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Semenza D, Silver I, Stansfield R, Boen C. Concentrated disadvantage and functional disability: a longitudinal neighbourhood analysis in 100 US cities. J Epidemiol Community Health 2023; 77:676-682. [PMID: 37451845 DOI: 10.1136/jech-2023-220487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Socioeconomic disadvantage related to poverty, unemployment and social disinvestment contributes to significant disparities in community health in the USA. Yet, there remains limited ecological research on the relationship between neighbourhood disadvantage and functional disability. Much of the work in this area has focused on elderly populations without attention to variation across age and sex groups. METHODS Using a longitudinal dataset of almost 16 000 neighbourhoods, we examine the relationship between neighbourhood disadvantage and functional disability. Leveraging a series of cross-lagged panel models, we account for reciprocal dynamics and a range of pertinent covariates while assessing differences across age- and sex-specific groups. RESULTS Accounting for reciprocal effects, we found that the association between concentrated disadvantage and functional disability varies across age and sex groups. Concentrated disadvantage is most consistently associated with increased functional disability among boys (5-17 years), young men (18-34 years) and middle-aged men (35-64 years). Similar associations are found among girls (5-17 years) and middle-aged women (35-64 years). CONCLUSION Local neighbourhood economic conditions are significantly associated with functional disability among relatively young populations of males and females. Exposure to neighbourhood disadvantage and deprivation may accelerate disablement processes and shift the age curve of disability risk.
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Affiliation(s)
- Daniel Semenza
- Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, New Jersey, USA
- Urban-Global Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Ian Silver
- Center for Courts and Corrections Research, Research Triangle Institute, Research Triangle Park, North Carolina, USA
| | - Richard Stansfield
- Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, New Jersey, USA
| | - Courtney Boen
- Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Barnert ES, Scannell C, Ashtari N, Albertson E. Policy Solutions to End Gaps in Medicaid Coverage during Reentry after Incarceration in the United States: Experts' Recommendations. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 30:2201-2209. [PMID: 36172337 PMCID: PMC9512259 DOI: 10.1007/s10389-021-01483-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Elizabeth S Barnert
- UCLA, David Geffen School of Medicine at UCLA, Department of Pediatrics, 10833 Le Conte Ave, Los Angeles, CA 90095
- Mattel Children's Hospital, Children's Discovery & Innovation Institute, 757 Westwood Plaza, Los Angeles, CA 90095
| | - Christopher Scannell
- UCLA/VA National Clinician Scholars Program, 1100 Glendon Ave, Suite 900, Los Angeles, CA 90095
| | - Neda Ashtari
- UCLA, David Geffen School of Medicine at UCLA, Department of Pediatrics, 10833 Le Conte Ave, Los Angeles, CA 90095
- Mattel Children's Hospital, Children's Discovery & Innovation Institute, 757 Westwood Plaza, Los Angeles, CA 90095
| | - Eleanor Albertson
- UCLA, UCLA Fielding School of Public Health, Department of Health Policy & Management, 650 Charles E Young Dr, Los Angeles, CA 90095
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3
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Termos M, Holzer KJ, Vaughn MG, Kelton K. Gender Differences in Prescription Medications Among Transitioning Justice-Involved Individuals. JOURNAL OF CORRECTIONAL HEALTH CARE 2022; 28:198-202. [PMID: 35475658 DOI: 10.1089/jchc.20.10.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Little is known-especially with regard to gender differences-about the prescription trends among justice-involved individuals with health conditions after release from correctional facilities. This article presents initial findings from a large outreach program designed to provide prescription support during the turbulent prison-to-community transition period. We analyzed data derived from a prescription outreach program during the years 2018-2019. Multivariate logistic regression was employed to examine the association between gender and therapeutic areas, controlling for age and race. Compared with men, women were at higher odds of receiving prescriptions for psychiatric conditions followed by neurological conditions, but lower odds of receiving prescriptions for cardiovascular conditions. Further research is necessary to unpack the causal pathways that underlie the associational trends observed in our current analysis.
