News and Articles on Health. Medical research topics.

A meta-analysis of clinical trials indicated that when the 5 A’s brief counseling intervention is used by a trained provider, and is accompanied by pregnancy-specific, self-help materials, cessation rates can be increased by 30–70% (Mullen, 1999). However, a survey showed that only 35% of providers used the full 5 A’s intervention, with most providers only asked and advised about smoking (Floyd et al., 2001). This is consistent with Oregon data that indicates that 60% of prenatal care providers used three of the recommended 5 A’s protocol (Ask, Advise, and Assist) (Oregon Pregnancy Risk Assessment Monitoring System, 2001). (We have no data on Assess and Arrange.) Other studies have also addressed the lack of consistency with which providers identify smoking status, advise cessation, and provide counseling to their patients who smoke (Thorndike, 1998).

Smoke Free Mothers and Babies Program was designed using DiClemente and Prochaska’s Stages of Change model (1998) and Rogers’ Diffusion of Innovations Theory (2004) to disseminate the 5 A’s brief intervention and motivational interviewing. The 5 A’s is seen as the vehicle to disseminate change in perinatal systems, both Maternity Case Management and private Prenatal Care Providers. An important component used with the “Assist” piece of the 5 A’s is Rollnick’s Motivational Interviewing (1995). Motivational interviewing is a counseling strategy used to encourage, or motivate, behavior change (Miller, 1999). Motivational interviewing is often paired with the Stages of Change model.

Diffusion Theory is based on spreading an idea or innovation through both formal and informal communication channels. With the 5 A’s as the innovation, SFMB was charged with getting nurses excited about the changes. According to Rogers’ Theory, once 15 percent of a group adopts a new theory, others in the group will follow. SFMB planned on diffusing tobacco cessation best practices through Oregon’s Maternity Case Management System and then through the prenatal care providers.

Prior to this project, the most widely used and available cessation intervention for all Oregonians has been the Oregon Tobacco Quit Line (http://www.oregonquitline.org). Pregnant women received quit line services specifically tailored to issues around pregnancy. Services included a twenty to forty minute phone call, “Quit Kit” materials, information on local cessation programs that their insurance carrier would cover, and a later call-back. The Quit Line provided reactive services; the women who needed services had to initiate the contact.

Part of the SFMB program design was to include the Quit Line as a resource for nurses when conducting the “Assist” piece of the intervention. One variation in the standard quit line services was made. Instead of a reactive process, the quit line would be proactive, calling women who had been referred. Several organizations at that time were evaluating a fax referral process to the quit line. SFMB decided to incorporate that process and encourage public health nurses and prenatal care providers to fax their referrals, rather than simply giving the smoking client a phone number. In addition, nurses would fax client tobacco use information (including information about quit line referrals) to the client’s prenatal care provider. Thus, the three-pronged approach to SFMB was developed including nurses, the prenatal care providers, and the Oregon Tobacco Quit Line.

In an effort to focus more directly on the population of pregnant women in Oregon and address the need for nurses and providers to screen and assist women to quit smoking, the Smoke Free Mothers and Babies Program (SFMB) was developed. The goal of the program, funded by the National Dissemination office of Smoke Free Families (at the University of North Carolina at Chapel Hill, funded by the Robert Wood Johnson Foundation), was to increase smoking cessation among low income and other high risk pregnant women through introducing the 5 A’s brief intervention protocol to prenatal care providers and public health nurses. This paper addresses the portion of the program that taught public health nurses how to help pregnant women stop smoking. Activities included training nurses and providing them with client materials and streamlining existing systems that allowed nurses to use the 5 A’s with greater ease.
Ten counties in Oregon were originally recruited for the project. They were culled from a total of 36 counties in Oregon, nine of which were not eligible because of their involvement in another Smoke Free Families Project or their lack of a Maternity Case Management (MCM) program. Out of the remaining 27 counties, 10 agreed to participate. During the course of the project, two counties discontinued their participation.

