Self-reported injection drug use and needle sharing behavior among soon-to-be-released adult male inmates.Abstract: This study was intended to evaluate self-reported injection drug use as reported by a sample of soon-to-be-released adult male inmates in Georgia. The study participants were enrolled in a randomized ran·dom·ize
tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es
To make random in arrangement, especially in order to control the variables in an experiment. trial of a Human Immunodeficiency immunodeficiency
Defect in immunity that impairs the body's ability to resist infection. The immune system may fail to function for many reasons. Immune disorders caused by a genetic defect are usually evident early in life. Virus/recidivism prevention program. Analyses involved calculating measures of linear association in the form of chi square chi square (kī),
n a nonparametric statistic used with discrete data in the form of frequency count (nominal data) or percentages or proportions that can be reduced to frequencies. to examine relationships between selected variables, injection drug use, and needle-sharing behavior prior to incarceration Confinement in a jail or prison; imprisonment.
Police officers and other law enforcement officers are authorized by federal, state, and local lawmakers to arrest and confine persons suspected of crimes. The judicial system is authorized to confine persons convicted of crimes. . Findings suggest that African American African American Multiculture A person having origins in any of the black racial groups of Africa. See Race. inmates reported significantly less IV drug use than whites and others ([chi square] = 37.4, p < .01, df = 2). No statistically significant differences were evidenced in self-reported IV drug use between sample participants with respect to education. However, African American inmates were more likely to report sharing needles than were whites and others. Findings suggest the need for expanded intervention efforts in prisons leading toward effective clinic- and community-based programs to reduce IV drug use among inmate populations.
Research indicates that adult male inmates often evince e·vince
tr.v. e·vinced, e·vinc·ing, e·vinc·es
To show or demonstrate clearly; manifest: evince distaste by grimacing. relatively poor healthcare status (Braithwaite & Arriola, 2003). One reason for this is related to problem behaviors practiced by inmate populations prior to and while incarcerated incarcerated /in·car·cer·at·ed/ (in-kahr´ser-at?ed) imprisoned; constricted; subjected to incarceration.
Confined or trapped, as a hernia. . One such behavior discussed often in the literature is injection drug use (Arndt, Turvey, & Flaum, 2002; Clarke, Stein, Hanna, Sobota, & Rich, 2001; May & Williams, 2002; Neighbors, O'Leary, & Labouvie, 1999). Over the past two decades a number of studies have documented the growing problem of poor health status among inmates in correctional facilities, in particular infectious diseases infectious diseases: see communicable diseases. including HIV/MDS. This is a major concern since primary risk factors for HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. , in addition to having unprotected sex Unprotected sex refers to any act of sexual intercourse in which the participants use no form of barrier contraception. Sexually transmitted infections
Specifically, unprotected sex and having sex with multiple partners, also included use and/or sharing of needles for IV drug use (IVDU IVDU Intravenous Drug Use
IVDU Individual Visual Display Unit (US Army) ).
It is estimated that correctional facilities may house more IV drug users than there are in drug treatment centers (Decker, Vaughn, & Brodie, 1984). Intravenous drug use intravenous drug use Intravenous drug abuse The habitual IV injection of drugs of abuse Epidemiology In the US ± 2.5 million–population ± 235 million have used IVDs Infections Pyogenic–eg, endocarditis, pneumonia, sepsis Common agents has consistently continued as a behavior prevalent among inmate populations. Some have suggested that approximately 25% of inmates report IVDU while in prison (Adams, 1985; Decker, Vaughn, & Brodie, 1984). In addition, sharing of improperly cleaned injection solutions, containers, cotton, and other paraphernalia PARAPHERNALIA. The name given to all such things as a woman has a right to retain as her own property, after her husband's death; they consist generally of her clothing, jewels, and ornaments suitable to her condition, which she used personally during his life. contribute to this problem. Another concern is that, when needles are not available, pieces of pens and light bulbs are sometimes used by inmates to inject drugs (Mahon, 1994). Due to the national drug control strategy, a growing population of injection drug users has emerged in the prison population over the past 15 to 20 years. Harlow (1993) reported that by the end of 1991, nearly one in four state inmates had used a needle to inject illegal drugs during their lives. Access to illegal drugs and injection equipment continues to be a prevalent occurrence in many correctional systems.