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Affiliation(s)
- Mirvat Termos
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA
| | - Katherine J Holzer
- Division of Clinical and Translational Research, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael G Vaughn
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA.,Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Katherine Kelton
- Department of Psychology, Saint Louis University, St. Louis, Missouri, USA
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4
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Winetsky D, Fox A, Nijhawan A, Rich JD. Treating Opioid Use Disorder and Related Infectious Diseases in the Criminal Justice System. Infect Dis Clin North Am 2021; 34:585-603. [PMID: 32782103 DOI: 10.1016/j.idc.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article provides an overview of the diagnosis and management of opioid use disorder and its infectious complications among populations with criminal justice involvement. Opioid use disorder and chronic infections such as human immunodeficiency virus and hepatitis C virus are highly prevalent among incarcerated individuals and some of the unique features of correctional facilities present challenges for their appropriate medical management. We outline evidence-based strategies for integrated, patient-centered treatment during incarceration and the potentially hazardous transition back to the community upon release.
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Affiliation(s)
- Daniel Winetsky
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, 622 West 168th Street, PH 8 W-876, New York, NY 10032, USA; HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, NY, USA.
| | - Aaron Fox
- Department of Internal Medicine, Montefiore Medical Center, 305 East 161th Street, Room 4, Bronx, NY, USA
| | - Ank Nijhawan
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Josiah D Rich
- Department of Medicine, Brown University, 164 Summit Avenue, Providence, RI 02906, USA; Department of Epidemiology, Brown University, 164 Summit Avenue, Providence, RI 02906, USA
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5
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Farrell CM, Gottlieb A. The Effect of Health Insurance on Health Care Utilization in the Justice-Involved Population: United States, 2014-2016. Am J Public Health 2020; 110:S78-S84. [PMID: 31967872 DOI: 10.2105/ajph.2019.305399] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine the impact of health insurance coverage on utilization of outpatient, hospital, and emergency department care among justice-involved individuals in the United States.Methods. We performed repeated cross-sectional analyses with data from the National Survey of Drug Use and Health. The study population included 6086 adults with justice involvement within the past year. We used logistic regression to examine the odds of health care utilization based on either a dichotomous or categorical measure of health insurance coverage. We used negative binomial regression to examine the number of times a specific type of care was utilized with both a dichotomous measure of health insurance coverage and a categorical measure of type of health insurance.Results. Health insurance was associated with increased utilization of outpatient, inpatient, and emergency department care.Conclusions. Health insurance coverage was associated with increased utilization of outpatient, inpatient, and emergency department health care among justice-involved individuals. Therefore, expanding access to health insurance in this population has the potential to increase care utilization of all types and decrease barriers to medical services.
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Affiliation(s)
- Caitlin M Farrell
- Caitlin M. Farrell is with the McGaw Medical Center of Northwestern University Department of Family and Community Medicine, Chicago, IL. Aaron Gottlieb is with the University of Illinois at Chicago, Jane Addams School of Social Work, Chicago
| | - Aaron Gottlieb
- Caitlin M. Farrell is with the McGaw Medical Center of Northwestern University Department of Family and Community Medicine, Chicago, IL. Aaron Gottlieb is with the University of Illinois at Chicago, Jane Addams School of Social Work, Chicago
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6
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Albertson EM, Scannell C, Ashtari N, Barnert E. Eliminating Gaps in Medicaid Coverage During Reentry After Incarceration. Am J Public Health 2020; 110:317-321. [PMID: 31944846 PMCID: PMC7002937 DOI: 10.2105/ajph.2019.305400] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2019] [Indexed: 11/04/2022]
Abstract
This commentary explores the health and social challenges associated with gaps in Medicaid health insurance coverage for adults and youths exiting the US criminal justice system, and highlights some potential solutions.Because a high proportion of recently incarcerated people come from low-income backgrounds and experience a high burden of disease, the Medicaid program plays an important role in ensuring access to care for this population. However, the Medicaid Inmate Exclusion Policy, or "inmate exclusion," leads to Medicaid being terminated or suspended upon incarceration, often resulting in gaps in Medicaid coverage at release. These coverage gaps interact with individual-level and population-level factors to influence key health and social outcomes associated with recidivism.Ensuring Medicaid coverage upon release is an important, feasible component of structural change to alleviate health inequities and reduce recidivism. High-yield opportunities to ensure continuous coverage exist at the time of Medicaid suspension or termination and during incarceration prior to release.
