Health Literacy and Cardiovascular Health Among Formerly Incarcerated Individuals: Evidence from the JUSTICE Study
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Health 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. Methods Using 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 Association’s Life’s Essential 8 (LE8). Results Among 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 (β = −11.9, 95% CI: −22.9 to −0.8, p = 0.04). Conclusion Health 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 Perspective What is new? We 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 Association’s Life’s 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.
Source: medRxiv
Institution: Yale University
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7223669710