Multimorbidity patterns and associations with functional limitations among an aging population in prison.

OBJECTIVES: Co-occurring chronic diseases are associated with functional limitations, particularly for the aging population ≥50 years old. Aging offenders (individual who are imprisoned) tend to have greater prevalence of chronic, mental health, and substance use disorders compared to non-imprisoned populations. Our primary aim was to determine patterns of co-occurring conditions associated with functional limitations among aging offenders. MATERIALS AND METHODS: We included all male offenders from one correctional system who were ≥50 years old (n = 2270) and extracted diagnoses for chronic diseases, mental health, substance use disorders, and functional limitations from an electronic health record. We performed a principal factor analysis (PFA) to identify patterns and chi-square to determine if the multimorbid population (≥3 diagnoses) differed from peer groups in regard to functional limitations. RESULTS: Three patterns (chronic diseases, geriatric conditions, and mental health/substance use) emerged from PFA. Functional limitations were associated with the chronic disease pattern (p = .03) where the multimorbid group compared to non-multimorbid peers had 1.5 odds, 95% CI [1.0, 2.1], for having a physical impairment. The geriatric (p = .10) and mental health/substance use disorders (p = .07) patterns were not associated with having a functional limitation compared to the population without multiple diagnoses. Controlling for multimorbidity, functional limitations, and overlapping patterns, increasing age was the only significant factor (p = .02) associated with having a physical impairment. CONCLUSION: The chronic disease pattern was consistent with investigations that included non-imprisoned populations. However, the geriatric pattern was not significant, which was unexpected.

Substance Use Disorders and Related Health Problems in an Aging Offender Population.

Substance use disorders (SUD), including alcohol and tobacco, have been associated with chronic, infectious diseases, and mental health disorders. Few studies have examined associations between SUD and health issues for aging offenders (≥ 45 years old), who may have been long-term users. This study investigated associations between SUD and health problems in a prison population (men and women). We included 10,988 offenders, of whom 26.8% were aging. Aging offenders were more likely than younger peers to have health problems, such as cardiovascular diseases and hypertension, (80.8% compared with 63.6%). We found that aging African Americans with SUD had greater odds for being diagnosed with chronic conditions than White peers (p <.0001). Controlling for SUD, cardiovascular disease emerged as the most significant and frequently associated health problem for aging offenders. Results suggest a need to focus on the health of aging offenders with a history of SUD, particularly African Americans.

Associations among Substance Use, Mental Health Disorders, and Self-Harm in a Prison Population: Examining Group Risk for Suicide Attempt.

Substance use disorders (SUD) and mental health disorders are significant public health issues that co-occur and are associated with high risk for suicide attempts. SUD and mental health disorders are more prevalent among offenders (i.e., prisoners or inmates) than the non-imprisoned population, raising concerns about the risk of self-harm. This cross-sectional study examined the population of a state prison system (10,988 out of 13,079) to identify associations among SUD (alcohol, cannabis, intravenous drugs, narcotics, and tobacco smoking), mental health disorders (anxiety, bipolar, depression, and psychotic disorders), and suicide attempts. The primary aim was to determine which groups (SUD, mental health disorders, and co-occurrences) were strongly association with suicide attempts. Groups with a documented SUD or mental health disorders compared to peers without these issues had 2.0 and 9.2 greater odds, respectively, for attempting suicide, which was significant at p < 0.0001 for both conditions. There were also significant differences within SUD and mental health disorders groups in regard to suicide attempts. Groups with the greatest odds for suicide attempts were offenders with comorbid bipolar comorbid and anxiety, alcohol combined with depression, and cannabis co-occurring with depression. Documentation of suicide attempts during imprisonment indicates awareness, but also suggest a need to continue enhancing screening and evaluating environmental settings.

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

BACKGROUND: Studies have found that antipsychotics and antidepressants are associated with weight gain and obesity, particularly among women and some minority groups. Incarcerated populations (also referred to as offenders, prisoners or inmates) have a high prevalence of mental health problems and 15 % of offenders have been prescribed medications. Despite rates of antidepressant and antipsychotic use, investigations of weight gain and obesity in regard to these agents seldom have included offenders. METHODS: This retrospective descriptive study (2005-2011) was conducted with a Department of Corrections in the east south central United States to investigate the relationship between antidepressant and antipsychotic agents, weight gain, obesity and race or gender differences. We sampled adult offenders who had an active record, at least two weight observations and height data. Offenders were classified into one of four mutually exclusive groups depending upon the type of medication they were prescribed: antidepressants, antipsychotics, other medications or no pharmacotherapy. RESULTS: The sample population for this study was 2728, which was 25.2 % of the total population. The population not on pharmacotherapy had the lowest baseline obesity rate (31.7 %) compared to offenders prescribed antipsychotics (43.6 %), antidepressants (43.6 %) or other medications (45.1 %). Offenders who were prescribed antidepressants or antipsychotics gained weight that was significantly different from zero, p < .001 and p = .019, respectively. Women in the antidepressant group gained 6.4 kg compared to 2.0 kg for men, which was significant (p = .007). Although women in the antipsychotic group gained 8.8 kg compared to 1.6 kg for men, the finding was not significant (p = .122). Surprisingly, there were no significant differences in weight gain between African Americans and Whites in regard to antidepressants (p = .336) or antipsychotic agents (p = .335). CONCLUSION: This study found that women and men offenders prescribed antidepressant or antipsychotic agents gained weight during their incarceration. Women prescribed antidepressants gained significantly more weight than men. However, there was no significant difference in weight gain between African Americans and Whites. Results suggest further investigation is needed to understand the effect of medication history, metabolic syndrome and to explain gender disparities.

A Call to Develop Evidence-based Interventions to Reduce Sexually Transmitted Infections in Juvenile Justice Populations.

Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) risk, are a significant health issue for young women (ages 16-21), especially African Americans with a juvenile justice history. Studies have found that 44% of young African American women have had at least one STI compared to 24.1% for all young women. The rate of STIs among young women with juvenile justice histories, particularly African Americans, is likely much higher than their non-detained peers. Yet, there are few evidence-based interventions (EBIs) designed specifically for the detained population. In 2014, the Centers for Disease Control and Prevention's Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention listed few programs that comprehensively included components related to mental health, intimate relationships and high risk sexual behaviors that would be salient for a detained population. Further, many EBIs have had limited or no long-term protective effect. We propose that interrelated factors (mental health, substance use, trauma and intimate relationships) can effectively decrease risk and increase protective behaviors for the detained population most at risk.

Exploration of barriers and facilitators to publishing local public health findings: A mixed methods protocol.

BACKGROUND: Worldwide, the US accounts for a large proportion of journals related to public health. Although the American Public Health Association (APHA) includes 54 affiliated regional and state associations, little is known about their capacity to support public health scholarship. The aim of this study is to assess barriers and facilitators to operation of state journals for the dissemination of local public health research and practices. METHODS: A mixed methods approach will be used to complete the 12-month study. Affiliate websites will be accessed through the APHA membership portal to evaluate organizational infrastructure and ascertain the presence/absence of a journal. The leader of each affiliate will be contacted via email containing a link to a 12-question on-line survey to collect his/her perceptions of scholarly journals and the publication of local health data. To determine barriers and facilitators to publication of local public health findings, 30-minute semi-structured telephone interviews will focus on the infrastructure of the association, perceptions of the leader about the journal (if in place), and its operation. ANTICIPATED RESULTS: We anticipate that 54 affiliate websites will be reviewed to complete the extraction checklist, that 74% of affiliate leaders will respond to the survey, and that 11 semi-structured interviews will be conducted. A limited number of state/regional public health associations will operate journals and a small percentage of those without journals may express an interest in implementing them. Barriers to operation of journals may include lack of resources (i.e., personnel, funding), and low prioritization of publication of state and local public health findings. Facilitators may include strong affiliate-academic relationships, affiliate leadership with experience in publications, and affiliate relationships with state and local departments of health. CONCLUSIONS: The research proposed in this protocol may stimulate other state public health associations and other academic public health programs to follow suit; it would not be the first time that an observational research study served as an intervention.

The impact of incarceration on obesity: are prisoners with chronic diseases becoming overweight and obese during their confinement?

INTRODUCTION: The association between incarceration and weight gain, along with the public health impact of former prisoners who are overweight or obese, warrants more investigation to understand the impact of prison life. Studies regarding incarceration's impact on obesity are too few to support assertions that prisons contribute to obesity and comorbid conditions. This study examined a statewide prison population over several years to determine weight gain. METHODS: Objective data for weight, height, and chronic diseases, along with demographics, were extracted from an electronic health record. These data were analyzed statistically to determine changes over time and between groups. RESULTS: As a total population, prisoners not only gained weight, but also reflected the distribution of BMIs for the state. There were differences within the population. Male prisoners gained significantly less weight than females. The population with chronic diseases gained less weight than the population without comorbid conditions. Prisoners with diabetes lost weight while hypertension's impact was negligible. CONCLUSION: This study found that weight gain was a problem specifically to females. However, this prison system appears to be providing effective chronic disease management, particularly for prisoners with diabetes and hypertension. Additional research is needed to understand the impact incarceration has on the female population.

Understanding Psychosocial and High-Risk Sexual Behaviors Among Detained Juveniles: A Descriptive Study Protocol.

BACKGROUND: African American women are disproportionately impacted by sexually transmitted infections (STIs), such as chlamydia and gonorrhea, which are known risk factors for human immunodeficiency virus (HIV) infection. STIs, particularly chlamydia and gonorrhea, are even more prevalent among young African American women with a juvenile detention history. The population with experiences with the criminal justice system has greater rates of STIs and is diagnosed more often with mental health issues, often related to sexual abuse or intimate partner violence, compared to peers who have not been detained by law enforcement. Psychosocial factors, especially those related to intimate relationships (ie, the imperativeness of being in a relationship and the power one has in their relationship), have emerged as important explanatory factors for acquiring STIs, including HIV, and a component of risk reduction interventions. OBJECTIVE: To investigate more comprehensively the relationship between psychosocial risk factors and STIs, including HIV, as it relates to reduction and prevention of these diseases. The long-term goal is to improve the effectiveness of evidence-based interventions with a major focus on intimate relationship dynamics. METHODS: This descriptive study surveys young women (ages 13-17) who have been detained (incarcerated) by a department of juvenile justice. In addition to being female and detained, eligibility criteria include being detained longer than 30 days and being free of cognitive impairments. This study will include young women from one juvenile detention center. The primary outcomes to be measured are STI knowledge, intimate relationship dynamics (ie, imperativeness and power), and high-risk sexual behaviors. High-risk sexual behaviors will be assessed using data extracted from health records. RESULTS: Preliminarily, we have received assent from 26 primarily young African American women. The majority of participants (81%) had inadequate knowledge about STIs, 52% perceived a lack of power in their relationship, 56% were fearful of negotiating condom use, and 60% were not comfortable refusing sex. Interestingly, a majority of participants (68%) did not perceive a relationship as imperative. CONCLUSIONS: When enrollment and data collection are completed, it is expected that the primary outcome of intimate relationship dynamics (ie, imperativeness and power) will be associated with high-risk sexual behaviors and having an STI. Further, the findings are expected to provide guidance in developing a risk reduction intervention, for the population in which psychosocial factors related to intimate relationships will be central.