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To decrease opioid overdose mortality, prisons and jails in the US are increasingly offering medications for opioid use disorder (OUD) to incarcerated people. It is unknown how receipt of these medications in a correctional setting affects health services use after release. In this article we analyze changes in postrelease health care use after the implementation of a statewide medications for OUD program in the unified jail and prison system of the Rhode Island Department of Corrections. Using Medicaid claims data, we examined individual health care use in the community before and after receipt of medications for OUD while incarcerated. We found that inpatient admissions did not change, emergency department visits decreased, and both nonacute outpatient services and pharmacy claims increased after people received medications for OUD while incarcerated. There was no change in total health care costs paid by Medicaid. Our findings provide evidence that people's use of health care services paid for by Medicaid did not increase after they started medications for OUD in correctional settings. Given the frequent interaction of people with OUD with the criminal justice system, offering evidence-based treatment of OUD in correctional settings is an important opportunity to initiate addiction treatment.

Women experiencing incarceration (WEI) in the United States are disproportionately impacted by HIV, yet HIV pre-exposure prophylaxis (PrEP) is underutilized by women in the United States. In order to inform an intervention to promote PrEP initiation during incarceration and facilitate linkage to PrEP care following release from incarceration, we conducted individual, semistructured qualitative interviews with WEI (N = 21) and key stakeholders (N = 14). While WEI had little or no previous knowledge about PrEP, they viewed it as something that would benefit women involved in the criminal justice system. Participants stated that HIV-related stigma and underestimation of HIV risk might serve as barriers to PrEP initiation during incarceration. Participants reported that competing priorities, difficulty scheduling an appointment, and lack of motivation could interfere with linkage to PrEP care in the community. Further, cost, substance use, and difficulty remembering to take the medication were cited most commonly as likely barriers to adherence.

Background Fentanyl and related compounds have recently saturated the illicit drug supply in the United States, leading to unprecedented rates of fatal overdose. Individuals who are incarcerated are particularly vulnerable, as the burden of opioid use disorder is disproportionately higher in this population, and tolerance generally decreases during incarceration. Methods We conduct a systematic search for publications about fentanyl overdoses during incarceration in PubMed and PsycINFO, as well as lay press articles in Google, from January 1, 2013 through March 30th, 2021. Results Not a single fentanyl overdose was identified in the medical literature, but 90 overdose events, comprising of 76 fatal and 103 nonfatal fentanyl overdoses, were identified in the lay press. Among the 179 overdoses, 138 occurred in jails and 41 occurred in prisons, across the country. Conclusions Fentanyl-related overdoses are occurring in correctional facilities with unknown but likely increasing frequency. In addition to the need for improved detection and reporting, immediate efforts to 1) increase understanding of the risks of fentanyl and how to prevent and treat overdose among correctional staff and residents, 2) ensure widespread prompt availability of naloxone and 3) expand the availability of medications to treat opioid use disorder for people who are incarcerated will save lives.

Correctional facilities provide health care to large numbers of medically underserved people. As such, preventive health in correctional settings is an important yet underused investment in public health. Because they often have histories of poor access to health care, the justice-involved population is more likely than the general population to be diagnosed with advanced-stage cancers. We report on the first 2 years of an ongoing collaboration between a state correctional system and state health department to implement annual colorectal cancer screening for sentenced people using fecal immunochemical testing (FIT). Preparation for the annual iterations begins in January, and patient engagement begins in March. In the first year of implementation (2018), 1396 of 1856 (75.2%) sentenced people completed an eligibility screen, and 254 of 321 (79.1%) eligible patients completed a FIT (eligible patients were aged ≥50 [≥45 if Black] in year 1 [lowered to ≥45 in year 2] and reported no previous relevant medical or family history of colorectal cancer); 54 (21.3%) completed FITs were positive. Of the 54 patients with positive FITS, 33 (61.1%) completed follow-up colonoscopies resulting in the identification of polyps in 26 (48.1%) patients with a positive FIT. We found invasive adenocarcinoma for 2 (3.7%) of the positive FITs (6.1% of colonoscopies performed). In the second year (2019), after a conversion from paper to tablet-based eligibility screening, 1707 of 2059 (82.9%) sentenced people completed an eligibility screen, and 200 of 285 (70.2%) eligible patients completed a FIT, 27 (13.5%) of whom had a positive result. We share lessons learned about implementing mass screening to encourage further communication among departments of health and corrections to advance preventive health.

Purpose The purpose of this paper is to describe the course, “Designing Education for Better Prisoner and Community Health,” which provided students with the knowledge, skills and resources needed to build real-world health education materials for persons who are criminal justice involved. Design/methodology/approach A multiphase engaged scholarship course was designed and implemented through the Brown University School of Public Health in Rhode Island, USA. Findings Students collaborated closely with instructors, subject matter experts and affected community members to develop highly tailored health education projects across six topic areas. The structure and outcomes of the paper are described with the hope that other instructors and institutions might replicate components of the model. Originality/value Engaged scholarship in public health can provide students with rich, collaborative learning experiences, and when executed effectively, these endeavors can provide underserved communities with robust and informed health education interventions and programs.

Objectives Rates of unintended pregnancies in women with a history of incarceration are high and access to contraception before and after arrest can be limited. Individualized counseling can better prepare women for healthy pregnancy or provide an opportunity for contraceptive education and access within correctional facilities. In this study, we assessed the efficacy of motivational interviewing as an individualized intervention to increase the initiation of contraceptive methods while incarcerated and continuation after release in female inmates who wanted to avoid pregnancy for at least one year after release. Study design We performed an RCT in a population of incarcerated women who wanted to avoid pregnancy. Women were randomized to either a computer-assisted motivational interviewing intervention group (n = 119) or an educational video with counseling control group. (n = 113). The primary outcome was initiation of a method of birth control prior to release from the correctional facility. Results Initiation of contraception was higher in the intervention group (56% vs. 42%, p = 0.03), but this difference was not significant after controlling for number of male partners within the year prior to incarceration. There was no difference between the groups in the rates of pregnancies or STIs or continuation of contraception after release, which was generally low (21%). Conclusion Computer-assisted motivational interviewing did not improve uptake or continuation of contraception in this study. Implications Periods of incarceration provide an opportunity to offer contraceptive services to women who want to avoid a pregnancy. Motivational interviewing may not be an effective method to affect contraceptive behaviors in this population. Future research should explore the family planning values and preferences of women who become involved with the correctional system.

