Criminology Public Health Effects of Incarceration
by
Bryan L. Sykes, Ernest Chavez, Evelyn Patterson
  • LAST MODIFIED: 11 January 2018
  • DOI: 10.1093/obo/9780195396607-0234

Introduction

The rise of mass incarceration since the early 1970s has profoundly affected the labor market prospects and familial relationships of former inmates. Yet, a burgeoning literature is now focused on the collateral consequences of incarceration for the physical health and psychological well-being of ex-offenders and their family members. While many studies have focused on the contraction, spread, and treatment of infectious diseases during and after periods of incarceration, recent scholarship has shifted to understanding the impact of criminal justice contract on premature mortality, mental health stability, and the post-release health of former offenders. Growth in imprisonment has also increased the number of women incarcerated and the modal age of inmates, necessitating increased use of hospices and particular forms of specialized health care for pregnant women and elderly prisoners. This bibliography examines four main areas of the public health effects of mass incarceration: drug use, infectious diseases, and incarceration; the general health and well-being of inmates and their families; the health and mortality of current and former inmates; and growing old behind bars (i.e., the health care and aging process of older inmates).

Drug Use, Infectious Diseases, and Incarceration

HIV Testing/Screening among Former and Current Inmates

HIV testing among former and current inmates is necessary to prevent the spread of infectious disease within and beyond correctional walls. Sykes and Piquero 2009 explores how state-level health testing policies during confinement, as well as at admission and release from custody, shape the health and well-being of inmates and their communities. Tarver, et al. 2016 assesses state laws regulating HIV testing and screening in correctional facilities. Seth, et al. 2015 analyzes data collected by sixty-one health department jurisdictions in 2013, on the outcomes of Center for Disease Control–funded HIV testing programs. The researchers in Arriola, et al. 2001 arranged a medical screening system at five county jails. Harawa, et al. 2009 uncovers health indicators that justify selective screening. Lyons, et al. 2014 evaluates the availability of HIV prevention programs inside of jails and prisons. Sykes, et al. 2016 assesses a 2014 US Department of Justice Best Practices Report, which advocates that states eliminate HIV-specific criminal penalties. Alemagno, et al. 2009 tests the effectiveness of brief negotiation interviewing (BNI) strategies for teaching HIV prevention.

  • Alemagno, S. A., R. C. Stephens, P. Stephens, P. Shaffer-King, and P. White. 2009. Brief motivational intervention to reduce HIV risk and to increase HIV testing among offenders under community supervision. Journal of Correctional Health Care 15:210–221.

    DOI: 10.1177/1078345809333398Save Citation »Export Citation »E-mail Citation »

    The authors test the effectiveness of brief negotiation interviewing (BNI) strategies for teaching HIV prevention, compared to traditional educational programs. BNI takes the form of a computerized interview, and it demonstrated greater changes in behavior and attitudes toward risky sexual practices immediately following the test. These findings were given further support in a follow-up assessment two months after the initial testing.

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    • Arriola, K. R. J., R. L. Braitwaite, S. Kennedy, et al. 2001. A collaborative effort to enhance HIV/STI screening in five county jails. Public Health Reports 116:520–529.

      DOI: 10.1016/S0033-3549(04)50084-5Save Citation »Export Citation »E-mail Citation »

      In an attempt to improve public health, the authors arrange a medical screening system at five county jails, specifically focusing on HIV infection, chlamydia, gonorrhea, and syphilis. Numerous cases of these illnesses are identified, the majority of which were treated with appropriate medications. However, the authors note that providing sustained and long-term treatment at the county jail level would be expensive and difficult.

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      • Harawa, N. T., T. A. Bingham, Q. R. Butler, et al. 2009. Using arrest charge to screen for undiagnosed HIV infection among new arrestees: A study in Los Angeles County. Journal of Correctional Health Care 15:105–117.

        DOI: 10.1177/1078345808330038Save Citation »Export Citation »E-mail Citation »

        Since universal HIV screening in jail settings are costly and impossible to implement in some settings, the authors attempt to uncover indicators that justify selective screening. After testing 1,322 new arrestees, authors discover that 2.7 percent of males and 1.0 percent of females had undiagnosed HIV-positive. Furthermore, male arrestees with parole violations and sex or theft charges were associated with a higher likelihood of having undiagnosed HIV. This pattern did not hold for females.

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        • Lyons, T., E. Osunkoya, I. Anguh, A. Adefuye, and J. Balogun. 2014. HIV prevention and education in state prison systems: An update. Journal of Correctional Health Care 20:105–115.

          DOI: 10.1177/1078345813518630Save Citation »Export Citation »E-mail Citation »

          The authors note that although HIV rates in US prisons and jails have declined over the past few decades, the current infection rate is approximately five times greater than the rate of non-incarcerated populations. They evaluate the availability of HIV prevention programs inside of jails and prisons. Results show that states in the Northeast are more likely to provide services such as HIV testing, education, and other preventive strategies, while New York, Louisiana, and Maryland exhibit highest infection rates.

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          • Seth, P., A. Figueroa, G. Wang, L. Reid, and L. Belcher. 2015. HIV testing, HIV positivity, and linkage and referral services in correctional facilities in the United States, 2009–2013. Sexually Transmitted Diseases 42:643–649.

            DOI: 10.1097/OLQ.0000000000000353Save Citation »Export Citation »E-mail Citation »

            The authors analyze data collected by sixty-one health department jurisdictions in 2013, on the outcomes of Center for Disease Control–funded HIV testing programs. Of these tests, 7.9 percent were implemented within correctional facilities, with African Americans comprising the demographic group with the highest HIV-positive rates.

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            • Sykes, B. L., T. Hoppe, and K. Maziarka. 2016. Cruel intentions? HIV prevalence and criminalization during an age of mass incarceration, U.S. 1999–2012. Medicine 95.16: e3352–e3361.

              DOI: 10.1097/MD.0000000000003352Save Citation »Export Citation »E-mail Citation »

              A 2014 US Department of Justice Best Practices Report advocates that states eliminate HIV-specific criminal penalties except when a HIV-positive person intentionally commits a sex crime or transmits the virus by engaging in behavior that poses a significant risk of transmission, regardless of actual transmission. The authors investigate the premise of these exceptions. They find that the selection of national surveys distorts contemporary estimates of HIV prevalence by 7 percent to 20 percent, and that HIV-positive inmates are less likely to be incarcerated for violent, sexual offenses.

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              • Sykes, B. L., and A. R. Piquero. 2009. Structuring and re-creating inequality: Health testing policies, race, and the criminal justice system. The Annals of the American Academy of Political and Social Science 623:214–227.

                DOI: 10.1177/0002716208330486Save Citation »Export Citation »E-mail Citation »

                This article explores how state-level health testing policies during confinement, as well as at admission and release from custody, shape the health and well-being of inmates and their communities. They find significant racial, educational, and marital inequalities in health testing and test results. These inequalities vary across types of institutional testing policies and inmate cohorts, with later admission cohorts being less likely to receive HIV tests and future release cohorts having a higher likelihood of being HIV-positive.

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                • Tarver, B. A., J. Sewell, and N. Oussayef. 2016. State laws governing HIV testing in correctional settings. Journal of Correctional Health Care 22:28–40.

                  DOI: 10.1177/1078345815620182Save Citation »Export Citation »E-mail Citation »

                  This article assesses state laws regulating HIV testing and screening in correctional facilities. Researchers find that eighteen states utilize mandatory HIV screening upon admission; twenty-six states allow for testing during confinement; and nine states require mandatory testing upon release. Furthermore, forty-one states utilize testing when an inmate is admitted for crimes of a sexual nature. Although laws govern testing procedures, it is difficult to ascertain when and where such tests are actually implemented.

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                  HIV Treatment/Services among Former and Current Inmates

                  The prevalence of HIV among current and former inmates is much higher than the general population, making treatment services paramount for effective public health intervention. Yet, states have implemented a variety of different programs and strategies for connecting current and former inmates to treatment services. Culbert 2011 advocates for the implementation of HIV treatment strategies that will reduce stigmatization. Inciardi 1996 outlines strategies to reduce the risk of HIV in criminal justice and community settings. Beckwith, et al. 2010 reviews the current state of HIV testing, prevention, treatment, and transition services available in US prisons and jails. However, Fleury-Steiner 2008 and Robillard, et al. 2011 both discuss how funding cuts and health-care costs compromise an inmate’s ability to obtain treatment services. Research details that a current and former inmate’s ability to access health care and community services after incarceration depend on a host of factors. Fleury-Steiner 2008 shows that one factor is staff training; Rich, et al. 2001 illustrates how substance addiction and mental illness in New York are factors affecting health-care access; Baillargeon, et al. 2009 highlights how medical prescription programs in Texas affect HIV retroviral treatments during community re-entry; and Bracken, et al. 2015 shows how interpersonal and professional support relationships in California aid in continued HIV medical care upon release.

                  • Baillargeon, J., T. P. Giordano, J. D. Rich, et al. 2009. Accessing antiretroviral therapy following release from prison. Journal of American Medical Association 301:848–857.

                    DOI: 10.1001/jama.2009.202Save Citation »Export Citation »E-mail Citation »

                    The authors examine the continued use of antiretroviral HIV therapy among prison inmates after release. Of the 2,115 HIV-positive inmates released from the Texas Department of Corrections, only 5.4 percent filled out a prescription for antiretroviral therapy within ten days after release, 17.7 percent within thirty days, and 30 percent within sixty days. Authors note that inmates who participated in the AIDS Drug Assistance Program were more likely to seek out timely treatment after release.

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                    • Beckwith, C., N. Zaller, J. Fu, B. Montague, and J. Rich. 2010. Opportunities to diagnose, treat, and prevent HIV in the criminal justice system. Journal of Acquired Immune Deficiency Syndromes (JAIDS) 55:S49–S55.

                      DOI: 10.1097/QAI.0b013e3181f9c0f7Save Citation »Export Citation »E-mail Citation »

                      This article reviews the current state of HIV testing, prevention, treatment, and transition services available in US prisons and jails. The authors argue that correctional settings can facilitate access to and delivery of HIV treatment to patients. This paper outlines a number of recommendations for research and practice to improve the health of inmates and their communities, including the expanded use of routine opt-out HIV testing and an assessment of the impact of integrating substance dependence treatment as HIV prevention.

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                      • Bracken, N., C. Hilliard, W. J. McCuller, and N. T. Harawa. 2015. Facilitators of HIV medical care engagement among former prisoners. AIDS Education and Prevention 27:566–583.

                        DOI: 10.1521/aeap.2015.27.6.566Save Citation »Export Citation »E-mail Citation »

                        This paper investigates the factors that aid in continued HIV medical care. Researchers conducted seven focus group discussions with twenty-seven HIV-positive former prisoners who were recently released from a California state prison. Findings indicate that interpersonal relationships and support, professional relationships, developing positive coping strategies, and personal attitudes are key factors in predicting successful and consistent HIV medical care.

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                        • Culbert, G. J. 2011. Understanding the health needs of incarcerated men living with HIV/AIDS: A primary health care approach. 2011. Journal of the American Psychiatric Nurses Association 17:158–170.

                          DOI: 10.1177/1078390311401617Save Citation »Export Citation »E-mail Citation »

                          Although many existing studies track whether or not an incarcerated individual receives HIV-related medical treatment, there is a gap in the literature pertaining to the question of how or why they chose to do so, which is an especially crucial question, considering that some HIV-positive men choose not to report their condition to health-care workers and therefore do not receive treatment. The author advocates for the implementation of HIV treatment strategies that will reduce stigmatization and can make care more accessible and acceptable.

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                          • Fleury-Steiner, B. D. 2008. Dying inside: The HIV/AIDS ward at Limestone Prison. Ann Arbor: Univ. of Michigan Press.

                            DOI: 10.3998/mpub.17471Save Citation »Export Citation »E-mail Citation »

                            This article provides a detailed case analysis of an Alabama prison’s medical ward, with special focus placed on the experiences of prisoners diagnosed with HIV/AIDS. The author argues that mass incarceration emphasizes aggressive incarceration policies coupled with cost-cutting strategies that have resulted in dismal health standards in prisons. Furthermore, poorly trained correctional staff, combined with the stigmatization of prisoners, especially those living with HIV/AIDS, has ultimately established medical neglect as a normal part of the prison system.

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                            • Inciardi, J. 1996. HIV risk reduction and service delivery strategies in criminal justice settings. Journal of Substance Abuse Treatment 13.5: 421–428.

                              DOI: 10.1016/S0740-5472(96)00117-1Save Citation »Export Citation »E-mail Citation »

                              This paper outlines strategies to reduce the risk of HIV in criminal justice and community settings. The author advocates for drug abuse treatment while incarcerated, which will lessen exposure to HIV among intravenous drug users and those who trade sex for drugs. Through a combination of HIV control, prevention, and education programs while incarcerated, this paper promotes continuous and integrated treatment services during specific stages of correctional supervision.

