Prevalence and Predictors of Chronic Health Conditions of Inmates Newly Admitted to Maximum Security Prisons

Burden of diabetes in correctional facilities: A global systematic review and meta-analysis

Background

Diabetes mellitus presents significant public health challenges worldwide. While its prevalence and management in the general population have been extensively studied, comprehensive research on diabetes among incarcerated individuals is lacking. This study aims to conduct a systematic review and meta-analysis to determine the prevalence of diabetes within the prison population.

Methods

The systematic review included studies reporting on the prevalence of diabetes in prison populations. Searches were conducted in PubMed, Web of Science, and EMBASE from 2000 to November 4, 2023, with an update on December 15, 2023. Nested Knowledge web software was utilized for screening and data extraction. Quality assessment was conducted using the JBI tool. A meta-analysis was performed using a random-effects model in R software version 4.3.

Results

Thirty-three studies were included, encompassing 807,617 participants, with 67,291 reported as patients with diabetes. The pooled prevalence of diabetes in prison populations was found to be 7.1% (95% CI: 4.9% to 10.1%), exhibiting high heterogeneity (I2 = 100%). Subgroup analysis revealed significant geographical variability: the United States had a prevalence of 9% (95% CI: 4 %to 17 %), Italy 5% (95% CI: 0% to 40 %), Iran 10% (95% CI: 7 % to 15 %), and Egypt 21% (95% CI: 14% to 28 %). Notable variations in prevalence were also observed in countries like France, Australia, Taiwan, India, the UK, Spain, Brazil, and Sub-Saharan Africa. An LFK index of -3.3 indicated the presence of publication bias.

Conclusion

The study reveals that diabetes mellitus is a significant health concern in prisons, with a prevalence of 7.1%, comparable to that in the general population. The marked variability across studies indicates the challenges of diabetes management in correctional settings. These findings highlight the need for tailored healthcare strategies, considering prisons' unique challenges and risk factors.

A Scoping Review of Organ Transplantation in Populations Experiencing Incarceration

Despite an aging confined population, the current state of organ transplantation in carceral systems is largely unknown. This scoping review aimed to assess the literature on organ transplantation in populations experiencing incarceration. The review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for a scoping review. Included references were published between January 2000 and January 2022 in PubMed, Cumulative Index to Nursing and Allied Health Literature via EBSCO, EMBASE.com, PsycInfo via EBSCO, Sociological Abstracts via ProQuest, and Scopus. Two reviewers conducted title and abstract screening, full-text review, and data extraction in order to generate common themes. The initial search yielded 3,225 studies, and 2,129 references underwent screening. Seventy studies underwent full-text review, and 10 met inclusion criteria. These studies revealed heterogeneous perspectives and policies by providers and transplant centers regarding transplant consideration of individuals with incarceration history or current involvement. Two studies on a kidney transplant program for patients experiencing incarceration showed transplant as a sustainable and potentially superior option for people who are incarcerated, as compared with chronic hemodialysis. Literature on transplantation for populations experiencing incarceration is sparse. More research is required to understand the demand for transplants and the ethical implications of the heterogeneous perspectives and policies on practice patterns.

Communicating sexual health to the incarcerated population: information dissemination in a US sample of inmate handbooks

Incarcerated individuals frequently enter prison with a history of high-risk lifestyle behaviours likely to contribute to the transmission of infectious disease. Prisons offer a unique setting in which to advance health equity to an underserved population by disseminating information and education. Sexual health education has the potential to mitigate negative health consequences in the incarcerated population and improve sexual health practices upon community re-entry, benefiting both incarcerated individuals and communities. Limited empirical research examines sexual health information and education in US correctional facilities. Handbooks, given to all people upon incarceration, have the potential to provide vital information and education to promote safe sexual practice and prevent disease transmission. This work, guided by 22 critical sexual health education recommendations from the US Centers for Disease Control and Prevention, examines the presence (or absence) of recommended sexual health information and guidance in prison handbooks. Handbooks (n = 74) from 49 of 50 US states were qualitatively analysed with results revealing limited information, education or guidance about sexual health/safe sexual practice during incarceration or afterwards. Utilising handbooks for comprehensive sexual education could be a critical step towards reaching members of an already at-risk underserved population.

Factors associated with non-treatment for long-term illness among incarcerated individuals

PURPOSE

The prison population is seldom studied and often overlooked in many countries despite their vulnerability to long-term illness. This study aims to explore the factors associated with the non-treatment for long-term illnesses among incarcerated individuals.

DESIGN/METHODOLOGY/APPROACH

This study is a cross-sectional analysis. The authors conducted a secondary data analysis using information collected in the Peruvian census of incarcerated individuals. The study population consisted of incarcerated individuals diagnosed with a long-term illness. To evaluate the factors associated with non-treatment, the authors used a Poisson regression model.

