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Ethical, Regulatory, and Investigator Considerations in Prison Research
Abstract
Although numbers of prison inmates are increasing rapidly, limited research addresses health-related conditions prevalent in prisons. Compelling reasons exist for prison research to address high rates of psychiatric, neurological, and other health-related conditions that may precipitate or result from incarceration, high-risk behaviors, infectious disease transmission, traumatic brain injuries, and other issues related to incarceration. Prison research is critical because inmates are frequently re-incarcerated and released, posing potential risks to themselves and the community. The purpose of this article is to provide a pragmatic overview of ethical, regulatory, and investigator considerations to facilitate critically needed research with vulnerable prison populations.
... women so that they also gain social independence, thus removing them from codependent relationships and other circumstances that contribute to their criminal lifestyles. 36 Possessing job skills is the first step on the path to desistance, but more importantly, prisoners must find a career that is open to ex-prisoners, which is no easy task. Stigma limits employment opportunities and increases ostracism. ...
... In order to maintain the confidentiality of subjects, women were asked to choose their own pseudonyms, Prisoners are trained to provide counseling, educational workshops, and facilitate support groups. 36 which served as a unique identifier to describe a part of their personality. On average (of all 49 subjects), interviews took approximately one hour and fifteen minutes to complete (range of 105 and a standard deviation of 25.15). ...
... It has been found that teaching 'consequential thinking' can reduce impulsivity, which is a risk factor for many of the men at Grendon. 36 …that led onto me realising the consequences for the bigger picture and the implications for my family…even the value of the houses on the street because there was a murder there. ...
Whole families can experience serious disruptions and disadvantages when a mother is imprisoned.1 The enforced separation generated by prison creates challenges for sustaining meaningful mother-child relationships. This paper focuses on ‘family visits’; which are visiting opportunities generally designed to provide extended time and interaction between imprisoned parents and their children in the prison setting. The paper draws on the author’s doctoral research findings which explored the lives of families following the mother’s incarceration in England and Wales. Qualitative data was collected from in-depth, semistructured interviews with fifteen imprisoned mothers and twenty-four caregivers (comprised of family members and friends) looking after children of female prisoners. Chiming with previous research, thematic data analysis revealed how family visits were highly valued and appreciated by families as they provided a special opportunity to engage in more ‘normalised’ family practices. However, extending prior knowledge, this study also identified how institutional barriers in the prison setting could hinder or prevent families from accessing and participating in family days. Practical recommendations attempt to respond to these issues, and to improve access and support for mother-child relationships during the mother’s incarceration.
... women so that they also gain social independence, thus removing them from codependent relationships and other circumstances that contribute to their criminal lifestyles. 36 Possessing job skills is the first step on the path to desistance, but more importantly, prisoners must find a career that is open to ex-prisoners, which is no easy task. Stigma limits employment opportunities and increases ostracism. ...
... In order to maintain the confidentiality of subjects, women were asked to choose their own pseudonyms, Prisoners are trained to provide counseling, educational workshops, and facilitate support groups. 36 which served as a unique identifier to describe a part of their personality. On average (of all 49 subjects), interviews took approximately one hour and fifteen minutes to complete (range of 105 and a standard deviation of 25.15). ...
... It has been found that teaching 'consequential thinking' can reduce impulsivity, which is a risk factor for many of the men at Grendon. 36 …that led onto me realising the consequences for the bigger picture and the implications for my family…even the value of the houses on the street because there was a murder there. ...
This paper explored the impact on the Fathers who are separated from their children through imprisonment
... women so that they also gain social independence, thus removing them from codependent relationships and other circumstances that contribute to their criminal lifestyles. 36 Possessing job skills is the first step on the path to desistance, but more importantly, prisoners must find a career that is open to ex-prisoners, which is no easy task. Stigma limits employment opportunities and increases ostracism. ...
... In order to maintain the confidentiality of subjects, women were asked to choose their own pseudonyms, Prisoners are trained to provide counseling, educational workshops, and facilitate support groups. 36 which served as a unique identifier to describe a part of their personality. On average (of all 49 subjects), interviews took approximately one hour and fifteen minutes to complete (range of 105 and a standard deviation of 25.15). ...
... It has been found that teaching 'consequential thinking' can reduce impulsivity, which is a risk factor for many of the men at Grendon. 36 …that led onto me realising the consequences for the bigger picture and the implications for my family…even the value of the houses on the street because there was a murder there. ...
... Women are more likely to commit violent crimes now than in the past. During recent decades, imprisonment rates have risen exponentially for women in the United States (Court Services and Offender Supervision Agency [COSA], 2016) who represented 18% of all arrestees for violent felony offenses in 2008, up from 11% in 1990(WCWG, 2011. Most studies of violence while the perpetrator was under the influence of substances do not separate alcohol's effects from that of other illicit substances. ...
... Briefly, data were collected by the first author during individual private interviews and examinations of female prison inmates who were recruited from minimum and maximum-security sections of a women's prison in the Mid-Atlantic region of the United States. All federal regulations related to research with prisoners were adhered to (Brewer-Smyth, 2008). All inmates signed informed consent forms approved by the University of Pennsylvania or University of Delaware Institutional Review Boards. ...
