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Cumming C, Kinner SA, McKetin R, Young JT, Li I, Preen DB. Using the Alcohol, Smoking and Substance Involvement Screening Test to predict substance-related hospitalisation after release from prison: A cohort study. Addiction 2024; 119:236-247. [PMID: 37855049 PMCID: PMC10952305 DOI: 10.1111/add.16365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/13/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND AND AIMS Poor substance use-related health outcomes after release from prison are common. Identifying people at greatest risk of substance use and related harms post-release would help to target support at those most in need. The Alcohol Smoking and Substance Involvement Screening Test (ASSIST) is a validated substance use screener, but its utility in predicting substance-related hospitalisation post-release is unestablished. We measured whether screening for moderate/high-risk substance use on the ASSIST was associated with increased risk of substance-related hospitalisation. DESIGN A prospective cohort study. SETTING Prisons in Queensland and Western Australia. PARTICIPANTS Participants were incarcerated and within 6 weeks of expected release when recruited. A total of 2585 participants were followed up for a median of 873 days. MEASUREMENTS Baseline survey data were combined with linked unit record administrative hospital data. We used the ASSIST to assess participants for moderate/high-risk cannabis, methamphetamine and heroin use in the 3 months prior to incarceration. We used International Classification of Diseases (ICD) codes to identify substance-related hospitalisations during follow-up. We compared rates of substance-related hospitalisation between those classified as low/no-risk and moderate/high-risk on the ASSIST for each substance. We estimated adjusted hazard ratios (aHR) by ASSIST risk group for each substance using Weibull regression survival analysis allowing for multiple failures. FINDINGS During follow-up, 158 (6%) participants had cannabis-related, 178 (7%) had opioid-related and 266 (10%) had methamphetamine-related hospitalisation. The hazard rates of substance-related hospitalisation after prison were significantly higher among those who screened moderate/high-risk compared with those screening low risk on the ASSIST for cannabis (aHR 2.38, 95% confidence interval [CI] 1.74, 3.24), methamphetamine (aHR 2.23, 95%CI 1.75, 2.84) and heroin (aHR 5.79, 95%CI 4.41, 7.60). CONCLUSIONS Incarcerated people with an Alcohol Smoking and Substance Involvement Screening Test (ASSIST) screening of moderate/high-risk substance use appear to have a significantly higher risk of post-release substance-related hospitalisation than those with low risk. Administering the ASSIST during incarceration may inform who has the greatest need for substance use treatment and harm reduction services in prison and after release from prison.
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Affiliation(s)
- Craig Cumming
- Centre for Health Services Research, School of Population and Global HealthUniversity of Western AustraliaCrawleyAustralia
| | - Stuart A. Kinner
- Centre for Adolescent HealthMurdoch Children's Research InstituteParkvilleAustralia
- Melbourne School of Population and Global HealthThe University of MelbourneParkvilleAustralia
- Griffith Criminology InstituteGriffith UniversityMt GravattAustralia
- School of Population HealthCurtin UniversityPerthAustralia
| | - Rebecca McKetin
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyAustralia
| | - Jesse T. Young
- Centre for Adolescent HealthMurdoch Children's Research InstituteParkvilleAustralia
- Institute for Mental Health Policy ResearchCentre for Addiction and Mental HealthTorontoCanada
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneParkvilleAustralia
- National Drug Research InstituteCurtin UniversityPerthAustralia
- School of Population and Global HealthUniversity of Western AustraliaCrawleyAustralia
| | - Ian Li
- School of Population and Global HealthUniversity of Western AustraliaCrawleyAustralia
| | - David B. Preen
- Centre for Health Services Research, School of Population and Global HealthUniversity of Western AustraliaCrawleyAustralia
