Environmental Justice is an issue that has been relevant in the mind of the federal government for the past 18 years. Within society, the goal of Environmental Justice looks to prevent the exploitation of vulnerable populations through the siting of environmentally hazardous sites. Instead of over burdening specific vulnerable populations, fair distribution of hazards throughout the population is desired. Although there is a large body of research that study the location and impact of hazardous sites on the surrounding communities, there are few existing models which look to locate vulnerable populations through the use of quantitative data. Of the existing models none implement an intensity scaling method based upon the percent of the population that exist within certain study area dependent thresholds. The purpose of this study is to develop a multi level index that examines a study area based upon intensity scaling of census data as well as hazard siting proximity analysis. A gap in the current literature is filled by the creation of the index and introduction of intensity scaling. The final output of the index presents a method that is modular allowing for the application of each level of the index to be applied individual of the other level. The index can be used to support and facilitate decision making performed by local, state, or federal agencies, to prevent the over burdening of a community. A second use is as a predictive model, providing a base upon which a better understanding of the local impacts of future siting and/or removal of a hazardous site can be evaluated. A final use of this index is as a foundation upon which future research can be conducted, providing an environmental justice understanding of a region, allowing for targeted research to be performed.

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A particularly unhealthy and high-risk group of individuals at the intersection of the criminal justice and public health systems often cycle between arrest, jail, prison, public hospitals, emergency departments, homeless shelters, and similar institutions over time. This population, while relatively small, represents disproportionate public spending and complex, multidimensional needs. The overarching goal of the current study is to gain a deeper understanding of the patterns and dimensions of frequent cross-system involvement, or repeat cycling between the criminal justice and public health systems. Specifically, the overlap of arrest by police and contact with the ED was examined. A secondary goal was to illuminate what factors work together to encourage or differentiate between various patterns of cross-system cycling. Group-based trajectory modeling was used to determine patterns of arrest and ED contact among adults that accessed these systems in Camden, NJ between 2010 and 2014. These groups were then brought together to determine patterns of cross-system involvement with a focus on patterns representative of frequent cycling between arrest and the ED. These joint groups were then described in detail using descriptive and predictive methods. By comparing across different patterns of frequent cycling, it is clear that cross-system involved individual do not represent a homogenous group; nor is mental illness and substance abuse the only factors driving this overlap. The most frequent joint trajectory groups exhibited significantly more ED visits to address injuries including skull-related injuries, chronic physical health conditions, dental and skin issues, anxiety, depression, suicide attempts, substance abuse and co- and multimorbidity measured as chronic conditions experienced with behavioral health concerns and drug/alcohol abuse. Arrests for disorderly, drug and prostitution offenses were also significantly more prevalent among frequent cross-system cyclers when compared to groups with fewer system contacts. Many of these same factors were also more prevalent among a subsample of young adults aged 18 in 2010 with repeat contacts with both systems. These steps, together with qualitative interviews with service providers in the Camden community, illuminated important factors associated with more frequent arrest and ED contact. These are important contributions to criminological research as discussion is often restricted to behavioral health and is less often concerned with physical health, co- and multi-morbidity. This is also among the first research studies to dig deeper into specific diagnoses associated with frequent arrest and frequent cross-system cycling, among adults and young adults. Healthcare provider interviews were able to confirm that certain issues like dental and skin conditions, depression, anxiety and suicide attempts/ideation tend to increase in prevalence as system contacts accumulate. These are factors that could be targeted earlier in the lifecourse in order to reduce cross-system cycling – an important form of concentrated disadvantage and vulnerability on which to focus attention and resources. / Criminal Justice

A main challenge in medicine concerns questions of how to integrate the context and values of patient perspectives with general conceptions of illness and treatment. With medicine increasingly focused on patient-centered and individualized care, approaches to medicine must find ways to gain access to and understand the patient in such a way that recognizes her story as real while at the same time maintaining the value of medicine as an objective practice. Adding to this is the reality that under current models of medicine and decision-making in medicine, healthcare disparities persist for persons belonging to marginalized and vulnerable populations, including racial and ethnic minorities, women, and LGBTQ persons, amongst others. I argue that an approach integrative of shared decision-making built upon a phenomenological framework is a good alternative on which to try and understand questions like these and begin to address disparities in healthcare. / Urban Bioethics

The Ryan White HIV/AIDS Program (RWHAP) provides HIV-related medical and support services for uninsured and underinsured people living with HIV (PLWH) in the United States. In addition to HIV-related medical care, the program provides medical nutrition therapy and food assistance. The role of nutrition in the health of PLWH is well-documented, especially in resource poor areas; however, the role of medical nutrition therapy and food assistance provided through the RWHAP in resource rich areas is not well documented. This study addressed the association between the nutrition services of food assistance and medical nutrition therapy and the HIV-related health outcomes of viral suppression, retention in care, and CD4 counts. The behavioral model for vulnerable populations was used as the theoretical foundation for this quantitative cross-sectional study. A sample of 428 RWHAP clients was used from the Ryan White Services Report data. Pearson's chi-square was used to examine the association between medical nutrition therapy (MNT) and viral suppression. Findings indicated statistically significant associations between MNT and viral suppression, retention in care and any nutrition service (food assistance, MNT, or both), and MNT and retention in care. Implications for social change include emphasizing the role of nutrition services in HIV-related health outcomes for PLWH in resource rich areas.

Since the war on drugs in the 1980s, the United States has seen an exponential rise in the number of imprisoned individuals. This increase has been particularly dramatic for women. Nationwide, the population of women in prison has grown by 834% over the past 40 years, more than double the growth rate of men. Compared with incarcerated men, women in prison have higher rates of substance abuse, histories of physical and sexual abuse, mental illness, infectious disease and chronic illness. Most women in prison are defined by a challenging intersection of lower socioeconomic status and largely racial, ethnic, and minority gender status. This combination of identity factors both contributes to their health disparities and influences their experiences with health care. Given that the majority of women in prison are of reproductive age, gynecological care is a central aspect of women’s overall health care. However, women in prison are a small minority of the overall incarcerated population, and because of this, their gender-specific health needs are frequently unacknowledged. Using a feminist epistemology, this qualitative multiple case study provides an examination of the experiences of women before prison and in prison with gynecological care and prison staff’s experiences providing this care. The Gelberg Andersen Behavioral Model for Vulnerable Populations is adapted here for the study of women in prison. The model explains factors enabling and impeding women’s utilization of health care services, including previous health care experiences, prison infrastructure, and personal autonomy. Women in contact with the criminal justice system face difficulties accessing health care both outside and inside prison. Barriers on the outside included lack of health insurance, being addicted to drugs, and prioritizing children’s needs first. On the inside women cited a lack of confidentiality, the absence of trust in providers, and the inability to participate in treatment decision-making. In the case of women in prison, multiple external oppressions result in internalized negative beliefs. Such feelings of powerlessness, lack of control, curtailed agency, and threatened self-worth ultimately influence how women experience gynecological care in prison. Policy, practice and research implications are provided to meet the gender specific health needs of women in prison.