In response to RFA-MD-12-003 (Social, Behavioral, Health Services, and Policy Research on Minority Health and Health Disparities), this R01 application by a new, early stage investigator seeks to examine the extent of criminal justice involvement and its association with unmet healthcare needs among African American women who use illicit drugs. Extensive research has determined that there are significant disparities in meeting the health care needs of African American women. However, the role that criminal justice involvement plays in contributing to or reducing these disparities is largely unexplored. The proposed study will be among the first to examine the extent of criminal justice involvement and its association with unmet healthcare needs among African American women. It will be conducted with African American women who use illicit drugs, a highly vulnerable group in frequent contact with the criminal justice system. An understudied, but potentially significant, aspect of criminal justice involvement is the frequency, type, and duration of this involvement. Individual experiences with the criminal justice system are diverse and often recurring, involving multiple cycles of arrest, community supervision through probation or parole, and incarceration in jail or prison. By studying women who use illicit drugs in community settings, we will be able to examine the range of involvement in the criminal justice system, compare unmet healthcare needs among groups of similar women with and without criminal justice involvement, and assess whether associations vary according to frequency, type, and duration of criminal justice involvement. Our inquiry will be guided by the Behavioral Model for Vulnerable Populations.
Specific aims are:
Aim 1 : To characterize the range and accumulation of criminal justice involvement (no involvement, arrest, community supervision, incarceration) in a community-based sample of African American women who use illicit drugs.
Aim 2 : To examine the association of unmet healthcare needs with range and accumulation of criminal justice involvement, while controlling for predisposing, enabling/impeding and need factors. The proposed cross-sectional study will use targeted sampling methods to recruit 600 African American women who use illicit drugs in Oakland, CA. To achieve Aim 1, we will assess the prevalence, frequency and duration of different types of recent and lifetime criminal justice involvement. Because the levels of involvement are diverse, in Aim 2, we will use data reduction methods to categorize individuals into different patterns of criminal justice involvement, and examine how these patterns are associated with unmet healthcare needs. By examining how criminal justice involvement is associated with unmet healthcare needs among African American women who use illicit drugs, this study will identify important areas for future research, and provide information that can help guide sound correctional and public health policies to reduce health disparities.
We propose to conduct a 3-year cross-sectional quantitative study to examine the extent of criminal justice involvement and its association with unmet health care needs among African American women who use illicit drugs. As the number of African American women living under the supervision of the criminal justice system continues to grow, it is imperative that we develop a better understanding of the impact being involved in the system has on their health. By examining how criminal justice involvement is associated with unmet health care needs among African American women who use illicit drugs, the proposed study will identify important areas for future research and provide information that can help guide sound correctional and public health policies to reduce health disparities.