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Austin A, Favril L, Craft S, Thliveri P, Freeman TP. Factors associated with drug use in prison: A systematic review of quantitative and qualitative evidence. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104248. [PMID: 37952319 DOI: 10.1016/j.drugpo.2023.104248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND About a third of people use drugs during their incarceration, which is associated with multiple adverse health and criminal justice outcomes. Many studies have examined factors associated with in-prison drug use, but this evidence has not yet been systematically reviewed. We aimed to systematically review and synthesise the evidence on factors related to drug use in prison. METHODS Three databases (PubMed, PsycINFO and Embase) were systematically searched as well as grey literature, for quantitative, qualitative and mixed-methods studies examining factors related to drug use inside prison. We excluded studies that did not explicitly measure in prison drug use or only measured alcohol and/or tobacco use. Study quality was assessed using the Newcastle Ottawa Scale (NOS) for quantitative studies and Critical Appraisal Skills Programme (CASP) for qualitative studies. The review was prospectively registered on PROSPERO (CRD42021295898). RESULTS Fifty-four studies met the inclusion criteria, reporting data on 26,399 people in prison. Most studies were of low or moderate-quality, and all used self-report to assess drug use. In quantitative studies, studies found that previous criminal justice involvement, poor prison conditions, pre-prison drug use and psychiatric diagnosis were positively associated with drug use in prison. In qualitative studies, reasons for drug use were closely linked to the prison environment lacking purposeful activity and the social context of the prison whereby drug use was seen as acceptable, necessary for cohesion and pressurised. CONCLUSION In the first systematic review of factors associated with drug use in prison, key modifiable risk factors identified from quantitative and qualitative studies were psychiatric morbidity and poor prison conditions. Non-modifiable factors included previous drug use and criminal history linked to substance use. Our findings indicate an opportunity to intervene and improve the prison environment to reduce drug use and associated adverse outcomes.
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Affiliation(s)
- Alice Austin
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
| | - Louis Favril
- Faculty of Law and Criminology, Ghent University, Belgium
| | - Sam Craft
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
| | - Phoebe Thliveri
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK.
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Cumming C, Kinner SA, McKetin R, Li I, Preen DB. The health needs of people leaving prison with a history of methamphetamine and/or opioid use. Drug Alcohol Rev 2023; 42:778-784. [PMID: 36917515 PMCID: PMC10947398 DOI: 10.1111/dar.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/30/2023] [Accepted: 02/12/2023] [Indexed: 03/15/2023]
Abstract
INTRODUCTION Methamphetamine use is more common than opioid use among prison entrants in some countries, including Australia, yet most research and policy focuses on opioid use. This suggests that traditional opioid-focused interventions are no longer appropriate for the majority of this group in countries such as Australia. To inform policy and practice, we compared socio-demographic characteristics and health needs of people leaving prison with a history of methamphetamine use and/or opioid use. METHODS A cross-sectional survey of incarcerated adults administered the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test was used to identify moderate-/high-risk methamphetamine use (n = 909), opioid use (n = 115) or combined methamphetamine/opioid use (n = 356) before incarceration. We compared groups using modified log-linked Poisson regression with robust error variance. RESULTS Compared to the opioid-only group, the methamphetamine-only group were: significantly more often aged <25 years; significantly more likely to identify as Indigenous; significantly less likely to have a history of prior incarceration, drug injection or overdose. A significantly lower proportion of methamphetamine-only and methamphetamine-and-opioid participants self-reported current hepatitis C infection compared to opioid-only participants. A majority of participants in all groups screened positive for current psychological distress according to the K10. DISCUSSION AND CONCLUSIONS People leaving prison with a history of methamphetamine use differ from opioid users with respect to demographics, patterns of substance use and related health concerns. Treatment and harm reduction efforts for people who experience incarceration must respond to patterns of drug use in this population, and invest at scale in coordinated, continuous services for co-occurring substance use and mental health problems.