In agreeing to participate in the program, County Health Department Nurses providing MCM services were required to recruit pregnant women who smoked into the project and to provide additional documentation, including a project consent form, the client’s reports on smoking cessation activities by their provider during prenatal visits, and a client postpartum survey. Nurses were required to complete three surveys during the course of the project. Finally, the “Five A’s Intervention Record” (FAIR) Form was introduced, which required public health nurses to document use of the cessation interventions by checking boxes, rather than through written progress notes.

The 5 A’s
The U.S. Public Health Service’s Clinical Practice Guidelines (Fiore, et al., 2000) recommend the use of the 5 A’s as a brief clinical intervention for health care providers. After reviewing the results from randomized clinical trials involving the 5 A’s brief intervention, Melvin et al. (2000) recommended the 5 A’s for use in working with pregnant women who smoke. The estimated that total contact time for this procedure ranges from 5 to15 minutes, plus additional time needed to read self-help materials. Specifically, they identified the 5 A’s for pregnant women as:

Oregon’s efforts in tobacco cessation have historically focused on the general population and have depended on quit line services as the primary intervention. The Oregon Smoke Free Mothers and Babies Program (SFMB) was developed in 2002 to focus on public health nurses and prenatal care providers who work with high risk pregnant women. It seeks to increase smoking cessation among low income and other high risk pregnant women by disseminating the U.S. Public Health Service best practices, the 5 A’s (Ask, Advise, Assess, Assist, Arrange) tobacco brief intervention protocol, to public health nurses and prenatal care providers. Interventions included teaching nurses the 5 A’s, how to use stages of change for pregnant quitters and providing them with client materials. We report the survey results gathered from nurses regarding their use of the 5 A’s. Nurses were questioned at 3 intervals: at the beginning of the SFMB project, 12 months later and 24 months later. While over 45 nurses in 10 counties were involved in the program, staff turnover and budget cuts affected program evaluation and analysis of the survey responses. As a result, only 10 nurses completed all three surveys. We found that, at baseline, all of the nurses were already performing the Ask and Advise components. The training resulted in a significant increase in the nurses using Assess (p<0.05) and Assist (p<0.05) both at 12 and 24 months. We also found that there was a statistically significant increase in the use of Arrange at 12 months (p<0.01) that was not sustained at 24 months (p=0.07). We conclude that public health nurses were already routinely doing Ask and Advise; our 5 A’s program was successful in improving Assess and Assist. More work is needed to understand why increases in Arrange were not sustained. Introduction
In Oregon, tobacco cessation activities have typically occurred through the Oregon Tobacco Quit Line focusing on a broad population base. The Quit Line was established in 1998 for all Oregonians who smoked and wanted to quit. The Quit Line provides free telephone counseling to all callers, but they do no outreach: callers must contact them for services. Specific cessation interventions, while recommended, were not routinely being conducted by providers in public health or private offices. The Oregon Office of Family Health administers a home-visiting program called Maternity Case Management (MCM) for high-risk pregnant women. The program is funded through the US Title V program and the Oregon State Medicaid Program. State rules for the MCM program required that tobacco use be assessed for every client. Those clients who smoked were considered “high-risk” and could receive additional services. However, specific methods for assessing tobacco use were not spelled out for nurses. Nurses had received little information and training regarding tobacco cessation or motivational interviewing. They were also unfamiliar with cessation resources.

Because female inmates tend to serve shorter sentences, it is of particular importance that specific health issues be tackled while they are incarcerated. This is very applicable to women in jails, which tend to house pretrial detainees and inmates with sentences of a year or less. In California, for instance, the average jail stay in 2004 was approximately 20 days, and many inmates make bail in a day or two (California Board of Corrections, 2005). This creates a debate about how much health care should be delivered to these short-term populations, and whether the jail is the most appropriate place for public health interventions (see Leach, 2004).

