Background Over 20 million Americans are currently incarcerated or have been in the past. Most are from medically underserved populations; one in three African American men and one in six Latino men born in 2001 are projected to go to prison during their lifetimes. The amount of funding from the National Institutes of Health (NIH) to understand and improve the health of criminal justice-involved persons is unknown. Objective Describe NIH funding for research addressing the health and healthcare needs of criminal justice-involved individuals. Design Review of NIH grants (from 2008 through 2012) in the RePORT (Research Portfolio Online Reporting Tools) database. Setting The NIH RePORT database. Patients Criminal justice involved individuals participating in NIH-funded clinical research. Measurements NIH research and training grants awarded by number, type, research area, institute or center, and dollar amount. Results Of more than 250,000 NIH funded grants, 180 (less than 0.1%) focused on criminal justice health research. The three most common foci of criminal justice health research grants were substance use and/or HIV (64%), mental health (11%), and juvenile health (8%). Two institutes, the National Institute on Drug Abuse and the National Institute of Mental Health, funded 78% of all grants. In 2012, the NIH invested $40.9 million in criminal justice health research, or 1.5% of the $2.7 billion health disparities budget for that year. Limitations NIH-supported research that did not explicitly include current or former prisoners but may have relevance to criminal justice health was not included. Conclusions Federal funding for research focused on understanding and improving the health of criminal justice-involved persons is small, even when compared to the NIH’s overall investment in health disparities research. The NIH is well-positioned to transform the care of current and former prisoners by investing in this critical yet overlooked research area. Primary Funding Source One author received funding support from the National Institute on Aging at the National Institutes of Health and Tideswell at UCSF.

Among older adults, distressing symptoms are associated with decreased function, acute care use and mortality. The number of older jail inmates is increasing rapidly, prompting calls to develop systems of care to meet their healthcare needs. Yet little is known about multidimensional symptom burden in this population. This cross-sectional study describes the prevalence and factors associated with distressing symptoms and the overlap between different forms of symptom distress in 125 older jail inmates in an urban county jail. Physical distress was assessed using the Memorial Symptom Assessment Scale. Several other forms of symptom distress were also examined, including: psychological (GAD-2 and PHQ-2), existential (Patient Dignity Inventory), and social (Three Item Loneliness Scale). Participant sociodemographics, multimorbidity, serious mental illness (SMI), functional impairment and behavioral health risk factors were collected through self-report and chart review. Chi-squared tests were used to identify factors associated with physical distress. Overlap between forms of distress was evaluated using set theory analysis. Overall, many participants (74%) reported distressing symptoms including having one or more physical (44%), psychological (37%), existential (54%), or social (45%) symptom. Physical distress was associated with poor health (multimorbidity, functional impairment, SMI) and low income. Of the 93 participants with any symptom, 49% reported 3 or more forms of distress. These findings suggest that an optimal model of care for this population would include a geriatrics-palliative care approach that integrates the management of all forms of symptom distress into a comprehensive treatment paradigm stretching from jail to the community.