Abnormal Pap Follow-Up among Criminal-Legal Involved Women in Three U.S. Cities by

Criminal-legal involved women experience significant barriers to preventive cervical care, and consequently there is a higher incidence of cervical cancer in this population. The purpose of this study is to identify variables that may facilitate abnormal Pap follow-up among criminal-legal involved women living in community settings. The study included n = 510 women with criminal-legal histories, from three U.S. cities—Birmingham, AL; Kansas City, KS/MO; Oakland, CA. Participants completed a 288-item survey, with questions related to demographics, social advantages, provider communication, and reasons for missing follow-up care. There were n = 58 women who reported abnormal Pap testing, and n = 40 (69%) received follow-up care. Most women received either repeat Pap/HPV testing (n = 15, 38%), or colposcopy and/or biopsy (n = 14, 35%). Women who did not follow-up (n = 15, 26%) cited that they forgot (n = 8, 53%), were uninsured (n = 3, 20%), or were reincarcerated (n = 3, 20%). In a multivariate analysis, both having a primary care provider (OR 4.6, 95% CI 1.3–16.0) and receiving specific provider communication about follow-up (OR 3.8, 95% CI 1.1–13.2) were independent predictors for abnormal Pap follow-up. Interventions that offer linkages to providers in the community or ensure abnormal Pap care plans are communicated effectively may mitigate the disparate incidence of cervical cancer among criminal-legal involved women

Factors associated with smoking among adolescent males prior to incarceration and after release from jail: a longitudinal study

Background The prevalence of cigarette smoking among incarcerated adult men and women is three-four times higher than in the general population, ranging from 70-80%. However, little is known about factors associated with smoking among incarcerated adolescents, especially upon their re-entry into communities after release from jail. The current study explores factors associated with smoking among adolescent males prior to incarceration and one year after their release from jail. Methods We conducted a secondary data analysis of the Returning Educated African-American and Latino Men to Enriched Neighborhoods (REAL MEN) study, which was designed to reduce HIV risk, substance use, and recidivism among 16–18 year old males leaving jail. We examined differences between smokers and non-smokers at the time of their incarceration (N = 552) and one year after their release from jail (N = 397) using t-tests and chi-square tests. Using logistic and linear regression we examined factors associated with current smoking status, frequency of smoking, and quantity of cigarettes smoked per day both prior to the young men’s incarceration and one year after their release from jail. Results Prior to incarceration, 62% of the young men reported smoking, and one-year after jail release, 69% reported smoking. Prior to incarceration, foster care history, not living with parents, not attending school, drug sales, number of sex partners, gang involvement, current drug charges, and number of prior arrests were positively associated with smoking indicators prior to incarceration. Having violent charges was inversely associated with smoking indicators prior to incarceration. One-year after release from jail, foster care history and number of prior arrests before the index incarceration were associated with smoking indicators. Conclusions Several problem behaviors may be associated with adolescent males’ smoking behaviors prior to incarceration. However, the young men’s histories of difficult life circumstances and engagement in illegal activity may have long-term consequences on smoking for these young men during their transition between jail and community. Findings suggest a need for comprehensive risk reduction interventions in settings in which disadvantaged young men are institutionalized, starting in childhood

Utilization of Alcohol Treatment Among HIV-Positive Women with Hazardous Drinking