Pre-exposure prophylaxis (PrEP) may be an effective approach to prevent HIV among people who are currently incarcerated or who have been recently released from incarceration. However, awareness and interest in PrEP are largely unknown in this population. This study assessed 417 incarcerated men's lifetime HIV risk engagement and gauged their interest and willingness to take PrEP. Twenty percent reported ever injecting drugs and 4% ever having sex with a man without a condom; 88% had never heard of PrEP. More White men had heard of PrEP, but higher percentages of men of color were interested in learning more about PrEP and willing to take PrEP to prevent HIV. Future interventions should focus on PrEP education and uptake among individuals who are incarcerated.

Resilience, which is a measure of a patient's ability to recover from a traumatic event, varies among the general population, and previous studies have suggested that it has an important influence on a patient's quality of life. We conducted a study of patients treated for cancer of the head and neck to investigate the relation between scores for resilience and quality of life (QoL). A total of 98 patients, who had been treated with curative intent, completed the University of Washington quality of life questionnaire (UW-QoL) and the Connor-Davidson resilience scale (CD-RISC). Retrospective analysis of patients' records identified demographic data, stage of disease, and treatment. The Mann-Whitney U-test, Kruskal-Wallis test, and Spearman's rank correlation were used to assess the significance of differences between the groups. The mean (SE) QoL score after treatment was 61 (2.081), and the mean CD-RISC score 0.427 for QoL in the last seven days. There was a significant correlation between overall scores for QoL and resilience (Spearman's Rho=0.427, p

People who are incarcerated are at increased risk for HIV (human immunodeficiency virus) acquisition upon release, and one possible intervention for prevention is the use of pre-exposure prophylaxis (PrEP) upon release. The present study assessed HIV risk perceptions as well as PrEP awareness and interest among 39 people who were incarcerated and enrolled in a structured Medication for Addiction Treatment (MAT) program at the Rhode Island Department of Corrections using semi-structured, qualitative interviews. Analysis was conducted using a generalized, inductive method in NVivo 12. While PrEP awareness was low across the study sample, some participants were interested in PrEP uptake or learning more about PrEP after they were provided with an overview of it. PrEP interest strongly related to current perceived HIV risk. Potential barriers included side effects, adherence, and reluctance to take medications in general. MAT programs for people who are criminal justice (CJ) involved may serve as useful linkage spaces to PrEP information, access, and retention.

Incarceration provides an opportunity for public health interventions, but communication and the delivery of services are complicated by considerable variability even within this generally high-needs population. Public health practitioners have relied heavily on social determinants of health data in their work, but this does not fully explain key patterns in responses and success. Psychometric work related to the "big five" or "five-factor" personality domains may provide important additional guidance to health communications and interventions. The Contraceptive Awareness and Reproductive Education clinical trial provided health risk factor and personality data on 257 incarcerated women aged 18-35. Of the study population, 85.9% reported at least one of the five forms of childhood trauma. Three of the five personality domains were associated with multiple health risk factors and four of the five were associated with fair or poor general health. Personality data provide important guidance in understanding variability in responses to public health interventions in the correctional setting.

Background Women experiencing incarceration (WEI) engage in high rates of sex- and drug-related behavior that places them at risk for HIV. Pre-exposure prophylaxis (PrEP) is an efficacious means of reducing HIV acquisition. There is a general lack of knowledge regarding PrEP among women at elevated risk, and only a small percentage of at-risk women are currently engaged in PrEP care. The period of incarceration represents an opportunity to identify at-risk women, initiate PrEP during incarceration, and establish linkage to community-based PrEP care upon release from incarceration. Further, post-release is a time period that is particularly risky, and there are numerous barriers, including substance use, that may impede linkage to community-based care in the absence of intervention. The current protocol describes plans for the development and pilot randomized controlled trial (RCT) of an intervention to promote PrEP uptake during incarceration and facilitate linkage to community-based PrEP care post-release. Methods/design The motivational interviewing-navigation (MI-NAV) study intervention is being developed, refined, and tested over three phases within the framework of the social ecological model. All phases of the study are being conducted at a women’s correctional facility and community-based PrEP provider located in the Northeastern region of the United States. Phase 1 consists of individual qualitative interviews to be conducted with key stakeholders (n = 6–10) from the community-based PrEP care site and (n = 6–10) from the women’s correctional facility, as well as with (n = 18–30) WEI. Recruitment for Phase 1 was initiated in November 2017. In Phase 2, MI-NAV will be piloted with a small cohort (n = 8–12) of WEI and will be refined based upon participant feedback. During Phase 3, a pilot RCT of MI-NAV and a standard of care condition will be conducted with 80 WEI. RCT participants will complete baseline and follow-up assessments 1, 3, and 6 months post-release. The primary study outcome is linkage to community-based PrEP care, verified via medical records. Discussion This study will develop and evaluate a psychosocial intervention (MI-NAV) to promote PrEP uptake and facilitate linkage to community-based PrEP care among women at-risk for HIV. It is expected that, as a result of this project, the feasibility, acceptability, and preliminary efficacy of MI-NAV will be determined. If found to be efficacious, this intervention has the potential to reduce HIV acquisition in a high-need, underserved community. Clinical trial registration NCT03281343

