Uplifting the Social Determinants of Health of Adults Exiting Carceral Settings May Aid Health Care Access.

Abstract

This article investigates health care access (i.e., health insurance coverage, usual source of care, doctor visit) among adults exiting carceral settings. Between 2022 and 2024, adults aged 18 and over (N = 202) enrolled in two health studies in San Diego, California. Surveys collected demographic and health care access data. Logistic regression models assessed factors independently associated with health care access. Overall, 27% of participants were uninsured, 66% had Medicaid insurance, and 21% lacked a usual place of care. In logistic regression models, adults released from custody within 6 months or who had high school or fewer years of education were significantly less likely to be insured. Increasing age and high school or fewer years of education, one to two chronic conditions, or a positive anxiety screener were significantly associated with having a usual source of care, whereas those recently returned to communities were less likely to have a usual source of care. Reliable transportation was significantly associated with a doctor visit in the past 6 months. Coordinated interventions are needed to bolster the social determinants of health among adults who have experienced incarceration; particularly education, employment, and transportation. Policy interventions (e.g., Medicaid expansion), expansive community outreach, and transportation supports for low-income or underemployed adults can address financial and logistical barriers to health care access.