Health Literacy and Cardiovascular Health Among Formerly Incarcerated Individuals: Evidence from the JUSTICE Study
- 1Yale University School of Medicine
Abstract
BackgroundHealth literacy, defined as the ability to find, understand, and use health information, is a key determinant of cardiovascular disease but remains underexamined among individuals transitioning from incarceration to community life. This study examined the association between health literacy and cardiovascular health among adults recently released from incarceration.
MethodsUsing baseline data from the Justice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE) study, a prospective cohort of individuals with cardiovascular risk factors released from correctional facilities, we examined the association between health literacy, as measured by the Short Test of Functional Health Literacy in Adults, and cardiovascular health, as measured by the American Heart Associations Lifes Essential 8 (LE8).
ResultsAmong 439 participants (mean age 45 years), 32 (7%) demonstrated inadequate health literacy. Hispanic ethnicity (53% vs. 25%), less than high school education (50% vs. 20%), and homelessness (16% vs. 3.2%) were significantly associated with inadequate health literacy. In bivariate analyses, inadequate health literacy was associated with lower LE8 blood glucose (63.1 vs. 76.8, p = 0.02), and LE8 physical activity (19.4 vs. 32.2, p = 0.03), but higher LE8 diet (55.5 vs. 43.8, p = 0.04) scores. After adjusting for age, gender, race/ethnicity, education level, and housing status, inadequate health literacy remained independently associated with lower LE8 glucose scores ({beta} = -11.9, 95% CI: -22.9 to -0.8, p = 0.04).
ConclusionHealth literacy is a modifiable determinant of cardiovascular health, particularly glycemic control, in justice-involved populations. Interventions strengthening health literacy may help reduce health disparities among formerly incarcerated individuals.
Clinical PerspectiveO_ST_ABSWhat is new?C_ST_ABSWe find that lower health literacy among individuals recently released from incarceration is associated with poorer glycemic control, a key component of cardiovascular health, as measured by the American Heart Associations Lifes Essential 8 framework.
What are the clinical implications?Our data suggest that health literacy may represent a modifiable factor in cardiovascular risk reduction among formerly incarcerated individuals. Integrating literacy-sensitive education, chronic disease self-management support, and improved care coordination between the carceral and community health systems could strengthen cardiovascular prevention and promote long-term health equity.
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BibTeX
@misc{bouzarjomehri2026health,
title = {{Health Literacy and Cardiovascular Health Among Formerly Incarcerated Individuals: Evidence from the JUSTICE Study}},
author = {B. Bouzarjomehri and L. B. Puglisi and E. A. Wang and J. A. Aminawung},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.23.26366373},
url = {https://www.medrxiv.org/content/10.64898/2026.10.23.26366373v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Health Literacy and Cardiovascular Health Among Formerly Incarcerated Individuals: Evidence from the JUSTICE Study
AU - B. Bouzarjomehri
AU - L. B. Puglisi
AU - E. A. Wang
AU - J. A. Aminawung
PY - 2026
DA - 2026/10/23
PB - medRxiv
DO - 10.64898/2026.10.23.26366373
UR - https://www.medrxiv.org/content/10.64898/2026.10.23.26366373v1
AB - BackgroundHealth literacy, defined as the ability to find, understand, and use health information, is a key determinant of cardiovascular disease but remains underexamined among individuals transitioning from incarceration to community life. This study examined the association between health literacy and cardiovascular health among adults recently released from incarceration. MethodsUsing baseline data from the Justice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE) study, a prospective cohort of individuals with cardiovascular risk factors released from correctional facilities, we examined the association between health literacy, as measured by the Short Test of Functional Health Literacy in Adults, and cardiovascular health, as measured by the American Heart Associations Lifes Essential 8 (LE8). ResultsAmong 439 participants (mean age 45 years), 32 (7%) demonstrated inadequate health literacy. Hispanic ethnicity (53% vs. 25%), less than high school education (50% vs. 20%), and homelessness (16% vs. 3.2%) were significantly associated with inadequate health literacy. In bivariate analyses, inadequate health literacy was associated with lower LE8 blood glucose (63.1 vs. 76.8, p = 0.02), and LE8 physical activity (19.4 vs. 32.2, p = 0.03), but higher LE8 diet (55.5 vs. 43.8, p = 0.04) scores. After adjusting for age, gender, race/ethnicity, education level, and housing status, inadequate health literacy remained independently associated with lower LE8 glucose scores ({beta} = -11.9, 95% CI: -22.9 to -0.8, p = 0.04). ConclusionHealth literacy is a modifiable determinant of cardiovascular health, particularly glycemic control, in justice-involved populations. Interventions strengthening health literacy may help reduce health disparities among formerly incarcerated individuals. Clinical PerspectiveO_ST_ABSWhat is new?C_ST_ABSWe find that lower health literacy among individuals recently released from incarceration is associated with poorer glycemic control, a key component of cardiovascular health, as measured by the American Heart Associations Lifes Essential 8 framework. What are the clinical implications?Our data suggest that health literacy may represent a modifiable factor in cardiovascular risk reduction among formerly incarcerated individuals. Integrating literacy-sensitive education, chronic disease self-management support, and improved care coordination between the carceral and community health systems could strengthen cardiovascular prevention and promote long-term health equity.
ER -