Bather Jemar R, Goodman Melody S, Kaphingst Kimberly A
Health Lit Res Pract. 2025 Jan;9(1):e8-e18. doi: 10.3928/24748307-20241219-01. Epub 2025 Jan 13.
Formerly incarcerated individuals (FIIs) encounter difficulties with covering the cost of dental and medical care, adhering to medication regimens, and receiving fair treatment from health care providers. Yet, no published research has examined modifiable pathways to increase FIIs' health literacy (HL), which is essential for addressing the health needs of this vulnerable population.
The aim of this article is to examine neighborhood characteristics (neighborhood deprivation, racial and economic polarization, and residential segregation) and public assistance program enrollment as structural determinants of limited health literacy (LHL) among FIIs.
Using a socioecological framework, we analyzed a subsample of 578 FIIs from the 2023 Survey of Racism and Public Health, an online cross-sectional survey spanning U.S. Department of Health & Human Services Regions 1, 2, and 3. HL was assessed using the Brief Health Literacy Screen. Logistic regression models estimated unadjusted and adjusted associations of LHL with neighborhood characteristics and public assistance program enrollment. Adjusted models controlled for age, race and ethnicity, gender identity, educational attainment, marital and employment status, number of children, chronic health conditions, and incarceration length.
The 578 FIIs had an average age of 46, with 42% having LHL. We observed a statistically significant association between public assistance program enrollment and LHL (unadjusted odds ratio [OR] = 2.72, 95% confidence interval [CI]: 1.87, 4.01; adjusted = 2.50, 95% CI: 1.62, 3.88). We found no statistically significant associations of LHL with neighborhood deprivation, racial and economic polarization, and residential segregation.
Our findings suggest that there may be an opportunity to develop tailored interventions for increasing HL among FIIs through public assistance programs. Dissemination of HL resources among this marginalized group can improve their self-management of chronic diseases. This is of paramount importance because FIIs must simultaneously navigate other challenges after incarceration (e.g., unstable housing). [].
曾经入狱的个体（FIIs）在支付牙科和医疗费用、坚持药物治疗方案以及从医疗服务提供者那里获得公平治疗方面面临困难。然而，尚无已发表的研究探讨可改变的途径以提高FIIs的健康素养（HL），而健康素养对于满足这一弱势群体的健康需求至关重要。
本文旨在研究社区特征（社区贫困、种族和经济两极分化以及居住隔离）和公共援助项目登记情况，将其作为FIIs中健康素养有限（LHL）的结构决定因素。
我们使用社会生态框架，分析了来自2023年种族主义与公共卫生调查的578名FIIs的子样本，该调查是一项在线横断面调查，涵盖美国卫生与公众服务部第1、2和3地区。使用简短健康素养筛查工具评估健康素养。逻辑回归模型估计了LHL与社区特征和公共援助项目登记情况之间未经调整和调整后的关联。调整后的模型控制了年龄、种族和族裔、性别认同、教育程度、婚姻和就业状况、子女数量、慢性健康状况以及监禁时长。
578名FIIs的平均年龄为46岁，其中42%有LHL。我们观察到公共援助项目登记与LHL之间存在统计学上的显著关联（未经调整的优势比[OR]=2.72，95%置信区间[CI]：1.87，4.01；调整后=2.50，95%CI：1.62, 3.88）。我们发现LHL与社区贫困、种族和经济两极分化以及居住隔离之间没有统计学上的显著关联。
我们的研究结果表明，可能有机会通过公共援助项目制定针对性的干预措施来提高FIIs的健康素养。在这一边缘化群体中传播健康素养资源可以改善他们对慢性病的自我管理。这至关重要，因为FIIs在出狱后还必须同时应对其他挑战（例如，住房不稳定）。