Injection drug use is also a problem behavior that places people at risk for HIV/AIDS HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome . It has been reported that HIV in prisons is approximately five times that of the general population (Ross, 2001). The present investigation is unlike many of the previous studies in that it is part of a longitudinal study longitudinal study
a chronological study in epidemiology which attempts to establish a relationship between an antecedent cause and a subsequent effect. See also cohort study. designed to apply a model for delivering prevention programs to soon-to-be-released prison inmates. The intervention program was designed to reduce risky sexual behaviors sexual behavior A person's sexual practices–ie, whether he/she engages in heterosexual or homosexual activity. See Sex life, Sexual life. (RSBs), such as alcohol, tobacco, and other drug (ATOD)-related behaviors, once the felon An individual who commits a crime of a serious nature, such as Burglary or murder. A person who commits a felony.
felon n. a person who has been convicted of a felony, which is a crime punishable by death or a term in state or federal prison. returns to the community. Accordingly, the purpose of this study was to evaluate self-reported injection drug use as reported by a sample of soon-to-be-released adult male inmates in Georgia. In addition, measures outside of substance use that may be linked to risk behaviors reported by this population, such as length of incarceration, history of incarceration, and demographic variables were also examined.
A Latin Square Noun 1. Latin square - a square matrix of n rows and columns; cells contain n different symbols so arranged that no symbol occurs more than once in any row or column
square matrix - a matrix with the same number of rows and columns study design was used. The study participants were soon-to-be released adult male inmates enrolled in a randomized trial of a Human Immunodeficiency Virus/recidivism prevention program. All study participants who had completed a baseline survey at the time were included in the analysis. The basis of the health education curriculum provided participants with information related to health, infectious disease Infectious disease
A pathological condition spread among biological species. Infectious diseases, although varied in their effects, are always associated with viruses, bacteria, fungi, protozoa, multicellular parasites and aberrant proteins known as prions. transmission, substance use behavior, personal health empowerment, community reintegration reintegration /re·in·te·gra·tion/ (-in-te-gra´shun)
1. biological integration after a state of disruption.
2. restoration of harmonious mental function after disintegration of the personality in mental illness. , and sexual risk behaviors. Baseline data and 6-month, 12-month, and 18-month follow-up data collected from adolescents randomized to the control condition were used for this study.
The study delivered a health education intervention to soon-to-be-released adult male inmates. Eligibility for this study required that inmates be at a point between 60 and 90 days prior to release from the facility and returning to the metropolitan area of a major southeastern city. Participants were recruited from a population of inmates at three medium security correctional institutions for men located in middle Georgia Middle Georgia refers to the metropolitan area surrounding the city of Macon, in Bibb County in the U.S. state of Georgia.
Similar, and possibly coextensive, named regions include Central Georgia and the Heart of Georgia. and a transitional center located in a major southeastern city. Pilot testing of interview materials was conducted in a fifth medium security facility not included in the baseline. More detailed descriptions of the study have been published elsewhere regarding the curriculum (Stephens, Braithwaite, Robillard, Finnie, & Colbert, 2002) and methodology (Braithwaite, Stephens, Conerly, Arriola, & Robillard, In press). The university Institutional Review Board approved all study protocols.
Data were collected at baseline (prior to implementing the intervention), at release, and at 3-, 6-, and 9-months post-release. However, only baseline data are presented in the current study, and these data were collected from August 2000 to February 2002. Trained interviewers and peer educators collected data inside the correctional facility. After explaining the purpose of the study and obtaining written informed consent, the interviewer reviewed the data collection instrument with each participant. The instrument was written on a fourth grade reading level and, as noted previously, pre-tested prior to actual data collection. Inmates received monetary incentives and personal kits (including materials related to the intervention) when participating in the follow-up interviews.
