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Women with criminal-legal system involvement bear a disproportionate burden of cervical cancer, indeed 4–5 times more than women without criminal-legal system involvement. While we also know that sexual minority identification (lesbian/gay, queer, bisexual, or not straight) is more common among women with criminal-legal system involvement, we lack understanding of the cervical cancer risk and prevention practices of this group of women. In 2019–2020, we used surveys to investigate cervical cancer risk and prevention practices among 510 women with criminal-legal system involvement in Kansas City (KS and MO), Oakland (CA), and Birmingham (AL). In a secondary data analysis, we compared sexual minority women (SMW defined as women who identified as lesbian/gay, bisexual, or other—19% of the sample, to women who identified as heterosexual or straight—81% of sample). SMW were less likely to have ever gotten a cervical cancer screening test, compared to straight women. Having a provider whom women felt they could rely on was associated with having an up-to-date cervical cancer screening test among SMW. SMW with criminal-legal system involvement are missing out on necessary cancer screenings. Further study to understand why and interventions to ensure this group receives preventive care are needed to prevent cervical cancer and reduce disparities.

BACKGROUND: This study aims to understand how criminal-legal involved women from three U.S. cities navigate different health resource environments to obtain cervical cancer screening and follow-up care. METHODS: We conducted a cross-sectional study of women with criminal-legal histories from Kansas City KS/MO; Oakland, CA; and Birmingham, AL. Participants completed a survey that explored influences on cervical cancer prevention. Responses from all women with/without up-to-date cervical cancer screening and women with abnormal Pap testing who did/did not obtain follow-up care were compared. Proportions and associations were tested with chi-square or analysis of variance tests. Multivariable regression was performed to identify variables independently associated with up-to-date cervical cancer screening and reported as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: There were n = 510 participants, including n = 164 Birmingham, n = 108 Kansas City, and n = 238 Oakland women. Criminal-legal involved women in Birmingham (71.3%) and Kansas City (68.9%) were less likely to have up-to-date cervical cancer screening than women in Oakland (84.5%, p = 0.01). More women in Birmingham (14.6%) and Kansas City (16.7%) needed follow-up for abnormal Pap than women in Oakland (6.7%, p = 0.003), but there were no differences in follow-up rates. Predictors for up-to-date cervical cancer screening included access to a primary care provider (OR: 3.3, 95% CI: 1.4–7.7), health literacy (OR: 0.3, 95% CI: 0.2–0.7), and health behaviors, including avoiding tobacco (OR: 0.4, 95% CI: 0.1–0.9) and HPV vaccination (OR: 3.4, 95% CI: 1.0–10.9). CONCLUSIONS: Cervical cancer screening and follow-up varied by study site. The results suggest that patient level factors coupled with the complexity of accessing care in different health resource environments impact criminal-legal involved women's cervical cancer prevention behaviors.

The unintentional consumption of fentanyl is a serious health risk for people who use illicit drugs. In an ongoing community-based study regarding polysubstance use among people who use opioids, we found that 17 of 58 (29%) of participants who did not endorse fentanyl use in the past thirty days tested positive for fentanyl during point-of-care urinalysis (UA). This paper describes the reactions and experiences of participants who were informed they had consumed fentanyl unintentionally, as well as how the research team handled the unanticipated occurrence of discordant results. Consistent with other recent studies, we found that people learning of unintentional fentanyl use expressed strong concerns about accidental overdose. It was common for participants to reflect on recent substance use experiences that were atypical and might have involved fentanyl, as well as to examine sources of recent drug purchases. While not all participants were surprised that they had unintentionally consumed fentanyl, all felt that learning their positive results was important due to risk of overdose. Research and medical staff who routinely conduct urinalysis have an opportunity to promote awareness of possible contamination by sharing and discussing UA test results with people who use drugs in non-judgmental manner. In addition to the widely promoted harm reduction strategy of testing drugs with fentanyl test strips, self-administered UA, particularly after an unexpected reaction to using a drug, could provide useful information for people buying and using illicit drugs.

