Megha Ramaswamy

Reducing Drug Use, Human Immunodeficiency Virus Risk, and Recidivism Among Young Men Leaving Jail: Evaluation of the REAL MEN Re-entry Program

PURPOSE This study assesses the impact of REAL MEN (Returning Educated African-American and Latino Men to Enriched Neighborhoods), an intervention designed to reduce drug use, risky sexual behavior and criminal activity among 16-18-year-old males leaving New York City jails. METHODS Participants (N = 552) were recruited in city jails and randomly assigned to receive an intensive 30-hour jail/community-based intervention or a single jail-based discharge planning session. All participants were also referred to optional services at a community-based organization (CBO). One year after release from jail, 397 (72%) participants completed a follow-up interview. Logistic and ordinary least squares regression was used to evaluate the impact of the intervention on drug use, risky sexual behavior, criminal justice involvement, and school/work involvement post release. RESULTS Assignment to REAL MEN and, independently, use of CBO services, significantly reduced the odds of substance dependence (odds ratio [OR] = .52, p ≤ .05; OR = .41, p ≤ .05, respectively) 1 year after release. Those assigned to the intervention spent 29 fewer days in jail compared with the comparison group (p ≤ .05). Compared to non-CBO visitors, those who visited the CBO were more likely to have attended school or found work in the year after release (OR = 2.02, p ≤ .01). CONCLUSIONS Jail and community services reduced drug dependence 1 year after release and the number of days spent in jail after the index arrest. While these findings suggest that multifaceted interventions can improve outcomes for young men leaving jail, rates of drug use, risky sexual behavior, and recidivism remained high for all participants after release from jail, suggesting the need for additional policy and programmatic interventions.

Understanding the Role of Violence in Incarcerated Women's Cervical Cancer Screening and History

In this exploratory study the authors investigated characteristics, including reported experiences of violence, related to incarcerated womens self-report of cervical cancer screening and cancer history and treatment. During a four month period in 2010, 204 women in Kansas City jails were surveyed. Multiple logistic regression models were used to examine the relations of socio-demographic and community characteristics and history of violence among the women to their cervical cancer screening, diagnosis, and treatment histories. Forty percent of the women in the current sample reported abnormal Pap histories, though only 6% of all Pap smears done in the U.S. are abnormal. Women who reported abuse histories in this study were found to be more likely to report having ever had an abnormal Pap smear (for physical abuse Odds Ratio [OR] = 6.05; CI 2.36, 15.54 and for past year intimate partner violence OR = 2.41; CI 1.09, 5.31). Participants who did not fear neighborhood violence were less likely to report an abnormal Pap history (OR = 0.57; CI 0.34, 0.96) and more likely to visit a family doctor for their Pap screenings (OR = 1.91; CI 1.01, 3.60). Women who perceived greater neighborhood violence had increased odds of reporting that they received Pap screenings in a hospital setting (OR = 1.47; CI 1.08, 2.00). Frequency of Pap screening did not differ in women who did and did not have fear of neighborhood violence. This study highlights the heightened cervical cancer risk experienced by women with criminal justice histories and suggests that violence at several levels has implications for cervical cancer prevention for these women.

The Development of a Brief Jail-Based Cervical Health Promotion Intervention

The primary objective of this article was to describe the development and pilot implementation of a brief jail-based cervical health promotion intervention. The intervention was guided by a preliminary study of incarcerated women’s cervical health knowledge, awareness, and health literacy, as well as a social and feminist approach to intervention development. We developed and conducted a pilot implementation of the Sexual Health Empowerment Project to increase cervical health knowledge, reduce barriers related to beliefs about cervical cancer, and improve self-efficacy and confidence in navigating health systems. This article offers a framework for how empirically and theory-based interventions are developed and tailored for a jail setting. Future work should include the evaluation of the long-term effects of such a disease-specific program on health behaviors and outcomes among high-risk and vulnerable groups of women as they leave jails and enter communities.

