Megan R. Hebert

Reproductive Health Care and Family Planning Needs Among Incarcerated Women

OBJECTIVES Women in correctional institutions have substantial reproductive health problems, yet they are underserved in receipt of reproductive health care. We assessed the level of risk for sexually transmitted diseases (STDs) and the reproductive health needs of 484 incarcerated women in Rhode Island to plan an intervention for women returning to the community. METHODS We used a 45-minute survey to assess medical histories, pregnancy and birth control use histories, current pregnancy intentions, substance use during the past 3 months, histories of childhood sexual abuse, and health attitudes and behaviors. RESULTS Participants had extremely high risks for STDs and pregnancy, which was characterized by inconsistent birth control (66.5%) and condom use (80.4%), multiple partners (38%), and a high prevalence of unplanned pregnancies (83.6%) and STDs (49%). Only 15.4% said it was not likely that they would have sexual relations with a man within 6 months after release. CONCLUSION Reproductive health services must be offered to incarcerated women. Such interventions will benefit the women, the criminal justice systems, and the communities to which the women will return.

Prevalence and Patterns of Sexual Assault Across the Life Span Among Incarcerated Women

This study investigated the prevalence of and associations among sexual assault by life stage (childhood, adolescence, or adulthood) and perpetrator (family, stranger, friend, or partner) via a survey of a statewide sample of incarcerated women (N = 484). Participants were 18 to 56 years old, and the majority were White (56%). Results demonstrate higher rates of sexual assault in childhood (35%) and adulthood (22%) as compared with adolescence (14%). Logistic regression analyses revealed significant associations between childhood sexual assault by family and adulthood sexual assault by friend, stranger, and partner; adolescent sexual assault was not significantly associated with sexual assault in childhood or adulthood. These findings suggest that the lifetime sexual victimization pattern of incarcerated women differs from that seen in the general population.

Improving Birth Control Service Utilization By Offering Services Prerelease Vs Postincarceration

OBJECTIVES We examined whether incarcerated women would substantially increase birth control initiation if contraceptive services were available within the prison compared with after their release back into the community. METHODS During phase 1 of the study, a nurse educator met with women at the Rhode Island Adult Correctional Institute and offered them referrals for contraceptive services at a community health clinic after their release. During phase 2, contraceptive services were offered to women during their incarceration. RESULTS The majority of the participants (77.5%) reported a desire to initiate use of birth control methods. Within 4 weeks of their release, 4.4% of phase 1 participants initiated use of a contraceptive method, compared with 39.1% of phase 2 participants (odds ratio [OR]=14.6; 95% confidence interval [CI]=5.5, 38.8). CONCLUSIONS Provision of contraceptive services to women during their incarceration is feasible and greatly increases birth control initiation compared to providing services only in the community.

Feasibility of Gaining Access to Women in Jail for Health Interventions

ABSTRACT Female jail populations are comprised of women at high-risk for an array of psychological and physical health problems. Jails offer an opportune site to deliver clinical health interventions to women who often quickly cycle back into the community. In contrast with prison population studies, many investigators have encountered recruitment problems when attempting to engage the jailed population in clinical research. This study addressed the feasibility of recruiting detained women for eligibility for clinical research. Methods: Commitments to the Womens Facility at the Rhode Island Department of Corrections were chronicled for 40 months, from February 2004 to June 2007. Research staff, working 8 a.m. to 5 p.m., Monday through Friday, attempted to screen all detained women for a randomized clinical trial. Results: During the 40-month study period, 4,131 individual women had 8,010 commitments to the facility. Staff was able to gain access to nearly 50% of women. Of the inaccessible women, 65% were released in less than 24 hours. In total, 88% of accessed women agreed to be screened for study participation. No significant differences were observed by race/ethnicity or age between women who were screened and those who were not. Conclusions: Clinical research with the female jail population is feasible. The jail setting requires researchers to plan for short-commitment lengths and high rates of recidivism to optimize screening and recruitment in this population.

