Retrospective cohort study of cancer incidence and mortality by HIV status in a Georgia, USA, prisoner cohort during the HAART era

OBJECTIVE:

Non-AIDS-defining cancers (NADCs) have emerged as significant contributors to cancer mortality and morbidity among persons living with HIV (PLWH). Because NADCs are also associated with many social and behavioural risk factors that underlie HIV, determining the extent to which each of these factors contributes to NADC risk is difficult. We examined cancer incidence and mortality among persons with a history of incarceration, because distributions of other cancer risk factors are likely similar between prisoners living with HIV and non-infected prisoners.

DESIGN:

Registry-based retrospective cohort study.

PARTICIPANTS:

Cohort of 22 422 persons incarcerated in Georgia, USA, prisons on 30 June 1991, and still alive in 1998.

OUTCOME MEASURES:

Cancer incidence and mortality were assessed between 1998 and 2009, using cancer and death registry data matched to prison administrative records. Age, race and sex-adjusted standardised mortality and incidence ratios, relative to the general population, were calculated for AIDS-defining cancers, viral-associated NADCs and non-infection-associated NADCs, stratified by HIV status.

RESULTS:

There were no significant differences in cancer mortality relative to the general population in the cohort, regardless of HIV status. In contrast, cancer incidence was elevated among the PLWH. Furthermore, incidence of viral-associated NADCs was significantly higher among PLWH versus those without HIV infection (standardised incidence ratio=6.1, 95% CI 3.0 to 11.7, p<0.001).

CONCLUSIONS:

Among PLWH with a history of incarceration, cancer incidence was elevated relative to the general population, likely related to increased prevalence of oncogenic viral co-infections. Cancer prevention and screening programmes within prisons may help to reduce the cancer burden in this high-risk population.

Full article at:   http://goo.gl/bU7ddc

By:  Zlotorzynska M1, Spaulding AC1, Messina LC1, Coker D1, Ward K1, Easley K1, Baillargeon J2, Mink PJ3, Simard EP1.

• 1Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
• 2University of Texas Medical Branch, Galveston, Texas, USA.
• 3Rollins School of Public Health, Emory University, Atlanta, Georgia, USA Division of Applied Research, Allina Health, Minneapolis, Minnesota, USA.
• BMJ Open. 2016 Apr 11;6(4):e009778. doi: 10.1136/bmjopen-2015-009778. 

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New Mexico plaintiffs filing lawsuits against prison healthcare providers by year

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Correlates of Preincarceration Health Care Use among Women and Men in Jail

Although women and men in jails bear a burden of health problems, little is known about factors associated with their health care use. We conducted a cross-sectional survey of preincarceration health care use with 596 jail inmates. Descriptive statistics and correlates of participants’ health care use were assessed. 

A year before incarceration, 54% of participants used an emergency room, 24% were hospitalized, and 39% used primary care. Correlates of health care use included gender, health insurance status, and drug dependence. For participants without mental health problems, use was associated with living in neighborhoods where a higher percentage of residents did not complete high school. 

Findings suggest individual and community factors that can be targeted by reentry programs to improve health care use after jail.

...There was an interesting interaction between individual- and community-level variables, however, which was that ER use and hospitalizations were significant only for the group of participants without a mental health diagnosis and living in a neighborhood with low educational status. Factors associated with primary care use included having health insurance, not reporting drug dependence, and having a mental health diagnosis. Thus, we found that although community-level factors may have a role in health care use patterns, individual-level factors such as gender, health insurance status, drug dependence, and mental health diagnosis history were important correlates of preincarceration health care use for our sample.

...The model [Andersen’s Behavioral Model of Health Services Use, Andersen, 1995; Harzke et al., 2006;Leukefeld et al., 2006; Webster et al., 2005] however, fails to explain our finding that low educational status at the community level is associated with health care that is used for emergency and more serious conditions, but only for those without mental health problems. Low educational status at the community level could be a proxy for community-level social capital (Bourdieu, 1986), which has been associated with both health outcomes and health care access (Chuang, Ennett, Bauman, & Foshee, 2005; Kirby & Kaneda, 2005). It could also signal lack of investment by the health care sector in poor, disadvantaged communities where the economic capital of residents is compromised by their collective educational status. It is interesting, however, that other potential associations with social capital variables were not significant and suggest the need to repeat this study with other populations. Our finding that community matters only for those without mental health problems can perhaps be explained by the magnitude of the mental health burden on inmates. Mental health as an indicator of health need may determine the relative impact of community on health care use for this group of women and men. Given that one national study found that 64% of people in the jails had a mental health problem (James & Glaze, 2006), the burden unique to this population is significant and perhaps more significant than any community-level factors...