The survey instrument contained items designed to assess socio-demographic and other background characteristics of participants. These variables included ethnicity, marital status marital status,
n the legal standing of a person in regard to his or her marriage state. , education, income prior to incarceration, and incarceration history. The variable of injection drug use was measured in two forms. Both of these items ("have you ever used injection drugs without out a doctor's prescription" and "prior to incarceration this time, have you ever shared needles") were both represented by a dichotomous di·chot·o·mous
1. Divided or dividing into two parts or classifications.
2. Characterized by dichotomy.
di·chot response item (1 = yes, 2 = no).
Analyses presented herein also involved calculating measures of linear association in the form of chi square to examine what relationships were between selected demographic variables and the injection drug use items aforementioned. The general model specified self-reported IVDU and history of sharing needles as an outcome with selected demographic variables including ethnicity, age, education, and income prior to incarceration as predictor variables. All measures were entered independently into the estimated models. Basic descriptive analysis was also employed.
Approximately 286 inmates had agreed to enroll in the study. Most of the sample were African American (n = 193, 67.48%), with approximately 27.62% (n = 79) and less than 5% (n = 14), respectively, reporting their ethnicity as white and other. The mean total number of years incarcerated reported by inmates for their lifetime was 8.94 years (SD = 14.13). Participants of the sample of inmates indicated that they had attended high school or less (78.6%, n = 224) while 21.4% reported having attained an educational level of high school or above. The mean age for inmates reporting using IV drugs without a doctor's prescription and a history of sharing needles was 39.05 (SD = 8.3) and 40.8 (SD = 8.1).
Overall, 11% of African Americans reported that they had used IV drugs without a physician's prescription compared to 36% and 34% for others and whites, respectively. The total self-reported proportion of inmates who indicated IVDU was approximately 27% of the population. Thus, African American inmates reported significantly less IVDU than whites and others ([chi square] = 37.4, p < .01, df = 2). There were no statistically significant differences in self-reported IV drug use between sample participants with respect to education. In fact, nearly equal proportions of inmates with education equal to and above high school (22.9%) and attainment of high school or less (21.4%) reported using IV drugs. In addition, a similar trend was noted in terms of reported income prior to incarceration.
SELF-REPORTED SHARING OF NEEDLES
As with the variable on history of IV drug use, statistical significant linear associations were observed with respect to a history of sharing needles and ethnicity ([chi square] = 37.4, p <.01, df = 2). African American inmates were more likely to report sharing of needles in comparison to whites and others. Specifically, 82.3% of whites, and 85.7% of other ethnicities, reported that they shared needles compared to 92.8% of African Americans. No associations were noted with respect to educational attainment Educational attainment is a term commonly used by statisticans to refer to the highest degree of education an individual has completed.
The US Census Bureau Glossary defines educational attainment as "the highest level of education completed in terms of the and income prior to incarceration. However, 16.6% of those who reported an annual income of $20,000 revealed that they shared needles in the past. This was a larger proportion when compared to other income ranges examined, but not statistically significantly larger (p < .06).
It is well documented that prisons often lack consistent and effective health education interventions (Amankwaa, Bavon, & Amankwaa, 2001; Krebs & Simmons, 2002). Our findings indicate that there are some trends based on demographics that may be used to develop and enhance problem behavior risk reduction interventions for soon-to-be-released inmate populations. Participants reporting a history of IV drug use in our study tended to be older, by approximately six years, than non-users. In addition, more whites reported these problem behaviors than African Americans and other ethnic groups.
The current findings support the empirical literature, and are both consistent with and different from other studies that deal with inmate populations and their substance use patterns. In the present study, we noted that approximately 21% of the participants reported using IV drugs without a physician's prescription compared to 12% reported by Thiede, Romero, Bordelon, Hagan, and Murrill (2001). Moreover, our findings add to the current corpus of literature since it is the first study to use inmates right before release into the community. This study also extends the research by using two singular objective measures to corroborate To support or enhance the believability of a fact or assertion by the presentation of additional information that confirms the truthfulness of the item.
