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2023

"Nothing but a rope to hang yourself:" The toll of mass supervision on mental well-being

LeMasters, K., Camp, H., Benson, A., Corsi, C., Cullins, Z., & Brinkley-Rubinstein, L.

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.

2023

A call to action to public health institutions and teaching to incorporate mass incarceration as a sociostructural determinant of health

McCauley, E. J., LeMasters, K., Behne, M. F., & Brinkley-Rubinstein, L.

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.

2023

Analyzing COVID-19 rates between residents and staff in correctional facilities: A telemedicine opportunity

Khairat, S., Bohlmann, A., Wallace, E., & Brinkley-Rubinstein, L.

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.

2023

Anticipated barriers to sustained engagement in treatment with medications for opioid use disorder after release from incarceration

Kaplowitz, E., Truong, A., Macmadu, A., Berk, J., Martin, H., Burke, C., Rich, J. D., & Brinkley-Rubinstein, L.

Background: Although the burden of opioid use disorder is disproportionately high among persons who are incarcerated, medications for opioid use disorder are often unavailable in correctional settings. The Rhode Island Department of Corrections provides all 3 classes of medications for opioid use disorder to clinically eligible persons who are incarcerated. Despite a decrease in fatal overdoses among persons with recent criminal legal system involvement since the program's implementation, barriers to continued engagement in treatment after release from incarceration still exist. Methods: We conducted 40 semistructured, qualitative interviews with people who were incarcerated and enrolled in the comprehensive medications for opioid use disorder program at the Rhode Island Department of Corrections. Analysis applied a general, inductive approach using NVivo 12. Results: Participants discussed barriers to treatment engagement before incarceration, as well as anticipated barriers to medications to treat opioid use disorder continuation after release from incarceration. Structural factors including housing, health insurance, transportation, and the treatment program structure, as well as social factors such as social support networks were perceived to influence retention in medications to treat opioid use disorder post-release. Conclusion: Our findings suggest that people with opioid use disorder who are incarcerated encounter unique challenges upon community reentry. Addressing structural factors that pose barriers to post-release engagement is essential to sustaining retention. We recommend utilization of peer recovery specialists to alleviate some of the stress of navigating the structural barriers identified by participants.

2023

COVID-19 vaccine deliberation in individuals directly impacted by incarceration

Kim, C., Aminawung, J. A., Brinkley-Rubinstein, L., Wang, E. A., & Puglisi, L. B.

Delays in vaccinating communities of color to COVID-19 have signaled a need to investigate structural barriers to vaccine uptake, with mass incarceration demanding greater characterization as a potential factor. In a nationally representative survey from February-March 2021 (N = 1,157), exposure to the criminal legal system, defined as having been incarcerated in prison or jail or having had a family member or close friend incarcerated, was associated with higher odds for COVID-19 vaccine deliberation. Individuals with criminal legal system exposure reported lower confidence in physician recommendation as a reason to get vaccinated. They were also more likely to decline vaccination out of fear it would cause COVID-19 infection, and that the vaccine might be promoted as a political tool. Our analysis suggests that populations impacted by the criminal legal system would benefit from targeted vaccine outreach by trusted community members who can address distrust during current and future pandemics.
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