Prisons In Queensland Research Articles

Using the Alcohol, Smoking and Substance Involvement Screening Test to predict substance-related hospitalisation after release from prison: A cohort study.

Poor substance use-related health outcomes after release from prison are common. Identifying people at greatest risk of substance use and related harms post-release would help to target support at those most in need. The Alcohol Smoking and Substance Involvement Screening Test (ASSIST) is a validated substance use screener, but its utility in predicting substance-related hospitalisation post-release is unestablished. We measured whether screening for moderate/high-risk substance use on the ASSIST was associated with increased risk of substance-related hospitalisation. A prospective cohort study. Prisons in Queensland and Western Australia. Participants were incarcerated and within 6weeks of expected release when recruited. A total of 2585 participants were followed up for a median of 873 days. Baseline survey data were combined with linked unit record administrative hospital data. We used the ASSIST to assess participants for moderate/high-risk cannabis, methamphetamine and heroin use in the 3months prior to incarceration. We used International Classification of Diseases (ICD) codes to identify substance-related hospitalisations during follow-up. We compared rates of substance-related hospitalisation between those classified as low/no-risk and moderate/high-risk on the ASSIST for each substance. We estimated adjusted hazard ratios (aHR) by ASSIST risk group for each substance using Weibull regression survival analysis allowing for multiple failures. During follow-up, 158 (6%) participants had cannabis-related, 178 (7%) had opioid-related and 266 (10%) had methamphetamine-related hospitalisation. The hazard rates of substance-related hospitalisation after prison were significantly higher among those who screened moderate/high-risk compared with those screening low risk on the ASSIST for cannabis (aHR 2.38, 95% confidence interval [CI] 1.74, 3.24), methamphetamine (aHR 2.23, 95%CI 1.75, 2.84) and heroin (aHR 5.79, 95%CI 4.41, 7.60). Incarcerated people with an Alcohol Smoking and Substance Involvement Screening Test (ASSIST) screening of moderate/high-risk substance use appear to have a significantly higher risk of post-release substance-related hospitalisation than those with low risk. Administering the ASSIST during incarceration may inform who has the greatest need for substance use treatment and harm reduction services in prison and after release from prison.

Sex differences in acute health service contact after release from prison in Australia: a data linkage study

ObjectivesWomen released from prison typically experience worse health outcomes than their male counterparts. We examined sex differences in the patterns, characteristics, and predictors of acute health service contact (AHSC) (i.e. ambulance and/or emergency department use) after release from prison. Study designData linkage study. MethodsBaseline survey data from 1307 adults (21% women) within six weeks of expected release from prisons in Queensland, Australia (2008–2010) were linked prospectively with state-wide ambulance and emergency department, correctional, mental health, and death records. Crude and adjusted incidence rates and incidence rate ratios of AHSC were calculated overall and by sex. An Andersen–Gill model was fit to examine whether sex predicted AHSC. The interaction effect between sex and each model covariate was tested. ResultsThe crude incidence rates of AHSC after release from prison were 1.4 (95% confidence interval [CI]: 1.3–1.5) and 1·1 (95%CI: 1.1–1.2) per person-year for women and men, respectively. The relationship between perceived physical health–related functioning at the baseline and AHSC was modified by sex (P = 0·039). The relationship between perceived health-related functioning and AHSC also differed among women. Compared to women who perceived their physical health as fair or good at the baseline, women who perceived their physical health as poor were at greater risk of AHSC (hazard ratio = 2.4, 95%CI: 1.4–3·9, P = 0.001) after release from prison. ConclusionsAmong people released from prison, women's and men's AHSC differs depending on how they perceive their own physical health. The specific needs of women and men must be considered in transitional support policy and planning to improve their health outcomes.

The predictive validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for moderate- to high-risk cannabis, methamphetamine and opioid use after release from prison.

