Looking behind the bars: emerging health issues for people in prison.

Introduction: There are more than 10 million people imprisoned worldwide. These individuals experience a higher burden of communicable and non-communicable disease, mental health and substance misuse problems than the general population and often come from marginalized and underserved groups in the community. Prisons offer an important opportunity for tackling health problems in a way that can deliver benefits to the individual and to the community. This paper focuses specifically on emerging health issues for prisons across the world. Sources of data: This paper uses sources of international data from published systematic reviews and research studies, the Ministry of Justice for England and Wales, the Prisons and Probations Ombudsmen Review and other United Kingdom government briefing papers. Areas of agreement: Deaths in custody are a key concern for the justice system as well as the health system. Areas of controversy: Suicide is the leading cause of mortality in prisons worldwide but non-communicable diseases, such as cardiovascular disease, are increasing in importance in high-income countries and are now the leading cause of mortality in prisons in England and Wales. Growing points: The prison population is ageing in most high-income countries. Older people in prison typically have multiple and complex medical and social care needs including reduced mobility and personal care needs as well as poor health. Areas timely for developing research: Further research is needed to understand the complex relationship between sentencing patterns, the ageing prison population and deaths in custody; to model its impact on prisons and healthcare provision in the future and to determine effective and cost-effective models of care. Research into the health of prisoners is important in improving the health of prisoners but there is considerable variation in quantity and quality between countries. Recent innovations seek to address this disparity and facilitate the sharing of good practice.

Ethnic differences in the health of women prisoners.

OBJECTIVES: The numbers of female and ethnic minority prisoners in the UK are increasing. Despite recent policy initiatives to improve both prison healthcare and the status of women and ethnic minority groups, there are few data with which to inform service development. This is the first study in the UK to examine differences in subjective health status and health behaviours between Black and White female prisoners. STUDY DESIGN: Retrospective secondary analysis of data from the Health of Women in Prison Study by the University of Oxford. The latter was a longitudinal survey. METHODS: Participants were given a questionnaire containing the Short Form 36 (SF-36) and questions about cigarette smoking, alcohol consumption, illicit drug use, physical exercise, diet, imprisonment history and ethnicity. Data from Black and White participants were compared. Physical and mental component summary scores from the SF-36 were assessed using the independent t-test for means. Differences in health behaviours between the Black and White women were assessed using a paired samples t-test for continuous variables or Chi-squared test for categorical data. RESULTS: Black women were more likely to have stayed in full-time education for longer and to have been legally employed prior to imprisonment. The average length of their current sentence was significantly higher than that for White women. Black women scored higher in general health perception, but there were no other significant differences in subjective health status. Significantly fewer Black women smoked or drank to excess, or had used drugs in the 6 months prior to imprisonment. Black women ate more healthily, but were more likely to be overweight and to have higher blood pressure than their White counterparts. Both groups, however, demonstrated poor health and health behaviours overall. CONCLUSION: Black women entering prison are more likely to be educated, employed, drug free and, in some ways, healthier than White women. However, all the prisoners, regardless of ethnicity, had poorer levels of mental and physical health than the general population; thus, a need exists for researchers and policy makers alike to examine the health of these groups within and out of prison.

Predictors of hepatitis B vaccination in women prisoners in two prisons in England.

BACKGROUND: Hepatitis B is an important public health issue, especially in the female prison population. The high prevalence in this population is largely accounted for by the high rates of injecting drug use and the fact that these women are more likely to exchange sex for drugs or money and practice unprotected sex. There is a national programme in English prisons to vaccinate everyone against Hepatitis B. This study aimed to investigate whether women who had been in prison before were more likely to have been vaccinated against hepatitis B and whether contact with community services was more likely to predict hepatitis B vaccination. METHODS: A questionnaire survey of new entrants into two women's prisons in England. RESULTS: Four hundred and eighty seven out of 613 women approached completed the questionnaire and gave complete data on hepatitis B vaccination status, giving a response rate of 79.4%. One hundred and thirty three women (27.3%) had received at least three vaccinations against hepatitis B. Previous imprisonment and intravenous drug use were independent predictors of vaccination. Six months or more in prison greatly increased an individual's odds of being immunized [odds ratio 12.01 (95% confidence interval (CI) 5.53-26.10)]. Registration with a general practitioner (GP), contact with drug or alcohol services and exchanging money or goods for sex were not independently associated with vaccination status. CONCLUSION: Prisons play an important role in the delivery of hepatitis B vaccination. However, this should not prevent providers of health services making greater efforts to engage this marginalized group and to ensure that they receive an appropriate level of healthcare in the community.