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                              • Rich, J. D., L. Holmes, C. Salas, et al. 2001. Successful linkage of medical care and community services for HIV-positive offenders being released from prison. Journal of Urban Health 78:270–289.

                                DOI: 10.1093/jurban/78.2.279Save Citation »Export Citation »E-mail Citation »

                                The authors evaluate the effectiveness of Program Bridge in Rhode Island, New York, and the success rate of being able to provide consistent health care to HIV-positive prisoners upon their release from custody. The program is multifaceted in a way that seeks to address not only HIV-related health care, but also various other conditions such as substance addiction, mental illness, and general medical needs. The authors find that 100 percent of their sample sought and received HIV-related health care, and 75 percent were also linked with other medical services.

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                                • Robillard, A. G., R. L. Braithwaite, P. Gallito-Zaparanuik, and S. K. Kennedy. 2011. Challenges and strategies of frontline staff providing HIV services for inmates and releases. Journal of Correctional Health Care 17:344–360.

                                  DOI: 10.1177/1078345811413088Save Citation »Export Citation »E-mail Citation »

                                  This study focuses on the challenges faced by staff in successfully providing HIV-related treatment and support to inmates. The focus group sessions were analyzed using content analysis and uncovered several critical themes that include the difficulties involved in building trust between inmates and staff, maintaining consistent visits to health-care providers for released inmates, and lack of sufficient funding for programs and services.

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                                  Hepatitis and Incarceration

                                  Inmates have high prevalence rates of hepatitis. Buck, et al. 2006 finds that nearly 30 percent of formerly incarcerated inmates are affected by hepatitis B, and Harzke, et al. 2009 shows that the mortality rate related to hepatitis C has increased at an annual rate of 21 percent. Devasia, et al. 2006 argues that screening and vaccinating jail inmates would not only produce cost-benefits but would also prevent future hepatitis B outbreaks; yet, Pisu, et al. 2002 shows that, on average, there are no cost-savings for prisons unless the particular facility has a high burden of disease or preventing the spread of the infection is proven to be cost-effective in the long-term. Vong, et al. 2004; Costumbrado, et al. 2012; Gondles 2005; and Freudenberg and Heller 2016 argue that substance abuse addictions and mental health illnesses are significant predictors for hepatitis, and Freudenberg and Heller 2016 discusses how states devise public health interventions to test, vaccinate, and treat current and former offenders. A number of programs have been implemented across states that have had varying levels of success that are highly dependent on the types of services and outreach methods utilized. Nyamathi, et al. 2012 shows how these implementation strategies work for homeless populations with a history of incarceration, while Vallabhaneni, et al. 2004 focuses on implementation strategies for people currently incarcerated.

                                  • Buck, J. M., K. M. Morrow, A. Margolis, et al. 2006. Hepatitis B vaccination in prison: The perspectives of formerly incarcerated men. Journal of Correctional Health Care 12:12–23.

                                    DOI: 10.1177/1078345806287937Save Citation »Export Citation »E-mail Citation »

                                    Nearly 30 percent of formerly incarcerated inmates are affected by the hepatitis B virus. The authors argue for routine hepatitis B screening and treatment among incarcerated populations. Although there are multiple barriers to vaccination, this finds that educating men who test positive for hepatitis B resulted in an increased willingness to receive treatment.

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                                    • Costumbrado, J., A. Stirland, G. Cox, et al. 2012. Implementation of a hepatitis A/B vaccination program using an accelerated schedule among high-risk inmates, Los Angeles County Jail, 2007–2010. Vaccine 30:6878–6882.

                                      DOI: 10.1016/j.vaccine.2012.09.006Save Citation »Export Citation »E-mail Citation »

                                      Researchers design the first large-scale hepatitis A/B vaccination project carried out in a US jail. This project targeted populations of men who have sex with other men, as well as injection drug users in Los Angeles County Jail, as both populations are particularly vulnerable to infection. The authors posit that their program is the first of its kind by leveraging the unique conditions of imprisonment to increase vaccination rates among populations at risk.

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                                      • Devasia, R. A., T. F. Jones, M. A. Kainer, et al. 2006. Two community hepatitis B outbreaks: An argument for vaccinating incarcerated persons. Vaccine 24:1354–1358.

                                        DOI: 10.1016/j.vaccine.2005.09.023Save Citation »Export Citation »E-mail Citation »

                                        Two separate hepatitis B outbreaks that resulted in fifty-two new infections in the community are traced back to a correctional setting. In the first outbreak, jail inmates who were granted weekend furloughs spread the infection through sexual contact, while in the second outbreak, transmission was most likely caused by recently released inmates. The authors argue that screening and vaccinating jail inmates would not only produce cost-benefits but would also prevent similar future outbreaks.

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                                        • Freudenberg, N., and D. Heller. 2016. A review of opportunities to improve the health of people involved in the criminal justice system in the United States. Annual Review of Public Health 37:11.1–11.21.

                                          DOI: 10.1146/annurev-publhealth-032315-021420Save Citation »Export Citation »E-mail Citation »

                                          The authors provide a range of strategies and policy recommendations aimed at reducing health inequalities produced through the criminal justice system in the United States Specifically, these measures include placing special focus on individuals with substance addictions and mental health issues in order to divert them from jails and prisons, and instead, into alternative treatment facilities based in the community. The authors also advocate for improving health-care provisions inside of carceral institutions, as well as coordinating sustained medical attention with “outside” organizations for those who are released.

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                                          • Gondles, E. F. 2005. A call to immunize the correctional population for hepatitis A and B. The American Journal of Medicine 118:845–895.

                                            DOI: 10.1016/j.amjmed.2005.07.025Save Citation »Export Citation »E-mail Citation »

                                            The authors argue that prior to incarceration, inmates are often exposed to risky behavior that increases their chances of contracting hepatitis A or B. Although there are no federal mandates for screening and treating all prisoner populations for these infections, the authors note that the Centers for Disease Control and Prevention recommends that all inmates receive hepatitis B vaccination. Furthermore, in order to implement successful assessment, prevention, and treatment strategies for these infections, cooperation must occur between correctional authorities and providers of prevention and intervention services.

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                                            • Harzke, A. J., J. G. Baillargeon, M. F. Kelley, P. M. Diamon, K. J. Goodman, and D. P. Paar. 2009. HCV-related mortality among male prison inmates in Texas, 1994–2003. Annals of Epidemiology 19:582–589.

                                              DOI: 10.1016/j.annepidem.2009.03.009Save Citation »Export Citation »E-mail Citation »

                                              The authors note that although it is well established that high rates of hepatitis C exist among prisoner populations, data pertaining to the mortality rates caused by the illness is lacking. By tracking the number of hepatitis C–related deaths among prisoners between 1994 and 2003, the authors find that the mortality rate related to hepatitis C has increased at an annual rate of 21 percent. Furthermore, hepatitis C is shown to be a contributing risk factor for other medical-related causes of death.

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                                              • Nyamathi, A. M., E. Marlow, C. Branson, M. Marfisee, and K. Nandy. 2012. Hepatitis A/B vaccine completion among homeless adults with history of incarceration. Journal of Forensic Nursing 8:13–22.

                                                DOI: 10.1111/j.1939-3938.2011.01123.xSave Citation »Export Citation »E-mail Citation »

                                                Because homeless adults with a history of incarceration tend to display higher rates of hepatitis A/B infection, the authors focus on the factors that predict vaccination among this population. In a study of 297 homeless adults with a history of incarceration, findings indicate that adults who are over the age of forty, with a steady partner, and who experience long-term homelessness, tend to complete vaccination at a higher rate than young homeless adults. Time since incarceration and release was not a significant predictor of vaccination.

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                                                • Pisu, M., M. I. Meltzer, and R. Lyerla. 2002. Cost-effectiveness of hepatitis B vaccination of prison inmates. Vaccine 21:312–321.

                                                  DOI: 10.1016/S0264-410X(02)00457-7Save Citation »Export Citation »E-mail Citation »

                                                  The authors seek to assess the cost-effectiveness of vaccinating prisoner populations for hepatitis B. On average, there are no cost-savings for prisons, unless the particular facility has a high burden of disease or preventing the spread of the infection is proven to be cost-effective in the long-term. However, the public health-care system would observe a cost-benefit from vaccinating prisoners because vaccination effects would diminish the spread of infection after release.

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                                                  • Vallabhaneni, S., G. E. Macalino, S. E. Reinert, B. Schwartzapfel, F. Wolf, and J. D. Rich. 2004. Prisoners’ attitudes toward hepatitis B vaccination. Preventive Medicine 38:828–833.

                                                    DOI: 10.1016/j.ypmed.2003.12.024Save Citation »Export Citation »E-mail Citation »

                                                    Based on a sample of 153 prisoners in Rhode Island, this study seeks to address the willingness of prison inmates to receive hepatitis B vaccination while incarcerated. Although researchers were concerned that general distrust of prison staff among inmates would affect the likelihood of accepting treatment, they found that if inmates are properly informed about the effects and transmissibility of the disease, then they are receptive to vaccination.

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                                                    • Vong, S., A. E. Fiore, D. O. Haight, et al. 2004. Vaccination in the county jail as a strategy to reach high risk adults during a community-based hepatitis A outbreak among methamphetamine drug users. Vaccine 23:1021–1028.

                                                      DOI: 10.1016/j.vaccine.2004.07.038Save Citation »Export Citation »E-mail Citation »

                                                      In a study of over four hundred hepatitis A cases in a Florida county, the authors find that 48 percent of individuals infected were substance users and approximately 80 percent were recently incarcerated. County jails represent important vaccination venues because they are clustered with infected or vulnerable people who will soon return to the general public. The authors note that one limitation of this strategy is the difficulty in administering a second vaccination dose, as jailed inmates are generally released before the second treatment can be administered.

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                                                      Injection Drug Users, Criminology, and Public Health

                                                      Injection drug use is a major public health problem that affects communities throughout America. Yet, some social spaces prevent the distribution of clean needles. Allen, et al. 2016 finds how harm reduction strategies are prohibited within one thousand feet of a public or private school. This is unfortunate, as Cooper, et al. 2016 shows lower high school dropout rates are statistically related to lower levels of drug use, particularly among African Americans. Latkin, et al. 2013 finds that injection drug users routinely witness violence by drug dealers, and both Beletsky, et al. 2011 and Cooper, et al. 2005 discuss how injection drug users are systematically targeted by police. Despite the extensive surveillance and incarceration of drug users, Nunn, et al. 2009 finds that many prison systems do not provide pharmacological treatment for opiate addiction or referrals for opiate replacement therapy upon release from correctional institutions. Stein, et al. 2000 finds that alcohol use and abuse are risk factors for needle-sharing, and Clarke, et al. 2001 concludes that these behaviors persist during periods of incarceration. Zaller, et al. 2009 shows that racial differences in attitudes about methadone treatment are related to beliefs about desistence. Public health officials should educate jurists and legal practitioners on the benefits of medication-assisted treatment, particularly as Matusow, et al. 2013 shows that many courts remain uncertain about the safety and efficacy of such treatment programs to improve outcomes for opioid dependence.

                                                      • Allen, S. T., M. S. Ruiz, J. Jones, and M. M. Turner. 2016. Legal space for syringe exchange programs in hot spots of injection drug use-related crime. Harm Reduction Journal 13.1: 1–7.

                                                        DOI: 10.1186/s12954-016-0104-3Save Citation »Export Citation »E-mail Citation »

                                                        This study shows that the “thousand-foot rule,” which prohibits the distribution of clean syringes via syringe exchange programs within one thousand feet of any elementary or secondary school, has a detrimental effect on harm reduction. A consequence of this policy is that many hotspots associated with injection drug use exist inside of the one-thousand-foot boundaries. This policy prevents syringe exchange programs from harm reduction services, particularly within crucial educational zones.

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                                                        • Beletsky, L., L. E. Grau, E. White, S. Bowman, and R. Heimer. 2011. The roles of law, client race and program visibility in shaping police interference with the operation of US syringe exchange programs. Addiction 106.2: 357–365.

                                                          DOI: 10.1111/j.1360-0443.2010.03149.xSave Citation »Export Citation »E-mail Citation »

                                                          This study investigates how characteristics of syringe exchange programs are associated with police interference. Overall, programs reported various forms of interference, including client harassment or arrest, confiscating clean syringes, and uninvited police presence within facilities. Programs characterized as serving predominantly non-white injection users were 3.56 times more likely to report client arrest while en route to the facility, and 3.92 times more likely to experience unauthorized confiscation of syringes.

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                                                          • Clarke, J. G., M. D. Stein, L. Hanna, M. Sobota, and J. D. Rich. 2001. Active and former injection drug users report of HIV risk behaviors during periods of incarceration. Substance Abuse 22.4: 209–216.

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                                                            The authors argue that there is a high rate of injection drug usage in prisons. Drawing on a sample of injection drug users in Rhode Island, the authors find that nearly 50 percent of respondents injected drugs while incarcerated. Being male and the number of past incarcerations were associated with drug usage in prison. American inmates using drugs while incarcerated require public health interventions (e.g., needle exchange programs and methadone maintenance).

