Limited data exist on cancer screening in carceral facilities. This study evaluates the feasibility and outcomes of a population-based lung cancer screening initiative in a carceral setting. This is a retrospective review of a lung cancer screening event at the Rhode Island Department of Corrections. Sentenced individuals meeting U.S. Preventive Services Task Force age criteria for lung cancer screening were mailed a letter asking about their smoking history. Low-dose computed tomography (LDCT) scans were offered to individuals who responded and met the criteria. Retrospective analyses examined patients' LDCT scoring using the American College of Radiology's Lung CT Screening Reporting and Data System (Lung-RADS v1.1). Among more than 2,000 incarcerated individuals, 282 met the age criteria and 117 (41.5%) replied with interest in screening, of whom 57 (48.7%) verified as eligible. All 57 (100%) received LDCT. Most scans (94.4%) were categorized as Lung-RADS 1 or 2, indicating negative or benign findings. Comparisons with general population estimates showed no significant differences in Lung-RADS scores. The screening identified 21 incidental findings, including aortic aneurysms and severe coronary artery calcification. The implementation of lung cancer screening in a carceral setting was shown to be feasible and accepted by the incarcerated population.

People in prison are at an increased risk of long-term conditions that have been associated with poor nutrition intake, low levels of physical activity, and obesity. We aim to identify the necessary components of nutrition education to impact the health and health behaviors of people in prison. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the structure of this article. Our protocol was registered in PROSPERO (CRD42022353925). Electronic databases were searched for relevant studies published in the English language from January 1, 2000, to December 31, 2023. Data were extracted and narrative synthesis completed. The search identified 394 studies, of which 10 studies included nutrition education delivered to and with people in prison. In most cases, nutrition was one element of a complex intervention, with the inclusion of physical activity and/or a focus on health. The outcomes measured varied considerably across studies; therefore, our narrative synthesis explored the (1) development and delivery, (2) content, and (3) impact of nutrition education delivered for people in prison. There remains a need for nutrition education for people in prison, developed through coproduction, that encompasses their individual needs, with quantifiable outcome measures through validated tools and/or physiological measures.

In hospitals across the country, most patients admitted from jails or prisons receive their care in custodial restraints regardless of clinical concerns or public safety risk. Blanket restraint protocols are deemed necessary for public safety; however, the indiscriminate use of custodial restraints causes harm to patients physically, mentally, and through propagation of prejudice. Hospitals and correctional officials must create policies that allow for a case-by-case analysis of patients to develop an individualized custodial restraint plan that will balance public safety and patient care needs. In this Viewpoint, we recommend a collaborative stakeholder approach to address this needed public policy evolution. Now is the time for health care professionals, correctional and hospital administrators, those with lived incarceration experience, and community members to work together to create policies on custodial restraints that support patient healing and reduce physical harm, emotional distress, and prejudice while optimizing staff and public safety.

There is no standardized curriculum that teaches medical residents to navigate the ethical and logistical complexities of bedside care delivery to patients who are incarcerated. In this article, we describe resident physician bedside experiences at a community teaching hospital caring for patients who are incarcerated. From 2022 to 2023, residents in emergency medicine, general surgery, internal medicine, and obstetrics and gynecology were offered an anonymous survey, self-administered via REDCap software, to explore their experiences caring for this patient population. Of 168 resident physicians, 78 (46.4%) completed the survey. The majority were cisgender women (62.3%), 20 to 30 years old (78.2%), and White (70.5%). Of these residents, 98.7% had cared for a patient who was incarcerated or in custody, yet only 15.4% reported receiving formal education regarding caring for this patient population, and only 24.4% were aware of relevant institutional policies. Qualitative analysis revealed themes including barriers to care, permission and authorization, conditional treatment, inconsistency, and conflict. Resident curricula that target knowledge gaps related to procedure and policy and address ethical concerns at the bedside may improve the clinical learning environment and lead to more consistent, equitable care delivery for patients who are incarcerated.

This integrative review examines the use of appreciative inquiry in correctional health care settings, following the guidelines of Whittemore and Knafl. Using the Johns Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal Tool, it assessed the level and quality of the evidence. Search terms included , , and . Nine of the 92 articles reviewed used steps of the appreciative inquiry process and were selected for the final review and analysis. Most study authors recommended organizational change. In carceral settings, appreciative inquiry was used to reduce bias, increase empowerment, and improve workplace relationships. Wider dissemination of the usefulness of this process is needed to address workforce shortages.

