Purpose: Vitamin D deficiency is a global concern, disproportionately affecting vulnerable populations, including prisoners. Vitamin D was found to be protective against Covid-19 during the pandemic. As a response, Nottinghamshire Healthcare NHS Foundation Trust implemented a vitamin D supplementation policy across three prison health-care settings in the UK. The purpose of this study was to assess the overall impact of this policy on supplementation rates and Vitamin D deficiency.
Design/methodology/approach: This pragmatic cross-sectional study retrospectively evaluated the impact of the vitamin D supplementation policy on supplementation uptake and deficiency rates. Vitamin D deficiency was defined as less than 50 nmol/L. Cross-sectional data were collected from 768 prisoners for periods of two years before and two years after introduction of the policy.
Findings: Overall supplementation rates were lower after the policy introduction (43%, n = 330 versus 35%, n = 270; McNemar's χ2, p = 0.004). However, there was increased uptake among previously untreated individuals - 40% (n = 175) of those previously untreated (n = 438) received supplementation after policy implementation. There was an overall reduction in vitamin D deficiency from 71% to 55% after policy introduction (χ2 = 12.3, Cramer's V = 0.13, p < 0.001). Mean vitamin D levels increased from 41.3 nmol/L to 50.3 nmol/L. In a small subsample (n = 23) in whom vitamin D levels were available before and after the policy, paired sample analysis showed significant mean vitamin D level increase (p < 0.001). An exploratory analysis using binary logistic regression suggested the specific prison location and pre-existing vitamin D deficiency as significant predictors of deficiency post-policy.
Originality/value: The findings highlight the potential effectiveness of a simple, population-wide supplementation strategy in reducing vitamin D deficiency within prisons. Future research should use prospective designs and explore factors influencing supplementation adherence and long-term health outcomes, toward developing the most effective strategies.
Purpose: This study aims to examine associations between history of incarceration (HOI) and two oral health outcomes (tooth loss and dental care utilization) among older adults with diabetes, as well as identify factors that may mediate these associations.
Design/methodology/approach: The authors used self-report data from the 2012 and 2014 waves of the Health and Retirement Study (a population-based study of adults aged >50 in the USA) to evaluate associations between HOI and the two oral health outcomes, controlling for demographics.
Findings: HOI was associated with greater odds of permanent tooth loss (OR = 1.43, 95% CI = 1.08-1.90) and reduced odds of dental care utilization in the past two years (OR = 0.70, 95% CI = 0.53-0.92). After adjusting for social support and perceived provider mistrust, the association remained but was attenuated (direct effect = -0.310, p = 0.030). Further, 11% of the total effect was explained by the mediators, with social support accounting for 74% of the indirect effect, and perceived provider mistrust accounting for the remaining 26%.
Research limitations/implications: Findings are limited by the study design. This cross-sectional study had data that was collected at one point in time. Thus, long-term follow-up could not occur. Additionally, the HRS does not differentiate between prison and jail, and health disparities tend to differ between jail and prison. Evidence from this study was preliminary and correlational, and longitudinal work should be conducted.
Practical implications: There are disparities in oral health indicators among those with diabetes based on HOI. Future research should identify barriers to oral health diabetes management in prison and test potential interventions to improve diabetes management following release from prison.
Originality/value: To the best of the authors' knowledge, this study is the first to provide evidence of oral health disparities among older adults with diabetes with a history of incarceration. No study has yet investigated these important health markers in individuals with a history of incarceration. This is important for future intervention to improve healthcare in the justice system.
Purpose: Despite an increasing body of knowledge on suicide methods, no previous studies have examined methods of past suicide attempts among individuals in pretrial jail detention and a follow-up after release from jail in the USA or in any other country. This study aims to describe suicide attempt methods considered and used in one's lifetime prior to pretrial jail detention and suicide attempt methods considered and used in the year following release from pretrial jail detention.
Design/methodology/approach: Participants (n = 800) were recruited as part of a randomized controlled trial. They provided information on methods considered or acted on in their lifetime prior to the current pretrial jail detention as well as in the first year of release from jail.
Findings: Participants most frequently reported having considered and attempted suicide by poisoning (82% and 72.8%), cutting/piercing (47.8% and 35.3%), suffocation (42.1% and 20.8%), transportation (39.9% and 25.3%), falls and jumping (27.4% and 8.0%) prior to jail detention. After jail detention, they mostly considered and attempted suicide by poisoning (73.6% and 73.4%), cutting/piercing (28.6% and 13.9%), suffocation (33.2% and 10.1%), transportation (23.6% and 18.6%), falls and jumping (20.9% and 2.5%).
