Challenges to Pap Smear Follow-up among Women in the Criminal Justice System

Women involved in the United States criminal justice system face a variety of challenges in maintaining their health. Histories of sexual abuse, early initiation of sex, and substance abuse are reflected in more negative reproductive health outcomes, including cervical cancer, than those found among non-incarcerated women. Little is known about how to close this health gap. The present study assessed what incarcerated women perceived to be facilitators and inhibitors of obtaining recommended follow-up for abnormal Pap tests. In-depth individual interviews were conducted with 44 women in an urban county jail about experiences with Pap tests and how they followed-up on abnormal results. We analyzed data using the process of thematic content analysis. Four themes were found, Pap test abnormality as an all-inclusive phrase for women’s health problems, unstable lives, the structural challenges of money, and competing demands. Women with criminal justice histories have numerous and complex challenges in following-up abnormal Pap test results, as well as other health problems. Understanding the context around the follow-up for abnormal Pap tests in this population may increase providers’ ability to help women effectively obtain cancer prevention care that can be life-saving, as well as to more effectively provide care for other health problems.     

Health Disparities and the Criminal Justice System: An Agenda for Further Research and Action

Although racial and ethnic minorities are more likely to be involved with the criminal justice system than whites in the USA, critical scientific gaps exist in our understanding of the relationship between the criminal justice system and the persistence of racial/ethnic health disparities. Individuals engaged with the criminal justice system are at risk for poor health outcomes. Furthermore, criminal justice involvement may have direct or indirect effects on health and health care. Racial/ethnic health disparities may be exacerbated or mitigated at several stages of the criminal justice system. Understanding and addressing the health of individuals involved in the criminal justice system is one component of a comprehensive strategy to reduce population health disparities and improve the health of our urban communities.     

Health Care Reform,Behavioral Health,and the Criminal Justice Population

The 2010 Patient Protection and Affordable Care Act (ACA) has a number of important features for individuals who are involved with the criminal justice system. Among the most important changes is the expansion of Medicaid to more adults. The current study estimates that 10% of the total Medicaid expansion could include individuals who have experienced recent incarceration. The ACA also emphasizes the importance of mental health and substance abuse benefits, potentially changing the landscape of behavioral health treatment providers willing to serve criminal justice populations. Finally, it seeks to promote coordinated care delivery. New care delivery and appropriate funding models are needed to address the behavioral health and other chronic conditions experienced by those in criminal justice and to coordinate care within the complex structure of the justice system itself.     

Examining the Temporal Relationship Between Criminal Justice Involvement and Sexual Risk Behaviors among Drug-Involved Men

Although criminal justice involvement has repeatedly been associated with human immunodeficiency virus (HIV)/sexually transmitted infection prevalence and sexual risk behaviors, few studies have examined whether arrest or incarceration uniquely contributes to sexually risky behavior. We examined the temporal relationship between criminal justice involvement and subsequent sexual HIV risk among men in methadone maintenance treatment in New York City. A random sample of 356 men was interviewed at baseline (time 1), 6-month (time 2), and 12-month (time 3) follow-ups. Propensity score matching, negative binomial, and multiple logistic regression were used to isolate and test the effect of time 2 arrest and incarceration on time 3 sexual risk behaviors. Incidence of time 2 criminal justice involvement was 20.1% for arrest and 9.4% for incarceration in the prior 6 months. Men who were arrested at time 2 demonstrated increased number (adjusted incidence rate ratio [IRR] = 1.62; 95% confidence intervals [CI] = 1.11, 2.37) and proportion (IRR = 1.36; 95% CI = 1.07, 1.72) of unprotected vaginal sex acts at time 3. Men incarcerated at time 2 displayed increased number (IRR = 2.07; 95% CI = 1.23, 3.48) and proportion (IRR = 1.45; 95% CI = 1.06, 1.99) of unprotected vaginal sex acts at time 3. Within this sample of drug-involved men, arrest and incarceration are temporally associated with and may uniquely impact successive sexual risk-taking. Findings underscore the importance of HIV prevention interventions among individuals with low-intensity criminal justice involvement. Developing prevention efforts aimed at short-term incarceration, community reentry, and alternatives to incarceration settings will address a large and under-researched segment of the criminal justice population. Alternative approaches to current criminal justice policy may result in public health benefits.     