Introduction: E-cigarette or Vaping Product Use Associated Lung Injury (EVALI) and Coronavirus Disease 2019 (COVID-19) are both relatively new disease processes which can cause acute respiratory failure. This report describes the case of a 17-year-old male with a history of vaping cannabis during the first wave of the COVID-19 pandemic in Michigan. Report: A previously healthy 17-year-old male presented with cough, shortness of breath, chest pain, fever, and hypoxia requiring 40L high flow nasal cannula (HFNC) and 100% FiO2 to maintain oxyhemoglobin saturations of 88%. He showed no tachypnea or retractions, mimicking the “happy hypoxia” reported in COVID-19 patients. His physical exam demonstrated inspiratory crackles and migratory diminished breath sounds. Chest x-ray showed mild peri-bronchial thickening, subtle right perihilar opacities, and hyperexpansion. Bloodwork showed a procalcitonin of 10 nanograms/milliliter, ESR of 10 millimeters/hour, and CRP of 3.5 milligrams/deciliter. Three prior SARS-CoV2 tests were negative, but given clinical suspicion, the patient was treated as a Patient Under Investigation (PUI) for COVID-19 for 48 hours and re-tested. Care was aligned with institutional COVID-19 guidelines to minimize aerosol-generating procedures;diagnostic bronchoscopy, positive pressure ventilation, and transport for chest CT were discouraged, especially as our patient was awake, interactive, and with gradually improving trajectory. Infection prevention guidelines prohibited our patient's parents from leaving his room for a private interview, but friends alerted them to a history of vaping cannabis, which our patient corroborated. He was transitioned towards supportive care for EVALIinduced bronchoconstriction and improved with beta agonists, systemic steroids, and HFNC. After his fourth negative SARS CoV2 test, the patient underwent a high-resolution chest CT, which showed diffuse ground-glass opacities with subpleural sparing. He was discharged after four days with Pediatric Pulmonology follow up. He was counseled against further e-cigarette or cigarette use. Discussion: This case illustrates challenges in the diagnosis of EVALI during the COVID-19 pandemic, particularly among adolescents. Both conditions present with acute respiratory failure absent another source. Both can have significant hypoxia, elevated inflammatory markers, and an ARDS phenotype. Both demonstrate ground-glass opacities on CT scan. Importantly, here are differences in the workup, management, and public health implications of EVALI and COVID-19. Both are reportable to the Department of Public Health and warrant intervention: Anti-vaping campaigns and restriction on access for EVALI, infection control and immunization programs for COVID-19. As the world endeavors to contain the COVID-19 pandemic through surveillance, treatment, and immunization, we also hope to regain momentum against EVALI.

A proof of concept single center prospective study aimed at evaluating the safety and efficacy of utilizing Glucommander outpatient insulin dosing software to assist providers in titrating basal bolus insulin doses, using Abbott Freestyle Libre 14-day glucose monitoring system. A total of 25 adults (18-80), having T2D and an A1C > 8%, were enrolled. A nurse educator provided patient education on insulin administration, meal planning and use of the glucose sensor. Baseline CGM data was collected during week 1, after which time participants insulin doses were titrated weekly for the next 4 weeks. Data was collected on initial HbA1C, days of CGM wear, time in range (TIR), and time in hypoglycemia. Use of Glucommander significantly improved TIR from a baseline of 48.02% during the initial week to 73.84% during the final week of treatment (p0.557). % Changes in insulin: %Change(Basal) = 10.5%, %Change(Total Boluses)= 19.7%, %Change(TDD)= 15.1%. Disclosure B.W. Bode: Advisory Panel; Self; Medtronic, Novo Nordisk A/S. Consultant; Self; Eli Lilly and Company, Medtronic, Novo Nordisk A/S. Research Support; Self; Abbott, Advance, Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc., Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Insulet Corporation, Janssen Pharmaceuticals, Inc., MannKind Corporation, Medtronic, National Institutes of Health, Nova Biomedical, Novo Nordisk A/S, Provention Bio, Inc., Sanofi, Senseonics. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., MannKind Corporation, Medtronic, Novo Nordisk A/S, Sanofi, Senseonics. Stock/Shareholder; Self; Aseko. J.G. Clarke: Employee; Self; Glytec. Stock/Shareholder; Self; Glytec. Funding Glytec, LLC

Background We examined the impact of expanded access to medications for opioid use disorder (MOUD) in a unified prison and jail system on post-release, opioid-related overdose mortality. Methods We developed a microsimulation model to simulate a population of 55,000 persons at risk of opioid-related overdose mortality in Rhode Island. The effect of an extended-release (XR) naltrexone only intervention and the effect of providing access to all three MOUD (i.e., methadone, buprenorphine, and XR-naltrexone) at release from incarceration on cumulative overdose death over eight years (2017–2024) were compared to the standard of care (i.e., limited access to MOUD). Results In the standard of care scenario, the model predicted 2385 opioid-related overdose deaths between 2017 and 2024. An XR-naltrexone intervention averted 103 deaths (4.3% reduction), and access to all three MOUD averted 139 deaths (5.8% reduction). Among those with prior year incarceration, an XR-naltrexone only intervention and access to all three MOUD reduced overdose deaths by 22.8% and 31.6%, respectively. Conclusions Expanded access to MOUD in prison and jail settings can reduce overdose mortality in a general, at-risk population. However, the real-world impact of this approach will vary by levels of incarceration, treatment enrollment, and post-release retention.

Risk factors for depression among 179 women recently released from prison or jail in a state correctional facility in the northeastern United States were examined in this study. The Center for Epidemiologic Studies Depression Scale (CESD-10) was used to measure longitudinal, self-reported depression data. In addition, potential risk factors for depression among women recently released from prison and jail were analyzed. Findings of this study indicated that approximately 83% of the women suffered depression throughout baseline and/or at least one follow up period after release. Significant risk factors for depression among these women included drug use, alcohol use, physical partner abuse, number of living children, and emotional abuse during childhood. Women who used drugs other than marijuana were eight times as likely to suffer from depression compared with women who had never used such drugs.

Background Back pain and musculoskeletal conditions negatively affect the health-related quality of life (HRQL) of employees and generate substantial costs to employers. Aims To assess the cost-effectiveness of yoga for managing musculoskeletal conditions. Methods A randomized controlled trial evaluated an 8-week yoga programme, with a 6-month follow-up, for National Health Service (NHS) employees. Effectiveness in managing musculoskeletal conditions was assessed using repeated-measures generalized linear modelling for the Roland-Morris Disability Questionnaire (RDQ) and the Keele STarT Back Screening Tool. Cost-effectiveness was determined using area-under-the-curve linear regression for assessing HRQL from healthcare and societal perspectives. The incremental cost per quality-adjusted life year (QALY) was also calculated. Sickness absence was measured using electronic staff records at 6 months. Results There were 151 participants. At 6 months, mean differences between groups favouring yoga were observed for RDQ [−0.63 (95% CI, −1.78, 0.48)], Keele STarT [−0.28 (95% CI, −0.97, 0.07)] and HRQL (0.016 QALY gain). From a healthcare perspective, yoga yielded an incremental cost-effectiveness ratio of £2103 per QALY. Given a willingness to pay for an additional QALY of £20 000, the probability of yoga being cost-effective was 95%. From a societal perspective, yoga was the dominant treatment compared with usual care. At 6 months, electronic staff records showed that yoga participants missed a total of 2 working days due to musculoskeletal conditions compared with 43 days for usual care participants. Conclusions Yoga for NHS employees may enhance HRQL, reduce disability associated with back pain, lower sickness absence due to musculoskeletal conditions and is likely to be cost-effective.