Objective We examined if abortion-related knowledge among women with criminal legal system involvement differed in three U.S. cities in states with varying abortion policies. Study Design Respondents were self-identified women with criminal legal system involvement. Data come from a cross-sectional baseline survey of 381 women in three U.S. cities: Oakland, California, Kansas City, Kansas/Missouri, and Birmingham, Alabama. The primary outcome, high abortion-related knowledge, was based on a 10-item scale dichotomized into low vs high abortion-related knowledge. We used descriptive statistics, bivariable associations, and logistic regression to assess the association between high abortion-related knowledge, city of residence, and other possible related factors. Results Respondents in Kansas City, KS/MO and Birmingham, AL had lower odds of high abortion-related knowledge compared to respondents in Oakland, CA (OR: 0.19, 95% CI: 0.10–0.38 and OR: 0.17, 95% CI: 0.11–0.28, respectively). In adjusted analysis, the association remained after controlling for race/ethnicity, insurance status, and community supervision past year. Conclusions Findings underscore the need for communicating clear and accurate information about abortion care, especially in states where laws and ongoing political challenges make it difficult to access both reliable information and services. Implications Efforts to disseminate accurate information regarding abortion care, particularly among marginalized people, should utilize multiple venues in addition to traditional healthcare information sources. Reproductive justice advocates should connect with jails and probation offices to reach people with criminal legal system involvement and foster increased knowledge of reproductive rights and services.

Since the mainstream racial awakening to pervasive and entrenched structural racism, many organizations have made commitments and adopted practices to increase workplace diversity, inclusion, and equity and embed these commitments in their organizational missions. A question often arises about how these concepts apply to research. This paper discusses how organizations can build on their specific commitments to diversity, inclusion, and equity by applying these principles in the research enterprise. RTI International’s framework for conducting equity-centered transformative research highlights how incorporating principles of diversity, inclusion, and equity requires a departure from mainstream practice because of historical and intentional exclusion of these principles. Drawing on methodologies of culturally responsive evaluation, research, and pedagogy; feminist, Indigenous, and critical methodologies; community-based participatory research; and theories of social transformation, liberation, and racial justice, this organizing framework illustrates what this departure requires and how research can serve liberation and social justice by transforming the researcher, the research content, and the day-to-day practice of conducting research. Centering the work of seminal scholars and practitioners of color in the field, this paper provides a holistic framework that incorporates various research approaches and paradigms intended to shift power to minoritized and marginalized communities to achieve social transformation through research.

Objective To examine the relationship between social stability and access to healthcare services among a community-based sample of adult female drug users. Methods We developed a measure of social stability and examined its relationship to health care access. Data came from a cross-sectional sample of female drug users (N = 538) in Oakland, CA who were interviewed between September 2014 and August 2015. We categorized women as having low (1-5), medium (6-10), or high (11-16) social stability based on the tertile of the index sample distribution. We then used ordered logistic regression to examine the relationship between social stability and self-reported access to mental health services and medical care. Results Compared with women in the low stability group, those with high stability experienced a 58% decline in the odds of needed but unmet mental health services [AOR: 0.42; 95% C.I.: 0.26, 0.69] and a 68% decline in the odds of unmet medical care [AOR: 0.32; 95% C.I.: 0.19, 0.54] after adjusting for confounders. The coefficients we observed reduced in size at higher levels of the stability index suggesting a positive association between social experiences and access to healthcare services. Conclusion Women who use drugs are at increased risk of adverse health outcomes and often experience high levels of unmet healthcare needs. Our study highlights the importance of addressing social determinants of health and suggests that improving social factors such as housing stability and personal safety may support access to healthcare among female drug users.

Pretrial assessments are criticized for inherent biases. We conduct research in Kentucky to assess the predictive validity and differential prediction by sex of one pretrial assessment, the Public Safety Assessment (PSA). Our research is unique because we find equal base rates by sex for missing a court date, which allows us to assess for error rate balance by sex. We find the PSA to have predictive validity within acceptable ranges for the criminal legal field. The analyses show a lack of evidence of predictive bias for any arrest or missing a court date, and we find equal error rates for five different error measures. The analyses contribute to methodological debates about how to measure predictive bias with assessments.