... Inmates were less likely to report, at the time of the crime, substance use to law enforcement or correctional authorities in fear of reprehension, especially if the offender was not apprehended until hours or days after testing could detect substance use. The informed consent forms signed by participants, as required by federal mandates (Brewer-Smyth, 2008), explained that participation in this research would have no influence on their sentence, time served, probation, parole or treatment by prison staff; and to discourage inmates from providing false information, they were informed that no one would have access to their individual responses Additionally, self-reports of alcohol use have been shown to be reliable (Sobell & Sobell, 1988) and are used in most studies (Robinson, Sobell, Sobell, Arcidiacono, & Tzall, 2014). ...
Purpose:
We investigated women under the influence of alcohol compared with other illicit substances at the time of committing a crime to identify predictors of being under the influence of alcohol and female-enacted crime.
Methods:
Analyses of data, obtained from private interviews and examinations of female prison inmates, included regression analyses exploring predictors of being under the influence of alcohol at the time of the crime and predictors of violent crime. In addition, a reanalysis of a previously reported model, predicting conviction of a violent crime, was conducted including a new variable, being under the influence of alcohol at the time of the crime.
Results:
Those under the influence of alcohol at the time of their crime had experienced greater nonfamilial childhood sexual abuse and traumatic brain injuries with loss of consciousness predating their crime. They were more likely to have committed a violent, rather than nonviolent, crime compared with those under the influence of other substances, with the latter being not significantly different for those not under the influence of any substance. Being under the influence of alcohol increased the risk of committing a violent crime, adjusting for other predictors of female violence.
Conclusion:
Women under the influence of alcohol are at a greater risk for committing violent crimes than those under the influence of other substances. Female nonfamilial childhood sexual abuse and traumatic brain injury victims were at a higher risk for being under the influence of alcohol, in comparison with other substances, at the time of committing a violent crime.
... Ultimately, we suggest that our text is more process and less policy focused and therefore ultimately contributes to quite a different and distinct perspective on prison health research. We hope that this first book to explicitly focus on issues and innovations associated with prison health research also contributes to a small but important literature on ethics in prison research (Arboleda-Flórez 2005;Brewer-Smyth 2008;Crighton 2006;Fine and Torre 2006;Freudenberg 2007;Gostin 2007;Hornblum 1997;Moser et al. 2004;Overholser 1987;Pope et al. 2007;Shaw et al. 2014;Ward and Bailey 2012). Ethical issues are at the forefront of any research study, but arguably require more careful consideration in a prison context where notions of informed consent, for example, are more complicated. ...
... Within the wide range of literature exploring aspects of ethical considerations associated with prison health research (Arboleda-Flórez 2005;Brosens et al. 2015;Brewer-Smyth 2008;Crighton 2006;Eldridge et al. 2011;Freudenberg 2007;Gostin 2007;Lazzarini and Altice 2000;Pope et al. 2007;Simpson et al. 2017;Silva et al. 2017;Ward and Willis 2010;Weijer et al. 2011), a number of themes emerge that resonate with the subsequent chapters of this book. For example, the literature relating to consent specifically in relation to prison health research is relatively thin with the following study aside (Waldram 1998). ...
This book constitutes the first publication to utilise a range of social science methodologies to illuminate diverse and new aspects of health research in prison settings. Prison contexts often have profound implications for the health of the people who live and work within them. Despite these settings often housing people from extremely disadvantaged and deprived communities, many with multiple and complex health needs, health research is generally neglected within both criminology and medical sociology. Through the fourteen chapters of this book, a range of issues emerge that the authors of each contribution reflect upon. The ethical concerns that emerge as a consequence of undertaking prison health research are not ignored, indeed these lie at the heart of this book and resonate across all the chapters. Foregrounding these issues necessarily forms a significant focus of this introductory chapter.
Alongside explicitly considering emerging ethical issues, our contributing authors also have considered diverse aspects of innovation in research methodologies within the context of prison health research. Many of the chapters are innovative through the methodologies that were used, often adapting and utilising research methods rarely used within prison settings. The book brings together chapters from students, scholars, practitioners and service users from a range of disciplines (including medical sociology, medical anthropology, criminology, psychology and public health).
... While the ethics forms for the two boards were not substantially different in focus, reconciling discrepant recommendations from each board extended the preparatory period of the study. For instance, offering participants an honorarium, a common practice in research, is forbidden in most incarcerated settings (Brewer-Smyth, 2008) and was authorized by one ethics review board but not the other. A compromise was reached by offering refreshments (juice or coffee and muffins). ...
... We had to not only learn ways of negotiating the space while collecting data, but also grapple with the feelings that lingered each time we left the correctional facility. For us, feeling was a way of knowing (Ferrell, 2005), as we believed that the research process was strengthened by the emotions that emerged (e.g., sorrow, powerlessness, guilt, anger, and frustration) (Arditti et al., 2010;Brewer-Smyth, 2008). The emotions grounded us and were sources of insight into the experience of conducting research with criminalized women. ...
Although women incarcerated by the criminal justice system encounter significant challenges to their health, there has been little research focusing on their health practices. To contribute to the research literature on the health experiences of criminalized women, the authors conducted a multi-method study as part of a program of research exploring the health promotion and health-literacy skills of women in conflict with the law. Conducting research in an incarcerated setting posed unique challenges and ethical dilemmas that problematized each phase of data collection. The authors share their experiences as health researchers conducting research in an incarcerated setting and with criminalized women. They document some of the challenges, successes, and valuable lessons learned during the research process in the hope that by sharing their knowledge with other health researchers they will support future studies with criminalized women.