Full article at:   http://goo.gl/QsDbjg

By:  Megha Ramaswamy, PhD, MPH,1 Francisco Diaz, PhD,2 Tyson Pankey, MPH,3 Suzanne L. Hunt, MS,2 Andrew Park, DO, MPH,4 and Patricia J. Kelly, PhD, MPH, APRN5

¹Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS, USA

²Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS, USA

³Department of Counseling Psychology, University of Wisconsin–Madison, Madison, WI, USA

⁴Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS, USA

⁵School of Nursing, University of Missouri–Kansas City, Kansas City, MO, USA

Corresponding Author: Megha Ramaswamy, PhD, MPH, Preventive Medicine and Public Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., MS 1008, Kansas City, KS 66160, USA.

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Accuracy of Reported Service Use in a Cohort of People Who Are Chronically Homeless & Seriously Mentally Ill

Background

Self-reported service use is an integral feature of interventional research with people who are homeless and mentally ill. The objective of this study was to investigate the accuracy of self-reported involvement with major categories of publicly funded services (health, justice, social welfare) within this sub-population.

Methods

Measures were administered pre-randomization in two randomized controlled trials, using timeline follow back with calendar aids for Health, Social, and Justice Service Use, compared to linked administrative data. Variables examined were: psychiatric admissions (both extended stays of more than 6 months and two or more stays within 5 years); emergency department visits, general hospitalization and jail in the past 6 months; and income assistance in the past 1 month. Participants (n = 433) met criteria for homelessness and a least one mental illness.

Results

Prevalence adjusted and bias adjusted kappa (PABAK) values ranged between moderate and almost perfect for extended psychiatric hospital separations, multiple psychiatric hospitalizations, emergency department visits, jail, and income assistance. Significant differences in under versus over reporting were also found.

Conclusions

People who are homeless and mentally ill reliably reported their overall use of health, justice, and income assistance services. Evidence of under-reporting and over-reporting of certain variables has implications for specific research questions.

Full article at:   http://goo.gl/ROq2xv

By:  Julian M. Somers, Akm Moniruzzaman, Lauren Currie, Stefanie N. Rezansoff, Angela Russolillo, and Milad Parpouchi

Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada

Julian M. Somers, Email: ac.ufs@sremosj.

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Paternalistic Breaches of Confidentiality in Prison: Mental Health Professionals' Attitudes & Justifications

AIM:

This manuscript presents mental health practitioners' (MHPs) practice, attitudes and justifications for breaching confidentiality when imprisoned patients disclose suicidal thoughts or abuse by others.

METHODS:

24 MHPs working in Swiss prisons shared their experiences regarding confidentiality practices. The data were analysed qualitatively and MHPs' attitudes and course of action were identified.

RESULTS:

Analysis revealed paternalistic breaches of confidentiality. When patients reported suicidal thoughts and abuse, MHPs believed that forgoing confidentiality is necessary to protect patients, providing several justifications for it. Patients were informed that such information will be transmitted without their consent to medical and non-medical prison personnel. With reference to suicidal attempts, MHPs resorted to methods that may reduce suicidal attempts such as transfer to hospital or internal changes in living arrangements, which would require provision of certain information to prison guards. In cases of abuse, some MHPs convinced patients to accept intervention or sometimes overrode competent patients' refusals to report. Also in the case of abuse, provision of limited information to other prison personnel was seen as an acceptable method to protect patients from further harm.

DISCUSSION:

Breaches of confidentiality, whether limited or full, remain unethical, when used for competent patients based solely on paternalistic justifications. Institutionalising ethical and legal procedures to address suicidal and abuse situations would be helpful. Education and training to help both medical and prison personnel to respond to such situations in an appropriate manner that ensures confidentiality and protects patients from suicide and abuse are necessary.

Purchase full article at:   http://goo.gl/LVApNU

By:  Elger BS1, Handtke V2, Wangmo T2.