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Affiliation(s)
- Elaine Michelle Albertson
- Elaine Michelle Albertson is with the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles. Christopher Scannell is with the VA Greater Los Angeles Healthcare System and the National Clinician Scholars Program, University of California, Los Angeles. Neda Ashtari and Elizabeth Barnert are with the David Geffen School of Medicine, University of California, Los Angeles
| | - Christopher Scannell
- Elaine Michelle Albertson is with the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles. Christopher Scannell is with the VA Greater Los Angeles Healthcare System and the National Clinician Scholars Program, University of California, Los Angeles. Neda Ashtari and Elizabeth Barnert are with the David Geffen School of Medicine, University of California, Los Angeles
| | - Neda Ashtari
- Elaine Michelle Albertson is with the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles. Christopher Scannell is with the VA Greater Los Angeles Healthcare System and the National Clinician Scholars Program, University of California, Los Angeles. Neda Ashtari and Elizabeth Barnert are with the David Geffen School of Medicine, University of California, Los Angeles
| | - Elizabeth Barnert
- Elaine Michelle Albertson is with the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles. Christopher Scannell is with the VA Greater Los Angeles Healthcare System and the National Clinician Scholars Program, University of California, Los Angeles. Neda Ashtari and Elizabeth Barnert are with the David Geffen School of Medicine, University of California, Los Angeles
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Nowotny KM, Frankeberger J, Rodriguez VE, Valdez A, Cepeda A. Behavioral, Psychological, Gender, and Health Service Correlates to Herpes Simplex Virus Type 2 Infection among Young Adult Mexican-American Women Living in a Disadvantaged Community. Behav Med 2019; 45:52-61. [PMID: 29558260 PMCID: PMC6148393 DOI: 10.1080/08964289.2018.1447906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Herpes simplex virus type 2 (HSV-2) is among the most prevalent sexually transmitted infections in the United States. Despite this, there has been limited research on the correlates to HSV-2 among disadvantaged and marginalized women, particularly among Latinas. Data for the present analysis include 125 young adult Mexican-American women enrolled in a longitudinal study in a disadvantaged urban community in San Antonio, Texas. The current rate of tested HSV-2 infection is 56.8%. Our findings suggest strong comorbidity of genital herpes with injecting heroin use, Hepatitis C, sexual violence, incarceration, and mental illness. Contributing to this population's nexus of risk are the low rates of health service utilization among those infected with HSV-2. Integration between behavioral health and primary care, including access to preventative services, are essential for improving the health of Latinas living in disadvantaged neighborhoods.
