Grant Number:	5R01CA181047-08 Interpret this number
Primary Investigator:	Ramaswamy, Megha
Organization:	University Of Kansas Medical Center
Project Title:	Sexual Health Empowerment for Jail-Involved Women's Health Literacy and Prevention
Fiscal Year:	2021

ABSTRACT Over the last 35 years, there has been a 700% increase in the number of women in prisons and jails. These women, mostly women of color, have pervasive trauma histories, mental health problems, and drug use, all of which compromise their ability to engage in preventive health behaviors. For the last eight years, our research team has studied women leaving jail and why they are 4-5 times more likely to develop cervical cancer, a disparity that has remained unchanged for over 50 years. The original objective of the Sexual Health Empowerment (SHE) for Cervical Health Literacy and Prevention program (R01 CA181047) was to assess the effectiveness of a jail-based intervention to increase cervical health literacy and screening. SHE increased jailed women’s cervical health literacy and rates of cancer screening after the women left jail. While delivering SHE, we observed: 1) the cross-cutting nature of women’s health risk factors, i.e. the risks that jailed women faced for cervical cancer also could lead to other women’s health problems; and 2) opportunity for taking an evidence-based intervention, with a rich theoretical framing, to expand to other women’s health issues faced by this group, around, not only cervical cancer prevention, but also breast cancer, unintended pregnancy, and STI prevention. While following women after release from jail (85% follow-up rate after 3 years), we also identified strategies for reaching this high-risk population through electronic communication. SHE participants were high users of mobile phones (88%), text (76%), Web (79%), and Facebook (70%). This renewal application presents an opportunity to holistically address health disparities experienced by women leaving jail and test new modalities for intervention delivery given their use of electronic communication and social media. In our first aim, we will assess the feasibility and pilot effectiveness of ‘SHE-Women’, an electronic women’s health literacy intervention, with women leaving jail. The second aim uses an RCT to test the effectiveness of SHE-Women with women leaving jail on increasing women’s health literacy, screening, and risk reduction practices (for cervical, breast cancer, unintended pregnancy, and STIs) against a standard of care. Our third aim will be to understand the role and impact of human interaction in electronic interventions by tracking participants and interviewing key stakeholders. Knowledge gained from this study will lead to an understanding of: 1) how a comprehensive women’s health literacy intervention can narrow health disparities among justice-involved women and 2) the role of human interaction in successful electronic interventions, thereby creating a sustainable model for dissemination of health promotion interventions.




COVID-19 and influenza vaccine uptake in women with criminal-legal system involvement.
Authors: Asupoto O. , Li X. , Hemberg J.L. , Emerson A. , Black D. , Geana M.V. , Wickliffe J. , Glenn J. , Ramaswamy M. , Wurcel A.G. .
Source: Vaccine, 2024-08-30 00:00:00.0; 42(21), p. 126176.
EPub date: 2024-07-30 00:00:00.0.
PMID: 39079808
Related Citations

Characterizing Aging-Related Health in Older Women with a History of Incarceration: Multimorbidity, Polypharmacy, Mortality, Frailty, and Depression.
Authors: Emerson A. , Li X. , Zaller N. , Ramaswamy M. .
Source: Journal Of Aging And Health, 2024-02-20 00:00:00.0; , p. 8982643241233322.
EPub date: 2024-02-20 00:00:00.0.
PMID: 38374771
Related Citations

Menstrual Equity in the Criminal Legal System.
Authors: Darivemula S. , Knittel A. , Flowers L. , Moore S. , Hall B. , Kelecha H. , Li X. , Ramaswamy M. , Kelly P.J. .
Source: Journal Of Women's Health (2002), 2023 Sep; 32(9), p. 927-931.
EPub date: 2023-08-03 00:00:00.0.
PMID: 37535828
Related Citations

Decentering trust to connect with criminal legal system-involved women in research.
Authors: Hemberg J. , Wickliffe J. , Ramaswamy M. .
Source: Journal Of Communication In Healthcare, 2023-09-01 00:00:00.0; , p. 1-5.
EPub date: 2023-09-01 00:00:00.0.
PMID: 37655725
Related Citations