... People in prison experience high levels of socio-economic disadvantage and poorer mental and physical health than the general community (Fazel & Baillargeon, 2011;Kinner & Young, 2018;Plugge et al., 2017). With over 10 million people in prison globally (Walmsely, 2021), a figure that continues to rise (Institute for Crime & Justice Policy Research, 2021), research to better understand their experiences has become increasingly important (Brewer-Smyth, 2008;Silva et al., 2017). ...
Studies aimed at improving the health and well-being needs of people in prison are increasing in number. The ethical and logistical challenges of conducting this research, however, pose challenges for researchers which can limit its scope. Emerging literature provides insights into these challenges, but little is focused on the Australian perspective, and most are based on the experiences of recruiting and collecting data for ethnographic and qualitative research. Literature describing the challenges of conducting quantitative prospective studies in prisons is limited. Furthermore, despite the fact that people who inject drugs are overrepresented amongst prison populations, and experience higher levels of socioeconomic disadvantage and poorer health than the general prison population, we are unaware of literature describing the particular sensitivities associated with their recruitment and participation in research in prisons. We intend to address these gaps by drawing on our experience and reflecting on learnings that emerged from longitudinal research we conducted with 400 incarcerated males with recent histories of injecting drug use, in Victoria, Australia. Our aim is to provide guidance and lessons for future research.
... With a disproportionate scholarly focus on prisons, there is also a noticeable paucity of criminological research on jails. While research in a correctional setting is notoriously difficult to begin with (Brewer-Smith, 2008;Camp, 2005;O'Brien & Bates, 2003;Quina et al., 2007;Wakai et al., 2009), much of the literature on corrections staff has largely centered on job satisfaction, correctional ideology, and occupational role conflict (Kifer, Hemmens, & Stohr, 2003). There is a conspicuous dearth of scholarship focused on correctional staff assessments of the administration of jail policy and procedure, as well as jail personnel's perspectives on the effects of legislative directives on day-to-day facility operations. ...
Jurisdictions across the Commonwealth of Virginia are working to broaden and refine the implementation of community-oriented alternative sentencing programs. From the perspective of practitioners, this article examines the statutory expansion of one such alternative sanction in Virginia—nonconsecutive day sentencing (“weekend” or “part-time” jail time)—as adopted in Senate Bill No. 36 during the General Assembly’s 2018 Regular Session. Presenting mixed-methods survey results from a large sample of correctional professionals across the Commonwealth, the study finds little practitioner support for the expanded application of weekend jail programming. Based on such stakeholder input, the article discusses anticipated adverse effects of the statutory amendments passed in SB36 and argues that practitioners, with the assistance of criminal justice researchers, must lend their expertise to legislators in policy development process from proposal through implementation.
... There is a longstanding ethical debate relating to research in prisons, 36 that highlights the importance of peple in custody being able to take part in studies that they might expect to participate in, in community settings. 37 However, that the research in this literature review is so heavily focused on two prisons, raises ethical concerns relating to the research burden amongst the female people in custody and young offenders who participate in research, as well as for the staff who have to facilitate access. ...
The criminal justice system in Scotland is in many ways distinct from criminal justice systems both within the UK and Europe, which is reflected in the institutions, processes and experiences for those whose lives are affected by it. Within this context, the Scottish Prison Service (SPS) is an Executive Agency of the Scottish Government which was established in April 1993. Since having been established, a wide range of research has
been undertaken on and about the SPS throughout the prison estate that illustrates aspects of the distinct nature of imprisonment in Scotland.
... Researchers interested in the health of incarcerated people must build effective partnerships with correctional administrators based on mutual understanding and respect. A related barrier, sometimes imposed by well-meaning ethics committees, is the somewhat paternalistic and avoidable exclusion of people in prison from research on ethical grounds (80). People who cycle through prisons are entitled to special protections given their vulnerability but are also entitled to participate in research, to protect their right to self-determination, and to benefit from high-quality evidence to inform their health care (81). ...
The world prison population is growing at a rate that exceeds the rate of population growth. This issue of Epidemiologic Reviews comprises articles in which researchers summarize what is known about some of the key health issues facing people in prison, particularly in relation to human immunodeficiency virus and other blood-borne viral infections. A key recurring theme is that addressing the health needs of people in prison is important to reducing health inequalities at the population level-that prisoner health is public health. The reviews also highlight some critical evidence gaps, notably the lack of evidence from low- and middle-income countries, and the limited number of longitudinal studies in which health behaviors, health outcomes, or health service experiences after release from prison are documented. Despite growing evidence of the poor health of detained adolescents, none of the included reviews considered this population. Further research on the health of young people who cycle through juvenile detention should be a priority. Despite a rapidly growing literature on the health of people who experience incarceration, some critical health issues remain poorly understood, and there has been insufficient attention devoted to co-occurring health conditions and the consequent need for coordinated care. Key populations in custodial settings remain understudied, limiting capacity to develop targeted, evidence-based responses to their health needs. The quality of many studies is suboptimal, and although rigorous, independent research in correctional settings can be challenging, it is not impossible and is critical to laying the groundwork for evidence-based reform.
