A systematic review of the effect of dietary and nutritional interventions on the behaviours and mental health of prisoners

Prisoners experience a higher burden of poor health, aggressive behaviours and worsening mental health than the general population. This systematic review aimed to identify research that used nutrition-based interventions in prisons, focusing on outcomes of mental health and behaviours. The systematic review was registered with Prospective Register of Systematic Reviews on 26 January 2022: CRD42022293370. Inclusion criteria comprised of current prisoners with no limit on time, location, age, sex or ethnicity. Only quantitative research in the English language was included. PubMed/Medline, Web of Science, EMBASE, PsycINFO and CINAHL were searched, retrieving 933 results, with 11 included for qualitative synthesis. Studies were checked for quality using the revised tool to assess risk of bias in randomised trials or risk of bias in non-randomised studies of interventions tool. Of the included studies, seven used nutritional supplements, three included diet changes, and one used education. Of the seven supplement-based studies, six included rule violations as an outcome, and only three demonstrated significant improvements. One study included mental health as an outcome; however, results did not reach significance. Of the three diet change studies, two investigated cognitive function as an outcome, with both reaching significance. Anxiety was included in one diet change study, which found a significant improvement through consuming oily fish. One study using diet education did not find a significant improvement in overall mental resilience. Overall, results are mixed, with the included studies presenting several limitations and heterogeneity. Future research should aim to consider increased homogeneity in research design, allowing for a higher quality of evidence to assess the role nutrition can play in improving the health of prisoners.

Nutritional interventions in prison settings: a scoping review

BACKGROUND

Mounting evidence has shown that incarceration can affect the health and well-being of individuals and increase the risk of noncommunicable diseases (NCDs). Diet quality is known to be one of the main determinants of risk of NCDs, and dietary changes are the first approach used in primary care to reduce the incidence of NCDs.

OBJECTIVE

This scoping review aimed to summarize the evidence for (1) the diet quality of inmates, and (2) the effect of nutritional intervention in prison systems. In addition, we aimed to describe limitations in the current literature and to suggest potential future research areas.

METHOD

A systematic search was performed in 2 databases (PubMed and Web of Science) using predefined search terms and covering the period May 2023 to June 2023. Additionally, reference lists from the retrieved studies were hand-searched to identify any additional relevant publications. The identified literature was screened based on defined search strategies, criteria, and research questions defined using the PICo (population or problem, interest, and context) framework. The review was conducted referring to the PRISMA-ScR and the PICo framework.

RESULTS

A total of 19 studies out of 63 initially identified records were included in this review (11 cross-sectional evaluations and 9 intervention-based studies). In almost all studies, assessment of the diet quality of menus showed the menus to be nutritionally adequate, except for having a higher-than-recommended intake of total energy, saturated fatty acids, sodium, cholesterol, and sugar. In addition, some studies reported a lower-than-recommended intake of fiber, magnesium, potassium, vitamins D, E, and A, and omega-3 fatty acids. Nutritional interventions were mainly planned in the form of workshops, seminars, and written material to deliver information on healthy dietary choices. Although no significant changes in inmates' dietary choices were observed in any of the studies, a high participation rate was detected.

CONCLUSION

Inmates might require additional prevention intervention to reduce their susceptibility to cardiometabolic diseases by virtue of their isolation from community facilities. Interventions should be tailored to the characteristics of prison settings and inmates to increase adherence to nutritional recommendations.

A Scoping Review of Nutrition Education Interventions Applied in Prison Settings

PURPOSE OF REVIEW

Over 11 million individuals are incarcerated globally, facing health challenges such as obesity, diabetes, and cardiovascular disease, possibly exacerbated by prison diets. The objective of this scoping review is to explore the various available types of nutrition education interventions that currently exist in the literature applied in prison settings.

RECENT FINDINGS

Utilizing the PRISMA Extension for Scoping Reviews, 19 databases were searched for studies on nutrition interventions in prisons from 2000 to May 2023, guided by the "PICO" structure. Inclusion criteria encompassed articles in five languages from peer-reviewed journals focusing solely on nutrition education interventions. Rayyan QCRI software was utilized for screening and data extraction. Fifteen international studies were analyzed, covering various countries and targeting different populations in prisons. Interventions varied from nutrition education to comprehensive health programs. The outcomes were inconsistent, with some showing health improvements and others encountering challenges. Few utilized established theoretical frameworks, indicating a research gap. The range of interventions highlights the potential complexity of nutrition education interventions within prisons. Implementing recognized theoretical frameworks may enhance effectiveness. The diverse outcomes highlight the challenges in creating impactful programs, emphasizing foundational issues. Recommendations focus on rigorous research designs and understanding prison-specific complexities. Nutrition education interventions in incarcerated settings present varied results, emphasizing the need for well-structured, theoretically grounded, and carefully evaluated programs. Future strategies should recognize the multifaceted nature of correctional facilities, aiming for holistic approaches to improve health in prisons.