Adolescent Substance Use and Other Illegal Behaviors and Racial Disparities in Criminal Justice System Involvement: Findings From a US National Survey

We used data from a national survey to examine arrest rate disparities between African American and White adolescents (aged 12–17 years; n = 6725) in relation to drug-related and other illegal behaviors. African American adolescents were less likely than Whites to have engaged in drug use or drug selling, but were more likely to have been arrested. Racial disparities in adolescent arrest appear to result from differential treatment of minority youths and to have long-term negative effects on the lives of affected African American youths.Racial disparities in the juvenile and criminal justice systems are important in both criminology and public health. African American youths have higher rates of arrest and detention than White youths.1–4 The US governmental policies known collectively as the War on Drugs have contributed significantly to increases in rates of arrest and incarceration, especially of African Americans,5–13 although rates of substance use and abuse among African Americans are either similar to14^,15 or even lower than those of Whites.16Two main hypotheses address the overrepresentation of racial/ethnic minorities in the juvenile and criminal justice systems: (1) the “differential offending” hypothesis (that this overrepresentation generally reflects racial and ethnic differences in the incidence, seriousness, and persistence of engagement in delinquent and criminal behavior) and (2) the “differential treatment” hypothesis (that this overrepresentation is attributable to inequities—intended or unintended—in justice system practices as they affect particular populations).2,17–20We used data from a nationally representative survey of youths to examine the relationship of substance use and other illegal behaviors with arrest among African American and White youths to better understand racial disparities in arrest by testing whether the differential offending hypothesis or the differential treatment hypothesis best explains observed disparities, and by examining the longitudinal impact of arrest in adolescence on educational attainment.     

Adolescent Criminal Justice Involvement and Adulthood Sexually Transmitted Infection in a Nationally Representative US Sample

Criminal justice involvement (CJI) disrupts social and sexual networks, and sexually transmitted infections (STIs) thrive on network disruption. Adolescent CJI may be a particularly important determinant of STI because experiences during adolescence influence risk trajectories into adulthood. We used Wave III (2001–2002: young adulthood) of the National Longitudinal Study of Adolescent Health (N = 14,322) to estimate associations between history of adolescent (younger than 18 years) CJI and adult STI risk. Respondents who reported a history of repeat arrest in adolescence, adolescent conviction, and arrest both as an adolescent and an adult (persistent arrest) had between two to seven times the odds of STI (biologically confirmed infection with chlamydia, gonorrhea, or trichomoniasis) in adulthood and between two to three times the odds of multiple partnerships and inconsistent condom use in the past year in adulthood. In analyses adjusting for sociodemographic and behavioral factors, history of having six or more adolescent arrests was associated with more than five times the odds of STI (adjusted odds ratio (AOR) 5.44, 95 % confidence interval (CI) 1.74–17.1). Both adolescent conviction and persistent CJI appeared to remain independent correlates of STI (conviction: AOR 1.90, 95 % CI 1.02–3.55; persistent CJI: AOR 1.60, 95 % CI 0.99–2.57). Adolescents who have repeat arrests, juvenile convictions, and persist as offenders into adulthood constitute priority populations for STI treatment and prevention. The disruptive effect of adolescent CJI may contribute to a trajectory associated with STI in adulthood.     

