Jail Provision of Pregnancy and Sexual Health Services in Four Midwestern States.

OBJECTIVE: Women incarcerated in local jails have pregnancy and sexual health needs, yet little information is available about what services are provided and how jail administrators prioritize this care. Our objective was to document jails' provision of pregnancy and sexual health services in four states in the Midwest. METHODS: We invited all jail administrators (N = 347) in Kansas, Missouri, Iowa, and Nebraska to participate in a web-based survey conducted from November 2017 to October 2018. We asked administrators which pregnancy and sexual health services they offered and to rate the importance of offering services. Results were analyzed using descriptive statistics and logistic regression. RESULTS: The survey response rate was 55% (192/347). Jails most often provided pregnancy testing (n = 116 [60%]) and distribution of prenatal vitamins (n = 85 [44%]). Sexually transmitted infection treatment was offered at 23% of jails (n = 45). Larger, accredited jails located in urban areas and with high numbers of clinical providers on staff were more likely to provide sexual health services. Jails with privately contracted health care were more likely to provide pregnancy services compared with other entities providing medical care. The most prioritized sexual health service was sexually transmitted infection testing, with 39% of administrators believing it was important. Only 6% of administrators responded that contraception was important. CONCLUSIONS: Local jails in the Midwest do not meet the basic reproductive and sexual health needs of women. Provision of these services is not a priority for jail administrators. Appropriate partnerships could engage administrators and increase the availability of services to meet the needs of women in jail.

Social Resources, Abortion, and Contraceptive Use Among Women With Criminal Justice Histories.

Women in the criminal legal system face structural barriers to social resources such as education, employment, and benefits. Little is known how these resources intersect with their reproductive lives, specifically with obtaining abortions. We explored the relationship between social resources and abortion history among women incarcerated in a county jail through a secondary analysis of survey data from a 2014 to 2016 jail-based sexual health intervention. Regression analyses determined correlates of having an abortion history. Thirty percent of participants had an abortion and were more likely to have at least a high school education (adjusted odds ratio [aOR] = 3.3; 95% confidence interval [CI] = 1.25-8.77) and a history of sexually transmitted infections (aOR = 3.2; 95% CI = 1.25-8.06). Appropriate systems-level efforts should be expanded to support women with criminal legal histories in their reproductive lives.

Developing a Cancer Prevention Health Education Resource: a Primer of Process and Evaluation.

Limited women's health and cancer prevention materials are available that have been validated for vulnerable populations. Such materials are especially important for groups, which have intermittent and typically low-quality healthcare access and are at greatest risk for missing out on women's health and cancer prevention screening. Health education materials are developed from heterogeneous sources. Clinical and research teams have minimal guidance in terms of sources, timelines, outputs, and evaluation in the development of such materials. The goal of this paper is to share our process in developing and evaluating an up-to-date women's health and cancer prevention learning guide appropriate for a target population of women involved in the criminal justice system. A ten-page learning guide was drafted using the current evidence-based data, with the objective of providing educational material on four topics: cervical cancer, breast cancer, sexually transmitted infection, and unintended pregnancy prevention. The learning guide was then tested on a convenience sample of 33 women at a local county jail. Feedback was organized into three parts in which the participants Responded to open-ended question, "What is missing?" Rated each of the four topics for design and content Completed a usability assessment Common themes were participants' interest in learning about side effects of birth control and wanting more information on testing and treatment, specifically for sexually transmitted infections (STIs). Women were satisfied with the cancer prevention information presented to them. This report provides a framework for cancer prevention researchers who are developing health education materials for vulnerable populations.

Health and Health Service Needs: Comparison of Older and Younger Women with Criminal-Legal Involvement in Three Cities.

Objectives: We profiled the health and health services needs of a sample of older adult women (age 50+) with criminal-legal system (CLS) involvement and compared them with younger women (age 18-49), also CLS-involved. Methods: Using survey data collected from January to June 2020 from adult women with CLS involvement in three US cities, we profiled and compared the older adult women with younger women on behavioral and structural risk factors, health conditions, and health services access and use. Results: One-third (157/510) were age 50+. We found significant differences (p < .05) in health conditions and health services use: older women had more chronic conditions (e.g., hypertension and stroke) and more multimorbidity and reported more use of personalized care (e.g., private doctor, medical home, and health insurance). Discussion: Although older women with CLS involvement reported good access to health services compared with younger women, their chronic health conditions, multimorbidity, and functional declines merit attention.

Cervical Cancer Risk and Prevention Practices Among Sexual Minority Women with Criminal-Legal System Involvement.

