Substance misuse as a marker of vulnerability among male prisoners on remand.
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BACKGROUND: More treatment for substance misuse should be provided within prisons. AIMS: To examine differences between prisoners on remand with substance misuse problems and other prisoners on remand. METHOD: Random selection and interview of unconvicted male prisoners (n = 750, a 9.4% sample), plus examination of the prison medical record. RESULTS: Of the sample of 750, 253 subjects (33.7%) reported either drug- or alcohol-related health problems or dependency. Compared with other prisoners on remand, they reported more childhood adversity, conduct disorder, self-harm, past psychiatric treatment and current mood disorder, and had fewer qualifications, were more likely to be unemployed and have more housing difficulties. CONCLUSIONS: One-third of unconvicted men in prison report substance-related problems, and these are a marker for vulnerability within a disadvantaged population. Health care providers should involve this group in treatment and rehabilitation, both inside prison and following release. (+info)
Antiretroviral prescribing patterns in the Texas prison system.
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Although the prevalence of human immunodeficiency virus (HIV) infection among prison inmates is reported to be high, little is known about anti-HIV treatment patterns in correctional institutions. The present study assessed antiretroviral prescribing patterns for 2360 Texas Department of Criminal Justice (TDCJ) inmates infected with HIV. In 1998, 66.8% of all TDCJ inmates infected with HIV who had CD4 lymphocyte counts < 500 cells/mm(3) were treated with highly active antiretroviral therapy (HAART). However, no substantial differences in the use of HAART were exhibited according to the sociodemographic factors under study. While the majority of inmates receiving HAART in 1998 were prescribed a combination of 2 nucleoside reverse transcriptase inhibitors (NRTIs) and 1 protease inhibitor, 11.2% were prescribed a combination of 2 NRTIs and 1 non-NRTI. In view of the elevated rate of HIV infection in correctional settings, it will be important to continue to document the pharmacotherapy patterns among prison inmates, both during and following incarceration. (+info)
Drug-susceptible tuberculosis outbreak in a state correctional facility housing HIV-infected inmates--South Carolina, 1999-2000.
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During 1999-2000, South Carolina's Department of Corrections (SCDC), Department of Health and Environmental Control (DHEC), and CDC investigated an outbreak of drug-susceptible tuberculosis (TB) that occurred in a state correctional facility housing human immunodeficiency virus (HIV)-infected inmates. All culture-confirmed case-patients have been linked by IS6110-based DNA fingerprinting of Mycobacterium tuberculosis isolates. This report describes the outbreak investigation and illustrates the need for increased vigilance for TB in settings in which HIV-infected persons congregate. (+info)
Peak expiratory flow in youths with varying cigarette smoking habits.
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Measurements of peak expiratory flow (P.E.F.) were done on 195 boys arriving at a detention centre, and again eight weeks later at the time of their discharge. During this time they took much physical exercise, and cigarette smoking and drug taking were not permitted. At the initial assessment there was an impairment of P.E.F. inversely proportional to the amount of cigarettes smoked which was statistically significant. There was a significant improvement in P.E.F. between reception and discharge in all groups of boys with varying smoking habits, all groups except the heavy smokers achieving near normal results after eight weeks. The heavier smokers improved more than the non-smokers or light smokers, but this difference was not statistically significant. Suggested reasons for this improvement are discussed. (+info)
Smoking in correctional facilities: a survey of employees.
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OBJECTIVE: To assess level of endorsement and expected consequences of worksite smoking restriction policies among correctional employees. DESIGN: Mailed survey to Vermont state correctional employees. MAIN OUTCOME MEASURES: Support for various policy alternatives for both staff and inmate smoking; expected consequences of restrictive smoking policies and smoking behaviour. PARTICIPANTS: 321 of 640 (50%) state correctional employees responded. RESULTS: Employees were somewhat receptive to smoking restrictions for inmates, but less supportive of staff smoking restrictions. A complete ban on inmate smoking both indoors and outdoors was supported by 56% and 49% of never and ex-smokers, respectively, but only 15% of current smokers (p < 0.01). A similar ban on employee smoking was supported by 38% of never and ex-smokers, but only 3% of current smokers (p < 0.01). Overall, employees were most supportive (52%) of a policy for themselves that banned indoor smoking and restricted it to certain areas outdoors. Current smokers were more likely to expect negative consequences as a result of further restrictions than were never or ex-smokers. CONCLUSIONS: Although our findings are limited by a low response rate, most employees support an indoor ban, but not a total ban on smoking. Employees generally favoured a policy that was slightly more restrictive than the current policy, but were less supportive of tighter smoking restrictions for themselves. However, a more restrictive smoking policy is likely to result in some degree of resistance among current smoking employees, who may require specific attention to address their opposition. (+info)
Evaluation of mycobacteria growth indicator tube for direct and indirect drug susceptibility testing of Mycobacterium tuberculosis from respiratory specimens in a Siberian prison hospital.
