Urban Jail Research Articles

COVID-19 in the New York City Jail System: Epidemiology and Health Care Response, March-April 2020.

People detained in correctional facilities are at high risk for infection with severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19). We described the epidemiology of the COVID-19 outbreak in a large urban jail system, including signs and symptoms at time of testing and risk factors for hospitalization. This retrospective observational cohort study included all patients aged ≥18 years who were tested for COVID-19 during March 11-April 28, 2020, while in custody in the New York City jail system (N = 978). We described demographic characteristics and signs and symptoms at the time of testing and performed Cox regression analysis to identify factors associated with hospitalization among those with a positive test result. Of 978 people tested for COVID-19, 568 received a positive test result. Among symptomatic patients, the most common symptoms among those who received a positive test result were cough (n = 293 of 510, 57%) and objective fever (n = 288 of 510, 56%). Of 257 asymptomatic patients who were tested, 58 (23%) received a positive test result. Forty-five (8%) people who received a positive test result were hospitalized for COVID-19. Older age (aged ≥55 vs 18-34) (adjusted hazard ratio [aHR] = 13.41; 95% CI, 3.80-47.33) and diabetes mellitus (aHR = 1.99; 95% CI, 1.00-3.95) were significantly associated with hospitalization. A substantial proportion of people tested in New York City jails received a positive test result for COVID-19, including a large proportion of people tested while asymptomatic. During periods of ongoing transmission, asymptomatic screening should complement symptom-driven COVID-19 testing in correctional facilities. Older patients and people with diabetes mellitus should be closely monitored after COVID-19 diagnosis because of their increased risk for hospitalization.

Establishing an Epidemiologic Profile of Hepatitis C Virus Infection at the Los Angeles County Jail

The hepatitis C virus (HCV) is the most common blood-borne infection in the United States. Although 2% to 3% of the global population is estimated to be infected with HCV, an estimated 18% of the US prison population may be infected. The objective of this study was to establish an epidemiologic profile of HCV infection in the largest urban jail system in the United States. We retrospectively analyzed 20 years of data on demographic characteristics, risk factors, and HCV positivity among 80 681 individuals incarcerated at the Los Angeles County Jail who were tested for HCV infection from January 1, 2000, through December 31, 2019. We used multivariate logistic regression analysis to determine predictors of HCV positivity. Of the 80 681 individuals tested, 27 881 (34.6%) had positive test results for HCV infection. In the multivariate analysis, HCV positivity was most strongly associated with injection drug use (adjusted odds ratio [aOR] = 34.9; 95% CI, 24.6-49.5) and being born during 1946-1955 (aOR = 13.0; 95% CI, 11.9-14.2). Men were more likely than women to have HCV infection (aOR = 1.4; 95% CI, 1.3-1.5), and Hispanic (aOR = 4.2; 95% CI, 3.9-4.4) and non-Hispanic White (aOR = 3.8; 95% CI, 3.5-4.0) individuals were more likely than non-Hispanic African American individuals to have HCV infection. Noninjection drug use, homelessness, and mental health issues were also significantly associated with HCV positivity. Even in the absence of resources for universal screening for HCV infection, the creation of a risk profile and its implementation into a screening program may be a beneficial first step toward improving HCV surveillance and establishing an accurate estimate of HCV infection in the incarcerated population.

Effectiveness of interventions to reduce COVID-19 transmission in a large urban jail: a model-based analysis

ObjectivesWe aim to estimate the impact of various mitigation strategies on COVID-19 transmission in a US jail beyond those offered in national guidelines.DesignWe developed a stochastic dynamic transmission model of...