The testimony of a witness is corroborated if subsequent evidence, such as a coroner's report or the testimony of other self-reported IV drug use, namely prior IV drug use and past history of needle sharing Needle sharing is the colloquialism for the reuse of syringes by multiple illegal drug users to administer intravenous drugs, and is a primary vector for diseases which can be transmitted through blood, including hepatitis and AIDS. . It is essential to find out which inmates have a history of IV drug use and needle sharing since it is suggested that infectious diseases for these parameters are more likely diagnosed in the state correctional facility than in other testing sites (Desai, Larta, Spaulding, Rich, & Flanigan, 2002).
The consistency of the noted associations with respect to race/ethnicity is a major finding, given that it suggests that such interventions designed to address IV drug use need to be culturally sensitive along racial/ ethic distinctions as well as age. In addition, these programs should be firmly rooted in the competency of understanding prison life and culture.
To the best of our knowledge, this is the first prospective report showing that soon-to-be-released adult male inmates' IV drug use and needle sharing behaviors are problematic and vary. Other research has either used inmates as a monolithic population (Seaman & Bird, 2001) or is conducted in foreign countries (Christensen, Krarup, Niesters, Norder, & Georgsen, 2000; Dolan, 2001; Koulierakis, Gnardellis, Agrafiotis, & Power, 2000). None have used inmates who were scheduled for immediate release after completion of intervention. This evidence adds to the emerging empirical literature supporting inmate problem behaviors and risk for infectious disease transmission. It also helps by providing supportive information that may be used to refine approaches to advance proactive health promotion and intervention programs designed to reduce inmates' problem behaviors related to IV drug use and infectious disease transmission. Inmates basic level of health care offered has been considered an issue of concern over the past few decades.
There are a variety of reasons that could contribute to our findings. Inmates who use IV drugs and share needles may have perceptions of their health risk as being secondary to real life experiences. Drugs in this sense, regardless of the risk (known or unknown), as sources of infectious disease transmission may not be a serious health motive. Our findings suggest that expanded efforts leading toward effective clinic- and community-based programs to reduce IV drug use among inmate populations requires intervention in prisons. In addition, these interventions should adopt a critical period specifically targeting the three months prior to release and making direct contact immediately (up to 72 hours) after release. Thus, intervention programs involving peer educators may be warranted.
Correctional health staff are in a unique position to facilitate holistic programs that involve inmates and prepare them to be active in maintaining efficacious ef·fi·ca·cious
Producing or capable of producing a desired effect. See Synonyms at effective.
[From Latin effic health practices upon release from prison. Our findings suggest that one potentially beneficial talking point between inmates and health educators may be the importance of frequent self-monitoring. Beyond the reduced risk of acquiring infectious disease via this vector, more frequent health interaction while incarcerated and self-monitoring upon release may lead to inmates' less frequent engagement in problem behaviors, decreased odds of IV drug use, and decreased risk of needle sharing. Thus, such interventions designed to promote self-monitoring may be beneficial on multiple levels with respect to health empowerment.
In the longer term, it is paramount that correctional institutions confront the problems associated with poor health status and incarceration. This means that prison administrators and public health officials can no longer ignore the fact that many prison systems are very much under-resourced for implementing preventive or health promotion-based activities. Moreover, it must be understood that political leaders need to accept that if they continue to incarcerate in·car·cer·ate
tr.v. in·car·cer·at·ed, in·car·cer·at·ing, in·car·cer·ates
1. To put into jail.
2. To shut in; confine. large groups of men, who disproportionately tend to be from ethnic and minority communities, they need to accept that adequate funding will be required to make sure the gap between public safety and public health is corrected.
Acknowledgements: This research was supported by the National Institute on Drug Abuse The National Institute on Drug Abuse (NIDA) is a United States federal-government research institute whose mission is to "lead the Nation in bringing the power of science to bear on drug abuse and addiction. , grant # DA 1233105.
