The review, led by Amy Woods and Sarah Walker of La Trobe University’s School of Psychology and Public Health, together with Daniel Simsion of the Victorian Institute of Forensic Mental Health, Anita Raspovic and Leah Brennan, followed the PRISMA-ScR reporting guideline, with the protocol registered on the Open Science Framework. The team searched five major databases, MEDLINE, PsycINFO, Scopus, CINAHL and ProQuest, for peer-reviewed studies reporting on eating disorders or disordered eating among individuals with any forensic or correctional involvement. From 1,314 articles screened, only 29 met the inclusion criteria: 27 quantitative studies, one case study and one ethnography. That small body of evidence, spread across decades and jurisdictions, is what constitutes virtually the entire published record on the topic.

The risk factors that make this population vulnerable are well established in the broader eating disorder literature. Eating disorders and disordered eating occur at disproportionately high rates among people with elevated psychosocial risk, including Indigenous people, LGBTQIA individuals, and those with histories of trauma or mental illness. Each of these groups is overrepresented in prisons and forensic settings. Trauma and substance use, in particular, are strongly linked to disordered eating, and both are endemic in correctional populations. The review found that past trauma and past substance use frequently co-occurred with eating pathology in the studies it examined, reinforcing the picture of a population in which multiple vulnerabilities converge.

Prevalence figures varied across the included studies, but the overall trend was clear and concerning: rates of eating disorders and disordered eating trend high in forensic and correctional settings, particularly in women’s prisons. This aligns with community data showing that women experience eating disorders at higher rates than men, but the correctional context adds unique pressures, including restricted food access, loss of control over eating routines, body-focused stigma and the psychological strain of confinement, that may shape or exacerbate disordered eating behaviours in ways community research does not capture.

Perhaps the most alarming gaps concern who is missing from the evidence. The reviewed studies focused mostly on women in prisons, with limited data on men and, remarkably, no studies at all on transgender or gender-diverse individuals. Given that LGBTQIA people face elevated eating disorder risk in the community and are also overrepresented in the justice system, this absence represents a substantial blind spot. The review also found a lack of consistent data collection tools across studies, making it difficult to compare prevalence estimates or build a coherent epidemiological picture, and little research exploring the lived experience of incarcerated people with eating pathology or the perspectives of correctional and health staff who work alongside them.

The clinical consequences of this evidence vacuum are concrete. In community settings, eating disorders are typically supported through stepped levels of care, engagement with evidence-based treatments such as cognitive behavioural therapy or family-based approaches, and adjunct recovery supports. These services remain largely inaccessible to people who are incarcerated, who made up the majority of individuals considered in the studies reviewed. Instead, the review found that eating disorder behaviours in institutional settings are being responded to through suicide and self-harm protocols, including seclusion and restraint. Such responses treat the visible symptom, food refusal or self-harm, without addressing the underlying disorder, and may in fact worsen distress in vulnerable individuals.

The authors highlight that no forensic or correctional specific eating disorder guidelines or validated screening tools exist anywhere in the literature they reviewed. This leaves correctional health services without an evidence base for identifying who needs help, deciding what treatment to provide, or training staff to recognise the often-hidden signs of disordered eating. The review’s recommendations are correspondingly direct: routine screening for eating disorders and disordered eating on entry and during incarceration, the development of evidence-based, eating-disorder-targeted interventions adapted to secure environments, and staff training so that correctional officers and health professionals can recognise and respond appropriately.

There is also a rehabilitation dimension that extends beyond individual suffering. The review notes a limited understanding of the links between eating pathology and criminal behaviour, and of how untreated eating disorders might influence criminogenic needs or rehabilitation outcomes. Because eating disorders carry among the highest mortality rates of any psychiatric illness, and because disordered eating intertwines with trauma, substance use and self-harm, leaving them unaddressed in custodial settings may undermine the broader goals of correctional health and rehabilitation. The authors argue that targeted research and the development of prevention and treatment protocols for forensic and correctional settings are urgently needed.

The review, conducted in partial completion of a Doctorate of Public Health at La Trobe University and supported by the Australian Eating Disorder Research and Translation Centre Publication Support Project, ultimately serves as both a map and a warning. It confirms that eating disorders and disordered eating are prevalent among people in the forensic and correctional system, that the evidence base is thin, fragmented and demographically narrow, and that the systems responsible for the health of incarcerated people currently lack the tools to respond. Until screening, inclusive research, trauma-informed care and setting-specific treatment protocols are developed, hundreds of thousands of people in custody worldwide with eating pathology will continue to go unidentified and untreated, their illness managed only through crisis protocols never designed for it.