Genomic Epidemiological Insights Into MRSA Transmission and Adaptation in an Urban Jail and the Surrounding Community

Genomic Epidemiological Insights Into MRSA Transmission and Adaptation in an Urban Jail and the Surrounding Community

1064. Hepatitis C Epidemiology at the Dallas County Jail: A Changing Demographic

BackgroundNearly 1 in 3 people living with HCV pass through the CJ system each year. As a result, the CJ system is a crucial location for Hepatitis C screening, education and linkage to care. We aim to 1) identify the prevalence and incidence of HCV and 2) evaluate HCV demographic trends at a large urban jail.MethodsUniversal opt-out HCV testing was offered in four separate testing cycles from 2015 to 2019 to any individual undergoing a routine blood draw at the Dallas County Jail (N=14490; Figure 1). HCV antibody (Ab) assay (LabCorp) was used with reflex RNA testing added on in 2017. Demographic variables were extracted from the electronic medical record for all tested, with risk factors collected from those who tested positive for HCV Ab (HCV Ab+). Multivariate logistic regression was performed.Figure 1. HCV Ab and HCV RNA positivity among people screened for HCV in the Dallas County Jail from 2015 to 2019 (N=14490). ResultsThe prevalence of HCV Ab+ was 16.7% in the Dallas County Jail; 75.3% of those who tested HCV Ab+ were also HCV RNA+ (Figure 1). The HCV Ab+ incidence rate was 13.5 cases per 1000 person-years. People who were HCV Ab+ were more frequently (adjusted odds ratio [95% confidence interval], p-value): older (1.07 (1.06-1.07), p< 0.001), female (1.24 [1.07-1.44], p=0.004), white (2.12 [1.83-2.45], p< 0.001), and in the birth cohort 1945-65 (1.79 [1.44-2.23], p< 0.001; Table 1). In earlier birth cohorts (1940s), black men were more often HCV Ab+; in more recent birth cohorts (1990s), white and Hispanic females were more often HCV Ab+ (Figure 2). Among individuals who tested HCV Ab+, IDU was more frequently reported by white individuals, particularly women, compared to black individuals (p< 0.001; Figure 3).Table 1. Demographic predictors of Hepatitis C Antibody positivity among those undergoing routine blood draws from 2015-19 at the Dallas County Jail (AIC 7041; BIC 7048; df 10; p<0.001). Figure 2. Trends of Hepatitis C Antibody prevalence and demographic prevalence ratios by birth year (prevalence ratio= proportion with disease/proportion with exposure) among people at the Dallas County Jail screened from 2017-2019 (N=10183). Demographic prevalence ratios were categorized by race (White, Hispanic, Black) and gender (Male, Female) into six categories. Gray bars represent the overall prevalence of HCV Ab+ by birth year. Figure 3. The racial demographics of injection drug use by gender among those who tested HCV Ab positive at the Dallas County Jail in 2017-2018 (n=672; total population p<0.001; male p=0.004; female p=0.008). ConclusionThe high prevalence and incidence of HCV at the Dallas County Jail argues for routine, universal testing and linkage to treatment. Additionally, demographic trends mirror the IDU epidemic and have valuable implications for risk reduction and treatment interventions.Disclosures Ank E. Nijhawan, MD, MPH, Gilead (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)

The health effects of gendered and devalued work: health outcomes of incarcerated women engaging in sex work and care/service work

BackgroundWomen with a history of incarceration are often engaged in highly gendered work, either sex work or low-wage care/service work jobs. While employment is an important element of reentry plans, low-wage jobs may not necessarily help women leave illicit activities, including commercial sex work. Incarcerated women often move between care/service work and sex work to supplement income, putting them at greater risk for negative health outcomes.ResultsUsing survey data from 400 women detained in a large urban jail, we examined how incarcerated women’s experience with sex work and low-wage care/service work affects four health-related outcomes: overall health concerns, clinical depression, regular drug use, and self-esteem. Of the survey participants, 24% engaged exclusively in sex work and 34% in care/service work. However, 41% of women held both sex work and care/service work jobs, prior to incarceration. Compared to women engaged in care/service work, a greater proportion of women engaged in sex work reported overall health concerns, clinical depression, and regular drug use. On the other hand, women in care/service work jobs exclusively reported lower levels of self-esteem than women engaging in sex work.ConclusionsMany reentry programs emphasize the importance of employment for former inmates, and yet, job options for women detained in jail are often limited to low-wage care/service jobs, which do not necessarily provide adequate security to lift women’s economic burdens. Consequently, many women with a history of incarceration may supplement their income with sex work to meet their basic economic needs. However, both of these highly gendered and devalued jobs may negatively affect health and wellbeing of women.

