Correctional inmates and ex-offenders are disproportionately burdened by medical and mental health problems. This article reviews the state of programs and research in five health-related issues important to these inmates' successful transitions to the community: discharge planning, community linkages, and continuity of care; adherence to treatment regimens; availability of housing; quick access to benefit programs; and the particular needs of dually and triply diagnosed individuals. In general, such services are currently inadequate, although there are exemplary programs and promising strategies in some of these realms. Additional research is needed to evaluate current programs and encourage their replication and enhancement. The disproportionate share of the nation's total burden of health problems found among inmates and the potential public health and fiscal benefits of an improved response should make this research a high priority.

Approximately 70% of incarcerated people smoke tobacco, and an estimated 12% of all smokers in the United States leave correctional facilities annually. Many facilities prohibit smoking, but no published study has measured the relapse to tobacco after release. In a study of 200 people with chronic health conditions reentering the community from jail, 165 (83%) were cigarette smokers. Of these, 129 were interviewed at 1 and/or 6 months after release. Self-reported sustained abstinence rates were 37.3% at the end of the first day, 17.7% for the first week, 13.7% for 1 month, and 3.1% for 6 months. These abstinence rates are lower than those reported after military basic training and medical hospitalization but similar to rates after inpatient psychiatric and addiction programs. More efforts and resources are needed to determine successful tobacco cessation interventions during incarceration and after release.

A cooperative, community-oriented "public health model of correctional healthcare" was developed to address the needs of persons temporarily displaced into jail from the community, and to improve the health and safety of the community. It emphasizes 5 key elements: early detection, effective treatment, education, prevention, and continuity of care. In the program, physicians and case managers are "dually based"-they work both at the jail and at community healthcare centers. This, together with discharge planning, promotes continuity of care for inmates with serious and chronic medical conditions. This report characterizes the health status and healthcare in this group, and identifies facilitators and barriers to engagement in primary medical and mental health care after release from jail.