Objectives: We profiled the health and health services needs of a sample of older adult women (age 50+) with criminal–legal system (CLS) involvement and compared them with younger women (age 18–49), also CLS-involved. Methods: Using survey data collected from January to June 2020 from adult women with CLS involvement in three US cities, we profiled and compared the older adult women with younger women on behavioral and structural risk factors, health conditions, and health services access and use. Results: One-third (157/510) were age 50+. We found significant differences ( p < .05) in health conditions and health services use: older women had more chronic conditions (e.g., hypertension and stroke) and more multimorbidity and reported more use of personalized care (e.g., private doctor, medical home, and health insurance). Discussion: Although older women with CLS involvement reported good access to health services compared with younger women, their chronic health conditions, multimorbidity, and functional declines merit attention.

In a prospective cohort study of Latinx adolescents living in an agricultural county in California, we examined perceptions of federal immigration policy and its effects on community and individual wellbeing. From May to December 2017, 565 youth responded to an open-ended item integrated into ongoing surveys. Median age was 14 (range 13–16 years), 53% female, and 94% Latinx. About 12% were immigrants, 71% children of immigrant parents, and 52% had a parent employed in farm work. Most (78%) indicated they directly experienced or observed effects of current federal immigration policies. Adolescents described anti-immigrant sentiment as heightening discrimination, isolation, fear, and mental health changes. They also perceived constraints on future educational and employment opportunities. These findings suggest that the federal immigration policy environment can negatively impact the wellbeing of youth in Latinx communities and that immigration policy should be considered a social determinant of health.

Women in the United States criminal legal (CL) system are at the nexus of several drivers of the COVID-19 pandemic, including incarceration, poverty, chronic illness and racism. There are 1.25 million women incarcerated or on community supervision (probation or parole) in the U.S. We present findings regarding the impact of COVID-19 on women in the CL system (N=344) during the early days of the pandemic. Participants were drawn from community settings in an ongoing study of cervical cancer risk in three U.S. cities: Birmingham, Alabama, Oakland, California and Kansas City, which straddles the states of Kansas and Missouri. Regional differences were found in COVID-19 testing and perceived susceptibility to the virus, but not in COVID-related disruptions to health care. We found differences by race/ethnicity in trusted sources of information about COVID. Black women had higher odds of choosing TV as their most trusted source of information, while White women were more likely to cite government or social service agencies as their most trusted source. Notably, 15% of women said they did not trust any source of information regarding COVID-19. COVID-19 disproportionately impacts populations with high levels of mistrust towards medical and government institutions, a result of the twin legacies of medical mistreatment and structural racism. Our findings underscore the need for innovative strategies to reach these groups with accurate and timely information.

In March–April, 2020, we communicated with a cohort of criminal justice–involved (CJI) women to see how they were navigating COVID-19, chronic illness, homelessness, and shelter-in-place orders in Oakland, Birmingham, and Kansas City. We report on conversations with N = 35 women (out of the cohort of 474 women) and our own observations from ongoing criminal justice involvement studies. Women reported barriers to protecting themselves given widespread unstable housing and complex health needs, though many tried to follow COVID-19 prevention recommendations. Women expressed dissatisfaction with the suspension of research activities, as the pandemic contributed to a heightened need for study incentives, such as cash, emotional support, and other resources. COVID-19 is illuminating disparities between those who can follow recommended actions to prevent infection and those who lack resources to do so. Concerted efforts are required to reduce inequities that put the 1.3 million U.S. women under criminal justice supervision at risk for infection and mortality.

Advocates have long raised concerns about the potential for partner violence after a spouse’s or partner’s return from prison, but few programs or policies exist to prevent it. In an era in which experiences of incarceration and reentry—and by extension, experiences of a partner’s or coparent’s incarceration and reentry—are commonplace in low-income urban communities, the safety of families reuniting after a prison stay merits serious attention. The current study examines qualitative data from 167 reentering men and their partners to identify contextual influences on post-prison partner violence. Insights from the data offer a valuable starting point for future research and for considering how prevention could effectively target economic, physical, social, and cognitive conditions at multiple social-ecological levels.