Glaser and Greifinger (1993, p. 143) recommend devoting attention to communicable disease, in the form of treatment and prevention, an effort which can “yield broad social benefits.” The time to identify these problems is at intake, when screenings for STDs, HIV, and certain chronic health problems can be done (Kane & DiBartolo, 2002; Lindquist & Lindquist, 1999). Identifying tuberculosis and hepatitis exposure is also necessary (Glaser & Greifinger, 1993). Intake procedures may identify diseases in their early, more treatable stages, which can be addressed more cost effectively than when such issues have advanced (Acoca, 1998). Finally, pregnancy screenings should be performed at intake as well. This early identification allows pregnant inmates to begin receiving appropriate prenatal care, including special diets. It also alerts medical care providers to foreseeable complications that might arise with the pregnancy or birth (Parker, forthcoming).

While adequate and quality healthcare in correctional facilities faces many challenging obstacles, a few promising programs have been developed and implemented in prisons/jails across the country in the past decade, especially those focused on inmates with mental illnesses (Hills, Siegfried, & Ickowitz, 2004). Maryland, Oregon, and Texas have established programs, identified by the National Institute of Corrections as successful, that seek to enhance the treatment and services provided to offenders. Maryland’s Community Criminal Justice Treatment Program, Oregon’s Department of Corrections’ Mental Health Program, and the Texas Department of Criminal Justice’s Correctional Health Care/Mental Health Services Program all include comprehensive screenings for mental illness and substance use as well as ongoing therapy, medication, progress evaluations, and individualized and group counseling (Hills et al., 2004). Additionally, Maryland’s program is currently provided solely to women and has plans to offer additional services to pregnant and postpartum inmates. Finally, these programs also have been deemed as successful — or at least promising — in that they view treatment as an ongoing process, thus providing aftercare and transition services to inmates leaving the facilities (Hills et al., 2004).

Given the issues discussed throughout this paper, it is important to reiterate the complexity of the factors that underlie the issue of providing adequate and appropriate mental and medical health care to female inmates. The provision of care for these inmates must be realistic in what it can accomplish and that, given the scarce resources and limited means available for their care, education and the treatment of communicable diseases should be the main priorities. It is inevitable that many of these inmates will eventually be released from prison. Educating these women regarding signs, symptoms, and prevention and treating any serious, debilitating, and transmittable diseases that they have are issues that must be at the forefront of any conceivable health care policy for women in prison.

Problems

One significant consideration with regard to inmates is that the socioeconomic and other challenges faced prior to incarceration are also faced by women in similar straits who are not offenders, and thus, are unable to benefit from the health care — even that which is minimal — within correctional facilities. More consideration should be given, then, to provision of health care services that would benefit all women in need, not merely devoting that benefit to women who offend. In this way, the social safety net of last resort need not be correctional facilities.

Ultimately, policymakers who determine what activities to criminalize must be realistic about the cost of their decisions (e.g., three strikes laws, the “War on Drugs”). Outlawing specific behaviors and “get tough on crime” mentalities have long-term costs beyond building cells for inmates (for example see Bush-Baskette, 2000; Tonry, 1995). Health care for inmates is among these costs, one that can be particularly high given that some populations are going to place greater financial demands on a correctional health care system, even for basic care alone. As noted by Marquart et al. (1996, p. 352), “Incarcerating more women, coupled with their unique health demands, will be a costly crime control policy.” Moreover, the costs of health care increase threefold as inmates age (see Aday, 2003). As an alternative, legislators and corrections officials might be better served by learning about women at risk of falling into the criminal justice system and creating interventions that would be more cost-effective than correctional supervision (Fearn & Parker, 2004).

Correctional administrators need to consider how their policies can affect the health care for inmates, both those which are specific to care itself and those which affect that care indirectly. This includes distinguishing between offering treatment and programming and being capable of providing that to all inmates who require care. As our data indicate, there appears to be a discrepancy between the types of services corrections officials report exist, and what inmates actually receive.

