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Self-Reported Health and Prior Health


Behaviors of Newly Admitted Correctional
Inmates
A B S T R A C T Thomas J. Conklin, MD, Thomas Lincoln, MD, and Robert W. Tuthill, PhD

Objectives. This study obtained More than 2 million individuals, or 0.7% Methods
comprehensive health information from of the US population, are incarcerated in
newly admitted correctional inmates. county, state, and federal correctional facili- HCCC is a medium-security correc-
Methods. Interviews were con- ties.1 Including individuals on probation or pa- tional center located in western Massachu-
ducted with 1198 inmates on day 3 of role, 6 million persons, or about 3% of all US setts that houses 1800 inmates, including per-
their incarceration. adults, are under the jurisdiction of corrections sons awaiting court appearances and
Results. Interviewers found a high systems.1 Direct expenditures for corrections sentenced prisoners. Approximately one third
prevalence of chronic medical and men- tripled over a decade to reach $40 billion in of the inmates remain 3 days or less, one third
tal health issues, limited access to health 1995.2 stay for 4 to 90 days, and one third stay for 91
care, high rates of infections and sexually Correctional institutions have long been days to 2 years. Successive inmates newly
transmitted diseases, substantial sub- seen as reservoirs of physical and mental illness admitted to HCCC over a 5-month period
stance abuse, other unhealthy behaviors and of psychosocial problems, all of which were interviewed on the third day of their in-
and violence, and a strong desire for help flow back into the community as inmates are carceration concurrently with, but separately
with health-related problems. released.3 However, only more recently have from, their clinical examination.
Conclusions. The data document the medical and correctional communities begun The interviews were conducted in a pri-
need to apply the public health approach to recognize the full extent to which mental vate room in the medical facility by trained,
to correctional health care, including de- problems, substance abuse disorders, and com- ethnically diverse interviewers employed
tection and early treatment of disease, municable diseases are concentrated in the cor- specifically for this purpose. This context was
education and prevention to facilitate rectional system and the public health oppor- chosen to maximize the likelihood of disclosure
health and behavior change, and conti- tunity this presents.4–11 of highly personal and criminally liable be-
nuity of care into the community. (Am J To address these issues, the Hampden havior. Inmates were read an informed con-
Public Health. 2000;90:1939–1941) County Correctional Center (HCCC) over the sent statement and were asked if they wished
past 5 years has been developing a systematic
public health model of correctional medical
care emphasizing detection, early and effec- Thomas J. Conklin is with the Hampden County Cor-
tive treatment, patient education, prevention, rectional Center, Ludlow, Mass. Thomas Lincoln is
and continuity of care. A key feature of the sys- with the Department of Medicine, Baystate Medical
tem is the sharing of correctional health care Center, Springfield, Mass, and also with Tufts Uni-
versity School of Medicine, Boston, Mass, and Hamp-
with community health agencies through physi- den County Correctional Center. Robert W. Tuthill
cians and case managers dually based in the is with the School of Public Health and Health Sci-
correctional center and in the communities to ences, University of Massachusetts at Amherst.
which inmates return on release.12 Requests for reprints should be sent to Thomas
HCCC and the University of Massachu- J. Conklin, MD, Director of Health Services, Hamp-
setts School of Public Health and Health Sci- den County Correctional Center, 627 Randall Rd,
Ludlow, MA 01056 (e-mail: tom.conklin@
ences in Amherst conducted a baseline health sdh.state.ma.us).
study of the HCCC correctional population to This brief was accepted April 14, 2000.
better elucidate the extent of inmate preincar- Note. A copy of the study questionnaire and a
ceration health problems, health facility use, complete set of tables for the data reported here may
and health-related risky behaviors. be obtained from the lead author.