Illicit substance use is common among people entering prisons, as is returning to substance use after release from prison. We aimed to assess the predictive validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for returning to substance use after release from prison. A longitudinal design with baseline survey conducted between 2008 and 2010 in the 6weeks before expected prison release and up to three follow-up surveys in the 6months after release. Prisons in Queensland, Australia. A total of 1054 adults within 6 weeks of expected release from prison. The ASSIST was used to assess problematic use of cannabis, methamphetamine, heroin and other non-prescribed opioids in the 3months before incarceration. Post-incarceration substance use was measured at 1, 3 and 6months after release. We calculated the area under the receiver operating characteristic curve (AUROC) and the optimal ASSIST cut-off score for each substance, using Youden's index (J). Forty-one per cent (n = 434) of the cohort reported any substance use during follow-up: 33% (n = 344) used cannabis, 20% (n = 209) methamphetamine, 10% (n = 109) heroin and 9% (n = 97) illicit other opioids. The optimal ASSIST cut-off score was ≥ 4 for heroin, methamphetamine and cannabis and ≥ 1 for other opioids. Using these cut-offs, the AUROC was highest for heroin in predicting both any use (AUROC = 0.82) and weekly use (AUROC = 0.88) in the past 4weeks. AUROCs for other drugs ranged from 0.73 to 0.79. The ASSIST shows promise as an accurate and potentially scalable tool that may be useful for predicting a return to substance use after release from prison and could inform service delivery. The substantial rates of returning to substance use after release from prison suggest that prison serves to interrupt rather than cease substance use.

Navigating pregnancy and early motherhood in prison: a thematic analysis of mothers’ experiences

BackgroundMaternal imprisonment negatively impacts mothers and their children and is likely to have lifelong and intergenerational sequelae. In many jurisdictions nationally and internationally, young children (usually those less than 5 years) can reside with their mothers in prison. However, there is considerable debate regarding the impact of prison environments on incarcerated mothers and their children who are born, and/or raised in prison. Research to date on the pregnancy and mothering experiences of imprisoned mothers and their preferences for care arrangements for their babies and young children is limited.MethodsThis study was part of the Transforming Corrections to Transform Lives project, in which workshops were conducted with imprisoned mothers to understand their needs while in custody and post-release, and the kind of supports and system changes that are required to meet those needs. Incarcerated mothers (n = 75) participated in seven workshops conducted across four Queensland prisons. Themes were generated through reflexive thematic analysis.ResultsThree themes characterised mothers’ experiences of being pregnant and undertaking a mothering role of a young child while in prison. First, for most mothers, imprisonment adds vulnerability and isolation during pregnancy and childbirth. Second, although mothers felt that residing together with their children in prison motivated them to change for a better future, they were concerned about the potential negative impact of the prison environment on the child’s development. Lastly, most mothers voiced losing autonomy and agency to practice motherhood independently within custodial settings. Mothers expressed a need for the correctional system to be adapted, so it is better equipped to address the unique and additional needs of mothers with young children.ConclusionMothers’ experiences indicated that the correctional system and policies, which were predominantly designed for men, do not adequately address the varied and complex needs of pregnant women, mothers, and their young children. Imprisonment of pregnant women and mothers with young children should be the last resort, and they should be provided with holistic, individually tailored support, most preferably in community settings, to address their multiple intersecting needs.

Association between contact with mental health and substance use services and reincarceration after release from prison.