Responsibility I--Assessing Individual and Community Needs for Health Education
Competency A--Obtain health related data about social and cultural environments, growth and development factors, needs, and interests.
Competency C--Infer needs for health education on the basis of obtained data.
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Hepatitis B is a potentially serious form of liver inflammation due to infection by the hepatitis B virus (HBV). It occurs in both rapidly developing (acute) and long-lasting (chronic) forms, and is one of the most common chronic in Tennessee prisoners. Journal of Infectious Diseases, 150, 205-216.
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Rhode Island, island, 15 mi (24 km) long and 5 mi (8 km) wide, S R.I., at the entrance to Narragansett Bay. It is the largest island in the state, with steep cliffs and excellent beaches. experience. AIDS Education and Prevention, 14(5, Suppl B), 45-52.
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Hepatitis C is a form of liver inflammation that causes primarily a long-lasting (chronic) disease. Acute (newly developed) hepatitis C is rarely observed as the early disease is generally quite mild. transmission be reduced in Australian prisons
This is a list of operational and former Australian prisons. Prisons listed as museum are former prisons now open for public inspection and tours. ? Medical Journal of Australia, 174(8), 378-379.
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Please help recruit one or [ improve this article] yourself. See the talk page for details. : HIV transmission and prevention behind bars. International Conference on AIDS, 10(2), 335.
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Health disparities (also called health inequalities in some countries) refer to gaps in the quality of health and health care across racial, ethnic, and socioeconomic groups. among incarcerated populations: The HIV example for inmates returning to the community. Health Promotion Practice, 3(2), 255-263.
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Hepatitis A is an inflammation of the liver caused by a virus, the hepatitis A virus (HAV). It varies in severity, running an acute course, generally starting within two to six weeks after contact with the virus, and lasting no epidemic. Epidemiology and Infections, 127(3), 461-467.
Torrance Stephens, PhD, Ronald Braithwaite, PhD, and Rhonda Conerly, PhD, are affiliated with Emory University Emory University (ĕm`ərē), near Atlanta, Ga.; coeducational; United Methodist; chartered as Emory College 1836, opened 1837 at Oxford. It became Emory Univ. in 1915 and in 1919 moved to Atlanta. . Address all correspondence to Torrance Stephens, PhD, Rollins School of Public Health The Rollins School of Public Health (RSPH) is the public health school of Emory University. Founded in 1990, RSPH has more than 850 students pursuing master's degrees (MPH/MSPH) and over 100 students pursuing doctorate degrees (PhD). , 1518 Clifton Road Clifton Road is main street in Clifton neighborhood of Saddar Town in Karachi, Sindh, Pakistan.
Its name dates from the British Colonial rule, and its market is posh areas of Karachi. , Atlanta, GA 30322; PHONE: 404-691-6336; FAX: 404-727-8768; Email: email@example.com.
Table 1. Bivariate Relationships of Self-Reported Injection Drug Use and Demographic Factors Variable Injection Drug No Injection Chi Sq Use w/o Doctors Drug Use w/o Permission Doctors % Permission % Ethnicity Black 88.6 11.4 37.4 * White 64.3 35.7 Other 55.7 44.3 Education Above HS 77.1 22.9 0.06 HS or less 78.6 21.4 Income <20K 75.7 24.3 2.18 <40K 76.5 23.6 <60K 81.1 18.9 >=60K 85.4 14.6 * p < .01 Table 2. Bivariate Relationships of Self-Reported History of sharing needles prior incarceration and Demographic Factors Variable Prior Incarceration Prior Incarceration Chi Sq Shared needles did not Share Needles Ethnicity Black 92.8 7.3 6.76 * White 82.3 17.7 Other 85.7 14.3 Education Above HS 91.8 8.2 0.44 HS or less 88.8 11.2 Income <20K 83.5 16.5 7.18 ** <40K 92.9 7.1 <60K 89.2 10.8 >=60K 95.8 4.2 * p < .03; ** p < .06