Transcript Healthy Community Interventions for Incarcerated

Healthy Community
Interventions for
Incarcerated Populations
Kim Marie Thorburn, MD, MPH;
Michael Cohen, MD; Nancy Stoller
Healthy People 2010 Goals
Goal 1: Increase Quality and Years of Healthy Life
Goal 2: Eliminate Health Disparities
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
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
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
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
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
Focus Area 18Mental 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
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)
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
Focus Area 25Sexually 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
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
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
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
Focus Area 14Immunization & 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
Focus Area 15Injury & 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
Focus Area 16Maternal, 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
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
Focus Area 27-Tobacco Use
Goal: Reduce illness, disability, and death related to tobacco
use and exposure to second-hand smoke