Women with criminal-legal system involvement bear a disproportionate burden of cervical cancer, indeed 4-5 times more than women without criminal-legal system involvement. While we also know that sexual minority identification (lesbian/gay, queer, bisexual, or not straight) is more common among women with criminal-legal system involvement, we lack understanding of the cervical cancer risk and prevention practices of this group of women. In 2019-2020, we used surveys to investigate cervical cancer risk and prevention practices among 510 women with criminal-legal system involvement in Kansas City (KS and MO), Oakland (CA), and Birmingham (AL). In a secondary data analysis, we compared sexual minority women (SMW defined as women who identified as lesbian/gay, bisexual, or other -19% of the sample) to women who identified as heterosexual or straight - 81% of sample). SMW were less likely to have ever gotten a cervical cancer screening test, compared to straight women. Having a provider whom women felt they could rely on was associated with having an up-to-date cervical cancer screening test among SMW. SMW with criminal-legal system involvement are missing out on necessary cancer screenings. Further study to understand why and interventions to ensure this group receives preventive care are needed to prevent cervical cancer and reduce disparities.

Physical health programs and interventions with women during incarceration: a scoping review.

PURPOSE: The USA outpaces most other countries in the world in the rates at which it incarcerates its citizens. The one million women held in US jails and prisons on any day in the USA face many physical health challenges, yet interventional work to address physical health in carceral settings is rare. This study's purpose was to summarize the literature on programs and interventions implemented with women in US carceral settings (jail or prison) that primarily addressed a physical health issue or need. DESIGN/METHODOLOGY/APPROACH: A scoping review was conducted. The authors searched databases, reference lists, individual journals and websites for physical health program descriptions/evaluations and research studies, 2000-2020, that included women and were set in the USA. FINDINGS: The authors identified 19 articles and a range of problem areas, designs, settings and samples, interventions/programs, outcomes and uses of theory. The authors identified two cross-cutting themes: the carceral setting as opportunity and challenges of ethics and logistics. RESEARCH LIMITATIONS/IMPLICATIONS: Much potential remains for researchers to have an impact on health disparities by addressing physical health needs of women during incarceration. ORIGINALITY/VALUE: Interventional and programmatic work to address physical health needs of women during incarceration is sparse and diversely focused. This review uniquely summarizes the existing work in a small and overlooked but important area of research and usefully highlights gaps in that literature.

Differences in abortion-related knowledge among women involved in the criminal legal system in three US cities.

OBJECTIVE: We examined if abortion-related knowledge among women with criminal legal system involvement differed in three U.S. cities in states with varying abortion policies. STUDY DESIGN: Respondents were self-identified women with criminal legal system involvement. Data come from a cross-sectional baseline survey of 381 women in three U.S. cities: Oakland, California, Kansas City, Kansas/Missouri, and Birmingham, Alabama. The primary outcome, high abortion-related knowledge, was based on a 10-item scale dichotomized into low vs high abortion-related knowledge. We used descriptive statistics, bivariable associations, and logistic regression to assess the association between high abortion-related knowledge, city of residence, and other possible related factors. RESULTS: Respondents in Kansas City, KS/MO and Birmingham, AL had lower odds of high abortion-related knowledge compared to respondents in Oakland, CA (OR: 0.19, 95% CI: 0.10-0.38 and OR: 0.17, 95% CI: 0.11-0.28, respectively). In adjusted analysis, the association remained after controlling for race/ethnicity, insurance status, and community supervision past year. CONCLUSIONS: Findings underscore the need for communicating clear and accurate information about abortion care, especially in states where laws and ongoing political challenges make it difficult to access both reliable information and services. IMPLICATIONS: Efforts to disseminate accurate information regarding abortion care, particularly among marginalized people, should utilize multiple venues in addition to traditional healthcare information sources. Reproductive justice advocates should connect with jails and probation offices to reach people with criminal legal system involvement and foster increased knowledge of reproductive rights and services.

Abnormal Pap Follow-Up among Criminal-Legal Involved Women in Three U.S. Cities.

Criminal-legal involved women experience significant barriers to preventive cervical care, and consequently there is a higher incidence of cervical cancer in this population. The purpose of this study is to identify variables that may facilitate abnormal Pap follow-up among criminal-legal involved women living in community settings. The study included n = 510 women with criminal-legal histories, from three U.S. cities-Birmingham, AL; Kansas City, KS/MO; Oakland, CA. Participants completed a 288-item survey, with questions related to demographics, social advantages, provider communication, and reasons for missing follow-up care. There were n = 58 women who reported abnormal Pap testing, and n = 40 (69%) received follow-up care. Most women received either repeat Pap/HPV testing (n = 15, 38%), or colposcopy and/or biopsy (n = 14, 35%). Women who did not follow-up (n = 15, 26%) cited that they forgot (n = 8, 53%), were uninsured (n = 3, 20%), or were reincarcerated (n = 3, 20%). In a multivariate analysis, both having a primary care provider (OR 4.6, 95% CI 1.3-16.0) and receiving specific provider communication about follow-up (OR 3.8, 95% CI 1.1-13.2) were independent predictors for abnormal Pap follow-up. Interventions that offer linkages to providers in the community or ensure abnormal Pap care plans are communicated effectively may mitigate the disparate incidence of cervical cancer among criminal-legal involved women.

