has many benefits, including the early detection and treatment of disease and the opportunity to modify behaviors that increase the risk of acquiring new diseases. However, preventive healthcare is not universally available. Well-established barriers to healthcare, such as a lack of health insurance, homelessness, mental illness, and substance use, are common in incarcerated women.1
In addition, minority women, who already experience disparities in health outcomes, are overrepresented in jail and prison.2
As a result of these barriers, women who are released from jails and prisons are at great risk for multiple preventable illnesses and are not receiving adequate preventive healthcare in their communities.
Several research studies have highlighted this discord between need and access to medical care in this population. In a study at an Oregon county jail, 60% of female inmates had self-reported poor health.3
The Department of Justice noted that 53% of female inmates (compared with 35% of males) reported a medical problem at the time of entry into jail.4
Despite this high rate of medical problems, one study found that approximately one third of inmates in Massachusetts had not gone to a medical provider when they were ill in the 12 months preceding their incarceration because of cost.5
Similarly, only approximately half of 511 female inmates released from New York City jails with a chronic medical or psychiatric illness received primary care within 12 months of release.6
Incarceration, therefore, presents a unique opportunity to engage underserved women in preventive medical care. Individuals may be incarcerated in a jail, which typically holds those who are awaiting trial or with short sentences, or in a prison, which is reserved for inmates with longer sentences. Many usual stressors, such as housing concerns, substance use, food expenses, or child care are reduced in jail and prison, and female inmates have the opportunity to focus on their own health. Preventive health measures that are particularly relevant to incarcerated women include cancer screening (cervical and breast), infectious disease testing and immunization (sexually transmitted infections [STIs], hepatitis), and smoking cessation.
Female inmates are at particularly high risk for cervical neoplasia; inmates' rates of high-grade squamous epithelial lesions (HGSIL) are more than twice as high as that of the general population.7
The Federal Bureau of Prisons (BOP), based on guidelines from the U.S. Preventive Services Task Force (USPSTF), recommends that all sentenced female inmates receive a Pap smear at intake, and all average-risk sentenced women >40 receive mammograms every 2 years.8
These recommendations do not necessarily extend to women who are in jail rather than prison. Nonetheless, in a study of cancer screening among female jail inmates, 90% had had a Pap smear in the past 3 years, although only 41% of incarcerated women >40 years old had had a mammogram within 2 years.9
The prevalence of STIs, such as Chlamydia
infection, gonorrhea, and trichomoniasis, as well as hepatitis B and C is also several times higher among incarcerated women.10–13
Although the BOP recommends routine screening for syphilis and risk-based screening for Chlamydia
and hepatitis B and C in prison,8
the opportunity to screen and vaccinate is often missed, particularly in the jail setting.14,15
Given the overlap of injection drug use (IDU) and high-risk sexual encounters, the prevalence of HIV is also higher among incarcerated women than in the general population. HIV in correctional facilities disproportionately affects women; 2.4% of female inmates and 1.8% of male inmates were found to be HIV positive in state prisons.16
HIV screening in jails and prisons is a crucial prevention intervention among incarcerated women. In Rhode Island, routine confidential testing for HIV was begun in 1989, and from 1989 to 1999, nearly one third of all positive HIV tests in the state of Rhode Island were performed in the Rhode Island Department of Corrections (RIDOC).17
All inmates at RIDOC are offered HIV testing upon admission; we, therefore, did not include HIV testing as an outcome in our study.
Smoking is highly prevalent among incarcerated women. In a study conducted in Mississippi, 74% of female inmates were smokers, 12.5% of whom reported a smoking-related health problem.18
However, smoking cessation programs in corrections have not been reported in the literature.
In this resource-limited setting, public health efforts should focus on the most effective interventions and highest risk populations. Through patient interviews, this study explores the prevalence and efficacy of several health interventions to address some of the most common diseases afflicting women incarcerated at the RIDOC. We also identify which subpopulations of inmates would benefit most from future preventive interventions.