Incarceration Postpartum: Is There a Right to Prison Nurseries?

Rising rates of female incarceration within the United States are incompatible with the lack of federal standards outlining the rights of incarcerated mothers and their children. A robust body of evidence demonstrates that prison nurseries, programmes designed for mothers to keep their infants under their care during detainment or incarceration, provide essential and beneficial care that could not otherwise be achieved within the current carceral infrastructure. These benefits include facilitation of breastfeeding, bonding during a critical period of child development, and decreased recidivism rates for participants. Legal precedent exists to support the rights of the mother to continue to parent their child but remains in stark opposition to current prison infrastructure that could allow them to do so. Existing state policies also have inconsistent mechanisms for determining child eligibility and should move to centre decision-making on a case-by-case basis. This work will demonstrate that a just society, supported by law and ensuring maternal-child welfare supports the establishment of prison nursery programmes as a part of the existing right to healthcare for incarcerated individuals.

The Nutritional Content of Food in Carceral Institutions: A Systematic Review of Quantitative Studies.

The nutritional content of food in carceral institutions is important because it influences weight gain and health during incarceration. This systematic review assessed the available quantitative data and nutritional analyses of food in carceral institutions. Methodology is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement with four phases (identification, screening, eligibility, and inclusion). Nine articles were selected. Most carceral institutions provided adequate nutrition for micronutrients, except for vitamin D (inadequate) and sodium (excessive). Most menus followed recommendations for macronutrients. Food from the commissary stores is high in calories, sugar, fat, and sodium. Most menus are adequate according to Dietary Reference Intakes. Changing menus drastically to meet nutritional targets may lead to consuming more food from commissary, potentially leading to poorer eating. For some menus, minor adjustments could bring the nutritional content closer to recommendations.

Spatiotemporal Facility-Level Patterns of Summer Heat Exposure, Vulnerability, and Risk in United States Prison Landscapes.

Heat is associated with increased risk of morbidity and mortality. People who are incarcerated are especially vulnerable to heat exposure due to demographic characteristics and their conditions of confinement. Evaluating heat exposure in prisons, and the characteristics of exposed populations and prisons, can elucidate prison-level risk to heat exposure. We leveraged a high-resolution air temperature data set to evaluate short and long-term patterns of heat metrics for 1,614 prisons in the United States from 1990 to 2023. We found that the most heat-exposed facilities and states were mostly in the Southwestern United States, while the prisons with the highest temperature anomalies from the historical record were in the Pacific Northwest, the Northeast, Texas, and parts of the Midwest. Prisons in the Pacific Northwest, the Northeast, and upper Midwest had the highest occurrences of days associated with an increased risk of heat-related mortality. We also estimated differences in heat exposure at prisons by facility and individual-level characteristics. We found higher proportions of non-white and Hispanic populations in the prisons with higher heat exposure. Lastly, we found that heat exposure was higher in prisons with any of nine facility-level characteristics that may modify risk to heat. This study brings together distinct measures of exposure, vulnerability, and risk, which would each inform unique strategies for heat-interventions. Community leaders and policymakers should carefully consider which measures they want to apply, and include the voices of directly impacted people, as the differing metrics and perspectives will have implications for who is included in fights for environmental justice.

Mental Health Crisis Responses and (In)Justice: Intrasystem and Intersystem Implications.

Mental health crises among people who are marginalized merit special consideration. These groups are both overserved and underserved by mental health crisis systems: over-represented in acute treatment settings by number while facing inequities in outcomes. The predisposing, precipitating, and perpetuating factors that contribute to crises, however, neither begin nor end with the mental health system. Rather, these factors are multisystemic. As an illustration of this concept, this article highlights select marginalized groups, those that have faced inequities in mental health diagnosis and treatment due to race, medical complexity, age, and criminal justice system involvement.

Health disparities among incarcerated populations: a crucial laboratory and pathology review.

