Degree Name
DrPH (Doctor of Public Health)
Program
Public Health
Date of Award
8-2025
Committee Chair or Co-Chairs
Robert Pack
Committee Members
Casey Balio, Stephanie Mathis
Abstract
Formerly incarcerated individuals face challenges to successful reentry, a critical component of reducing recidivism and improving public health outcomes. These challenges are particularly acute in rural Appalachia, where structural disadvantages such as limited economic opportunities, healthcare access, and public transportation intersect with stigma and systemic barriers related to prior incarceration. This dissertation addresses these gaps through a mixed-methods examination of reentry and recidivism, grounded in public health frameworks and focused on the unique context of rural Appalachia.
This work includes three studies. First, a PRISMA-guided systematic review synthesized qualitative research on barriers and facilitators to employment following incarceration. Findings highlighted multi-level barriers, including criminal records, lack of resources, and stigma, as well as facilitators such as social capital, targeted reentry programs, and education opportunities. Notably, there was an absence of research specific to rural or Appalachian populations.
Second, a novel state-level panel dataset was constructed to examine predictors of recidivism across U.S. states from 2010 to 2019. Recidivism rates declined nationally over the decade, with several states demonstrating sharp shifts following major policy reforms. Higher rates of high school completion were associated with lower recidivism. State suspension of Medicaid enrollment during incarceration was associated with significantly lower average recidivism compared to states where coverage was terminated. These findings provide population-level insights into the structural conditions shaping reentry outcomes and inform potential policy and programmatic interventions.
Third, qualitative interviews with Appalachian reentry program leaders provided perspectives on the distinct barriers and facilitators present in rural reentry efforts. Participants emphasized chronic gaps in housing and transportation, the value of staff with lived experience of incarceration, and the importance of flexible, locally tailored partnerships. These findings offer novel insights into how successful reentry programs operate in rural Appalachian settings and highlight community-level impacts, including reduced jail populations and decreased stigma.
Collectively, these studies underscore the complexity of reentry as a public health issue requiring multi-level, place-based interventions that address structural, social, and individual factors. This work contributes to the reentry literature by providing new empirical data and contextual insights specific to Appalachia, offering evidence to inform future research, programs, and policies aimed at improving reentry outcomes and reducing recidivism in rural settings.
Document Type
Dissertation - embargo
Recommended Citation
Francisco, Margaret E., "Reentry for Formerly Incarcerated Individuals: A Focus on Workforce Reentry and Recidivism in Appalachia" (2025). Electronic Theses and Dissertations. Paper 4584. https://dc.etsu.edu/etd/4584
Copyright
Copyright by the authors.
Included in
Community Health and Preventive Medicine Commons, Public Health Education and Promotion Commons