The article explores the Rhode Island Department of Corrections (RIDOC), the first state correctional system to initiate a comprehensive program to screen all individuals for opioid use disorder. Particular focus is given to how the program led to a 12 percent drop in statewide overdose deaths. Additional topics discussed include how the program utilizes medications including methadone and naltrexone, efforts in the state to reduce opioid overdose deaths, and Gina Raimondo, governor of Rhode Island.

For years, advocates in Rhode Island, including many individuals on staff at the Rhode Island Department of Corrections, envisioned a criminal justice system that did not perpetuate the crises of substance use disorder and overdose and instead helped address them thought treatment and recovery supports. In 2016, the state’s corrections department introduced the first statewide correctional system medication-assisted treatment program in the country to initiate a comprehensive program to screen for opioid use disorder. The program is demonstrating successful results. Continued public health and corrections collaboration lay the groundwork for additional innovations in program implementation, including the Rhode Island Department of Health’s focus on health equity and the social determinants of health. This chapter shares the Rhode Island experience as a potential model for other state programs.

Background and aims The established standard care in pregnancy is medication for opioid use disorder (MOUD); however, many institutions of incarceration do not have MOUD available. We aimed to describe the number of incarcerated pregnant women with opioid use disorder (OUD) in the United States and jails' and prisons' MOUD in pregnancy policies. Design Epidemiological surveillance study of 6 months of outcomes of pregnant, incarcerated women with OUD and cross-sectional survey of institutional policies. Setting United States. Participants Twenty-two state prison systems and six county jails. Measurements The number of pregnant women with OUD admitted and treated with methadone, buprenorphine or withdrawal; policies on provision of MOUD and withdrawal in pregnancy. Findings Twenty-six per cent of pregnant women admitted to prisons and 14% to jails had OUD. One-third were managed through withdrawal. The majority who were prescribed MOUD were on methadone (78%, prisons; 81%, jails), not buprenorphine. While most sites (n = 18 prisons, n = four jails) continued pre-incarceration MOUD in pregnancy, very few initiated in custody (n = four prisons; n = two jails). Two-thirds of prisons and three-quarters of jails providing MOUD in pregnancy discontinued it postpartum. Conclusions In this sample of US prisons and jails, one-third required pregnant women with opioid use disorder to go through withdrawal, contrary to medical guidelines. More women were prescribed methadone than buprenorphine, despite the fewer regulatory barriers on prescribing buprenorphine. Most sites stopped medication for opioid use disorder postpartum, signaling prioritization of the fetus, not the mother. Pregnant incarcerated women with opioid use disorder in the United States frequently appear to be denied essential medications and receive substandard medical care.

OBJECTIVES: Medications for opioid use disorder (MOUD) in the criminal justice setting is an effective way to address opioid use disorder and prevent associated deaths in the community. The Rhode Island Department of Corrections (RIDOC) is the first statewide correctional system in the United States to offer comprehensive MOUD services to incarcerated individuals; however, due to stigma, eligible individuals may be reluctant to engage with MOUD. This study aims to 1) evaluate the efficacy of an educational video intervention and 2) characterize MOUD-related attitudes in a general incarcerated population. METHODS: Participants were recruited from eight elective classes offered to soon-to-be-released incarcerated individuals at the RIDOC. Participants viewed an eight-minute video featuring incarcerated individuals speaking about their experiences using MOUD, designed to reduce MOUD-related stigma. Participants were administered surveys prior to and after watching the video to assess changes in MOUD knowledge (MOUD-K) and MOUD attitudes (MOUD-A). RESULTS: This evaluation of the intervention included 80 incarcerated participants (median age = 35), 93% male, 36% non-Hispanic White, and 26% non-Hispanic Black). Forty percent indicated non-medical opioid use within six months prior to incarceration; 13% had previously used MOUD. Significant improvements in MOUD-K scores (t(65) = −7.0, p < 0.0001) and MOUD-A scores (t(69) = −5.8, p < 0.0001) were detected after participants viewed the video. The intervention yielded greater Δ MOUD-A scores among those identifying as non-Hispanic Black, compared to non-Hispanic Whites (β = 2.6, CI = 0.4, 4.8). CONCLUSION: The educational video improved both knowledge and positive attitudes towards MOUD, with changes in MOUD attitudes being influenced by race. These findings may inform future MOUD educational programs, thereby helping to reduce opioid use disorder-related morbidity and mortality.

The Rhode Island Department of Corrections (RIDOC) recently implemented the first state-wide, comprehensive medications for addiction treatment (MAT) program in the US. The objective of this study was to elucidate perceived barriers for individuals who participated in RIDOC's MAT program while incarcerated. Of the 588 individuals eligible for this study, 227 phone surveys were completed with 214 individuals. Data relevant to demographic characteristics, probation/parole status, retention in MAT treatment, MAT type received during incarceration, MAT treatment history, location where they received community treatment, perceived barriers to treatment, and future goals for MAT were collected. Simple percentages, frequencies, means, and standard deviations were calculated with SPSS. Most participants (82.4%) reported continuing MAT post-release and a majority (74.3%) received treatment at an opioid treatment program. Those who did not connect with treatment post-release reported transportation issues (23.1%) and not wanting to continue MAT (20.5%) as major reasons for not continuing treatment. The most commonly reported goal for treatment was to continue MAT long-term (43.5%). Results indicate that most participants linked to MAT treatment post-release. Participants reported reasons for why they did not continue MAT and had mixed intentions about continuing MAT in the future. Results provide identification of novel factors, such as side effects, time between release and treatment linkage, and family and friends' opinions that influence MAT continuation post-incarceration. Results highlight areas of exploration to influence treatment retention, including the role of probation/parole officers and the potential for peer support specialists to assist in reducing stigma and increasing interest in MAT.

Prior research has not examined the self-identified goals and plans of incarcerated people as they approach release from prison. This study analyzed the goals and plans generated during a motivational interviewing counseling session of incarcerated men who participated in a randomized controlled trial of a smoking abstinence intervention in a tobacco-free prison in the northeastern United States. Using thematic analysis, 53 written goals and plans were independently coded by trained research assistants to identify major themes that included (1) staying smoke-free or reducing the number of cigarettes smoked postrelease, (2) engaging in physical activities to improve health and wellness, and (3) spending time with family and/or friends. Implications for working with inmates to identify their plans and goals to remain smoke-free after incarceration are discussed.

