The proposed training program will focus on cancer risks, screening behaviors and preventive health care among men returning to the community after incarceration. Individuals who have extensive criminal justice histories have disproportionately high rates of smoking, greater burden of viral infections associated with cancer (e.g., hepatitis, HPV, HIV) and greater barriers to establishing and obtaining routine health care. Although efforts are underway to connect people to health care settings upon release, there is an absence of evidence about men's health-seeking behaviors after returning to the community. Little is known about men's motivations and intentions to participate in screening, prevention or treatment, or about contextual factors that affect their health behavior. A five year research and training program is proposed to prepare the principal investigator for a career in cancer-health disparities and participatory health services research focused on socially-marginalized, at-risk groups, such as former prisoners. The candidate's long-term goals are to advance her skills in community-partnered research, research design and psychometric development of measures. This program will build upon her strong background in HIV/AIDS, community practice and qualitative research, by providing a deeper understanding of factors that foster cancer-related health disparities among men with histories of criminal justice and substance abuse problems. Specific training objectives are: 1) to become proficient in the development, design, and use of psychometrically-sound instruments to measure health-seeking behavior among high-risk, socioeconomically disadvantaged men;2) to gain experience with participatory research methods, in order to maximize former offenders'involvement in research and engagement in interventions to increase their use of needed health services;3) to learn about the design of multilevel health services interventions, in order to create a program focusing on ethnic minority men with extensive criminal justice and substance abuse histories, and;4) to develop an understanding of the ethical issues that enter into health services research among people recently released from the criminal justice system. Structured training activities involve coursework in methodology, psychometrics/scale development, biostatistics, epidemiology, bioethics, advanced data analysis, and correctional health research. Mentors and advisors will provide additional readings, research supervision and consultation. The research and training activities will be pursued through the Division of Community Collaboration and Implementation Science in the Department of Epidemiology and Population Health at the Albert Einstein College of Medicine with senior researchers in a number of institutions including Columbia University and the University of Michigan. This training will provide an important foundation for collaborative planning of evidence-based community health services for this population. The proposed research will examine the health-related needs and health-seeking behaviors of 300 men ages 35-64 that have criminal justice and substance abuse histories in New York City.
Specific aims are: 1) to explore unmet health and psychosocial needs and quality of life among ethnic minority men who have extensive criminal justice and substance histories;2) to assess health-seeking behaviors among these men, including influences on their decisions to participate in cancer screening, prevention and treatment;3) to describe contextual barriers and facilitators that affect men's use of services;and 4) to evaluate the reliability and validity of instruments developed or adapted for use with men with criminal justice and substance use histories. In addition to characterizing men's health concerns, this study will describe barriers and facilitators to seeking care and treatment as well as the complex set of circumstances (e.g. health/illness, parenting, vocational skills, housing stability, employment, and social support) that may impede men's ability to prioritize their health care needs. Research and training activities described in this proposal are intended to develop the community connections, preliminary data and research skills necessary for the candidate to launch an independent program of community intervention research, designed to improve health and well-being and reduce cancer burden among vulnerable and largely disenfranchised segments of our society.
. The proposed K01 Research Scientist Development Award title, Health Seeking among Men with Criminal Justice and Substance Abuse Histories has serious relevance to public health agenda and priorities. Of the 7.3 million adults who are under some form of correctional supervision (e.g., probation, parole, prison and jail inmates), ethnic minority men are four times as likely than whites and nearly 2.5 times as likely to be under correctional supervision[40]. Nationwide, many states are recognizing that chronic and infectious diseases are concentrated in correctional populations and the punitive responses to nonviolent offenders are no longer a viable, economical option. Once these men return to the community, men who have extensive criminal justice and substance abuse histories often have unequal or lack access to health care services and fail to continue treatments that were initiated during incarceration[42]. Not only do ex-offenders report a wide array of problems and unmet health needs, but cancer-health disparities also exist. The proposed study contributes to the area of cancer-health disparities research and is consistent with NCI's strategic plan to chart the risk trajectories that may contribute to cancer and other adverse health conditions among vulnerable and disadvantaged populations.
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