Individuals who work in medication-assisted treatment (MAT) programs that serve justice-involved populations face challenging conditions that can cause elevated levels of stress. Although some studies focus on stress faced by MAT professionals, few examine their coping mechanisms. This study applies the Mayo Clinic's "4A's" of stress management-accept, adapt, avoid, and alter-to better understand ways medical staff working in MAT programs manage stress. The research team used NVivo software to analyze original qualitative data from 83 MAT employees servicing justice-involved populations. The 4A's framework successfully applies to the MAT employee context. Specifically, respondents relied on the stress management techniques and more often than and . Descriptive demographic trends were found in the data, including Black females most often reporting they accept and adapt to stress at work. In contrast, White females chose acceptance over other management tactics, although they also reported avoidance more than other groups. MAT organizations should empower employees to amend stressors to improve personal and professional outcomes. Future studies should use qualitative and quantitative methods to examine stress in industries with compounding stressors, such as MAT professionals working in justice settings.

Many people with HIV (PWH) in jail have not been well engaged in HIV treatment in the community. This study aimed to assess the impact of a data exchange paired with care coordination for PWH on HIV outcomes after jail release. We developed an automated process to match jail booking records with HIV surveillance data. Health department HIV relinkage specialists and jail release planners used the data in weekly case conferences to facilitate care coordination for PWH who were out of care (no CD4 or viral load [VL] reported in the past 12 months) or viremic (VL ≥ 200 copies/mL) before booking. We compared VL testing within 3 months after release and viral suppression (VL < 200 copies/mL) within 6 months after release in preintervention (October 1, 2016-October 1, 2017) versus postintervention (April 1, 2018-February 1, 2019) periods using Cox proportional hazard models. Comparing 153 bookings among PWH in the preintervention period to 80 in the postintervention period, VL testing after release did not differ (47% vs. 55%; adjusted hazard ratio [aHR]: 1.05, 95% confidence interval [CI]: 0.68-1.64) nor did viral suppression (35% vs. 44%; aHR: 1.28 [95% CI: 0.80-2.05]). Data exchange and care coordination are insufficient to improve postrelease outcomes among PWH without additional interventions in the jail and community.

With an aging prison population facing various chronic diseases, the importance of palliative and end-of-life care (EOLC) in correctional facilities is heightened. This systematic review aimed to identify facilitators and barriers to palliative and EOLC in prisons. PubMed, Web of Science, Scopus, and Cochrane databases were searched for primary qualitative studies (January 2014 to December 2022) in English. Eligible studies focused on people in prison, health care professionals, administrators, and governors regarding palliative or EOLC provision within prison settings. Five studies were included, from Australia, France, the United Kingdom, and the United States, whose overall quality was moderate to high. Key facilitators included access to family, support from prison staff, specialized care availability, and cultural/spiritual support. Barriers encompassed discomfort, patient-clinician relationship constraints, time limitations, protocol uncertainty, restricted patient agency, negative attitudes, inequality, conflicting priorities, and lack of grief support. Addressing these barriers and leveraging facilitators will be crucial in ensuring equitable access to compassionate EOLC for individuals experiencing incarceration. Policymakers, health care providers, and correctional authorities must prioritize the enhancement of palliative care services within prisons, supported by further research and targeted interventions to address disparities and optimize care provision.

The participation of incarcerated individuals in research is necessary to appropriately address the health disparities that affect them and to adapt and implement health services for the carceral setting. Incarceration significantly impacts health, leading to negative outcomes including accelerated aging and increased mortality, with these effects disproportionately impacting communities of color. The U.S. Department of Health and Human Services' Office for Human Research Protections outlines ethical approaches to compensating individuals who participate in research activities, yet lacks specific guidance for payment within carceral settings. Historical abuses in carceral research underscore the persistent need for robust protections for incarcerated research participants. Existing regulations offer some protection but inadequately address ethical payment practices. Substantial variability in payment policies across carceral systems and vague national guidelines pose ethical challenges in ensuring equitable treatment for incarcerated research participants. We outline the ethical concerns related to compensating incarcerated individuals for participating in research and present a framework of approaches to payment. We argue for payment parity between incarcerated and community research participants. More community-engaged research is needed to understand the perspectives of incarcerated individuals on ethical payment.

The epidemic of opioid overdose brought a major health crisis to the front line of public health in the United States. Early efforts have focused on the prevention of production, distribution, and consumption of the drugs. However, there is little information about youth populations at risk for opioid overdose and their response to targeted treatment plans. The San Bernardino County Youth Opioid Response (SBCYOR) coalition in collaboration with the San Bernadino County (SBC) Probation Department organized a safety net system for at-risk youth by improving communication among county resources. This program mainly focused on individuals aged 12 to 24 years in the county's detention centers along with educational and prevention projects such as naloxone programs for first responders in the region. To describe the impact of the SBCYOR program on at-risk youth, we compare the frequencies of patients referred and treated with medications for opioid use disorder (MOUD) at the SBC Probation Department, which was responsible for individuals from age 12 to less than 18 years, with those from the West Valley Detention Center (WVDC), which was responsible for adults (18 to 24 years of age), from September 2020 through June 2022. Similar proportions of youths were referred for treatment of opioid use disorder (OUD) at the respective sites (3.7% SBC Probation Department, 3.6% WVDC). Of these, however, 78.0% were treated with MOUD at SBC Probation Department compared with only 7.1% at WVDC. SBCYOR coalition partners were able to transform their services into a comprehensive medical and behavioral health program for the incarcerated youth population at risk for OUD.