Opportunities

Incarceration can provide an opportunity to improve health for people “whose risk factors and infection prevalence rates far exceed those of other populations” (Glaser & Greifinger, 1993, p. 139). It is an opportunity that can help inmates. It is also one that can help others who may be affected by the health problems of inmates—unfortunately, release from a correctional facility is no guarantee that an individual will cease engaging in risky behaviors that can expose others in the community. Addressing these problems — especially through education and treatment of particular health conditions — in correctional facilities may be an important preventive measure for all.

Educating inmates about their health while they are incarcerated is an investment that empowers these women and may reduce the burdens they present to health care systems, both in correctional facilities and in the community for those who are released. Given the lack of education that many of these women have about health issues (Ammar & Erez, 2000; Maeve, 1999), providing them with information about a variety of health issues — such as basic preventive care, family planning, disease prevention, and the like — has the potential to make a constructive difference in their lives. Ross and Lawrence (1998) suggest helping inmates to develop skills and esteem that would enable them to avoid risky behaviors. They also suggest that educating women about navigating the health care system, encouraging the development of positive attitudes toward wellness, and providing direction and referrals for women facing release with regard to post-incarceration health care options such as Medicaid.

Medical care providers and the inmates they treat place different weight on empathy. Women in Young’s (2000) study placed a priority on empathetic care, valuing some level of personal interest on the part of providers caring for them as well as respect and a willingness to listen. Accordingly, “[e]mpathetic treatment requires being aware of and understanding the needs, feelings, and views of others” (Young, 2000: 228). However, as discussed above, medical professionals construe the level of empathy they demonstrate within the context of having to balance that emotion with distancing themselves from inmates (Ammar & Erez, 2000). Medical professionals articulate a need to “protect” themselves, maintaining distinct boundaries between the professional and personal aspects of the care provided, as well as having concerns about the personal safety of the care providers. This arises from concerns about the risk of violence, as well as from concerns about being manipulated and deceived by inmates. In addition to using manipulation and/or deception, inmates might also malinger — intentionally feigning or exaggerating physical or psychological symptoms for person gain (see Allen & Bosta, 1981; American Psychiatric Association, 2000; Sykes, 1958). Although these behaviors may take many forms — and are attempted for many reasons (e.g., to increase goods and services, avoid work, gain autonomy or safety, see Sykes, 1958) — once an inmate has been recognized as a malingerer, staff are more likely to “dismiss legitimate…requests for help” (American Psychiatric Association, 2000). On the other hand, are those malingering inmates who are never identified and are “automatically” provided treatment for whatever symptoms or ailments they report (American Psychiatric Association, 2000).

Prison inmates often try to manipulate prison staff, and it has long been recognized that they have much to gain and little to lose in these attempts (see Allen & Bosta, 1981). For example, Lindquist and Lindquist (1999) describe several motivations for seeking medical attention that have no basis in actual need, including obtaining drugs. These prescriptions could be for personal use or, as Ammar and Erez (2000, p. 24) note, as coveted commodities in “inmates’ informal market system.” This assertion can be contrasted with that of an inmate in Mahan’s (1984) study, who felt that it was easier to get illegal drugs within the prison than to get legally prescribed medications. Maeve (1999) reports an interesting cycle of skepticism and exaggeration demonstrated by staff and inmates in the facility she studied. Because care was often delayed in the prison, some inmates exaggerated their symptoms to receive more expedient care. Such observations confirm the notions of the medical care providers that they were being manipulated and increased their resistance to being duped. Maeve (1999), however, argued that actual instances of manipulation among prisoners were rare. Skepticism may also be necessary to providing appropriate health care itself. Kane and DiBartolo (2002) found, on occasion, a problem among false reporting by some jail inmates of health conditions they did not have, or a failure to admit candidly those behaviors that might put them at risk for particular illnesses. This required, then, that assertions made by inmates be substantiated by appropriate testing. As a result, some level of skepticism on the part of medical care providers within correctional facilities is clearly warranted.