• 1Institute for Biomedical Ethics, University of Basel, Basel, Switzerland Center for Legal Medicine, University of Geneva, Geneva, Switzerland.
• 2Institute for Biomedical Ethics, University of Basel, Basel, Switzerland. 
• J Med Ethics. 2015 Jun;41(6):496-500. doi: 10.1136/medethics-2013-101981. Epub 2015 Jan 13.

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Women in Community Corrections in New York City: HIV Infection and Risks

Although the incidence of HIV among women on probation, parole and alternatives to incarceration programs is significant to public health, drivers of this concentrated epidemic among women under community corrections remain understudied. 

This study examined prevalence of HIV and sexually transmitted infections and the associations between substance use, socio-demographic factors and the prevalence of biologically-confirmed HIV and other sexually transmitted infections among a sample of 337 substance-using women recruited from community correction sites in New York City. 

Prevalence of HIV was 13% and sexually transmitted infections was 26% (Chlamydia, trachomatis and Neisseria gonorrhea). After adjusting for covariates, 

• HIV-positive women were 1.42 times more likely to use crack/cocaine than HIV-negative women. 
• HIV-positive women were 25% less likely than HIV-negative women to report any unprotected vaginal and anal sex with their main partner
• They were 70% less likely than HIV-negative women to report unprotected vaginal sex with a non-paying casual partner and 
• 22% less likely to report unprotected vaginal sex across all partners. 

Community corrections settings may be optimal venues to launch HIV/sexually transmitted infections prevention that have potential to reach and engage an ever-growing number of substance-using women.

Purchase full article at:   http://goo.gl/uDS2o9

By:  El-Bassel N1, Marotta PL2, Shaw SA2, Chang M2, Ma X2, Goddard-Eckrich D2, Hunt T2, Johnson K2, Goodwin S3, Almonte M4, Gilbert L2

• 1Social Intervention Group, Columbia University, New York, New York, USA ne5@columbia.edu.
• 2Social Intervention Group, Columbia University, New York, New York, USA.
• 3The New York City Department of Probation, New York, New York, USA.
• 4Bronx Community Solutions, Center for Court Innovation, Bronx, New York, USA. 
• Int J STD AIDS. 2016 Feb 16. pii: 0956462416633624.

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Residential Patterns in Older Homeless Adults: Results of a Cluster Analysis

Adults aged 50 and older make up half of individuals experiencing homelessness and have high rates of morbidity and mortality. They may have different life trajectories and reside in different environments than do younger homeless adults. Although the environmental risks associated with homelessness are substantial, the environments in which older homeless individuals live have not been well characterized. 

We classified living environments and identified associated factors in a sample of older homeless adults. From July 2013 to June 2014, we recruited a community-based sample of 350 homeless men and women aged fifty and older in Oakland, California. We administered structured interviews including assessments of health, history of homelessness, social support, and life course. Participants used a recall procedure to describe where they stayed in the prior six months. We performed cluster analysis to classify residential venues and used multinomial logistic regression to identify individual factors prior to the onset of homelessness as well as the duration of unstable housing associated with living in them. 

We generated four residential groups describing those who were unsheltered, cohabited unstably with friends and family, resided in multiple institutional settings (shelters, jails, transitional housing), or lived primarily in rental housing (recently homeless). 

Compared to those who were unsheltered, having social support when last stably housed was significantly associated with cohabiting and institution use. Cohabiters and renters were significantly more likely to be women and have experienced a shorter duration of homelessness. Cohabiters were significantly more likely than unsheltered participants to have experienced abuse prior to losing stable housing. 

Pre-homeless social support appears to protect against street homelessness while low levels of social support may increase the risk for becoming homeless immediately after losing rental housing. 

Our findings may enable targeted interventions for those with different manifestations of homelessness.

Purchase full article at:   http://goo.gl/nOkgLO

By:  Lee CT1, Guzman D2, Ponath C2, Tieu L2, Riley E3, Kushel M4.

• 1Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA. Electronic address: christopher_lee@post.harvard.edu.
• 2Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
• 3Division of HIV/AIDS, University of California San Francisco, San Francisco General Hospital, San Francisco, CA, USA.
• 4Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA. 
• Soc Sci Med. 2016 Feb 10;153:131-140. doi: 10.1016/j.socscimed.2016.02.004.