Levels of trauma among women inmates with HIV risk and alcohol use disorders: behavioral and emotional impacts

SUMMARY An increasing number of women are involved in the criminal justice system. Women in corrections are often of low socio-economic status, medically underserved and exposed to a variety of traumatic events. Programs and services provided in correctional settings should be informed by the unique profiles and needs of these women. This study sought to identify distinct sub-groups (classes) of incarcerated women based on differences in their qualitative (types of trauma) and quantitative (number of) trauma experiences. Demographics, psychosocial and behavioral characteristics were measured in 149 women entering jail, who reported recent hazardous drinking and HIV sexual risk behavior. Two classes based on trauma exposure of women were identified through latent class analysis. The classes did not differ with respect to qualitative differences in trauma exposure (both classes reported all forms of trauma), but did differ with respect to quantitative differences (Class 2 reported more exposure to trauma in all categories than Class 1). The classes also differed significantly on current psychological functioning, alcohol treatment, problems, and consequences, drug histories, sexual risk, medical conditions, and social group characteristics. In all areas, members of Class 2 were significantly more likely to report higher levels of measured variables. Nearly all women in our sample reported levels of trauma exposure, suggesting a need for intervention and attention. Through identifying these separate classes, limited resources for trauma survivors in the correctional setting could be most appropriately allocated.

Follow-Up of Abnormal Pap Smears Among Incarcerated Women

Risk factors for cervical cancer are endemic among incarcerated women, and brief incarcerations make follow-up a challenge. This article describes Pap smear results and follow-up evaluations among women in a combined jail and prison system. Medical records of 785 women incarcerated between 1999 and 2004 were reviewed. Charts with abnormal Pap smear results (195) were reviewed for cervical cancer risk factors and colposcopy results. Women with ASCUS (atypical squamous cells of undetermined significance) Pap smears were less likely to have had a colposcopy than other women, but biopsy results often demonstrated significant pathology. Longer length of incarceration post–Pap smear was associated with undergoing colposcopy. Providing Pap smears and colposcopy to this population of women is vital in the prevention of cervical cancer.

Backpack Needle Exchange: Background, Design, and Pilot Testing of a Program in Rhode Island

ABSTRACT Many individuals who inject drugs do not access existing needle and syringe exchange programs. The ability to obtain clean needles from needle exchanges is limited by operational difficulties, the hours of operation, the location of the programs, and a lack of transportation. Providing multiple points of access to clean needles, including mobile exchange sites, may be necessary to prevent the transmission of the human immunodeficiency virus and other blood-borne viruses. A novel backpack needle exchange outreach model was implemented in Providence, Rhode Island. Backpack exchange participants completed surveys similar to those done by clients of Providences storefront needle exchange. Backpack exchangers were significantly more likely to be Hispanic and inject more frequently than those who utilized the fixed site. Backpack exchange is a feasible method for providing needle exchange services and referrals to hard-to-reach injectors.

Correlates of acceptance of a hypothetical gonorrhea vaccine by incarcerated women.

Objectives: This study sought to identify correlates of acceptance of a hypothetical Neisseria gonorrhea (GC) vaccine in a high-risk sample of incarcerated women. Goals: The goal of this study was to inform efforts to promote acceptance of STI vaccines in development. Study Design: This study consisted of a cross-sectional survey using a structured questionnaire. Results: The majority (79%) of incarcerated women surveyed would accept GC vaccine. In multivariate analyses that controlled for demographics, significant health belief model psychosocial correlates of higher acceptance were perceived severity of infection (OR = 3.33) and vulnerability to infection (OR = 2.85). Fear of vaccination was significantly correlated with lower acceptance (OR = 0.42). Conclusions: Incarcerated womens willingness to accept a hypothetical GC vaccine is explained by components of the health belief model and a component of the theory of reasoned action.