Background: Single session, multiple Band Ligations (BL) for haemorrhoids has been practised in the UK for more than 40 years. It has been claimed that multiple BL in a single session can cause pain and discomfort [1]-[3], although this issue has not been formally assessed in the past. Our study was designed to examine this claim. Methods: Patients were randomly chosen for this study from rectal bleeding clinics and endoscopy lists. On diagnosis of haemorrhoids at proctoscopy these patients were offered, and treated with multiple BL. Results: 50 patients were treated with BL for 2nd and (the majority) 3rd degree haemorrhoids. All patients needed 2 - 3 haemorrhoids banded. 76% stated that they had no pain or discomfort, 14% complained of slight pain and 10% complained of very slight discomfort. 90% were successfully treated, and 97% stated that they would be prepared to undergo further treatment if necessary. Conclusion: Single session multiple haemorrhoids band ligations are a safe procedure which can be performed by surgeons in outpatient clinics with minimal discomfort for patients.

Sex exchange among incarcerated women is not well-described in the literature. Sex exchange can lead to numerous adverse health outcomes, especially when combined with individual factors (e.g., depression and homelessness) and larger systemic inequalities. The purpose of this study was to explore factors associated with having a history of sex exchange among a sample of incarcerated women. Of 257 women surveyed in this study, 68 women (26.5%) reported a history of sex exchange. In multivariate logistic regression analysis, physical abuse history (p=.05, OR 2.20), history of two or more sexually transmitted infections (p=.01, OR 2.90), injection drug use (p=.04, OR 2.46) and crack-cocaine use (plt;.01, OR 3.42) were associated with prior sex exchange. This is one of only two studies to examine factors associated with prior sex exchange among incarcerated women. Our study has important implications for corrections providers to provide more comprehensive care, directly addressing the unique needs of this population.

Background Medications for opioid use disorder (OUD) are the most effective treatment for OUD, but uptake of these life-saving medications has been extremely limited in US prisons and jail settings, and limited data are available to guide policy decisions. The objective of this study was to estimate the impact of screening and treatment with medications for OUD in US prisons and jails on post-release opioid-related mortality. Methods We used data from the National Center for Vital Statistics, the Bureau of Justice Statistics, and relevant literature to construct Monte Carlo simulations of a counterfactual scenario in which wide scale uptake of screening and treatment with medications for OUD occurred in US prisons and jails in 2016. Results Our model predicted that 1840 (95% Simulation Interval [SI]: -2757 – 4959) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated. The model also predicted that approximately 4400 (95% SI: 2675 – 5557) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated and were retained in treatment post-release. These estimates correspond to 668 (95% SI: -1008 – 1812) and 1609 (95% SI: 972 – 2037) lives saved per 10,000 persons incarcerated, respectively. Conclusions Prison and jail-based programs that comprehensively screen and provide treatment with medications for OUD have the potential to produce substantial reductions in opioid-related overdose deaths in a high-risk population; however, retention on treatment post-release is a key driver of population level impact.

We examined factors associated with women's use of highly effective birth control before and after incarceration, since women with ongoing criminal justice involvement bear a disproportionate burden of sexual and reproductive health problems, including high rates of unintended pregnancy and inconsistent contraceptive use.Using a longitudinal study design, we conducted surveys with 102 women in an urban midwestern jail and then followed up with 66 of them 6 months after incarceration. We used stepwise logistic regression to assess individual, interpersonal, resource-based, organizational, and environmental factors associated with utilizing highly effective birth control.Forty-two percent of women reported utilizing highly effective birth control (e.g., sterilization or other highly effective reversible methods) prior to incarceration, and 54% reported using these methods after release from jail (p0.001). Ninety percent of women reported not wanting to get pregnant. Consistent use of birth control (p=0.001) and alcohol problems (p=0.027) were associated with utilization of highly effective birth control prior to incarceration. Previous pregnancies (p=0.012) were the only factor associated with utilization of highly effective birth control after release from jail.Clinicians and public health practitioners can use findings from this study to develop clinical and intervention efforts aimed at improving unintended-pregnancy prevention among incarcerated women both during their confinement and during the tumultuous period after their release from jail.

Introduction A major health challenge facing persons who are incarcerated is tobacco smoking. Upon reentry to the community, concerns regarding smoking cessation may be less likely to receive needed attention. Many individuals have partners who are pregnant and/or reside in households where children and pregnant women live. We explored incarcerated adults' attitudes of smoking in the presence of children and pregnant women and how post-release smoking behaviors are influenced by their attitudes. Methods Two hundred forty-seven incarcerated adults participated in a smoking cessation randomized clinical trial in a tobacco-free prison. An instrument was developed to examine smoking attitudes and behaviors around children and pregnant women. Moderating effects of smoking factors on post-release abstinence were examined by evaluating interactions between smoking factors and treatment group. Results Four factors were defined using factor analysis: smoking around children; impact of smoking on child's health; awareness of environmental tobacco smoke (ETS) risk for pregnant women; and importance of smoking avoidance during pregnancy. We found moderation effects of smoking factors on smoking outcomes which included: treatment group by smoking behavior around children (β = 0.8085; standard error [SE] = 0.4002; P = .04); treatment group by impact of smoking on child's health (β = 1.2390; SE = 0.5632; P = .03) and for those smoking 50% fewer cigarettes post-release, treatment group by smoking impact on child's health (β = 1.2356; SE = 0.4436; P Conclusions Concern for smoking around children and pregnant women and awareness of ETS risk for pregnant women was not found to be significantly associated with smoking outcomes and requires additional investigation. Among individuals who continue to smoke post-release, effective ETS interventions are needed aimed at protecting children and pregnant women with whom they live.

Smoking cessation is the primary goal for managing patients with chronic obstructive pulmonary disease (COPD) who smoke. However, previous studies have demonstrated poor cessation rates. The "lung age" concept (an estimate of the age at which the FEV(1) would be considered normal) was developed to present spirometry data in an understandable format and to serve as a tool to encourage smokers to quit. Primary care physicians' (PCPs) views of using lung age to help COPD patients to quit smoking were assessed.Post-intervention interviews were conducted with PCPs in the U.S. who participated in the randomized clinical trial, "Translating the GOLD COPD Guidelines into Primary Care Practice."29 physicians completed the interview. Themes identified during interviews included: general usefulness of lung age for smoking cessation counseling, ease of understanding the concept, impact on patients' thoughts of quitting smoking, and comparison to FEV(1). Most providers found lung age easy to communicate. Moreover, some found the tool to be less judgmental for smoking cessation and others remarked on the merits of having a simple, tangible number to discuss with their patients. However, some expressed doubt over the long-term benefits of lung age and several others thought that there might be a potential backfire for healthy smokers if their lung age was ≤ to their chronological age.This study suggests that lung age was well received by the majority of PCPs and appears feasible to use with COPD patients who smoke. However, further investigation in needed to explore COPD patients' perspectives of obtaining their lung age to help motivate them to quit in randomized clinical trials.

