Dr. Emily Wang, MD, MAS is a general internist at Yale University who is conducting patient oriented research to reduce cardiovascular disease in patients with a history of incarceration. The United States has the highest rate of incarceration worldwide, such that more than 13 million individuals have been incarcerated in jail or prison. Current and former inmates are disproportionately ethnic minorities, poor, and have co-morbid substance abuse and psychiatric disorders. Patients with a history of incarceration are at increased risk for cardiovascular disease morbidity and mortality, although the specific mechanisms for this are unknown. Dr. Wang's goal is to understand how to prevent and mitigate cardiovascular disease in patients with a history of incarceration;this proposal will support her professional development and allow her to achieve her goal of becoming an independent clinical investigator. She will enlist the mentorship of a multidisciplinary team of highly accomplished researchers to achieve her training and research plans. Dr. Wang's training goals proposed for the K23 are to develop skills in: (1) advanced statistical techniques for longitudinal data analyses, (2) qualitative and mixed (qualitative and quantitative) methods, (3) design, recruitment, and management of a longitudinal patient cohort, and (4) multidisciplinary training in the measurement of cardiovascular disease and substance abuse as it relates to incarcerated populations. Her prior research has shown that having a history of incarceration is an independent risk for developing hypertension and left ventricular hypertrophy, even after adjusting for confounding factors. Moreover, she has found that individuals with cardiovascular risk factors and disease have poor access to community health care upon release from correctional facilities. Dr. Wang's research plan for this application builds on her past clinical and research experience and explores three population-specific factors that may affect health outcomes in patients released from correctional facilities with cardiovascular risk factors and disease. The first project will use 25 years of data from the NHLBI-funded Coronary Artery Risk Development in Young Adults (CARDIA) cohort of 5115 young adults to study the impact of incarceration on the cumulative incidence of cardiovascular risk factors and long-term disease control and potential mediators of observed associations. The second project is a survey study designed to examine the nature of cardiovascular risk factors and disease care in prison health care systems. The third project will assess 50 recently released prisoners'knowledge, attitudes, and beliefs regarding their cardiovascular risk factors using both established instruments and in-depth interviews and, secondarily, will follow these individuals for 12 months to assess the feasibility of a future prospective cohort study. The studies proposed within this award application will provide preliminary data for an R01 to conduct a larger prospective cohort study to identify targets for future intervention studies designed to reduce cardiovascular morbidity and mortality in the growing number of adults with a history of incarceration.

Public Health Relevance

Current and former inmates with cardiovascular risk factors and disease typically fall at the intersection of two poorly functioning health care systems: the correctional health care system and the public safety net health care system. Neither health care system is well equipped to take care of this growing population of individuals who cycle in and out of both systems. By studying three areas that impact the cardiovascular outcomes of returning inmates, the proposed studies will provide valuable information on modifiable risk factors and targets for interventions to reduce cardiovascular disease in patients with a history of incarceration and reduce health care costs in correctional facilities and in the community.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZHL1-CSR-R (M1))
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Scott, Jane
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Yale University
Internal Medicine/Medicine
Schools of Medicine
New Haven
United States
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Wang, Emily A; Redmond, Nicole; Dennison Himmelfarb, Cheryl R et al. (2017) Cardiovascular Disease in Incarcerated Populations. J Am Coll Cardiol 69:2967-2976
Thomas, Emily H; Wang, Emily A; Curry, Leslie A et al. (2016) Patients' experiences managing cardiovascular disease and risk factors in prison. Health Justice 4:4
Howell, Benjamin A; Long, Jessica B; Edelman, E Jennifer et al. (2016) Incarceration History and Uncontrolled Blood Pressure in a Multi-Site Cohort. J Gen Intern Med 31:1496-1502
Wang, Emily A; McGinnis, Kathleen A; Long, Jessica B et al. (2015) Incarceration and health outcomes in HIV-infected patients: the impact of substance use, primary care engagement, and antiretroviral adherence. Am J Addict 24:178-84
Wang, Emily A; McGinnis, Kathleen A; Goulet, Joseph et al. (2015) Food insecurity and health: data from the Veterans Aging Cohort Study. Public Health Rep 130:261-8
Wang, Emily A; Aminawung, Jenerius A; Wildeman, Christopher et al. (2014) High incarceration rates among black men enrolled in clinical studies may compromise ability to identify disparities. Health Aff (Millwood) 33:848-55
Wang, Emily A; Aminawung, Jenerius A; Ferguson, Warren et al. (2014) A tool for tracking and assessing chronic illness care in prison (ACIC-P). J Correct Health Care 20:313-33
Rich, Josiah D; Chandler, Redonna; Williams, Brie A et al. (2014) How health care reform can transform the health of criminal justice-involved individuals. Health Aff (Millwood) 33:462-7
Kinner, Stuart A; Wang, Emily A (2014) The case for improving the health of ex-prisoners. Am J Public Health 104:1352-5
Frank, Joseph W; Linder, Jeffrey A; Becker, William C et al. (2014) Increased hospital and emergency department utilization by individuals with recent criminal justice involvement: results of a national survey. J Gen Intern Med 29:1226-33

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