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Sexual Health Empowerment Projects


Sexual health empowerment for jail-involved women's health literacy and prevention (2R01CA181047, 2019-2024)

The original objective of SHE (R01 CA181047) was to assess effectiveness of a jail-based sexual health empowerment intervention to increase cervical health literacy and cancer screening. With a strong record of productivity and promising results (SHE was associated with increased cervical health literacy and up-to-date cervical cancer screening), we started piloting adaptations of SHE to address breast cancer, birth control, and STI literacy, as well as documenting successful strategies of reaching women leaving jail, using integrated multimedia approaches. Thus, the objective of this renewal is to expand reach of SHE to address women's health disparities more broadly to create a sustainable model for dissemination of health promotion interventions for vulnerable populations.

Tri-City Cervical Cancer Prevention Study among Women in the Justice System (R01CA226838 2018-2023)

The objective of this study is to develop a better understanding the natural history of cervical cancer risk and prevention behaviors among community-based justice-involved women. For this study we plan to leverage three existing samples of community-based, justice-involved women - in Kansas City, MO, Birmingham, AL, and Oakland, CA - to become one of the first long-term cancer prevention studies of high-risk women across cities in the U.S.


Sexual Health Empowerment (SHE) for Cervical health Literacy and Cancer Prevention (R01CA181047-S2, Diversity Supplement with Michelle Pickett)

The primary objective of the diversity supplement subproject is to assess the effectiveness of the SHE cervical health literacy intervention at reducing sexual health risk, create and pilot an STI prevention adaptation of the intervention, and explore the feasibility of an electronic platform for delivering the intervention.

Improving Cervical Cancer Prevention In The Community Health Delivery System For Post-Incarcerated Women (R01 CA181047-04S1, Diversity supplement with Sharla Smith)

The primary objective of the study is to identify post-incarcerated women's community health delivery systems (CHDS) and explore barriers to care availability and accessibility of cervical cancer prevention treatment and decision-making on cervical cancer preventive care in the existing CHDS.

Correctional and public health links to bolster HPV vaccine and cancer prevention (R21 CA204767) 2016 –2018

Our project objective is to assess a pilot implementation strategy that links county juvenile detention facilities with county health departments to provide HPV vaccination for incarcerated young women and men.  We will also collect information about the barriers and facilitators of such a potential linkage throughout a four-state region (Kansas, Missouri, Nebraska, Iowa), directly informing a subsequent R01 project to scale up our implementation strategy to the region. 

Findings: Ramaswamy, M. (2017). Immunizations and Jails. Public Health Nurs,  34(5),411. 

Allison, M., Musser, B., Satterwhite, C., Ault, K., Kelly, P., Ramawamy, M. (2018). Human Papillomavirus Vaccine Knowledge and Intention Among Adult Inmates in Kansas, 2016-2017. American Journal of Public Health, 108(8), 1000-1002. 

Opportunity Votes: A Public Health and Community Organizing Collaboration to Register Voters in Jails 2016

Opportunity Votes was a partnership between our public health research team and a local group, Communities Creating Opportunity (CCO), to register voters in Kansas City jails.

Findings: Ramaswamy, M., & Emerson, A. M. (2016). Researchers Register Voters in County Jails. Racism Review. 

Addressing Health Disparities through Critical Health Literacy with Inmates

Our objective was to run a pilot evaluation of the Health, Activism, Literacy, and Opportunity (HALO) curriculum, which was a 9-hour critical health literacy intervention that would empower incarcerated men to learn about social determinants of health, how to identify their sources, assess the differential effects in their own and others' lives, take action to address health disparities, and ultimately take better care of their own health

Sexual health empowerment for cervical health literacy and cancer prevention (R01 CA181047)
2014 - 2019

Using an experimental design, the first aim of the study was to assess the impact of a sexual health empowerment intervention (SHE Project) on cervical health knowledge, barriers to screening that are related to beliefs about cervical cancer, and self-efficacy for screening and follow-up among women leaving jail.  Using a three-year observational design employing both survey and ethnographic methods for follow-up, the second aim of the study was to understand how knowledge, beliefs, self-efficacy, and other factors change post-release cervical health prevention behaviors over time. 

Findings: Kelly, P.J., Ramaswamy, M. (2017). Closing the cervical cancer disparity gap. Public Health Nurs.,34(3), 195-196. 

Ramaswamy, M., Simmons, R., & Kelly, P.J.(2015). The development of a brief jail-based cervical health promotion intervention. Health Promotion Practice, 16(3), 432-442. 

Ramaswamy M., Lee, J., Wickliffe, J., Allison, M., Emerson, A., Kelly, P.J. (2017). Impact of a brief intervention on cervical health literacy; A waitlist control study with jailed women. Prev Med Rep., 5(6), 314-321.

Gwynn, K., Ramaswamy, M. Why We Need to Talk About Violence Against Women When We Talk about Cervical cancer Prevention. Rewire. 2017 Nov 16. 

Emerson, A.M. 2018. Strategizing and fatalizing: Self and other in the trama narratives of justice-involved women. Qual Health Res., (28)6.

Kelly, P.J., Allison, M., & Ramaswamy, M. (2018). Cervical cancer screening among incarcerated women, PLoS One, 13(6), e0199220. 

Kelly, P.J., Emerson, A., Fair, C., Ramaswamy, M. (2018). Assessing fidelity: balancing methodology and reality in jail interventions, BMC Womens Health, 18(1), 127.

Pickett, M.L., Allison, M., Twist, K., Klemp, J.R., Ramaswamy, M. (2018). Breast Cancer Risk Among Women in Jail, Biores Open Access, 7(1), 139-144.