BACKGROUND: The United States notoriously has one of the highest rates of incarceration in the world, yet scant attention to the health care needs of those incarcerated exists within laboratory medicine and pathology training and education. This article explores health disparities among incarcerated and released individuals regarding diagnostic laboratory testing and pathology services. METHODS: A literature search was conducted for articles published between 2002 and 2023 using keywords including "healthcare," "incarcerated," "laboratory services," "pathology services," and "health insurance for prisoners." Central themes were extracted and discussed to reveal the realities of health care during and after release from incarceration. Excluded from the analysis were articles about the immediate or extended family of incarcerated persons. RESULTS: Incarcerated individuals have an increased risk for the development and exacerbation of communicable and noncommunicable diseases and mental health disorders, which results in exceedingly high morbidity and mortality rates. CONCLUSION: Policy changes are needed to mitigate disparities and improve health outcomes for incarcerated and released persons. Central to these disparities is decreased access to laboratory and pathology services, impeded by inadequate health care funding for these carceral institutions. Providing additional funding to the carceral system's health care budget is necessary to improve access to pathology and laboratory services.

When safety for you means danger for me: the racial politics of carceral public safety discourse.

Safety is a human right and universal need, and yet we as researchers and practitioners often take for granted the conditions that help people feel safe. In this conceptual review, we focus on factors that contribute to people's sense of safety in service of understanding how, when, and where people feel safe. Moreover, we consider how race, power, and privilege shape people's sense of safety and danger. In doing so, we highlight how public safety is not an objective or static reality but rather a political project that reflects dominant ideologies and serves state interests. We begin this conceptual review with a discussion of how public safety is a social construct whose meaning varies across time, space, and place. Next, we discuss three dominant ideologies that are embedded within collective public safety discourse: permanent bad guy syndrome, the victimization-fear paradox, and the politics of ideal victimhood. Together, these ideologies help to shape carceral public safety frameworks, which is the dominant paradigm in our culture. We then illuminate some of the underlying assumptions within carceral public safety frameworks and their implications for responses to public safety concerns, including elevating the safety concerns of dominant groups while criminalizing undesirable bodies, undermining stigmatized communities' ability to access public safety and justice, legitimizing suspicion and surveillance, incentivizing carceral responses while diverting resources from safety promotion programs, and altering public spaces. In doing so, we highlight how carceral public safety frameworks reflect and reinforce existing injustices while also contributing to the stigmatization, marginalization, and manufactured precarity of social groups deemed undesirable and therefore unworthy of protection. We conclude with a discussion of alternative models of public safety which are rooted in life-affirming frameworks, which focus on improving people's material conditions as a means of lessening and preventing the likelihood and impact of interpersonal violence.

Operationalization of Status Neutral Human Immunodeficiency Virus Care for Criminal-Legal Involved Populations.

The United States has the highest number of people incarcerated in the world. Criminal-legal involved populations, including people who are incarcerated in jails and prisons and people who are under community carceral control through probation or parole are at an increased risk for human immunodeficiency virus (HIV). Increasing access to HIV testing, treatment and prevention is necessary to curb the HIV epidemic. This chapter outlines the history of HIV testing in jails and prisons and suggests a Status Neutral HIV Care Framework for improving access to HIV prevention services.

Correlates of Staff Acceptability of a Novel Telemedicine-Delivered Medications for Opioid Use Disorder Program in a Rural Detention Center.

Opioid overdose death is significantly increased immediately following incarceration. Evidence-based medications are underutilized in rural jails and detention centers. We have reported our efforts to address this gap through telemedicine-based medications for opioid use disorder treatment (tele-MOUD) for incarcerated patients. Staff acceptance and perceptions are critically important factors in the assurance of program validation. We assessed tele-MOUD acceptability and perceptions of effectiveness and stigma in one detention center. Overall, we found that jail staff's general acceptability of the program was rather low, as was perceived effectiveness of MOUD, while stigmatizing beliefs were present. Furthermore, tele-MOUD acceptability was positively correlated with perceptions of MOUD effectiveness and negatively correlated with stigmatizing notions of MOUD (p's < 0.001). Findings suggest the need for educational interventions. Future research investigating the potential moderating effects of training on staff acceptability of jail-based tele-MOUD will support the implementation and sustainability of these life-saving programs.

Addressing COVID-19 and Health Literacy Disparities Among Correctional Facility Residents Through Dialogue-Based Education.

Carceral communities face heightened COVID-19-related risks while simultaneously experiencing medical mistrust and limited access to health information and services. Health education programs that incorporate dialogue-based, participatory learning models have been shown to motivate health behavior and increase health knowledge in carceral settings. To increase health literacy and change COVID-19-related health behavior among jail residents in the United States, a local health department developed a dialogue-based education program centered around COVID-19 prevention, misinformation, and navigating health care systems. Dialogue-based health information sessions took place in person in a county jail. Pre- and postsurveys gauged the sessions' influence on self-reported health literacy and behavior intention. Overall, 595 residents collectively attended 43 facilitated discussions. Key findings indicate that dialogue-based education can temper medical mistrust, influencing COVID-19 preventive behaviors and increasing health literacy in a carceral setting.