Work-Family Conflict, Depression, and Burnout Among Jail Correctional Officers: A 1-Year Prospective Study.

BackgroundCorrectional officers (COs) experience elevated rates of mental and physical ill-health as compared with other general industry and public safety occupations. The purpose of this study was to investigate demographic, mental health, job tenure, and work–family characteristics and their prospective association to burnout within and between jail officers during one year of new employment.MethodsIn 2016, newly hired jail officers (N = 144) completed self-reported surveys across four time points in a one-year prospective study at a Midwestern United States urban jail. Linear mixed-effects and growth modeling examined how work–family conflict (W-FC) and depressive symptoms relate to perceptions of burnout over time.ResultsJail officer burnout increased and was related to rises in W-FC and depression symptoms. Within-person variance for W-FC (Bpooled = .52, p < .001) and depression symptoms (Bpooled = .06, p < .01) were significant predictors of burnout. Less time on the job remained a significant predictor of burnout across all analyses (Bpooled = .03, p < .001).ConclusionsResults from this study indicate that burnout increased during the first year of new employment; and increased W-FC, higher depression, and brief tenure were associated with burnout among jail COs. Future study of correctional workplace health is needed to identify tailored, multilevel interventions that address burnout and W-FC prevention and early intervention among COs.

Estimation of COVID-19 basic reproduction ratio in a large urban jail in the United States

PurposeTo estimate the basic reproduction ratio () of SARS-CoV-2 inside a correctional facility early in the COVID-19 pandemic. MethodsWe developed a dynamic transmission model for a large, urban jail in the United States. We used the next generation method to determine the basic reproduction ratio We included anonymized data of incarcerated individuals and correctional staff with confirmed COVID-19 infections in our estimation of the basic reproduction ratio () of SARS-CoV-2. ResultsThe estimated is 8.44 (95% Credible Interval (CrI): 5.00-13.13) for the entire jail. ConclusionsThe high of SARS-CoV-2 in a large urban jail highlights the importance of including correctional facilities in public health strategies for COVID-19. In the absence of more aggressive mitigation strategies, correctional facilities will continue to contribute to community infections.

Cost-effectiveness analysis of a large jail-based methadone maintenance treatment continuation program in New Mexico

The U.S. has the second-highest incarceration rate in the world and spends more than $80 billion annually to house inmates. The clinical research literature suggests that methadone maintenance treatment (MMT) is an effective method to treat opioid use disorders (OUD) and that jails are a potentially valuable environment to implement MMT. Currently, jail-based MMT is rarely implemented in practice, due in part to resource limitations and other economic considerations. The primary goal of this study was to perform a cost-effectiveness analysis (CEA) of jail-based MMT using data from a unique MMT continuation program located in a large urban jail in New Mexico. Recidivism data were collected for a three-year period both before and after incarceration, and quasi-control groups were constructed from both substance-using and general populations within the jail. Base models show that inmates enrolled in jail-based MMT exhibited significantly fewer days of incarceration due to recidivism (29.33) than a group of inmates with OUDs who did not receive MMT. Economic estimates indicate that it cost significantly less ($23.49) to reduce an incarcerated day using jail-based MMT than incarceration per se ($116.49). To mitigate potential sample selection bias, we used both propensity-score-matching and difference-in-differences estimators, which provided comparable estimates when using the OUD non-MMT comparison group. Difference-in-differences models find that, on average, MMT reduced recidivism by 24.80 days and it cost $27.78 to reduce an incarcerated day using jail-based MMT. Assuming a willingness to pay threshold of the break-even cost of reducing one incarcerated day, we estimate a 93.3% probability that this MMT program is cost-effective. Results were not as strong or consistent when using other comparison groups (e.g., alcohol-detoxified and general-population inmates). Overall, results suggest that it costs substantially less to provide jail-based MMT than incarceration alone. Jail administrators and policymakers should consider incorporating MMT in other jail systems and settings.