ObjectivePeople released from prison who experience mental health and substance use problems are at high risk of reincarceration. This study aimed to examine the association between contact with mental health and substance use treatment services, and reincarceration, among adults released from prison.MethodsPre-release survey data from 1,115 adults released from prisons in Queensland, Australia were linked with administrative health and correctional records covering a median of 787 days post-release. We constructed marginal structural Cox proportional hazards models, adjusting for pre-release variables and time-varying indicators of emergent mental health and substance use problems, to examine the association between contact with mental health and substance use treatment services, and reincarceration.ResultsThe adjusted hazard ratio (AHR) for reincarceration associated with mental health service contact was 1.76 (95%CI 1.23,2.51). Among those not on parole following release, the AHR for reincarceration associated with substance use treatment service contact was 3.16 (95%CI 2.09,4.77); we found no evidence for an association among those who were released on parole (AHR = 1.07; 95%CI 0.80,1.43).ConclusionsAlthough we cannot eliminate the possibility of residual confounding, our findings suggest that infrequent or unsustained contact with community-based mental health and substance use treatment services is not protective against reincarceration, and may even be iatrogenic. Increased investment in high-quality and timely behavioural health services for people released from prison may simultaneously improve health outcomes, and reduce reincarceration.

Asthma-related mortality after release from prison: a retrospective data linkage study

Background People who experience incarceration are at increased risk of asthma and have a higher prevalence of risk factors associated with asthma-related mortality. However, there has been little research on the relationship between asthma and mortality in people released from prison. Objectives This study examined the association between asthma and all-cause and cause-specific mortality, and estimated the increased risk of asthma-related mortality among adults released from prison compared to the age- and sex-matched general population. Design We used data from a nested case-control sample (N = 1658) within a retrospective cohort study of all adults released from prisons in Queensland, Australia, from 1994 to 2007 (N = 42015). Deaths were identified using linkage to national mortality records. Nested study cases were sampled from deaths, with a matched control from the cohort. We examined medical and case management records to identify risk factors potentially associated with mortality. Asthma-related mortality in the cohort was compared to that of the matched general population of Queensland. Results People released from prison were more likely than their age and sex matched general population counterparts to have an asthma-related death (HR = 3.32 95%CI:2.14-5.16). Those who had been identified as having asthma in prison had increased odds of mortality from all-cause (OR = 1.86 95%CI:1.40-2.47), drug-related (OR = 2.5 95%CI:1.40-4.46), cardiovascular-related (OR = 3.2 95%CI:1.57-6.51), and respiratory-related (OR = 3.30 95%CI:1.63-6.70). Conclusion Among people exposed to incarceration, those with asthma are at elevated risk of death after release from custody. Improved management of respiratory disease in this population may contribute to reducing their high rate of preventable mortality.

Impact of dual diagnosis on healthcare and criminal justice costs after release from Queensland prisons: a prospective cohort study.

People released from prison have poorer health than the general public, with a particularly high prevalence of mental illness and harmful substance use. High-frequency use of hospital-based services is costly, and greater investment in transitional support and primary care services to improve the health of people leaving prison may therefore be cost-effective. A prospective cohort study of 1303 men and women released from prisons in Queensland, Australia, between 2008 and 2010, using linked data was performed. We calculated healthcare costs and the cost of re-incarceration. We compared healthcare costs to the general public, and assessed the impact of past mental illness, substance use disorder, and dual diagnosis on both healthcare and criminal justice costs. Healthcare costs among the cohort were 2.1-fold higher than expected based on costs among the public. Dual diagnosis was associated with 3.5-fold higher healthcare costs (95% CI 2.6-4.6) and 2.8-fold higher re-incarceration costs (95% CI 1.6-5.0), compared with no past diagnosis of either mental illness or substance use disorder. People released from prison incur high healthcare costs, primarily due to high rates of engagement with emergency health services and hospital admissions. Comorbid mental illness and substance use disorders are associated with high health and criminal justice costs among people recently released from prison.

Violence-related morbidity among people released from prison in Australia: A data linkage study.