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                                                            • Cooper, H., L. Moore, S. Gruskin, and N. Krieger. 2005. The impact of a police drug crackdown on drug injectors’ ability to practice harm reduction: A qualitative study. Social Science & Medicine 61.3: 673–684.

                                                              DOI: 10.1016/j.socscimed.2004.12.030Save Citation »Export Citation »E-mail Citation »

                                                              The authors conduct a qualitative study analyzing the effect of a policing crackdown on injection drug users within a particular New York City precinct. The study finds that there are adverse effects of the police crackdowns for safe injection practices. Due to frequent police searches and surveillance, many drug users ceased carrying materials that aided in safe injection methods and also abandoned their usual and safe injection locations.

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                                                              • Cooper, H., B. West, S. Linton, et al. 2016. Contextual predictors of injection drug use among black adolescents and adults in US metropolitan areas, 1993–2007. American Journal of Public Health 106.3: 517–526.

                                                                DOI: 10.2105/AJPH.2015.302911Save Citation »Export Citation »E-mail Citation »

                                                                The researchers utilize surveillance data to analyze the contextual factors associated with rates of black injection drug use across ninety-five US metropolitan statistical areas. They find that declining black high school dropout rates, histories of black uprisings, and higher percentages of black residents are related to lower levels of black injection drug use. Incarceration rates were not significantly associated with injection drug use among African Americans.

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                                                                • Latkin, C. A., C. Yang, K. E. Tobin, and D. German. 2013. Injection drug users’ and their risk networks’ experiences of and attitudes towards drug dealer violence in Baltimore, Maryland. International Journal of Drug Policy 24.2: 135–141.

                                                                  DOI: 10.1016/j.drugpo.2012.07.007Save Citation »Export Citation »E-mail Citation »

                                                                  The authors examine the attitudes of injection drug users toward violent drug dealers. Although many drug users reported witnessing violent acts carried out by dealers within the prior six months, most of these participants state that they would rather accept this violence than contact the police. Authors imply that police should improve relations with drug users in order to better prevent violence from drug dealers.

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                                                                  • Matusow, H., S. L. Dickman, J. D. Rich, et al. 2013. Medication assisted treatment in US drug courts: Results from a nationwide survey of availability, barriers and attitudes. Journal of Substance Abuse Treatment 44.5: 473–480.

                                                                    DOI: 10.1016/j.jsat.2012.10.004Save Citation »Export Citation »E-mail Citation »

                                                                    This study surveyed ninety-three drug court coordinators or administrators from forty-seven states plus the District of Columbia and Puerto Rico to explore attitudes and practices of drug courts regarding medication assisted treatment for opioid dependence. The authors find that nearly all surveyed drug courts report some participants being addicted to opioids upon entering the program, but that in 66 percent of the courts, agonist therapy is not available. A policy mandating medical withdrawal appears to be contrary to established best practices and expert opinion.

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                                                                    • Nunn, A., N. Zaller, S. Dickman, C. Trimbur, A. Nijhawan, and J. D. Rich. 2009. Methadone and buprenorphine prescribing and referral practices in US prison systems: Results from a nationwide survey. Drug and Alcohol Dependence 105.1: 83–88.

                                                                      DOI: 10.1016/j.drugalcdep.2009.06.015Save Citation »Export Citation »E-mail Citation »

                                                                      The authors surveyed medical directors from fifty states, the District of Columbia, and the Federal Department of Corrections to learn about each state/federal facility’s policies and referral programs for opiate replacement therapy. They find that twenty-eight prison systems (55 percent) offer methadone to inmates in some situations, with over 50 percent of correctional facilities offering methadone for pregnant women or for chronic pain management. Prison staff and policymakers should be educated about the medical and social benefits of opiate dependence treatment.

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                                                                      • Stein, M. D., L. Hanna, R. Natarajan, et al. 2000. Alcohol use patterns predict high-risk HIV behaviors among active injection drug users. Journal of Substance Abuse Treatment 18.4: 359–363.

                                                                        DOI: 10.1016/S0740-5472(99)00070-7Save Citation »Export Citation »E-mail Citation »

                                                                        Alcohol use is associated with needle-sharing behavior among a group recruited from a needle exchange program, and this is the first such study showing an association between these behaviors. Using multiple logistic regression, high-level “at-risk” alcohol use and alcohol abuse were significantly associated with needle sharing, even after controlling for other demographic and behavioral factors previously found to be associated with sharing. HIV prevention effects in needle exchange programs should address alcohol use.

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                                                                        • Zaller, N. D., A. R. Bazazi, L. Velazquez, and J. D. Rich. 2009. Attitudes toward methadone among out-of-treatment minority injection drug users: Implications for health disparities. International Journal of Environmental Research and Public Health 6.2: 787–797.

                                                                          DOI: 10.3390/ijerph6020787Save Citation »Export Citation »E-mail Citation »

                                                                          The authors assess racial differences in attitudes toward methadone treatment. Black and Latino injection drug users in this sample hold negative opinions about methadone. Respondents believe that methadone is detrimental to health and that people should attempt to discontinue methadone treatment. Substance use researchers and treatment professionals should engage minority communities in order to better understand the treatment needs of a diverse population, develop culturally appropriate methadone programs, and raise awareness of the benefits of this treatment.

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                                                                          The General Health and Well-Being of Inmates and their Families

                                                                          The General Health of Inmates

                                                                          While many studies largely focus on the relationship between incarceration and infectious disease, few studies have examined the general health of inmates. Binswanger, et al. 2009 and Baillargeon, et al. 2001 both show that a number of other chronic and acute conditions affect the inmate population. Massoglia 2008 documents how hypertension, stress, depression, cancer, hepatitis, and HIV are much higher among men and women exposed to incarceration; however, Massoglia and Pridemore 2015 finds that the association between imprisonment and other health conditions is mixed. Fazel and Baillargeon 2011 recommends that prisons are appropriate sites for providing quality medical and health interventions for at-risk populations, and Okie 2007 shows that the US correctional system is ideal for providing disadvantaged members of society with health care. Conklin, et al. 2000 advocates for a public health model that can continue to provide treatment after inmates are released and will limit the spread of illness among receiving communities.

                                                                          • Baillargeon, J., A. D. Linton, S. A. Black, S. Zepeda, and J. J. Grady. 2001. Medication prescribing and adherence patterns among prison inmates with diabetes mellitus. Journal of Correctional Health Care 8:37–53.

                                                                            DOI: 10.1177/107834580100800103Save Citation »Export Citation »E-mail Citation »

                                                                            In this study, the authors focus on compliance rates of prisoners in receiving treatment for diabetes mellitus. Of the 4,061 Texas inmates who were diagnosed with diabetes mellitus, approximately one-third were prescribed insulin only, one-third were prescribed oral hypoglycemic agents (OHA), 13 percent were prescribed both, and the remaining were prescribed neither forms of medication. The study revealed a compliance rate of approximately 61 percent for insulin only, 66 percent for OHA only, and between 56 and 66 percent for the combined treatment.

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                                                                            • Binswanger, A., P. M. Krueger, and J. F. Steiner. 2009. Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the general population. Journal of Epidemiology and Community Health 63:912–919.

                                                                              DOI: 10.1136/jech.2009.090662Save Citation »Export Citation »E-mail Citation »

                                                                              The authors combine prison and jail surveys to compare health conditions between the incarcerated and non-incarcerated. After controlling for socio-demographic factors and alcohol consumption, they find that incarcerated populations display higher rates of hypertension, asthma, arthritis, cervical cancer, and hepatitis, while experiencing comparable rates of diabetes, heart attack, and lower rates of obesity. Authors advocate for early treatment in order to improve the health conditions of incarcerated populations before release.

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                                                                              • Conklin, T. J., T. Lincoln, and R. W. Tuthill. 2000. Self-reported health and prior health behaviors of newly admitted correctional inmates. American Journal of Public Health 90:1939–1941.

                                                                                DOI: 10.2105/AJPH.90.12.1939Save Citation »Export Citation »E-mail Citation »

                                                                                A total of 1,198 inmates at a medium-security correctional facility are interviewed for fifteen minutes per person in order to assess their health history, prevalence of substance use, sexually transmitted infections, physical abuse, and prior incarceration. The most commonly reported medical issues are substance abuse, and oral health concerns, bone and joint problems, back and neck issues, and mental health concerns.

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                                                                                • Fazel, S., and J. Baillargeon. 2011. The health of prisoners. The Lancet 377:956–965.

                                                                                  DOI: 10.1016/S0140-6736(10)61053-7Save Citation »Export Citation »E-mail Citation »

                                                                                  The authors trace prisoner health patterns among several countries that lead the world in incarceration rates. They uncover several underlying concerns across an international context, including the prevalence of mental illness, the spreading of HIV and AIDS, high rates of tuberculosis, a high rate of suicide-related mortalities, and inadequate medical provisions for especially vulnerable populations such as the elderly and pregnant women. An international study.

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                                                                                  • Greifinger, R. 2007. Public health behind bars: From prisons to communities. New York: Springer Science and Business Media.

                                                                                    DOI: 10.1007/978-0-387-71695-4Save Citation »Export Citation »E-mail Citation »

                                                                                    This book covers an extensive range of topics pertaining to corrections and public health. Much focus is placed on the role of legal cases that govern various aspects of incarceration and health, the treatment of communicable diseases, different strategies for the prevention of the spread of disease, and policy recommendations that emphasize collaboration between correctional administration and community-level institutions.

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                                                                                    • Massoglia, M. 2008. Incarceration as exposure: The prison, infectious disease, and other stress-related illnesses. Journal of Health and Social Behavior 49:56–71.

                                                                                      DOI: 10.1177/002214650804900105Save Citation »Export Citation »E-mail Citation »

                                                                                      The author examines the relationship between incarceration and health by age forty. He finds that former inmates have consistently higher rates of specific health problems such as hypertension, emotional and psychological problems, heart problems, hepatitis, and depression. However, incarceration is not statistically associated with increased rates of diabetes, cancer, or arthritis. One limitation of the study is that the sample age restriction may limit the full range of health disparities in life-course studies.

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                                                                                      • Massoglia, M., and W. A. Pridemore. 2015. Incarceration and health. Annual Review of Sociology 41:291–310.

                                                                                        DOI: 10.1146/annurev-soc-073014-112326Save Citation »Export Citation »E-mail Citation »

                                                                                        The authors review the literature on incarceration and health within a variety of social contexts, including the health of families and communities among those who are incarcerated; the spread of infectious disease; and heightened mortality rates for individuals who experience incarceration. The authors also provide key research limitations (e.g., data scarcity and the lack of longitudinal studies). They recommend that more data is needed in order to establishing detailed causal claims about the impact of incarceration on health.

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                                                                                        • Okie, S. 2007. Sex, drugs, prisons, and HIV. The New England Journal of Medicine 356:105–108.

                                                                                          DOI: 10.1056/NEJMp068277Save Citation »Export Citation »E-mail Citation »

                                                                                          The author argues US prisons fail to meet international standards for HIV care under the World Health Organization and Joint United Nations Programs on HIV/AIDS. Although the distribution of condoms within correctional facilities could potentially reduce the spread of infectious diseases, only two US state prison systems and five jail systems retain such policies. The US corrections system is a “reservoir” for infectious diseases, and institutions must address these risks.

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                                                                                          Correctional Systems and Public Health

                                                                                          Prisons and jails concentrate the most disadvantaged members of society. The racial and ethnic health disparities among inmates mirror the inequalities observed in the general population, providing public health officials with a unique opportunity to intervene for the improvement of population health. Dumont, et al. 2012 traces the roots of mass incarceration back to the War on Drugs. Potter and Akers 2010 argues that public health collaborations with correctional systems can reduce racial and ethnic disparities in recidivism and infectious diseases, and Potter and Tewksbury 2005 contends that such improvements can occur through the creation of programs and measures aimed at improving sexual health within institutions. Potter 2010 shows that the contextual factors unique to each setting must be assessed in order to facilitate improvements between public health and correctional institutions. Schnittker, et al. 2015 finds that the growth in mass incarceration has produced spillover effects that affect the health-care system, but Rich, et al. 2014 argues that the Affordable Care Act can potentially make an important contribution to lessening the health risks among released offenders. Williams 2007 and Goncalves, et al. 2014 both believe that if health-care coverage is expanded to current and former inmates, health risks among former offenders can be mitigated.

                                                                                          • Dumont, D. M., B. Brockmann, S. Dickman, N. Alexander, and J. D. Rich. 2012. Public health and the epidemic of incarceration. Annual Review of Public Health 33:325–339.

                                                                                            DOI: 10.1146/annurev-publhealth-031811-124614Save Citation »Export Citation »E-mail Citation »

                                                                                            The authors trace the roots of mass incarceration back to the War on Drugs and posit that incarcerated populations are particularly vulnerable to health problems because they are often drawn from social backgrounds that are structurally disadvantaged. They note that previous research largely focuses black-white inequalities and should broaden to include other racial groups and structural differences. The authors also suggest that there is a large population of elderly, mentally ill, and substance addicted incarcerated populations that should receive specialized services.

