Henrie M. Treadwell

Health Disparities and Incarcerated Women: A Population Ignored

I am an invisible man. No, I am not a spook like those who haunted Edgar Allan Poe; nor am I one of your Hollywood-movie ectoplasms. I am a man of substance, of flesh and bone, fiber and liquids—and I might even be said to possess a mind. I am invisible, understand, simply because people refuse to see me.… When they approach me they see only my surroundings, themselves, or figments of their imagination—indeed, everything and anything except me. Ralph Ellison, Invisible Man Although Ralph Ellison’s Invisible Man (1952) was written to chronicle the plight of one who was both Black and American, the quotation above might also describe the feelings of incarcerated populations, particularly incarcerated women, in the United States. Incarcerated women are largely African American; thus, many of them bear the quadruple burden of their race/ethnicity, class, gender, and status as a criminal offender. That being Black, being female, being poor, and being a criminal offender confers serious health risks is clear. Because incarcerated women are “invisible,” there has been little in the way of research and policy development that would advance their health status. Thus it is no surprise that for the most part, the health of incarcerated women is worse than that of incarcerated men and than that of women in the general population.1

Social determinants of health among African–American men

Abstract The health disparities among African–American men are staggering when compared to other racial, ethnic, and gender groups in the United States. While there have been considerable efforts to eliminate health disparities in recent years, disparity elimination efforts have often focused on changing health behavior with regard to African–American men, and grave health disparities continue to exist among this population. This article argues that a consideration of the social determinants of health among African–American men is long overdue. It highlights the serious health disparities among this population, and considers the social determinants of health of African–American men in relation to health status, health behavior, and health care. Finally, suggestions are offered for addressing the social determinants of health among African–American men.

Poverty, Race, and the Invisible Men

Improving access to primary health care by the poor, the underserved, and those living at the economic and social margins of this nation’s social construct has been work that the W. K. Kellogg Foundation has pursued rigorously and with deep commitment. We have worked to lead and serve as we supported health clinics, as well as to define, refine, and implement pathways to improve health for many. But like most, we have neglected a significant part of the population most in need of health care. We were blind to the fact that when we visited clinics and worked with communities to address their health needs, there were few men in the waiting rooms of the clinics where primary health and prevention services were being provided. Virtually no health efforts were directed toward men. Poor men had become invisible and their health needs neglected.

Oral Health is the Measure of a Just Society

Former Surgeon General David Satchers report, Oral Health in America, documents the higher burden of oral diseases and conditions borne by those with relatively low social standing at each stage of life. When an entire community suffers from a health concern, that concern becomes a social justice issue. Racial and ethnic minorities, prisoners, and seniors suffer disproportionately from oral diseases and conditions due to societal prejudices that place them at risk over and above any risk associated with their economic means. Community-based delivery models that involve the community in planning and implementation, build upon the existing health safety net to link oral health services with primary care, and change public or institutional policy to support the financing and delivery of oral health care have proven successful. Here we champion the need for a national health plan that includes oral health care to promote social justice and oral health for all.

Short-term Impact of an HIV Risk Reduction Intervention for Soon-to-be Released Inmates in Georgia

The purpose of this study was to determine the impact of an intervention seeking to reduce risk for HIV/AIDS infection among a sample of soon-to-be-released adult male inmates. This analysis is based on a random sample of 116 adult male prisoners recruited and interviewed prior to their participation in an HIV/AIDS and recidivism risk reduction intervention and again three months after they were reintegrated into the community. The intervention program was designed to reduce risky sexual behaviors and alcohol, tobacco, and other drug-related behaviors. It had a randomized, Latin-square design to evaluate adult male offenders across four conditions. Findings indicate that the intervention for the inmate population was effective in reducing sexual self-expectation and substance use and increasing condom use self-efficacy over a three-month period.

Improving the Oral Health of Prisoners to Improve Overall Health and Well-Being

General health and oral health are linked. The surgeon general’s report on the state of the nation’s oral health indicates that you can’t have one without the other. The same report notes that while the oral health of the nation improved significantly over the 20th century, there are major disparities in oral health among subpopulations.1 The formal call for papers for this issue of the Journal yielded no papers on oral health in the prison system. A review of the literature in PubMed turned up very few published articles on the oral health of prisoners or systems to provide prisoners with oral health care; of the 12 peer-reviewed articles found, 5 were published outside the United States, 4 were published in 1977 or earlier, and only 1 discussed juvenile offenders in detention. To better understand the status of oral health in our nation’s prisons, we read what literature we could find and spoke to several dentists who work in the prison system.