The Contribution of Volunteers to Work with Children in a Criminal Justice Organisation

This article outlines the experience of managing a large pool of volunteers to work with children in a criminal justice charity, and some of the attendant issues. The extent of volunteering contributions is shown to be both significant and worthwhile, and much of The Northern Ireland Association for the Care and Resettlement of Offenders' work with children could not take place without volunteer input. Associated with this is the fact that in order to ensure safe and satisfactory operations, the organisation has to manage its volunteers in an increasingly sophisticated manner, which to all intents and purposes is tantamount to managing a workforce. Yet an organisation that involves volunteers cannot make the same demands of them as can be made of a paid workforce. These are important factors that are well known to our colleagues in the voluntary sector, and which need to be recognised by government when encouraging the involvement of volunteers. There are also important resource implications if volunteering is to be managed properly and responsibly.     

The Institutional Effects of Incarceration: Spillovers From Criminal Justice to Health Care

Context

This study examines the spillover effects of growth in state-level incarceration rates on the functioning and quality of the US health care system.

Methods

Our multilevel approach first explored cross-sectional individual-level data on health care behavior merged to aggregate state-level data regarding incarceration. We then conducted an entirely aggregate-level analysis to address between-state heterogeneity and trends over time in health care access and utilization.

Findings

We found that individuals residing in states with a larger number of former prison inmates have diminished access to care, less access to specialists, less trust in physicians, and less satisfaction with the care they receive. These spillover effects are deep in that they affect even those least likely to be personally affected by incarceration, including the insured, those over 50, women, non-Hispanic whites, and those with incomes far exceeding the federal poverty threshold. These patterns likely reflect the burden of uncompensated care among former inmates, who have both a greater than average need for care and higher than average levels of uninsurance. State-level analyses solidify these claims. Increases in the number of former inmates are associated simultaneously with increases in the percentage of uninsured within a state and increases in emergency room use per capita, both net of controls for between-state heterogeneity.

Conclusions

Our analyses establish an intersection between systems of care and corrections, linked by inadequate financial and administrative mechanisms for delivering services to former inmates.     

Implementation Science and Employer Disability Practices: Embedding Implementation Factors in Research Designs

Purpose For work disability research to have an impact on employer policies and practices it is important for such research to acknowledge and incorporate relevant aspects of the workplace. The goal of this article is to summarize recent theoretical and methodological advances in the field of Implementation Science, relate these to research of employer disability management practices, and recommend future research priorities. Methods The authors participated in a year-long collaboration culminating in an invited 3-day conference, “Improving Research of Employer Practices to Prevent Disability”, held October 14–16, 2015, in Hopkinton, MA, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with a special panel of knowledge experts with direct employer experience. Results A 4-phase implementation model including both outer and inner contexts was adopted as the most appropriate conceptual framework, and aligned well with the set of process evaluation factors described in both the work disability prevention literature and the grey literature. Innovative interventions involving disability risk screening and psychologically-based interventions have been slow to gain traction among employers and insurers. Research recommendations to address this are : (1) to assess organizational culture and readiness for change in addition to individual factors; (2) to conduct process evaluations alongside controlled trials; (3) to analyze decision-making factors among stakeholders; and (4 ) to solicit input from employers and insurers during early phases of study design. Conclusions Future research interventions involving workplace support and involvement to prevent disability may be more feasible for implementation if organizational decision-making factors are imbedded in research designs and interventions are developed to take account of these influences.     

Patterns of School Victimization and Problem Behaviors: Longitudinal Associations with Socioeconomic Well-Being and Criminal Justice Involvement

Child & Youth Care Forum - Middle school victimization and problem behaviors often co-occur, but little is known about patterns of co-occurrence, or how long effects persist into adulthood....     

Criminal Justice Contact and Health Service Utilization among Women across Health Care Settings: Analyzing the Role of Arrest

Background

It is well-established in the United States that incarceration negatively influences women's health, and researchers have called for examinations of the health effects of criminal justice contact more broadly. This study uses the behavioral model for vulnerable populations to document the prevalence of illness and health risks for recently arrested women, and examines potential ways that illness and health risks are associated with health service use across health care settings.