FINDINGS

The authors included 12,512 incarcerated individuals (age: 40.9 ± 13.1 years), and 39% of them did not receive treatment for their long-term illness. The authors observed that non-treatment was statistically associated with gender, age, having children, use of the Spanish language, sexual identity, judicial situation, penitentiary location, discrimination inside the penitentiary and health insurance before incarceration. However, only having children (prevalence ratio [PR]: 1.11, confidence interval [CI]95% 1.03-1.19), using the Spanish language (PR: 1.15, CI95%: 1.01-1.31), being in a penitentiary not in Lima (PR: 1.11, CI95%: 1.06-1.17) and perceiving discrimination inside the penitentiary (PR: 1.12, CI95% 1.06-1.18) increased the prevalence of non-treatment.

ORIGINALITY/VALUE

Identifying the factors associated with non-treatment will allow us to implement measures for prioritizing groups and developing strategies for the evaluation, close follow-up of their health and management of comorbidities.

The Reintegration of Men into Society after a Sexual Offense: A Hermeneutic Phenomenology Study

The purpose of this study was to describe the lived experience and meaning of being a 'sex offender' for the individual who is reintegrating into society, considering issues associated with self-perception, perception of others, stigma and humanization. Fourteen male adults were invited to participate in this hermeneutic phenomenological study. Data analysis was completed using an iterative process as described by van Manen. Five major themes were identified: exposed secret leads to humiliation; being considered a sex offender is living in fear of the unknown; stigma and shame consume the identity of the individual charged with a sexual offense; reframing and "leveling" of the crime are coping strategies; and the path toward healing and forgiveness is complex. Contextualizing individuals' experiences and examining barriers and motivators post-charge are essential to minimize stigma and risk factors linked to recidivism, as well as to facilitate recovery and healing.

Mortality in women with a history of incarceration in Norway: a 20-year national cohort study

BACKGROUND

Women carry a substantial burden of psychiatric, somatic and lifestyle-related morbidity in the prison context. By describing causes of death and estimating the risk and burden of mortality compared with the general population, this study investigates how mortality operates in this highly marginalized and under-researched population.

METHODS

In this registry-based study of all women incarcerated in Norwegian prisons from 2000 to 2019 (N = 11 313), we calculated crude mortality rates, years of lost life and, by using mortality in age-matched women from the general population as a reference, age-standardized mortality ratios and years of lost life rates.

RESULTS

Over a mean follow-up time of 10.7 years, at a median age of 50 years, 9% of the population had died (n = 1005). Most deaths (80%) were premature deaths from an avoidable cause. Drug-induced causes and deaths from major non-communicable diseases (NCDs) were most frequent (both 32%). Compared with women in the general population, women with a history of incarceration were more likely to die from any cause. Trends in annual age-standardized years of lost life rates suggest that the mortality burden associated with major NCDs has gradually replaced drug-induced causes.

CONCLUSIONS

Women with a history of incarceration die at a greater rate than their peers and largely from avoidable causes. The profile of causes contributing to the substantial burden of mortality placed on this population has changed over time and has important implications for future efforts to reduce morbidity and the risk of premature death following release from prison.

Challenging Health Inequities in Incarceration: a Call for Equitable Care for Kidney Disease and Hypertension

PURPOSE OF REVIEW

To review the current literature on care of hypertension and chronic kidney disease for people who are currently and formerly incarcerated, and to make recommendations for improving outcomes.

RECENT FINDINGS

There is a growing body of literature describing care for kidney disease and hypertension for incarcerated and formerly incarcerated individuals that documents the provision of care itself, notably that many jails contract with private companies; the system is not designed to provide sustained, chronic disease care; and the transition from incarceration to community is fraught with gaps in care. However, deficiencies in data collection and regulation still limit our understanding of the quality of care provided in jails and prisons. Furthermore, more data is needed to understand the impact of structural racism in the criminal legal system on overall disparities in care for hypertension and kidney disease. Insurance coverage rates for people who were formerly incarcerated continue to be lower than the general population despite Medicaid expansion in many states. There is little recent data regarding kidney replacement therapy for this population despite known variation in dialysis modalities and transplant programs by state. Transitions clinics, which connect people who were formerly incarcerated with care in the community upon release, are growing and are important avenues by which to deliver care. People who are incarcerated are disproportionately affected by hypertension and kidney disease, yet data regarding the extent of these inequities and availability of quality care is lacking. More work is needed to understand the care of individuals with kidney disease and hypertension in prisons and to improve outcomes for these common chronic conditions. Both providing effective treatment of kidney disease and hypertension in prisons and jails and providing coordinated, quality transition to community care upon release represents an important opportunity for reform in care for a marginalized population.

Obesity Epidemic in U.S. Prison Populations: A Meta-Analysis and Review of the Literature

Limited existing evidence and health provider perceptions suggest that prevalence of obesity among incarcerated people residing in U.S. correctional institutions is high. Evaluating evidence of obesity and weight change during incarceration will allow for the determination of whether people are subject to weight gain during incarceration. A systematic review of three online databases, gray literature, and reference lists of articles of interest was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A meta-analysis to obtain pooled prevalence estimates of obesity among U.S. incarcerated people was then completed. A total of 11 studies met our inclusion criteria. Results show the estimated pooled prevalence of obesity in incarcerated men (30.0%) was less than the national average. The estimated pooled prevalence of obesity in females (39.8%) was similar to the national average.