Sex and aging: Perspectives of older adult women with experience of incarceration.
Authors: Emerson A. , Valleroy E. , Knittel A. , Ramaswamy M. .
Source: Journal Of Women & Aging, 2023-02-25 00:00:00.0; , p. 1-17.
EPub date: 2023-02-25 00:00:00.0.
PMID: 36840534
Related Citations

Decreased Homelessness among Women Involved in the Criminal Legal System after a COVID-19 Housing Intervention.
Authors: Lorvick J. , Hemberg J.L. , Browne E.N. , Alter H. , Comfort M.L. .
Source: Journal Of Social Distress And The Homeless, 2023; 32(2), p. 377-380.
EPub date: 2022-04-12 00:00:00.0.
PMID: 38144398
Related Citations

A Scoping Review of Digital Health Interventions to Promote Healthy Romantic Relationships in Adolescents.
Authors: Emerson A. , Pickett M. , Moore S. , Kelly P.J. .
Source: Prevention Science : The Official Journal Of The Society For Prevention Research, 2022-08-17 00:00:00.0; , .
EPub date: 2022-08-17 00:00:00.0.
PMID: 35976523
Related Citations

Health and Health Service Needs: Comparison of Older and Younger Women with Criminal-Legal Involvement in Three Cities.
Authors: Emerson A. , Lipnicky A. , Comfort M. , Lorvick J. , Cropsey K. , Smith S. , Ramaswamy M. .
Source: Journal Of Aging And Health, 2022 01; 34(1), p. 60-70.
EPub date: 2021-06-12 00:00:00.0.
PMID: 34120499
Related Citations

Associations among betrayal trauma, dissociative posttraumatic stress symptoms, and substance use among women involved in the criminal legal system in three US cities.
Authors: Mildrum Chana S. , Wolford-Clevenger C. , Faust A. , Hemberg J. , Ramaswamy M. , Cropsey K. .
Source: Drug And Alcohol Dependence, 2021-10-01 00:00:00.0; 227, p. 108924.
EPub date: 2021-07-27 00:00:00.0.
PMID: 34333280
Related Citations

A phenomenological reflection on women's lived experience of giving in circumstances of material scarcity.
Authors: Emerson A.M. .
Source: Nursing Inquiry, 2021-08-30 00:00:00.0; , p. e12456.
EPub date: 2021-08-30 00:00:00.0.
PMID: 34462991
Related Citations

COVID-19 vaccine hesitancy among women leaving jails: A qualitative study.
Authors: Geana M.V. , Anderson S. , Ramaswamy M. .
Source: Public Health Nursing (boston, Mass.), 2021-05-11 00:00:00.0; , .
EPub date: 2021-05-11 00:00:00.0.
PMID: 33973268
Related Citations

Managing Technology, Content, and User Experience: An mHealth Intervention to Improve Women's Health Literacy after Incarceration.
Authors: Geana M.V. , Anderson S. , Lipnicky A. , Wickliffe J.L. , Ramaswamy M. .
Source: Journal Of Health Care For The Poor And Underserved, 2021 May; 32(2 Suppl), p. 106-127.
PMID: 37333690
Related Citations

Sources of Information and Health Care Experiences Related to COVID-19 among Women Involved in Criminal Legal System in Three U.S. Cities.
Authors: Lorvick J. , Hemberg J. , Cropsey K. , Wickliffe J. , Faust A. , Comfort M. , Ramswamy M. .
Source: Archives Of Women Health And Care, 2020 Dec; 3(5), .
EPub date: 2020-10-08 00:00:00.0.
PMID: 34661199
Related Citations

Correlates of sexually transmitted infection testing following women's release from jail.
Authors: Pickett M.L. , Lee J. , Brousseau D.C. , Satterwhite C. , Ramaswamy M. .
Source: Women & Health, 2020 Nov-Dec; 60(10), p. 1109-1117.
EPub date: 2020-08-05 00:00:00.0.
PMID: 32757716
Related Citations

A State-Level Examination of School Nurses' Perceptions of Condom Availability Accompanied by Sex Education.
Authors: Smith S. , Platt J.M. , Clifford D. , Preston M. , Satterwhite C. , Kelly P.J. , Ramaswamy M. .
Source: The Journal Of School Nursing : The Official Publication Of The National Association Of School Nurses, 2020 Oct; 36(5), p. 386-393.
EPub date: 2019-01-22 00:00:00.0.
PMID: 30669935
Related Citations