Efforts to support help-seeking by victims of partner violence in couples affected by incarceration represent a key part of larger efforts in the fields of domestic violence and victim services to improve the accessibility of services in marginalized communities and better meet complex victim needs. Qualitative data from 167 Multi-site Family Study participants suggest that involvement with the criminal justice system (whether directly or through a family member) introduces unique individual, interpersonal, and sociocultural barriers to defining one’s experiences as a problem, deciding to seek help, and selecting sources of help. Opportunities exist not only to tailor service delivery approaches in ways that overcome the individual and interpersonal obstacles that affect victims but also to pursue longer-range shifts in public policy and community infrastructure that will address broader and more-entrenched barriers to help-seeking.

Supplemental Security Income (SSI) is a United States federal welfare program examined here as emblematic of the sociostructural configurations of welfare-related deservingness and punitive governance within social welfare. We operationalize Quesada, Hart, and Bourgois' (2011) framework of structural vulnerability to ethnographically examine people's experience with applying for and receiving SSI in the context of a mixed-method intervention study. Our study population is comprised of HIV-positive people who use drugs and live at the nexus of extreme poverty and housing instability, serious mental illness, past or current experiences of violence and/or trauma, repeated incarceration, and lack of access to health care and social services. We found that people navigating SSI application procedures were subject to exclusionary practices at the front end of the process and punitive tactics once approved. Policies and procedures embedded within this system of social welfare not only functioned to compound exis...

The use of multiple illicit drugs (polydrug use) is associated with health-related harms and elevated risk of drug overdose. Polydrug use in common among women who use 'hard' drugs, such as cocaine, heroin or methamphetamine.Quantitative data collection was conducted with a community-recruited sample of 624 women who used heroin, methamphetamine or cocaine in Oakland, CA during 2014-2015. We conducted latent class analysis to classify polydrug use patterns. We assessed associations between classes of polydrug use and infectious disease risk behaviors, health care utilization and unmet health care need.We identified four distinct classes of drug use: (1) predominantly crack (52% of women); (2) powder cocainenon-heroin opioids (8%); (3) moderate polydrug use (25%); (4) heavy polydrug use (15%). Odds of sexual risk, injection drug use and unmet healthcare need were twice as high in the heavy polydrug use class as the predominantly crack class (p 0.01 for each outcome). The rate of binge drinking (as days per month) was also significantly higher in the heavy polydrug class (p = 0.01). The moderate polydrug use class had higher odds of injection drug use and drug treatment participation, compared to the mainly crack class (p 0.001 for each outcome). There were no differences between classes in health insurance or health care utilization.Reduction of polydrug use could be an effective harm reduction strategy to address sexual and injection risk among women. The use of both opioids and stimulants in three of the four classes suggests that multi-modal substance abuse treatment approaches may be most appropriate.

Rationale Despite the importance of primary partners for health, little is known about factors that constrain the ability of couples to work collaboratively towards HIV care and treatment (dyadic coordination). This study examined the interplay of marital infidelity, food insecurity, and couple instability on dyadic coordination and adherence to antiretroviral therapy (ART) in Malawi. Methods In 2016, we conducted 80 in-depth interviews with 25 couples with at least one partner on ART. Couples were recruited at two HIV clinics in the Zomba district when attending clinic appointments. Participants were asked about their relationship history, relationship dynamics (love, trust, conflict), experiences with HIV care and treatment, and how partners were involved. Using an innovative analysis approach, we analyzed the data at the couple-level by examining patterns within and between couples. Results Three patterns emerged. For some couples, ART led to positive changes in their relationships after men terminated their extramarital partnerships in exchange for love and support. For other couples with power imbalances and ongoing conflict, men's infidelity continued after ART and negatively affected dyadic coordination. Finally, some couples agreed to remain “faithful”, but could not overcome stressors related to food insecurity, which directly impacted their adherence. Conclusions Couples-based interventions targeting ART adherence should improve relationship quality, while also addressing interpersonal stressors such as marital infidelity and food insecurity. Multi-level interventions that address both dyadic and structural levels may be necessary for couples with severe food insecurity.