Recommendations for Delivering COVID-19 Vaccine in Jails: Evidence from Kansas, Iowa, Nebraska, and Missouri.

We report on data we collected from a 2018 survey examining jails' human papillomavirus virus vaccine delivery capacity and on a secondary analysis we conducted to describe factors similarly associated with delivery planning for the COVID-19 vaccine. We provide recommendations for delivering the COVID-19 vaccine in jails, based on evidence from Kansas, Iowa, Nebraska, and Missouri. Our key finding is that jails have limited staff to implement vaccination and will require collaboration between jail administrators, jail medical staff, and local health departments.

An Analysis of How Characteristics of Local Health Department Jurisdictions Influence Involvement in PHAB Accreditation: Implications for Health Equity.

OBJECTIVE: To explore how characteristics of local health department (LHD) jurisdictions impact involvement in Public Health Accreditation Board (PHAB) accreditation and to characterize the implications for health equity. METHODS: Data from the 2016 National Profile of LHDs survey were linked with data from the American Community Survey, National Center for Health Statistics, Behavioral Risk Factor Surveillance System, and the 2016 presidential election. Outcome measures included LHDs that were formally engaged in PHAB accreditation and LHDs that planned to apply for PHAB accreditation but were not formally engaged. Logistic regression was used to assess for the impact LHD jurisdictions' socioeconomic position, demographics, population health status, political ideology, and LHD organizational characteristics have on PHAB accreditation. RESULTS: Approximately 37% of the participants were formally engaged (n = 297) and planned to apply (n = 337) for PHAB accreditation. Involvement in PHAB accreditation was equal among LHDs based on poverty and income inequality, but median household income was negatively associated. Diverse jurisdictions were more likely to be involved in PHAB accreditation but less likely to be involved after controlling for covariates. Jurisdictions with worse population health status were either as likely or more likely to be involved in PHAB accreditation. Jurisdictions with a greater conservative political ideology were less likely to be involved. CONCLUSION: LHD involvement in PHAB accreditation varies by their jurisdiction's characteristics. This has implications for health equity based on socioeconomic, racial, and population health status. Policies and practices are needed to improve the uptake of PHAB accreditation in LHD jurisdictions impacted most by health inequities.

Facebook as a follow-up tool for women with criminal justice histories.

PURPOSE: The purpose of this study is to measure Facebook (FB) use as a tool for maintaining research contact with hard-to-reach women with criminal justice histories. DESIGN/METHODOLOGY/APPROACH: Retrospective data were analyzed from a jail health intervention. Bivariate analysis compared the rates of follow-up between FB group users and non-FB group users at one post-intervention time point. Multivariate models explored predictors for FB group follow-up. FINDINGS: Among 184 participants, 89 (48.4%) used the private research FB group. This group was more likely to complete the follow-up survey one year after enrollment compared to non-FB group users (P = 0.002). Regression analyses showed that, compared to non-FB group users, FB group users were more likely to be younger and have a history of sexually transmitted infections. PRACTICAL IMPLICATIONS: FB is popular among women with criminal justice histories. Use of this social media site with study participants from hard-to-reach populations may enhance study retention. ORIGINALITY/VALUE: This paper fills a gap in examining the long-term use of FB as a research strategy to maintain contain with typically hard-to-reach populations.

Troponoids Can Inhibit Growth of the Human Fungal Pathogen Cryptococcus neoformans.

Cryptococcus neoformans is a pathogen that is common in immunosuppressed patients. It can be treated with amphotericin B and fluconazole, but the mortality rate remains 15 to 30%. Thus, novel and more effective anticryptococcal therapies are needed. The troponoids are based on natural products isolated from western red cedar, and have a broad range of antimicrobial activities. Extracts of western red cedar inhibit the growth of several fungal species, but neither western red cedar extracts nor troponoid derivatives have been tested against C. neoformans We screened 56 troponoids for their ability to inhibit C. neoformans growth and to assess whether they may be attractive candidates for development into anticryptococcal drugs. We determined MICs at which the compounds inhibited 80% of cryptococcal growth relative to vehicle-treated controls and identified 12 compounds with MICs ranging from 0.2 to 15 µM. We screened compounds with MICs of ≤20 µM for cytotoxicity in liver hepatoma cells. Fifty percent cytotoxicity values (CC50s) ranged from 4 to >100 µM. The therapeutic indexes (TI, CC50/MIC) for most of the troponoids were fairly low, with most being <8. However, two compounds had TI values that were >8, including a tropone with a TI of >300. These tropones are fungicidal and are not antagonistic when used in combination with fluconazole or amphotericin B. Inhibition by these two tropones remains unchanged under conditions favoring cryptococcal capsule formation. These data support the hypothesis that troponoids may be a productive scaffold for the development of novel anticryptococcal therapies.