Background Few studies have examined the relation between impulsivity and drug involvement with prison inmates, in spite of their heavy drug use. Among this small body of work, most studies look at clinically relevant drug dependence, rather than drug use specifically. Method N = 242 adult inmates (34.8% female, 52% White) with an average age of 35.58 ( SD = 9.19) completed a modified version of the 15-item Barratt Impulsiveness Scale (BIS) and measures assessing lifetime alcohol, opiate, benzodiazepine, cocaine, cannabis, hallucinogen, and polysubstance use. Lifetime users also reported the frequency of use for the 30 days prior to incarceration. Results Impulsivity was higher among lifetime users (versus never users) of all substances other than cannabis. Thirty day drug use frequency was only related to impulsivity for opiates and alcohol. Discussion This study extends prior work, by showing that a lifetime history of non-clinical substance use is positively associated with impulsivity among prison inmates. Implications for drug interventions are considered for this population, which is characterized by high rates of substance use and elevated impulsivity.

Parental incarceration is associated with mental and physical health problems in children, yet little research directly tests mechanisms through which parental incarceration could imperil child health. We hypothesized that the incarceration of a woman or her romantic partner in the year before birth constituted an additional hardship for already-disadvantaged women, and that these additionally vulnerable women were less likely to engage in positive perinatal health behaviors important to infant and early childhood development. We analyzed 2006-2010 data from the Pregnancy Risk Assessment and Monitoring System to assess the association between incarceration in the year prior to the birth of a child and perinatal maternal hardships and behaviors. Women reporting incarceration of themselves or their partners in the year before birth of a child had .86 the odds (95 % CI .78-.95) of beginning prenatal care in the first trimester compared to women not reporting incarceration. They were nearly twice as likely to report partner abuse and were significantly more likely to rely on WIC and/or Medicaid for assistance during pregnancy. These associations persist after controlling for socioeconomic measures and other stressors, including homelessness and job loss. Incarceration of a woman or her partner in the year before birth is associated with higher odds of maternal hardship and poorer perinatal health behaviors. The unprecedented scale of incarceration in the US simultaneously presents an underutilized public health opportunity and constitutes a social determinant of health that may contribute to disparities in early childhood development.

Most adults report initiation of cigarette smoking during adolescence, a time also marked by developmental striving for independence and freedom. Tobacco use may retain its association with independence and/or freedom into adulthood. This association may contribute to continued tobacco use and/or increased risk of relapse to smoking among some individuals. This study examines the relationship between cigarette smoking and perceptions of independence and freedom among inmates in a tobacco-free prison in the northeastern United States.Questionnaires administered to 247 male and female inmates 6 weeks prior to scheduled prison release assessed demographics, smoking history, nicotine dependence, attitudes toward smoking, and plans for tobacco use or abstinence after prison release. Perceptions of smoking as an expression of independence and freedom were measured using 2 items. Smoking was assessed 3 weeks postrelease.Constructs of freedom and independence were correlated but did not overlap completely. Both constructs were negatively associated with plans for smoking abstinence after prison release, and with perceived costs of continued smoking. Number of cigarettes smoked postrelease and perception of the pros of smoking were associated with freedom, but not independence.Associations of smoking as an expression of freedom and independence may negatively influence plans for renewed smoking after a forced abstinence. Additional research is needed to determine the degree to which these 2 constructs predict smoking behavior and whether they can be used to improve interventions for incarcerated smokers.

Incarcerated pregnant women are shackled while giving birth and routinely separated from their children immediately, which in many states leads to permanent termination of parental rights.

Prior research has found high levels of depression and stress among persons who are incarcerated in the United States (U.S.). However, little is known about changes in depression and stress levels among inmates post-incarceration. The aim of this study was to examine changes in levels of depression and stress during and after incarceration in a tobacco-free facility. Questionnaires that included valid and reliable measures of depression and stress were completed by 208 male and female inmates approximately eight weeks before and three weeks after release from a northeastern U.S. prison. Although most inmates improved after prison, 30.8% had a worsening in levels of depression between baseline and the three-week follow-up. In addition, 29.8% had a worsening in levels of stress after release than during incarceration. While it is not surprising that the majority of inmates reported lower levels of depression and stress post-incarceration, a sizable minority had an increase in symptoms, suggesting that environmental stressors may be worse in the community than in prison for some inmates. Further research is needed to address depression and stress levels during and after incarceration in order for inmates to have a healthier transition back into the community and to prevent repeat incarcerations.

Stress and back pain are two key factors leading to sickness absence at work. Recent research indicates that yoga can be effective for reducing perceived stress, alleviating back pain, and improving psychological well-being.To determine the effectiveness of a yoga-based intervention for reducing perceived stress and back pain at work.Participants were recruited from a British local government authority and randomized into a yoga group who received one 50 min Dru Yoga session each week for 8 weeks and a 20 min DVD for home practice and a control group who received no intervention. Baseline and end-programme measurements of self-reported stress, back pain and psychological well-being were assessed with the Perceived Stress Scale, Roland Morris Disability Questionnaire and the Positive and Negative Affect Scale.There were 37 participants in each group. Analysis of variance and multiple linear regression showed that in comparison to the control group, the yoga group reported significant reductions in perceived stress and back pain, and a substantial improvement in psychological well-being. When compared with the control group at the end of the programme, the yoga group scores were significantly lower for perceived stress, back pain, sadness and hostility, and substantially higher for feeling self-assured, attentive and serene.The results indicate that a workplace yoga intervention can reduce perceived stress and back pain and improve psychological well-being. Larger randomized controlled trials are needed to determine the broader efficacy of yoga for improving workplace productivity and reducing sickness absence.