Background Jail is frequently described as a “revolving door,” which can be profoundly destabilizing to people moving in and out of the system. However, there is a dearth of research attempting to understand the impacts of the accumulation of incarceration events on women who use drugs. We examined the association of the frequency of jail incarceration with hardship, perceived health status, and unmet health care need among women who use drugs. Methods Our community-based sample included women who use heroin, methamphetamine, crack cocaine, and/or powder cocaine (N = 624) in Oakland, California, from 2012 to 2014. Poisson regression models with robust variances were built to estimate adjusted prevalence ratios between the frequency of jail incarcerations and measures of hardship, perceived health, and unmet health care need, adjusting for a set of a priori specified covariates. Results We observed associations between high levels of jail frequency and higher levels of homelessness (p = .024), feeling unsafe in their living situation (p = .011), stress (p = .047), fair to poor mental health (p = .034), unmet mental health care need (p = .037), and unmet physical health care need (p = .041). We did not observe an association between jail frequency and unmet subsistence needs score or fair to poor physical health. Conclusions We observed associations between higher levels of jail frequency and a higher prevalence of hardship, poor mental health, and unmet health care need. Our findings suggest areas for additional research to untangle the impacts of frequent incarceration on women's health and well-being.

Qualitative and preliminary quantitative research suggests that reentry from prison could be a time of heightened intimate partner violence (IPV) risk. Using data from 666 different-sex couples who...

The Multisite Family Study on Incarceration, Partnering and Parenting documented the implementation and effectiveness of family-strengthening programming for incarcerated and reentering men and the...

In this article, we utilize quantitative and qualitative data from the Multi-Site Family Study on Incarceration, Parenting, and Partnering (MFS-IP) to examine couple relationships during men’s reen...

Parenting and romantic partnership changes and challenges that occur in the context of incarceration are not yet fully understood, in part due to longstanding limitations in available data on the family lives of justice-involved individuals. This article reviews that prior work and introduces a set of new contributions in this volume of findings from the Multisite Family Study on Incarceration, Parenting, and Partnering (MFS-IP). The MFS-IP study brings new insight on parenting and partnership during incarceration and reentry, using longitudinal data collected from 2008–2015 with 1,482 committed romantic or coparenting couples in which the male partner was incarcerated at baseline.

Despite a substantial base of literature on father–child relationships, little is known about how incarceration affects these relationships, or how fathers connect with and support their children d...

The Multisite Family Study on Incarceration, Partnering, and Parenting documented the impact of couples-based relationship education on intimate relationship quality; parenting and coparenting qual...

