In the United States, young adults (ages 18-25) represent 1 in 10 of the prison population and 1 in 5 of the jail population. They face significant physical and mental health challenges during their transition from incarceration back to community life. These challenges are compounded by the structural barriers of reentry, including challenges accessing housing, employment, and healthcare. While previous research has explored young adults' health status during the transition, less is known about their perspective on what constitutes health and well-being, and how their understanding of health is shaped or influenced by the reentry process. This study investigates the following research questions: 1) How do young adults in reentry conceptualize health and well-being? and 2) How do they describe the relationship between their health and the reentry process? The study draws on longitudinal semi-structured interviews (N = 66) with 16 young adults, aged 18-25, who were recently released from jail or on probation in June and July 2020. Findings suggest that the young adults define health as the ability to exert control over their lives. This control is demonstrated through abstaining from substances-though cannabis is often viewed as a legitimate exception-managing daily responsibilities, and coping with stressors such as mental health challenges and strained relationships. Participants also described their health status as intertwined with the reentry process, a process they viewed as both a major stressor exacerbating existing health challenges and an opportunity to break from their perceived past unhealthy behaviors. While they ascribed personal responsibility for their health outcomes, their efforts to improve their well-being were constrained by systemic barriers imposed by reentry, such as housing instability, lack of healthcare access, and employment challenges. These barriers undermined both their reentry- and health-related goals. Findings highlight a contrast between young adults' conceptions of health as the exertion of agency and the structural constraints they face during reentry. Their transition from incarceration shapes health in both symbolic and material ways, informing how they define and understand health, while also impacting their physical, emotional, and mental well-being.

People who use drugs face barriers to accessing HIV prevention tools. The status-neutral model for HIV care starts with the HIV test and offers linkage to HIV treatment if the person tests positive and linkage to pre-exposure prophylaxis (PrEP) if the person tests negative. The goal of this study was to evaluate barriers and facilitators impacting the implementation of a status-neutral HIV model of care in the jail setting. Between June and August 2024, we recruited people working in and incarcerated in the jails operated by the Suffolk County Sheriff’s Department (Jail and House of Correction) for in-depth interviews. The Consolidated Framework for Implementation Research (CFIR) 2.0 guided interview development. Interviews were recorded, transcribed, coded, and analyzed using rapid thematic analysis (RTA) methods. Relevant themes were mapped onto CFIR domains. We conducted 28 interviews: 13 with correctional and clinical staff and 15 with incarcerated people. Clinical and administrative staff members indicated that strong relationships with state and local agencies and the state’s proactive approach to preventative carceral healthcare helped facilitate HIV treatment and prevention pathways. Incarcerated individuals identified issues in the system used to report health needs and unreliable test result delivery mechanisms as major barriers. Staff also identified barriers, including understaffing, but overwhelmingly endorsed the jails’ existing systems of accessing and delivering care. Findings identified multiple potential intervention targets to enhance a status-neutral approach to HIV testing and treatment in jail settings, including leveraging existing partnerships, and educational opportunities for staff. Strategies that reinforce a patient-centered institutional culture (with a focus on incarcerated individuals’ health), improve care continuity for transitions into and out of jail, and highlight gaps in healthcare delivery are critical for successful implementation of status-neutral HIV care in jails.

BackgroundMany people with histories of criminalized drug use resume using drugs after leaving incarceration, yet limited research explores the specific needs and vulnerabilities of these individuals compared to those who remain abstinent. We examined the relationship between post-incarceration drug use and competing psychosocial needs, as well as these needs’ association with views regarding substance use disorder (SUD) treatment.Aims(1) Compare psychosocial needs between individuals with recent drug use post-incarceration and those who were abstinent. (2) Examine which needs are associated with participants’ views on the importance of SUD treatment.MethodsAmong 244 participants with a history of drug use who were previously incarcerated, currently on community supervision, and had elevated risk of HIV, we compared those who used drugs within 30 days post-release (n = 97) to those who did not (n = 147) on health insurance coverage, alcohol use, food security, employment status, housing stability, social support, and depressive symptoms. We analyzed bivariate associations between these needs and the importance of SUD treatment using Wilcoxon-Mann-Whitney and Jonckheere-Terpstra tests.ResultsParticipants with recent drug use reported higher rates of hazardous alcohol consumption (35.4% vs. 18.1%), food insecurity (58.8% vs. 42.9%), un- or under-employment (61.7% vs. 49.0%), low social support (44.3% vs. 24.7%), and depressive symptoms (50.5% vs. 21.8%). Substance-related problems were significantly linked to higher treatment importance for both groups. Multiple additional competing needs correlated with treatment importance among abstinent individuals.ConclusionsIndividuals who return to drug use post-incarceration face greater psychosocial challenges. Results highlight the need for disentanglement of access to services from treatment and the provision of comprehensive services regardless of stage of recovery.

