BACKGROUND:Hepatitis A is a vaccine-preventable infection which may lead to serious consequences, and which may spread among people experiencing homelessness or substance use disorder. Because these factors are highly prevalent in incarcerated populations, identifying susceptible groups and establishing high levels of immunity are crucial to reducing disease transmission and morbidity. AIM:To describe hepatitis A immunity and vaccination status in the California prison population and to identify predictors of susceptibility. METHODS:This cross-sectional study used secondary data and employed descriptive, bivariate, and multivariable logistic regression analyses. RESULTS:Among the 86,387 incarcerated adults in June 2024, 41.7% had received at least two doses of hepatitis A vaccine, 49.3% had an identified risk factor for HAV, and 47.2% had been tested by serology. The majority (83.1%) had evidence of immunity either by vaccination or seropositivity. Among those who underwent serological testing, 29.7% were seronegative. Independent predictors in an adjusted model of susceptibility included older age, being non-Hispanic, and being U.S.-born. Individuals with certain medical conditions were less likely to be susceptible. CONCLUSION:Although HAV immunity was high among the California prison population, the substantial prevalence of risk factors supports correctional facilities as an important venue for routine HAV vaccination.
Despite well-documented barriers to ophthalmic services, ophthalmic care delivery among incarcerated populations remains understudied. This prospective observational study aimed to characterize ophthalmic referral patterns, triage timelines, and follow-up attendance among incarcerated individuals referred to a tertiary eye care center (July 1, 2024 to July 1, 2025). On-call ophthalmology residents assigned referrals to standardized triage categories based on urgency. Referral and clinical data were extracted to evaluate wait times, triage delays, and follow-up attendance. Of 56 referrals, 48 patients (65 eyes) completed an initial visit. Trauma was the most common indication (37.5%). Most referrals were assigned high-priority triage (≤24 hours: 27.1%; ≤48 hours: 33.3%). Median wait time increased with decreasing triage priority (p < 0.001), with longer delays for lower-priority triages (p = 0.002). Follow-up was more frequently requested for trauma (66.7%) versus nontrauma (26.7%; p = 0.002). Among those scheduled for repeat appointments, 44.4% were lost to follow-up, more commonly among trauma (33.3%) versus nontrauma (6.7%; p = 0.040). Despite appropriate triage, lower-priority cases experienced delays beyond triage targets. The high rate of loss to follow-up among patients with ocular trauma, who may require complex ongoing care, highlights the need for improved continuous ophthalmic care access.
People experiencing incarceration (PEI) have high rates of trauma and emergency department (ED) utilization, yet limited data describe their ED evaluation and outcomes. We sought to compare trauma patient characteristics, ED care, and disposition by incarceration status. We hypothesized PEI would have shorter ED lengths-of-stay (LOSs), undergo more cross-sectional imaging, and have lower rates of admission. We conducted a single-center retrospective cohort study of adult incarcerated and nonincarcerated trauma patients presenting to a Level 1 trauma center from 1/2010 to 12/2020. The primary outcome was ED LOS. Patient characteristics were described, and multivariable median and logistic regression were used to compare outcomes. The cohort included 535 patients. Seventy-nine percent were male; 40% were Black, 32% Hispanic, and 18% White. On univariable analysis, PEI had lower triage acuity, had more blunt injuries, were more likely to receive imaging, and had lower rates of admission. After adjustment, PEI had a shorter median ED LOS (-1.08 hours; 95% CI: [-1.90, -0.26]; p = .01), higher odds of imaging (OR: 1.98; 95% CI: [1.18, 3.33]; p = .01), and similar admission odds (p = .55). PEI with trauma had lower-acuity visits and shorter ED LOS but underwent more imaging, suggesting more extensive evaluation. Further studies are needed to explore reasons for increased imaging in lower-acuity PEI visits and develop ED best practice guidelines.
Period poverty is the lack of access to an affordable and adequate supply of menstrual products. Period poverty pervades carceral facilities, posing an intersectionality between economic disadvantage, wage disparities, and terrible facility conditions. The affordability of period products contributes to period poverty in general populations but is underexamined as a contributing factor within U.S. prisons. To examine the affordability of these products, we conducted a content analysis of commissary listings from 2022 to 2024 for prisons across the Southeastern United states. We reviewed listings from 14 Southeastern U.S. states, a region selected due to limited menstrual equity legislation, poverty levels, and high carceral rates. Statewide commissary listings from official Department of Corrections postings were inductively coded by two independent reviewers to thoroughly categorize the type of product(s) available, listing price, quantity, and associated taxes when provided. Hourly wages within facilities of each state were compared against commissary pricing to estimate labor hours required to afford menstrual products. Results reveal discrepancies within commissary listings, including differences in product types available, wage disparities, and considerable pricing differences across states for comparable products. These findings reveal menstrual inequity driven by exploitative labor structures and inadequate product variability and pricing, underscoring the need for prison policy reform.