HIV/AIDS is a serious, but preventable disease that can have improved outcomes with early diagnosis and treatment. Primary care providers are experts in prevention and early treatment. The Centers for Disease Control and Prevention has recommended that HIV testing be routinely incorporated into health care settings for patients aged 13 to 64 years. There has been much confusion and noncompliance with these recommendations. Primary care providers should understand the rationale behind these latest guidelines as well as their own states’/territories’ regulations and laws around HIV testing to embrace these latest recommendations in order to provide their patients with the best possible care.

Aims—To determine whether collaborative behavioral management (CBM) reduces substance use, crime and re-arrest among drug-involved parolees. Design—Step’n Out was a randomized behavioral trial of CBM versus standard parole (SP) during 2004-2008. CBM adapted evidence-based role induction, behavioral contracting, and contingent reinforcement to provide parole officer/treatment counselor dyads with positive tools in addition to sanctions to manage parolees’ behavior over 12 weeks. Setting—Six parole offices in five states in the U.S.A. Participants—Parolee volunteers with a mandate for addiction treatment and a minimum of three months of parole (N=476). Follow-up was 94% at 3- and 86% at 9-months. Measurements—Drug use and crime in a given month from calendar interviews 3- and 9months after parole initiation, and re-arrests from criminal justice administrative data. Findings—The CBM group had fewer months in which they used their primary drug (adjusted risk ratio (ARR) 0.20, 95% CI: 0.05, 0.78, p = .02) and alcohol (ARR 0.38, 95% CI: 0.22, 0.66, p=.006) over follow-up. CBM had its greatest effects among parolees who reported marijuana or another “non-hard” drug as their primary drug; parolees who preferred stimulants or opiates did not benefit. No differences were seen in total crime, re-arrests or parole revocations. Conclusions—Collaborative behavioral management may reduce substance use among primary marijuana or other “non-hard” drug-using parolees without increasing revocations. Since the majority of drug violation arrests in the U.S. are for marijuana, these findings have important implications for the management of a substantial proportion of the U.S. community correctional population.

Background. Day-case laparoscopic cholecystectomy (LC) is a safe and cost-effective treatment for gallstones. In 2006, our institution recorded an 86% laparoscopic, 10% day-case, and 5% readmission rate. A gallbladder pathway was therefore introduced in 2007 with the aim of increasing daycase rates.Methods. Patients with symptomatic gallstones, proven on ultrasound, were referred to a specialist-led clinic. Those suitable for surgery were consented, preassessed, and provided with a choice of dates. All defaulted to day case unless deemed unsuitable due to comorbidity or social factors.Results. The number of cholecystectomies increased from 464 in 2006 to 578 in 2008. Day-case rates in 2006, 2007, 2008, and June 2009 were 10%, 20%, 30%, and 61%, respectively. Laparoscopic and readmission rates remained unchanged. Conversion rates for elective cholecystectomy fell from 6% in 2006 to 3% in 2009.Conclusions. Development of a gallbladder pathway increased day-case rates sixfold without an associated increase in conversion or readmission rates.

This study evaluated time to first drink in women being released from jail to determine predictors of early relapse among women with hazardous drinking and HIV risk behaviors. Between February 2004 and June 2007, 245 participants were recruited from the Rhode Island Department of Corrections. Following the baseline assessment, participants were randomized to a motivational intervention group or to a control condition. Follow-up assessments at 1, 3, and 6 months were completed for 210 participants. Alcohol use during follow-up occurred in 86.7% of participants, 42.4% initiated alcohol use on Day 1. The rate of initiation was associated with norms favorable to using alcohol (p.01) and having a partner with an alcohol problem (hazard ratio [HR] = 1.62, p.01). The rate of drink initiation decreased significantly (HR = 0.82, p.05) as length of incarceration increased. The intervention was not associated with decreased drinking. Interventions to maintain abstinence need to reach women within their first days postrelease.

This analysis examines the association of death from overdose among individuals released from the Rhode Island correctional system after implementation of a comprehensive program of medications for addiction therapy.

Approximately 6% to 10% of women entering jails are pregnant. Women entering jail are often poor, medically underserved, and at high risk for substance abuse and unplanned pregnancies. We hypothesize that many women who are pregnant when entering jail have had a prior incarceration and conceived soon after release. We reviewed charts of 269 pregnant women entering the Rhode Island jail between August 1997 and November 2002. Of these women, 52.4% had prior incarcerations. In addition, 117 women conceived within 1 year of a prior release (50% within 90 days, 24% within 91 to 180 days, and 26% more than 180 days postrelease). Women who conceived within 90 days were more likely to be incarcerated for more than 30 days while pregnant than women who conceived after 90 days (relative risk 2.38; 95% confidence interval 1.12 to 5.07). Providing contraceptive services at the time of release may help decrease the number of women who enter jail pregnant.

To test the hypothesis that among hazardously drinking incarcerated women who are returning to the community, a brief alcohol intervention will result in less alcohol use at follow-up relative to standard of care.Eligible participants endorsed hazardous alcohol consumption-four or more drinks at a time on at least 3 separate days in the previous 3 months or a score of 8 or above on the Alcohol Use Disorders Identification Test. Participants were randomized to either an assessment-only condition or to two brief motivationally focused sessions, the first delivered during incarceration, the second 1 month later after community re-entry. Participants recalled drinking behaviors at 3 and 6 months after the baseline interview using a 90-day time-line follow-back method.The 245 female participants averaged 34 years of age, and were 71% Caucasian. The mean percentage of alcohol use days in the 3 months prior to incarceration was 51.7% and heavy alcohol use days was 43.9%. Intervention effects on abstinent days were statistically significant at 3 months (odds ratio = 1.96, 95% confidence interval 1.17, 3.30); the percentage of days abstinent was 68% for those randomized to intervention and 57% for controls. At 6 months the effect of the intervention was attenuated and no longer statistically significant.Among incarcerated women who reported hazardous drinking, a two-session brief alcohol intervention increased abstinent days at 3 months, but this effect decayed by 6 months. Study participants continued to drink heavily after return to the community. More intensive intervention pre-release and after re-entry may benefit hazardously drinking incarcerated women.