Examining Attitudes, Expectations, and Tobacco Cessation Treatment Outcomes Among Incarcerated Tobacco Smokers

People who are incarcerated have limited resources to help them quit tobacco smoking. This study assessed the association between baseline attitudes and expectations of the program with final smoking status as the outcome. A 6-week group-based counseling with nicotine patches was provided to incarcerated individuals to quit smoking. A cross-sectional survey was given at the first session. Questions surrounding attitudes such as interest, confidence, motivation, and expectations were used to assess associations with smoking cessation. Exhaled carbon monoxide (CO) levels were taken at each sessions. Participants were categorized as nonsmoking or continued smoking at a 6.0 parts per million (ppm) CO at their final session attended. Overall, 123 participants had a CO higher than 6.0 ppm or missed more than two sessions at their final session, and 54 had a CO under 6.0 ppm. A total of 102 participants completed the 6-week program. Differences among the two groups in exhaled CO began at Session 3 and continued throughout the study.

Barriers and facilitators to attending and being physically active during recreation time among women incarcerated

BACKGROUND

Most women incarcerated in jail are not physically active and do not attend recreation time (rec-time), a time dedicated to being physically active, outside. The purpose of this study was to determine barriers and facilitators to attending and being physically active during rec-time among women incarcerated in jail.

METHODS

We recruited and distributed a cross-sectional questionnaire to 100 women incarcerated at the Coconino County Detention Facility (CCDF) in Flagstaff, Arizona from March to July 2020. Women were asked about their experience with rec-time at CCDF, including if they had ever attended, how often they attended, if they exercised at rec-time, activities they participated in, and facilitators, barriers, and benefits to attend rec-time.

RESULTS

Among 99 women who completed the questionnaire, 89% had ever attended rec-time. Most women identified environmental- and health-related facilitators to attending rec-time including enjoying natural light (74%), getting fresh air (83%), a change in environment (62%), and to move around and exercise (72%). Many women indicated environmental-, equipment-, clothing, and motivation-related barriers to attending rec-time. Specifically, women believed there was a lack of equipment (56%) and limited access to proper footwear (49%).

CONCLUSIONS

As health and environment are important facilitators and barriers to being physically active among women incarcerated in jail, it is important to identify appropriate environmental and policy interventions to increase the use of rec-time and physical activity. If a correctional facility does not offer rec-time or a similar alternative, one should be established, accessible, and welcoming.

Kidney Disease among People Who Are Incarcerated

CKD affects 15% of US adults and is associated with higher morbidity and mortality. CKD disproportionately affects certain populations, including racial and ethnic minorities and individuals from disadvantaged socioeconomic backgrounds. These groups are also disproportionately affected by incarceration and barriers to accessing health services. Incarceration represents an opportunity to link marginalized individuals to CKD care. Despite a legal obligation to provide a community standard of care including the screening and treatment of individuals with CKD, there is little evidence to suggest systematic efforts are in place to address this prevalent, costly, and ultimately fatal condition. This review highlights unrealized opportunities to connect individuals with CKD to care within the criminal justice system and as they transition to the community, and it underscores the need for more evidence-based strategies to address the health effect of CKD on over-represented communities in the criminal justice system.

Disparities in cancer prevalence, incidence, and mortality for incarcerated and formerly incarcerated patients: A scoping review

BACKGROUND

Racial and ethnic minority status, structural racism, low educational attainment, and poverty are consistently associated with cancer disparities and with higher rates of incarceration. The objective of this scoping review is to conduct a qualitative synthesis of the literature on cancer prevalence, incidence, mortality, and disparities in these outcomes for incarcerated and formerly incarcerated patients, as this literature is fragmented and heterogenous.

METHODS

This scoping review included Bureau of Justice Statistics reports and searched PubMed in May 2021 for all English language studies published between 1990 and 30 April 2021, that reported on cancer prevalence, incidence, or mortality for incarcerated or formerly incarcerated individuals in the United States.

RESULTS

Twenty studies were selected. Data on cancer prevalence and incidence were scarce but suggested that incarcerated and formerly incarcerated patients have a similar overall risk of cancer diagnosis as the general population, but elevated risk of certain cancers such as cervical, lung, colorectal, and hepatocellular carcinoma for which effective prevention and screening interventions exist. Cancer mortality data in state and local jails as well as prisons were robust and suggests that both incarcerated and formerly incarcerated patients have higher cancer mortality than the general population.

CONCLUSIONS

Incarcerated and formerly incarcerated patients likely have a higher risk of dying from cancer than the general population, but important gaps in our knowledge about the extent and drivers of disparities for this population remain. Additional research is needed to guide interventions to reduce cancer disparities for patients experiencing incarceration.

Nutrition in Midwestern State Department of Corrections Prisons: A Comparison of Nutritional Offerings With Commonly Utilized Nutritional Standards

Improvement in nutritional care in correctional institutions may reduce the burden of related chronic health conditions. Even when nutritional standards are used, inconsistent use of standards and lacking regulations may be leading to inappropriate or inconsistent nutrition care in corrections. Midwestern state department of corrections' menus revealed excessive calorie offerings and low offerings of vegetables on male and female menus, and low fruit and dietary fiber offerings on male menus. A majority of vitamin and mineral offerings met recommendations when reported; however, they were inconsistently underreported across states. When reported, potassium and vitamin E were offered at less than recommended levels while sodium was excessively offered. Consistency in use and increased accountability in meeting nutrition standards may improve nutrition care within corrections.