Assessment of Nutritional Status and Health Perception among Male Inmates in Israeli Prisons

The nutritional and health perceptions of inmates are crucial to their overall well-being. However, limited research has been conducted on this topic. This study aimed to assess the nutritional and health perception state of male inmates in eleven prisons in Israel. A cross-sectional study was conducted between February and September 2019 with 176 voluntary participants. Structured questionnaires were used to collect data on socio-demographic characteristics, healthy habits, subjective health status, and prison situation variables. The study found that the prevalence of overweight (40%) and obesity (18.1%) among 18-34-year-old inmates was significantly higher than in the reference Israeli population. Short detention periods (up to one year) predicted less weight gain, while older age predicted poorer health status. Better emotional status significantly predicted better subjective health status among male inmates. There is a need for nutrition interventions to improve the health of inmates. The significant weight gain during incarceration and the associated lower health index and stress highlights the importance of increasing knowledge and promoting a healthier lifestyle in incarceration as early as possible and continuing over time.

Developing an Evidence-Based Nutrition Curriculum for Correctional Settings

People experiencing incarceration in the United States face numerous health disparities before, during, and after imprisonment, with prison conditions often exacerbating the severity of their health conditions. Within prisons, inadequate nutrition may contribute to the high prevalence of chronic disease such as diabetes and heart disease. This article discusses the development of an evidence-based nutrition curriculum for prison settings, informed by literature on current nutrition in prison, as well as previous health interventions designed to improve the health of incarcerated individuals. The curriculum was developed using guidelines for an effective health curriculum from the Centers for Disease Control and Prevention. Furthermore, this article discusses the theoretical foundations and effective pedagogies for teaching health materials in prison and provides further recommendations for improving nutrition in correctional institutions.

Physical health programs and interventions with women during incarceration: a scoping review

PURPOSE

The USA outpaces most other countries in the world in the rates at which it incarcerates its citizens. The one million women held in US jails and prisons on any day in the USA face many physical health challenges, yet interventional work to address physical health in carceral settings is rare. This study's purpose was to summarize the literature on programs and interventions implemented with women in US carceral settings (jail or prison) that primarily addressed a physical health issue or need.

DESIGN/METHODOLOGY/APPROACH

A scoping review was conducted. The authors searched databases, reference lists, individual journals and websites for physical health program descriptions/evaluations and research studies, 2000-2020, that included women and were set in the USA.

FINDINGS

The authors identified 19 articles and a range of problem areas, designs, settings and samples, interventions/programs, outcomes and uses of theory. The authors identified two cross-cutting themes: the carceral setting as opportunity and challenges of ethics and logistics.

RESEARCH LIMITATIONS/IMPLICATIONS

Much potential remains for researchers to have an impact on health disparities by addressing physical health needs of women during incarceration.

ORIGINALITY/VALUE

Interventional and programmatic work to address physical health needs of women during incarceration is sparse and diversely focused. This review uniquely summarizes the existing work in a small and overlooked but important area of research and usefully highlights gaps in that literature.

Symptomatic menopause: Additional challenges for incarcerated women

Menopause is an age-associated physiological transition in women, usually occurring between the ages of 40 and 58 years, with an average of 51 years. As the age of women residing in the prison system is increasing globally, it becomes increasingly important for older female inmates to be assessed for menopausal symptoms and offered effective, personalized management. Middle-aged and older women, regardless of their living situation, are at increased risk of experiencing vasomotor symptoms and developing pelvic floor problems, bladder dysfunction and osteoporosis. However, all of these menopausal sequelae are typically exacerbated by prison conditions and by a lack of health support. Therefore, it is critical to implement prison programs and to create gender-specific training to aid in the health care needs of aging female inmates. Addressing this growing population of incarcerated women and attending to their menopausal needs require advocacy and active monitoring of prison-specific templates of care to ensure quality care. One such initiative legislated to address the health care needs of incarcerated women was commenced in New Jersey, USA. This entity, the NJ Commission on Women's Reentry, is addressing the unique health care needs of women, including menopausal ones, while incarcerated and then upon reentry into their community.