Suicide rates are higher in prison environments than those in the general population. Therefore, preventive activities are crucial. We aimed to evaluate the effectiveness of a psychoeducational group intervention in decreasing the number of suicidal behaviors in prisons. We conducted a randomized controlled trial in nine prisons in Catalonia. Main outcome: total number of suicidal behaviors. Other variables: suicidal ideations, depressive and anxiety symptoms, and quality of life. The intervention group carried out 17 psychoeducation sessions and the control group received information. 171 individuals participated in the study, mean age of 34.9 years, 84.8% males. The intervention group (n = 85) reduced anxiety and depression and increased quality of life post-intervention (p < 0.05), with no changes in the control group (n = 86). Both groups reduced all suicide items except for the number of interrupted/aborted attempts and the percentage of people with non-suicidal self-injurious behavior, which improved only in the intervention group. In both groups, the absolute number of suicide attempts decreased (p > 0.05). The psychoeducational intervention had an impact on suicidal ideation observed in both groups, with a non-significant reduction in the number of suicide attempts. Furthermore, the intervention improved levels of anxiety, depression, and quality of life. This trial was registered at ClinicalTrials.gov on January 19, 2022 (NCT05195554).

BackgroundJustice-impacted persons aged 40 and up with substance use disorders (SUD) demonstrate increased health risks and health disparities relative to general population peers. Persons with SUD are less likely to age out of criminal behavior, appearing on criminal dockets, in jails, prisons, and under community supervision throughout the life course, with greater community-level cost burdens as they age. Justice system involvement presents health risks that compound with SUD to undermine well-being, which is amplified as people age and experience age-related health decline. Propensity for premature mortality from overdose is startlingly high for this population, highlighting demand for targeted policies to better meet the needs of this vulnerable group. To better understand justice-impacted older adults in treatment for SUD and inform policy, we examined opioid use outcomes among 357 low-income justice-impacted adults in SUD treatment in the Midwest, USA, including a natural oversampling of Black and American Indian or Alaska Native (AIAN) persons. We explored patterns among persons in their 40s, 50s, and 60s, relative to those under 40, conceptualizing life-course risk factors and using logistic regression to assess overdose, opioid use, and opioid agonist medication use.ResultsSignificant differences in opioid use by age were observed, with older persons less likely to report opioid prescription misuse or illicit opioid use. Differences were not significant once controlling for user preferences, race/ethnicity, gender, family, childhood, and life course experiences. Overdose history was also significantly less likely for the 40 and older SUD patient, though this was no longer significant when controlling for demographic covariates. Opioid agonist medication use did not significantly differ by age.ConclusionsJustice-involved patients aged 40 and up in SUD treatment were less likely to have experienced overdose or report opioid use, relative to their younger peers, but this variation dissipated when considering demographic, family and/or life course factors. Targeted treatment services for gender and racial minorities may be beneficial for patients 40 and up. We identify preference for one substance, versus two, as protective against overdose and opioid use among older persons who use drugs.

People who use opioids (PWUO) have asserted police opioid seizures increase risk of overdose in their proximate aftermath. Ecological studies and causal models exhibit a positive association between police opioid seizures and overdose risk. To further characterize this relationship, this qualitative study explores how police officers who conduct drug enforcement understand the relationship between their opioid seizures and overdose risk. Semi-structured interviews were conducted with officers from the Providence, Rhode Island (USA) Police Department (n = 26) who patrolled areas with highly concentrated public substance use, or who conducted narcotics investigations. Interviews explored beliefs about the effects of police opioid seizures on overdose risk, reasons why seizures may modify this risk, and the motivations for narcotics enforcement. In contrast to patrol officers, narcotics investigators and patrol supervisors with narcotics investigation experience expressed four themes: (1) police opioid seizures increase subsequent overdose risk; (2) the reasons why closely track accounts put forth by researchers, and PWUO who experience this risk firsthand; (3) this risk was one of many faced by PWUO, and (4) police narcotics work should weigh it against the perceived need to address the effects of the illicit narcotics trade on a community. This consensus across diverse study populations, supported by ecological research and causal models, suggests the overdose risks generated by police opioid enforcement should be taken seriously in formulating drug policy.