People released from prison have an increased risk of morbidity, including from nonfatal violence. We examined the incidence and predictors of violence-related morbidity after release from prison and investigated whether there are differences according to sex and Indigenous status. Baseline data were collected from 1325 people within 6 weeks of release from prisons in Queensland, Australia, between 1 August 2008 and 31 July 2010. Data were linked to state-wide health (ambulance, emergency department and hospital) and prison records, and national death records until 31 July 2012. Predictors were identified using a multivariable Andersen-Gill model. Differences according to sex and Indigenous status were investigated using effect modification. A total of 225 (18.2%) people experienced 410 violence-related events that were recorded in health records. The incidence was 12.8 per 100 person-years [95% confidence interval (CI) 11.7, 14.1]. Risk factors for violence-related morbidity included diagnosed mental illness [hazard ratio (HR)=2.0, 95% CI 1.1, 3.8], substance use disorder (HR=1.6, 95% CI 1.1, 2.3) or dual diagnosis (HR=3.2, 95% CI 2.2, 4.8); high-risk alcohol use (HR=2.1, 95% CI 1.5, 2.8); being Indigenous (HR=1.7, 95% CI 1.2, 2.5); and two or more prison releases (HR=1.7, 95% CI 1.2, 2.6). Indigenous status modified the risk of violence-related morbidity, with Indigenous men having twice the risk of non-Indigenous men (HR=1.9, 95% CI 1.3, 2.8). Approximately one in five people released from prisons in Queensland experienced violence-related morbidity. Coordinated and continuous mental health and substance use treatment from prison to the community may reduce the risk of violence-related morbidity in this population.

Health and Welfare Outcomes for Adolescents Following Release from Prison in Queensland, Australia: A Prospective Cohort Study

Background: The transition from prison to the community can be a difficult process and may present different challenges for adolescents (aged < 25 years) compared with their older peers. Methods: Using data from a prospective cohort study in Australia, we compared the health and welfare outcomes of adolescents (aged < 25 years) and adults (aged ≥ 25 years) at 1, 3, and 6 months after release from prison. Results: After one month, adolescents were less likely to be unemployed (adjusted odds ratio (aOR) 0.31; 95% CI 0.15–0.63), report low levels of social support (aOR 0.41; 95% CI 0.21–0.80), or report high psychological distress (aOR 0.50; 95% CI 0.25–0.99). After three months, adults were more likely to have visited a general practitioner (aOR 2.05; 95% CI 1.04–4.07) and adolescents remained less likely to be unemployed (aOR 0.37; 95% CI 0.19–0.74). After six months, adolescents were three times more likely to have used amphetamine-type stimulants (aOR 3.42; 95% CI 1.29–9.09). Conclusions: Adolescents experience different challenges than their older peers when transitioning from prison to the community. Age-specific, integrated support is needed for adolescents during this critical period, including strategies to promote early primary care contact, capitalise on social support networks, and discourage risky substance use.

Contact with Mental Health Services After Acute Care for Self-Harm Among Adults Released from Prison: A Prospective Data Linkage Study.

To determine the care pathway and rate and predictors of mental health care contact within seven days of discharge from acute care following self-harm. In a representative cohort of adults released from prisons in Queensland, Australia, we probabilistically linked person-level, statewide ambulance, emergency department, and hospital records, both prospectively and retrospectively, and community mental health service and Medicare records prospectively, to baseline survey data. We fit multivariate modified log-linked Poisson regression models to examine the association between sociodemographic, health, and criminal justice factors and mental health care contact after self-harm. Of 217 discharges from acute care following self-harm, 55% (n=119) received mental health care within seven days of discharge. Mental health care contact was associated with substance use disorder (adjusted relative risk (ARR)=0.48; 95% CI: 0.27-0.85), dual diagnosis (ARR=0.58; 95% CI: 0.41-0.82), physical health-related functioning (ARR=0.98; 95% CI: 0.97-0.99), being female (ARR=1.39; 95% CI: 1.02-1.90), being identified as at risk of self-harm by correctional authorities (ARR=1.50; 95% CI: 1.07-2.09), and prior engagement with state-funded mental health care (ARR=1.55; 95% CI: 1.08-2.22). Our findings highlight the need to improve the integration of community mental health care for people who present to acute care following self-harm with a recent history of incarceration, particularly for men and those with substance use disorder or dual diagnosis.