Subject of Research: Prevalence and management of eating disorders and disordered eating among people in forensic and correctional settings

Article Title: Eating disorders and disordered eating in the forensic and correctional system: a scoping review

Article References: Woods, A., Walker, S., Simsion, D., Raspovic, A., & Brennan, L. (2026). Eating disorders and disordered eating in the forensic and correctional system: a scoping review. Journal of Eating Disorders. https://doi.org/10.1186/s40337-026-01761-0

Image Credits: AI Generated

DOI: 10.1186/s40337-026-01761-0

Keywords: eating disorders, disordered eating, forensic mental health, correctional health, prison, incarceration, scoping review, trauma, substance use, screening, women's prisons, rehabilitation

Vision loss is a major and growing concern in the aging population of the United States. Approximately 37 million adults aged 50 and older experience some degree of vision impairment, including one in four adults aged 80 and older. Poor eyesight is not merely an inconvenience; it is closely linked to reduced quality of life, depression, falls, loss of independence, and difficulty performing everyday tasks such as reading medication labels, driving, and managing finances. A substantial body of research shows that social conditions across the life course—from childhood poverty to employment and access to preventive care—shape the risk of both acute vision loss and chronic visual impairment. Yet until now, almost nothing was known about how incarceration, one of the most consequential life events experienced by millions of Americans, shapes vision over time.

The scale of the aging prison population gives the question particular urgency. Correctional systems typically define older incarcerated adults as those over approximately age 50, a threshold set far lower than in the general population because incarcerated individuals display health profiles comparable to non-incarcerated adults 10 to 15 years older. Between 1999 and 2016, the number of adults aged 55 and older in state and federal prisons increased by a staggering 280 percent, while the count of prisoners under 55 grew by just 3 percent over the same period. Outside prison walls, an estimated one in 15 American adults over age 50 has been previously incarcerated. These older adults face elevated rates of chronic disease, sensory and functional impairment, and accelerated biological aging, yet jails, prisons, and reentry programs are largely designed for younger populations and often lack geriatric-trained staff, routine sensory screening, and structured protocols for managing age-related conditions.

To investigate whether incarceration leaves a measurable imprint on visual health, a research team led by Alexander Testa of the University of Texas Health Science Center at Houston, along with Luis Mijares, Mengyao Hu, Joana E. Andoh, Matthew W. Wade, and Dylan B. Jackson, analyzed data from the Health and Retirement Study, a nationally representative biennial survey of older Americans. Their analytic sample included 8,347 respondents aged 55 and older who completed a leave-behind questionnaire in 2012 or 2014 assessing incarceration history and who provided vision data across at least four survey waves between 2012 and 2022. Overall, 6.7 percent of respondents—529 individuals—reported having ever been an inmate in a jail, prison, juvenile detention center, or other correctional facility.

The team employed a statistical technique known as group-based trajectory modeling, a finite-mixture approach that identifies latent subpopulations following similar patterns on a measure over time. Rather than treating vision as a single snapshot, the method uses age as the underlying time scale and polynomial functions to capture developmental change, allowing researchers to classify individuals into distinct long-term pathways. Model selection was guided by fit statistics including the Bayesian Information Criterion, the transformed Bayes factor, and the odds of correct classification, with trajectories specified using a logistic distribution for the binary outcome of poor or fair self-rated vision. After estimation, respondents were assigned to the trajectory group with the highest posterior probability of membership, and multinomial logistic regression was used to test associations between incarceration history and group membership, with full accounting for the survey’s complex design through weighting, clustering, and stratification.

Three distinct vision trajectories emerged from the data. The largest group, accounting for 65.5 percent of the sample, was characterized by stable good vision, with a consistently low probability of reporting poor or fair eyesight. A second group, comprising 25.6 percent of respondents, followed a path of increasing poor vision, beginning midlife with modest rates of visual difficulty that rose sharply with age. The smallest group, 8.9 percent, experienced persistently poor vision throughout the study period. In unadjusted models, prior incarceration roughly doubled the relative risk of belonging to either the increasing poor vision group or the stable poor vision group compared with the stable good vision group.