Cardiovascular Risk Factors among Individuals Incarcerated in an Arizona County Jail

We aimed to estimate the prevalence of cardiovascular risk factors, including hypertension, diabetes, high cholesterol, cigarette smoking, alcohol consumption, and obesity among a sample of individuals incarcerated in an Arizona county jail and compare prevalence estimates to a matched non-institutionalized population. From 2017–2018, individuals housed at a county jail completed a cross-sectional health survey. We estimated the prevalence of hypertension, diabetes, cholesterol, overweight/obesity, cigarette smoking, binge drinking, and self-reported health among individuals incarcerated. We compared prevalence estimates of cardiovascular risk factors to a matched sample of 2017–2018 NHANES participants. Overall, 35.9%, 7.7%, and 17.8% of individuals incarcerated in jail self-reported hypertension, diabetes, and high cholesterol, respectively. Of individuals incarcerated, 59.6% were overweight or obese and 36.8% self-reported fair or poor general health. Over half of individuals incarcerated reported ever smoking cigarettes (72.3%) and binge drinking (60.7%). Compared to a matched sample of NHANES participants, individuals incarcerated in jail had a statistically higher prevalence of cigarette smoking and binge drinking. Screening of cardiovascular risk factors and providing preventive measures and interventions, such as healthy eating, physical activity, or pharmacological adherence interventions, while individuals are incarcerated may contribute to the prevention and management of cardiovascular risk factors and, eventually, cardiovascular disease.

Assessing the Mortality Impact of the COVID-19 Pandemic in Florida State Prisons

Background

The increased risk of COVID-19 infection among incarcerated individuals due to environmental hazards is well known and recent studies have highlighted the higher rates of infection and mortality prisoners in the United States face due to COVID-19. However, the impact of COVID-19 on all-cause mortality rates in incarcerated populations has not been studied.

Methods

Using data reported by the Florida Department of Corrections on prison populations and mortality events we conducted a retrospective cohort study of all individuals incarcerated in Florida state prisons between 2015 and 2020. We calculated excess deaths by estimating age-specific expected deaths from mortality trends in 2015 through 2019 and taking the difference between observed and expected deaths during the pandemic period. We calculated life table measures using standard demographic techniques and assessed significant yearly changes using bootstrapping.

Findings

The Florida Department of Corrections reported 510 total deaths from March 1, 2020 to December 31, 2020 among the state prison population. This was 42% higher (rate ratio 1.42, 95% CI 1.15 to 1.89) than the expected number of deaths in light of mortality rates for previous years. Reported COVID-19 deaths in a month were positively correlated with estimated excess deaths (80.4%, p <.01). Using age-specific mortality estimates, we found that life expectancy at age 20 declined by 4 years (95% CI 2.06-6.57) between 2019 and 2020 for the Florida prison population.

Interpretation

The Florida prison population saw a significant increase in all-cause mortality during the COVID-19 pandemic period, leading to a decrease in life expectancy of more than four years. Life years lost by the Florida prison population were likely far greater than those lost by the general United States population, as reported by other studies. This difference in years lost highlights the need for increased interventions to protect vulnerable incarcerated populations during pandemics.

Funding

Vital Projects Fund, Arnold Ventures, US Centers for Disease Control, Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The Impact of Quality Improvement Measures in the Management of Asthma Patients in Juvenile Detention Facilities

Asthma is a serious chronic lung disease with a significant economic burden. The population of the San Bernardino County Juvenile Detention and Assessment Centers have higher odds of asthma as compared to the general population. Research has shown that a significant number of patients with a prior history of asthma were misdiagnosed. A protocol using objective testing, along with the detailed patient's history, was successfully implemented to verify the diagnosis and guide more effective medical care. After the implementation of those steps, the prevalence of asthma was found to be lower with the new protocol, from 18.1% in the pre-protocol period to 11.2% in the post-protocol period. This decrease resulted in an associated reduction in both direct and indirect healthcare costs and more efficient medical care.

COVID-19: The Additional Sentence for the Incarcerated

Incarcerated people are one of the most vulnerable populations during the coronavirus pandemic. There are varying perspectives regarding how to address the health care barriers seen in this population. Some individuals and organizations advocate for a mandatory release of the incarcerated who are not deemed a risk to the general population, whereas others advocate for improving health care in jails and prisons. This article highlights the importance of addressing access to care issues, overcrowding, societal implications, and access to hygienics for the incarcerated during the coronavirus disease 2019 pandemic, and solutions forward.

Epidemiology of Incarceration: Characterizing Jail Incarceration for Public Health Research

BACKGROUND

Each year, 9 million individuals cycle in and out of jails. The under-characterization of incarceration as an exposure poses substantial challenges to understanding how varying levels of exposure to jail may affect health. Thus, we characterized levels of jail incarceration including recidivism, number of incarcerations, total and average number of days incarcerated, and time to reincarceration.

METHODS

We created a cohort of 75,203 individuals incarcerated at the Coconino County Detention Facility in Flagstaff, Arizona, from 2001 to 2018 from jail intake and release records.