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Affiliation(s)
- Kathryn M Nowotny
- a Department of Sociology , University of Miami , Coral Gables , FL , USA
| | - Jessica Frankeberger
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Victoria E Rodriguez
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Avelardo Valdez
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Alice Cepeda
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
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8
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Trotter Ii RT, Camplain R, Eaves ER, Fofanov VY, Dmitrieva NO, Hepp CM, Warren M, Barrios BA, Pagel N, Mayer A, Baldwin JA. Health Disparities and Converging Epidemics in Jail Populations: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2018; 7:e10337. [PMID: 30355562 PMCID: PMC6231773 DOI: 10.2196/10337] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/24/2018] [Accepted: 08/05/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Incarcerated populations have increased in the last 20 years and >12 million individuals cycle in and out of jails each year. Previous research has predominately focused on the prison population. However, a substantial gap exists in understanding the health, well-being, and health care utilization patterns in jail populations. OBJECTIVE This pilot study has 5 main objectives: (1) define recidivists of the jail system, individuals characterized by high incarceration rates; (2) describe and compare the demographic and clinical characteristics of incarcerated individuals; (3) identify jail-associated health disparities; (4) estimate associations between incarceration and health; and (5) describe model patterns in health care and jail utilization. METHODS The project has two processes-a secondary data analysis and primary data collection-which includes a cross-sectional health survey and biological sample collection to investigate infectious disease characteristics of the jail population. This protocol contains pilot elements in four areas: (1) instrument validity and reliability; (2) individual item assessment; (3) proof of concept of content and database accessibility; and (4) pilot test of the "honest broker" system. Secondary data analysis includes the analysis of 6 distinct databases, each covered by a formal memorandum of agreement between Northern Arizona University and the designated institution: (1) the Superior Court of Arizona Public Case Finder database; (2) North Country Health Care; (3) Health Choice Integrated Care; (4) Criminal Justice Information Services; (5) Correctional Electronic Medical Records; and (6) iLEADS. We will perform data integration processes using an automated honest broker design. We will administer a cross-sectional health survey, which includes questions about health status, health history, health care utilization, substance use practices, physical activity, adverse childhood events, and behavioral health, among 200 Coconino County Detention Facility inmates. Concurrent with the survey administration, we will collect Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus (samples from the nose) and dental microbiome (Streptococcus sobrinus and Streptococcus mutans samples from the mouth) from consenting participants. RESULTS To date, we have permission to link data across acquired databases. We have initiated data transfer, protection, and initial assessment of the 6 secondary databases. Of 199 inmates consented and enrolled, we have permission from 97.0% (193/199) to access and link electronic medical and incarceration records to their survey responses, and 95.0% (189/199) of interviewed inmates have given nasal and buccal swabs for analysis of S. aureus and the dental microbiome. CONCLUSIONS This study is designed to increase the understanding of health needs and health care utilization patterns among jail populations, with a special emphasis on frequently incarcerated individuals. Our findings will help identify intervention points throughout the criminal justice and health care systems to improve health and reduce health disparities among jail inmates. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/10337.
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Affiliation(s)
- Robert T Trotter Ii
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.,Department of Anthropology, Northern Arizona University, Flagstaff, AZ, United States
| | - Ricky Camplain
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Emery R Eaves
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.,Department of Anthropology, Northern Arizona University, Flagstaff, AZ, United States
| | - Viacheslav Y Fofanov
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.,School of Informatics, Computing, and Cyber Systems, Northern Arizona University, Flagstaff, AZ, United States
| | - Natalia O Dmitrieva
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.,Department of Psychological Sciences, Northern Arizona University, Flagstaff, AZ, United States
| | - Crystal M Hepp
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.,School of Informatics, Computing, and Cyber Systems, Northern Arizona University, Flagstaff, AZ, United States
| | - Meghan Warren
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ, United States
| | - Brianna A Barrios
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, AZ, United States
| | - Nicole Pagel
- School of Informatics, Computing, and Cyber Systems, Northern Arizona University, Flagstaff, AZ, United States
| | - Alyssa Mayer
- Department of Nursing and Health Professions, University of South Carolina, Beaufort, SC, United States
| | - Julie A Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.,Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, United States
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Montague BT, John B, Sammartino C, Costa M, Fukuda D, Solomon L, Rich JD. Use of viral load surveillance data to assess linkage to care for persons with HIV released from corrections. PLoS One 2018; 13:e0192074. [PMID: 29432472 PMCID: PMC5809020 DOI: 10.1371/journal.pone.0192074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 12/28/2017] [Indexed: 11/18/2022] Open
Abstract
Incarcerated people remain a priority group in efforts to control and reverse the HIV epidemic. Following release, social instability and reengagement in key transmission risk behaviors increase the risk of secondary transmission of HIV. Targeted programs have been developed to facilitate reengagement in care on reentry. Evaluation of the impact of these initiatives requires a systematic, confidential, framework for assessment of linkage to care for persons released from corrections. By linking HIV viral load surveillance data to corrections release data, the time to the first laboratory monitoring service in the community as well as the virologic status can be assessed. Using this method, we linked release data for sentenced individuals released from Massachusetts state correctional facilities in 2012 to HIV surveillance data from the Massachusetts HIV/AIDS Surveillance Program (MHASP) for the years 2012–2013. We identified 41 individuals with HIV released in 2012. Ninety-one percent had identified virologic assessments post release, 41% within 30 days. Thirty-three percent did not have a viral load assessed for more than 90 days and 31% had detectable virus at the time of their initial assessment. Persons with longer incarcerations (> 180 days) were more likely to have suppressed viral load at the time of follow-up (p = 0.05). This work demonstrates the important value of HIV laboratory surveillance data and correctional release data as a tool to assess linkage to care following release from corrections. We encourage jurisdictions to explore utilizing similar methodology to evaluate the effectiveness of the linkage to HIV care after release from incarceration.
