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Grant Details

Grant Number: 5R01CA226838-05 Interpret this number
Primary Investigator: Wickliffe, Joi
Organization: University Of Kansas Medical Center
Project Title: Tri-City Cervical Cancer Prevention Study Among Women in the Justice System
Fiscal Year: 2023


ABSTRACT Women with criminal justice histories persist as one of the groups most affected by cervical cancer, with 4- 5 times the rates of cancer compared to other women. Our research team has spent the last 8 years investigating the factors that account for this disparity. We have found that abnormal Pap tests are high, with sexual health risk, trauma, women's life circumstances, and low cervical health literacy as facilitators of risk and barriers to care. But questions remain about justice-involved women's screening trajectories over time given complex cervical screening recommendations and the difficulty of interfacing with health systems and navigating complex health insurance environments. Thus, there is insufficient information available to inform interventions that address justice-involved women's cervical cancer prevention needs in the community. The specific objective of this study is to develop a better understanding of the natural history of cervical cancer risk and prevention behaviors among community-based justice-involved women. The long-term goal of this study is to identify strategies for where and how to intervene to change the factors and environments that structure women's cervical health risk. We have a unique opportunity to conduct a natural history study of cervical health risk and screening among community-based justice-involved women in three geographically and demographically diverse cities. We plan to leverage three existing samples of community-based, justice-involved women – in Kansas City, MO, Birmingham, AL, and Oakland, CA – to become one of the first long-term cancer prevention studies of high-risk women across cities in the U.S. By studying three geographically and demographically diverse cities, we can draw conclusions about factors at each level of inquiry across study sites, accounting for variation in cities and increasing our ability to generalize findings. By leveraging samples generated by our ongoing projects in each city, we also offer a cost-effective and feasible way to engage in long-term follow-up of hard to reach women, with whom we've already established trust and rapport. In our first aim, we use the Behavioral Model for Vulnerable Populations (BMVP) to explain the natural history of cervical health risk behaviors, screening, and treatment among community-based justice-involved women (N~600) over a 5-year period in three cities. In the second aim, we use a mixed methods approach to unpack the ways in which significant domains of the BMVP operate in the daily lives of a subsample of women (N~60) recruited from the larger sample. Public health significance of this study centers on two products: 1) Development of a multi-level conceptual framework that explains the environment in which justice-involved women engage in cervical cancer prevention. 2) Creation of intervention models that address “upstream” determinants of health in clinical and service settings, while addressing justice-involved women's unique needs.


Cervical cancer screening barriers and facilitators from the perspectives of women with a history of criminal-legal system involvement and substance use.
Authors: Emerson A. , Dogan M. , Hawes E. , Wilson K. , Chana S.M. , Kelly P.J. , Comfort M. , Ramaswamy M. .
Source: Health & justice, 2024-02-26; 12(1), p. 9.
EPub date: 2024-02-26.
PMID: 38407688
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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 Dec; 16(4), p. 334-338.
EPub date: 2023-09-01.
PMID: 37655725
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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 Sep-Oct; 35(5), p. 487-503.
EPub date: 2023-02-25.
PMID: 36840534
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Perceived healthcare quality and contraception utilization among persons recently incarcerated.
Authors: Hall B. , Atrio J. , Moore S. , Lorvick J. , Cropsey K. , Ramaswamy M. .
Source: Journal of criminal justice, 2022 Nov-Dec; 83, .
EPub date: 2022-08-06.
PMID: 37663234
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Cervical Cancer Risk and Prevention Practices Among Sexual Minority Women with Criminal-Legal System Involvement.
Authors: Mansour Y. , Emerson A. , Lipnicky A. , Lorvick J. , Comfort M. , Mildrum Chana S. , Ramaswamy M. .
Source: Annals of LGBTQ public and population health, 2022 Jun; 3(2), p. 98-110.
PMID: 37727363
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Cervical Cancer Prevention Behaviors Among Criminal-Legal Involved Women from Three U.S. Cities.
Authors: Salyer C. , Lee J. , Lorvick J. , Comfort M. , Cropsey K. , Smith S. , Emerson A. , Ramaswamy M. .
Source: Journal of women's health (2002), 2022 Apr; 31(4), p. 533-545.
EPub date: 2021-10-14.
PMID: 34652231
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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 Jan; 34(1), p. 60-70.
EPub date: 2021-06-12.
PMID: 34120499
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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; 227, p. 108924.
EPub date: 2021-07-27.
PMID: 34333280
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Abnormal Pap Follow-Up among Criminal-Legal Involved Women in Three U.S. Cities.
Authors: Salyer C. , Lipnicky A. , Bagwell-Gray M. , Lorvick J. , Cropsey K. , Ramaswamy M. .
Source: International journal of environmental research and public health, 2021-06-18; 18(12), .
EPub date: 2021-06-18.
PMID: 34207093
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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.
PMID: 34661199
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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 Aug; 47(4), p. 544-548.
EPub date: 2020-05-08.
PMID: 32380869
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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, 2020 Jan; 34(1), p. 87-90.
EPub date: 2019-07-17.
PMID: 31315420
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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; 7(1), p. 12.
EPub date: 2019-06-28.
PMID: 31254119
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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.
PMID: 31260465
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