RESULTS

The median number of incarcerations during the study period was one (interquartile range [IQR] = 1-2). Forty percent of individuals had >1 incarceration. The median length of stay for first observed incarcerations was 1 day (IQR = 0-5). The median total days incarcerated was 3 (IQR = 1-23). Average length of stay increased by number of incarcerations. By 18 months, 27% of our sample had been reincarcerated.

CONCLUSION

Characteristics of jail incarceration have been largely left out of public health research. A better understanding of jail incarcerations can help design analyses to assess health outcomes of individuals incarcerated in jail. Our study is an early step in shaping an understanding of jail incarceration as an exposure for future epidemiologic research. See video abstract at, http://links.lww.com/EDE/B536.

Special Considerations Related to Race, Sex, Gender, and Socioeconomic Status in the Preoperative Evaluation: Part 1: Race, History of Incarceration, and Health Literacy

Patients anticipating surgery and anesthesia often need preoperative care to reduce risk and facilitate services on the day of surgery. Preparing patients often requires extensive evaluation and coordination of care. Vulnerable, marginalized, and disenfranchised populations have special concerns, limitations, and needs. These patients may have unidentified or poorly managed comorbidities. Underrepresented minorities and transgender patients may avoid or have limited access to health care. Homelessness, limited health literacy, and incarceration hinder perioperative optimization initiatives. Identifying patients who will benefit from additional resource allocation and knowledge of their special challenges is vital to reducing disparities in health and health care.

Health Behaviors and Outcomes Associated With Personal and Family History of Criminal Justice System Involvement, New York City, 2017

Objectives. To quantify the association between personal and family history of criminal justice system (CJS) involvement (PHJI and FHJI, respectively), health outcomes, and health-related behaviors.Methods. We examined 2017 New York City Community Health Survey data (n = 10 005) with multivariable logistic regression. We defined PHJI as ever incarcerated or under probation or parole. FHJI was CJS involvement of spouse or partner, child, sibling, or parent.Results. We found that 8.9% reported only FHJI, 5.4% only PHJI, and 2.9% both FHJI and PHJI (mean age = 45.4 years). Compared with no CJS involvement, individuals with only FHJI were more likely to report fair or poor health, hypertension, diabetes, obesity, depression, heavy drinking, and binge drinking. Respondents with only PHJI reported more fair or poor health, asthma, depression, heavy drinking, and binge drinking. Those with both FHJI and PHJI were more likely to report asthma, depression, heavy drinking, and binge drinking.Conclusions. New York City adults with personal or family CJS involvement, or both, were more likely to report adverse health outcomes and behaviors.Public Health Implications. Measuring CJS involvement in public health monitoring systems can help to identify important health needs, guiding the provision of health care and resource allocation.

Prevalence of Diabetes and Associated Risk Factors among a Group of Prisoners in the Yaoundé Central Prison

BACKGROUND

Diabetes is a public health problem worldwide, associated with increased morbidity and mortality. According to the International Diabetes Federation (IDF) 2017 data, around 425 million people worldwide suffer from diabetes. This number is expected to increase to 629 million in 2045. Various occidental studies reported the increased prevalence and lower control of diabetes among prisoners. However, there is no data on the characteristics of inmates with diabetes in sub-Saharan Africa.

METHODS

A cross-sectional study among incarcerated detainees from the Yaoundé Central Prison was conducted from January to July 2017. Diabetes was defined according to the American Diabetes Association (ADA) criteria. Analyzed variables included phenotypic characteristics, lifestyle, the reason for detention, the sentence severity, and the length of detention.

RESULTS

We recruited 437 inmates (344 men) with an average age of 37.0 (95% CI: 35.9-38.3) years. The most frequent age group was 20 to 39 years with 281 (64.7%) inmates, and the mean prison stay was 29.1 (95% CI: 25.7-32.8) months. The prevalence of diabetes in the Yaoundé Central Prison was 9.4%. The main cardiovascular risk factors were a sedentary lifestyle (91.1%), hypertension (39.6%), smoking (31.6%), and alcohol consumption (28.1%). Hypertension (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (.

CONCLUSION

Diabetes prevalence in the Yaoundé Central Prison was high, at 9.4%, compared to that in the general population. It was associated with other classical cardiovascular risk factors and factors linked to the sentence (minor and major crimes). This trial is registered with CE00617/CRERSHC/2016.

Cardiovascular risk factors in people deprived of their liberty: an integrative review

ABSTRACT Objective: To investigate the scientific evidence on the most frequent risk factors for cardiovascular disease in persons deprived of their liberty. Methods: An integrative literature review carried out in the CINAHL, Medline/Pubmed, Scopus, LILACS, CUIDEN, Web of Science and Virtual Health Library portal databases using the following keywords: cardiovascular diseases, risk factors, prisons, prisoners. Results: The final sample consisted of 17 primary articles published in English and Spanish. Overweight and obesity were the most cited cardiovascular risk factors besides diabetes, hypertension, smoking, dyslipidemia, consumption of alcohol and other drugs, physical inactivity, metabolic syndrome, anxiety, depression and unhealthy heart diet. Conclusions: The most frequent risk factors for cardiovascular disease in persons deprived of their liberty were those classified as modifiable. In the prison setting, these factors are enhanced due to an environment with little modification of these opportunities.