Emerson, A.M., Wickliffe, J., Kelly, P.J. & Ramaswamy, M. (2019). Feminism and Bourdieusian Social Theory in a Sexual Health Empowerment Project with Incarcerated and Recently Released Women. Soc Theory Health, 1(1), 57-74.

Social context for sexual health risk and health care access among women leaving jail (KL2TR000119, CTSA - KL2 Scholar)
2011- 2014

 The objective of this project was, from the perspectives of incarcerated women, to understand factors that support or undermine utilization of STI and family planning services among women leaving jail. Our research team proposed a two-aim investigation to understand the prevalence, predictors, and underlying causes of utilization of sexual health care after release from jail.

Findings: Ramaswamy, M., & Kelly, P. J. (2014). Factors associated with sterilization use among women leaving a U.S. jail: a mixed methods study. BMC Public Health, 14, 773.

Ramaswamy, M., Chen, H.-F., Cropsey, K. L., Clarke, J. G., & Kelly, P. J. (2015). Highly effective birth control use before and after women’s incarceration. Journal of Women’s Health, 24(6), 530–539.

Ramaswamy, M., Upadhyayula, S., Chan, K. Y. C., Rhodes, K., & Leonardo, A. (2015). Health Priorities among women recently released from jail. American Journal of Health Behavior, 39(2), 222–231.

Ramaswamy, M., Unruh, E., & Comfort, M. (2018). Navigating Social Networks, Resources, and Neighborhoods: Facilitators of Sexual and Reproductive Health Care Use among Women Released From Jail, Women's Reproductive Health, 5(1), 44-58.

Emerson, A., Carroll, H.-F., & Ramaswamy, M. (2018). Education level as a predictor of condom use in jail-incarcerated women, with fundamental cause analysis, Public Health Nurs., 35(4), 273-280.

Mental health service needs among men and women in community corrections

The purpose of this study was to better understand the mental health needs and services for the populations of men and women under the supervision North Central Region of the Community Corrections Program of the Federal Bureau of Prisons.

Findings: Kelly, P. J., Ramaswamy, M., & Denny, D. (2015). Wellness and illness self-management skills in community corrections. Issues in Mental Health Nursing, 36(2), 89-95.

Understanding the cervical cancer health gap for women in jail (R03 CA162869)

The objective of this application was, from the perspectives of incarcerated women and medical record review, to understand incarcerated women’s abnormal Pap events and difficulty with subsequent follow-up.  First, we conducted focus groups and in-depth interviews with 40 women in a Kansas City county jail about abnormal Pap screening and subsequent follow-up events. Second, we asked the women previously interviewed for permission to access their medical records, in order to investigate whether incarcerated women’s self-report of abnormal Pap and follow-up events matched actual medical records of these events.

Findings: Pankey, T., & Ramaswamy, M. (2015). Incarcerated women’s HPV awareness, beliefs, and experiences. International Journal of Prisoner Health, 11(1), 49–58.

Ramaswamy, M., & Kelly, P. J. (2015). “The vagina is a very tricky little thing down there”: Cervical health literacy among incarcerated women. Journal of Health Care for the Poor and Underserved, 26(4), 1265–1285.

Kelly, P. J., Hunter, J., Daily, E. B., & Ramaswamy, M. (2016). Challenges to pap smear follow-up among women in the criminal justice system. Journal of Community Health.

Expressing writing program for women in jails

A five-session expressive writing intervention was piloted with six jailed women to address high levels of stress, a critical mediator for mental, physical health, and drug problems.

Findings: Pankey T, Kelly PJ, Ramaswamy M. Stress Reduction Through a Brief Writing Intervention With Women in Jail. J Correct Health Care. 2016 Jul;22(3):240-6.

Assessing cervical cancer risk, barriers to care and follow-up for women leaving Kansas City jails (ACS IRG-09-062-01, Pilot Grant)

This project assessed cervical cancer risk, barriers to cervical cancer screening and care for women in Kansas City jails. 

Findings:  Ramaswamy, M., Kelly P. J., Koblitz, A., Kimminau, K.S., & Engelman, K. K. (2011). Understanding the role of violence in incarcerated women’s cervical cancer screening and history. Women and Health, 51(5), 423-441.

Health service use among men and women prior to incarceration
Over six months in spring-fall 2010, University of Kansas School of Medicine and University of Missouri Kansas City research staff conducted a health care use assessment with men and women (N=596) in three jails serving greater Kansas City. The objective of this project was to describe community-based health service use prior to incarceration among men and women in the justice system. Further, researchers sought to understand contextual and community factors related to health outcomes and health service use among men and women in jail. This project laid the foundation for the (S)HE team's research program in Kansas City.

Findings: Ramaswamy, M., Diaz, F., Pankey, T., Hunt, S. L., Park, A., & Kelly, P. J. (2015). Correlates of preincarceration health care use among women and men in jail. Journal of Correctional Health Care, 21(3), 286-297.

Rogers, J. D., Ramaswamy, M., Cheng, C.-I., Richter, K., & Kelly, P. J. (2012). Perceptions of neighborhood social environment and drug dependence among incarcerated women and men: A cross-sectional analysis. Substance Abuse Treatment, Prevention, and Policy, 7, 39.

Ramaswamy, M., & Kelly, P. J. (2015). Sexual health risk and the movement of women between disadvantaged communities and local jails. Behavioral Medicine, 41(3), 115-122.

Kelly, P. J., & Ramaswamy, M. (2012). The association between unintended pregnancy and violence among incarcerated women and men. Journal of Community Health Nursing, 29(4): 202-13.

Kelly, P. J., Cheng, A.-L., Spencer-Carver, E., & Ramaswamy, M. (2014). A syndemic model of women incarcerated in community jails. Public Health Nursing, 31(2), 118-125.

(S)HE: Sexual Health Empowerment

Joi Wickliffe
Project Director
(913) 588-2646