December 2000, Vol. 90, No. 12 American Journal of Public Health 1939
to participate; the statement indicated that any differences in the emotional/mental problems testing rates were high for both sexes—two
information they provided would be medically being the most striking at 53% vs 20%. Ap- thirds of the men and 86% of the women re-
confidential and that refusal to participate proximately one sixth of both sexes had a phys- ported having been tested. Most of both sexes
would in no way negatively affect their incar- ical problem that kept them from normal ac- considered themselves to be at low or no risk
ceration experience. Inmates were also told tivities during the past 12 months. About a for contracting HIV, but a significantly greater
that the information they provided would be quarter of the men and half of the women were proportion of men fell into this category than
part of the medical record, would be used for interested in having the medical staff help them women.
program planning purposes, and would be re- with a health-related problem, with both sexes
ported only in aggregate form. indicating a very high level of interest in Other Health-Related Behaviors
The 15-minute interview of 130 items was such help.
composed of several sections containing ques- Among the other risky health behaviors
tions on demographic and household data; Medical Facility Use queried, women were significantly more likely
health status and health problems; medical fa- to report having tried to kill themselves (39%
cility use; tobacco, alcohol, and drug use; HIV, About one third of the men and women vs 13%). A third of both sexes reported kick-
other sexually transmitted infections, and sex- had not gone to a medical provider during the ing, punching, or hurting someone in the past
ual behavior; other health-related habits; and past 12 months when they needed to because 12 months.
prior jail time; an additional component on of the cost. But nearly half of the men and al-
women’s health and physical abuse was in- most two thirds of the women obtained health Women’s Health Issues
cluded. The interview was designed for easy care at an emergency room during that same
administration, ready comprehension, and sim- time. During the past 12 months, 15% of the Almost half of the women reported being
ple data entry. The interviews were edited, men and 25% of the women had visited 1 or physically abused in the past 12 months, with
open-ended questions were coded, and the data more of the 4 community health centers affil- the majority abused by a boyfriend or
were double entered for accuracy into Epi Info iated with HCCC. When health care was ob- spouse. Of the three quarters of the women
(Centers for Disease Control and Prevention, tained, it was paid for primarily with various who reported a current partner, 20% felt un-
Atlanta, Ga). forms of public assistance. safe with the partner. Seventeen percent of the
women reported being stalked by a prior part-
Substance Abuse ner. One third of the women were in the sex
Results trade and/or exchanged sex for food, drugs, or
The inmates reported extensive abuse of money.
Of the inmates initially admitted to HCCC tobacco, alcohol, and drugs before their incar-
during the study period, 70% remained in the ceration. Some three quarters of both sexes
facility for the third-day medical examination. were cigarette smokers, with more than 70% of Discussion
For various administrative reasons, 20% of the those smoking a pack or more per day.
remaining inmates were not interviewed. The Two thirds of the men and almost 60% of This study covered a comprehensive range
interview completion rate was not significantly the women had consumed alcohol during the of health and health-related behaviors. Our data
different by race or age but differed for men 3 months before incarceration; one third of the showed that newly incarcerated correctional
(79%) and women (96%). Data are reported drinkers consumed alcohol daily, and almost inmates have a high prevalence of health is-
separately for 1082 men (90%) and 116 women three quarters of the drinkers reported regular sues at admission, prior limited access to health
(10%) when their responses differed. binge drinking. Sex differences were apparent care, very high rates of disease and unhealthy
in that women drinkers were significantly more behavior, and a strong desire for help in im-
Demographic Data likely than men to report having a drinking proving their health and in changing health-
problem (59% vs 36%) and to indicate that related behavior. The questionnaire results con-
Half of the inmates were younger than 30, they wanted help with their problem (51% vs firmed the significant need for medical, mental,
and the racial/ethnic group distribution was 35%). dental, and substance abuse health care, with
Hispanic (40%), non-Hispanic White (33%), More than two thirds of the inmates ad- additional prevention and education programs
and African American (27%). One third of the mitted to having ever used drugs, with about to modify risky health behavior. Generaliza-
inmate households included children younger 80% of those having used drugs in the last tion of the data could be limited because they
than 12 years. Fewer than half of the inmates 3 months before incarceration. Women re- describe the experience of 1 correctional cen-
had completed high school. Wages were the porting drug use were twice as likely as men ter, but we found our data to be consistent with
major income source for both sexes, but women (24% vs 11%) to have ever shared needles and data from other reports in the literature cover-
relied more widely on a variety of income also were significantly more likely (70% vs ing similar areas as this study.13–30
sources than did men, especially regarding wel- 50%) to have had confrontations with the law It should be noted that the health and be-
fare payments. because of their drug use, to admit to having a havioral information collected from the inmates
drug problem, to have received prior drug treat- was self-reported and not independently vali-
Health Status and Health Problems ment, and to want help with their drug problem. dated by us. However, the extremely high rates
of such behavior reported by the inmates do
Half of all the men and women rated their Sexually Transmitted Infections and document extensive problems.
health as only good, fair, or poor. Other than Sexual Behavior The public health community has a unique
substance abuse, the 4 most frequently reported opportunity to confront this reservoir of dis-
health concerns were teeth/gums, bone/joints, Women were at least twice as likely as ease and health problems in the correctional
back/neck, and emotional/mental problems. men to report that a medical professional had population in a comprehensive manner that
For the 20 health concerns asked about, women told them that they had chlamydia, gonorrhea, will ultimately benefit the whole community.
reported higher rates than did the men, with syphilis, genital warts, or trichomoniasis. HIV Intake health assessment as such can provide

1940 American Journal of Public Health December 2000, Vol. 90, No. 12
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December 2000, Vol. 90, No. 12 American Journal of Public Health 1941
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