How COVID-19's Disruption of the U.S. Correctional System Provides an Opportunity for Decarceration

The COVID-19 pandemic has amplified decades of vulnerabilities, disparities, and injustices within the U.S. correctional system. The spread of the coronavirus poses a particularly serious threat to those that comprise the system, including personnel, attorneys, prisoners, their families and extends into the communities in which facilities are located. These correctional facilities and communities were especially underprepared for the sudden onset of a highly contagious virus, which has resulted in an exceedingly high number of infections among those who work and are held in the facilities. Rampant overcrowding in the U.S. correctional system, an aging population, and a population exhibiting high rates of underlying health conditions are highly likely to exacerbate the spread of this highly contagious virus. This potentially dire set of interrelated circumstances necessitates rapid decarceration measures that effectively balance public safety and public health. Unfortunately, there has been unclear guidance as well as changing and even contradictory information coming from the federal government concerning rapid measures to mitigate the spread of infection to justice system personnel and federal prisoners. In this paper we summarize the federal response and how it has impacted those responsible for implementation. Furthermore, we discuss how systemic deleterious conditions of the U.S. correctional system serve as both accelerants to as well as effects of the pandemic. We end highlighting critical issues relating to early release due to COVID-19 that will necessitate future research.

Prison primary care and non-communicable diseases: a data-linkage survey of prevalence and associated risk factors

BACKGROUND

The size and mean age of the prison population has increased rapidly in recent years. Prisoners are a vulnerable group who, compared with the general population, experience poorer health outcomes. However, there is a dearth of research quantifying the prevalence of non-communicable diseases (NCDs) among prisoner populations.

AIM

To explore both the prevalence of NCDs and their risk factors.

DESIGN & SETTING

A cross-sectional survey was undertaken that was compared with clinical records in two male prisons in the north of England.

METHOD

Self-report surveys were completed by 199 prisoners to assess sociodemographic characteristics, general health, NCD prevalence, and risk factor prevalence. Data were checked against that retrieved from prison clinical records.

RESULTS

It was found that 46% reported at least one NCD and 26% reported at least one physical health NCD. The most common self-reported NCD was 'anxiety and depression' (34%), followed by 'respiratory disease' (17%), and 'hypertension' (10%). Having a physical health NCD was independently associated with increasing age or drug dependence.The level of agreement between clinical records and self-report ranged from 'fair' for alcohol dependence (kappa 0.38; P<0.001) to 'very good' for diabetes (kappa 0.86; P<0.001).

CONCLUSION

Compared with mainstream populations and despite high prevalence of risk factors for NCDs physical illness NCDs, with the exception of respiratory disease, are less common. However, poor mental health is more common. These differences are possibly owing to the younger average age of prison populations, since prevalence of risk factors was reported as high.Secondary data analysis of clinical records is a more methodologically robust way of monitoring trends in prisoner population disease prevalence.

Health Disparities and Converging Epidemics in Jail Populations: Protocol for a Mixed-Methods Study

BACKGROUND

Incarcerated populations have increased in the last 20 years and >12 million individuals cycle in and out of jails each year. Previous research has predominately focused on the prison population. However, a substantial gap exists in understanding the health, well-being, and health care utilization patterns in jail populations.

OBJECTIVE

This pilot study has 5 main objectives: (1) define recidivists of the jail system, individuals characterized by high incarceration rates; (2) describe and compare the demographic and clinical characteristics of incarcerated individuals; (3) identify jail-associated health disparities; (4) estimate associations between incarceration and health; and (5) describe model patterns in health care and jail utilization.

METHODS

The project has two processes-a secondary data analysis and primary data collection-which includes a cross-sectional health survey and biological sample collection to investigate infectious disease characteristics of the jail population. This protocol contains pilot elements in four areas: (1) instrument validity and reliability; (2) individual item assessment; (3) proof of concept of content and database accessibility; and (4) pilot test of the "honest broker" system. Secondary data analysis includes the analysis of 6 distinct databases, each covered by a formal memorandum of agreement between Northern Arizona University and the designated institution: (1) the Superior Court of Arizona Public Case Finder database; (2) North Country Health Care; (3) Health Choice Integrated Care; (4) Criminal Justice Information Services; (5) Correctional Electronic Medical Records; and (6) iLEADS. We will perform data integration processes using an automated honest broker design. We will administer a cross-sectional health survey, which includes questions about health status, health history, health care utilization, substance use practices, physical activity, adverse childhood events, and behavioral health, among 200 Coconino County Detention Facility inmates. Concurrent with the survey administration, we will collect Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus (samples from the nose) and dental microbiome (Streptococcus sobrinus and Streptococcus mutans samples from the mouth) from consenting participants.

RESULTS

To date, we have permission to link data across acquired databases. We have initiated data transfer, protection, and initial assessment of the 6 secondary databases. Of 199 inmates consented and enrolled, we have permission from 97.0% (193/199) to access and link electronic medical and incarceration records to their survey responses, and 95.0% (189/199) of interviewed inmates have given nasal and buccal swabs for analysis of S. aureus and the dental microbiome.