Social Networks of Substance Users With HIV Infection: Application of the Norbeck Social Support Scale

The role of social support networks in medication adherence among HIV-infected substance users remains understudied. In this secondary data analysis, the authors sought to determine the relationship between social support networks and antiretroviral adherence among HIV-infected substance abusers receiving methadone. They analyzed data collected in a 24-week study of 76 methadone-maintained, HIV-infected substance abusers randomized to directly observed antiretroviral therapy or treatment as usual. The authors used logistic regression to examine the relationship between social support networks and self-reported antiretroviral adherence. Their results showed that study participants had an average of 1.36 social network members (SD = 1.4); 34% of participants had at least one drug user and 25% had at least one HIV-infected person in their network. The presence of network drug users and HIV-infected network members was associated with less antiretroviral medication adherence (p < .05). The authors conclude that both social network density and characteristics of network members have implications for medication adherence.

The Association between Unintended Pregnancy and Violence among Incarcerated Men and Women

Background: In this article, we examine the association between unintended pregnancy and individual and community level indicators of violence in a population of both women and men in the criminal justice system. Methods: We conducted a cross-sectional survey with 290 women and 306 men in 3 correctional facilities in Kansas City and used logistic regression models to assess relationships between key independent variables and unintended pregnancy. Findings: In gender-specific logistic regression models, women with a history of intimate partner violence were 2.02 times more likely (CI 1.15, 3.56), and those with a history of sexual abuse before age 16 were 1.23 times more likely (CI 1.02–1.49) to have experienced unintended pregnancy. Men or their family members who were victimized by neighborhood violence were 1.82 times more likely to have experienced unintended pregnancy (CI 1.01, 3.28). Discussion: These findings suggest the need for gender and community-specific interventions that address the relationship between violence and unintended pregnancy.

The Vagina is a Very Tricky Little Thing Down There: Cervical Health Literacy among Incarcerated Women.

The objective of this study was to understand factors associated with women’s ability to engage in cervical cancer prevention and follow-up care given ongoing criminal justice involvement. We conducted four focus groups with 45 incarcerated women to assess barriers to cervical health promotion, and used a grounded theory method to analyze data. We administered the Short Test of Functional Health Literacy in Adults to assess general health literacy as a standalone factor related to cervical health promotion. Ninety-one percent of participants had adequate health literacy scores. However, we found that the women had varying levels of cervical health literacy, which we operationalized as knowledge, beliefs, and self-efficacy related to cervical health promotion. Practitioners should establish broader interventions to empower women with criminal justice histories to take control of their own cervical health and focus on communicating updated recommendations to improve cervical health understanding, beliefs, and practices among high-risk women.

Sexual Health Risk and the Movement of Women Between Disadvantaged Communities and Local Jails.

Drawing on cross-sectional data collected in three Kansas City jails, our objective was to describe the social, neighborhood-based context of sexual health risk prior to incarceration for 290 women. Half of the participants were clustered in Kansas Citys urban core before their incarceration. Women who lived in these neighborhoods, which had the highest density of our incarcerated participants, were 3 times as likely to report a history of trading sex for money, drugs, or life necessities compared to women who lived elsewhere in the city. Living in a neighborhood that was perceived to have low social capital was also associated with sexually transmitted infection history. Gaining an understanding of these social influences in womens lives—particularly at the neighborhood level—provides key insights that will allow future interventions to change the health outcomes of women who move between disadvantaged communities and local jails.

Health priorities among women recently released from jail.

OBJECTIVE To describe the health priorities of women recently released from jail. METHOD We open-coded semi-structured interview transcripts collected from 28 women within 6 months after their release from jail to identify themes associated with prioritization of health. RESULTS Five out of 28 women listed health as their top post-release priority. However, many women had competing priorities after release, including housing, employment, and children. We found that women described several reasons why health was not a priority; however, participants reported regular use of the healthcare system upon release from jail, indicating that health was important to them to some degree. CONCLUSIONS Our findings from may inform intervention efforts that connect women to healthcare resources and increase health-promoting behavior during the transition from jail to community.

Social Support Networks and Primary Care Use by HIV-Infected Drug Users

&NA; HIV‐infected current and former drug users utilize primary care and preventive health services at suboptimal rates, but little is known about how social support networks are associated with health services use. We investigated the relationship between social support networks and the use of specific types of health services by HIV‐infected drug users receiving methadone maintenance. We found that persons with greater social support, in particular more social network members or more network members aware of their HIV status, were more likely to use primary care services. In contrast, social support networks were not related to emergency room or inpatient hospital use. Interventions that build social support might improve coordinated and continuous health services utilization by HIV‐infected persons in outpatient drug treatment.

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.