Monday, March 21, 2016

Correlates of Preincarceration Health Care Use among Women and Men in Jail

Although women and men in jails bear a burden of health problems, little is known about factors associated with their health care use. We conducted a cross-sectional survey of preincarceration health care use with 596 jail inmates. Descriptive statistics and correlates of participants’ health care use were assessed. 

A year before incarceration, 54% of participants used an emergency room, 24% were hospitalized, and 39% used primary care. Correlates of health care use included gender, health insurance status, and drug dependence. For participants without mental health problems, use was associated with living in neighborhoods where a higher percentage of residents did not complete high school. 

Findings suggest individual and community factors that can be targeted by reentry programs to improve health care use after jail.

...There was an interesting interaction between individual- and community-level variables, however, which was that ER use and hospitalizations were significant only for the group of participants without a mental health diagnosis and living in a neighborhood with low educational status. Factors associated with primary care use included having health insurance, not reporting drug dependence, and having a mental health diagnosis. Thus, we found that although community-level factors may have a role in health care use patterns, individual-level factors such as gender, health insurance status, drug dependence, and mental health diagnosis history were important correlates of preincarceration health care use for our sample.

...The model [Andersen’s Behavioral Model of Health Services Use; ;; however, fails to explain our finding that low educational status at the community level is associated with health care that is used for emergency and more serious conditions, but only for those without mental health problems. Low educational status at the community level could be a proxy for community-level social capital (), which has been associated with both health outcomes and health care access (; ). It could also signal lack of investment by the health care sector in poor, disadvantaged communities where the economic capital of residents is compromised by their collective educational status. It is interesting, however, that other potential associations with social capital variables were not significant and suggest the need to repeat this study with other populations. Our finding that community matters only for those without mental health problems can perhaps be explained by the magnitude of the mental health burden on inmates. Mental health as an indicator of health need may determine the relative impact of community on health care use for this group of women and men. Given that one national study found that 64% of people in the jails had a mental health problem (), the burden unique to this population is significant and perhaps more significant than any community-level factors...

Full article at:

By:  Megha Ramaswamy, PhD, MPH,1 Francisco Diaz, PhD,2 Tyson Pankey, MPH,3 Suzanne L. Hunt, MS,2 Andrew Park, DO, MPH,4 and Patricia J. Kelly, PhD, MPH, APRN5
1Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS, USA
2Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS, USA
3Department of Counseling Psychology, University of Wisconsin–Madison, Madison, WI, USA
4Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS, USA
5School of Nursing, University of Missouri–Kansas City, Kansas City, MO, USA
Corresponding Author: Megha Ramaswamy, PhD, MPH, Preventive Medicine and Public Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., MS 1008, Kansas City, KS 66160, USA.

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