Conflicts that exist between the perceptions of inmates and their care providers include differing definitions of and expectations regarding health as well as who is responsible for achieving health. Whereas society generally, and by extension care providers in correctional facilities, sees health care as being a matter of “personal responsibility,” Maeve (1999) argues that women prisoners often see their health care as being in the hands of providers. Thus, inmates are expected by providers to participate in the joint venture that is “health,” although this appears unclear to the women.

In addition to not clearly understanding their role in health promotion, inmates often face challenges that prevent them from taking an active role in achieving improved health. In large measure this is due to the “dependence demanded by the nature of prison” (Maeve, 1999, p. 66). Often, health care is subordinated to institutional needs, creating tensions between medical care providers and other corrections officials. According to one physician, front-line corrections officers believe that “the medical needs are not as important as safety” (Ammar & Erez, 2000, p. 24). On one end of the spectrum, this can include an inability to engage in self-care for minor problems such as headaches or menstrual cramps (Acoca, 1998). Other women, who may be aware of how to treat their medical conditions, may have less discretion in the treatment options for addressing their particular needs. For example, diabetic women in the facility studied by Maeve (1999) had no ability to calibrate their insulin doses to correspond with their dietary intake. At the opposing end of the spectrum are situations, such as that described by Ammar and Erez (2000), in which a doctor’s efforts to get a woman with serious heart problems transported to an outside specialist were thwarted by a corrections officer’s unwillingness to drive the woman to the cardiologist because of fog. This then may result in a perception that women are not sufficiently compliant with regard to taking responsibility for their health, despite the fact that “substantive health care is available within an environment capable of enforcing expected health care behaviors” (Maeve, 1999, p. 51).

A delay in the medical care received is also a considerable complaint of inmates, one which often combines with their perceptions of inadequate care. For example, women in Young’s (2000) study reported lengthy gaps between reporting a condition and receiving the proper care for that problem. According to one woman, “Somebody can be almost dying or whatever in here, and they just take their time about things” (Young, 2000, p. 226). Once care is provided, it is also perceived as inadequate (Belknap, 1997; Young, 2000). From the perspective of medical care providers, however, staffing levels are often a factor in this delay. The resources for providing specific services may also be limited, which necessitates transporting women to outside care providers—a cumbersome task laden with red tape.

Many of the reported negative perceptions held by medical care providers in correctional facilities are derived from studies that seem to reflect assumptions of scholars rather than the actual feelings of the care providers themselves. As admitted by Dabney and Vaughn (2000, p. 178), “we know very little about the men and women who work in this field.”

Providing care in women’s correctional facilities has an air of chaos about it. As one nurse stated, “Health delivery here is like the emergency room. Everything is noisy, done in a hurry and everyone is overworked” (Ammar & Erez, 2000, p. 20). The challenges of correctional health care create cynicism on the part of some treatment staff. An example of this is the response of one care provider to an inmate’s sinus problems, in which the provider commented that “if you were on the street you’d be smoking rocks or shoving cocaine up your nose . . .” (Maeve, 1999: 63). Dabney and Vaughn (2000) attribute some of these negative perceptions of inmates to penal policies that dehumanize inmates and make them seem unworthy of care. Maeve (1999: 63) reports the frustration of medical care providers to being overwhelmed by sick call requests from women at the prison, described as being “preoccupied” with their bodies and some of whose complaints were “elusive” and incapable of being ascertained. Additionally, care providers feel it is important to “remember that [inmates] are here for a reason,” no matter how concerned they are for their patients (Ammar & Erez, 2000, p. 23). Ross and Lawrence (1998, p. 128) caution, however, medical care providers in correctional facilities to “adopt a less judgmental approach to their patients.”

Not all care providers share these stereotypes and are instead genuinely concerned about the women for whom they provide care. This is a notion explored by Ammar and Erez’s (2000) research and is a factor that distinguishes their study of health care in Ohio’s women’s prisons from other studies that feature the voices of those involved in correctional life. Care providers interviewed by Ammar and Erez (2000) expressed pride in their work and indicated that the difficulties were outweighed by the benefits of being able to see marked improvement in the women they treated. Additionally, some of the care providers noted their feelings that women were more amenable to being rehabilitated — physically and otherwise — than men.

