Date of Award

January 2026

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Emily Wang

Second Advisor

Jenerius Aminawung

Abstract

Health literacy, defined as the ability to find, understand, and use health information, is a key determinant of chronic disease management 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 using baseline data from the JUSTICE (Justice-Involved Individuals Cardiovascular Disease Epidemiology) study, a prospective cohort of individuals with cardiovascular risk factors just released from correctional facilities in Connecticut. Health literacy was measured using the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and categorized as inadequate (≤22) or adequate (≥23). Cardiovascular health was assessed using the American Heart Association’s Life’s Essential 8 (LE8) score, with a higher score indicating better overall and component-level cardiovascular health. Among 439 participants (mean age 45 years), 32 (7%) demonstrated inadequate health literacy. Hispanic ethnicity (53% vs. 25%), having completed less than a high school education (50% vs. 20%), and experiencing homelessness (16% vs. 3.2%) were significantly associated with inadequate health literacy. In bivariate analyses examining cardiovascular health, adequate health literacy was associated with higher LE8 blood glucose (76.8 vs. 63.1, p = 0.02), and higher LE8 physical activity scores (32.2 vs. 19.4, p = 0.03), but lower LE8 diet scores (43.8 vs. 55.5, p = 0.04). After adjusting for age, gender, race/ethnicity, education level, and housing status, adequate health literacy remained independently associated with a higher LE8 glucose score (β = 11.9, 95% CI: 0.9–22.9, p = 0.04), indicating better glycemic control. These findings highlight health literacy as a modifiable determinant of cardiovascular health in justice-involved populations. Interventions that strengthen health literacy through targeted education, self-monitoring support, and improved care continuity during reentry may play a vital role in reducing disparities in glycemic control among formerly incarcerated individuals.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 03/16/2027

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