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Affiliation(s)
- Craig Cumming
- Centre for Health Services Research, School of Population and Global HealthUniversity of Western AustraliaPerthAustralia
| | - Stuart A. Kinner
- Centre for Adolescent HealthMurdoch Children's Research InstituteMelbourneAustralia
- Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
- Griffith Criminology InstituteGriffith UniversityBrisbaneAustralia
- School of Population HealthCurtin UniversityPerthAustralia
| | - Rebecca McKetin
- National Drug and Alcohol Research CentreUNSW SydneySydneyAustralia
| | - Ian Li
- School of Population and Global HealthUniversity of Western AustraliaPerthAustralia
| | - David B. Preen
- Centre for Health Services Research, School of Population and Global HealthUniversity of Western AustraliaPerthAustralia
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Grella CE, Ostile E, Scott CK, Dennis M, Carnavale J. A Scoping Review of Barriers and Facilitators to Implementation of Medications for Treatment of Opioid Use Disorder within the Criminal Justice System. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 81:102768. [PMID: 32446130 DOI: 10.1016/j.drugpo.2020.102768] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Policies aimed at addressing the high rates of opioid overdose have prioritized increasing access to medications for treatment of opioid use disorder (MOUD). Numerous barriers exist to providing MOUD within the criminal justice system and/or to justice-involved populations. The aim of this study was to conduct a scoping review of the peer-reviewed literature on implementation of MOUD within criminal justice settings and with justice-involved populations. METHODS A systematic search process identified 53 papers that addressed issues pertaining to implementation barriers or facilitators of MOUD within correctional settings or with justice-involved populations; these were coded and qualitatively analyzed for common themes. RESULTS Over half of the papers were published outside of the U.S. (n = 28); the most common study designs were surveys or structured interviews (n = 20) and qualitative interviews/focus groups (n = 18) conducted with correctional or treatment staff and with incarcerated individuals. Four categories of barriers and facilitators were identified: institutional, programmatic, attitudinal, and systemic. Institutional barriers typically limited capacity to provide MOUD to justice-involved individuals, which led to programmatic practices in which MOUD was not implemented following clinical guidelines, often resulting in forcible withdrawal or inadequate treatment. These programmatic practices commonly led to aversive experiences among justice-involved individuals, who consequently espoused negative attitudes about MOUD and were reluctant to seek treatment with MOUD following their release to the community. Facilitators of MOUD implementation included increased knowledge and information from training interventions and favorable prior experiences with individuals being treated with MOUD among correctional and treatment staff. Few systemic facilitators to implementing MOUD with justice-involved individuals were evident in the literature. CONCLUSION Barriers to implementing MOUD in criminal justice settings and/or with justice-involved populations are pervasive, multi-leveled, and inter-dependent. More work is needed on facilitators of MOUD implementation.
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Affiliation(s)
- Christine E Grella
- Chestnut Health Systems, 221 W. Walton St., Chicago, IL 60610, USA. (CORRESPONDING AUTHOR).
| | - Erika Ostile
- Carnevale Associates LLC, 4 Belinder Rd., Gaithersburg, MD 20878, USA..
| | - Christy K Scott
- Chestnut Health Systems, 221 W. Walton St., Chicago, IL 60610, USA..
| | - Michael Dennis
- Chestnut Health Systems, 448 Wylie Dr., Normal, IL 61761, USA..
| | - John Carnavale
- Carnevale Associates LLC, 4 Belinder Rd., Gaithersburg, MD 20878, USA..
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Bukten A, Lund IO, Kinner SA, Rognli EB, Havnes IA, Muller AE, Stavseth MR. Factors associated with drug use in prison - results from the Norwegian offender mental health and addiction (NorMA) study. HEALTH & JUSTICE 2020; 8:10. [PMID: 32399643 PMCID: PMC7218530 DOI: 10.1186/s40352-020-00112-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/01/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Remarkably little is known about drug use during imprisonment, including whether it represents a continuation of pre-incarceration drug use, or whether prison is also a setting for drug use initiation. This paper aims to describe drug use among people in prison in Norway and investigate risk factors associated with in-prison drug use. METHODS We used data from the Norwegian Offender Mental Health and Addiction (NorMA) Study, a cross-sectional survey of 1499 individuals in Norwegian prisons. Respondents reported on drug use (narcotics and non-prescribed medications) both before and during imprisonment. We used multivariate logistic regression to investigate the associations between drug use in prison and demographics, previous drug use, mental health, and criminal activity. RESULTS Sixty-five percent of respondents reported lifetime drug use, and about 50% reported daily use of drugs during the 6 months before incarceration. Thirty-five percent reported ever using drugs in prison, but initiation of drug used during incarceration was uncommon. In a multivariate model, factors independently associated with drug use in prison included lifetime number of drugs used (adjusted odds ratio [aOR] = 1.17; 95% confidence interval [CI] 1.12-1.23; p < 0.001), daily drug use in the 6 months before imprisonment (aOR = 7.12; 95%CI 3.99-12.70; p < 0.001), and being intoxicated while committing the crime related to current imprisonment (aOR = 2.13; 95%CI 1.13-4.03; p = 0.020). CONCLUSIONS In-prison drug use is independently associated with high-risk drug use before imprisonment. To reduce drug use in prison, correctional services must systematically screen for pre-prison drug use and offer effective drug treatment for those in need.