A recurring theme in this research is one of having to balance empathy with distance and professionalism with compassion. Some of the caution that care providers deploy is motivated by concerns about hostile responses from inmates who do not succeed in getting what they want. One nurse commented that, upon refusing the request of an inmate, the inmate became abusive and went “out of her way to try to make the medical staff and medical service here look terrible” (Ammar & Erez, 2000, p. 23). Other concerns reported focused on not being manipulated by inmates, who might be seeking medical attention for drugs or simply to break up the monotony of life in a correctional facility, avoid work, and the like (Lindquist & Lindquist, 1999; Marquart et al., 1996).

How inmates and their care providers perceive the health care in correctional facilities is invaluable in the areas of disagreement it reveals between these stakeholders. Each group has different perceptions of what is possible and what each is expected to contribute to the effort. Examining the concerns of each group is highly valuable for the purposes of illustrating how disagreement arises with regard to this sensitive issue. Understanding the respective positions of each group may be useful for preventing some conflict over health care.

Some caution must be used when reporting outcomes of studies that examine the perspectives of inmates or their caretakers regarding the care received and provided. Many of these studies focus on a single facility or system making some of their findings hard to generalize (Ammar & Erez, 2000; Belknap, 1997; Kane & DiBartolo, 2002; Lindquist & Lindquist, 1999; Maeve, 1999; Vaughn & Smith, 1999) and some have small sample sizes (Kane & DiBartolo, 2002; Maeve, 1999; Mahan, 1984; Young, 2000). Some of the studies may focus only on the perspectives of a single group, leaving out the views of others who may have alternative explanations. Furthermore, each group may have its own biases that color their statements—such as wardens who want to conceal limitations within their correctional program or prisoners who may be motivated by either ill will or unrealistic expectations regarding health care treatment.

Perceptions Held by Inmates
Increasingly, scholars studying corrections are seeking to include the narratives of female inmates, whose voices had long been disregarded (Young, 2000). The purpose is to validate the experiences of these women, as well as to provide insight into problems in correctional health care.

Some inmates have articulated the view that “prison was their ‘big chance’ to get healthy,” in light of their prior lack of access to this resource (Maeve, 1999, p. 62). Medical care in corrections may also be perceived by inmates as a defense against the hostile nature of prisons and jails (Mahan, 1984). This optimism, however, can be dashed by the realities of what is possible within correctional health care systems, where limitations include not only scarce resources, but also concerns for safety and the need to maintain boundaries between the care providers and the women they treat (Ammar & Erez, 2000).

Women prison inmates studied by Young (2000) — whose findings echo similar observations made by Dobash et al. (1986) — generally held negative views of the health care they received while incarcerated. Although these perceptions were somewhat mitigated by instances of care they perceived as empathetic and adequate, the overall consensus was one of treatment that was nonempathetic — characterized by disregard for the patients and an abrupt manner in personnel — and inadequate — characterized by care that was considered incomplete, unresponsive, delayed, or misdirected. With regard to adequacy, some women sought a different type of medication than was prescribed, perceived that they had been misdiagnosed, or that care was delayed beyond reasonable lengths of time. Complaints about nonempathetic care were found among all the women studied. Of greatest concern to the women Young (2000, p. 228) interviewed was the sense that the prisoners had been “lumped together” by care providers whose perceptions appeared to include specific stereotypes about the prisoners, such as their being unworthy of good-quality care, drug-seekers, responsible for their own health problems, and so forth.

Another problem reported in studies of inmates’ perceptions of their health care indicates a view that medical providers are apathetic toward the needs of inmates (Belknap, 1997; Dobash et al., 1986; Maeve, 1999; Mahan, 1984; Young, 2000). This view is exemplified by one prisoner’s sense that “They don’t seem to care what happens to you. They just do what they have to do…. If it’s not the right time, right day, if it’s not convenient or whatever, you could suffer and die and it wouldn’t really matter” (Mahan, 1984, p. 375).