Violence-Related Deaths Among People Released From Prison: A Data Linkage Study.

People released from prison are a socially marginalized group and are at high risk of death from preventable causes, including violence. Despite this, little is known about the epidemiology of violence-related death (VRD) after release from prison. This knowledge is essential for developing targeted, evidence-informed violence prevention strategies. We examined VRDs among a representative sample of people released from prisons in Queensland, Australia, by sex and Indigenous status. Correctional records for all people (aged ≥17 years) released from prisons from January 1994 until December 2007 (N = 41,970) were linked probabilistically with the National Death Index. The primary outcome was VRD following release from prison. We calculated crude mortality rates (CMRs) and standardized mortality ratios (SMRs) standardized by age and sex to the Australian population. We used Cox regression to identify predictors of VRD. Of 2,158 deaths after release from prison, 3% (n = 68) were violence-related. The SMR for VRD was 10.0 (95% confidence interval (CI): [7.9, 12.7]) and was greatest for women (SMR = 16.3, 95% CI: [8.2, 32.7]). The rate of VRD was 2.5 deaths per 10,000 person-years (95% CI: [2.0, 3.2]) and was highest between 2 and 6 months after release from prison (CMR = 6.3, 95% CI: [3.4, 11.6]). Risk factors for VRD included short sentences (<90 days; for males and non-Indigenous people) and experiencing two or more imprisonments (for non-Indigenous people). No significant risk factors for VRD were identified for women or Indigenous people. People released from prison die from violence at a rate that is greatly elevated compared with the general population, with women experiencing the greatest elevation in risk. Reducing the number of VRDs in this population could improve the health and wellbeing of some of our most marginalized community members.

Trends in hepatitis B prevalence and associated risk factors among Indigenous and non‐Indigenous prison entrants in Australia, 2004 to 2013

ObjectiveThis study describes and compares prevalence trends of markers for hepatitis B (HBV) from 2004 to 2013 and HBV risk factors between Indigenous and non‐Indigenous prison entrants. MethodsA cross‐sectional survey carried out over two weeks in 2004, 2007, 2010 and 2013 in reception prisons in New South Wales, Queensland, Western Australia and Tasmania. ResultsThe study included 2,223 prison entrants; 544 were Indigenous. Indigenous prison entrants had significantly higher hepatitis B core antibody (anti‐HBc) prevalence than non‐Indigenous prisoners in 2004 (29% vs. 18%, P=0.026), 2007 (40% vs. 15%, P<0.001) and 2010 (21% vs. 16% 2010, P=0.002), and similar anti‐HBc prevalence to non‐Indigenous entrants in 2013 (14% vs. 14%, P=0.888), with a significant decline from 2007 for Indigenous entrants (P=0.717)ᶺ. Being more than 30 years old and coming from an area classified as ‘non‐highly accessible’ were associated with anti‐HBc positivity in both populations. For Indigenous prison entrants, first time in prison and survey year was associated with anti‐HBc positivity. For non‐Indigenous participants, a history of injecting drug use and body piercings was associated with anti‐HBc positivity. ConclusionThere are unique risk factors associated with HBV prevalence for both Indigenous and non‐Indigenous prison entrants. Implications for public healthIn developing public health programs and policies for HBV, consideration of similarities and differences of associated HBV risk factors between Indigenous and non‐Indigenous offenders is required.

