PURPOSE:The purpose of this study is to investigate the prevalence of chronic illness, multimorbidity, mental illness and comorbidity among older adults incarcerated in a Mid-South state prison system. DESIGN/METHODOLOGY/APPROACH:This study used a cross-sectional descriptive design, gathering data through face-to-face interviews with older adults (n = 499) incarcerated in five state prisons in Kentucky. FINDINGS:Uncovered was a substantial prevalence of chronic diseases and mental health disorders among older adults incarcerated in a Mid-South state prison system. Specifically, hypertension was reported by 65.5% of the participants, arthritis by 52.3% and diabetes by 23%. In terms of mental health, significant findings included that 34% of the older adult population scored above the threshold for major depression, and over one-third met the criteria for post-traumatic stress disorder. RESEARCH LIMITATIONS/IMPLICATIONS:Constrained by its cross-sectional design, the study may not reflect changes in chronic and mental health conditions over time. The predominantly white demographic of the Kentucky state prison system limits the generalizability of findings to more racially diverse populations. PRACTICAL IMPLICATIONS:Findings highlight the need for integrated health-care models within prison systems to address the complex, coexisting chronic and mental health conditions among older inmates. SOCIAL IMPLICATIONS:These findings illuminate the substantial social implications of inadequate health care for aging incarcerated persons, revealing a pressing public health issue within correctional facilities. ORIGINALITY/VALUE:The study highlights the often-overlooked demographic of older adults within the correctional system, particularly within a specific geographical region of the Mid-South, which is known for its higher disease prevalence. It contributes valuable insights into the multimorbidity and comorbidity of chronic and mental health conditions among incarcerated older adults.

Prison staff experience physical and mental health conditions at rates exceeding those in the general population. These adverse health outcomes, alongside poor job satisfaction and burnout, contribute to high rates of absenteeism, turnover, and vacancies among carceral workforces. Yet little is known about how to reduce the occupational strains of prison work. This mixed-methods study describes an intervention, the “Contact Mentor Program,” which adapts the role of Norwegian prison officers to a U.S. prison setting, and trains and inspires prison staff to serve as supportive mentors to assigned incarcerated individuals. Drawing on questionnaire data from staff ( n = 52) and semi-structured interviews ( n = 21), the study compares the experiences of contact mentors to non-mentors and explores the program’s impact on professional identity, job satisfaction, and well-being. Participants reported improved autonomy, organizational support, and purpose. Findings suggest this model may be a promising approach to reducing stress among correctional staff.

This JAMA Insights discusses the need to expand prison hospice and compassionate release and enrich clinician understanding of the needs of dying patients who are incarcerated to provide compassionate and appropriate end-of-life care.

OBJECTIVE:The aim of this study was to quantify and describe National Health and Medical Research Council (NHMRC) funding for research on the health of justice-involved people (i.e. people who are incarcerated or otherwise under criminal justice supervision). METHODS:We searched the NHMRC funding database for the period 2000-2022 using keywords and names of prominent researchers. Potentially relevant grants were independently reviewed by two authors for inclusion. Information about included grants was independently extracted by the same two authors. RESULTS:Of A$16.4 billion in NHMRC funding over the period 2000-2022, A$38.7 million (0.22%) was for justice health research. Most grants were for research in Australia's most populous eastern states and focused on mental health, substance use and/or infectious disease. Only A$4.5 million (0.03% of the total NHMRC allocation) was for research on the health of justice-involved children and adolescents. CONCLUSIONS:NHMRC funding for justice health research in Australia is out of step with the substantial health and economic burden associated with Australian criminal justice systems. Greater investment in independent, high-quality research in the justice health field has the potential to improve public health, reduce costs and reduce health inequities. More funding for research on non-communicable disease, disability, and the health of justice-involved children and adolescents is required.

