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Grant Details

Grant Number: 2R01CA181047-06 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: 2019
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Abstract

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.

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Publications

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; , p. 890117119863714.
EPub date: 2019-07-17.
PMID: 31315420
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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 Jul; 25(3), p. 231-237.
EPub date: 2019-06-26.
PMID: 31242801
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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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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; , .
EPub date: 2019-05-31.
PMID: 31148339
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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.
PMID: 30853856
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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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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; 18(1), p. 127.
EPub date: 2018-07-23.
PMID: 30037333
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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 Jul/Sep; 41(3), p. 260-274.
PMID: 29901467
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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.
PMID: 30250761
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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.
PMID: 29944694
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Strategizing and Fatalizing: Self and Other in the Trauma Narratives of Justice-Involved Women.
Authors: Emerson A.M. .
Source: Qualitative health research, 2018 05; 28(6), p. 873-887.
EPub date: 2018-02-24.
PMID: 29478403
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Closing the cervical cancer disparity gap.
Authors: Kelly P.J. , Ramaswamy M. .
Source: Public health nursing (Boston, Mass.), 2017 05; 34(3), p. 195-196.
PMID: 28493356
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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.
PMID: 28435785
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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, 2017 Feb; 42(1), p. 15-20.
PMID: 27449030
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"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 11; 26(4), p. 1265-85.
PMID: 26548678
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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.
EPub date: 2014-07-25.
PMID: 25063589
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