Barriers and facilitators of maintained smoking abstinence following release from smoke-free prisons: A qualitative enquiry

BackgroundThe prevalence of smoking among people entering prisons is high. Despite increasing adoption of prison smoke-free policies, relapse to smoking after release from prison is nearly universal, and policy to effectively mitigate this is largely absent. Informed by a risk environment framework, we aimed to identify key barriers and facilitators to maintaining smoking abstinence among former smokers released from smoke-free prisons. MethodTwenty-one people released from smoke-free prisons in Queensland, Australia, were followed up from a larger survey of 114 former prisoners. Semi-structured interviews were used to explore the perceived barriers and facilitators of maintained smoking abstinence. FindingsIdentified barriers to continued abstinence included pre-release intention to resume smoking; normalisation of smoking in home or social environments, resumption of smoking as a symbolic act of freedom and resistance from and to a restrictive environment; a perception that smoking provides stress relief to their difficult lives, and the use of tobacco/smoking to cope with cravings experienced on release for illicit substances. A number of interviewees were unable to provide clear reflective reasons for relapse. For those who did manage to remain abstinent for a period of time, identified facilitators included an awareness of the health and financial benefits of smoking abstinence, the use of intrinsic motivation, distraction from nicotine cravings using alternative activities, and social support from family and peers. DiscussionInterventions promoting continued smoking abstinence among people exiting smoke-free prisons should focus on targeting the perceived individual- and environmental-level barriers to maintained smoking abstinence while simultaneously promoting perceived facilitators, so as to reduce smoking-related health and economic disparities in this marginalised population.

Self-harm following release from incarceration: Patterns and measurement issues

IntroductionDespite an elevated prevalence of self-harm in the incarcerated adult population, little is known about patterns of self-harm following release from prison.&#x0D; Objectives and ApproachBaseline self-report interviews with 1315 adults immediately prior to release from prison in Queensland, Australia, combined with interrogation of linked health data from &gt;3750 post-release emergency department presentations, &gt;2000 ambulance attendances, and corrections data during periods of re-incarceration.&#x0D; ResultsApproximately 5% of all contacts with medical emergency services following release from prison resulted from self-harm. These were associated with being Indigenous, having a lifetime history of a mental disorder and having been identified by prison staff as being at risk of self-harm. Agreement between self-reported self-harm and medically-verified episodes of self-harm was poor.&#x0D; Conclusion/ImplicationsEmergency services contacts resulting from self-harm following release from prison are common and represent an opportunity for tertiary intervention for self-harm. Our findings suggest that a self-reported history of self-harm should not be considered a reliable indicator of prior self-harm, or of future self-harm risk, in incarcerated adults.

Constituents of "teabacco": A forensic analysis of cigarettes made from diverted nicotine replacement therapy lozenges in smoke-free prisons.

Following the implementation of prison smoke-free policies, there have been reports of prisoners creating substitute cigarettes made from nicotine replacement therapy patches or lozenges infused with tea leaves ("teabacco"). No studies have analyzed the chemical constituents of teabacco made from nicotine lozenges, so as to document any potential related health hazards. Teabacco samples were made by a participant who reported creating teabacco while incarcerated in a smoke-free prison in Queensland, Australia, and the process was video-recorded for replication in a laboratory. A simple linear smoking system captured the teabacco smoke for analysis. Inductively coupled plasma optical emission spectroscopy (ICP-OES) was used to analyze elemental composition and gas chromatography coupled with a mass spectrometer (GC-MS) analyzed the captured smoke using the National Institute of Standards and Technology mass spectral library. Analyses determined that quantities of copper, aluminum, and lead concentrations, and levels of inhaled total particulate matter, were above recommended guidelines for safe ingestion. Analysis of teabacco smoke using GC-MS identified potentially toxic compounds catechol and nicotine. However, our findings show that smoking this form of teabacco is less harmful than smoking teabacco made from nicotine patches, or smoking traditional tobacco cigarettes. Considering the limited potential health harm of smoking teabacco made from lozenges, and that nicotine lozenges represent the only form of smoking cessation support for individuals entering smoke-free prisons, we caution against the removal of nicotine lozenges from Queensland's prisons, at least until further research directly establishes health harms associated with this form of teabacco.

'Teabacco': Smoking of nicotine-infused tea as an unintended consequence of prison smoking bans.