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From Punishment to Treatment: The "Clinical Alternative to Punitive Segregation" (CAPS) Program in New York City Jails

The proliferation of jails and prisons as places of institutionalization for persons with serious mental illness (SMI) has resulted in many of these patients receiving jail-based punishments, including solitary confinement. 

Starting in 2013, the New York City (NYC) jail system developed a new treatment unit for persons with SMI who were judged to have violated jail rules (and previously would have been punished with solitary confinement) called the Clinical Alternative to Punitive Segregation (CAPS) unit. CAPS is designed to offer a full range of therapeutic activities and interventions for these patients, including individual and group therapy, art therapy, medication counseling and community meetings. 

Each CAPS unit requires approximately $1.5 million more investment per year, largely in additional staff as compared to existing mental health units, and can house approximately 30 patients. Patients with less serious mental illness who received infractions were housed on units that combined solitary confinement with some clinical programming, called Restrictive Housing Units (RHU). 

Between 1 December 2013 and 31 March 2015, a total of 195 and 1433 patients passed through the CAPS and RHU units, respectively. A small cohort of patients experienced both CAPS and RHU (n = 90). For these patients, their rates of self-harm and injury were significantly lower while on the CAPS unit than when on the RHU units. Improvements in clinical outcomes are possible for incarcerated patients with mental illness with investment in new alternatives to solitary confinement. We have started to adapt the CAPS approach to existing mental health units as a means to promote better clinical outcomes and also help prevent jail-based infractions. 

The cost of these programs and the dramatic differences in length of stay for patients who earn these jail-based infractions highlight the need for alternatives to incarceration, some of which have recently been announced in NYC.

Full article at:   http://goo.gl/jCSAJB

By:  Glowa-Kollisch S1, Kaba F2, Waters A3, Leung YJ4, Ford E5, Venters H6.

• 1Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA. sglowakollisch@nychhc.org.
• 2Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA. fkaba@nychhc.org.
• 3Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA. awaters1@nychhc.org.
• 4Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA. yleung2@nychhc.org.
• 5Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA. eford@nychhc.org.
• 6Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA. hventer1@nychhc.org. 
• Int J Environ Res Public Health. 2016 Feb 2;13(2). pii: E182. doi: 10.3390/ijerph13020182

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The King of Baltimore Bail Bonds

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Assessing Risk-Based Policies for Pretrial Release and Split Sentencing in Los Angeles County Jails

Court-mandated downsizing of the CA prison system has led to a redistribution of detainees from prisons to CA county jails, and subsequent jail overcrowding. 

Using data that is representative of the LA County jail system, we build a mathematical model that tracks the flow of individuals during arraignment, pretrial release or detention, case disposition, jail sentence, and possible recidivism during pretrial release, after a failure to appear in court, during non-felony probation and during felony supervision. 

We assess 64 joint pretrial release and split-sentencing (where low-level felon sentences are split between jail time and mandatory supervision) policies that are based on the type of charge (felony or non-felony) and the risk category as determined by the CA Static Risk Assessment tool, and compare their performance to that of the policy LA County used in early 2014, before split sentencing was in use. 

In our model, policies that offer split sentences to all low-level felons optimize the key tradeoff between public safety and jail congestion by, e.g., simultaneously reducing the rearrest rate by 7% and the mean jail population by 20% relative to the policy LA County used in 2014. 

The effectiveness of split sentencing is due to two facts: 

1. convicted felony offenders comprised ≈ 45% of LA County’s jail population in 2014, and 
2. compared to pretrial release, split sentencing exposes offenders to much less time under recidivism risk per saved jail day.

Below:  For each of the four options for split sentencing in the right column of Table 1, the optimal (i.e., optimizing over the remaining 16 options in Table 1) tradeoff curves of the annual rearrest rate vs. (a) the mean jail population and (b) mean jail overcrowding. The circle denotes the status quo policy for LA County in early 2014.

Full article at:   http://goo.gl/06yV9h

By:   

Mericcan Usta

Management Science & Engineering Department, Stanford University, Stanford, CA, United States of America

Lawrence M. Wein

Graduate School of Business, Stanford University, Stanford, CA, United States of America

  

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Connecticut - Unlocking Potential: Alternatives to Youth Prisons

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Disparities in Mental Health Referral and Diagnosis in the New York City Jail Mental Health Service

To better understand jail mental health services entry, we analyzed diagnosis timing relative to solitary confinement, nature of diagnosis, age, and race/ethnicity.