This study examined YouTurn's program, a volunteer-based mentoring initiative for individuals released after completing their full prison sentences in Israel. Unlike parolees, this group generally lacks structured transitional and healthcare support, risks of adverse health outcomes, and recidivism. Drawing on semi-structured interviews with mentors, staff, and institutional partners involved in the program, the study employed thematic analysis to explore the program's strengths, challenges, and broader implications. Findings indicate that YouTurn's civilian volunteer mentors deliver holistic support that addresses emotional, social, and practical reentry needs, while fostering organizational cohesion and continuity during crisis. The program's distinctive reliance on civic volunteers offers an alternative model of support rooted in community commitments, positioning YouTurn as a strengths-based intervention that fills gaps in current rehabilitation policy. Respondents also indicated significant challenges, including participants' dropout, limited resources, and a lack of diversity among mentees. The study extends theoretical understandings of mentoring models and demonstrates the potential of civic volunteer-driven initiatives to complement peer- and professional-based approaches in offender rehabilitation.

As the opioid overdose crisis continues to produce excessive morbidity and mortality in the United States, government agencies have applied various approaches to prevent overdoses, including law-enforcement efforts (e.g., arresting people who use drugs, interrupting drug traffickers, etc.) and treatment-based approaches (e.g., naloxone, medications for opioid use disorder, etc.). Public perception and support of these approaches are relevant for informing policy, allocating resources, and effectively implementing community interventions to prevent drug-related harms. Using an embedded informational survey design, we experimentally assessed whether public support for strategies to prevent overdose in South Carolina is influenced by language from federal agencies describing treatment- or enforcement-based approaches. Respondents were randomly assigned to one of three groups: (1) enforcement -based approach, (2) treatment-based approach, or (3) the control condition. Those assigned to experimental groups were presented with statistics on drug overdose deaths, followed by an informational prompt with language about overdose prevention approaches from either DEA (enforcement) or NIH (treatment), while the control group received no informational prompt. Findings from a sample of 4,675 respondents indicated that those assigned the DEA prompt were significantly more likely to support enforcement-based approaches in arresting drug traffickers and people who use drugs (AME = 0.060, p < 0.001). On the other hand, those assigned to the NIH prompt were significantly more likely to agree that both law enforcement (AME = 0.065, p < 0.0001) and clinicians (AME = 0.044, p < 0.05) are capable of preventing drug overdose deaths. These findings shed light on public perceptions of approaches to addressing the opioid epidemic and limited modifiability when presented with language from federal agencies. This may inform future research, practice, and/or policy aiming to maintain public safety while also providing treatment options to people who use drugs in order to reduce overdose deaths.

Youth involved in the juvenile justice system (YIJ), including those under community supervision, have disproportionately high rates of behavioral health disorders compared to community samples, yet the vast majority do not receive the care they need. When left unaddressed, youths’ behavioral health concerns can contribute to deepening juvenile justice involvement, which is frequently accompanied by increasing severity of behavioral health disorders and negative long-term ramifications for youth, families, and communities. The majority of YIJ are under community supervision, meaning they reside in the community and must receive behavioral health treatment through the community-based behavioral health system. To highlight the need for innovative approaches that break this cycle by closing the gap between clinical need and uptake of effective treatment for these high-risk and often overlooked youth, we synthesize existing literature on the prevalence of psychiatric disorders and intersecting domains of risk for disorder and justice involvement among youth under community supervision, drawing on ecodevelopmental and ecological systems theory to advance an understanding of specific barriers to services for youth under community supervision. We review existing efforts to facilitate treatment access and conclude with data-driven recommendations for future research, clinical practice, and policy changes.

BackgroundResearch suggests that educational programs that impact well-being show the greatest promise for promoting behavioral change and providing incarcerated men and women with the skills necessary to reintegrate into communities successfully. The development of well-being is a key component of such educational programs, as it affords important protective factors in the face of stress and difficulty and improves individuals’ chances of stable re-entry to their communities. The Urban Ministry Institute (TUMI) is a faith-based, seminary-level, higher-education program that enhances healthy thinking, prosocial behavior, and positive interpersonal relationships for incarcerated men and women in the United States.MethodsWe evaluated well-being among TUMI participants incarcerated in correctional facilities in Texas, Kansas, and among groups of formerly incarcerated TUMI graduates in California, Texas, and Kansas. We conducted focus groups with 109 men and women inside six prisons, and 157 people completed mixed methods surveys, for a total of 266 data points.ResultsQualitative results fell into three primary themes related to well-being, namely healthy thinking patterns, prosocial behavior, and positive interpersonal relationships. Participants completed the Flourishing Scale, reporting agreement with all eight statements, with particularly strong agreement to statements related to healthy thinking patterns.ConclusionsFindings provided support for the growing argument that faith-based correctional education promotes wellbeing, which is a key factor in improving behavior, reducing disciplinary infractions, and preparing incarcerated men and women for successful reintegration into their communities. Overall, this research demonstrates the potential value of providing educational opportunities like TUMI to incarcerated individuals.