... Prisoner access issues due to lock-downs (prisoner confinement to cell) and prisoner movements within, between, and outside (e.g. court visit) the prison are well documented organizational challenges to conducting research in prisons (Quina et al., 2007;Brewer-Smyth, 2008;Cislo and Trestman, 2013). Such access issues present as significant material barriers to advancing research and health outcomes of prisoners, and sits regardless of the fact that many prisoners desire to participate in researchseeing such participation as an expression of civic engagement and a chance to "engage with non-prisoners and be treated as a person with the capacity to make valuable contributions" (Lafferty et al., 2016, p. 8). ...
Purpose
Given that prisoners have significant health needs across most areas, the paucity of prisoner health research, and the difficulties involved in the conduct of research in this setting, there is a need to develop research priorities that align with key stakeholder groups. One such group are those responsible for health service provision in prisons – prison health service directors. The paper aims to discuss these issues.
Design/methodology/approach
Prison health service directors in each Australian state and territory were invited to participate in a national (deliberative) roundtable where the consensus building nominal group technique was utilized. This involved the identification of research priorities and organizational issues in conducting research with prisoners, and ranking research priorities. A thematic analysis was conducted on organizational issues.
Findings
In total, 13 participants attended the roundtable. Participants identified 28 research priorities and 12 organizational issues. Top ranked research priorities were mental health, cognitive and intellectual disability, post-release health maintenance, ageing prisoners, chronic health conditions and Aboriginal and Torres Strait Islander health. Themes identified from the organizational issues included prisoner access to research participation, health and research literacy of custodial staff, and institutional protectionism in response to research that may discover negative information about the custodial setting.
Research limitations/implications
These findings should inform future efforts to improve research infrastructures to undertake research to improve the health of people in Australian prisons, and help to align researchers’ efforts with those of a key organizational stakeholder.
Originality/value
This is the first paper to determine the research priorities and organizational issues in conducting research in prisons of prison health service directors.
... Of those who participated, complete data were available for the variables of interest for this study for 629 participants. (Brewer-Smyth, 2008). The state Department of Corrections (DOC), research committee, and institutional review board of the principal investigator's university, an independent international research firm, and the CDC approved the study. ...
The staggering prevalence of obesity and obesity-related health conditions takes exorbitant tolls on health care resources. This cross-sectional study with private evaluations of 636 adult inmates in a southern state prison was conducted with regressions comparing obese (body mass index [BMI] ≥ 30) to nonobese individuals to define obesity risk factors. Obese individuals more likely were female, were victims of childhood sexual abuse, suffered greater severity of childhood sexual abuse, attempted suicide, reported drug dependency, were non-Caucasian, and were older than nonobese. Psychopathy predicted lower BMI. Though obesity might be expected in victims of childhood physical abuse, traumatic brain injury, or other mental health conditions due to mobility or decision-making deficits, neither were significant. Adjusting for related variables, childhood sexual abuse remained significant. Females attempted suicide more frequently and suffered greater childhood sexual abuse.
... The study was approved by the institutional review boards of the principal investigator's institutions and all participants signed written informed consents. Procedures were conducted in accordance with federal regulations for the conduct of research with prisoners (Brewer-Smyth, 2008). ...
A secondary analysis of data from adult female prison inmates in the mid-Atlantic United States defined relationships between having incarcerated adult family members during childhood and neurological outcomes. Of 135 inmates, 99(60%) had one or more incarcerated adult family members during childhood. Regression analyses revealed that having incarcerated adult family members was related to greater frequency and severity of childhood abuse and higher incidence of neurological deficits in adulthood, especially related to traumatic brain injuries, compared to those without incarcerated adult family members. Along with being role models, adult family members impact the neurological health of children throughout their lifespan.
... Yet, this topic has remained relatively unexplored, at least in part because of the challenges encountered when implementing intervention programs and conducting research in correctional facilities. [15][16][17][18] Of paramount concern is gaining (and maintaining) access. Once access has been granted, researchers often face additional barriers developing positive relationships with corrections staff and inmates. ...
Background: There are more than 200,000 incarcerated women in U.S. prisons and jails, and it is estimated that 6% to 10% are pregnant. Pregnant incarcerated women experience complex risks that can compromise their health and the health of their offspring.
Objectives: Identify lessons learned from a community–university pilot study of a prison-based pregnancy and parenting support program.
Methods: A community–university–corrections partnership was formed to provide education and support to pregnant incarcerated women through a prison-based pilot program. Evaluation data assessed women’s physical and mental health concerns and satisfaction with the program. Between October 2011 and December 2012, 48 women participated.
Lessons Learned: We learned that providing services for pregnant incarcerated women requires an effective partnership with the Department of Corrections, adaptations to traditional community-based participatory research (CBPR) approaches, and resources that support both direct service and ongoing evaluation.
Conclusions: Effective services for pregnant incarcerated women can be provided through a successful community– university–corrections partnership.
... Protective regulations to address this vulnerability are encapsulated in Subpart C (45 CFR 46, Subpart C; Protection of Human Subjects, U.S. Department of Health and Human Services, 2009) and include several requirements, including the need for a prisoner representative on all IRB reviews of correctional research protocols and restrictions on the types of research in which prisoners may participate. These added protections, along with other factors related to the nature of correctional settings, have unintentionally created barriers to conducting research with incarcerated populations, and have resulted in limitations in the access to research and its benefits for individuals in correctional settings (Brewer-Smyth, 2008;Hammett & Dubler, 1990;Harris, 2001;IOM, 2006;Kalmbach & Lyons, 2003). ...