After adjusting for a comprehensive set of covariates—including race and ethnicity, sex, educational attainment, veteran status, maternal education, marital status, income-to-poverty ratio, household wealth, and chronic conditions such as heart disease, hypertension, and diabetes—the association remained robust. A history of incarceration was linked to a 67 percent higher relative risk of membership in the increasing poor vision group (relative risk ratio 1.67, 95 percent confidence interval 1.20 to 2.33), indicating that formerly incarcerated older adults are disproportionately likely to experience eyesight that deteriorates as they age. The researchers ground these findings in life course theory, which conceptualizes aging as a set of long-term trajectories shaped by the timing and sequencing of pivotal life events. Within this framework, incarceration operates as a turning point that redirects trajectories of attainment and health: it erodes employment prospects, depletes wealth, and disrupts health care access—all resources needed to maintain optimal vision health—and has been linked to markers of accelerated epigenetic aging.

The study’s authors emphasize that the mechanisms linking imprisonment to failing eyesight remain poorly understood and merit deeper investigation. Inside correctional facilities, vision care is frequently limited to intake screening, with access to optometry services and replacement eyewear constrained by copays, specialty-care backlogs, and security-related barriers. Prior research has documented inaccurate ophthalmology follow-up among incarcerated patients and gaps in glaucoma care. Upon release, formerly incarcerated individuals often struggle to reestablish care, making continuity of vision services a critical but understudied challenge. The researchers point to promising strategies, including routine age-based vision screening consistent with clinical guidelines, expanded tele-ophthalmology, and partnerships with academic eye care programs inside prisons, along with pre-release insurance enrollment, warm handoffs to community providers, and integration of vision care into transition clinics after release.

The stakes extend beyond clinical outcomes. Declining vision can undermine core reentry tasks that determine whether a person successfully rebuilds a life after prison, including reading program materials, completing supervision paperwork, obtaining the driver’s license needed for reliable transportation, and securing employment. Studies have shown that vision loss is associated with job loss and reduced workforce participation, meaning that untreated visual impairment may compound the economic disadvantages that incarceration already imposes. The authors argue that screening for and accommodating visual impairment in correctional programming and community supervision could improve reentry outcomes for older adults.

The researchers acknowledge important limitations. Incarceration was measured as any lifetime history, without capturing the length, timing, or type of facility involved, and self-reported vision was dichotomized rather than measured through objective visual acuity testing—though prior studies show self-reported vision correlates well with clinical impairment. Because the sample was restricted to adults aged 55 and older, individuals in the poorest health may be underrepresented, since formerly incarcerated people experience elevated premature mortality with a median age of death before 50. This survivor bias means the reported associations may actually underestimate the true relationship between incarceration and poor vision. The observational design also precludes definitive causal inference, and covariates such as education and income may function either as confounders or as mediators of the incarceration-vision link.

Nevertheless, the study opens a striking new window on the long shadow cast by imprisonment. As the population of older Americans with incarceration histories continues to grow, the findings underscore the need for coordinated strategies across correctional, public health, and aging systems—improved access to preventive eye care during incarceration, continuity of care at reentry, and integration of vision screening into community-based services—to reduce vision-related disparities and support healthy aging for a population that has long been invisible to mainstream public health efforts.

Subject of Research: Association between history of incarceration and vision trajectories in older U.S. adults

Article Title: History of Incarceration and Vision Trajectories in Older Adults

Article References: Testa, A., Mijares, L., Hu, M., Andoh, J. E., Wade, M. W., & Jackson, D. B. (2026). History of Incarceration and Vision Trajectories in Older Adults. American Journal of Criminal Justice. https://doi.org/10.1007/s12103-026-09948-6

Image Credits: AI Generated

DOI: 10.1007/s12103-026-09948-6

Keywords: incarceration, vision trajectories, older adults, Health and Retirement Study, vision impairment, group-based trajectory modeling, life course theory, mass incarceration, aging prison population, eye care access, reentry health, History

The scale of the problem motivating the study is difficult to overstate. The impact of mass incarceration extends far beyond the isolated experiences of justice-involved individuals; the authors describe a reaching, multifactorial impact on the health of society as a whole. People who cycle through carceral facilities frequently return to communities with untreated chronic disease, unmanaged psychiatric illness, and histories of disrupted care. Healthcare providers must therefore be prepared to treat patients returning from prisons and jails, whether in emergency departments, primary care clinics, or community mental health settings. Unfortunately, as the research team notes, health professional programs often lack any correctional medicine curriculum whatsoever, leaving graduates to encounter this population with little preparation and, in some cases, with unexamined biases.