Indirect vaccine effectiveness in an outbreak of Alpha B.1.1.7 variant in a California state Prison, May 2021.

Incarcerated populations experienced high rates of SARS-CoV-2 infection and death during early phases of the COVID-19 pandemic. To evaluate vaccine effectiveness in the carceral context, we investigated the first outbreak of COVID-19 in a California state prison following widespread rollout of vaccines to residents in early 2021. We identified a cohort of 733 state prison residents presumed to be exposed between May 14 and June 22, 2021. 46.9 % (n = 344) were vaccinated, primarily with two doses of mRNA-1273 (n = 332, 93.6 %). In total, 92 PCR-positive cases were identified, of which 14 (14.5 %) occurred among mRNA-1273 vaccinated residents. No cases required hospitalization. All nine isolates collected belonged to the Alpha (B.1.1.7) variant. We used Cox proportional hazard regression to estimate vaccine effectiveness for at least one dose of any vaccine at the start of the outbreak. Vaccine effectiveness was 86 % (95 % CI: 75 %-97 %) against PCR-confirmed infection, with similar results for symptomatic infection. Higher rates of building-level vaccine uptake were associated with a lower overall rate of PCR-confirmed infection and symptomatic infection among unvaccinated residents. Among unvaccinated residents who lived in shared cells at the time of presumed exposure, exposure to a vaccinated cellmate was associated with a 38% (95% CI: 0.37, 1.04) lower hazard rate of PCR-confirmed infection over the study period. In this outbreak involving the Alpha SARS-CoV-2 variant, vaccination conferred direct and possibly indirect protection against SARS-CoV-2 infection and symptomatic COVID-19. Our results support the importance of vaccine uptake in mitigating outbreaks and severe disease in the prison setting and the consideration of community vaccination levels in policy and infection response.

Infection Prevention and Control in Correctional Settings.

Correctional facilities house millions of residents in communities throughout the United States. Such congregate settings are critical for national infection prevention and control (IPC) efforts. Carceral settings can be sites where infectious diseases are detected in patient populations who may not otherwise have access to health care services, and as highlighted by the COVID-19 pandemic, where outbreaks of infectious diseases may result in spread to residents, correctional staff, and the community at large. Correctional IPC, while sharing commonalities with IPC in other settings, is unique programmatically and operationally. In this article, we identify common challenges with correctional IPC program implementation and recommend action steps for advancing correctional IPC as a national public health priority.

Best practice guidelines for evaluating patients in custody in the emergency department.

Patients in custody due to arrest or incarceration are a vulnerable population that present a unique ethical and logistical challenge for emergency physicians (EPs). People incarcerated in the United States have a constitutional right to health care. When caring for these patients, EPs must balance their ethical obligations to the patient with security and safety concerns. They should refer to their institutional policy for guidance and their local, state, and federal laws, when applicable. Hospital legal counsel and risk management also can be helpful resources. EPs should communicate early and openly with law enforcement personnel to ensure security and emergency department staff safety is maintained while meeting the patient's medical needs. Physicians should consider the least restrictive restraints necessary to ensure security while allowing for medical evaluation and treatment. They should also protect patient privacy as much as possible within departmental constraints, promote the patient's autonomous medical decision-making, and be mindful of ways that medical information could interact with the legal system.

National Survey of Oncologists' Knowledge, Attitudes, and Practice Behaviors: Caring for Cancer Patients Experiencing Incarceration.

Cancer is the leading cause of illness-related death in state prisons in the United States. The experiences of physicians providing oncological care to individuals experiencing incarceration are underexplored. The study aims were to evaluate knowledge, attitudes, and practices of oncologists caring for cancer patients who are incarcerated. An online survey was distributed to a random sample of 150 oncologists from the American Society of Clinical Oncology and the American Society for Radiation Oncology from July 2020 to December 2021. Statistical analyses included two proportion Z-test, Fisher's exact test, Kruskal-Wallis test, and Cramer's V to estimate factors associated with attitudes and barriers to care. Of the 55 respondents (36.7% response rate), 21 were medical oncologists and 34 were radiation oncologists. Academic center oncologists were more likely to report caring for incarcerated patients than community or private practice oncologists (p = .04). Most (53%) incorrectly reported "heart disease" as the leading cause of death, as opposed to "cancer" (15% identified correctly). Oncologists practicing at both academic and community centers were more likely to report care coordination barriers than oncologists at academic or community centers (p < .01). We identified potential barriers in caring for incarcerated cancer patients. Future studies should explore ways to improve care coordination between oncology teams and prisons.