Objectives: The one million U.S. women under supervision of the criminal-legal (CL) system are a populuation with 4-5 times the rate of cervical cancer than the general population–a disparity that has persisted for over 50 years. CL-involved women include those who have recently left jails/prisons, are on probation, or are in community corrections but still under legal supervision. Up to 60% of CL-involved women have a history of an abnormal Papanicolaou (Pap) test due to sexual health risks, trauma histories, and tenuous life circumstances that increase their risk of cervical dysplasia and serve as barriers to preventative care. The purpose of this study is to understand how women with CL involvement navigate individual, social, and community level systems to maintain their cervical health in varied funding and healthcare access environments. Methods: Retrospective cross-sectional study that analyzed baseline data from an ongoing longitudinal (2019-2024) study with CL-involved women, the Tri-City study. Data was collected from January-June 2020 and includes 508 CL-involved women from Kansas City, KS/MO (KC); Oakland, California (Oak); and Birmingham, AL (Birm). Participants completed a 288-item survey that explored influences on health services use as guided by the behavioral model for vulnerable populations (BMVP). Categorical variables were reported using frequencies and continuous data was reported as means with standard deviations. Proportions and associations were tested with chi-square or fisher's exact test. Multivariate regression was performed after controlling for study site and reported as odds ratios (OR) with 95% confidence intervals (CI) and corresponding p-values. Results: CL-involved women in KC (68.9%) and Birm (71.3%) were less likely to have up-to-date Pap testing than women in Oak (84.5%, p=0.01). Of the CL-involved women who needed follow-up for abnormal Pap results, only 58% of Birm and 66% of KC women completed follow-up whereas 88% of women in Oak completed follow-up and other 5% had an appointment scheduled (p=0.1). Using a BMVP framework, predictors for up-to-date Pap test included lower belief score for barriers to screening (OR 0.3, 95% CI 0.2-0.7, p=0.003), personal doctor (OR 3.3, 95% CI 1.4-7.7, p=0.005), not using tobacco (OR 0.4, 95% CI 0.1-0.9, p=0.05), and HPV vaccination (OR 3.4, 95% CI 1.0-10.9, p=0.04). When comparing CL-involved women who did or did not obtain follow-up for an abnormal Pap result, factors associated with follow-up in the bivariate analysis included lower susceptibility score (2.4 follow-up vs 3.1 no follow-up, p=0.007), lower severity of disease scores (3.3 follow-up vs 4.0 no follow-up, p=0.008), using hormonal birth control (22.5% follow-up vs 11.1% no follow-up, p=0.05), and not using condoms (42.5% follow-up vs 11.1% no follow-up, p=0.05). However, none of these variables were significant predictors of abnormal Pap follow-up in the multivariate model. Conclusions: Pap testing and follow-up varied by study site with the highest rates observed in Oakland, which was the only city that offered health services through Medicaid expansion. The results of our baseline data suggest that patient level factors coupled with the complexity of navigating community health delivery systems impacts CL-involved women's cervical cancer prevention behaviors.

Among people who use illegal drugs, engagement with the criminal justice (CJ) system often involves an ongoing, intermittent series of arrests, incarcerations, and periods of community supervision. The potential associations between the lifetime accumulation of CJ involvement and social and health outcomes is largely unexplored. In a cross-sectional sample of women who use crack, heroin, and/ or methamphetamine recruited from communities in Oakland, CA (N = 624), we developed an approach to characterize CJ accumulation. We used latent class analysis (LCA), a multivariate person-centered method that assumes an unobserved categorical variable that divides a population into a small number of mutually exclusive and exhaustive classes. Using observed measures of incarceration and community supervision as indicator variables, we developed a model of CJ accumulation that elucidates patterns of involvement as lived by the women in the sample. Based on model fit statistics, we selected a three-class model and labeled the classes “low,” “medium,” and “high.” We then explored associations between the classes of CJ accumulation and health and health-related outcomes using logistic regression. The odds of homelessness (p for trend = 0.004), transience (p for trend = 0.017), and recent victimization (p for trend = 0.023) were higher among women in higher accumulation classes. Higher class of CJ accumulation was associated with higher odds of reporting unmet need for physical health care (p for trend

Engaging highly marginalized HIV positive people in sustained medical care is vital for optimized health and prevention efforts. Prior studies have found that strengths-based case management helps link people who use drugs to HIV care. We conducted a pilot to assess whether a strengths-based case management intervention may help people who use injection drugs (PWID) or smoke crack cocaine (PWSC) achieve undetectable HIV viral load. PWID and PWSC were recruited in Oakland, California using targeted sampling methods and referral from jails and were tested for HIV. HIV positive participants not receiving HIV care (n = 19) were enrolled in a pilot strengths-based case management intervention and HIV positive participants already in HIV care (n = 29) were followed as comparison participants. The intervention was conducted by a social worker and an HIV physician. Special attention was given to coordinating care as participants cycled through jail and community settings. Surveys and HIV viral load tests were conducted quarterly for up to 11 visits. HIV viral load became undetectable for significantly more participants in the intervention than in the comparison group by their last follow-up (intervention participants: 32% at baseline and 74% at last follow-up; comparison participants: 45% at baseline and 34% at last follow-up; p = 0.008). In repeated measures analysis, PBO intervention participants had higher odds of achieving undetectable viral load over time than comparison participants (p = 0.033). Strengths-based case management may help this highly vulnerable group achieve undetectable HIV viral load over time.