Criminal Justice-Involved Women Navigate COVID-19: Notes From the Field.
Authors: Ramaswamy M. , Hemberg J. , Faust A. , Wickliffe J. , Comfort M. , Lorvick J. , Cropsey K. .
Source: Health Education & Behavior : The Official Publication Of The Society For Public Health Education, 2020 08; 47(4), p. 544-548.
EPub date: 2020-05-08 00:00:00.0.
PMID: 32380869
Related Citations

A Systematic Evaluation of Barriers and Facilitators to the Provision of Services for Justice-Involved Women.
Authors: Smith S. , Wickliffe J. , Rivera-Newberry I. , Redmond M. , Kelly P.J. , Ramaswamy M. .
Source: Journal Of Community Health, 2020-07-31 00:00:00.0; , .
EPub date: 2020-07-31 00:00:00.0.
PMID: 32737745
Related Citations

Developing a Cancer Prevention Health Education Resource: a Primer of Process and Evaluation.
Authors: Kelly P.J. , Driscoll D. , Lipnicky A. , Anderson S. , Glenn J. , Ramaswamy M. .
Source: Journal Of Cancer Education : The Official Journal Of The American Association For Cancer Education, 2020-06-25 00:00:00.0; , .
EPub date: 2020-06-25 00:00:00.0.
PMID: 32583352
Related Citations

Facebook as a follow-up tool for women with criminal justice histories.
Authors: Lipnicky A. , Kelly P.J. , Ramaswamy M. .
Source: International Journal Of Prisoner Health, 2020-04-10 00:00:00.0; 16(2), p. 117-122.
PMID: 33634650
Related Citations

Voter Registration and Jail-Incarcerated Women: Are Justice-Involved Women Civically Engaged?
Authors: Emerson A. , Allison M. , Ramaswamy M. .
Source: Women & Criminal Justice, 2020; 30(3), p. 172-187.
EPub date: 2019-04-11 00:00:00.0.
PMID: 32742078
Related Citations

Justice-involved women's preferences for an internet-based Sexual Health Empowerment curriculum.
Authors: Pickett M.L. , Wickliffe J. , Emerson A. , Smith S. , Ramaswamy M. .
Source: International Journal Of Prisoner Health, 2019-08-20 00:00:00.0; 16(1), p. 38-44.
PMID: 32040270
Related Citations

Effectiveness of a Kansas City, Jail-Based Intervention to Improve Cervical Health Literacy and Screening, One-Year Post-Intervention.
Authors: Emerson A.M. , Smith S. , Lee J. , Kelly P.J. , Ramaswamy M. .
Source: American Journal Of Health Promotion : Ajhp, 2019-07-17 00:00:00.0; , p. 890117119863714.
EPub date: 2019-07-17 00:00:00.0.
PMID: 31315420
Related Citations

The role of the community health delivery system in the health and well-being of justice-involved women: a narrative review.
Authors: Smith S.A. , Mays G.P. , Collins T.C. , Ramaswamy M. .
Source: Health & Justice, 2019-06-28 00:00:00.0; 7(1), p. 12.
EPub date: 2019-06-28 00:00:00.0.
PMID: 31254119
Related Citations

Retention Strategies in Working With Justice-Involved Women.
Authors: Wickliffe J. , Kelly P.J. , Allison M. , Emerson A. , Ramaswamy M. .
Source: Journal Of Correctional Health Care : The Official Journal Of The National Commission On Correctional Health Care, 2019-06-26 00:00:00.0; , p. 1078345819853310.
EPub date: 2019-06-26 00:00:00.0.
PMID: 31242801
Related Citations

A Research Agenda for Emergency Medicine-based Adolescent Sexual and Reproductive Health.
Authors: Miller M.K. , Chernick L.S. , Goyal M.K. , Reed J.L. , Ahmad F.A. , Hoehn E.F. , Pickett M.S. , Stukus K. , Mollen C.J. .
Source: Academic Emergency Medicine : Official Journal Of The Society For Academic Emergency Medicine, 2019-05-31 00:00:00.0; , .
EPub date: 2019-05-31 00:00:00.0.
PMID: 31148339
Related Citations

