Tawandra L. Rowell-Cunsolo

Objectives: More than 3.7 million individuals are currently under community correctional supervision (eg, probation, parole) in the United States, and approximately 46% of them use illicit substances. Although high rates of substance use and the need for high-quality treatment for this population have been acknowledged, additional research is needed to characterize treatment needs among this population, especially those residing in rural or underserved communities. Methods: Data were drawn from the Rural Opioid Initiative, a study focused on substance use in rural communities across 10 states in the United States. Our analyses examined past 6-month substance use disorder (SUD) treatment receipt among 978 participants under community supervision in the past 6 months. Results: More than 55 percent had engaged in some type of treatment for substance use in the past 6 months; among those, nearly half (46%) had enrolled in inpatient or residential treatment. The odds of receiving treatment were greater among women than men (odds ratio [OR] 1.49, 95% confidence interval [CI] [1.15–1.94]), those with health insurance coverage (OR 3.10, 95% CI: [2.24–4.31]) and those with access to transportation (OR 1.54, 95% CI: [1.08–2.20]). Treatment receipt was lower among participants who used methamphetamine/amphetamine as their primary drug of choice compared with other substances. Conclusions: Initiatives to increase SUD treatment engagement among rural people who use drugs under community correctional supervision should address gaps in insurance coverage, transportation access, and treatment modalities that target stimulant use disorders. Gender-specific needs should also be considered when creating substance use interventions for this population.

More than one million adults in Mississippi have hypertension. We examined the association between a summary measure of social determinants of health (SDOH) and health equity (SDOH/HE) and hypertension prevalence among Mississippi adults. Using data from 3867 respondents to the 2023 Mississippi Behavioral Risk Factor Surveillance System SDOH/HE Module, we performed multivariable logistic regression analyses to examine the association between hypertension prevalence and a summary SDOH/HE measure. The SDOH/HE summary measure score was created using responses to 10 questions assessing employment/economic and housing stability, receipt of food assistance, access to quality food and transportation, utilities security, social isolation, social and emotional support, life satisfaction, and mental well-being of the participants. The likelihood of experiencing 0, 1, 2, 3, or 4 or more SDOH/HE risk factors was 38.6, 22.9%, 13.7%, 7.9%, and 16.8%, respectively. Mississippi adults experiencing one (adjusted odds ratio, AOR, 1.47) and four or more (AOR, 2.62) of SDOH/HE risk factors had higher odds of hypertension compared to those experiencing no SDOH/HE risk factors. Associations between presence of two or three SDOH/HE risk factors and hypertension were not significant. Mississippi adults with one and at least four SDOH/HE risk factors had significantly higher odds of hypertension risk than those with no SDOH/HE risk factors. These findings highlight an association between SDOH/HE factors and the burden of hypertension and underscore the need for targeted inventions among Mississippi adults with multiple SDOH/HE risk factors.

Over 600,000 individuals are released from correctional institutions annually in the United States. Substance use disorders (SUDs) are highly prevalent in this population, and only a small proportion receive adequate treatment during incarceration. Post-incarceration, substance use increases considerably, and the risk of drug overdose is higher among formerly incarcerated individuals than among their counterparts in the general population, especially among individuals who use illicit opioids. However, significant gaps exist in our understanding of individual- and environment-level pathways of post-incarceration substance use, limiting treatment effectiveness. For those who receive substance use treatment services post-incarceration, research suggests that these services are not medically appropriate and/or responsive to their unique needs - thereby jeopardizing substance use outcomes. The Addiction Treatment Adequacy Post-Incarceration (ATAP) Study aims to examine individual and environmental factors associated with changes in substance use and substance use treatment adequacy over a one-year period post-incarceration among formerly incarcerated individuals in New York City (NYC). We will examine the extent to which participants receive appropriate substance use treatment services, as recommended by their scores on the American Society of Addiction Medicine patient placement criteria (ASAM PPC). We will use innovative spatially informed multi-level modeling strategies to investigate individual- and environment-level factors that influence substance use among individuals released from correctional institutions and residing in the NYC metropolitan area. Guided by social ecological theory, this study will address the following specific aims: 1) Characterize substance use over a 12-month period (every three months) among 350 formerly incarcerated individuals who have been released in NYC during the past three years; 2) Identify individual (e.g., race, gender, income, mental health) and environmental (e.g., proximity to drug purchasing sites, neighborhood characteristics, residential mobility, access to treatment services) risk factors for drug use among formerly incarcerated individuals; and 3) Investigate discrepancies between ASAM PPC composite scores (a measure of addiction severity) generated and levels of substance use treatment. The proposed research will identify substance use treatment gaps and influential factors that are amenable to intervention in the interest of informing effective responses to the current opioid crisis.