Incarcerated people suffer stigmatized conditions at higher rates than nonincarcerated people, making upholding privacy and confidentiality ethically essential in prisons and jails. Yet these health professional values are widely acknowledged to be challenging to maintain in carceral settings. Robust qualitative data on how physicians and nurses navigate and perceive limitations to privacy and confidentiality in U.S. prisons and jails is lacking. This study reports on 55 semistructured interviews with physicians and nurses who have worked in federal or state prisons and/or jails across the United States. Participants perceive multiple challenges to privacy and confidentiality in prisons and jails and yet differ in how important they think it is to protect these values in comparison with other pressing concerns.
Detained youth are disproportionately affected by sociostructural determinants of health and consequently experience substantially higher rates of behavioral health (i.e., mental health and substance use) concerns than their similarly aged peers. Although the juvenile legal system is purportedly grounded in a rehabilitative model, gaps in access to timely behavioral health services during incarceration are common and undermine this goal, highlighting confinement itself as an additional sociostructural determinant of health. Brief, intensive, and concentrated (BIC) interventions have been proposed as a promising approach for addressing behavioral health needs among detained youth; however, empirical evaluations of such approaches are limited in correctional settings. One type of BIC intervention, single-session interventions (SSIs), holds significant potential for short-term youth detention settings but must be contextually adapted to support ethical, feasible, and effective implementation. In this commentary, we outline key ethical, cultural, and implementation considerations for SSI delivery and identify strategic points across the detention trajectory where SSIs may address unmet behavioral health needs (e.g., entry into detention, following disciplinary incidents, before and after court hearings, and before reentry). We conclude by discussing implications for future research aimed at expanding access to developmentally responsive behavioral health supports for detained youth.
Opioid use disorder (OUD) is highly prevalent in correctional settings, where assessment occurs under conditions of stress, surveillance, and timeconstraint. Under these conditions, fluctuating or inconsistent self-report is common and is frequently interpreted as deception, with consequences for documentation, treatment access, and patient safety. This article develops a conceptual framework for interpreting such response variability without presuming intentional dishonesty, and operationalizes it into a structured interpretive tool for real-time clinical use. The framework draws on three literatures: correctional health and OUD assessment, forensic work on malingering, and quantum cognition research on judgment under uncertainty. Constructs from this synthesis were mapped to recurring patterns observed in correctional OUD assessment. Four quantum cognition constructs (order effects, contextuality, superposition, and interference) account for commonly observed patterns, including environment-dependent disclosure, shifts in withdrawal reporting, and ambivalence toward opioid agonist therapy (OAT). These constructs are translated into a structured interpretive tool that prompts clinicians to consider nondeceptive mechanisms (order, context, motivation, and emotional state) before attributing variability to malingering. Applied at the point of care, the framework supports safer withdrawal management, clearer documentation, and more equitable OAT access in correctional environments.
Incarcerated people are more likely to become ill from foodborne disease outbreaks compared with the general public. Correctional settings face unique challenges when preventing, controlling, and mitigating foodborne outbreaks. To describe knowledge, attitudes, and practices (KAP) of correctional staff regarding food safety, food safety training, and barriers to food safety in their facilities, we conducted an anonymous survey of correctional staff through professional organizations and correctional employers throughout the United States. Participants' food safety KAP was compared by individual and facility characteristics using descriptive statistics, univariable and multivariable logistic regression. Chi-squared statistics indicate respondents from smaller facilities more frequently reported having confidence in preventing foodborne illness than those in medium and large facilities. Food service staff (adjusted odds ratio [aOR] = 9.9, 95% CI: [3.4-28.8]) and respondents who reported receiving food safety training (aOR = 2.9, 95% CI: [1.7-5.0]) were more likely to report higher confidence in preventing foodborne illness, controlling for other facility and respondent characteristics. Our data suggest that training, smaller facility size, and working in food service are associated with positive attitudes and self-efficacy related to food safety. Food safety training of all correctional staff is an important piece of preventing foodborne illness in correctional facilities.
