Comparison of heroin and fentanyl use in US nationally representative surveys.

Background: Given the opioid overdose crisis, surveillance of evolving opioid use patterns is critical to the effective deployment of mitigation strategies. The National Survey on Drug Use and Health (NSDUH) provided the first annual US estimate of illicitly manufactured fentanyl (IMF) use in 2022. However, as a household survey, NSDUH may not capture the full extent of population heroin and IMF use.

The role of epidemiologists in addressing the public health consequences of the United States criminal legal system.

Exposure to the United States criminal legal system - whether through contact with law enforcement, incarceration in a jail or prison, or community supervision - is associated with a range of adverse health outcomes. There is mounting evidence that mass incarceration drives health inequities, particularly for Black, Indigenous, and People of Color. However, relative to its outsized impacts on health and health inequities, the criminal legal system has received limited attention in epidemiology.

Criminal legal penalties, substance use, and overdose: a concept mapping study examining Colorado's criminal legal penalties.

Background: In the USA, many states, including Colorado, have increased criminal penalties for illicit opioid possession, which may alter overdose risk. We aimed to evaluate the relationship between Colorado's increased drug-related criminal legal penalties, risk of overdose, and substance use patterns.

Methods: We used concept mapping - a mixed-methods approach used to develop a conceptual understanding of an issue from a community lens - to engage with people with living and/or lived experience with the criminal legal system, substance use, and/or overdose, their loved ones, and service providers.

The Rhode Island transitions clinic: connections to social and healthcare services after release from incarceration.

Background: After release from incarceration, individuals are rarely connected to primary care or to social services despite bearing a disproportionate burden of poor health (e.g., chronic illness) and structural determinants of health (e.

Perceived versus actual HIV risk among PrEP indicated persons with criminal legal involvement.

Individuals involved with community supervision experience multi-level obstacles impacting health outcomes. This is a high-risk period for HIV acquisition due to potential reengagement in unprotected sex and/or unsafe injection drug practices. This study aimed to assess the congruence between actual and perceived HIV risk and the degree to which individual, social, and behavioral factors impact risk perception among individuals on community supervision.

New horizons in criminal legal data: creating a comprehensive archive.

While criminal legal involvement is a structural determinant of health, both administrative and national longitudinal cohort data are collected and made available in a way that prevents a full understanding of this relationship. Administrative data are both collected and overseen by the same entity and are incomplete, delayed, and/or uninterpretable. Cohort data often only ask these questions to the most vulnerable, and do not include all types of criminal legal involvement, when this involvement occurs in someone's life, or family and community involvement.

The physiological toll of arrests: An examination of arrest history on midlife allostatic load.

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.

Using decision tree models and comprehensive statewide data to predict opioid overdoses following prison release.

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.

Identifying structural risk factors for overdose following incarceration: a concept mapping study.

Background: Currently, there are more than two million people in prisons or jails, with nearly two-thirds meeting the criteria for a substance use disorder. Following these patterns, overdose is the leading cause of death following release from prison and the third leading cause of death during periods of incarceration in jails. Traditional quantitative methods analyzing the factors associated with overdose following incarceration may fail to capture structural and environmental factors present in specific communities.

Longitudinal pathways between maternal depression, parenting behaviors, and early childhood development: a mediation analysis.

Maternal depression is a global public health concern with far-reaching impacts on child development, yet our understanding of mechanisms remains incomplete. This study examined whether parenting mediates the association between maternal depression and child outcomes. Participants included 841 rural Pakistani mother-child dyads (50% female).

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

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.

Documenting Competing Needs to Well-Being Among Those on Community Supervision in the South.

Although the harms of incarceration on health are well known, little is known about individuals' competing priorities to maintaining their health while on probation and parole after release from incarceration. We explored individuals' competing needs on probation and parole (lack of health insurance/access, hazardous alcohol use, substance use, food insecurity, un/underemployment, housing insecurity, lack of social support, length of recent incarceration, prohibitive monthly fees, criminal legal discrimination) to achieving well-being. We explored overlap between competing needs and overall well-being.

Mass Probation: Effects of Sentencing Severity on Mental Health for Black and White Individuals.

Background: Incarceration is associated with negative impacts on mental health. Probation, a form of community supervision, has been lauded as an alternative. However, the effect of probation versus incarceration on mental health is unclear.

Maternal adverse childhood experiences on child growth and development in rural Pakistan: An observational cohort study.

Maternal adverse childhood experiences (ACEs) have significant impacts on the next generation with links to negative birth outcomes, impaired cognitive development, and increased socioemotional problems in children. However, not all types or levels of adversity are similarly deleterious and research from diverse contexts is needed to better understand why and how intergenerational transmission of adversity occurs. We examined the role of maternal ACEs on children's growth, cognitive, and socioemotional development at 36 months postpartum in rural Pakistan.

Challenging Health Inequities in Incarceration: a Call for Equitable Care for Kidney Disease and Hypertension.

Purpose Of Review: To review the current literature on care of hypertension and chronic kidney disease for people who are currently and formerly incarcerated, and to make recommendations for improving outcomes.

Recent Findings: There is a growing body of literature describing care for kidney disease and hypertension for incarcerated and formerly incarcerated individuals that documents the provision of care itself, notably that many jails contract with private companies; the system is not designed to provide sustained, chronic disease care; and the transition from incarceration to community is fraught with gaps in care. However, deficiencies in data collection and regulation still limit our understanding of the quality of care provided in jails and prisons.

Understanding the Accumulation of Health-Related Inequities Over the Life Course Using the Mean Cumulative Count.

Understanding how health inequities develop over time is necessary to inform interventions, but methods for doing so are underutilized. We provide an example of the accumulation of stressful life events using the mean cumulative count (MCC), which estimates the expected number of events per person as a function of time, allowing for censoring and competing events. Data came from the National Longitudinal Survey of Youth 1997, a nationally representative data set.

Retention strategies among those on community supervision in the South: Lessons learned during the COVID-19 pandemic.

Objectives: Cohort studies must implement effective retention strategies to produce internally valid and generalizable results. Ensuring all study participants are retained, particularly those involved in the criminal legal system, ensures study findings and future interventions will be relevant to this group, who are often lost to follow-up: critical to achieving health equity. Our objective was to characterize retention strategies and describe overall retention among an 18-month longitudinal cohort study of persons on community supervision prior to and during the COVID-19 pandemic.

Collateral consequences of COVID-19 for people on probation and parole.

Background: While the severe detrimental impact of COVID-19 on incarcerated people is well known, little is known about the experience of COVID-19 on those on community supervision. Our objective was to better understand the experience of the COVID-19 pandemic and its collateral consequences for those on community supervision (e.g.

The feasibility and acceptability of a task-shifted intervention for perinatal depression among women living with HIV in Malawi: a qualitative analysis.

Background: Perinatal depression (PND) is prevalent and negatively impacts HIV care among women living with HIV (WLHIV), yet PND remains under-identified in Malawian WLHIV. Accordingly, this formative study explored perceptions of the feasibility and acceptability of an integrated, task-shifted approach to PND screening and treatment in maternity clinics.

Methods: We completed consecutive PND screenings of HIV+ women attending pre- or post-natal appointments at 5 clinics in Lilongwe district, Malawi.