Health Literacy and Cardiovascular Health Among Formerly Incarcerated Individuals: Evidence from the JUSTICE Study

Background: Health literacy, defined as the ability to find, understand, and use health information, is a key determinant of cardiovascular disease 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. Methods: Using baseline data from the Justice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE) study, a prospective cohort of individuals with cardiovascular risk factors released from correctional facilities, we examined the association between health literacy, as measured by the Short Test of Functional Health Literacy in Adults, and cardiovascular health, as measured by the American Heart Association's Life's Essential 8 (LE8). Results: Among 439 participants (mean age 45 years), 32 (7%) demonstrated inadequate health literacy. Hispanic ethnicity (53% vs. 25%), less than high school education (50% vs. 20%), and homelessness (16% vs. 3.2%) were significantly associated with inadequate health literacy. In bivariate analyses, inadequate health literacy was associated with lower LE8 blood glucose (63.1 vs. 76.8, p = 0.02), and LE8 physical activity (19.4 vs. 32.2, p = 0.03), but higher LE8 diet (55.5 vs. 43.8, p = 0.04) scores. After adjusting for age, gender, race/ethnicity, education level, and housing status, inadequate health literacy remained independently associated with lower LE8 glucose scores (β = -11.9, 95% CI: -22.9 to -0.8, p = 0.04). Conclusion: Health literacy is a modifiable determinant of cardiovascular health, particularly glycemic control, in justice-involved populations. Interventions strengthening health literacy may help reduce health disparities among formerly incarcerated individuals.