The thousands of Americans who died from coronavirus disease 2019 (COVID-19) while incarcerated underscore the heightened vulnerability of people living behind bars. Although the risk of catastrophic outbreaks demands a robust public health response, the measures used to contain disease can also produce profound harms to freedom and justice for people experiencing incarceration. This study draws on an initial survey of 71 individuals formerly incarcerated in Los Angeles County jails, followed by 20 semi-structured interviews with a subset of survey participants, conducted between January 2023 and March 2024. We examine subjective experiences related to pandemic-era infection control measures, including quarantines and lockdowns, as well as their long-term consequences. Participants described pervasive institutional mistrust, including doubts about staff competence to implement infection control protocols, and identified prolonged detention linked to pandemic-era health policies as one of the most damaging outcomes. These findings highlight the need for policymakers to account for the lasting social and economic effects of public health interventions on justice-involved populations, to apply quarantine ethics principles that balance infection control with individual rights, and to pursue strategies that both improve infection control and reduce unjust incarceration within carceral systems. Ethical approval for this study was obtained from the University of California, Los Angeles Institutional Review Board, and informed consent was obtained from all participants.
Women with substance use disorders (SUDs) released from incarceration face a markedly elevated risk of fatal overdose during the first 2 weeks post-release compared with women with SUDs in the community. Prior research estimates that individuals leaving incarceration may be more than 100 times more likely to die from overdose during this period than the general population. This article describes a gender-responsive behavioral health reentry model, Engaging and Motivating to Prevent Overdose among Women via Effective Reentry (EMPOWER), implemented statewide in North Carolina. Among 359 self-referred women with SUDs, the program reported zero fatal overdoses during the 2-week post-release period. EMPOWER builds upon Jenna's Project: Preventing Overdose and Improving Recovery Outcomes for Women Leaving Incarcerated Settings During Pregnancy and Postpartum Periods, which served 132 perinatal women and reported zero fatal opioid overdoses at 6 months post-release. EMPOWER expanded the population to include women aged 18-44 years with a history of illicit substance use across three state prisons, regardless of pregnancy status. These findings suggest that evidence-based behavioral health interventions delivered during early reentry may reduce fatal overdose risk and demonstrate preliminary acceptability and feasibility. To our knowledge, this is among the first manuscripts to examine overdose outcomes during the critical 2-week post-release period among justice-involved women in North Carolina.
The U.S. carceral health care system presents a unique opportunity to expand reproductive health services. Evidence suggests that women incarcerated in jails want to initiate contraception, but access varies across facilities and is limited by concerns about cost, reproductive coercion, and a lack of consistent policies. To better understand the reproductive health needs of rural incarcerated women, a cross-sectional study of women incarcerated in four rural Maine jails was conducted using a 59-question survey on contraceptive history, needs, and preferences. Seventy-three women with complex histories of trauma, substance use, and poor reproductive health outcomes completed the survey. There were low rates of contraceptive use prior to incarceration. Thirty-nine percent plan to use contraception following release despite only 15% desiring pregnancy. Most respondents felt that women incarcerated in jails should have access to permanent sterilization but were concerned about coercion.
Menopausal Black women in U.S. prisons face a convergence of three accelerating crises: bodies made biologically older by structural racism and incarceration exposure, a menopausal transition that arrives earlier and manifests more severely for Black women than for any other group, and thermally hostile carceral infrastructure designed without their safety in mind. Estrogen decline disrupts thermoregulation-producing hot flashes, cardiovascular strain, and syncope risk-that becomes life-threatening when ambient temperatures reach 112°F-118°F and access to cooling, hydration, and hormone therapy is blocked. Drawing on a narrative synthesis of peer-reviewed literature, legal precedent, and policy documentation, I document how heat-related deaths are obscured through diagnostic miscoding, how formulary exclusions and copay requirements function as de facto bans on evidence-based care, and how symptom misclassification delivers women into solitary confinement as punishment for physiological events. Under the Estelle v. Gamble (1976) deliberate indifference standard, these patterns constitute cruel and unusual punishment. Drawing on the 2025 Tiede v. Collier ruling, I present a four-tier best practices toolkit-compassionate release, zero-copay hormone replacement therapy, thermometer protocols, and federal mandates-sequenced within a longer arc of structural decarceration. Thermal abandonment is deliberate indifference. It is also reversible.
Hepatitis C virus (HCV) infection is highly prevalent in U.S. jails, yet access to curative direct-acting HCV therapy remains limited because of the inmate Medicaid exclusion rule. However, an innovative expansion of the AIDS Drug Assistance Program in California now supports HCV treatment for individuals experiencing incarceration who are living with HIV. We describe the implementation of this pilot program in the Los Angeles County Jail, including the formation of a multidisciplinary task force designed to rapidly identify, evaluate, and initiate treatment despite the unpredictable length of stay and other barriers. Enabling treatment delivery within jail constraints has been possible with program adaptations such as provision of remaining HCV medications at release, shortened regimens and use of early sustained virologic response. Although challenges remain-including lack of universal screening, no funding for treatment of HCV monoinfection, and limited post-release linkage to care-this pilot demonstrates that targeted policy innovation combined with an effective implementation team can expand access to lifesaving HCV care in carceral settings in a group at very high risk.