Being disproportionately represented by individuals living with HIV/AIDS, correctional facilities are an important venue for potentially invaluable HIV/AIDS epidemiological and intervention research. However, unique ethical, regulatory, and environmental challenges exist in these settings that have limited the amount and scope of research. We surveyed 760 HIV/AIDS researchers, and IRB chairs, members, and prisoner representatives to identify areas in which additional training might ameliorate these challenges. Most commonly identified training needs related to federal regulations, ethics (confidentiality, protection for participants/researchers, coercion, privacy, informed consent, and general ethics), and issues specific to the environment (culture of the correctional setting; general knowledge of correctional systems; and correctional environments, policies, and procedures). Bolstering availability of training on the challenges of conducting HIV/AIDS research in correctional settings is a crucial step toward increasing research that will yield significant benefits to incarcerated individuals and society as a whole.
... Research can provide access to services and determine the most effective interventions for this underserved population, but regulatory, ethical, policy, and structural challenges have limited the growth of research in correctional settings (Brewer-Smyth, 2008;Harris, 2001;IOM, 2006). ...
Purpose: Given the high rates of HIV/AIDS and related risk behaviors in individuals who pass through correctional settings, incarceration offers an opportune time for HIV/AIDS prevention and treatment research with this population. Unfortunately, various challenges have limited the growth of HIV/AIDS research in correctional settings. This is the first empirical study to investigate specific recommendations for researchers in the conduct of HIV research with incarcerated populations. Methods: Based on literature reviews and snowball sampling, a nationwide sample of 92 individuals with experience in the conduct or oversight of HIV-related research in correctional systems participated in a 60-90 minute key informant interview conducted by telephone. The sample included 30 researchers, 15 prison administrators, 15 research ethicists, 16 IRB members or chairs and 16 IRB prisoner representatives. Interviews were audio-recorded, transcribed and analyzed using NVIVO software for qualitative data analysis. The current analysis focused on the question: "Within the context of HIV/AIDS research with incarcerated people, what are the three most important things you would tell someone embarking on this kind of work?" Results: An frequent theme that emerged was the importance of collaborating with all stakeholders involved in all stages of your research, including the correctional system staff, participants, regulatory oversight bodies, and experts in the field. Another key recommendation is to be knowledgeable about the stakeholders you are working with, along with the rules and regulations of the systems you are working with. And finally, when working with participants, be sure to ensure informed consent, respect for persons, and the principles of beneficence and justice. Conclusions: This study is an important step towards addressing the challenges of HIV/AIDS research in correctional settings and developing solutions to continue the growth of this type of research. However, more research is needed to further expand these areas of recommendations and to sample a wider range of respondents with experience in HIV/AIDS research with incarcerated populations.
... Schofield, Butler, Hollis, & D'Este, 2011) Reporting false information for secondary gain was limited or eliminated based on federally required informed consent for studying prison inmates and certificates of confidentiality. (Brewer-Smyth, 2008) For example, informed consents must clearly include in advance that participation in research has no effect on parole. A confidentiality certificate issued by the National Institutes of Health (NIH) protected identifiable research information from forced disclosure. ...
This study tested the hypothesis that obesity is related to history of traumatic brain injury (TBI), severity and frequency of childhood physical (CPA) and sexual abuse (CSA), and suicide attempts, adjusting for related variables in a high risk female population.
This cross-sectional study of 81 females compared obese to non-obese.
All variables were verified by private interviews, physical examination, and documented evidence, then statistically analyzed with logistic regression.
Obesity at the time of interview was related to history of a decreased number of TBIs per person, greater CSA, suicide attempts, and decreased CPA, adjusting for current smoking, depression, currently using selective serotonin reuptake inhibitors, and age.
Number of TBIs per person and CPA were inversely related to obesity, adjusting for related variables. Greater CSA frequency and severity, and having attempted suicide were significantly related to greater risk of obesity, adjusting for related variables. Though causes of obesity cannot be determined by this design, and findings should be viewed with caution, this study provides new insight into the obesity epidemic that requires further investigation.
Rehabilitation nurses are in ideal settings when patient's conditions are less acute, providing opportunities to address complex serious underlying etiologies of obesity. Obesity has not been alleviated by teaching about diet and exercise because obesity may be the result of dietary self-medication of pain from previous experiences. CSA is a very serious problem that could precipitate suicide attempts, obesity, and multifaceted poor health outcomes throughout the life span; subsequently placing individuals at greater risk of requiring rehabilitation services.
... Prison ers' confinement in punitive institutions is a fact that places unique stresses on the relationship between re searcher and participant. The restricted choices avail able within the prison setting and the limited nature of economic freedoms could mean that incentives to participate in research that would appear trivial to those at liberty can seem persuasive (17,18). ...
Health care provision in prisons is an area of increasing international concern. The spectrum of health problems which prisoners may bring to prison is wide and in many cases prevalence is greater than in the general population.The profound knowledge of delicate issues such as medical confidentiality and informed consent of the patient, with special refer to infectious disease, hunger strike and prison research is necessary in the prison working environment. In the following paragraphs the European and International conventions and guidelines on the matter are discussed.
... The challenges of conducting research in corrections have been well documented (Brewer-Smyth, 2008; Kalmbach & Lyons, 2003; Quina et al., 2007) and the need for developing a research infrastructure has been duly noted (Magaletta et al., 2007; Trestman, 2005). Simply documenting the concerns, however, does not bring us any closer to conducting applied research and implementing evidence-based practices to provide effective treatment to inmates. ...
