Purpose: To understand how allostatic load - cumulative physiologic burden of stress - varies by amount and timing of arrests stratified by race/ethnicity and by sex. Methods: Using The National Longitudinal Study of Adolescent to Adult Health, we calculated descriptive statistics and mean differences in bio-marker measured allostatic load by arrest history stratified by race/ethnicity and sex. Results: One-third of participants experienced at least one arrest, and most experienced arrests only as adults. Allostatic load scores were higher for those that had ever experienced an arrest compared to never (mean difference: 0.58 (0.33, 0.84)). Similar results held for men and women and across race/ethnicity, but Black non-Hispanic individuals had higher allostatic load at all levels compared to other individuals. Conclusions: Experiencing both any arrest and multiple arrests were associated with higher allostatic load. The stress of arrests may contribute to physiological maladaptations and poor health. The public health and law enforcement fields must recognize the detrimental consequences of arrests on physiological stress and search for non-carceral solutions.

Purpose: Identifying predictors of opioid overdose following release from prison is critical for opioid overdose prevention. Methods: We leveraged an individually linked, state-wide database from 2015-2020 to predict the risk of opioid overdose within 90 days of release from Massachusetts state prisons. We developed two decision tree modeling schemes: a model fit on all individuals with a single weight for those that experienced an opioid overdose and models stratified by race/ethnicity. We compared the performance of each model using several performance measures and identified factors that were most predictive of opioid overdose within racial/ethnic groups and across models. Results: We found that out of 44,246 prison releases in Massachusetts between 2015-2020, 2237 (5.1%) resulted in opioid overdose in the 90 days following release. The performance of the two predictive models varied. The single weight model had high sensitivity (79%) and low specificity (56%) for predicting opioid overdose and was more sensitive for White non-Hispanic individuals (sensitivity = 84%) than for racial/ethnic minority individuals. Conclusions: Stratified models had better balanced performance metrics for both White non-Hispanic and racial/ethnic minority groups and identified different predictors of overdose between racial/ethnic groups. Across racial/ethnic groups and models, involuntary commitment (involuntary treatment for alcohol/substance use disorder) was an important predictor of opioid overdose.

While incarceration has proven detrimental to mental well-being, it remains unknown if community supervision is better for mental well-being than incarceration. Our objective was to explore the individual- and community-level relationships between community supervision and mental well-being and to examine inequities by race. We conducted 20 in-depth interviews with individuals on community supervision (e.g., probation, parole) in North Carolina and conducted thematic analysis separately by race. For many, criminal legal involvement began at a young age, often due to substance use for White individuals or over-policing for Black participants. The themes were: (1) "It's a Thursday. Move on.": surviving over the life course in the context of the criminal legal system; (2) "Merry go round of death": the criminal legal system as a trap; (3) "I love you, but I have to love you from over here": social support as a double-edged sword while on community supervision; and (4) " [Probation] ain't nothing but a rope to hang yourself": mental health issues created and exacerbated by criminal legal involvement. Individuals' experiences on community supervision were often dehumanizing and difficult, preventing them from achieving well-being. This system must be redesigned to meet individual and community needs.

Mass incarceration refers to the system of social and racial control in the United States that arrests, convicts, incarcerates, and supervises racial and ethnic minority populations through probation and parole. Mass incarceration is referred to as “mass” because the current size of this system in the United States is historically and internationally unparalleled. Mass incarceration affects those who are incarcerated and under community supervision, as well as the families and communities where it is concentrated. Mass incarceration is a pervasive cause of health inequities in the United States. Yet, it has long been absent from both public health institutional priorities and core graduate training in public health. Mass incarceration is absent from the required curricula in general public health programs and even specialty programs focused on health equity and sociostructural determinants of health. Given this lack of prioritization and formal education and training, public health scholars may overlook the critical role it plays in individual and community health and the key it holds to achieving health equity. Increased broad awareness of the harms of mass incarceration is needed to disrupt its connection to health inequities and to abolish this system of social and racial control.

To evaluate the relationship of COVID-19 infection rates between residents and staff members in prison facilities. We collected historical data on daily COVID-19 counts for California, Florida, and Wisconsin residents and staff. We analyzed 78,250 COVID-19 cases among residents and 25,392 cases among staff. Strong positive associations were found in the rates of COVID-19 cases between residents and staff, suggesting telemedicine can help reduce outbreaks.