Following the introduction of smoke-free policies in prisons in several countries, there have been anecdotal reports of prisoners creating cigarettes by mixing nicotine patches or lozenges with tea leaves ('teabacco'). Among a sample of people recently released from smoke-free prisons in Queensland, Australia, the aims of this study were to explore the perceived popularity of teabacco use, motivations for its use and describe the process of creating teabacco to identify potential associated health risks. This study used a mixed-methods design. Eighty-two people recently released from prison in Queensland, Australia completed surveys at parole offices measuring teabacco use while incarcerated. Twenty-one teabacco smokers took part in follow-up, qualitative interviews to explore survey responses in greater depth. The majority of survey participants (57%) reported smoking teabacco while incarcerated, with 37% smoking teabacco frequently (> once per week). Teabacco use was primarily motivated by cigarette cravings. Participants described the perceived inevitability of prisoners finding substitutes for tobacco. Multivariate analyses found that self-rated poor physical health, having been incarcerated five or more times, experiencing cigarette cravings while incarcerated, and use of illicit drugs while incarcerated were positively associated with frequent teabacco use in prison. Our findings suggest that teabacco use has become common practice in Queensland's smoke-free prisons. Correctional smoking bans are an important public health initiative but should be complemented with demand and harm reduction measures cognisant of the risk environment.

Research round-up

The effects of co-occurring mental illness and substance use disorder on injury in recently released prisoners is highlighted in a study by Young and colleagues. Researchers analysed data for 1307 adults (median follow-up 495 days [IQR 163–958]) released from prison in Queensland, Australia. The crude rate for hospital contact for injury was 996 per 1000 person-years (95% CI 893–1112) in individuals with co-occurring mental illness and substance use disorder compared with 275 (247–307) in individuals with no mental illness. Relative to recently released prisoners without mental illness, individuals with both mental illness and substance use disorder had increased risk for injury (adjusted hazard rate ratio 3·27, 95% CI 2·30–4·64; p<0·0001), as did individuals with mental illness alone (1·87, 1·19–2·95; p=0·0071). Dual diagnosis of mental illness and substance use disorder and injury in adults recently released from prison: a prospective cohort studyPeople released from prison experience high rates of injury compared with the general population. Among people released from prison, dual diagnosis is associated with an increased risk of injury. Contact with the criminal justice system is a key opportunity to prevent subsequent injury morbidity in people with co-occurring mental health disorders. Engagement with integrated psychiatric and addiction treatment delivered without interruption during the transition from prison into the community might prevent the injury-related disparities experienced by this vulnerable group. Full-Text PDF Open Access

Relapse to smoking following release from smoke-free correctional facilities in Queensland, Australia

BackgroundSmoke-free prison policies are increasingly common, but few studies have investigated relapse to smoking after release from prison. This study investigated return to tobacco smoking and correlates of smoking at reduced levels after release among adults recently released from smoke-free prisons in Queensland, Australia. MethodsA cross-sectional survey of 114 people at parole offices within two months of release from prison was used. The survey measured health, social, and criminological factors related to tobacco smoking. We used logistic regression to identify factors associated with reduced post-release smoking levels compared to pre-incarceration levels. Results94% of participants relapsed to smoking within two months of release; 72% relapsed on the day of release. 62% of participants smoked significantly less per day after compared with before incarceration. Living with a partner (Odds Ratio (OR) 2.77, 95%CI 1.02–7.52), expressing support for smoke-free prison policies (OR 2.44, 95%CI 1.12–5.32), intending to remain abstinent post-release (OR 4.29, 95%CI 1.88–9.82), and intending to quit in the future (OR 3.88, 95%CI 1.66–9.07) were associated with reduced smoking post-release. Use of illicit drugs post-release was negatively associated with reduced smoking post-release (OR 0.27, 95%CI 0.09–0.79). In multivariate analyses, pre-release intention to remain smoke-free was associated with reduced smoking post-release (AOR 2.69, 95%CI 1.01–7.14). DiscussionRelapse to smoking after release from smoke-free prisons is common, but many who relapse smoke less than before incarceration, suggesting that smoke-free prison policies may reduce post-release tobacco smoking. There is a need for tailored, evidence-based tobacco cessation interventions for people recently released from prison.

