racial/ethnic minorities in the criminal justice system cannot be attributed to greater use of drugs and alcohol in general.

Adaptation of the System for Observing Play and Recreation in Communities (SOPARC) for the Measurement of Physical Activity in Jail Settings

Over 9 million people are incarcerated in jail each year, but physical activity has not been assessed among incarcerated populations. Measuring physical activity in the jail setting is complicated as current physical activity measurement tools are not designed for use inside jail facilities. Therefore, we adapted an evidence-based physical activity measurement tool, the System for Observing Play and Recreation in Communities (SOPARC), to assess physical activity within a jail facility. SOPARC was designed to obtain observational information on physical activity of individuals. The study team created a protocol for SOPARC for use in jail facilities. Unlike the original SOPARC, access to recreation time in jail required prior scheduling. Target areas were unnecessary as recreation spaces were enclosed. The adapted SOPARC protocol for jails included start and end times, the number of individuals that attended, and recreation time users’ physical activity levels, footwear, outerwear, uniform color, and use of mobility assistive devices. The use of SOPARC in the jail setting requires adaptation to adequately capture physical activity data among incarcerated individuals. Accurately measuring physical activity among incarcerated individuals and the environment in which they are active may allow for future development and testing of physical activity interventions in jail facilities.

Health disparities in jail populations: Mixed methods and multi-disciplinary community engagement for justice and health impacts

This special issue of Practicing Anthropology presents multidisciplinary and multisectoral views of a community engaged health disparities project titled "Health Disparities in Jail Populations: Converging Epidemics of Infectious Disease, Chronic Illness, Behavioral Health, and Substance Abuse." The overall project incorporated traditional anthropological mixed-methods approaches with theory and methods from informatics, epidemiology, genomics, evolutionary and computational biology, community engagement, and applied/translational science.