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                                                                                            • Goncalves, L. C., R. A. Goncalves, C. Martins, and A. J. E. Dirkzwager. 2014. Predicting infractions and health care utilization in prison: A meta-analysis. Criminal Justice and Behavior 41:921–942.

                                                                                              DOI: 10.1177/0093854814524402Save Citation »Export Citation »E-mail Citation »

                                                                                              A meta-analysis is conducted to determine what factors predict the likelihood of a prisoner utilizing health care. Health-care utilization was predicted by the age of prisoners (older prisoners tend to utilize more health care), as well as histories of mental health treatment and general medical problems. The authors note that a limitation to this meta-analysis is the relatively small sample size, and recommend that future studies utilize larger samples in order to produce more precise and generalizable findings.

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                                                                                              • Potter, R. H. 2010. Jails, public health, and generalizability. Journal of Correctional Health Care 16:263–272.

                                                                                                DOI: 10.1177/1078345810378252Save Citation »Export Citation »E-mail Citation »

                                                                                                To improve the conditions of health care in jails, researchers should refrain from universalist solutions, and instead should focus on contextual factors that are unique to each jail. To this end, the author proposes the following five unique points for improvement: differences in intake processes, size of the jail system, geographic region of a particular facility, inmate classification procedures, and the extent to which direct supervision is made possible inside a particular facility.

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                                                                                                • Potter, R. H., and T. A. Akers. 2010. Improving the health of minority communities through probation–public health collaborations: An application of the epidemiological criminology framework. Journal of Offender Rehabilitation 29:595–609.

                                                                                                  DOI: 10.1080/10509674.2010.519674Save Citation »Export Citation »E-mail Citation »

                                                                                                  An expanded framework for epidemiological criminology is provided in this article. Researchers aim to minimize criminogenic factors and health risks associated with both recidivism and the spread of infectious disease. The authors recommend implementing HIV and STD screening procedures in jails, which can be supplemented with a policy for providing further screening and/or referrals for treatment during regular probation and/or parole check-ins. Such a program could help to reduce both recidivism and spread of diseases among African American, Latino, and low-income communities.

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                                                                                                  • Potter, R. H., and R. Tewksbury. 2005. Sex and prisoners: Criminal justice contributions to a public health issue. Journal of Correctional Health Care 11:171–190.

                                                                                                    DOI: 10.1177/107834580401100205Save Citation »Export Citation »E-mail Citation »

                                                                                                    This article presents a review of the criminological literature on correctional settings and the sexual behavior of inmates, disease transmission, and sexual violence. The authors find that there are few existing programs and measures aimed at improving sexual health within correctional facilities. They advocate for greater collaboration between correctional and public health administrations in order to prevent the transmission of certain diseases within and beyond prisons.

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                                                                                                    • Rich, J. D., R. Chandler, B. A. Williams, et al. 2014. How health care reform can transform the health of criminal justice–involved individuals. Health Affairs 33:462–467.

                                                                                                      DOI: 10.1377/hlthaff.2013.1133Save Citation »Export Citation »E-mail Citation »

                                                                                                      The Affordable Care Act can potentially make an important contribution to lessening the health risks. Because more than 95 percent of prisoners are eventually released back to the public, untreated addictions and infectious diseases pose risks to former offenders and their communities. Because incarceration occurs at a racially disproportionate rate, an effort to improve the health conditions of corrections-involved populations will also positively impact historically underrepresented racial and ethnic groups.

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                                                                                                      • Schnittker, J., C. Uggen, S. K. S. Shannon, and S. M. McElrath. 2015. The institutional effects of incarceration: Spillovers from criminal justice to health care. The Milbank Quarterly 93:516–560.

                                                                                                        DOI: 10.1111/1468-0009.12136Save Citation »Export Citation »E-mail Citation »

                                                                                                        By combining cross-sectional individual and state level data, the authors show that individuals residing in states with a large number of former inmates have fewer health-care provisions, diminished access to care, less access to specialists, less trust in physicians, and less satisfaction with the care they receive. The demands placed on a state’s health-care system are producing a “spillover effect” that affects individuals who are insured and are not socioeconomically impoverished.

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                                                                                                        • Williams, N. H. 2007. Prison health and the health of the public: Ties that bind. Journal of Correctional Health Care 13:80–92.

                                                                                                          DOI: 10.1177/1078345807301143Save Citation »Export Citation »E-mail Citation »

                                                                                                          The author posits that prisoner populations in the United States are deprived of the basic right to health care, especially when taking gender and racial disparities into account. By focusing on chronic diseases, oral health, HIV/AIDS, mental health, and substance abuse issues, the author makes several policy recommendations that include expanding health coverage for current and former inmates.

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                                                                                                          Maternal Health and Reproductive Outcomes Behind Bars

                                                                                                          Women are the fastest growing prison population. The health-care needs of women are uniquely different from men, particularly around reproduction and pregnancy. The American College of Obstetricians and Gynecologists 2011 finds that approximately 6–10 percent of incarcerated women are pregnant. Ferszt 2011 shows that the highest rates of pregnancy among inmates are in local jails. Clarke, et al. 2006 illustrates that maternal and infant health are inextricably linked. Bell, et al. 2004 finds that incarcerated women are more likely to give birth to an underweight and premature baby than unincarcerated women, and Waldman and Levi 2011 interviews female inmates about their health-care experiences while incarcerated, including during periods of pregnancy. Hotelling 2008 argues that correctional policies should be changed to increase perinatal care, and Clarke and Adashi 2011 advocates for family planning services for female prisoners. Ultimately, Roberts 1997 contends that criminal justice reforms should address the constitutional rights of mothers to retain their bodily autonomy.

                                                                                                          • The American College of Obstetricians and Gynecologists. 2011. Committee Opinion No. 511: Health care for pregnant and postpartum incarcerated women and adolescent females. Obstetrics & Gynecology 118.5: 1198–1202.

                                                                                                            DOI: 10.1097/AOG.0b013e31823b17e3Save Citation »Export Citation »E-mail Citation »

                                                                                                            Pregnant, incarcerated women have health-care needs that require special and delicate treatment by clinicians. Approximately 6–10 percent of incarcerated women are pregnant, which raises questions about best practices for prenatal care and maternal health. The authors advocate against the use of restraints on pregnant incarcerated women, and that pregnant women be tested for HIV infection with patient notification unless they decline the test.

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                                                                                                            • Bell, J. F., F. J. Zimmerman, M. L. Cawthon, C. E. Huebner, D. H. Ward, and C. A. Schroeder. 2004. Jail incarceration and birth outcomes. Journal of Urban Health 81:630–644.

                                                                                                              DOI: 10.1093/jurban/jth146Save Citation »Export Citation »E-mail Citation »

                                                                                                              Researchers compare various birth outcomes among unincarcerated and incarcerated women. After controlling for several factors—including drug use, socioeconomic status, and use of health-care services—findings indicate that incarcerated women were more likely to deliver an underweight baby and experience preterm births, compared to their non-incarcerated peers. However, incarcerated women over the age of thirty-nine experienced fewer low birth weights and preterm births. Authors advocate for providing incarcerated women with quality prenatal care.

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                                                                                                              • Clarke, J. G., and E. Y. Adashi. 2011. Perinatal care for incarcerated patients: A 25-year-old woman pregnant in jail. Journal of American Medical Association 305:923–929.

                                                                                                                DOI: 10.1001/jama.2011.125Save Citation »Export Citation »E-mail Citation »

                                                                                                                After analyzing ten studies of pregnant women who give birth while incarcerated, the authors conclude that women who spend time in prison during their pregnancy experience improved fetal outcomes, compared with women of similar socioeconomic status, outside of prison. The authors recommend providing family planning services for female prisoners.

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                                                                                                                • Clarke, J. G., M. R. Hebert, C. Rosengard, J. S. Rose, K. M. DaSilva, and M. D. Stein. 2006. Reproductive health care and family planning needs among incarcerated women. The American Journal of Public Health 96:834–839.

                                                                                                                  DOI: 10.2105/AJPH.2004.060236Save Citation »Export Citation »E-mail Citation »

                                                                                                                  This is the first comprehensive report on the reproductive histories of incarcerated women. The authors evaluate the sexual histories and reproductive health needs of almost five hundred incarcerated women in Rhode Island and find that respondents had a high risk for a sexually transmitted disease and pregnancy. Inconsistent use of birth control and condom use among multiple partners resulted in a high rate of unplanned pregnancies.

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                                                                                                                  • Ferszt, G. G. 2011. Who will speak for me? Advocating for pregnant women in prison. Policy, Politics, & Nursing Practice 12:254–256.

                                                                                                                    DOI: 10.1177/1527154411424615Save Citation »Export Citation »E-mail Citation »

                                                                                                                    Author approximates that 6 percent of women incarcerated in local jails, 4–5 percent in state prisons, and 3 percent in federal facilities are admitted into these facilities while pregnant. Many face inadequate prenatal care, lack of proper nutrition, limited exercise habits, and generally unsanitary conditions. Author focuses on legislation that bans the practice of shackling and restraining pregnant prisoners during hospital visits and birthing, arguing that it is a violation of basic human rights.

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                                                                                                                    • Hotelling, B. A. 2008. Perinatal needs of pregnant, incarcerated women. The Journal of Perinatal Education 17:37–44.

                                                                                                                      DOI: 10.1624/105812408X298372Save Citation »Export Citation »E-mail Citation »

                                                                                                                      This article posits that US prisons and jails operate through gender-neutral policies that have a detrimental effect on women prisoners, especially those who experience pregnancy and/or give birth while incarcerated. Pregnant prisoners struggle to obtain basic perinatal care such as medical checkups, proper nutrition, education on self-care and birthing, and contact with family. The author advocates for specialized procedures that allow a mother to spend three months with her infant after birth, and providing Lamaze classes to pregnant prisoners and their partners.

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                                                                                                                      • Roberts, D. J. 1997. Killing the black body: Race, reproduction, and the meaning of liberty. New York: Random House/Pantheon.

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                                                                                                                        Chapter 4 focuses on how the state makes reproduction a crime among poor, pregnant women. The crack epidemic of the 1980s––as a public health crisis––was transformed into an opportunity to exact harsh punishments against mothers. The criminal justice system characterizes, criminalizes, and penalizes addiction among expecting mothers through coercive sterilization, increased punishments, and the disavowal of substance abuse treatment programs for pregnant women. Roberts shows how fetal rights are pitted against the constitutional rights of mothers to retain bodily autonomy.

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                                                                                                                        • Waldman, A., and R. Levi. 2011. Inside this place, not of it: Narratives from women’s prisons. San Francisco: McSweeney’s.

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                                                                                                                          The horrors experienced by incarcerated women are presented in narrative form in this book. Through vivid details of how women cope with their health while behind bars, readers learn the simple and complex methods women employ to manage their medical needs. The narratives delve into unauthorized sterilization, the high probability of delivering premature babies, and point to a host of medical ethics surrounding women’s health in prison.

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                                                                                                                          Health and the Intersection of Race, Gender, or Age

                                                                                                                          Freudenberg 2002 shows that incarceration rates are disproportionately higher among non-whites, young adults, and men. Yet women are the fastest growing group exposed to incarceration. The intersection of race, gender, and age highlights the need for health interventions that target specific demographic groups. Braithwaite, et al. 2005 argues that female prisoners represent an invisible population, and Eliason, et al. 2004 finds that women who enter correctional systems tend to exhibit greater pre-existing health problems compared to men. Lanier, et al. 2010; Lanier, et al. 2015; and Potter, et al. 2013 all show that incorporating principles of epidemiological criminology into outreach programs will greatly benefit the health of current and former offenders. Alarid and Hahl 2014 assesses the context of gender-specific HIV prevention for women, and Wang, et al. 2009 focuses on hypertension in African American men. Godette, et al. 2011 focuses on youth with substance abuse disorders, and Lichtenstein 2009 investigates the relationship between conviction and HIV rates among black men.

                                                                                                                          • Alarid, L. F., and J. M. Hahl. 2014. Seroconversion risk perception among jail populations: A call for gender-specific HIV prevention programming. Journal of Correctional Health Care 20:116–126.

                                                                                                                            DOI: 10.1177/1078345813518631Save Citation »Export Citation »E-mail Citation »

                                                                                                                            The authors administer a survey to 595 inmates, 44 percent of whom identify as female and 56 percent as male. Findings suggest that incarcerated women are more responsive to changing their behavior after receiving HIV education. The authors advocate for gender-specific HIV prevention programming in corrections facilities.

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                                                                                                                            • Braithwaite, R. L., H. M. Treadwell, and K. R. J. Arriola. 2005. Health disparities and incarcerated women: A population ignored. American Journal of Public Health 95:1679–1681.