Feminism and Bourdieusian Social Theory in a Sexual Health Empowerment Project with Incarcerated and Recently Released Women.
Authors: Emerson A.M. , Wickliffe J. , Kelly P.J. , Ramaswamy M. .
Source: Social Theory & Health : Sth, 2019 Mar; 17(1), p. 57-74.
EPub date: 2018-05-03 00:00:00.0.
PMID: 30853856
Related Citations

Validating self-reported cervical cancer screening among women leaving jails.
Authors: Webb S. , Kelly P.J. , Wickliffe J. , Ault K. , Ramaswamy M. .
Source: Plos One, 2019; 14(7), p. e0219178.
EPub date: 2019-07-01 00:00:00.0.
PMID: 31260465
Related Citations

Assessing fidelity: balancing methodology and reality in jail interventions.
Authors: Kelly P.J. , Emerson A. , Fair C. , Ramaswamy M. .
Source: Bmc Women's Health, 2018-07-23 00:00:00.0; 18(1), p. 127.
EPub date: 2018-07-23 00:00:00.0.
PMID: 30037333
Related Citations

Narrative Inquiry Into Shelter-Seeking by Women With a History of Repeated Incarceration: Research and Nursing Practice Implications.
Authors: Emerson A.M. .
Source: Ans. Advances In Nursing Science, 2018-06-12 00:00:00.0; , .
EPub date: 2018-06-12 00:00:00.0.
PMID: 29901467
Related Citations

Strategizing and Fatalizing: Self and Other in the Trauma Narratives of Justice-Involved Women.
Authors: Emerson A.M. .
Source: Qualitative Health Research, 2018-02-01 00:00:00.0; , p. 1049732318758634.
EPub date: 2018-02-01 00:00:00.0.
PMID: 29478403
Related Citations

Cervical cancer screening among incarcerated women.
Authors: Kelly P.J. , Allison M. , Ramaswamy M. .
Source: Plos One, 2018; 13(6), p. e0199220.
EPub date: 2018-06-26 00:00:00.0.
PMID: 29944694
Related Citations

Breast Cancer Risk Among Women in Jail.
Authors: Pickett M.L. , Allison M. , Twist K. , Klemp J.R. , Ramaswamy M. .
Source: Bioresearch Open Access, 2018; 7(1), p. 139-144.
EPub date: 2018-09-20 00:00:00.0.
PMID: 30250761
Related Citations

Corrigendum to "Impact of a brief intervention on cervical health literacy: A waitlist control study with jailed women" [Prev. Med. Rep. 6 (2017) 314-321].
Authors: Ramaswamy M. , Lee J. , Wickliffe J. , Allison M. , Emerson A. , Kelly P.J. .
Source: Preventive Medicine Reports, 2017 Dec; 8, p. 303-305.
EPub date: 2017-12-06 00:00:00.0.
PMID: 29881669
Related Citations

Impact of a brief intervention on cervical health literacy: A waitlist control study with jailed women.
Authors: Ramaswamy M. , Lee J. , Wickliffe J. , Allison M. , Emerson A. , Kelly P.J. .
Source: Preventive Medicine Reports, 2017 Jun; 6, p. 314-321.
EPub date: 2017-04-05 00:00:00.0.
PMID: 28435785
Related Citations

Closing the cervical cancer disparity gap.
Authors: Kelly P.J. , Ramaswamy M. .
Source: Public Health Nursing (boston, Mass.), 2017 May; 34(3), p. 195-196.
PMID: 28493356
Related Citations

Challenges To Pap Smear Follow-up Among Women In The Criminal Justice System
Authors: Kelly P.J. , Hunter J. , Daily E.B. , Ramaswamy M. .
Source: Journal Of Community Health, 2016-07-22 00:00:00.0; , .
PMID: 27449030
Related Citations

"the Vagina Is A Very Tricky Little Thing Down There": Cervical Health Literacy Among Incarcerated Women
Authors: Ramaswamy M. , Kelly P.J. .
Source: Journal Of Health Care For The Poor And Underserved, 2015 Nov; 26(4), p. 1265-85.
PMID: 26548678
Related Citations

The Development Of A Brief Jail-based Cervical Health Promotion Intervention
Authors: Ramaswamy M. , Simmons R. , Kelly P.J. .
Source: Health Promotion Practice, 2015 May; 16(3), p. 432-42.
PMID: 25063589
Related Citations