Originality/value: Given that poisoning, often with drugs or alcohol, was the commonest suicide attempt method, increasing access to effective substance use treatment may help to attenuate significant suicide risk. The study has laid the foundation for future research to explore potential moderators of suicide methods as well as to assess whether the findings are applicable to other parts of the world.
Purpose: This paper synthesises literature on non-visual effects of light in prison environments, drawing attention to disconnect between research evidence and current practices. This paper aims to guide prison designers and decision-makers towards lighting strategies that better support inmates' mental health and rehabilitation.
Design/methodology/approach: A focused literature search was conducted from June to October 2024 using Google Scholar and PubMed, targeting peer-reviewed studies published between 1985 and 2024. Included studies addressed the non-visual effects of light related to circadian rhythm, mental health, artificial and natural lighting, stress, aggression and hormonal regulation. Only English-language studies providing empirical or theoretical insights relevant to confinement settings were considered. Studies focused solely on visual performance, non-human subjects or lacking health implications were excluded. Keyword combinations were refined iteratively, although some relevant interdisciplinary work may have been missed due to indexing or terminological variations.
Findings: Neglecting the role of lighting in prison design contributes to poor psychological outcomes. Limited access to daylight and the overuse of artificial lighting with high blue light content disrupt circadian regulation, worsening sleep, mood and mental health. Conversely, designs that maximise daylight exposure and use adjustable artificial lighting with appropriate spectral qualities can promote emotional stability, reduce aggression and support rehabilitation.
Research limitations/implications: Relevant interdisciplinary studies may still have been missed due to database indexing limitations or terminological variations across fields.
Originality/value: This paper bridges the gap between lighting design, environmental psychology and prison reform. By focusing on how light affects inmates' psychological health and rehabilitation, it offers insights into how prison design can be improved to foster well-being.
Purpose: This study aims to determine the prevalence of selected modifiable risk factors of cardiovascular diseases (CVDs) among male prisoners in Karachi.
Design/methodology/approach: This cross-sectional study was conducted on a convenience sample of 400 male prisoners aged between 30 and 60 years at Central Jail Karachi in December 2024. Information on risk factors of CVDs was obtained using a modified World Health Organization (WHO) STEPS questionnaire. Data were analyzed using SPSS version 20. Logistic regression was performed to identify determinants of CVD risk factors, including smoking status, disturbed sleep and raised blood pressure, overweight and obesity.
Findings: Almost all participants had no moderate to vigorous physical activity (97.5%), no fruit intake (93.0%) and vegetable intake of less than three times per week (91.0%). Around one-third had raised blood pressure (38.5%), were current smokers (35.5%) and were overweight or obese (32.8%). Older age showed positive association with raised blood pressure. Education was positively associated with smoking and being overweight/obese. With reference to prisoners who had spent one to five years in jail, those who had spent six years or more were significantly less likely to have disturbed sleep.
Research limitations/implications: The study reveals a high prevalence of risk factors of CVDs among prisoners, making them highly vulnerable to encounter cardiovascular events. The findings emphasize the urgent need for prison reforms, including improving access to healthy food choices, reducing access to tobacco products and engaging prisoners in physical activity, offering intermittent screening and provision of treatment support when required.
Practical implications: The findings emphasize the critical need to introduce reforms in jails which include improving access to healthy food choices, reducing access to tobacco products, engaging prisoners in physical activity, offering intermittent screening and provision of treatment support if required.
Social implications: The findings will help to improve healthy lifestyles in prisons in a developing country setting.
Originality/value: The study presents the prevalence of modifiable risk factors in the biggest prison of Karachi which addresses an important public health gap focusing on the underprivileged and overlooked population of society. Use of a validated tool enhances reliability and validity to the findings of the research.
Purpose: The purpose of this study is to reinforce the importance of rehabilitation, which is considered to be one of the key elements in the correctional environment that deters crime and reduces the rates of recidivism. Although rehabilitation efforts, such as substance use treatment, have benefits, the condition of the prison environment, specifically the lack of basic needs, can thwart the efforts of the rehabilitative process. This study builds upon previous research to propose institutional adjustments to the incarceration environment to better support rehabilitation.