PurposeThe purpose of this paper is to describe standards for evidence-based reproductive healthcare for incarcerated women.Design/methodology/approachThe literature on reproductive healthcare in the US criminal justice system and recommendations from professional organizations were reviewed and critical areas of concern were identified. Within these areas, studies and expert opinion were synthesized and policy recommendations were formulated through an iterative process of group discussion and document revision. This brief specifically addresses women’s incarceration in the USA, but the recommendations are grounded in a human rights framework with global relevance.FindingsWomen who are incarcerated have health needs that are distinct from those of men, and there is a clear need for gender-responsive reproductive healthcare within the criminal justice system. This brief identifies five core domains of reproductive healthcare: routine screening, menstruation-related concerns, prenatal and postpartum care, contraception and abortion, and sexually transmitted infections. The recommendations emphasize the continuity between the criminal justice system and the community, as well as the dignity and self-determination of incarcerated women.Originality/valueThis brief provides a unique synthesis of the available evidence with concrete recommendations for improving the reproductive healthcare for incarcerated women.

Background Adults with co-occurring mental and substance use disorders (CODs) are overrepresented in jails. In-custody barriers to treatment, including a lack of evidence-based treatment options and the often short periods of incarceration, and limited communication between jails and community-based treatment agencies that can hinder immediate enrollment into community care once released have contributed to a cycle of limited treatment engagement, unaddressed criminogenic risks, and (re)arrest among this vulnerable and high-risk population. This paper describes a study that will develop research and communication protocols and adapt two evidence-based treatments, dual-diagnosis motivational interviewing (DDMI) and integrated group therapy (IGT), for delivery to adults with CODs across a jail-to-community treatment continuum. Methods/design Adaptations to DDMI and IGT were guided by the Risk-Need-Responsivity model and the National Institute of Corrections’ implementation competencies; the development of the implementation framework and communication protocols were guided by the Evidence-Based Interagency Implementation Model for community corrections and the Inter-organizational Relationship model, respectively. Implementation and evaluation of the protocols and adapted interventions will occur via an open trial and a pilot randomized trial. The clinical intervention consists of two in-jail DDMI sessions and 12 in-community IGT sessions. Twelve adults with CODs and four clinicians will participate in the open trial to evaluate the acceptability and feasibility of, and fidelity to, the interventions and research and communication protocols. The pilot controlled trial will be conducted with 60 inmates who will be randomized to either DDMI-IGT or treatment as usual. A baseline assessment will be conducted in jail, and four community-based assessments will be conducted during a 6-month follow-up period. Implementation, clinical, public health, and treatment preference outcomes will be evaluated. Discussion Findings have the potential to improve both jail- and community-based treatment services for adults with CODs as well as inform methods for conducting rigorous pilot implementation and evaluation research in correctional settings and as inmates re-enter the community. Findings will contribute to a growing area of work focused on interrupting the cycle of limited treatment engagement, unaddressed criminogenic risks, and (re)arrest among adults with CODs. Trial registration ClinicalTrials.gov, NCT02214667. Registered on 10 August 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2088-z) contains supplementary material, which is available to authorized users.

Background People who smoke crack cocaine and people who inject drugs are at-risk for criminal justice involvement as well as HIV and HCV infection. Compared to criminal justice involvement, substance use treatment (SUT) can be cost-effective in reducing drug use and its associated health and social costs. We conducted a cross-sectional study of people who smoke crack cocaine and people who inject drugs to examine the association between incarceration, community supervision and substance use treatment with HIV/HCV testing, components of the HIV treatment cascade, social and physical vulnerability and risk behavior. Methods Targeted sampling methods were used to recruit people who smoke crack cocaine and people who inject drugs (N = 2072) in Oakland, California from 2011 to 2013. Poisson regression models were used to estimate adjusted prevalence ratios between study exposures and outcomes. Results The overall HIV prevalence was 3.3% (95% CI 2.6–4.1). People previously experiencing incarceration were 21% (p