We analyzed 2011 to 2013 medical records on 45,189 New York City jail first-time admissions.

Of this cohort, 21.2% were aged 21 years or younger, 46.0% were Hispanic, 40.6% were non-Hispanic Black, 8.8% were non-Hispanic White, and 3.9% experienced solitary confinement. Overall, 14.8% received a mental health diagnosis, which was associated with longer average jail stays (120 vs 48 days), higher rates of solitary confinement (13.1% vs 3.9%), and injury (25.4% vs 7.1%). Individuals aged 21 years or younger were less likely than older individuals to receive a mental health diagnosis and more likely to experience solitary confinement. Blacks and Hispanics were less likely than Whites to enter the mental health service, but more likely to experience solitary confinement.

More consideration is needed of race/ethnicity and age in understanding and addressing the punishment and treatment balance in jails.

Below:  Timing of entry into mental health services (n = 6673): New York City jail, 2011–2013. Note. Mean = 24.62 days; SD = 65.929 days. The sample size was n = 6673.

Below:  Timing of mental health service entry with respect to the first solitary confinement episode (n = 876): New York City jail, 2011–2013. Note. 0 = service entry on the first day of solitary confinement. Mean = –43.82 days; SD = 168.822 days. The sample size was n = 876.

Full article at: http://goo.gl/QOV8nq

By: Fatos Kaba, MA, Angela Solimo, MA, Jasmine Graves, MPH, Sarah Glowa-Kollisch, MPH, Allison Vise, BA, Ross MacDonald, MD, Anthony Waters, PsyD, Zachary Rosner, MD, Nathaniel Dickey, MA, MPH, Sonia Angell, MD, MPH, and Homer Venters, MD, MS

Fatos Kaba, Angela Solimo, Jasmine Graves, Sarah Glowa-Kollisch, Allison Vise, Ross MacDonald, Anthony Waters, Zachary Rosner, Nathaniel Dickey, and Homer Venters are with the Bureau of Correctional Health Services, New York City Department of Health and Mental Hygiene, Queens, NY. Sonia Angell is with the Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene.

Corresponding author.

Correspondence should be sent to Homer Venters, MD, MS, Bureau of Correctional Health Services, New York City Department of Health and Mental Hygiene. 42-09 28th St, WS 10-84, Queens, NY 11101 (e-mail: vog.cyn.htlaeh@1retnevh). Reprints can be ordered athttp://www.ajph.org by clicking the “Reprints” link.

  

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Defining Success: Insights From a Random Assignment, Multisite Study of Implementing HIV Prevention, Testing, and Linkage to Care in U.S. Jails and Prisons

In the emerging field of implementation science, measuring the extent to which a new or modified healthcare program or practice is successfully implemented following an intervention is a critical component in understanding how evidence-based treatments become part of regular practice. 

This paper is intended to expand our understanding of factors that influence the successful adoption of new or modified HIV services in correctional settings. The nine-site project developed and directed an organization-level intervention designed to implement improvements in preventing, detecting, and treating HIV for persons under correctional supervision. 

Using semi-structured interviews to elicit perceptions from Senior Researchers and Executive Sponsors at each of the nine sites, this paper presents their views and observations regarding the success of the experimental intervention in their criminal justice setting. Within the areas of focus for implementation (either HIV prevention, testing, or linkage to community treatment) the complexity of programmatic needs was very influential with regards to perceptions of success. 

An organization's pre-existing characteristics, staffing, funding, and interorganizational relationships contributed to either the ease or difficulty of programmatic implementation. 

Results are discussed pertaining to furthering our understanding of why new or modified healthcare interventions achieve success, including whether the intervention is a modification of existing practice or is a new intervention, and the choice of implementation strategy.

Purchase full article at: http://goo.gl/oCrqNF

By: Mitchell SG1, Willett J2, Swan H3, Monico LB1, Yang Y4, Patterson YO2, Belenko S5, Schwartz RP1, Visher CA6.

• 1Friends Research Institute, Inc., Baltimore, Maryland.
• 2University of Connecticut, West Hartford, Connecticut.
• 3Abt Associates, Inc., Cambridge, Massachusetts.
• 4University of Louisiana at Lafayette, Lafayette, Louisiana.
• 5Temple University, Philadelphia, Pennsylvania.
• 6University of Delaware, Newark, Delaware.  

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