RTI International, San Francisco, CA, USA.
J Urban Health. 2018 Aug;95(4):584-593. doi: 10.1007/s11524-017-0204-8.
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 < 0.001) and mental health care (p for trend = 0.002). The odds of physical health conditions, such as hepatitis C infection (p for trend < 0.001) and mental health conditions, such as depression (p for trend = 0.003), also increased with higher class of accumulation. While the findings described here are limited by the cross-sectional nature of the study, they suggest that CJ accumulation is a potentially meaningful concept for assessing associations between the CJ system and health-related issues.
在使用非法药物的人群中，与刑事司法（CJ）系统的接触通常涉及一系列持续的、间歇性的逮捕、监禁和社区监管期。CJ 参与的终身积累与社会和健康结果之间的潜在关联在很大程度上尚未得到探索。在一项来自加利福尼亚州奥克兰社区的使用可卡因、海洛因和/或甲基苯丙胺的女性的横断面样本中（N=624），我们开发了一种描述 CJ 积累的方法。我们使用潜在类别分析（LCA），这是一种多变量的以人为中心的方法，假设存在一个未观察到的分类变量，将人群分为少数几个相互排斥和穷尽的类别。我们使用监禁和社区监管的观察指标作为指示变量，开发了一个 CJ 积累模型，该模型阐明了样本中女性的实际参与模式。根据模型拟合统计数据，我们选择了一个三类别模型，并将类别标记为“低”、“中”和“高”。然后，我们使用逻辑回归探索 CJ 积累类别与健康和健康相关结果之间的关联。在更高积累类别的女性中，无家可归（p 趋势=0.004）、短暂性（p 趋势=0.017）和最近受害（p 趋势=0.023）的可能性更高。更高类别的 CJ 积累与报告未满足的身体健康护理（p 趋势<0.001）和心理健康护理（p 趋势=0.002）需求的可能性更高相关。身体健康状况（如丙型肝炎感染，p 趋势<0.001）和心理健康状况（如抑郁，p 趋势=0.003）的可能性也随着积累类别的增加而增加。虽然这里描述的发现受到研究的横断面性质的限制，但它们表明 CJ 积累是评估 CJ 系统与健康相关问题之间关联的一个有意义的概念。