Evaluation of the Jail-Based Occupational Therapy Transition and Integration Services Program for Community Reentry.

Transition and integration reentry services continue to grow in carceral settings; however, related provision of occupational therapy is limited. To examine the implementation fidelity of an occupational therapy-administered interprofessional reentry program initiated in an urban jail. Retrospective, mixed quantitative and qualitative design. Community-based reentry services provided prerelease in a Midwestern urban jail and postrelease in the local St. Louis community. Occupational therapy practitioners tracking process measures for identifying reentry project feasibility. Provision of recruitment, assessment, and skilled occupational therapy services with people held in a short-term jail facility and follow-up during community reentry. Detailed logs were analyzed to describe attendance at and duration of sessions. We coded barriers to and facilitators of implementation from weekly team meeting notes and logs using social-ecological categories. Findings indicate that it was feasible to implement prerelease jail-based services (N = 63) because of jail operations and community partnerships (facilitators) and to overcome institutional policies and environmental limitations (barriers). Full 8-wk prerelease programming was completed by 38% (n = 24) of participants, and 52% (n = 33) participated less than 8 wk. All who completed the full prerelease program and transitioned to the community (n = 15) initiated postrelease occupational therapy services. The iterative feedback provided by process evaluation supported the feasibility of implementing the jail-based Occupational Therapy Transition and Integration Services program. This process evaluation provides evidence that implementation of an occupational therapy-based transition program in an urban jail is feasible.

Total Worker Health® Needs Assessment to Identify Workplace Mental Health Interventions in Rural and Urban Jails.

Jail officers are an underserved population of public safety workers at high risk for developing chronic mental health conditions. In response to national calls for the examination of stressors related to the unique work contexts of correctional facilities, we implemented a pilot study informed by the Total Worker Health® (TWH) strategy at two urban and two rural jails. Participatory teams guided areas of interest for a mixed-data needs assessment, including surveys with 320 jail officers to inform focus groups (N = 40). Urban and rural jails in the midwestern United States. Jail correctional officers and sheriff's deputies employed at participating jails. We measured mental health characteristics using the Patient-Reported Outcomes Measurement Information System Global Mental Health scale, the Center for Epidemiologic Studies Depression scale, and the two-item Posttraumatic Stress Disorder Checklist. Constructs to identify workplace characteristics included emotional support, work-family conflict, dangerousness, health climate, organizational operations, effectiveness of training, quality of supervision, and organizational fairness. On the basis of general population estimates, we found that jail officers were at higher risk for mental health disorders, including depression and posttraumatic stress disorder. Jail officers identified workplace health interventions to address individual-, interpersonal-, institutional-, and community-level needs. Implementation of a TWH needs assessment in urban and rural jails to identify evidence-informed, multilevel interventions was found to be feasible. Using this assessment, we identified specific workplace health protection and promotion solutions. Results from this study support the profession's vision to influence policies, environments, and systems through collaborative work. This TWH study has implications for practice and research by addressing mental health needs among jail officers and by providing practical applications to create evidence-informed, tailored interventions to promote workplace health in rural and urban jails.

Health Literacy Assessment of Detained Individuals and Correctional Officers Within a Large Urban Jail: Optimizing Health Education.