PURPOSE:Prisons are associated with poor health outcomes for incarcerated people and correctional staff. Efforts to remedy harmful prison conditions typically focus on litigation, legislation and administrative policy changes; however, implementing these top-down mandates is often impeded by cultural barriers among prison staff. The purpose of this study was to evaluate a novel intervention grounded in public health and international correctional principles, to educate and motivate frontline prison staff to lead culture change initiatives in US prisons. DESIGN/METHODOLOGY/APPROACH:Guided by an implementation science framework, researchers administered surveys and conducted semi-structured interviews with three cohorts of participants in the Amend Ambassadors Program. This study included a total of 37 participants: 28 US prison staff from four US states (Oregon, California, North Dakota and Washington) and 9 prison staff from Norway. The objectives were to assess the implementation of the program and its impacts based on the experiences of those who participated. FINDINGS:Results suggest that the Ambassadors program succeeded in its educational objectives, and provided participants with knowledge, skills and motivation to lead culture change projects in the prison systems where they work. Participants responded favorably to the pedagogical components of the program, and most reported improvements in their perceived levels of job satisfaction, overall well-being and inspiration to advance culture change efforts, as a result of their participation in the program. ORIGINALITY/VALUE:The Amend Ambassadors program is a novel approach to educating and inspiring correctional professionals to mobilize "ground up" culture change initiatives focused on improving human dignity and health promotion. This formative evaluation provides new insights into the potential for interventions that combine international immersion, health promotion and experiential learning components for fostering leadership and reducing cultural resistance to prison reform among prison workforces.

BACKGROUND:The United States has one of the highest incarceration rates in the world. Prior incarceration is associated with adverse health effects. While the era of "mass incarceration" began in 1973, little work has focused on older adults, whose lives have spanned the five decades of mass incarceration. METHODS:We conducted a cross-sectional analysis using data on adults 50 or older from the nationally representative Family History of Incarceration Survey to test the independent association between prior incarceration and self-reported physical and mental health. In logistic regression models, we controlled for age, gender, race/ethnicity, education, income, employment, and marital status. We also tested for effect modification by race/ethnicity, gender, and time since last incarceration, as well as financial and social wellbeing. RESULTS:Among 1318 older adults, 21% had been incarcerated. Formerly incarcerated older adults were more likely to be men; non-Hispanic Black or "other" race/ethnicity; meet criteria for disability; be unmarried; and have lower income and education compared with those never incarcerated. In fully adjusted models, prior incarceration was independently associated with greater odds of reporting "fair" or "poor" physical health (aOR:1.88, 95% CI: 1.19-2.98; p = 0.007). Prior incarceration was associated with reporting "fair" or "poor" mental health after adjusting for demographic covariates (aOR: 2.12, 95% CI: 1.24-3.65; p = 0.006) but was nonsignificant after adding socioeconomic covariates. Length of time from last incarceration did not moderate the observed association, meaning that even those incarcerated > 10 years ago had poor self-reported health. Financial wellbeing moderated the association between incarceration and mental health. CONCLUSION:Prior incarceration is a social determinant of health for older adults, even those with distant incarceration history, and is strongly associated with current poverty and meeting criteria for disability. Further research is needed to understand the mechanisms of these associations and means to mitigate health harms associated with prior incarceration.

This Viewpoint discusses the ways in which incarcerated individuals are negatively impacted by the consequences of climate change and steps carceral facilities and policymakers can take to mitigate extreme heat risks.

Having ever had an incarcerated family member is associated with worse health, but little is known about specifics among older adults, who have lived their entire adult lives in the era of mass incarceration. In a cross-sectional analysis of FamHIS data (2018), a nationally representative survey designed to understand family member incarceration in the United States, we used logistic regression models to examine associations with self-reported physical and mental health. Our primary exposure was any immediate family member incarceration. Secondary analyses examined relationship of incarcerated family member. Covariates were age, gender, race/ethnicity, education, income, employment, marital status, and personal incarceration history. Among 1,319 subjects, of whom 63% experienced incarceration of an immediate family member, family member incarceration was independently associated with increased odds of reporting “fair” or “poor” physical and mental health (aOR 1.46; 95% Confidence interval: 1.00-2.14); P = 0.05 and aOR 2.13; 95% CI: 1.27-3.58 ; P = 0.004, respectively). This differed by relationship, with ever parental incarceration independently associated with the highest odds of “fair” or “poor” physical and mental health (aOR 1.99, 95% CI: 1.07-3.68, P = 0.03; aOR 2.95, 95% CI: 1.48-5.90 respectively, P = 0.002), followed by children and siblings, regardless of when that incarceration occurred. Ever incarceration of a family member was independently associated with poor health among older adults, even for those whose parent was incarcerated in the distant past. Researchers should work to understand the mechanisms behind this, and clinicians and policy makers should intervene at earlier ages to ensure all Americans can age healthfully.

