Evaluating the health outcomes of COVID-19 policies in U.S. prisons

Camplain, Carolyn (2023) Evaluating the health outcomes of COVID-19 policies in U.S. prisons. Doctoral thesis, Northern Arizona University.

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Abstract

COVID-19 created a public health crisis behind bars, with people incarcerated in prison experiencing cases at four times the U.S. national rate. Individuals incarcerated in prisons experience higher rates of comorbidities for COVID-19, including chronic disease, mental illness, and substance abuse, compared to the general population. The incarcerated are confined to small, densely populated areas during their time in prison. Additionally, copayments for health care interactions in prisons are required, limiting who and when people can access medical services. One strategy to combat COVID-19 in prisons is to adopt and implement policies that have lasting impacts on health. However, policy decisions are often made without an evidence-based plan. Thus, the primary objectives for this dissertation are to (1) discuss the frameworks that explain the impact of law and policies on COVID-19 health outcomes in U.S. prisons, and (2) assess the impact of policy adoption on COVID-19 transmission in prisons across the U.S.Theoretical frameworks - disparate treatment and impact and the social and structural determinants of health - and a methodological framework - Public Health Law Research - provide guidance for two legal evaluation studies. This dissertation assessed the associations between (1) COVID-19 mitigation and containment strategies and (2) health care copayment policy adoption during the COVID-19 pandemic in prisons in all 50 states and ICE-run institutions with COVID-19 transmission (estimated by percent positivity). Associations were assessed using ordinal logistic regression models, and generalized estimating equations were used to address clustering of facilities at the state level. COVID-19 policies have the potential to control the spread of COVID-19 in prisons. States with facilities that had mass testing, mask wearing in group programs, or social distancing in sleeping quarters had lower COVID-19 transmission when compared with those jurisdictions and facilities that did not adopt these policies. Facilities and jurisdictions that suspended copayments for COVID-19 related visits had higher COVID-19 transmission when compared to facilities that suspended all copayments. This dissertation can help guide policy adoption and practice implementation in prisons to prevent and control the spread of infectious disease, whether during a pandemic, epidemic, or an outbreak in a facility.

Item Type:	Thesis (Doctoral)
Publisher’s Statement:	© Copyright is held by the author. Digital access to this material is made possible by the Cline Library, Northern Arizona University. Further transmission, reproduction or presentation of protected items is prohibited except with permission of the author.
Keywords:	COVID-19 in Prisons; Health policy; Incarceration and Health; Prison policy; Public health law
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
NAU Depositing Author Academic Status:	Student
Department/Unit:	Graduate College > Theses and Dissertations College of Health and Human Services > Health Sciences
Date Deposited:	29 Aug 2023 16:28
Last Modified:	29 Aug 2023 16:28
URI:	https://openknowledge.nau.edu/id/eprint/6095

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