Opioid use disorder is prevalent among incarcerated populations, who face elevated overdose risk post-release. Although effective, buprenorphine remains underutilized in U.S. jails, particularly in the South. This mixed-methods study evaluated clinical outcomes and implementation processes of a jail-based buprenorphine program in Appalachia. The State Department of Health piloted a model using telehealth prescribing and post-release navigation. Guided by the Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change, qualitative interviews with five program staff identified implementation barriers and facilitators. Retention outcomes were strong and comparable to community benchmarks. Barriers included staff skepticism, stigma, limited capacity, and role ambiguity, while facilitators included sustained education, leadership engagement, and cross-agency collaboration. Findings demonstrate feasibility in resource-constrained southern settings and highlight strategies to sustain and expand buprenorphine access for justice-involved populations.
Prisons, as total institutions organized around the sex/gender binary, are highly gendered institutions. Individual experiences of prison, therefore, vary dramatically by gender identity due to pains of imprisonment experienced differently by people experiencing incarceration. Building on the gendered pains of imprisonment literature, we use the public-use 2016 Survey of Prison Inmates to expand on previous research exploring the disproportionate mental health burden experienced by transgender and gender diverse (TGD) individuals who are incarcerated relative to cisgender men and women who are incarcerated. We disaggregate the TGD group to examine the different mental health burdens of TGD individuals and how the methodological task of categorizing gender identities can affect our understanding of mental health in prison. Results highlight the theoretical importance of acknowledging the stressful carceral environment and its impacts on psychological well-being and the methodological importance of understanding how decisions around the categorization of gender identity can differently impact our understanding of diverse individuals within the already-marginalized TGD population in prisons.
Carceral settings are particularly harmful for youth development and substantially impede their ability to pursue postsecondary education, a key determinant of health and protective factor against future legal system involvement. This article provides a review of innovative legislation that eliminated California's state-level Division of Juvenile Justice (DJJ) and incentivizes county-based, less restrictive programs (LRPs). In addition to discussing the national and state context for the policy changes, our community-research partnership identifies strengths and opportunities for the LRP model to support community reintegration and a pathway to success with postsecondary education for incarcerated youth.
Incarcerated pregnant and postpartum people experience poor mental health. Conditions of confinement (e.g., inadequate prenatal care, shackling, isolation, stigma) exacerbate distress, contributing to new or worsening psychological challenges. Although awareness of perinatal mental health needs is increasing, the extent to which federal and state laws address these needs remains unclear. To address this gap, we conducted a systematic search in WestLaw through July 2025, combining the terms pregnancy, postpartum, and incarceration. The search returned 545 statutes from 48 states and the federal government. Using a deductive codebook of maternal health topics, we extracted and analyzed legislative text related to mental health screening and treatment. Ten states had statutes addressing mental health care for incarcerated perinatal people. Nine mandated access to mental health treatment but varied in scope, screening, and conditions addressed. Five states referenced pregnant people only, three included both pregnant and postpartum people, and two focused exclusively on postpartum populations. Two states required specialized mental health training for carceral staff. Few states mandate availability of mental health care for incarcerated pregnant and postpartum people despite national clinical guidelines. Limited statutory guidance may hinder early identification and treatment, increasing the risk of adverse maternal outcomes, including postpartum depression, suicide, and recidivism.
Emergency departments (EDs) are highly utilized by individuals with criminal-legal system involvement (CLSI)-including those pre-arrest, in-custody, and post-release. EDs are often considered "adverse outcomes" in health services, clinical, and implementation research. We argue that EDs should also be considered an important partner in clinical carceral health practice and research. EDs have served important roles in addressing clinical and social determinants of health among other marginalized populations, such as those with behavioral health needs or housing insecurity. As EDs interact with patients throughout the correctional care continuum, we offer suggestions for partnership to improve clinical care. Finally, we highlight ED-based research being done to improve care for individuals with CLSI and why researchers should consider partnering with EDs to enhance recruitment, data collection, and intervention development of their studies. While it is never ideal for someone to require an ED visit, the reality is that for many, the ED is their primary source of care. We encourage our colleagues working in corrections medicine, re-entry services, and research to consider how they can partner with EDs as we all work to improve health systems and outcomes for our shared patients with CLSI.