Incidence and risk factors for mortality after release from prison in Australia: a prospective cohort study.

To estimate the incidence and identify risk factors for mortality in adults released from prisons in the state of Queensland, Australia. Prospective cohort study, linking baseline survey data with a national death register. Selected prisons within Queensland, Australia. Adults (n=1320) recruited in Queensland prisons within 6 weeks of expected release, between August 2008 and July 2010, followed for up to 4.7years in the community. Participants completed a comprehensive baseline survey covering psychosocial circumstances, physical and mental health, substance use and health risk behaviours. Clinical data were abstracted from prison medical records and obtained through probabilistic linkage with state-based, community health records. Dates of prison release and reincarceration were obtained from correctional records. Deaths were identified through probabilistic linkage with the National Death Index. Adjusted hazard ratios (AHR) were calculated using proportional hazards regression models. Standardized mortality ratios (SMR) were calculated using the population of Queensland as the reference. General population data were obtained from the Australian Bureau of Statistics. The rate of mortality in the cohort was higher than in the age- and sex-matched general population of Queensland for all causes [SMR=4.0, 95% confidence interval (CI)=2.9-5.4] and drug-related causes (SMR=32, 95% CI=19-55). In a multivariable model, adjusting for age, sex and Indigenous status, factors associated with increased mortality risk included expecting to have average or better funds available on release (AHR=2.9, 99% CI=1.2-7.1), poor mental health (AHR=2.6, 99% CI=1.1-6.1) and self-reported life-time history of overdose (AHR=2.5, 99% CI=1.04-6.2). People released from prison in Queensland, Australia are at increased risk of death, due particularly to drug-related causes. Those at greatest risk of death are characterized by poor physical and mental health and a history of risky substance use.

Modifiable risk factors for external cause mortality after release from prison: a nested case-control study.

People released from prison are at higher risk of mortality from potentially preventable causes than their peers in the general population. Because most studies of this phenomenon are reliant on registry data, there is little health and behavioural information available on those at risk, hampering the development of targeted, evidence-based preventive responses. Our aim was to identify modifiable risk and protective factors for external cause and cause-specific mortality after release from prison. We undertook a nested case-control study using data from a larger retrospective cohort study of mortality after release from prison in Queensland, Australia between 1994 and 2007. Cases were 286 individuals who had died from external causes (drug overdose, suicide, transport accidents, or violence) matched with 286 controls on sex, Indigenous status, and release date. We extracted data from detention, case-management, and prison medical records. Factors associated with increased risk of external cause mortality included use of heroin and other opioids in the community [odds ratio (OR) = 2.20, 95% CI 1.41-3.43, p &lt; 0.001], a prescription for antidepressants during the current prison sentence (OR = 1.94, 95% CI 1.02-3.67, p = 0.042), a history of problematic alcohol use in the community (OR = 1.54, 95% CI 1.05-2.26, p = 0.028), and having ever served two or more custodial sentences (OR = 1.51, 95% CI 1.01-2.25, p = 0.045). Being married (OR = 0.45, 95% CI 0.29-0.70, p &lt; 0.001) was protective. Fewer predictors were associated with cause-specific mortality. We identified several behavioural, psychosocial, and clinical markers associated with mortality from preventable causes in people released from prison. Emerging evidence points to interventions that could be targeted at those at increased risk of external cause mortality. These include treatment and harm reduction programmes (for substance use), improving transitional support programmes and continuity of care (for mental health), diversion and drug reform (for repeat incarceration) and nurturing stable relationships during incarceration. The period of imprisonment and shortly after release provides a unique opportunity to improve the long-term health of ex-prisoners and overcome the disadvantage associated with imprisonment.