Design/methodology/approach: This study builds upon the implications of a previously conducted qualitative case study that used semi-structured individual interviews, a focus group and site observations at a Louisiana facility to explore five incarcerated individuals' access to the five basic needs and uncover barriers to self-actualization while in substance use treatment programs. The findings were leveraged to determine best practices for creating an environment more conducive to rehabilitation and treatment.
Findings: This study argues for three actionable changes to the Department of Corrections system that can support rehabilitation efforts more effectively: improvements in meeting one of humanity's most essential needs - adequate and nutritious food, initiatives to improve incarcerated individuals' sense of safety and enhanced correctional officer training.
Originality/value: The environment in which substance use treatment is administered has the potential to be beneficial or detrimental to the rehabilitative process. Providing correctional institutions with the knowledge necessary to confront hindrances to successful treatment has the potential to change the trajectory of rehabilitative efforts and recidivism.
Purpose: The purpose of this study was to determine if a satellite sexually transmitted infection (STI) testing clinic increased STI/blood-borne virus testing and detection in a correctional setting in Australia.
Design/methodology/approach: A cohort study of males incarcerated in a correctional centre in Queensland, who voluntarily attended a satellite STI testing clinic over six months. Data were collected on purpose designed data collection sheets. A retrospective medical chart audit was conducted from three-months before commencement of the clinic until the end of the clinic period. Attendance rates for three-months following the clinic's completion were also considered. Attendance rates, treatment rates, time to treatment, follow-up rates, reinfection rates and client satisfaction were analysed using descriptive statistics, including program sustainability.
Findings: Success of the STI clinic was evidenced by an increase in attendance rates from 32/242 (13.2%) to 242/242 (100%), pre-intervention to the intervention, respectively. Treatment rates increased from 10/242 (4.1%) to 41/242 (16.9%) pre-intervention to intervention, respectively, and an increase in time to treatment from 43.11 (Std. Dev 36.77) mean days pre-intervention to 54.62 (Std. Dev 42.06) mean days during the intervention. Follow-up rates also increased from 5/242 (2.1%) pre-intervention to 24/242 (9.9%) during the intervention. Of the 242 participants, 52 received a positive STI/diagnosis with 44 being diagnosed with hepatitis C. Satisfaction was high with a mean score of 9.7 out of 10 (Std. Dev 0.685). Attendance rates showed no significant difference three-months pre- (n = 32) to post-intervention (n = 35), however, support for the intervention has continued. Future practice should incorporate satellite STI testing clinics as weekly practice.
Originality/value: To the best of the authors' knowledge, this is the first study to consider satellite STI testing within the corrections environment in Australia. The study uniquely showcased how the satellite STI clinic achieved increased STI testing attendance rates, treatment rates, follow-up rates and high satisfaction rates.
Purpose: Correctional populations have higher rates of substance use disorders and related healthcare visits relative to the general population. However, limited evidence on substance use-related healthcare visits exists among this population. Using population data for Ontario, Canada, this study aims to examine overall and substance use-specific healthcare visits for individuals with and without known provincial criminal justice system involvement (CJI versus non-CJI, respectively).
Design/methodology/approach: This retrospective study compared overall and substance use-related healthcare visits between April 1, 2015 and March 31, 2020 among provincially-incarcerated individuals (CJI group) versus those without criminal justice involvement (non-CJI group). Both groups were identified through available health administrative data and were individually matched by age, sex and material deprivation.
Findings: The authors identified and matched 208,188 individuals (59.9% male) with and without CJI and a healthcare visit. Compared to the non-CJI group, those with CJI had approximately 20 times the rate of healthcare visits for alcohol use, drug use and illicit drug-related overdoses. Among those with CJI, females had a higher prevalence of overall healthcare visits, whereas males had a higher prevalence of substance use-specific visits.
Research limitations/implications: Findings highlight the high number of healthcare visits for substance use-related needs among individuals with CJI in Ontario. These results can inform efforts to enhance correctional release planning, improve access to community-based treatment and strengthen substance use prevention and treatment interventions for this high-risk population.
Practical implications: Results can inform efforts to enhance correctional release planning, improve access to community-based treatment, and strengthen substance use prevention and treatment interventions for this high-risk population.
Originality/value: To the best of the authors' knowledge, this study is the first in Canada to draw on population-level administrative health data to identify and match a large sample of individuals with and without CJI and examine substance use-specific healthcare utilization, longitudinally.
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