                                                                                                                              DOI: 10.2105/AJPH.2005.065375Save Citation »Export Citation »E-mail Citation »

                                                                                                                              Female prisoners represent an invisible population. Because they are disproportionately comprised of racial and ethnic minority groups, they are at a heightened risk for unhealthy pregnancies, HIV/AIDS, hepatitis C, and cervical cancer. Women prisoners are also at heightened risk of sexual assault by prison staff. The authors recommend risk reduction approaches that will attend to substance addiction and treatment of transmittable diseases before returning individuals to the general public.

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                                                                                                                              • Eliason, M. J., J. Y. Taylor, and R. Williams. 2004. Physical health of women in prison: Relationship to oppression. Journal of Correctional Health Care 10:175–203.

                                                                                                                                DOI: 10.1177/107834580301000204Save Citation »Export Citation »E-mail Citation »

                                                                                                                                The authors posit that women who enter correctional systems tend to exhibit greater preexisting health problems compared to men. Furthermore, the population of incarcerated women of color are doubly stigmatized due to their racial and ethnic backgrounds. Compared to men, incarcerated women receive less rehabilitative support as well as fewer medical services when incarcerated. The authors recommend repealing harsh drug sentencing laws, implementing access to higher quality health care for women in prisons, and actualizing special protective measures for pregnant women that would safeguard against incarceration in the first place.

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                                                                                                                                • Freudenberg, N. 2002. Adverse effects of U.S. jail and prison policies on the health and well-being of women of color. American Journal of Public Health 92:1895–1899.

                                                                                                                                  DOI: 10.2105/AJPH.92.12.1895Save Citation »Export Citation »E-mail Citation »

                                                                                                                                  The rate of incarceration among women is increasing faster than the rate of male prisoners in the United States, resulting in sharp racial disparities. Various social processes are attached to these disparities, such as increased health risks for infection, sexual assault, and lack of proper medical care for these populations. The author advocates for strong reintegration support services for women who will be released from prison back into society, and states that health and social services workers have a responsibility to develop partnerships with correctional administration in order to ease transitional processes.

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                                                                                                                                  • Godette, D. C., M. S. Mulatu, K. J. Leonard, S. Randolph, and N. Williams. 2011. Patterns and determinants of criminal justice involvement among youth in substance abuse treatment programs. Journal of Correctional Health Care 17:294–308.

                                                                                                                                    DOI: 10.1177/1078345811413084Save Citation »Export Citation »E-mail Citation »

                                                                                                                                    This article explores race and health among youth in juvenile substance abuse facilities. The authors find that racial and ethnic minorities are over-represented in these facilities, even after controlling for criminal behaviors, mental health issues, substance abuse, and risk that can be attributed to socio-environmental factors. Attachment to educational programs produces a significant preventative effect, especially for minority youth. A close collaboration between correctional facilities and community organizations is proposed to help youth transition and reintegrate into their communities.

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                                                                                                                                    • Lanier, M. M., R. P. Pack, and T. A. Akers. 2010. Epidemiological criminology: Drug use among African American gang members. Journal of Correctional Health Care 16:6–16.

                                                                                                                                      DOI: 10.1177/1078345809348199Save Citation »Export Citation »E-mail Citation »

                                                                                                                                      Researchers interviewed 283 African American adolescents regarding their substance use habits, in an attempt to differentiate use patterns between self-identified gang members and non-gang members. Active and former gang members displayed greater substance use than non-gang members. Utilizing an epidemiological criminology approach, the authors argue that rather than increasing penalties for substance users, individuals should be encouraged to disassociate with gangs and associate with recovery communities.

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                                                                                                                                      • Lanier, M. M., B. H. Zaitzow, and C. T. Farrell. 2015. Epidemiological criminology: Contextualization of HIV/AIDS health care for female inmates. Journal of Correctional Health Care 21:152–163.

                                                                                                                                        DOI: 10.1177/1078345815575349Save Citation »Export Citation »E-mail Citation »

                                                                                                                                        As the number of women prisoners with serious health-care needs increases, the authors posit that researchers should adopt an approach that aims to link public health efforts with criminal justice policies and practices. Taking this intersection into account, they make several policy recommendations tailored specifically to the population of women in prisons, such as developing alternatives to imprisonment; providing reproductive health-care services that are unique to women; and implementing oversight and evaluations strategies to track the success rate of these changes.

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                                                                                                                                        • Lichtenstein, B. 2009. Drugs, incarceration, and HIV/AIDS among African American men: A critical literature review and call to action. American Journal of Men’s Health 3:252–264.

                                                                                                                                          DOI: 10.1177/1557988308320695Save Citation »Export Citation »E-mail Citation »

                                                                                                                                          The author provides a critical literature review of factors that link the disproportionate rate at which African American men both contract HIV and are convicted of criminal offenses. Illicit drug use is an important mediating variable that links HIV rates and criminal convictions due to increased criminalization following the War on Drugs. Five recommendations are made, including the need for increased research on the lives of HIV-positive African American men who have undergone incarceration.

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                                                                                                                                          • Potter, R. H., T. A. Akers, and D. R. Bowman. 2013. Replicating MISTERS: An epidemiological criminology framework analysis of a program for criminal justice–involved minority males in the community. Journal of Correctional Health Care 19:4–14.

                                                                                                                                            DOI: 10.1177/1078345812458085Save Citation »Export Citation »E-mail Citation »

                                                                                                                                            The Men in STD Training and Empowerment Research Study (MISTERS) program explores the intersections of public health and criminal behavior. This program is designed to trace the effectiveness of training and education in personal health care, such as risky sexual behavior and substance abuse among ex-offenders. Unlike existing intervention programs, MISTERS is unique in that it places focus on the relationship between improved self-healthcare and the likelihood of engaging in criminal behavior. The authors conclude that existing programs can benefit from incorporating principles of epidemiological criminology into outreach programs.

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                                                                                                                                            • Wang, E. A., M. Pletcher, F. Lin, et al. 2009. Incarceration, incident hypertension, and access to healthcare: Findings from the Coronary Artery Risk Development in young Adults (CARDIA) study. Archives of Internal Medicine 169:687–693.

                                                                                                                                              DOI: 10.1001/archinternmed.2009.26Save Citation »Export Citation »E-mail Citation »

                                                                                                                                              In this study, researchers examine the relationship between incarceration and rates of hypertension and cardiovascular disease in young adults. Findings indicate that hypertension is slightly more common among individuals who have experienced incarceration, and especially for African American men. The authors advocate for improving the continuity of health care between correctional institutions and medical organizations following release.

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                                                                                                                                              The Consequences of Incarceration for Mental Health

                                                                                                                                              Schnittker, et al. 2012 shows that many inmates suffer from a number of mental health illnesses and psychiatric disorders. A variety of factors are known to affect the mental health of inmates. Haugebrook, et al. 2010 focuses on sexual and substance abuse; Butler, et al. 2014 investigates how confinement in supermax prisons affect mental health; and McCorkle 2013 assesses whether rehabilitation programs in prison improve the mental health of women. Fagan, et al. 2010 and Lord 2008 both show how inmates with psychological disorders have an increased likelihood of experiencing re-incarceration, self-harm, and physical and psychological abuse. Adams and Ferrandino 2008 recommends the development of actuarial devices that can track patients with comorbid mental health issues. Baillargeon, et al. 2009 finds that untreated mental health disorders threaten a former offender’s successful re-entry into society. Schnittker 2014 and Schnittker and John 2007 both argue that the stigma of incarceration exacerbates mental health disorders among ex-offenders.

                                                                                                                                              • Adams, K., and J. Ferrandino. 2008. Managing mentally ill inmates in prisons. Criminal Justice and Behavior 35:913–927.

                                                                                                                                                DOI: 10.1177/0093854808318624Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                Given the rising number of individuals with mental health issues entering the correctional system, the authors argue that current actuarial devices that guide decisions surrounding intake, assessment, classification, and program assignment of newly admitted prisoners are inadequately equipped to address the varied nature of mental illness. The authors recommend for actuarial devices that can account for comorbidity of mental health issues with other disorders such as addiction or trauma.

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                                                                                                                                                • Baillargeon, J., I. A. Binswanger, J. V. Penn, B. A. Williams, and O. J. Murray. 2009. Psychiatric disorders and repeat incarcerations: The revolving prison door. American Journal of Psychiatry 166:103–109.

                                                                                                                                                  DOI: 10.1176/appi.ajp.2008.08030416Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                  Data on psychiatric disorders, demographic characteristics, and incarceration histories of 79,211 inmates are analyzed to assess the relationship between mental health and recidivism. Individuals with a major psychiatric disorder were more likely to have previous incarcerations, especially those with bipolar disorder. The authors recommend better use of discharge planning procedures so as to connect individuals with outside organizations that can provide services, before release.

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                                                                                                                                                  • Butler, H. D., W. W. Johnson, and O. H. Griffin III. 2014. The treatment of the mentally ill in supermax facilities: An evaluation of state supermax policies. 2014. Criminal Justice and Behavior 41:1338–1353.

                                                                                                                                                    DOI: 10.1177/0093854814535082Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                    Authors perform a content analysis of forty-two state correctional policies surrounding the use of supermax confinement with mentally ill prisoner populations. The analysis reveals that approximately 90 percent of the forty-two states under study provide two or more guidelines regarding the placement of mentally ill prisoners into supermax units. One limitation of this study is that policies are not always enacted as they are stated.

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                                                                                                                                                    • Fagan, T. J., J. Cox, S. J. Helfand, and D. Aufderheide. 2010. Self-injurious behavior in correctional settings. Journal of Correctional Health 16:48–66.

                                                                                                                                                      DOI: 10.1177/1078345809348212Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                      Authors argue for the need to develop a program that can prevent self-injurious behavior in jail and prison settings. The risk of suicide is higher in jails than in prisons because jails tend to house a higher number of individuals suffering from acute mental health issues. Correctional staff should be educated and better trained to identify potential cases of suicide among current inmates.

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                                                                                                                                                      • Haugebrook, S, K. M. Zgoba, T. Maschi, K. Morgen, and D. Brown. 2010. Trauma, stress, health, and mental health issues among ethnically diverse older adult prisoners. Journal of Correctional Health Care 16:220–229.

                                                                                                                                                        DOI: 10.1177/1078345810367482Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                        In this study of 144 adult prisoners aged fifty-five and above in a New Jersey correctional facility, researchers find that four out of five prisoners have survived traumatic experiences with sexual abuse. Although sexual abuse was the most common form of trauma experienced, physical abuse, neglect, and psychological abuse were also observed. As a result, the vast majority of participants struggled with substance abuse issues.

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                                                                                                                                                        • Lord, E. 2008. The challenges of mentally ill female offenders in prison. Criminal Justice and Behavior 35:928–942.

                                                                                                                                                          DOI: 10.1177/0093854808318660Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                          The author notes that the number of women prisoners with mental health issues has steadily increased over the past few decades, following mass closures of mental health facilities across the United States. One prevalent behavior associated with mental illness among this population is self-harm. The author suggests that self-injurious behavior in prison is often met with further punishment or prolonged confinement, both of which exacerbate the behavior. The creation of therapeutic housing units that focus on mental health care, rather than standard prison settings, is recommended.

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                                                                                                                                                          • McCorkle, J. 2013. Breaking women: Gender, race, and the new politics of imprisonment. New York: New York Univ. Press.

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                                                                                                                                                            Drawing on qualitative methods, this book examines how punishment and treatment converge to inflict psychological trauma on female inmates. Race and gender intersect to show how US drug policies and (re?)habilitation programs behind bars alter the perceptions women have of their lives and self-worth. This book finds that penal practices to reform female drug offenders often imposes stereotypes that further the humiliation and degradation of women in need of treatment.

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                                                                                                                                                            • Schnittker, Jason. 2014. The psychological dimensions and social consequences of incarceration. Annals of the American Academy of Political and Social Science 651:122–138.

                                                                                                                                                              DOI: 10.1177/0002716213502922Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                              This article examines the psychological costs of incarceration. The author assesses how psychological factors are related to the process of re-entry. Anxiety, fear, and uncertainty affect the mental health of former inmates, challenging ex-offenders’ abilities to make social connections while managing psychological disorders and the stigma of a criminal conviction.

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                                                                                                                                                              • Schnittker, Jason, and Andrea John. 2007. Enduring stigma: The long-term effects of incarceration on health. Journal of Health and Social Behavior 48:115–130.

                                                                                                                                                                DOI: 10.1177/002214650704800202Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                This study identifies the direct and indirect effects of incarceration on health. Using a nationally representative data source, the authors find that incarceration strongly increases the likelihood of severe health limitations. They also find that any contact with prison is more important than the amount of contact, leading the authors to conclude that stigma associated with incarceration has pronounced health effects.

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                                                                                                                                                                • Schnittker, Jason, Michael Massoglia, and Christopher Uggen. 2012. Out and down: Incarceration and psychiatric disorders. Journal of Health and Social Behavior 53:448–464.

                                                                                                                                                                  DOI: 10.1177/0022146512453928Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                  This article explores the multidimensional influences of psychiatric disorders among former inmates. The authors find that common disorders found among former inmates emerge in childhood and adolescence, and that disorders dissipate over time. Incarceration is shown to be related to mood disorders that include major depressive disorders, bipolar disorders, and dysthymia. Mood disorders may hinder the successful re-entry of former inmates.