Hazardous alcohol consumption has been frequently reported among women with HIV infection and is associated with a variety of negative health consequences. Treatments to reduce alcohol use may bring in health benefits. However, little is known regarding the utilization of alcohol treatment services among HIV+ women with hazardous drinking. Using data from the Women’s Interagency HIV Study (WIHS), this study assessed utilization of any alcohol treatment in the past 6 months and performed multivariable logistic regression to determine correlates of receipt of any alcohol treatment. Among 474 HIV+ women reporting recent hazardous drinking, less than one in five (19%) reported recent utilization of any alcohol treatment. Alcoholics Anonymous (AA) was the most commonly reported (12.9%), followed by inpatient detoxification (9.9%) and outpatient alcohol treatment program (7.0%). Half (51%) receiving any alcohol treatment reported utilization of multiple treatments. Multivariable analyses found alcohol treatment was more often utilized by those who had social support (Odds ratio [OR]=1.68, 95% Confidence Interval [CI]=1.00 to 2.83), fewer economic resources (income $12,000, OR = 3.10, 95% CI=1.53 to 6.27), higher levels of drinking (16–35 drinks/week vs. 12–15 drinks/week, OR=3.02, 95% CI=1.47 to 6.21; 36+ drinks/week vs. 12–15 drinks/week, OR=4.41, 95% CI=2.03 to 9.59), and those who reported any illicit drug use (OR=2.77, 95% CI=1.44 to 5.34). More efforts are needed to enhance the utilization of alcohol treatment. Our findings highlight the unique profile of those who utilized alcohol treatment. Such information is vital to improve treatment delivery to address unmet need in this particular population

HIV primary care providers—Screening, knowledge, attitudes and behaviors related to alcohol interventions

Alcohol has particularly harmful health effects in HIV-infected patients; therefore, HIV clinics are an important setting for integration of brief alcohol intervention and alcohol pharmacotherapy to improve patient outcomes. Current practices of alcohol screening, counseling, and prescription of pharmacotherapy by HIV providers are unknown

Smoking, HIV, and risk of pregnancy loss

Cigarette smoking during pregnancy increases risks of poor pregnancy outcomes including miscarriage and stillbirth (pregnancy loss), but the effect of smoking on pregnancy loss among HIV-infected women has not been explored. Here, investigated the impact of smoking on risk of pregnancy loss among HIV-positive and HIV-negative women, and estimated the potential impact of realistic smoking cessation interventions on risk of pregnancy loss among HIV-positive women

Not all non-drinkers with HIV are equal: demographic and clinical comparisons among current non-drinkers with and without a history of prior alcohol use disorders *

Studies of persons living with HIV (PLWH) have compared current non-drinkers to at-risk drinkers without differentiating whether current non-drinkers had a prior alcohol use disorder (AUD). The purpose of this study was to compare current non-drinkers with and without a prior AUD on demographic and clinical characteristics to understand the impact of combining them. We included data from 6 sites across the US from 1/2013–3/2015. Patients completed tablet-based clinical assessments at routine clinic appointments using the most recent assessment. Current non-drinkers were identified by AUDIT-C scores of 0. We identified a prior probable AUD by a prior AUD diagnosis in the electronic medical record (EMR) or a report of attendance at alcohol treatment in the clinical assessment. We used multivariate logistic regression to examine factors associated with prior AUD. Among 2235 PLWH who were current non-drinkers, 36% had a prior AUD with more patients with an AUD identified by the clinical assessment than the EMR. Higher proportions with a prior AUD were male, depressed, and reported current drug use compared to non-drinkers without a prior AUD. Former cocaine/crack (70% vs. 25%), methamphetamine/crystal (49% vs. 16%) and opioid/heroin use (35% vs. 7%) were more commonly reported by those with a prior AUD. In adjusted analyses, male sex, past methamphetamine/crystal use, past marijuana use, past opioid/heroin use, past and current cocaine/crack use and cigarette use were associated with a prior AUD. In conclusion, this study found that among non-drinking PLWH in routine clinical care, 36% had a prior AUD. We found key differences between those with and without prior AUD in demographic and clinical characteristics including drug use and depression. These results suggest non-drinkers are heterogeneous and need further differentiation in studies and that prior alcohol misuse including alcohol treatment should be included in behavioral health assessments as part of clinical care

