# JUSTice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE)

> **NIH NIH R01** · YALE UNIVERSITY · 2022 · $23,780

## Abstract

PROJECT SUMMARY
Individuals with a history of incarceration have higher rates of cardiovascular disease (CVD) morbidity and
mortality compared to the general population, especially in the weeks following release from correctional
facilities, but factors driving observed higher rates of CVD morbidity are unknown. Given the disproportionate
incarceration of poor and racial/ethnic minorities, there is an urgent need to understand the epidemiology of
CVD among individuals with a history of incarceration. Until these mechanisms are defined, we will not be able
to identify effective and durable interventions to mitigate CVD morbidity and mortality in this substantial
population of young adults. The long-term goal of this application is to reduce morbidity and mortality among
individuals with a history of incarceration and CVD risk factors. The overall objective, which is the next step
toward achieving this long-term goal, is to design the first longitudinal observational study of individuals who
are released from a correctional facility, so as to understand the epidemiology of CVD risk factors and
modifiable mediators of CVD risk factor control. The central hypothesis of JUSTice Involved Individuals Study
of Cardiovascular Disease Epidemiology (JUSTICE) is that there are population-specific risk factors that affect
poor control of traditional CVD risk factors, which in turn contribute to increased CVD morbidity and mortality
upon release. Preliminary data indicate that exposure to stricter incarceration policies results in higher levels of
chronic perceived stress and lower levels of self-efficacy, which in turn contributes to higher CVD risk. To test
the central hypothesis, the proposal tackles three aims: (1) Examine the association between population-
specific risk factors and clinical evidence of CVD risk factor control (hypertension, hyperlipidemia, diabetes,
and obesity), (2) Assess how changes in population-specific risk factors over time impact CVD risk factor
control, and (3) Estimate the impact of population-specific risk factors on long-term CVD morbidity and
mortality. Because there are no ongoing or past epidemiologic studies that enable us to test this hypothesis,
500 individuals just released from a Connecticut correctional facility will be recruited in a year-long, prospective
cohort study to explore the associations between psychosocial stress, self-efficacy, and exposure to
incarceration-related policies and CVD risk factor control, and then followed for an additional three years using
electronic health records. These data will be incorporated into the Cardiovascular Disease Policy Model, a
CVD risk prediction model, which will generate estimates of the impact of these factors on 10-year CVD
morbidity and mortality. JUSTICE represents a new and substantial departure from the status quo by shifting
focus to primary data collection to assess CVD risk factor control among a population recently released from
correctional facilities. It wi...

## Key facts

- **NIH application ID:** 10596244
- **Project number:** 3R01HL137696-05S1
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Emily Ai-hua Wang
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $23,780
- **Award type:** 3
- **Project period:** 2018-04-01 → 2024-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10596244

## Citation

> US National Institutes of Health, RePORTER application 10596244, JUSTice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE) (3R01HL137696-05S1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10596244. Licensed CC0.

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