Little research has been done to address the health literacy level of detained individuals and correctional officers. The aim of this pilot project was to describe the health literacy of individuals detained or working within a large urban jail to inform their health education. Health literacy assessments were conducted using the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) and the Newest Vital Sign (NVS) tools. Of the 48 participants, 17% (n = 8) exhibited low health literacy on the REALM-SF, whereas 38% (n = 18) demonstrated the need for improved health literacy when assessed with the NVS. Detained individuals from the women's tiers were more likely to have lower health literacy than the detained veterans or correctional officers. Results indicate that tailored health education programming, using evidence-based health literacy improvement techniques, should be offered to the individuals detained or working within a correctional facility.

Frequent Methicillin-Resistant Staphylococcus aureus Introductions Into an Inner-city Jail: Indications of Community Transmission Networks.

Jails may facilitate spread of methicillin-resistant Staphylococcus aureus (MRSA) in urban areas. We examined MRSA colonization upon entrance to a large urban jail to determine if there are MRSA transmission networks preceding incarceration. Males incarcerated in Cook County Jail (Chicago) were enrolled, with enrichment for people living with human immunodeficiency virus (PLHIV), within 72 hours of intake. Surveillance cultures assessed prevalence of MRSA colonization. Whole-genome sequencing (WGS) identified preincarceration transmission networks.We examined methicillin-resistant Staphylococcus aureus (MRSA) isolates to determine if there are transmission networks that precede incarceration. A large proportion of individuals enter jail colonized with MRSA. Molecular epidemiology and colonization risk factors provide clues to community reservoirs for MRSA. There were 718 individuals (800 incarcerations) enrolled; 58% were PLHIV. The prevalence of MRSA colonization at intake was 19%. In multivariate analysis, methamphetamine use, unstable housing, current/recent skin infection, and recent injection drug use were predictors of MRSA. Among PLHIV, recent injection drug use, current skin infection, and HIV care at outpatient clinic A that emphasizes comprehensive care to the lesbian, gay, bisexual, transgender community were predictors of MRSA. Fourteen (45%) of 31 detainees with care at clinic A had colonization. WGS revealed that this prevalence was not due to clonal spread in clinic but rather to an intermingling of distinct community transmission networks. In contrast, genomic analysis supported spread of USA500 strains within a network. Members of this USA500 network were more likely to be PLHIV (P < .01), men who have sex with men (P < .001), and methamphetamine users (P < .001). A large proportion of individuals enter jail colonized with MRSA. Molecular epidemiology and colonization risk factors provide clues to identify colonized detainees entering jail and potential community reservoirs of MRSA.

Smoking and Smoking Cessation Among Criminal Justice-Involved Older Adults.

Background:In jails and prisons worldwide, older adults are among the fastest growing demographic groups. Criminal justice–involved populations smoke tobacco at high rates. Older adults are also disproportionate smokers and have more difficulty quitting smoking than other age groups. Yet, little is known about tobacco use or knowledge and attitudes toward smoking cessation among the growing population of incarcerated older adults.Methods:A descriptive, cross-sectional survey study of 102 adults aged 55 years or older recently incarcerated in an urban jail using items from the Global Adult Tobacco Survey (GATS).Results:More than 70% of participants reported being current smokers despite strong knowledge (95%) of the connection between smoking and serious illness. More than half of current smokers reported a past failed quit attempt (62%) and/or said they would like to quit (60%).Conclusions:High rates of tobacco use in this population suggest that correctional institutions represent a critical site for the delivery of appropriate smoking cessation interventions to older adults, including integrated treatment approaches for those with co-occurring behavioral health diagnoses.

“They don’t know what it’s like in here”: Incarcerated individuals’ communication with family members

The incarcerated population is large and growing. Maintaining family connections during confinement is linked to positive outcomes, yet the family communication of incarcerated individuals is understudied. We examine the family communication of individuals incarcerated in an urban county jail for women. Four family communication themes were identified: 1) communication access and understanding, 2) family support, 3) parenting challenges, and 4) family conflict. The findings inform both theoretical and practical implications.