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                                                                                                                                                                  Incarceration and the Health of Family Members and Romantic Partners

                                                                                                                                                                  The negative effects of imprisonment extend beyond individual offenders, and implicate their romantic partners and children. Epperson, et al. 2011; Wildeman, et al. 2013; Lee, et al. 2014; Miller and Barnes 2015; and Wildeman and Muller 2012 show that the sexual and romantic partners of ex-offenders have elevated risks of infectious and chronic diseases, including hypertension, stroke, diabetes, asthma, and arthritis. More recent scholarship shows that the parents, children, and romantic partners of current and former inmates also experience increased likelihoods of stress, chronic and acute health conditions, and mental health disorders. Turney 2014 finds that parental incarceration negatively impacts child health, and Turney and Wildeman 2015 reports that maternal incarceration is associated with fair or poor health. Turney, et al. 2012 also show that incarceration affects levels of depression, and Wildeman, et al. 2012 presents evidence that this finding for mothers is a consequence of paternal incarceration. Green, et al. 2006 highlights how a son’s incarceration can have a negative impact on a mother’s psychological state.

                                                                                                                                                                  • Epperson, M. W., M. R. Khan, N. El-Bassel, E. Wu, and L. Gilbert. 2011. A longitudinal study of incarceration and HIV risk among methadone maintained men and their primary female partners. AIDS Behavior 15:347–355.

                                                                                                                                                                    DOI: 10.1007/s10461-009-9660-9Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                    This article focuses on the HIV-related risk for men whose sexual partners are women with histories of incarceration. A sample of 356 men from a methadone treatment clinic in New York City are interviewed at baseline, six months, and twelve-month periods. Findings indicate that when female partners becomes incarcerated, men seek out alternative sexual partners, putting them at risk for HIV. A couple-based HIV prevention educational program aimed at minimizing HIV risk for individuals who experience the incarceration of a partner is recommended.

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                                                                                                                                                                    • Green, K. M., M. E. Ensminger, J. A. Robertson, and H. S. Juon. 2006. Impact of adult sons’ incarceration on African American mothers’ psychological distress. Journal of Marriage and Family 68:430–441.

                                                                                                                                                                      DOI: 10.1111/j.1741-3737.2006.00262.xSave Citation »Export Citation »E-mail Citation »

                                                                                                                                                                      This study examines the effects of sons’ incarceration on their mother’s psychological distress. The more recent the incarceration, the greater the psychological stress of the mother, even after controlling for previous mental well-being. Mothers also experienced greater financial difficulties and an increased burden of grand-parenting. These findings show that the effects of incarceration extend to the emotional well-being of other family members.

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                                                                                                                                                                      • Lee, H., C. Wildeman, E. A. Wang, N. Matsuko, and J. S. Jackson. 2014. A heavy burden: The cardiovascular health consequences of having a family member incarcerated. American Journal of Public Health 104:421–427.

                                                                                                                                                                        DOI: 10.2105/AJPH.2013.301504Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                        This study assesses the relationship between having a family member incarcerated and health conditions. Findings indicate that for women, having a family member incarcerated increases the likelihood of hypertension, heart attack or stroke, diabetes, obesity, and fair or poor health. The same is not true for men. Study limitations include a reliance on self-reports and the lack of details on the incarcerated family member, including length of incarceration, the relationship to the family member, and whether s/he was held in prison or jail.

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                                                                                                                                                                        • Miller, V. H., and J. C. Barnes. 2015. The association between parental incarceration and health, education, and economic outcomes in young adulthood. American Journal of Criminal Justice 40:765–784.

                                                                                                                                                                          DOI: 10.1007/s12103-015-9288-4Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                          This study reveals numerous factors affecting children under the age of eighteen who experience parental incarceration. Findings indicate that paternal incarceration is a statistically significant predictor of asthma/bronchitis/emphysema, migraines, depression, anxiety, and self-injurious behavior.

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                                                                                                                                                                          • Turney, K. 2014. Stress proliferation across generations? Examining the relationship between parental incarceration and childhood health. Journal of Health and Social Behavior 55:302–319.

                                                                                                                                                                            DOI: 10.1177/0022146514544173Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                            This paper explores the impact of parental incarceration on children’s health. Controlling for demographic, socioeconomic, and familial characteristics, the author uncovers higher rates of learning disabilities, developmental delays, attention deficit disorder, behavioral or conduct disorder, and speech or language delay, among children who have experienced parental incarceration. The author notes that such collateral consequences of incarceration can exacerbate racially and ethnically disproportionate health inequalities found among children in the general population.

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                                                                                                                                                                            • Turney, K., and C. Wildeman. 2015. Self-reported health among recently incarcerated mothers. American Journal of Public Health 105:2014–2020.

                                                                                                                                                                              DOI: 10.2105/AJPH.2015.302743Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                              The relationship between maternal incarceration and self-reported heath is explored in this paper. Incarceration at any point within the past four years was associated with higher likelihood of depression, heavy drinking, fair or poor health, and other health complications. Furthermore, mothers who were connected with fathers with no incarceration history were more likely to experience poor health than those connected to fathers with an incarceration history.

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                                                                                                                                                                              • Turney, K., C. Wildeman, and J. Schnittker. 2012. As fathers and felons: Explaining the immediate and enduring effects of incarceration on major depression. Journal of Health and Social Behavior 53:465–481.

                                                                                                                                                                                DOI: 10.1177/0022146512462400Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                This article draws on stress process theory to investigate the relationship between incarceration and major depression. The authors consider how recent and current incarceration, changes in homelessness and relationship quality, and other mechanisms affect levels of depression. They find support for stress proliferation theory, as socioeconomic status and depression depends on the consequences of incarceration for reintegration processes and not solely on the direct psychological consequences of confinement.

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                                                                                                                                                                                • Wildeman, C., H. Lee, and M. Comfort. 2013. A new vulnerable population? The health of female partners of men recently released from prison. Women’s Health Issues 23:1–13.

                                                                                                                                                                                  DOI: 10.1016/j.whi.2013.07.006Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                  The authors examine the health of females whose male partners were recently released from incarceration. The study is based on a sample of 332 individuals, half of whom were recently released men, and the other half were their female partners. Findings indicate that women whose partners are incarcerated displayed higher levels of poor health behavior and negative conditions such as smoking, drug use, excessive alcohol consumption, asthma, hypertension, anxiety, and depression.

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                                                                                                                                                                                  • Wildeman, C., and C. Muller. 2012. Mass imprisonment and inequality in health and family life. Annual Review of Law and Social Science 8:11–30.

                                                                                                                                                                                    DOI: 10.1146/annurev-lawsocsci-102510-105459Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                    This article reviews the literature on imprisonment and health inequalities. Incarceration is shown to exacerbate preexisting racial disparities in earnings, health, and family stability. The mortality rates of African American males is lower than their similarly situated non-incarcerated peers, even though the causal reasons behind this disparity are not known. However, incarceration contributes to the spread of infectious disease and increases one’s susceptibility to hypertension, asthma, arthritis, various cancers, hepatitis, and the deterioration of mental health.

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                                                                                                                                                                                    • Wildeman, C., J. Schnittker, and K. Turney. 2012. Despair by association? The mental health of mothers with children by recently incarcerated fathers. American Sociological Review 77:216–243.

                                                                                                                                                                                      DOI: 10.1177/0003122411436234Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                      Paternal incarceration is hypothesized to affect maternal health. Findings show that a mother is at increased risk of a major depressive episode and life dissatisfaction if the father has been incarcerated. Under a number of stringent empirical tests, the authors conclude that the penal system has important effects on the mental well-being of women beyond the loss of economic support.

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                                                                                                                                                                                      The Health and Mortality of Current and Former Inmates

                                                                                                                                                                                      Post-Release Health of Former Inmates

                                                                                                                                                                                      The health conditions inmates experience while behind bars follow them when released from prison or jail. Porter 2014 shows how incarceration increases fast food consumption and cigarette use, and Schnittker, et al. 2011 finds that the post-release negative health effects due to incarceration are particularly large for African Americans, and Schnittker and Bacak 2013 illustrates that the effects of incarceration on social status are similar to having spent time in a psychiatric hospital. One challenge for public health officials is connecting former inmates with medical and health-care services upon release from custody. Freudenberg 2004 argues for a case management approach coupled with the expansion of community health providers for former offenders, and Wong, et al. 2010 illustrates how transitional clinics can be effective in affecting the health of newly released prisoners. These interventions are important, as Davis and Pacchiana 2004 shows that ex-offenders experience higher rates of tuberculosis and hepatitis B, and Spaulding, et al. 2009 finds that former inmates also have higher rates of HIV/AIDS. Scholarship seeks to establish the medical needs of the re-entry population and the health interventions that have been successful in maintaining treatment compliance.

                                                                                                                                                                                      • Davis, L. M., and S. Pacchiana. 2004. Health profile of the state prison population and returning offenders: Public health challenges. Journal of Correctional Health Care 10:303–331.

                                                                                                                                                                                        DOI: 10.1177/107834580301000305Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                        This article assesses the health patterns of populations released from jails and prisons. The authors note that 35 percent of all persons with active tuberculosis were formerly incarcerated; sexually transmitted disease (STD) prevalence is higher among the formerly incarcerated; 12 percent of all active hepatitis B cases are formerly incarcerated persons; the prevalence of AIDS is five times greater than the general US population; and the number of formerly incarcerated females with AIDS is growing.

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                                                                                                                                                                                        • Freudenberg, N. 2004. Community health services for returning jail and prison inmates. Journal of Correctional Health Care 10:369–397.

                                                                                                                                                                                          DOI: 10.1177/107834580301000307Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                          Ex-offenders experience higher rates of substance abuse, infectious diseases, dental problems, mental health, and chronic diseases than the general public. Once released, formerly incarcerated populations face special obstacles, delays, and denials in obtaining government-sponsored medical care. The author notes that such issues also affect public health because former inmates do not obtain proper medical care, which can result in a host of other negative health outcomes.

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                                                                                                                                                                                          • Porter, L. C. 2014. Incarceration and post-release health behavior. Journal of Health and Social Behavior 55:234–249.

                                                                                                                                                                                            DOI: 10.1177/0022146514531438Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                            The author examines the impact of incarceration on the health habits of young adults by comparing the frequency of fast food consumption and cigarette smoking of young adults who have been convicted of a crime but not incarcerated with those who have been incarcerated. Findings indicate that those who experience incarceration are more likely to consume fast food and to smoke cigarettes, placing ex-inmates are at higher risk of long term chronic illness and premature death.

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                                                                                                                                                                                            • Schnittker, J., and V. Bacak. 2013. A mark of disgrace or a badge of honor? Subjective status among former inmates. Social Problems 60:234–254.

                                                                                                                                                                                              DOI: 10.1525/sp.2013.60.2.234Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                              This article explores how exposure to incarceration affects the subjective status of men in their communities and in the United States. The authors distinguish between crime, arrest, and incarceration. They find support for a laddering effect of social status, whereby the type of criminal justice contact influences one’s subjective belief about their relative social status positioning. The negative effects of incarceration on social status are similar to having spent time in a psychiatric hospital.

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                                                                                                                                                                                              • Schnittker, J., M. Massoglia, and C. Uggen. 2011. Incarceration and the health of the African American Community. Du Bois Review 8:133–141.

                                                                                                                                                                                                DOI: 10.1017/S1742058X11000026Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                Because African Americans have the highest incarceration rates, the authors review evidence on the relationship between incarceration and health. Their review shows that negative health effects of incarceration can emerge after release during the process of reintegration. The authors draw attention to the difficulties in evaluating mechanisms and policies that may be promising in reducing the impact of incarceration on health.

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                                                                                                                                                                                                • Spaulding, A. C., R. M. Seals, M. J. Page, A. K. Brzozowski, W. Rhodes, and T. M. Hammett. 2009. HIV/AIDS among inmates of and releasees from U.S. correctional facilities, 2006: Declining share of epidemic but persistent public health opportunity. PLoS One 4.11: 1–7.

                                                                                                                                                                                                  DOI: 10.1371/journal.pone.0007558Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                  The authors explore whether the share of HIV/AIDS borne by inmates and releasees declined between 1997 and 2006. They find that in 1997, approximately one in five of all HIV-infected Americans was among the 7.3 million who left a correctional facility. By 2006, only one in seven (14 percent) of infected Americans was among the 9.1 million leaving, resulting in a 29.3 percent decline in the number of inmates with HIV/AIDS. Among black and Hispanic men, roughly one in five of recently released inmates were HIV-infected persons, a figure similar to the proportion borne by the correctional population as a whole in 1997.

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                                                                                                                                                                                                  • Wong, E. A., C. S. Hong, L. Samuels, S. Shavit, R. Sanders, and M. Kushel. 2010. Transition clinic: Creating a community-based model of health care for recently released California prisoners. Public Health Reports 125:171–177.