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Affiliation(s)
- Anne Bukten
- Norwegian Centre for Addiction Research, University of Oslo, Kirkveien 166, 0407, Oslo, Norway.
- Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway.
| | | | - Stuart A Kinner
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Public Health, University of Melbourne, Melbourne, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Griffith Criminology Institute, Griffith University, Brisbane, Australia
- Mater Research Institute-UQ, University of Queensland, Brisbane, Australia
| | - Eline Borger Rognli
- Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
| | | | | | - Marianne Riksheim Stavseth
- Norwegian Centre for Addiction Research, University of Oslo, Kirkveien 166, 0407, Oslo, Norway
- Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
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Azbel L, Wegman MP, Polonsky M, Bachireddy C, Meyer J, Shumskaya N, Kurmanalieva A, Dvoryak S, Altice FL. Drug injection within prison in Kyrgyzstan: elevated HIV risk and implications for scaling up opioid agonist treatments. Int J Prison Health 2019; 14:175-187. [PMID: 30274558 DOI: 10.1108/ijph-03-2017-0016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose Within-prison drug injection (WPDI) is a particularly high HIV risk behavior, yet has not been examined in Central Asia. A unique opportunity in Kyrgyzstan where both methadone maintenance treatment (MMT) and needle-syringe programs (NSP) exist allowed further inquiry into this high risk environment. The paper aims to discuss these issues. Design/methodology/approach A randomly selected, nationally representative sample of prisoners within six months of release in Kyrgyzstan completed biobehavioral surveys. Inquiry about drug injection focused on three time periods (lifetime, 30 days before incarceration and during incarceration). The authors performed bivariate and multivariable generalized linear modeling with quasi-binomial distribution and logit link to determine the independent correlates of current WPDI. Findings Of 368 prisoners (13 percent women), 109 (35 percent) had ever injected drugs, with most (86 percent) reporting WPDI. Among those reporting WPDI, 34.8 percent had initiated drug injection within prison. Despite nearly all (95 percent) drug injectors having initiated MMT previously, current MMT use was low with coverage only reaching 11 percent of drug injectors. Two factors were independently correlated with WPDI: drug injection in the 30 days before the current incarceration (AOR=12.6; 95%CI=3.3-48.9) and having hepatitis C infection (AOR: 10.1; 95%CI=2.5-41.0). Originality/value This study is the only examination of WPDI from a nationally representative survey of prisoners where both MMT and NSP are available in prisons and in a region where HIV incidence and mortality are increasing. WPDI levels were extraordinarily high in the presence of low uptake of prison-based MMT. Interventions that effectively scale-up MMT are urgently required as well as an investigation of the environmental factors that contribute to the interplay between MMT and WPDI.