Barriers and advocacy needs for hepatitis C services in prisons: Informing the prisons hepatitis C advocacy toolkit.

BACKGROUND: Carceral settings are a key focus of the 2030 WHO global hepatitis C virus (HCV) elimination goals. Despite this, access to HCV testing and treatment services in prisons remains low globally, limiting opportunities to achieve these goals. Advocacy efforts are needed to address service inequities and mobilise support for enhanced HCV programs in prisons globally. INHSU Prisons, a special interest group of the International Network on Health and Hepatitis in Substance Users (INHSU) is developing a Prisons HCV Advocacy Toolkit to address this need. Here we present findings of a mixed study to inform the development of the Toolkit. METHODS: The aim of this study was to inform the development of the Toolkit, including understanding barriers for scaling up prison-based HCV services globally and advocacy needs to address these. An online survey (n = 181) and in-depth interviews (n = 25) were conducted with key stakeholders from countries of different economic status globally. Quantitative data were statistically analysed using R Studio and qualitative data were analysed thematically. The data sets were merged using a convergent design. RESULTS: Key barriers for enhanced prison-based HCV services included lack of political will and action, lack of prison-based healthcare resources, and poor awareness about HCV and the importance of prison-based HCV services. These findings underscore how advocacy efforts are needed to motivate policymakers to prioritise HCV healthcare in prisons and ensure funds are available for services (including diagnostic tools and treatment, healthcare teams to implement services, and systems to measure their success). Advocacy resources to raise the awareness of policy makers, people working in the prison sector, and incarcerated populations were also identified as key to increasing HCV service uptake. CONCLUSION: The Toolkit has the potential to support advocacy efforts for reaching HCV elimination targets. By understanding the advocacy needs of potential Toolkit end-users, the findings can inform its development and increase its accessibility, acceptability, and uptake for a globally diverse audience.

eHealth-Enhanced Peer Navigation for Substance Use Treatment and HIV Prevention Service Linkage for Young Adults Surveilled by the Criminal Legal System: Protocol for a Pilot Randomized Trial Study.

BACKGROUND: In the United States, the proportion of criminal legal-involved (CLI) adults with a substance use disorder reaches 72%, and ~150,000 persons with HIV pass through a carceral setting annually, which represents 16% of the HIV-infected population nationally. Despite the high need for substance use treatment and HIV prevention services, few carceral settings successfully link CLI individuals to treatment upon release. Young adults represent 41.9% of the adults incarcerated in the United States and have the highest HIV incidence rates nationally. Peer patient navigation has successfully increased community-based care linkage for people living with HIV leaving jail; yet, peer-led navigation for HIV prevention among HIV-negative CLI populations is undeveloped and untested. eHealth approaches to substance use and HIV prevention services hold promise because they improve access to effective intervention services, particularly for younger people. OBJECTIVE: This paper describes a protocol for a pilot randomized controlled trial that aims to improve linkage to substance use treatment and HIV prevention services using peer navigation and a codeveloped eHealth technology adjunct. METHODS: The three aims of this study are to (1) adapt an existing evidence-based navigator model and incorporate codeveloped eHealth technology to refer and link young adults (18 to 29 years) surveilled by the criminal legal system to substance use and pre-exposure prophylaxis (PrEP) services; (2) refine and test the intervention with criminal legal-involved young adults (CLI-YAs); and (3) assess the feasibility, acceptability, and impact of the intervention. Data to inform the intervention will be collected via system partner interviews (n=4) and focus groups with CLI-YAs (n=24). Next, an open trial (n=10) will be conducted. The intervention will be refined via interviews with participants and facilitators, and a randomized pilot trial (n=75) will be conducted to assess the feasibility, acceptability, and preliminary impact of the eHealth-enhanced navigation on substance use and PrEP services linkage. Exit interviews conducted with a subsample of intervention participants (n=10), the navigator (n=1), and system partners (n=4) will assess intervention acceptability and suggestions for improvement. A community of practice, a group of system partners with an interest in working toward solutions to common problems, will inform each phase of the study. RESULTS: The project is currently ongoing. The project was funded in September 2022. Internal review board approval was received on March 21, 2022. The first results from early study aims are expected to be published in 2025. CONCLUSIONS: This study provides an opportunity to reduce HIV acquisition and improve access to substance use treatment in a systemically marginalized group: young CLI-YAs. The results will contribute to the development and testing of a future multilevel randomized controlled trial. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54815.