CONCLUSIONS

This study is designed to increase the understanding of health needs and health care utilization patterns among jail populations, with a special emphasis on frequently incarcerated individuals. Our findings will help identify intervention points throughout the criminal justice and health care systems to improve health and reduce health disparities among jail inmates.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/10337.

The Health of America's Aging Prison Population

Older incarcerated individuals comprise the fastest growing demographic in the US prison system. Unhealthy lifestyles among incarcerated individuals and inadequate health care lead to earlier onset and more rapid progression of many chronic conditions that are prevalent among community-living older adults. There are limited peer-reviewed epidemiologic data in this area; however, there is growing interest in identifying strategies for housing aging incarcerated individuals, delivering appropriate health care in prisons, and coordinating after-release health care. In this systematic review, we summarize the epidemiologic evidence of the health challenges facing the aging US prison population. Our comprehensive literature search focused on health outcomes, including diseases, comorbid conditions, mental health, cognition, and mobility. From 12,486 articles identified from the literature search, we reviewed 21 studies published between 2007 and 2017. All the studies were observational and cross-sectional, and most (n = 17) were based on regional samples. Sample sizes varied widely, ranging from 25 to 14,499 incarcerated people (median, 258). In general, compared with their younger counterparts, older incarcerated individuals reported high rates of diabetes mellitus, cardiovascular conditions, and liver disease. Mental health problems were common, especially anxiety, fear of desire for death or suicide, and depression. Activities of daily living were challenging for up to one-fifth of the population. We found no empirical data on cognition among older incarcerated individuals. The findings of this review reveal few empirical data in this area and highlight the need for new data to drive policy and practice patterns that address critical health issues related to the aging prison population.

Childhood Adversity and Mental Health Correlates of Obesity in a Population at Risk

The staggering prevalence of obesity and obesity-related health conditions takes exorbitant tolls on health care resources. This cross-sectional study with private evaluations of 636 adult inmates in a southern state prison was conducted with regressions comparing obese (body mass index [BMI] ≥ 30) to nonobese individuals to define obesity risk factors. Obese individuals more likely were female, were victims of childhood sexual abuse, suffered greater severity of childhood sexual abuse, attempted suicide, reported drug dependency, were non-Caucasian, and were older than nonobese. Psychopathy predicted lower BMI. Though obesity might be expected in victims of childhood physical abuse, traumatic brain injury, or other mental health conditions due to mobility or decision-making deficits, neither were significant. Adjusting for related variables, childhood sexual abuse remained significant. Females attempted suicide more frequently and suffered greater childhood sexual abuse.

Agency behind bars: Advance care planning with aging and dying offenders

Aging and terminally ill individuals in U.S. prisons are increasing, making critical the need for appropriate end-of-life (EOL) care and advance care planning (ACP). Applying Bandura's agentic perspective, the authors examined 20 aging/dying offenders' EOL preferences and ACP. Findings include 6 themes: decisions in the shadow of the past, what works best for me, feeling blessed, what is really going on, can anyone be trusted, and turning agency over to someone else. This study provides critical information that will assist professionals who work with dying offenders, as it presents a vivid illustration of their dying process.

Cancer Prevention During Early Adulthood: Highlights From a Meeting of Experts

Using a life course approach, the Centers for Disease Control and Prevention's Division of Cancer Prevention and Control and the National Association of Chronic Disease Directors co-hosted a 2-day meeting with 15 multidisciplinary experts to consider evidence linking factors in early adulthood to subsequent cancer risk and strategies for putting that evidence into practice to reduce cancer incidence. This paper provides an overview of key themes from those meeting discussions, drawing attention to the influence that early adulthood can have on lifetime cancer risk and potential strategies for intervention during this phase of life. A number of social, behavioral, and environmental factors during early adulthood influence cancer risk, including dietary patterns, physical inactivity, medical conditions (e.g., obesity, diabetes, viral infections), circadian rhythm disruption, chronic stress, and targeted marketing of cancer-causing products (e.g., tobacco, alcohol). Suggestions for translating research into practice are framed in the context of the four strategic directions of the National Prevention Strategy: building healthy and safe community environments; expanding quality preventive services in clinical and community settings; empowering people to make healthy choices; and eliminating health disparities. Promising strategies for prevention among young adults include collaborating with a variety of community sectors as well as mobilizing young adults to serve as advocates for change. Young adults are a heterogeneous demographic group, and targeted efforts are needed to address the unique needs of population subgroups that are often underserved and under-represented in research studies.

LOWER SERUM 25-HYDROXYVITAMIN D IS ASSOCIATED WITH OBESITY BUT NOT COMMON CHRONIC CONDITIONS: AN OBSERVATIONAL STUDY OF AFRICAN AMERICAN AND CAUCASIAN MALE VETERANS

OBJECTIVE

The study examined whether vitamin D insufficiency is a predictor of prevalent and/or incident common chronic conditions in African American men (AAM) and Caucasian American men (CAM).