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Affiliation(s)
- Lyuba Azbel
- Yale University , New Haven, Connecticut, USA
| | | | | | - Chethan Bachireddy
- University of Pennsylvania Department of Medicine , Philadelphia, Pennsylvania, USA
| | | | - Natalya Shumskaya
- AIDS Foundation East-West in the Kyrgyz Republic, Bishkek, Kyrgystan
| | | | - Sergey Dvoryak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Frederick L Altice
- Medicine at the School of Medicine, Yale University , New Haven, Connecticut, USA
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Ritter A, Livingston M, Chalmers J, Berends L, Reuter P. Comparative policy analysis for alcohol and drugs: Current state of the field. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 31:39-50. [PMID: 26944717 DOI: 10.1016/j.drugpo.2016.02.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 01/19/2016] [Accepted: 02/01/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND A central policy research question concerns the extent to which specific policies produce certain effects - and cross-national (or between state/province) comparisons appear to be an ideal way to answer such a question. This paper explores the current state of comparative policy analysis (CPA) with respect to alcohol and drugs policies. METHODS We created a database of journal articles published between 2010 and 2014 as the body of CPA work for analysis. We used this database of 57 articles to clarify, extract and analyse the ways in which CPA has been defined. Quantitative and qualitative analysis of the CPA methods employed, the policy areas that have been studied, and differences between alcohol CPA and drug CPA are explored. RESULTS There is a lack of clear definition as to what counts as a CPA. The two criteria for a CPA (explicit study of a policy, and comparison across two or more geographic locations), exclude descriptive epidemiology and single state comparisons. With the strict definition, most CPAs were with reference to alcohol (42%), although the most common policy to be analysed was medical cannabis (23%). The vast majority of papers undertook quantitative data analysis, with a variety of advanced statistical methods. We identified five approaches to the policy specification: classification or categorical coding of policy as present or absent; the use of an index; implied policy differences; described policy difference and data-driven policy coding. Each of these has limitations, but perhaps the most common limitation was the inability for the method to account for the differences between policy-as-stated versus policy-as-implemented. CONCLUSION There is significant diversity in CPA methods for analysis of alcohol and drugs policy, and some substantial challenges with the currently employed methods. The absence of clear boundaries to a definition of what counts as a 'comparative policy analysis' may account for the methodological plurality but also appears to stand in the way of advancing the techniques.
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Affiliation(s)
- Alison Ritter
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW, Sydney, NSW 2052, Australia.
| | - Michael Livingston
- Centre for Alcohol Policy Research (CAPR), Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3000, Australia
| | - Jenny Chalmers
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW, Sydney, NSW 2052, Australia
| | - Lynda Berends
- Centre for Health and Social Research, Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Peter Reuter
- School of Public Policy and Department of Criminology, University of Maryland, College Park, MD 20742, USA
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Zurhold H, Stöver H. Provision of harm reduction and drug treatment services in custodial settings – Findings from the European ACCESS study. DRUGS-EDUCATION PREVENTION AND POLICY 2015. [DOI: 10.3109/09687637.2015.1112363] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Heike Zurhold
- Zentrum für Interdisziplinäre Suchtforschung, Klinik für Psychiatrie und Psychotherapie des Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany and
| | - Heino Stöver
- Fachhochschule Frankfurt/Main, Fachbereich 4, Soziale Arbeit und Gesundheit, Frankfurt/Main, Germany
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van Dooren K, Kinner SA, Hellard M. A comparison of risk factors for hepatitis C among young and older adult prisoners. JOURNAL OF CORRECTIONAL HEALTH CARE 2014; 20:280-91. [PMID: 25134604 DOI: 10.1177/1078345814541536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Internationally, the prevalence of hepatitis C infection is higher among prisoners when compared to the general population, particularly among people who inject drugs. This study estimates the prevalence of, and compares the risk factors for, hepatitis C in young (< 25 years) and older (≥ 25 years) prisoners with a history of injection drug use. Participants were 677 sentenced prisoners in Queensland, Australia, with a lifetime history of injection drug use, recruited in the 6 weeks prior to release from custody. The prevalence of hepatitis C exposure was significantly lower in young prisoners than in older prisoners (20.7% vs. 29.4%, p = .03). Risk factors for hepatitis C varied between young and older prisoners. Young people who inject drugs and who have had shorter time at risk of hepatitis C exposure are an important target group for hepatitis C prevention efforts.
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Affiliation(s)
- Kate van Dooren
- Queensland Centre for Intellectual and Developmental Disability, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Stuart A Kinner
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia School of Medicine, The University of Queensland, Brisbane, Australia School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret Hellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia Centre for Population Health, Burnet Institute, Melbourne, Australia The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
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