Racism and violence in policing: Perspectives from a juvenile prison.

Following recent events involving racism and violence in policing, the current study sought to understand factors associated with support for related social movements and worries about personal, family, and peer safety. Data were from 78 currently incarcerated young people (M = 16.5 years; 31% Black) and 20 juvenile prison staff (M = 40.3 years; 72% Black) via online surveys. A comparable proportion of young people (47.3%) and staff (47.4%) reported participating in the Black Lives Matter movement. Among young people, prior experiences with police were significantly associated with support for social movements and worries about safety concerning racism and violence in policing. Among staff, race, ethnicity, sexual orientation, and racial and ethnic identity were significantly associated with social movement support and worries about safety. Civic education and interventions to promote racial and ethnic identity may promote support for systemic change and buffer against worries about racism and violence in policing.

Care or Complicity? Medical Personnel in Prisons.

Imprisonment may sometimes be a justified form of punishment. Yet the U.S. carceral system suffers from appalling problems of justice-in who is put into prisons, in how imprisoned people are treated, and in downstream personal and community health impacts. Medical personnel working in prisons and jails take on risky work for highly vulnerable and underserved patients. They are to be lauded for their professional commitments. Yet at the same time, prison care undercuts the ability of medical personnel to uphold their own professional standards and sometimes fails in even basic health protection. Doctors in prisons are stuck between their commitment to vulnerable patients and complicity in a system that requires their participation to uphold its constitutionality. Medical ethics is frayed in prisons, and the problem deserves our attention.

"What if that's your last sleep?" A qualitative exploration of the trauma of incarceration and sleep.

Study Background/Objectives: Sleep is an underexplored factor in the health of people involved in the criminal legal system. This study addresses the paucity of research on how individual, social, and physical environmental factors impact sleep health during and after incarceration by highlighting the voices of people involved in the criminal legal system through a community-engaged qualitative research approach. Methods: We conducted 20 semi-structured interviews with men recently released from prison for a study on trauma and healthcare during incarceration and after release. Interviews were coded and analyzed using reflexive thematic analysis and a critical realist framework. Our research team included people with a history of incarceration who performed central roles in the research process. Results: Three themes emerged from participants' descriptions of sleep during and after incarceration: (1) concerns about health contributing to sleep problems, (2) lack of access to treatment for sleep disorders leading to ongoing sleep problems, and (3) issues of safety contributing to sleep problems during incarceration and after release. Conclusions: This study identifies factors and domains influencing sleep during and after incarceration. By identifying which interpersonal, environmental, and structural factors impact sleep quality, medical and carceral staff are better equipped to ameliorate sleep health disparities within populations with a history of incarceration and those actively bound by the criminal legal system. Future research should examine other factors impacting sleep in incarcerated and recently released populations and develop multi-level interventions to improve sleep health. This paper is part of the Sleep and Circadian Health in the Justice System Collection.

Expanding Knowledge About Music and Well-Being in Carceral Settings: A Methodological Review.

This methodological review includes literature (1987-2022) concerning the role and influence of musical practices-including music therapy and participatory music interventions-on well-being in carceral settings such as jails, prisons, and immigration detention centers. We provide a thorough description of key methodological procedures used in 55 studies: (1) Key Elements of Research Questions; (2) Types of Musical Practices; (3) Musical Genres; (4) Methodologies and Designs; (5) Locations; (6) Theoretical Frameworks; and (7) Samples. Our review indicates that there is difficulty in conducting research in prisons due to limitations imposed on researchers, a paucity of randomized-control trials, and limited generalizability of results due to the heterogeneity of methodological approaches. We suggest that the literature base would benefit from increased attention to issues related to sampling procedures, research questions related to race and gender identity, as well as the delineation between the types of musical practices utilized by music interventions.