Research in correctional settings has progressed from the exploitation of a vulnerable population in the years prior to 1978 to its current overly protective and restrictive state. With the considerable growth in the numbers of inmates with medical and mental health care needs, developing effective interventions to serve this population is paramount. There now appear to be signs of interest in and support for research with inmates by correctional agencies, academia, and health care organizations. Innes (2003) has articulated the following strategies for implementing research in prison: (1) gather stakeholders; (2) include one or more experienced research collaborators; (3) consider obtaining technical assistance from a university or the National Institute of Corrections (NIC); (4) define potential opportunities/interests that support the institution's mission; (5) develop a relationship with an IRB; (6) pilot a small proposal that is of interest and potential value to the organization. The authors illustrate the implementation of a study in a correctional system that uses these strategies.
Survivors of trauma can thrive, not just survive. Resilience is the ability to bounce back with positive outcomes despite adversity. Part IV explains how to thrive and be resilient with a wide array of various different approaches that are important for everyone, regardless of the severity of exposures to adversities. The purpose of this chapter is to introduce Part IV and to address how to promote resilience through protective experiences, prevention, and compensatory experiences in relation to trauma. Resilience training is described. The remaining chapters of this book focus on optimizing brain function, which is critical for everyone, not just survivors of trauma, though trauma survivors are at greater risk as described in previous chapters.KeywordsAdverse childhood experiencesACEsTraumaResilienceResilience trainingProtective experiencesACE preventionCompensatory experiencesMental healthBrain healthCommunity supportFamily supportGovernment supportBrain healthPosttraumatic stress disorder (PTSD)PTSD
Neurobiology of female homicide perpetrators is not well understood. Data from private interviews and examinations of females were re-analyzed comparing those who committed homicide ( n = 9); other violent crimes, no known homicide ( n = 51); nonviolent crimes, no known violent convictions ( n = 49); and noncriminals ( n = 12). Homicide perpetrators suffered the most childhood sexual abuse (CSA); most recent abuse; had the most neurological histories, mainly traumatic brain injuries (TBIs); most health care access for abuse-related injuries; lowest AM and PM salivary cortisol; and greatest proportion who committed crime under the influence of alcohol. Only CSA, years since last abuse, TBI, neurological histories, and health care access for abuse-related injuries were significant. Those who committed homicide under the influence of alcohol suffered the most recent abuse and had the lowest AM cortisol and flattest diurnal cortisol slope (DCS) compared with others; though the n precludes determining significance. Amount of time since last abuse, AM cortisol and DCS progressively decreased as crime severity increased; other variables progressively increased as crime severity increased. These preliminary findings suggest that low AM cortisol, flat DCS, greater CSA frequency and severity, recent abuse, TBIs, and health care access for abuse-related injuries could be risk factors for females committing homicide. Further study is needed due to the small n of homicide perpetrators. Abuse victims may be at greater risk for alcohol use and cortisol dysregulation associated with perpetrating violence, especially homicide. Frontal lobe damage from TBIs may decrease ability to control behaviors associated with emotions from the limbic system. Health care providers released these women when their abuse-related injuries were not life-threatening; yet, they were life-threatening for victims of their subsequent homicides. Females accessing health care for abuse-related injuries present a critical opportunity for violent crime prevention interventions.
This chapter begins by establishing an historical trajectory of face-to-face research with prisoners. It goes on to identify fundamental features of prisons and prisoners’ lives that make them sensitive settings and populations for researchers to study, and it then presents ethical considerations that researchers must be mindful of when carrying out this kind of research. Ethical concerns both within and beyond the scope of formal Institutional Review Boards are outlined and explored, as are researcher strategies for managing boundaries and emotions when doing prison research. To the extent that ethics, emotions, researcher presentation of self, and similar themes have been written about within the context of prison research, they have primarily been framed as considerations for qualitative field researchers. By way of contrast, an underlying assumption of this chapter is that those who do other forms of face-to-face research with prisoners, including quantitative self-report surveys, mixed-method approaches, and focus groups, should similarly engage with these themes. This chapter ultimately endorses being reflectively engaged with the setting, the research process, and oneself when doing face-to-face research in prisons, regardless of the substantive goals of one’s study or the particular research methods one employs. Accordingly, the issues raised in this chapter will be relevant to a range of health and social science researchers who enter prisons to study prisoners.
Little is understood about childhood traumatic brain injury (TBI) and lifetime violent crime perpetration.
The purpose was to evaluate TBI before the age of 15 years and other childhood environmental factors, mental health, and lifetime history of committing a violent crime.
A cross-sectional study of 636 male and female offenders from a southeastern state prison population was conducted using Chi-squared tests, t tests, and logistic regression to determine factors associated with ever committing a violent crime.
Committing a violent crime was associated with male gender, younger age, greater childhood sexual abuse (CSA), greater childhood emotional abuse, no TBI by the age of 15 years, and greater neighborhood adversity during childhood.
Although TBI has been related to violent and nonviolent crime, this study showed that absence of TBI by the age of 15 years was associated with lifetime violent crime when adjusting for CSA, childhood emotional abuse, and neighborhood adversity during childhood. This builds upon neurobehavioral development literature suggesting that CSA and the stress of violence exposure without direct physical victimization may play a more critical role in lifetime violent criminal behavior than childhood TBI. Violence risk reduction must occur during childhood focusing on decreasing adversity, especially violence exposure as a witness as well as a direct victim.