Many neighborhoods with concentrated racial and ethnic minority older adult populations experience high neighborhood disadvantage. Yet, to date, no studies have analyzed how neighborhood disadvantage affects the relationship between race and hospitalization among older adults. To fill this gap, we examined if neighborhood disadvantage moderates the relationship between race and hospitalization among older adults in the United States. Medicare claims data from 2018 on 530 962 beneficiary hospitalizations were merged with neighborhood data, and regression models assessed if the Area Deprivation Index (ADI) moderated the association between race and hospitalization. At the highest ADI score, the odds ratio (OR) for hospitalization for Black compared with White beneficiaries was the lowest (OR: 0.96; 95% CI: 0.89-1.04). At the lowest ADI score, the OR for hospitalization for Black compared with White beneficiaries was the highest (OR: 1.19; 95% CI: 1.09-1.29). When Black and White beneficiaries reside in severely deprived areas, the disparity in their outcomes is narrower. However, when they reside in areas with more advantages, White beneficiaries experience better outcomes than Black beneficiaries. Our findings have implications for practice and policy to invest resources in communities to assure health equity.

More than 2.3 million individuals are currently incarcerated in the United States. Nearly half of incarcerated individuals are parents of minor children. Results from research on drug use among children of incarcerated individuals are conflicting. The purpose of this literature review is to identify and summarize the evidence base on the associations between parental incarceration (PI) and subsequent drug use in the United States. We performed a literature search of studies that examined associations between exposure to parental incarceration and subsequent drug use. We searched PubMed, Web of Science, Embase, Scopus, and SocIndex to identify studies that reported illicit drug use outcomes among individuals with a parent or primary guardian who had been incarcerated in the United States. Sixteen studies were included in our analysis. There was substantial evidence that parental incarceration contributes to increased drug use and problematic drug‐related behaviours in adolescence and adulthood, with positive associations reported in three‐fourths of the studies (75%). The relationship was significant across a range of drug classes, including marijuana, cocaine, prescription pain medication, injection drugs and other illicit drugs. While more diverse research methodologies and studies that examine the larger family context and dynamics are needed to comprehensively assess the pathways to drug use among PI‐exposed individuals, the current evidence base suggests that drug use prevention programs are needed to mitigate the increased likelihood of drug use. Early education drug use prevention programs and comprehensive assessments that identify potential triggers for drug use should be prioritized for this population.

Incarcerated individuals, who are overrepresented among those infected with HIV, experience multiple barriers to optimal antiretroviral therapy (ART) adherence after incarceration. Substance use is highly prevalent among legal system-involved individuals and is commonly associated with suboptimal medication adherence. This manuscript describes the development and pilot test results of two interventions designed to improve ART adherence among formerly incarcerated individuals living with HIV (PLWH). Thirty participants were randomized and completed a multi-session ART adherence and risk reduction intervention or a brief ART adherence intervention. Participants were interviewed at baseline, 1-month, and 3-month follow-up. While past 30-day ART adherence improved in both groups, participants in the brief intervention group took a higher proportion of their ART medication. Multi-session intervention group participants experienced greater reductions in substance use and problematic experiences associated with drug use. ART medication adherence interventions can potentially improve treatment outcomes among PLWH who experience incarceration.

On February 26, 2012, a Black child, Trayvon Martin, was executed in Sanford, Florida. Seventeen months later his killer was found not guilty. This is but one example of the state's brazen disregard for Black life, rooted in the kidnapping and enslavement of Africans more than 400 years ago, and the ways in which they and their descendants were systematically tortured. Trayvon Martin's murder catalyzed the Black Lives Matter (BLM) movement, which names and resists deeply entrenched state violence and inequities against Black people in the United States. In this manuscript we: (1) summarize examples of structural disregard for Black lives in the United States; (2) describe how this disregard is reflected in differential patterns of social inequities, morbidity, and mortality; and (3) discuss how we can better employ the BLM perspective to frame a more historicized understanding of patterns in population health and to envision ways to resist health inequities.

More than 600,000 incarcerated individuals are released annually in the United States; a large proportion are Black men incarcerated for drug-related offenses, including drug use and possession. Formerly incarcerated Black men report elevated rates of condomless sex and sexually transmitted infections, including human immunodeficiency virus (HIV). The purpose of this study was to explore condom usage among Black men who were formerly incarcerated for drug-related offenses and living in New York City (NYC). Using a semi-structured interview guide, in-depth interviews were conducted with 26 formerly incarcerated Black men. Interviews were audio-recorded, transcribed, and entered into NVivo, then manually coded utilizing thematic analysis methods. The following four themes were identified: partner type and length of the relationship affected condom use; diminished pleasure was a barrier for condom use; challenges with ill-fitting and poor-quality condoms; and the withdrawal method was used as an HIV prevention technique. Our findings suggest that formerly incarcerated Black men are engaging in condomless sex post-incarceration. Greater exposure to prevention messages and targeted interventions with content that includes interpersonal and condom use skill-building, methods to increase pleasurable condom use, information on HIV and STI transmission modes, and access to pre-exposure prophylaxis (PrEP) may be beneficial for this population.