This Viewpoint discusses how the health care quality that individuals receive while incarcerated is often deficient and how the passage of the Federal Prison Oversight Act represents an opportunity to improve the health of those living and working in carceral facilities.

This Viewpoint describes types of interpersonal and structural violence experienced by women in carceral settings and opportunities for reform.

ObjectivesIncreasing numbers of older adults are reentering community following incarceration (i.e., reentry), yet risk of incident neurodegenerative disorders associated with reentry is unknown. Our objective was to determine association between reentry status (reentry vs never-incarcerated) and mild cognitive impairment (MCI) and/or dementia.MethodsThis nationwide, longitudinal cohort study used linked Centers for Medicare & Medicaid Services and Veterans Health Administration data. Participants were aged 65 years or older who experienced reentry between October 1, 2012, and December 31, 2018, with no preincarceration MCI/dementia, compared with age-matched/sex-matched never-incarcerated veterans. MCI/dementia was defined by diagnostic codes. Fine-Gray proportional hazards models were used to examine association.ResultsThis study included 35,520 veterans, mean age of 70 years, and approximately 1% women. The reentry group (N = 5,920) had higher incidence of MCI/dementia compared with the never-incarcerated group (N = 29,600; 10.2% vs 7.2%; fully adjusted hazard ratio [aHR] 1.12; 95% CI 1.00-1.25). On further investigation, reentry was associated with increased risk of dementia with or without prior MCI diagnosis (aHR 1.21; 95% CI 1.06-1.39) but not MCI only.DiscussionTransition from incarceration to community increased risk of neurocognitive diagnosis. Findings indicate health/social services to identify and address significant cognitive deficits on late-life reentry. Limitations include generalizability to nonveterans.

This Viewpoint discusses legal provisions guiding health care delivery for incarcerated individuals, the impact of the First Step Act of 2018, and future federal criminal justice reform.

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Since prisons were an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, the experience of correctional health care professionals (HCPs) may differ from HCPs in other settings. This cross-sectional descriptive study assessed stress, anxiety, and burnout levels in home and work environments among HCPs employed by one U.S. state prison system during the period of initial COVID-19 vaccine rollout. Participants (N = 444) were invited to voluntarily participate in an anonymous questionnaire distributed by prison administration from March 1 through May 17, 2021. Measures were adapted from a prior study of noncorrectional HCPs during the COVID-19 pandemic. Descriptive statistics (mean; standard deviation; 25th, 50th, and 75th percentiles), ranking measures that could alleviate anxiety and stress related to the pandemic, and qualitative responses were analyzed. Responses from 43% of HCPs (192) revealed that correctional HCPs experienced high levels of stress and anxiety at work and at home during the pandemic, with particularly high levels among females and registered nurses. Understanding and addressing these stressors will be of critical importance as prison systems work to avoid turnover of experienced HCPs in such specialized settings and also help inform human resource planning at state prison systems for future public health responses.

The health of incarcerated populations is intertwined with the health of security staff, but the social mechanisms, and especially the specific interventions, that might mitigate these health harms are underexplored. We examine one possible mechanism of interrelated health harms: whether and how jail security staff are willing and able to care for mentally ill detainees. We hypothesize that the attitudes of security staff towards care affect the well-being of everyone in a jail setting-staff, as well as detainees. Analyzing 539 anonymous respondent surveys administered to a stratified cluster sample of security staff working in a large U.S. county jail system, we (1) describe the prevalence of a perceived duty to care and availability of caring resources among security staff and (2) analyze whether variations in a duty to care and caring resources predict outcomes associated with staff and detainee well-being. Across five maximum likelihood models estimated, both perceived duty to care and availability of caring resources are significantly associated with collaborative relationships with medical staff, increased perceptions of personal safety, decreased frequency of hostile encounters, and better self-reported health outcomes. Our models explain 20 percent of the variation in self-reported health outcomes (R2 = .20), a meaningful effect of care on security personnel's well-being. Our findings suggest security staff have an often-overlooked duty to care akin to that experienced by healthcare staff. Among healthcare staff, dual loyalty trainings have successfully amplified caring duties relative to security duties; similar trainings for security staff might better leverage their caring duties to improve both staff and detainee well-being.