Housing a large number of individuals living with or at risk for HIV/AIDS, correctional settings have considerable potential for epidemiological, prevention, and treatment research. However, federal regulations and institutional challenges have limited the extent and types of such research with prisoners. This study examines the degree to which HIV/AIDS correctional researchers report greater challenges than do their noncorrectional counterparts. Results indicate that correctional researchers reported significantly more frequent challenges than those in noncorrectional settings, even after controlling for experience, with the dominant difference related to challenges due to the research setting. These findings add empirical data and support previous research in the field; however, additional research should include correctional staff and incarcerated individuals, and explore whether these differences extend to other research topics.
© The Author(s) 2015.
Through the mid-1970s, most new drug clinical trials were conducted in America's jails and prisons. Due to the extensive human rights violations acknowledged at that time, laws were enacted that essentially brought corrections-based research to a halt. The Code of Federal Regulations, 45 CFR 46 subpart C, specifies the limitations upon research with correctional populations that are currently in place. These guidelines both informed the ethical conduct of research and arguably created a significant problem in today's correctional environment - prisoners are under-studied. We know far less about the health and health care needs of people under conditions of incarceration than those in the community. Linked with the extraordinary explosion over the last 20years in the population of America's jails and prisons and with a disproportionate number of mentally ill inmates, inadequate knowledge currently exists to guide clinical decision-making. Over the last decade, a gradually growing body of work, ethically developed and clinically focused, has been evolving. This article presents the challenges of conducting correctional research in health and healthcare delivery. Legal, ethical, and pragmatic barriers are reviewed. Further, practical solutions that allow meaningful research to be conducted are presented. Such research can create a foundation for developing both public policy and clinical practice.
There are little epidemiologic data on psychiatric disorders of women in jails. Accurate data on female jail detainees are critical because of their increasing numbers and their unique treatment needs.
Using the Diagnostic Interview Schedule, independent interviewers assessed a randomly selected, stratified sample of 1272 female jail detainees awaiting trial in Chicago, Ill. We tabulated lifetime and 6-month prevalence rates of disorders by race or ethnicity (African American, non-Hispanic white, Hispanic), age, and education and compared the jail rates with general population rates for women in the Epidemiologic Catchment Area program. We also examined whether or not psychiatric disorder was associated with the severity of the detainee's current arrest charges.
Over 80% of the sample met criteria for one or more lifetime psychiatric disorders; 70% were symptomatic within 6 months of the interview. The most common disorders were drug abuse or dependence, alcohol abuse or dependence, and post-traumatic stress disorder. Major depressive episode was the most prevalent major mental disorder. Rates were generally highest among non-Hispanic whites and among older detainees. Rates for all disorders were significantly higher than general population rates, except for schizophrenia. Most detainees with psychiatric disorders were arrested for nonviolent crimes.
These results suggest substantial psychiatric morbidity among female jail detainees.
During the past 20 years, researchers have documented the widespread problem of rape in American society. Approximately one in four women are raped in their adult lifetime, which causes severe psychological distress and long-term physical health problems. The impact of sexual assault extends far beyond rape survivors as their family, friends, and significant others are also negatively affected. Moreover, those who help rape victims, such as rape victim advocates, therapists, as well as sexual assault researchers, can experience vicarious trauma. Future research and advocacy should focus on improving the community response to rape and the prevention of sexual assault.
For several decades, mainstream criminology has been dominated by sociological and political perspectives. Although findings from these fields must not be discarded or underplayed, considered alone, they do not offer a complete assessment of the contributions to criminal behavior. Data currently being generated from numerous behavioral sciences, such as behavioral genetics, physiological psychology, psychopharmacology, and endocrinology, indicate that biological factors play an equally significant role in the development of antisocial behavior and should be considered accordingly. Incorporation of the theoretical parameters and findings of these behavioral sciences into a criminological framework would yield valuable in formation regarding processes underlying antisocial behavior. Such a multidisciplinary approach is likely to enhance capabilities to predict, prevent, and manage antisocial behavior. Theoretical parameters, methodological issues, selected research findings, potential applications, and precautions are discussed.
Background: Previous investigations suggest that maltreated children with a diagnosis of posttraumatic stress disorder (PTSD) evidence alterations of biological stress systems. Increased levels of catecholaminergic neurotransmitters and steroid hormones during traumatic experiences in childhood could conceivably adversely affect brain development.Methods: In this study, 44 maltreated children and adolescents with PTSD and 61 matched controls underwent comprehensive psychiatric and neuropsychological assessments and an anatomical magnetic resonance imaging (MRI) brain scan.Results: PTSD subjects had smaller intracranial and cerebral volumes than matched controls. The total midsagittal area of corpus callosum and middle and posterior regions remained smaller; while right, left, and total lateral ventricles were proportionally larger than controls, after adjustment for intracranial volume. Brain volume robustly and positively correlated with age of onset of PTSD trauma and negatively correlated with duration of abuse. Symptoms of intrusive thoughts, avoidance, hyperarousal or dissociation correlated positively with ventricular volume, and negatively with brain volume and total corpus callosum and regional measures. Significant gender by diagnosis effect revealed greater corpus callosum area reduction in maltreated males with PTSD and a trend for greater cerebral volume reduction than maltreated females with PTSD. The predicted decrease in hippocampal volume seen in adult PTSD was not seen in these subjects.Conclusions: These data suggest that the overwhelming stress of maltreatment experiences in childhood is associated with adverse brain development.