Bridges to Access was conceived as a direct response to that curricular vacuum. Organized as an interdisciplinary conference, the event brought together learners and practitioners from multiple health professions to learn about the effects of incarceration on mental health and overall health. The conference pursued three distinct educational objectives: to demonstrate the importance of education in correctional medicine, to illuminate the interplay of mental illness and incarceration, and to highlight the role healthcare providers can have in impacting change within justice-involved patient populations. Rather than targeting a single discipline, the event was designed to reach medical students, nursing learners, and other future professionals whose careers would intersect with justice-involved patients in different ways.

To measure whether the conference actually worked, the research team employed a pre- and post-conference survey design built around sixteen Likert-response styled questions. Each item assessed participants’ knowledge and perceptions of correctional healthcare, with responses anchored to specific numerical values so that quantifiable change could be detected. Participants completed the same instrument before and after the event, and their paired responses were averaged for each question before analysis. The investigators then applied a paired t-test to compare mean pre- and post-conference responses, setting statistical significance at a p-value of less than 0.05. This straightforward but rigorous design allowed the team to evaluate whether observed changes in attitude and knowledge exceeded what would be expected by chance alone.

The results were striking. One hundred and twenty-three participants completed both the pre- and post-conference surveys, providing a substantial analytic sample for an educational intervention study. Fourteen of the sixteen questions demonstrated statistically significant improvement with a p-value below 0.05. Statistical analysis, the authors conclude, demonstrated that the conference was an effective educational tool, and survey participants showed significant growth in their understanding of each of the three conference objectives. In practical terms, attendees left the event measurably better informed about why correctional medicine belongs in health professional education, how mental illness and incarceration reinforce one another, and what providers can do to advocate for justice-involved patients.

The findings arrive at a moment of growing national attention to carceral health. Incarceration rates in the United States remain among the highest in the world, and the transition between custody and community is widely recognized as a period of elevated risk, including elevated risks of overdose, psychiatric crisis, and preventable hospitalization. When clinicians understand the structural realities that shape their patients’ lives, such as interrupted prescriptions, stigma attached to incarceration histories, and limited access to continuity of care, they are better positioned to screen appropriately, coordinate transitions, and communicate without judgment. Educational interventions like Bridges to Access aim to seed exactly this kind of structural literacy early in professional training, before habits of practice and patterns of bias harden.

The methodological architecture of the study also illustrates how educational outcomes can be evaluated with the same statistical discipline applied to clinical interventions. By pairing each Likert response with a numerical value and subjecting averaged pre- and post-responses to paired t-tests, the investigators converted subjective self-assessments into analyzable data. The paired design is particularly important because each participant serves as their own control, reducing confounding from differences in baseline knowledge across attendees. That fourteen of sixteen items reached significance suggests the effect was broad rather than confined to a single domain of understanding, though the two items that did not reach significance are a reminder that not every perception shifts equally in response to a brief educational exposure.

The authors are candid about the limits of what a single conference can accomplish. Due to a lack of peer-reviewed literature addressing this topic, alongside several limitations inherent to the study design, they write that further research is required to establish best practices for correctional medicine education. Self-reported survey responses capture perceptions of knowledge rather than demonstrated clinical competence, and the durability of gains measured immediately after a conference remains an open question. The study itself was conducted under a minimal-risk exempt framework, evaluated by the investigators under federal regulations for exempt research, with written and oral consent processes for participants, and the event was free and open to the public, which broadens access but also introduces selection considerations typical of volunteer educational audiences.

Even with those caveats, the study carries a clear message for medical and health professions education: gaps in future clinicians’ understanding of justice-related healthcare are not immutable, and they can be measurably narrowed with targeted, interdisciplinary effort. As the justice-involved population continues to interface with mainstream healthcare systems, the demand for clinicians who can deliver equitable, informed, and humane care will only grow. Bridges to Access offers a replicable model, and its authors’ call for further research signals that this conference is best understood not as a finished solution but as the opening move in what will need to be a sustained, evidence-driven expansion of correctional medicine across the curricula that train tomorrow’s healthcare professionals.

Subject of Research: Educational intervention for future healthcare professionals' understanding of justice-related and correctional healthcare

Article Title: Bridging gaps in future healthcare professionals’ understanding of justice-related healthcare

Article References: Bridging gaps in future healthcare professionals’ understanding of justice-related healthcare. (n.d.). https://doi.org/10.1186/s12913-026-15453-7

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15453-7

Keywords: medical education, correctional medicine, incarceration, health equity, interdisciplinary education, mental illness, justice-involved patients, curriculum, health services research, BMC Health Services Research, Bridging, gaps