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Affiliation(s)
- Brian T. Montague
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver School of Medicine, Aurora, Colorado, United States of America
- * E-mail:
| | - Betsey John
- Bureau of Infectious Disease and Laboratory Science, Massachusetts Department of Public Health, Boston, Massachusetts, United States of America
| | - Cara Sammartino
- Department of Health Sciences, Johnson and Wales University, Providence, Rhode Island, United States of America
| | - Michael Costa
- Abt Associates, Cambridge, Massachusetts, United States of America
| | - Dawn Fukuda
- Bureau of Infectious Disease and Laboratory Science, Massachusetts Department of Public Health, Boston, Massachusetts, United States of America
| | - Liza Solomon
- Abt Associates, Cambridge, Massachusetts, United States of America
| | - Josiah D. Rich
- Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Medicine, Division of Infectious Diseases, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, United States of America
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Nowotny KM. Health care needs and service use among male prison inmates in the United States: A multi-level behavioral model of prison health service utilization. HEALTH & JUSTICE 2017; 5:9. [PMID: 28597357 PMCID: PMC5465228 DOI: 10.1186/s40352-017-0052-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/23/2017] [Indexed: 05/17/2023]
Abstract
BACKGROUND The purpose of this study is to apply Andersen's Behavioral Model of Health Service Use to men's prisons to assess the direct and indirect effects of inmate predisposing characteristics through multiple types of need. Also examined are the effects of prison-specific enabling factors and the variation in use of health services across prisons. This study uses a nationally representative U.S. sample of men incarcerated in state prisons (n = 8816) and generalized structural equation and multilevel modeling. Five types of need-medical condition, illness, dental problem, unintentional injury, and intentional injury-are assessed for their association with use of health services. RESULTS Findings indicate that a number of inmate predisposing (age, race, education) and vulnerability (mood/anxiety disorder,) characteristics are associated with use of health services but are partially mediated by enabling and need factors. Each type of medical need has strong direct effects with mood/anxiety disorder emerging as the strongest total effect (including both direct effects and indirect effects through need). There is significant variation in rates of health service utilization across prisons that is not accounted for by the prison-level factors included in the multilevel model. CONCLUSIONS The varying patterns of health service use across prisons suggest that incarceration may be an important circumstance that shapes health. In other words, where someone is incarcerated may influence their ability to access and use services in response to medical need. It is important that prisons provide integrated services for inmates with mood/anxiety disorder given high comorbidity with other health conditions.
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Affiliation(s)
- Kathryn M Nowotny
- Department of Sociology, University of Miami, 5202 Merrick Bldg Rm 120D, Coral Gables, FL, 33146, USA.
