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Race and Medication Adherence Moderate Cessation Outcomes in Criminal Justice Smokers.

ABSTRACT: Smokers in the criminal justice system represent some of the most disadvantaged smokers in the U.S., as they have high rates of smoking (70%-80%) and are primarily uninsured, with low access to medical interventions. Few studies have examined smoking-cessation interventions in racially diverse smokers, and none have examined these characteristics among individuals supervised in the community. The purpose of this study is to determine if four sessions of standard behavioral counseling for smoking cessation would differentially aid smoking cessation for African American versus non-Hispanic white smokers under community corrections supervision.An RCT.Five hundred smokers under community corrections supervision were recruited between 2009 and 2013 via flyers posted at the community corrections offices.All participants received 12 weeks of bupropion plus brief physician advice to quit smoking. Half of the participants received four sessions of 20-30 minutes of smoking-cessation counseling following tobacco treatment guidelines, whereas half received no additional counseling.Generalized estimating equations were used to determine factors associated with smoking abstinence across time. Analyses were conducted in 2014.The end-of-treatment abstinence rate across groups was 9.4%, with no significant main effects indicating group differences. However, behavioral counseling had a differential effect on cessation: whites who received counseling had higher quit rates than whites who did not receive counseling. Conversely, African Americans who did not receive counseling had higher average cessation rates than African Americans who received counseling. Overall, medication-adherent African American smokers had higher abstinence rates relative to other smokers.Racial disparities in smoking cessation are not evident among those who are adherent to medication. More research is needed to better understand the differential effect that behavioral counseling might have on treatment outcomes between white and African American smokers under community corrections supervision.

SUBMITTER: Cropsey KL

PROVIDER: S-EPMC4546875 | biostudies-literature | 2015 Sep

REPOSITORIES: biostudies-literature

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Project description:Abstract Background The overlap between justice system involvement and drug use is well‐documented. Justice‐involved people who misuse opioids are at high risk for relapse and criminal recidivism. Criminal justice policymakers consider opioid‐specific medication‐assisted therapies (MATs) one approach for improving outcomes for this population. More research is needed that explores the impacts of opioid‐specific MATs for justice‐involved people. Objectives This study sought to assess the effects of opioid‐specific MAT for reducing the frequency and likelihood of criminal justice and overdose outcomes for current or formerly justice‐involved individuals. Search Methods Records were searched between May 7, 2021 and June 23, 2021. We searched a total of sixteen proprietary and open access databases that included access to gray literature and conference proceedings. The bibliographies of included studies and relevant reviews were also searched. Selection Criteria Studies were eligible for inclusion in the review if they: (a) assessed the effects of opioid‐specific MATs on individual‐level criminal justice or overdose outcomes; included (b) a current or formerly justice‐involved sample; and (c) a randomized or strong quasi‐experimental design; and c) were published in English between January 1, 1960 and October 31, 2020. Data Collection and Analysis We used the standard methodological procedures as expected by The Campbell Collaboration. Main Results Twenty studies were included, representing 30,119 participants. The overall risk of bias for the experimental studies ranged from “some” to “high” and for quasi‐experimental studies ranged from “moderate” to “serious.” As such, findings must be interpreted against the backdrop of less‐than‐ideal methodological contexts. Of the 20 included studies, 16 included outcomes that were meta‐analyzed using mean log odds ratios (which were reported as mean odds ratios). Mean effects were nonsignificant for reincarceration (odds ratio [OR] = 0.93 [0.68, 1.26], SE = .16), rearrest (OR = 1.47 [0.70, 3.07], SE = 0.38), and fatal overdose (OR = 0.82 [0.56, 1.21], SE = 0.20). For nonfatal overdose, the average effect was significant (OR = 0.41 [0.18, 0.91], SE = 0.41, p < 0.05), suggesting that those receiving MAT had nearly 60% reduced odds of a nonfatal overdose. Implications for Policy, Practice, and Research The current review supports some utility for adopting MAT for the treatment of justice‐involved people with opioid addiction, however, more studies that employ rigorous methodologies are needed. Researchers should work with agencies to improve adherence to medication regimens, study design, and collect more detailed information on participants, their criminal and substance use histories, onset, and severity. This would help clarify whether treatment and control groups are indeed comparable and provide better insight into the potential reasons for participant dropout, treatment failure, and the occurrence of recidivism or overdose. Outcomes should be assessed in multiple ways, if possible (e.g., self‐report and official record), as reliance on official data alone may undercount participants' degree of criminal involvement.

Project description:ImportanceHealth disparities between African Americans and Whites have persisted in the United States. Researchers have recently hypothesized that the relatively poor health of African Americans may be caused, in part, by African American overrepresentation in the criminal justice system.ObjectivesTo test the hypothesis that criminal justice system involvement is associated with poor health and greater health risk when controlling for unobserved family factors through a discordant sibling design.MethodsSubjects were drawn from the Carolina African American Twin Study of Aging (CAATSA). Criminal conviction records were extracted from North Carolina's Department of Public Safety. Six measures of health and one measure of health risk were analyzed. The health of convicted respondents was compared to that of unrelated non-convicted respondents matched on childhood and demographic factors ("matched sample"). Convicted respondents were also compared to non-convicted siblings ("discordant sibling sample").ResultsThe matched sample included 134 CAATSA respondents. On average, convicted CAATSA respondents, compared to matched non-convicted respondents, were in worse health. Convicted respondents had worse mean self-reported health, worse lung function, more depressive symptoms, and smoked more. The discordant sibling sample included 74 respondents. Convicted siblings and non-convicted siblings had similar self-reported health, depressive symptoms, and smoking. In general, non-convicted siblings were in worse health than non-convicted respondents from the matched sample, implying that poor health runs in families.ConclusionsThis study provided preliminary evidence that some of the association between a criminal record and poor health is confounded by family factors. Though more research is needed to support these results, the study suggests that criminal involvement may not be associated with the surfeit of health problems observed among African Americans. The criminal justice system, nonetheless, could be used to decrease the health disparity.

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Race and Medication Adherence Moderate Cessation Outcomes in Criminal Justice Smokers.

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