Diabetes is prevalent among incarcerated individuals, necessitating effective management within prison settings. This study aims to assess diabetes management among incarcerated individuals and analyze the methodological aspects of relevant research focusing on incarcerated individuals with diabetes. A systematic search was conducted in PubMed, Web of Science, Scopus, and Google Scholar databases, with data parameters from 1990 to 2021 and following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, to investigate diabetes management in incarcerated individuals. The search yielded 706 records, from which 14 English-language quantitative studies meeting inclusion criteria were selected for analysis. These studies were predominantly retrospective with low levels of evidence. However, they consistently demonstrated the beneficial effects of dietary interventions, educational programs, and nursing guidance on diabetes management in incarcerated populations. This study highlights the need for more comprehensive and high-evidence research to further explore health professionals' practices with incarcerated individuals with diabetes and the effectiveness of diabetes management. Such studies are crucial for improving the quality of care provided to this vulnerable population.

Prevalence of adverse childhood experiences (ACEs) and the extent to which they relate to health among young adults (ages 18-25) returning home from jail is underexamined. To build on the growing literature examining associations between ACE exposure among young people involved with carceral systems and health, we (1) measured ACE prevalence and (2) explored associations between ACEs and health/well-being indicators among young adults experiencing reentry. Using a telephone survey on reentry experiences, participants completed an ACE screening, single-item responses on health and social indicators, and five-item responses on substance misuse. Fisher's exact tests and tests compared sociodemographic and health-related factors by the levels of ACEs. Among the 85 participants, 66 (78%) reported four or more ACEs and 48 (56%) reported six or more ACEs, including divorced parents ( = 69, 81%), witnessing violence ( = 63, 74%), and household member incarceration ( = 60, 71%). Higher exposure to ACEs was associated with mental health diagnoses, psychiatric medication prescriptions, psychiatric hospitalizations, drug dependence, binge drinking, and cannabis misuse. High ACE exposure among young adults experiencing reentry portends worse mental health and high rates of substance use. Findings signify an opportunity to apply a trauma-focused developmental framework to support emerging adults during the crucial reentry period.

This opinion consolidates regulatory frameworks, legal cases, workforce data, and research studies to advocate for the advancement of licensed practical nurses to registered nurses within correctional health care. By emphasizing adherence to nursing scope of practice and proposing a sustainable workforce development model, this article aims to enhance patient care and elevate standards in correctional facilities.

Due to the complex nature of correctional facilities, correctional health care professionals (CHPs) are at high risk of experiencing the harms of helping such as burnout, vicarious trauma, and post-traumatic stress disorder (PTSD). Although traditionally applied to military populations, the construct of moral injury has gained increasing application to health care and bears relevance to correctional health care. This qualitative study examines the prevalence of moral injury among CHPs while considering the moral dilemmas and ethical challenges of delivering care in a carceral environment. Employing an interpretative phenomenological analysis (IPA), 25 semi-structured interviews were conducted with a diverse sample of CHPs, selected through nonprobability, purposive sampling. Rigorous thematic analysis, guided by IPA principles, was used. The data revealed five key themes: moral injury is an occupational hazard for correctional health care workers; incidental versus cumulative moral injury; role of institutional betrayal; the intersectional relationship among moral injury, PTSD, and burnout; and the road to moral repair. These themes offer insights into the prevalence and effects of moral injury in correctional health care while offering solutions to navigating moral injury. These findings contribute to a deeper understanding of the complex ethical and psychological dynamics within correctional health care settings and explore implications for practice, policy, and future research.

The Texas Christian University Hub of the Justice Community Opioid Innovation Network Project includes a partnership with state criminal justice (CJ) agencies with the goal of impacting state- and local-level policies and practices that will lead to increased access to and retention in community-based substance use treatment services among parole clients. This article outlines how we successfully fostered policy changes and includes a five-step process for how researchers can bridge the gap between research and CJ agencies to implement similar changes. This process included the use of various strategies to support the justice partners in their efforts to implement changes within their organization.

People who experience incarceration have a heightened risk for cardiovascular disease (CVD) mediated by both traditional and incarceration-specific risk factors related to their environment. In this Viewpoint, we summarize what is known about the epidemiology and management of acute CV events, specifically acute myocardial infarction (AMI), congestive heart failure exacerbation (CHFe), and stroke, among people who are incarcerated. We also highlight gaps in available evidence. Our literature review found no studies that provided population-based rates (e.g., events per 1,000 incarcerated persons per year) of AMI, CHFe, or stroke in people who are incarcerated. Similarly, we did not identify any empirical studies that systematically described the treatment of AMI, CHFe, or stroke in this population. We outline a series of research studies that should be conducted to inform future interventions and guide quality improvement efforts.