Suicide In Jails And Prisons: What The Numbers Tell Us

Suicide is often the most common cause of death in correctional settings across the world. The World Health Organization (WHO) recently published a report stating that suicide is a public health problem that demands our attention. \u27 Across the world, one suicide attempt is made every three seconds, with one completed suicide every minute. More people die across the world from suicide than by armed conflict. The risk factors for suicide include being a young or elderly male, being indigenous, being an individual with a mental illness or substance abuse history, and being incarcerated or in custody. Further, individuals who have made a past suicide attempt are more likely to complete a suicide.2 This article describes the occurrence of suicide in jails and prisons in the United States and England. It proposes that guidelines from the American Correctional Association (ACA) and the National Commission on Correctional Health Care (NCCHC), both published in the early 1940s, may be useful in preventing suicides in jails and prisons

Self-initiated pre-quit smoking reduction among community correction smokers

Background Smoking remains the leading cause of preventable death in the United States. While smoking prevalence in the general population has declined in the U.S., smoking remains highly prevalent in prison populations with approximately 70% reporting current smoking. Individuals within the criminal justice system represent a vulnerable group of smokers with limited access to traditional healthcare or smoking cessation treatments. This study examined differences in smoking characteristics based on smokers' self-initiated pre-quit reductions in cigarettes per day (CPD). Methods This study utilized data from a randomized clinical trial comparing four sessions of smoking cessation counseling to brief physician advice only to quit. All participants received 12 weeks of bupropion. Participants (N=500) were recruited from community corrections supervision (M age = 37.4, 67% male, 68% non-white). Questionnaires assessed smoking history and participants were seen at baseline and one week later to begin treatment. The present study compared two groups of smokers based on whether they self-selected to reduce smoking by at least 25% between baseline and first treatment session (n = 121) or whether they increased smoking or did not reduce (n =365). Results Chi-square and one-way analysis of variance revealed that individuals who reduced smoking pre-quit were more likely to be Black and lower educated with at least one prior quit attempt. Additionally, individuals who reduced smoking were older when first become a daily smoker, reported higher expectations for self-help materials and group therapy, as well as reported lower withdrawal and withdrawal expectations. No reduction in smoking related to lower likelihood of achieving at least one quit attempt during the one-year study period as compared to either increased or reduced smoking. Conclusions Action pre-cessation resulted in successes post-quit. Overall, individuals who self-initiate pre-cessation smoking reduction exhibit higher expectations for some smoking cessation treatments and lower expectations for withdrawal improving likelihood of smoking cessation

Characteristics of individuals that complete treatment v. discontinue among criminal justice smokers

Background Tobacco kills over 7 million people annually worldwide and is the leading cause of preventable deaths in the United States. Individuals in criminal corrections are at increased risk for tobacco-related diseases and represent a particularly vulnerable group of tobacco smokers. Within the criminal justice system, there are elevated smoking rates (70-80%) and reduced availability of smoking cessation interventions. Further, these individuals experience significant individual- and social network-level barriers to completing interventions. The purpose of this study was to examine differences among individuals who completed treatment as compared to those who discontinued treatment prematurely among individuals within criminal corrections. Methods The present study utilized data from a one-year clinical trial which randomized participants to four-weeks of Bupropion medication and/or behavioral counseling treatment. Participants (N=500) were recruited from the criminal justice population (M age = 37.4, 67% male, 68% non-white). A battery of questionnaires assessed smoking characteristics and mental health history. A one-way analysis of variance (ANOVA) and chi-square analyses were conducted to determine differences among individuals who completed up to 1 month, 3 months, 6 months or 12 months of treatment. Results Individuals were more likely complete all 12 months of treatment if they were African American, demonstrated good medication compliance, never married, not receiving disability services, and never been treated for substance abuse. Strong smoking urges were associated with lower completion at 1 and 3 months, however, high nicotine dependence was associated with lower completion rates for all time points. A strong social support network was associated with higher rates of completing 12 months of treatment. Conclusions This study contributes to our understanding of a vulnerable group of smokers. While smoking urges are related to lower completion initially, nicotine dependence, social support and medication compliance lead to long-term success in treatment completion. Treatments would benefit from strengthen these factors to improve long-term outcomes