                                                                                                                                                                                                    DOI: 10.1177/003335491012500205Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                    This study evaluates a transitional clinic that provides health care to individuals released from prison within the last two weeks and were diagnosed with a chronic illness. Approximately 85 percent of the patients who utilized this clinic were historically underrepresented minorities and 38 percent were homeless. Findings show that sufficient program resources and repeated client contact increases program participation rates.

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                                                                                                                                                                                                    Cause-Specific Mortality among Former Inmates

                                                                                                                                                                                                    Parolees recently released from custody are at an immediate risk of mortality. Binswanger, et al. 2007; Zlodre and Fazel 2012; and Merrall, et al. 2010 show that an inmate’s risk of death is highest within the first two weeks after release, and Rosen, et al. 2008 finds that this higher rate of mortality extends to both black and white former inmates (compared to never incarcerated state residents). Binswanger, et al. 2013; Lim, et al. 2011; Merrall, et al. 2010; and Krinsky, et al. 2009 report that the post-release mortality of former inmates is largely a result of drug overdoses and homicides, and Spaulding, et al. 2011 illustrates how different ecological contexts matter for producing different types and levels of causes of death. Patterson 2013 notes that each additional year in prison produced a 15.6 percent increase in the odds of death for parolees.

                                                                                                                                                                                                    • Binswanger, I. A., P. J. Blatchford, S. R. Mueller, and M. F. Stern. 2013. Mortality after prison release: Opioid overdose and other causes of death, risk factors, and time trends from 1999 to 2009. Annals of Internal Medicine 159:592–600.

                                                                                                                                                                                                      DOI: 10.7326/0003-4819-159-9-201311050-00005Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                      The authors examine opioid overdose risks among recently released prisoners. Probabilistic matching is used to link National Death Index data with the identities of 76,208 individuals who have been released from correctional facilities. Findings indicate a mortality rate of 736 per 100,000 former prisoners, with 14.8 percent of these deaths resulting from opioid drug use, and 8.3 percent resulting from opioid overdose. Former female inmates were shown to have higher rates of opioid-related deaths as well as overdoses from other drugs.

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                                                                                                                                                                                                      • Binswanger, I. A., M. F. Stern, R. A. Deyo, P. J. Heagerty, A. Cheadle, J. G. Elmore, and T. D. Keopsell. 2007. Release from prison—a high risk of death for former inmates. The New England Journal of Medicine 356:157–165.

                                                                                                                                                                                                        DOI: 10.1056/NEJMsa064115Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                        This study implements a retrospective cohort design to examine the mortality rates of 30,237 released prisoners in Washington State. After adjusting for age, sex, and race, results indicate that risk of death among former inmates was 3.5 times greater than non-incarcerated state residents, and also that this rate sharply increases to 12.7, during the first two weeks immediately following release. The primary causes of death are drug overdoses, heart diseases, homicide, and suicide.

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                                                                                                                                                                                                        • Krinsky, C. S., S. L. Lathrop, P. B. Brown, and K. B. Nolte. 2009. Drugs, detention, and death: A study of the mortality of recently released prisoners. The American Journal of Forensic Medicine and Pathology 30:6–9.

                                                                                                                                                                                                          DOI: 10.1097/PAF.0b013e3181873784Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                          In a study based on a sample of ninety-six ex-offenders in New Mexico, the authors assess the likelihood of prisoner mortality soon after release. Findings indicate that individuals who are released from prison are at an increased risk of drug overdose compared to other forms of non-natural mortality, especially within the first two weeks of release. The average length of incarceration is also associated with higher risk of drug overdose.

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                                                                                                                                                                                                          • Lim, S., A. L. Seligson, F. M. Parvez, et al. 2011. Risks of drug-related death, suicide, and homicide during the immediate post-release period among people released from New York City jails, 2001–2005. American Journal of Epidemiology 175:519–526.

                                                                                                                                                                                                            DOI: 10.1093/aje/kwr327Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                            This study examines the mortality rates of 155,272 inmates released from New York City jails. Results show that the first two weeks following release were the most crucial for former offenders, as the risk for both drug-induced death and homicide are highest immediately upon release. Recently released inmates were twice as likely to be exposed to death, compared the average New York resident, even after implementing a variety of controls. Homelessness and longer jail sentences were associated with shorter survival times.

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                                                                                                                                                                                                            • Merrall, E. L. C., A. Kariminia, I. A. Binswanger, et al. 2010. Meta-analysis of drug-related deaths soon after release from prison. Addiction 105:1545–1554.

                                                                                                                                                                                                              DOI: 10.1111/j.1360-0443.2010.02990.xSave Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                              A meta-analysis of studies on drug-related deaths among former prisoners is conducted. Results indicate that drug-related deaths are highest within the first two weeks of release. In the United Kingdom, the rate of death was 8.4 times higher in the first two weeks than later weeks, and in Australia the rate was four times greater. Similar patterns are observed in US states. These findings support the hypothesis that prisoners are exposed to heightened risk of death during the first two weeks after release from a correctional facility.

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                                                                                                                                                                                                              • Patterson, E. J. 2013. The dose-response of time served in prison on mortality: New York State, 1989–2003. American Journal of Public Health 103.3: 523–528.

                                                                                                                                                                                                                DOI: 10.2105/AJPH.2012.301148Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                The author investigates the differential impact of length of stay on post-prison mortality among parolees. Each additional year in prison produced a 15.6 percent increase in the odds of death for parolees, which translated to a two-year decline in life expectancy for each year served in prison, with the highest risk occurring immediately upon release. However, the risk declined over time, pointing to unexplored pathways that lessen the risk of mortality later in life.

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                                                                                                                                                                                                                • Rosen, D. L., V. J. Schoenbach, and D. Wohl. 2008. All-cause and cause-specific mortality among men released from state prison, 1980–2005. American Journal of Public Health 12:2278–2284.

                                                                                                                                                                                                                  DOI: 10.2105/AJPH.2007.121855Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                  In a study comparing mortality rates between North Carolina state residents and former prisoners, the authors link state death records and prison records to estimate standardized mortality ratios. After adjusting for age, race, and cause-specific death rates, findings indicate that both white and black former prisoners experience higher death rates than state residents. Specifically, many of these deaths can be attributed to homicide, accidents, substance use, HIV, liver disease, and liver cancer. White prisoners were at greater risk for cardiovascular disease, lung cancer, respiratory illnesses, and diabetes.

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                                                                                                                                                                                                                  • Spaulding, A. C., R. M. Seals, V. A. McCallum, S. D. Perez, A. K. Brzozowski, and N. K. Steenland. 2011. Prisoner survival inside and outside of the institution: Implications for health-care planning. American Journal of Epidemiology 173:479–487.

                                                                                                                                                                                                                    DOI: 10.1093/aje/kwq422Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                    Researchers linked the Georgia Department of Corrections records with the Georgia Death Registry for 23,510 prisoners. Findings show higher death rates post-incarceration than during periods of confinement. The low mortality rate during incarceration was associated with homicide, transportation-related deaths, accidental poisoning, and suicide. The high mortality rate post-release was due to deaths caused by HIV, cancer, cirrhosis, homicide, transportation, and accidental poisoning. The authors recommend for medical intervention in order to reduce health-related mortality of this population.

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                                                                                                                                                                                                                    • Zlodre, J., and S. Fazel. 2012. All-cause and external mortality in released prisoners: Systematic review and meta-analysis. American Journal of Public Health 102:67–75.

                                                                                                                                                                                                                      DOI: 10.2105/AJPH.2012.300764Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                      The authors conduct a meta-analysis of more than 400,000 individuals released from various prisons to assess demographic patterns in mortality among former prisoners. Standardized mortality ratios ranged from 1.0 to 9.4, for men and 2.6 to 41.3 for females. Findings indicate that former prisoners experience higher risks of death immediately following release from confinement.

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                                                                                                                                                                                                                      Incarceration and Premature Mortality

                                                                                                                                                                                                                      While former inmates are at an increased risk of death immediately upon release from custody, a smaller number of studies compare the mortality rates of men and women unexposed and exposed to incarceration. These studies suggest a relationship between incarceration and premature mortality. Patterson 2010; Rosen, et al. 2011; and Dirkzwager, et al. 2012 all find that black men experience lower mortality rates inside of prison than outside confinement, and Massoglia, et al. 2014 shows that incarceration and premature mortality depends on gender, with female inmates more likely to experience death than never incarcerated women but the same is not true for men. However, Pridemore 2014 argues that theoretical and causal mechanisms that explain premature mortality among current and former inmates remains unknown and under-theorized.

                                                                                                                                                                                                                      • Dirkzwager, A., P. Nieuwbeerta, and A. Blokland. 2012. Effects of first-time imprisonment on postprison mortality: A 25-year follow-up study with a matched control group. Journal of Research in Crime and Delinquency 49:383–419.

                                                                                                                                                                                                                        DOI: 10.1177/0022427811415534Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                        In a longitudinal study spanning twenty-five years, researchers compare the mortality rates of Dutch offenders. Results indicate that 18 percent of the offenders died over this time period. Offenders who served time in prison were over three times more likely to die than similarly situated members from the general public with similar demographic characteristics. However, there was no statistically significant difference in mortality patterns between individuals who served time and those who were punished but did not serve time. An international study.

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                                                                                                                                                                                                                        • Massoglia, Michael, Paul-Philippe Pare, Jason Schnittker, and Alain Gagnon. 2014. The relationship between incarceration and premature adult mortality: Gender specific evidence. Social Science Research 46:142–154.

                                                                                                                                                                                                                          DOI: 10.1016/j.ssresearch.2014.03.002Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                          This article explores whether incarceration and premature mortality depends on gender. Results show strong gender differences using several different analytic procedures. Women with a history of incarceration are more likely to die than women without such a history, but the same is not true for men. The authors believe that future research would benefit from exploring gender differences in the collateral consequences of incarceration, even if women constitute a small (but growing) share of the inmate population.

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                                                                                                                                                                                                                          • Patterson, E. J. 2010. Incarceration death: Mortality in U.S. state correctional facilities, 1985–1998. Demography 47:587–607.

                                                                                                                                                                                                                            DOI: 10.1353/dem.0.0123Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                            The author utilizes data from the US Bureau of Justice Statistics and Census Bureau to compare mortality rates of prisoners and non-incarcerated populations. Results show that female prisoners experience higher mortality rates compared to male prisoners. Furthermore, black men experience lower mortality rates inside of prison than in the outside world. The author adjusts for deaths caused by firearms and motor vehicle accidents, but ultimately concludes that these factors do not account for the higher mortality rate of black men.

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                                                                                                                                                                                                                            • Pridemore, W. A. 2014. The mortality penalty of incarceration: Evidence from a population-based case-control study of working-age males. Journal of Health and Social Behavior 55:215–233.

                                                                                                                                                                                                                              DOI: 10.1177/0022146514533119Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                              This article assess the relationship between incarceration and increased risk of early death. Incarceration during any point in the life-course is associated with an increased risk of premature mortality. Consequently, a “mortality penalty” accompanies incarceration in ways that remain under-theorized by researchers. An international study.

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                                                                                                                                                                                                                              • Rosen, D. L., D. A. Wohl, and V. J. Schoenbach. 2011. All-cause and cause-specific mortality among black and white North Carolina state prisoners, 1995–2005. Annals of Epidemiology 21:719–726.

                                                                                                                                                                                                                                DOI: 10.1016/j.annepidem.2011.04.007Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                This study compares the mortality rates and causes of death of North Carolina prisoners and non-prisoners by linking prison and death records. Findings demonstrate lower mortality rates inside of prison, compared with the mortality rates of similarly situated black and white state residents.

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                                                                                                                                                                                                                                Growing Old Behind Bars

                                                                                                                                                                                                                                Aging Behind Bars

                                                                                                                                                                                                                                Reimer 2008 argues that changes in the criminal justice policy––mandatory minimum sentences, truth-in-sentencing laws, and three strikes legislation––have increased the number of inmates and the age distribution of the prison population. Porter, et al. 2016 finds that the median age of prisoners increased seven years between 1974 and 2004. The American Civil Liberties Union 2012 reports that, if current trends continue, nearly one-third of the nation’s prison population will be over the age of fifty-five. Maschi, et al. 2013 illustrates that many of the elderly prisoners will be men and racial/ethnic minorities. Loeb, et al. 2011 contends that the need to balance public safety with inmate health for an aging prison population will impact state budgets. For instance, Ferri 2014 and Rikard and Rosenberg 2007 both show that the costs of medical services for an aging prison population are expected to increase over time. Yet, as Head 2005 finds, compassionate release is rarely granted. As the age composition of correctional facilities grows older, the chronic health conditions of elderly prisoners have fueled calls for more compassionate release and end-of-life programs.

                                                                                                                                                                                                                                • American Civil Liberties Union. 2012. At America’s expense: The mass incarceration of the elderly.