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The manual Mycobacteria Growth Indicator Tube (MGIT) method was evaluated for performing direct and indirect drug susceptibility testing (DST) of Mycobacterium tuberculosis for isoniazid and rifampin on 101 strongly smear-positive sputum specimens in a Siberian prison hospital. Using the indirect method of proportion (MOP) as the "gold standard," the accuracies of isoniazid and rifampin susceptibility testing by the direct MGIT system were 97.0 and 94.1%, respectively. The accuracy of the indirect MGIT system was 98.0% for both drugs. The turnaround times from specimen processing to reporting of the DST results ranged between 4 and 23 (mean, 9.2) days by the direct MGIT method, 9 and 30 (mean, 15.3) days by the indirect MGIT method, and 26 and 101 (mean, 59.6) days by the indirect MOP. MGIT appears to be a reliable, rapid, and convenient method for performing direct and indirect DSTs in low-resource settings, but further studies are required to refine the direct DST protocol. Cost is the only factor prohibiting widespread implementation of MGIT. (+info)
Jails, prisons, and the health of urban populations: a review of the impact of the correctional system on community health.
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This review examined the interactions between the correctional system and the health of urban populations. Cities have more poor people, more people of color, and higher crime rates than suburban and rural areas; thus, urban populations are overrepresented in the nation's jails and prisons. As a result, US incarceration policies and programs have a disproportionate impact on urban communities, especially black and Latino ones. Health conditions that are overrepresented in incarcerated populations include substance abuse, human immunodeficiency virus (HIV) and other infectious diseases, perpetration and victimization by violence, mental illness, chronic disease, and reproductive health problems. Correctional systems have direct and indirect effects on health. Indirectly, they influence family structure, economic opportunities, political participation, and normative community values on sex, drugs, and violence. Current correctional policies also divert resources from other social needs. Correctional systems can have a direct effect on the health of urban populations by offering health care and health promotion in jails and prisons, by linking inmates to community services after release, and by assisting in the process of community reintegration. Specific recommendations for action and research to reduce the adverse health and social consequences of current incarceration policies are offered. (+info)
Characteristics and trends of newly identified HIV infections among incarcerated populations: CDC HIV voluntary counseling, testing, and referral system, 1992-1998.
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Inmate contact with the correctional health care system provides public health professionals an opportunity to offer HIV screening to a population that might prove difficult to reach otherwise. We report on publicly funded human immunodeficiency virus (HIV) voluntary counseling, testing, and referral (VCTR) services provided to incarcerated persons in the United States. Incarcerated persons seeking VCTR services received pretest counseling and gave a blood specimen for HIV antibody testing. Specimens were considered positive if the enzyme immunoassays were repeatedly reactive and the Western blot or immunofluorescent assay was reactive. Demographics, HIV risk information, and laboratory test results were collected from each test episode. Additional counseling sessions provided more data. From 1992 to 1998, there were 527,937 records available from correctional facilities from 48 project areas; 484,277 records included a test result and 459,155 (87.0%) tests came with complete data. Overall, 3.4% (16,797) of all tests were reactive for HIV antibodies. Of reactive tests accompanied by self-reports of previous HIV test results (15,888), previous test results were 44% positive, 23% negative, 6% inconclusive or unspecified, and 27% no previous test. This indicates that 56% of positive tests were newly identified. During the study period, the number of tests per year increased three-fold. Testing increased among all racial/ethnic groups and both sexes. The largest increase was for heterosexuals who reported no other risk, followed by persons with a sex partner at risk. Overall, the greatest number of tests was reported for injection drug users (IDUs) (128,262), followed by men who have sex with men (MSM) (19,928); however, episodes for MSM doubled during the study, while for IDUs, they increased 74%. The absolute number of HIV-positive (HIV+) tests increased 50%; however, the percentage of all tests that were HIV+ decreased nearly 50% due to the increased number of tests performed. HIV+ tests fell 50% among blacks (7.6% to 3.7%), Hispanics (6.7% to 2.5%), and males (5.1% to 2.5%); 33% among females (4.5% to 3.1%); 95% among IDUs (8.6% to 4.4%); and 64% among MSM (19.3% to 11.8%). Among HIV+ episodes, those for IDUs dropped from 61.5% to 36.6%, while episodes for heterosexuals with no reported risk factor increased from 4.3% to 18.2%. The use of VCTR services by incarcerated persons rose steadily from 1992 to 1998, and 56% of HIV+ tests were newly identified. High numbers of tests that recorded risk behaviors for contracting HIV indicate that correctional facilities provide an important access point for prevention efforts. (+info)