Addressing Obesity and Diabetes Among African American Men: Examination of a Community-Based Model of Prevention

The Save Our Sons study is a community-based, culturally responsive, and gender-specific intervention aimed at reducing obesity and diabetes among a small sample (n = 42) of African American men. The goals of the study were to: (1) test the feasibility of implementing a group health education and intervention model to reduce the incidence of diabetes and obesity among African American men; (2) improve regular access to and utilization of health care services and community supportive resources to promote healthy lifestyles among African American men; and (3) build community networks and capacity for advocacy and addressing some of the health needs of African American men residing in Lorain County, Ohio. Trained community health workers facilitated activities to achieve program aims. Following the 6-week intervention, results indicated that participants had greater knowledge about strategies for prevention and management of obesity and diabetes; increased engagement in exercise and fitness activities; decreased blood pressure, weight, and body mass index levels; and visited a primary care doctor more frequently. Also, local residents elevated African American mens health and identified it as a priority in their community. This model of prevention appears to be a substantial, robust, and replicable approach for improving the health and wellbeing of African American men.

The importance of location for tobacco cessation: rural-urban disparities in quit success in underserved West Virginia Counties.

CONTEXT Adults who live in rural areas of the United States have among the highest smoking rates in the country. Rural populations, including Appalachian adults, have been historically underserved by tobacco control programs and policies and little is known about their effectiveness. PURPOSE To examine the end-of-class quit success of participants in A Tobacco Cessation Project for Disadvantaged West Virginia Communities by place of residence (rural West Virginia and the urban area of Greater Charleston). METHODS This collaborative program was implemented in 5 underserved rural counties in West Virginia and consisted of 4 intervention approaches: (1) a medical examination; (2) an 8-session educational and behavioral modification program; (3) an 8-week supply of pharmacotherapy; and (4) follow-up support group meetings. FINDINGS Of the 725 program participants, 385 (53.1%) had successfully quit using tobacco at the last group cessation class they attended. Participants who lived in rural West Virginia counties had a lower end-of-class quit success rate than those who lived in the urban area of Greater Charleston (unadjusted odds ratio [OR]= 0.69, 95% confidence interval [CI]= 0.48, 0.99), even after taking into account other characteristics known to influence quit success (adjusted OR = 0.58, 95% CI = 0.35, 0.94). CONCLUSIONS Tobacco control programs in rural West Virginia would do well to build upon the positive aspects of rural life while addressing the infrastructure and economic needs of the region. End-of-class quit success may usefully be viewed as a stage on the continuum of change toward long-term quit success.

Determining What We Stand for Will Guide What We Do: Community Priorities, Ethical Research Paradigms, and Research With Vulnerable Populations

Prisoners, ex-offenders, and the communities they belong to constitute a distinct and highly vulnerable population, and research must be sensitive to their priorities. In light of recent suggestions that scientific experimentation involving prisoners be reconsidered, community-based participatory research can be a valuable tool for determining the immediate concerns of prisoners, such as the receipt of high-quality and dignified health care inside and outside prisons. In building research agendas, more must be done to ensure the participation of communities affected by the resulting policies.

Leadership Development for Health Researchers at Historically Black Colleges and Universities

Historically Black colleges and universities (HBCUs) have traditionally been a magnet for Black students at all levels nationwide and have been an exemplar of mentorship models for preparing leaders in many fields. A research career development program for junior faculty scholars that leverages the unique strengths of HBCUs has the potential to promote diverse leadership in health research and advance practical understanding of how to address HIV/AIDS and related health challenges that ravage vulnerable communities. A program that creates institutional bonds between HBCUs and other academic institutions can create a groundbreaking framework for more-effective community-based participatory research. We present a rationale for supporting an HBCU-led collaborative research program, one that both advances junior faculty and explores the interrelationship between HIV/AIDS, mental health, and substance abuse through research in correctional facilities.