METHODS

A total of 1,017 men were recruited at an urban VA medical center and followed prospectively for a mean of 5.4 years. Prevalent and incident chronic conditions evaluated were: obesity, type 2 diabetes, cancer, depression, dementia, and cardiovascular disease (CVD, including coronary artery disease [CAD], cerebrovascular accident [CVA], and congestive heart failure [CHF]). Univariate and multivariate regressions were performed to examine the association between 25-hydroxyvitamin D (25[OH]D) and these chronic illnesses.

RESULTS

This analysis was limited to 955 men (65.5% AAM, 27.2% CAM, 6.4% Hispanic) who had at least 1 year of follow-up (range, 1.0 to 7.1 years). Univariate analysis of the entire group showed that 25(OH)D correlated negatively with body mass index (BMI). There was no correlation between 25(OH)D and prevalent CVD (including separate analyses for CAD, CVA, and CHF), cancer, depression, dementia, all-cause mortality, or incident cancer, CAD, or CVA. Independent predictors of prevalent common conditions included increasing age, BMI, smoking, alcohol and polysubstance use, but not 25(OH)D levels.

CONCLUSION

The study does not support previously suggested associations of low vitamin D levels with prevalent common chronic conditions or increased risk for cancer, CAD, and CVA in a population of men with high burden of chronic disease. The finding that smoking and alcohol and polysubstance use are predictors of chronic conditions is an important reminder for addressing these risks during patient encounters.

ABBREVIATIONS

AAM = African American men BMI = body mass index CAD = coronary artery disease CAM = Caucasian American men CHF = congestive heart failure CI = confidence interval CVA = cerebrovascular accident CVD = cardiovascular disease HTN = hypertension OR = odds ratio T2DM = type 2 diabetes mellitus VAMC = Veteran Administration Medical Center 25(OH)D = 25-hydroxyvitamin D.

Cancer prevalence, incidence and mortality in people who experience incarceration in Ontario, Canada: A population-based retrospective cohort study

Introduction

Evidence suggests that many risk factors for cancer are overrepresented in people who experience incarceration, and data on cancer epidemiology are limited for this population. We aimed to describe cancer prevalence, incidence and mortality in adults admitted to provincial custody in Ontario, Canada in 2000.

Methods

We linked data on 48,166 adults admitted to provincial custody in Ontario in 2000 with Ontario Cancer Registry data to 2012. We calculated cancer prevalence in the 10 years prior to admission to custody in 2000, incidence between 2000 and 2012 and mortality between 2000 and 2011. Standardized for age, we calculated incidence and mortality ratios by sex compared to the general population of Ontario.

Results

The 10-year cancer prevalence was 0.4% in men and 0.6% in women at admission to provincial custody in 2000. Between 2000 and 2012, 2.6% of men and 2.8% of women were diagnosed with new cancer. The standardized incidence ratio for cancer was 1.0 (95% CI 0.9–1.0) for men and 0.9 (95% CI 0.7–1.0) for women compared to the general population, and was significantly increased for cervical, head and neck, liver and lung cancers. The standardized mortality ratio was 1.6 (95% CI 1.4–1.7) in men and 1.4 (95% CI 1.0–1.9) in women, and was significantly increased for head and neck, liver, and lung cancers.

Conclusions

There is an excess burden of cancer in people who experience incarceration. Cancer prevention should include people who experience incarceration, and the period of incarceration may offer an opportunity for intervention.

Gender and race disparities in weight gain among offenders prescribed antidepressant and antipsychotic medications

BACKGROUND

Studies have found that antipsychotics and antidepressants are associated with weight gain and obesity, particularly among women and some minority groups. Incarcerated populations (also referred to as offenders, prisoners or inmates) have a high prevalence of mental health problems and 15 % of offenders have been prescribed medications. Despite rates of antidepressant and antipsychotic use, investigations of weight gain and obesity in regard to these agents seldom have included offenders.

METHODS

This retrospective descriptive study (2005-2011) was conducted with a Department of Corrections in the east south central United States to investigate the relationship between antidepressant and antipsychotic agents, weight gain, obesity and race or gender differences. We sampled adult offenders who had an active record, at least two weight observations and height data. Offenders were classified into one of four mutually exclusive groups depending upon the type of medication they were prescribed: antidepressants, antipsychotics, other medications or no pharmacotherapy.

RESULTS

The sample population for this study was 2728, which was 25.2 % of the total population. The population not on pharmacotherapy had the lowest baseline obesity rate (31.7 %) compared to offenders prescribed antipsychotics (43.6 %), antidepressants (43.6 %) or other medications (45.1 %). Offenders who were prescribed antidepressants or antipsychotics gained weight that was significantly different from zero, p < .001 and p = .019, respectively. Women in the antidepressant group gained 6.4 kg compared to 2.0 kg for men, which was significant (p = .007). Although women in the antipsychotic group gained 8.8 kg compared to 1.6 kg for men, the finding was not significant (p = .122). Surprisingly, there were no significant differences in weight gain between African Americans and Whites in regard to antidepressants (p = .336) or antipsychotic agents (p = .335).

CONCLUSION

This study found that women and men offenders prescribed antidepressant or antipsychotic agents gained weight during their incarceration. Women prescribed antidepressants gained significantly more weight than men. However, there was no significant difference in weight gain between African Americans and Whites. Results suggest further investigation is needed to understand the effect of medication history, metabolic syndrome and to explain gender disparities.