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11
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Health Insurance Trends and Access to Behavioral Healthcare Among Justice-Involved Individuals-United States, 2008-2014. J Gen Intern Med 2016; 31:1523-1529. [PMID: 27638837 PMCID: PMC5130958 DOI: 10.1007/s11606-016-3845-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND A large proportion of justice-involved individuals have mental health issues and substance use disorders (SUD) that are often untreated due to high rates of uninsurance. However, roughly half of justice-involved individuals were estimated to be newly eligible for health insurance through the Affordable Care Act (ACA). OBJECTIVE We aimed to assess health insurance trends among justice-involved individuals before and after implementation of the ACA's key provisions, the dependent coverage mandate and Medicaid expansion, and to examine the relationship between health insurance and treatment for behavioral health conditions. DESIGN Repeated and pooled cross-sectional analyses of data from the National Survey on Drug Use and Health (NSDUH). PARTICIPANTS Nationally representative sample of 15,899 adults age 19-64 years between 2008 and 2014 with a history of justice involvement during the prior 12 months. MAIN MEASURES Uninsurance rates between 2008 and 2014 are reported. Additional outcomes include adjusted treatment rates for depression, serious mental illness, and SUD by insurance status. KEY RESULTS The dependent coverage mandate was associated with a 13.0 percentage point decline in uninsurance among justice-involved individuals age 19-25 years (p < 0.001). Following Medicaid expansion, uninsurance declined among justice involved individuals of all ages by 9.7 percentage points (p < 0.001), but remained 16.3 percentage points higher than uninsurance rates for individuals without justice involvement (p < 0.001). In pooled analyses, Medicaid, relative to uninsurance and private insurance, was associated with significantly higher treatment rates for illicit drug abuse/dependence and depression. CONCLUSION Given the high prevalence of mental illness and substance use disorders among justice-involved populations, persistently elevated rates of uninsurance and other barriers to care remain a significant public health concern. Sustained outreach is required to reduce health insurance disparities between individuals with and without justice involvement. Public insurance appears to be associated with higher treatment rates, relative to uninsurance and private insurance, among justice-involved individuals.
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12
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Nowotny KM. Social Factors Related to the Utilization of Health Care Among Prison Inmates. JOURNAL OF CORRECTIONAL HEALTH CARE 2016; 22:129-38. [PMID: 26984136 PMCID: PMC5557287 DOI: 10.1177/1078345816633701] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines the demographic and social factors related to health care utilization in prisons using the 2004 Survey of Inmates in State Correctional Facilities. The findings show that education and employment, strong predictors of health care in the community, are not associated with health care in prisons. Although female inmates have a higher disease burden than male inmates, there are no sex differences in health care usage. The factors associated with health care, however, vary for women and men. Notably, Black men are significantly more likely to utilize health care compared to White and Latino men. The findings suggest that, given the constitutionally mandated health care for inmates, prisons can potentially minimize racial disparities in care and that prisons, in general, are an important context for health care delivery in the United States.
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Affiliation(s)
- Kathryn M Nowotny
- Department of Sociology and Population Program, University of Colorado Boulder, Boulder, CO, USA
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Nowotny KM, Cepeda A, James-Hawkins L, Boardman JD. Growing Old Behind Bars: Health Profiles of the Older Male Inmate Population in the United States. J Aging Health 2015; 28:935-56. [PMID: 26553724 DOI: 10.1177/0898264315614007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study examines patterns of multimorbidity among elderly male inmates across four domains of health (chronic medical conditions, drug- and alcohol-related diseases, impairments, and mental and behavioral health) to understand the complex health care needs of this growing population. METHOD We use the 2004 Survey of Inmates in State Correctional Facilities and Latent Class Regression Analysis to examine 22 health problems among 1,026 men aged 50 and older. RESULTS There are four groups of elderly male inmates: (a) relatively healthy (45.1%), (b) substance users with behavioral health issues (23.4%), (c) chronic unhealthy with impairments and violence/injury (23.6%), and (d) very unhealthy across all domains (7.9%). These groups have unique sociodemographic background and incarceration history characteristics. CONCLUSION This study demonstrates the complexity of health for elderly inmates. Prison health should continue to be monitored to aid correctional and community health programs in understanding clinical risks, exposures, and health care needs for this population.
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Affiliation(s)
| | - Alice Cepeda
- University of Southern California, Los Angeles, USA
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14
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Wilkins C. Connecting Permanent Supportive Housing to Health Care Delivery and Payment Systems: Opportunities and Challenges. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2015. [DOI: 10.1080/15487768.2015.1001690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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