“No One Wants to Die Alone”: Incarcerated Patients' Knowledge and Attitudes About Early Medical Release

ContextDeaths among incarcerated individuals have steadily increased in the U.S., exceeding 5000 in 2014. Nearly every state has a policy to allow patients with serious life-limiting illness to apply for release from prison or jail to die in the community (“early medical release”). Although studies show these policies are rarely used, patient-level barriers to their use are unknown. ObjectivesTo assess incarcerated patients' knowledge of early medical release policies and to identify patient-level barriers to accessing these policies. MethodsA cross-sectional survey of 46 male patients in two state prisons and one large urban jail who had visited a primary care provider at least three times within three months was conducted. ResultsParticipants' average age was 64 years, and 89% had more than one chronic illness. Fewer than half (43%) demonstrated the knowledge needed to apply for early medical release and 22% demonstrated no relevant knowledge. Participants with sufficient knowledge were significantly more likely to endorse anxiety (35% vs. 0%, P = .003) and loneliness (65% vs. 30%, P = .017). ConclusionMany medically complex incarcerated patients in this study did not demonstrate sufficient knowledge to apply for early medical release suggesting that patient education may help expand access to these policies. Moreover, seriously ill patients with knowledge of early medical release may benefit from enhanced psychosocial support given their disproportionate burdens of anxiety and loneliness. Our findings highlight the pressing need for larger studies to assess whether improved patient education and support can expand access to early medical release.

Social Determinants of Health and What Mothers Say They Need and Want After Release From Jail.

Identifying the biopsychosocial needs of mothers who have been released from jail is critical to understanding the best ways to support their health and stability after release. In May through August 2014, we interviewed 15 mothers who had been released from an urban jail about their reentry experiences, and we analyzed transcripts for themes. Eight domains of community reentry emerged through analysis: behavioral health services, education, employment, housing, material resources, medical care, relationships with children, and social support. Participants defined barriers to successful reentry, which paralleled the social determinants of health, and shared suggestions that could be used to mitigate these barriers.

159. Genomic Epidemiology of MRSA at Intake to a Large Inner-City Jail: Evidence for Community Transmission Networks?

BackgroundUSA300 is endemic in the community, with congregate settings potentially facilitating spread. The impact of community MRSA transmission networks on importation of MRSA into urban jails is unknown. We examined MRSA colonization isolates entering the jail and determined whether there are community transmission networks for MRSA that precede incarceration.MethodsHIV-infected and HIV-negative males incarcerated at the Cook County Jail were enrolled within 72 hours of intake. Surveillance cultures (nares, throat, and groin) were collected to determine prevalence of MRSA colonization. A survey was administered to identify predictors of colonization. Whole-genome sequencing (WGS) and phylogenetic analysis were integrated with epidemiologic data to identify community transmission networks.ResultsA total of 800 males were enrolled (83% AA and 9% Hispanic); 58% were HIV-infected. The prevalence of MRSA colonization at intake was 19%. In multivariate analysis, methamphetamine use (METH), unstable housing, and prior jail incarceration were significant predictors of MRSA. Among HIV patients, injection drug use and HIV care at outpatient Clinic A that emphasize comprehensive care to the LGBTQ community were significant predictors of MRSA. Of the 31 (45%) patients with care at Clinic A, 14 had MRSA colonization. We sequenced 145 isolates from unique individuals, with 102 and 13 closely related to USA300 and USA500 reference genomes, respectively. USA300 strains from intake were diverse (median pairwise SNV distance = 109), with several small clusters noted. WGS revealed the high prevalence of MRSA in Clinic A was not due to clonal spread but rather an intermingling of distinct community transmission networks (strains were highly diverse; median pairwise SNV distance = 410). We did identify a 13-member community transmission network underlying spread of USA500 (figure). Members of this network were more likely to be HIV-infected (P < 0.004), MSM (P < 0.001), and METH (P < 0.001).ConclusionA high proportion of individuals enter jail already colonized with MRSA and colonization risk factors provide clues to community reservoirs for MRSA. WGS extended epidemiologic analysis and revealed community transmission networks that could be a potential focus for an intervention. Disclosures All authors: No reported disclosures.