We sought to determine the preventive healthcare needs of incarcerated women in the following areas: cervical cancer and breast cancer screening, sexually transmitted infection (STI) screening, hepatitis screening and vaccination, and smoking cessation.A cross-sectional interview survey of a random sample of 100 incarcerated women at the Rhode Island Department of Corrections (RIDOC) in Cranston, Rhode Island, was conducted.Participants were 62% white, 11% African American, 13% Hispanic, and 14% of mixed race. Mean age was 35 years. Of those surveyed, 67% reported having had a Papanicolou (Pap) smear in the past year, the strongest predictor of which was having received a Pap smear while incarcerated. Of the inmates40 years old, 58% reported having had a mammogram in the past 2 years. The majority (88%) reported testing for STIs in the past, and 39% desired testing during their current incarceration. As for hepatitis C, 70% had been tested previously and 37% of those reported testing positive. Hispanics were less likely than whites to have been tested for hepatitis C (OR 0.1). Over half (54%) of the women who reported testing positive for hepatitis C also reported having completed the hepatitis A and B vaccine series. Among smokers (80% of all survey participants), 61% were interested in quitting. Those who had been incarcerated multiple times were less likely to want to quit smoking (OR 0.1).Incarceration presents a unique opportunity to provide preventive healthcare to high-risk, medically underserved women.

Objective: To estimate prevalence of childhood ADHD among incarcerated women and determine its association with substance use and adult functioning. Method: 192 female participants are recruited from the Department of Corrections in Rhode Island. Childhood ADHD is defined as scoring >46 on the Wender Utah Rating Scale. Results: The findings reveal that 46% met criteria for childhood ADHD. Multivariate analysis reveal that women meeting WURS criteria were more likely to be inconsistently employed (OR = 0.23, 95% CI = 0.10-0.54), recently homeless (OR = 2.09, 95% CI = 1.02-4.30), lifetime incarceration of more than 90 days (OR = 3.00, 95% CI = 1.37-6.57), current smokers (OR = 2.99, 95% CI = 1.24-7.20), and ever used marijuana regularly (OR = 3.47, 95% CI = 1.61-7.45). Conclusion: Among incarcerated women, childhood ADHD is associated with negative social and health behaviors.

Background Our objective was to determine baseline, normative values for multiple shoulder outcome scores in a young, active population without shoulder symptoms. Methods One hundred ninety-two volunteers completed the Single Assessment Numeric Evaluation, modified American Shoulder and Elbow Surgeons score, Western Ontario Shoulder Instability index, Simple Shoulder Test, and Disabilities of the Arm, Shoulder and Hand score. Their mean age was 28.8 years (range, 17-50 years). Results Of the participants, 59 (31%) scored no deficiencies on any of the outcome instruments, whereas 133 (69%) demonstrated some abnormal shoulder score. The mean scores were as follows: Single Assessment Numeric Evaluation, 97.7 (SD, 5.2); modified American Shoulder and Elbow Surgeons score, 98.9 (SD, 3.3); Western Ontario Shoulder Instability index, 82.7 of 2100 (SD, 153.5); Simple Shoulder Test, 11.79 (SD, 0.60); and Disabilities of the Arm, Shoulder and Hand score, 1.85 (SD, 5.99). Conclusion Our results show that the best possible shoulder score in an asymptomatic population may not be equivalent to a perfect score on the outcome scale.

Inguinal hernia repair has been overlooked as a public health priority in Africa, with its high prevalence largely unrecognized, and traditional public health viewpoints assuming that not enough infrastructure, human resources, or financing capacity are available for effective service provision. Emerging evidence suggests that inguinal hernias in Ghana are approximately ten times as prevalent as in high-income countries, are much more long-standing and severe, and can be repaired with low-cost techniques using mosquito net mesh through international collaboration. Outcomes from surgery are comparable to published literature, and potential exists for scaling up capacity. Special attention must be paid to creating financing systems that encourage eventual local self-sustainability.

The use of alloplastic mesh is now commonplace in hernia repair. However, in developing countries, cheaper alternatives to commercial mesh are required due to the high associated cost. Whilst nylon mosquito net mesh has been trialled previously, this study aimed to assess the use of polyester mosquito net mesh in tension-free inguinal hernia repair in Ghana. All patients undergoing inguinal hernia repair during the 5-day 'Operation Hernia' mission in 2007 were eligible for the study. A piece of sterilised 10 x 15-cm 100% polyester mosquito net mesh, manufactured and donated by Scotmas Limited, was implanted for all tension-free hernia repairs. The surgeons' ease of handling and incidence of complications at 6 weeks and 6 months were assessed. Ninety-five patients underwent inguinal hernia repair using a total of 106 polyester mosquito net meshes. The mean (range) age of patients was 44.3 (15-78) years. Seventy-two (76%) were repaired using local anaesthesia. At 6 weeks and 6 months, a total of seven (7%) patients suffered wound complications (five haematomas, two wound infections). Ease of practical handling improved after the first 2-5 cases. The cost of an individual 10 x 15-cm mesh was estimated at US$0.0072-0.014, and the cost of sterilisation and packaging was US$1.46 per mesh. Polyester mosquito net mesh represents a cost-effective alternative to commercial meshes in developing countries, with a relatively low rate of early complications and similar short-term recurrence rates. The use of local anaesthesia may enhance this further.

This study examined gender differences in a range of lifetime psychiatric disorders in a sample of 272 offenders newly admitted to a prison substance abuse program. Although these men and women did not differ in severity of substance use in the six months prior to incarceration, women were significantly more likely than men to report a lifetime psychiatric disorder and a lifetime severe disorder. Furthermore, gender differences emerged in the pattern of lifetime psychiatric comorbidity. Women reported greater lifetime major depression, posttraumatic stress disorder, eating disorder, and borderline personality disorder; men were more likely than women to meet criteria for antisocial personality disorder. Additionally, female offenders were found to have a higher degree of internalizing disorders than male offenders, but there were no gender differences in degree of externalizing disorders. The study concluded that women offenders newly admitted to a prison substance abuse program present with a greater psychiatric vulnerability and a different pattern of psychiatric comorbidity than their male counterparts.

The Accreditation Council for Graduate Medical Education (ACGME) encourages internal medicine training programs to include specific curricula devoted to health care issues of vulnerable populations. Our aim was to determine the prevalence of curricula involving selected vulnerable populations among U.S. Internal Medicine residencies. We conducted a survey of Program Directors of all US Internal Medicine Residencies assessing whether the program had a curriculum for six vulnerable populations (racial and ethnic minorities, non-English speaking patients, lesbians, gay men, victims of domestic violence and patients with substance abuse problems). Most residencies address substance abuse and victims of domestic violence, while there remains a lack of dedicated teaching on other vulnerable populations, including lesbians, gay men, racial and ethnic minorities and non-English speaking patients.