Healthy Community Interventions for Incarcerated Populations

1. Healthy Community Interventions for Incarcerated Populations Kim Marie Thorburn, MD, MPH; Michael Cohen, MD; Nancy Stoller

2. Healthy People 2010 Goals Goal 1: Increase Quality and Years of Healthy Life Goal 2: Eliminate Health Disparities

3. Health Problems of Prisoners, 1997 21% reported a medical problem since admission >21% male prisoners reported a medical problem >27% female prisoners reported a medical problem >40% prisoners age 45 or older reported a medical problem 31% reported a physical impairment or mental condition >Speech disabilities 3 times higher than general population >Vision impairment 2 times higher than general population

4. 1999 Prison Population 476 prisoners per 100,000 population >From 1990 rate of incarceration increased from 1/218 to 1/147 Males 901/100,000 >White males 417/100,000 >African American males 3,408/100,000 >Hispanic males 1,335/100,000 Females 59/100,000 >White females 27/100,000 >African American 212/100,000 >Hispanic 87/100,000

5. Incarcerated Population 1999-female inmate population grew by 4.4%, males by 3.3% 1990 to 1999-84% increase in sentenced female prisoners/100,000 60% increase in sentenced male prisoners

6. Focus Area 13-HIV Goal: Prevent HIV infection and its related illness and death 13-9 Increase the number of state prison systems that provide comprehensive HIV/AIDS, sexually transmitted diseases, and tuberculosis education 13-10 Increase the proportion of inmates in state prison systems who receive voluntary HIV counseling and testing during incarceration

7. HIV in Prisons, 1999 • 24,607 state prisoners (2.3%) infected with HIV • >2.1% male prisoners infected with HIV • >3.4% female prisoners infected with HIV • >9.7% New York prisoners infected with HIV • Confirmed AIDS rate of 0.6% among prisoners 5 times general population (0.12%) • >27% of HIV-positive prisoners confirmed AIDS cases • In 1999, there were fewer than one quarter the number of AIDS-related deaths than in 1995 • >1 in 12 prisoner deaths due to AIDS-related causes

8. Focus Area 18-Mental Health & Mental Disorders Goal: Improve mental health and ensure access to appropriate, quality mental health services 18-8 Increase the proportion of juvenile justice facilities that screen new admissions for mental health problems 18-11 Increase the proportion of local governments with community-based jail diversion programs for adults with serious mental illness

9. Mental Disorders among Youth in the Juvenile Justice System 70% of incarcerated youth suffer from disabilities qualifying for Individuals with Disabilities Education Act 20% of students with emotional disabilities are arrested at least once before they leave school One third of incarcerated youth are unable to complete simple tasks of daily living (e.g., read a street map or bus schedule)

10. Mental Disorders among Jail Inmates 10% report mental or emotional condition 10% report prior mental hospitalization 16% identified as mentally ill >15.6% males mentally ill >22.7% females mentally ill 30% mentally ill inmates homeless compared to 17% others 38% mentally ill inmates abused alcohol compared to 24% others

11. Focus Area 25-Sexually Transmitted Diseases Goal: Promote responsible sexual behaviors, strengthen community capacity, and increase access to quality services to prevent STDs and their complications 25-14 Increase the proportion of youth detention facilities and adult city or county jails that screen for common bacterial STDs within 24 hours of admission and treat STDs (when necessary) before persons are released

12. Sexually Transmitted Diseases among Juvenile Detainees & Jail Inmates High prevalence of STDs among youth entering juvenile detention facilities and adults admitted to jails Sexual risk activities prevalent among detained youth and incarcerated adults 1999 CDC study found that most city and county jails had a policy for STD screening based only on symptoms or on request Rapid screening and treatment for STDs in arrestees is feasible

13. Focus Area 26-Substance Abuse Goal: Reduce substance abuse to protect health, safety and quality of life for all, especially children 26-19 Increase the proportion of inmates receiving substance abuse treatment in correctional institutions

14. Drug Use & Treatment among Correctional Inmates 70% of jail inmate used drugs regularly or had committed a drug offense 57% of state prison inmates reported using drugs in the month before their offense 10.5% of jail inmates test positive for drugs during incarceration 14% of parolees return to prison for drug offenses

15. Focus Area 14-Immunization & Infectious Diseases Goal: Prevent disease, disability, and death from infectious diseases, including vaccine-preventable diseases 10% male inmates and 12% female inmates LTBI, 1993 >1992 incidence of TB among New York inmates 189/100,000 88 foodborne outbreaks investigated in jails and prisons, 1974-91 >Mean outbreak size 163 cases compared to 31 cases in outbreaks in general population

16. Focus Area 15-Injury & Violence Prevention Goal: Reduce injuries, disability, and death due to unintentional injuries and violence 28% state prison inmates report injury since admission >20% report unintentional injury (occupational, recreational, other) >10% report injury from fight

17. Focus Area 16-Maternal, Infant, and Child Health Goal: Improve the health and well-being of women, infants, children and families 6% women enter prison pregnant Incarcerated women were mothers of 1.3 million minor children in 1999

18. Focus Area 21-Oral Health Goal: Prevent and control oral and craniofacial diseases, conditions, and injuries and improve access to related services 30% prisoners require dental treatment beyond routine prophylaxis

19. Focus Area 27-Tobacco Use Goal: Reduce illness, disability, and death related to tobacco use and exposure to second-hand smoke