1229. Prevalence and Acquisition of MRSA in Females During Incarceration at a Large Inner-City Jail

BackgroundUSA300 MRSA is endemic in the community, with congregate settings such as urban jails potentially facilitating spread. It has been reported previously that males have a higher risk for MRSA carriage and bacteremia than females. However, it is unclear if there is differential risk for MRSA based on gender in high-risk populations. We determined the prevalence of MRSA colonization at jail entrance in females and defined an acquisition rate during incarceration.MethodsFemales incarcerated at the Cook County Jail, one of the largest US single-site jails, were enrolled within 72 hours of intake. Surveillance cultures (nares, throat, groin) were collected to determine prevalence of MRSA colonization. A survey was administered to identify predictors of colonization. Detainees in jail at Day30 had cultures repeated to determine MRSA acquisition. Univariate and multivariate analyses were performed to identify predictors of MRSA colonization.Results250 women were enrolled (70% AA, 15% Hispanic) with 70% previously in jail (21% in the past 6 months). The prevalence of MRSA colonization at intake was 20% (50/250), with 42% of those colonized solely in the throat or groin. This intake prevalence is comparable to the 19% for male detainees in a parallel study. 9% (2/23) of initially negative women who remained in jail for 30 days acquired MRSA; five remained colonized and no one lost colonization. Univariate predictors (table) of MRSA at entrance to the jail were: illicit drug use (including using needles), unstable housing, engaging in anal sex, and recent exchange of sex for drugs/money. Women who exchange sex for drugs/money (vs. not) reported higher rates of needle use (35% vs. 4%, P < 0.001) and unstable housing (80% vs. 20%, P < 0.001). With multivariate adjustment for race/ethnicity, needles for illicit drugs was a significant predictor of MRSA (OR 5.89, 95% CI, 1.66, 20.94, P = 0.006).ConclusionWe found that a high proportion (20%) of females entered jail colonized with MRSA, comparable to rates in males, suggesting that previously reported gender disparities in MRSA may not exist in high-risk populations. Entrance colonization risk factors suggest high-risk activities or venues in the community, with potential for directing gender-specific interventions. Disclosures All authors: No reported disclosures.

Mindfulness-Based Relapse Prevention in a Jail Drug Treatment Program

Background: More than half of prisoners in the United States are estimated to suffer from a substance use disorder. Mindfulness involves attention to the present moment, and nonjudgmental acceptance of sensations, thoughts, and emotional states. Mindfulness-based relapse prevention (MBRP) following substance use disorder treatment has been shown to reduce substance use. Objective: We sought to adapt and test MBRP for a jail substance use disorder treatment setting. Methods: We enrolled successive cohorts of incarcerated men participating in a drug treatment program in a large urban jail (n = 189) into six weekly sessions of either MBRP or an comparison communication skills intervention, between 2013 and 2015. MBRP was delivered by a culturally competent African–American trainer. Pre- and post-test measures included mindfulness, anxiety, posttraumatic stress disorder (PTSD), and drug craving. Results: At baseline, measures of mindfulness were significantly inversely correlated with anxiety, PTSD symptoms and drug cravings. Anxiety, PTSD symptoms and cravings declined significantly in both treatment arms, and mindfulness increased. Comparison of the two study arms using maximum likelihood estimation suggested a small but significantly greater increase in mindfulness in the treatment arm. Conclusions/Importance. An attention control trial of a mindfulness intervention, delivered by a culturally competent trainer, is feasible in a jail setting.