Briefly, corrections officials report a broad range of services that are available to inmates; however, the processes through which inmates must go to attain these services remain unclear. Likewise, prior research has demonstrated that there is sometimes a disconnect between the services or programs that are said to exist and those that are actually available (Murphy, 2003).
Corrections officials also reported having various medical health services, including testing for serious and communicable diseases. Approximately 63 percent of facilities test inmates for Hepatitis C; 47 percent vaccinate inmates against Hepatitis B; 68 percent test inmates for HIV; and 62 percent screen inmates for TB. However, very few of the officials reported that their policy mandates that all inmates receive these tests or services. Most corrections officials report policies for testing and vaccinating inmates that pertain to high-risk groups, inmate requests, clinical indication, or when treatment is recommended by a physician.

Corrections officials also reported regarding mental/emotional health services. Sixty percent of officials reported having specific policies regarding the intake of mental-disordered inmates. More than 50 percent reported use of psychiatric evaluations and assessments while more than 66 percent reported the use of psychotropic medications. Additionally, some officials reported the availability of 24-hour mental health care (40.8 percent), therapy/counseling (59.2 percent), and assistance to inmates to obtain community mental health services (62.6 percent). However, 7.6 percent of corrections officials reported that there were no mental health services available/provided. More than 80 percent of officials reported having specific policies regarding suicide prevention. Services available/provided include assessment at intake (66.8 percent), counseling/psychiatric services (58.9 percent), and monitoring of high-risk inmates (36.6 percent).

Lastly, corrections officials reported on the availability of a wide range of education and counseling/special programs. Basic adult education, GED programs, and vocational training were among the most available education programs (62.9, 68.2, and 44.5 percent, respectively). Almost 13 percent of the corrections officials reported that there were no education programs in their facility. Regarding counseling and special programs, drug and alcohol dependency, employment, and life skills were the most widely available options for inmates within these facilities. However, only 1.3 percent of the corrections officials reported that there were no counseling/special programs available.

More than three-quarters of these women reported using alcohol while reports of the use of other drugs (from heroin to marijuana) ranged from 1.3 percent (“other” drugs) to 63.1 percent (marijuana/hashish). Additionally, almost one-quarter of these women reported having some kind of limiting disability ranging from difficulty seeing (8.7 percent) to mental/emotional conditions (14.2 percent).

More than 40 percent of the women surveyed reported treatment for drug/alcohol abuse at some point in their lives. Almost 31 percent stated they had received treatment while incarcerated; however, only 15 percent reported receiving any treatment since their current prison admission. Approximately 61 percent of inmates reported that the staff had checked for illness, injury, and intoxication at admission — 92 percent reported receiving a medical exam of some kind at admission. Especially important to women’s health issues, 87 percent reported receiving a pelvic exam while 85 percent stated they had been asked questions about their health and medical history.

With regard to medical testing, 95 percent of women reported being tested, at admission, for tuberculosis (TB) and 73 percent reported being tested for HIV. Approximately eight percent of women received positive TB skin test results while only 1.9 percent reported that their most recent HIV test was positive. However, 21 percent reported being injured at admission and almost 39 percent reported that they had other medical problems. Additionally, emotional/ mental problems were reported by almost one-third of the inmates and approximately 31 percent stated that they received some sort of counseling or therapy. Twenty-two percent of the women reported receiving medication for this problem, while 13 percent reported overnight programming and five percent received “other” mental health services. These inmates also reported participation in a wide variety of programming during incarceration. These included, for example, religious study groups (39.9 percent), prisoner assistance groups (8.9 percent), life skills classes (22.2 percent), and drug/alcohol groups (42.5 percent) as well as others (e.g., arts/crafts programs, pre-release programs, community-based programs). Altogether, these results indicate that many women are receiving at least some basic level of medical and mental health testing and services along with opportunities to participate in activities related to improving their chances for success upon reentry in their communities (e.g., life skills, job training).