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                                                                                                                                                                                                                                  This report provides an overview of demographic changes in the US prisoner population. The largest age group of aging prisoners is fifty to fifty-four years old, with black and Latino prisoners overrepresented. Aging prisoners require specialized medical attention, and that if current trends continue, by year 2030, approximately one-third of the nation’s prisoner population will be over the age of fifty-five. The report recommends expanding compassionate release procedures and offers a model for a “Conditional Release of Aging Prisoners Act.”

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                                                                                                                                                                                                                                  • Ferri, C. N. 2014. A stuck safety valve: The inadequacy of compassionate release for elderly inmates. Stetson Law Review 43:197–243.

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                                                                                                                                                                                                                                    The author describes the compassionate release of elderly prisoners as a process that is often misinterpreted. Even as the population of aging and elderly prisoners rapidly increases, there are numerous and strict eligibility criteria that result in very few actual releases. Because prisoners are afforded a constitutional right to adequate medical care, and are protected under the Americans with Disabilities Act, prison institutions will incur significant monetary costs by incarcerating large elderly populations.

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                                                                                                                                                                                                                                    • Head, B. 2005. Changing the culture of incarceration one life at a time. Journal of Hospice and Palliative Nursing 7:354–359.

                                                                                                                                                                                                                                      DOI: 10.1097/00129191-200511000-00016Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                      This article describes the centralized role of the prison hospice ward at Louisiana State (Angola) Penitentiary, where 85 percent of roughly five thousand prisoners are expected to die in prison before completing their sentences. The author notes that compassionate release is rarely granted even as the number of aging prisoners continues to increase.

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                                                                                                                                                                                                                                      • Loeb, S. J., J. Penrod, C. S. Hollenbeak, and C. A. Smith. 2011. End-of life care and barriers for female inmates. Journal of Obestetric, Gynecologic, and Neonatal Nursing 40:477–485.

                                                                                                                                                                                                                                        DOI: 10.1111/j.1552-6909.2011.01260.xSave Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                        Growth in the population of female prisoners is also increasing the number of women who grow old, sick, and die while incarcerated. Because correctional staff are not well trained to deal with ill prisoners and often distrust inmates and deny them proper care, particularly the provision of palliative medicine, the authors argue that correctional facilities should balance the need for security with the need to provide quality medical care, especially for dying prisoners.

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                                                                                                                                                                                                                                        • Maschi, T., M. B. Morrisey, and M. Leigey. 2013. The case for human agency, well-being, and community reintegration for people aging in prison: A statewide case analysis. Journal of Correctional Health Care 19:194–210.

                                                                                                                                                                                                                                          DOI: 10.1177/1078345813486445Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                          This study focuses on the burgeoning population of aging prisoners. Utilizing a Correctional Tracking Data Extraction Tool, researchers trace sociodemographic information on aging prisoner populations and find that a majority of older prisoners are males from ethnic and racial minorities. They propose a conceptual model that integrates life course perspectives, ecological systems, and critical theory to establish points where prevention and intervention might be most valuable.

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                                                                                                                                                                                                                                          • Porter, Lauren C., Shawn D. Bushway, Hui-Shien Tsao, and Herbert L. Smith. 2016. How the U.S. prison boom has changed the age distribution of the prison population. Criminology 54:30–55.

                                                                                                                                                                                                                                            DOI: 10.1111/1745-9125.12094Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                            This article presents a demographic analysis of the US prison population. Findings indicate that the age distribution of inmates increased significantly since the mid-1970s. In 1974, only 16 percent of the state prison population was forty years old; by 2004, however, the percentage had doubled to 33 percent, raising the median age of prisoners from twenty-seven to thirty-four years old over the time period.

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                                                                                                                                                                                                                                            • Reimer, G. 2008. The graying of the U.S. prisoner population. Journal of Correctional Health Care 14:202–208.

                                                                                                                                                                                                                                              DOI: 10.1177/1078345808318123Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                              The author traces the massive growth of elderly prisoner populations back to sentencing policies that have extended periods of confinement and parole practices that have increased recidivism rates. Changing prisoner demographics demonstrate that individuals over the age of fifty are now the fastest growing population inside of US prisons. Sharp increases in medical costs related to in-custody deaths of prisoners will become increasingly problematic for states and correctional facilities.

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                                                                                                                                                                                                                                              • Rikard, R. V., and E. Rosenberg. 2007. Aging inmates: A convergence of trends in the American criminal justice system. Journal of Correctional Health Care 13:150–162.

                                                                                                                                                                                                                                                DOI: 10.1177/1078345807303001Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                                Elderly prisoners require costly, age-specific care that places strain on the correctional system. Aging prisoners require special health-care services, including twenty-four-hour nursing attention, unique treatment facilities, kidney dialysis, and other forms of specialized care. The authors advocate for the expansion of early/medical release for aging prisoners who do not pose a public safety problem if released.

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                                                                                                                                                                                                                                                Hospice Care in Prisons

                                                                                                                                                                                                                                                Hospice care has emerged as one solution to an aging prison population. A number of political, bureaucratic, and social barriers exist in determining who will administer end-of-life care and the types of services that should be implemented. Cloyes, et al. 2015 finds that hospice patients in correctional facilities have higher rates of comorbid illnesses and infectious disease than the general public. Bronstein and Wright 2006 shows that prison wardens and administrators tend to be more supportive of hospice programs than correctional staff. Cost is often noted as a concern for hospice construction in prisons, but Evans, et al. 2002 reports that such wards can be cost-effective if a preexisting ward is converted, and Linder, et al. 2002 outlines a multidimensional approach to constructing an effective hospice program. Yet, Stone, et al. 2011 finds that there is only one on-site prison hospice facility in the United Kingdom, pointing to another method of dispensing health care to older inmates. Nevertheless, Hoffman and Dickinson 2011 reports that prison hospices employ stricter screening for volunteers, even as Supiano, et al. 2014 reports that many volunteers find providing care to be emotionally, physically, and spiritually taxing. However, Cloyes, et al. 2013 finds that volunteers are willing to endure these taxations because they build intimate friendships with terminally ill prisoner-patients. Granse 2003 recommends compassionate release as an alternative to life-long incarceration, and Mahon 1999 illustrates four cross-cutting themes that are relevant for prison hospice care.

                                                                                                                                                                                                                                                • Bronstein, L. R., and K. Wright. 2006. The impact of prison hospice: Collaboration among social workers and other professionals in a criminal justice setting that promotes care for the dying. Journal of Social Work in End-of-Life and Palliative Care 2:85–102.

                                                                                                                                                                                                                                                  DOI: 10.1300/J457v02n04_05Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                                  This study analyzes the role of collaboration between social workers and prison staff for the development of successful hospice programs. Findings show that prison wardens and administrators tend to be more supportive of hospice programs than correctional staff. Collaborations with outside professionals contribute to the success of prison hospice programs and greater satisfaction among patient-prisoners. The authors posit that social workers are uniquely positioned to contribute their expertise to the improvement of prison hospice programs.

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                                                                                                                                                                                                                                                  • Cloyes, K. G., P. H. Berry, J. Martz, and K. Supiano. 2015. Characteristics of prison hospice patients: Medical history, hospice care, and end-of-life symptom prevalence. Journal of Correctional Health Care 21:298–308.

                                                                                                                                                                                                                                                    DOI: 10.1177/1078345815588842Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                                    Researchers compare characteristics of hospice patients at Louisiana State Penitentiary with hospice patients in the general public. Results from this study reveal that prison hospice patients exhibit higher rates of comorbid illness and infectious disease; they also are admitted into, and die in, hospice care at younger ages; and hospice patients display rare and aggressive cancers more than the non-incarcerated hospice population.

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                                                                                                                                                                                                                                                    • Cloyes, K. G., S. J. Rosencranz, D. Wold, P. H. Berry, and K. P. Supiano. 2013. To be truly alive: Motivation among prison inmate hospice volunteers and the transformative process of end-of-life peer care service. American Journal of Hospice and Palliative Care 31.7: 735–748.

                                                                                                                                                                                                                                                      DOI: 10.1177/1049909113506035Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                                      Through the utilization of an open-ended survey, the authors analyze the experiences of seventy-five prisoners who labor as volunteer caregivers at the hospice ward in Louisiana State Penitentiary. They established a number of recurring themes expressed by the prisoners, including an appreciation for building intimate friendship with terminally ill prisoner-patients, undergoing deep self-reflection and change, and forming a positive self-identity by helping to ease the pain of dying prisoner-patients.

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                                                                                                                                                                                                                                                      • Evans, C., R. Herzog, and T. Tillman. 2002. The Louisiana state penitentiary: Angola prison hospice. Journal of Palliative Medicine 5:553–558.

                                                                                                                                                                                                                                                        DOI: 10.1089/109662102760269797Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                                        This study traces the establishment of a hospice program in Louisiana State Penitentiary, where 85 percent of over 5,100 inmates are projected to die while incarcerated. The hospice program was designed to meet criteria set forth by the National Hospice and Palliative Care Organization. The authors note that constructing a prison hospice ward can be a cost-effective project if a preexisting ward is converted for hospice use, and prisoner volunteers and correctional staff receive training from community hospice professionals.

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                                                                                                                                                                                                                                                        • Granse, B. L. 2003. Why should we even care? Hospice social work practice in a prison setting. Smith College Studies in Social Work 73:359–376.

                                                                                                                                                                                                                                                          DOI: 10.1080/00377310309517690Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                                          The author presents a series of case studies that reveal the experiences of prisoners struggling with health and medical complications. Compassionate release is recommended as an alternative to life-long incarceration. However, compassionate release petitions are rarely granted, and inmates often die before the paperwork is even processed. Even in instances when compassionate release is granted, oftentimes the prisoner is already very near to death.

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                                                                                                                                                                                                                                                          • Hoffman, H. C., and G. E. Dickinson. 2011. Characteristics of prison hospice programs in the United States. American Journal of Hospice and Palliative Care 28:245–252.

                                                                                                                                                                                                                                                            DOI: 10.1177/1049909110381884Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                                            This study assesses the characteristics and conditions of prison hospice facilities throughout the nation. Findings reveal that, compared to non-carceral hospices, prison hospices employ stricter screening criteria for volunteers, require greater training to be completed before caregivers begin to interact with patients, and labor for longer durations of time. Instances of health-care volunteers exploiting patient-prisoners are noted to be very rare.

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                                                                                                                                                                                                                                                            • Linder, J. F., S. R. Enders, E. Craig, J. Richardson, and F. J. Meyers. 2002. Hospice care for the incarcerated in the United States: An introduction. Journal of Palliative Medicine 5:549–552.

                                                                                                                                                                                                                                                              DOI: 10.1089/109662102760269788Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                                              This introduction provides data on the growth of elderly and terminally ill prisoner populations. Several challenges that confront palliative medical practices inside of correctional institutions are documented, including policies that restrict the use of pain reducing drugs; difficulties in establishing trust between correctional staff and prisoners; and strict visitation policies for families and friends. The authors suggest that their overview of prison hospice facilities can help to inform prison administration in how to construct an effective hospice program.

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                                                                                                                                                                                                                                                              • Mahon, N. B. 1999. Introduction: Death and dying behind bars—cross-cutting themes and policy imperatives. Journal of Law, Medicine, and Ethics 27:213–215.

                                                                                                                                                                                                                                                                DOI: 10.1111/j.1748-720X.1999.tb01454.xSave Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                                                This article explicates four cross-cutting themes that are central to understanding social conditions underlying prison hospice care. First, there are political barriers to providing adequate end-of-life care in prisons. Second, in the rare event that compassionate release is granted to a prisoner, it is often done so with no support or plan for discharge. Third, the prison environment places heavy priority on security, and therefore prisons are inherently not conducive to providing hospice care. Finally, a prisoner’s legal status deprives him of agency in making decisions over his own health care.

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                                                                                                                                                                                                                                                                • Stone, K., I. Papadopoulos, and D. Kelly. 2011. Establishing hospice care for prison populations: An integrative review assessing the UK and USA perspective. Palliative Medicine 26:969–978.

                                                                                                                                                                                                                                                                  DOI: 10.1177/0269216311424219Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                                                  This study compares the use of prison hospice care within the United States and the United Kingdom. The authors could only locate a single on-site prison hospice facility in the United Kingdom. Rather than constructing hospices inside of prisons, UK prison administration are more likely to transfer terminally ill prisoners to local hospitals in close proximity to the correctional facility. The granting of compassionate release petitions, however, remains sparse in both countries.

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                                                                                                                                                                                                                                                                  • Supiano, K. P., K. G. Cloyes, and P. H. Berry. 2014. The grief experience of prison inmate hospice volunteer caregivers. Journal of Social Work in End-of-Life & Palliative Care 10:80–94.

                                                                                                                                                                                                                                                                    DOI: 10.1080/15524256.2013.877866Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                                                                                                                                    Drawing on interviews of prison hospice volunteers at Louisiana State Penitentiary, this study assesses the experience of grief among health-care workers. Hospice volunteers indicate that providing care is emotionally, physically, and spiritually taxing, but that the outcome is worthwhile when they are able to make a difference for their patients. One limitation of this study is that it is based on a relatively small sample, and at only a single prison.

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