Although neurologic findings have been reported in as many as 100% of violent death row inmates, prior to this research no similar studies of the general female incarcerated population have been found. Women are vulnerable to abuse, potentially resulting in neurologic changes associated with both physical and emotional trauma. Such traumatic experiences have been correlated in previous studies with a dysregulated neuroendocrine stress response of cortisol production by the hypothalamic-pituitary-adrenal axis, which could contribute to violent or criminal behavior. This is the first similar study in a women's correctional institution. Female inmates (N = 120) and 12 noncriminal control females were evaluated for their history of having been a victim of abuse, neurologic history and examination findings, depression, and cortisol levels in order to determine the association of these variables as potential risk factors for violent or nonviolent criminal convictions. Logistic regression statistical analysis revealed the high number of histories of brain injuries with loss of consciousness and suicide attempts as well as the low levels of AM cortisol to be significantly associated with violent in comparison to nonviolent criminal convictions. Of the 120 inmates sampled, 96% were found to have neurologic problems, which was significantly higher than the small sample of noncriminal controls. This study provides valuable information in the ongoing investigation of neuropathophysiologic correlates in the, cycle of violence in order to provide a scientific basis for rehabilitation, as perpetrators of violent crimes have often been victims prior to their crimes.
Defense attorneys at the Nuremberg Medical Trial argued that no ethical difference existed between experiments in Nazi concentration camps and research in US prisons. Investigations that had taken place in an Illinois prison became an early focus of this argument. Andrew C. Ivy, MD, whom the American Medical Association had selected as a consultant to the Nuremberg prosecutors, responded to courtroom criticism of research in his home state by encouraging the Illinois governor to establish a committee to evaluate prison research. The governor named a committee and accepted Ivy's offer to chair the panel. Late in the trial, Ivy testified--drawing on the authority of this committee--that research on US prisoners was ethically ideal. However, the governor's committee had never met. After the trial's conclusion, the committee report was published in JAMA, where it became a source of support for experimentation on prisoners.
Correctional facilities are fertile fields for conducting nursing research and are virtually untapped by nurse researchers. Colleagues inclined to do research in correctional facilities can make significant contributions to nursing literature. This article focuses on the process, perils, and pitfalls of research in penitentiaries. Prison populations are overlooked and largely ignored by the nursing profession. Historically, nurses have ministered to underserved populations. Incarcerated individuals meet the criteria for underserved and understudied groups. Physical and psychosocial health care problems are abundant and beg to be studied. Administrative officials and inmates were cooperative and demonstrated a willingness to contribute to research. Participation proved to be therapeutic to the inmates and was a mutually rewarding experience for this researcher.
Previous investigations suggest that maltreated children with a diagnosis of posttraumatic stress disorder (PTSD) evidence alterations of biological stress systems. Increased levels of catecholaminergic neurotransmitters and steroid hormones during traumatic experiences in childhood could conceivably adversely affect brain development.
In this study, 44 maltreated children and adolescents with PTSD and 61 matched controls underwent comprehensive psychiatric and neuropsychological assessments and an anatomical magnetic resonance imaging (MRI) brain scan.
PTSD subjects had smaller intracranial and cerebral volumes than matched controls. The total midsagittal area of corpus callosum and middle and posterior regions remained smaller; while right, left, and total lateral ventricles were proportionally larger than controls, after adjustment for intracranial volume. Brain volume robustly and positively correlated with age of onset of PTSD trauma and negatively correlated with duration of abuse. Symptoms of intrusive thoughts, avoidance, hyperarousal or dissociation correlated positively with ventricular volume, and negatively with brain volume and total corpus callosum and regional measures. Significant gender by diagnosis effect revealed greater corpus callosum area reduction in maltreated males with PTSD and a trend for greater cerebral volume reduction than maltreated females with PTSD. The predicted decrease in hippocampal volume seen in adult PTSD was not seen in these subjects.
These data suggest that the overwhelming stress of maltreatment experiences in childhood is associated with adverse brain development.
This investigation examined the relationship between trauma, psychiatric symptoms and urinary free cortisol (UFC) and catecholamine (epinephrine [EPI], norepinephrine [NE], dopamine [DA]) excretion in prepubertal children with posttraumatic stress disorder (PTSD) secondary to past child maltreatment experiences (n = 18), compared to non-traumatized children with overanxious disorder (OAD) (n = 10) and healthy controls (n = 24).
Subjects underwent comprehensive psychiatric and clinical assessments and 24 hour urine collection for measurements of UFC and urinary catecholamine excretion. Biological and clinical measures were compared using analyses of variance.
Maltreated subjects with PTSD excreted significantly greater concentrations of urinary DA and NE over 24 hours than OAD and control subjects and greater concentrations of 24 hour UFC than control subjects. Post hoc analysis revealed that maltreated subjects with PTSD excreted significantly greater concentrations of urinary EPI than OAD subjects. Childhood PTSD was associated with greater co-morbid psychopathology including depressive and dissociative symptoms, lower global assessment of functioning, and increased incidents of lifetime suicidal ideation and attempts. Urinary catecholamine and UFC concentrations showed positive correlations with duration of the PTSD trauma and severity of PTSD symptoms.
These data suggest that maltreatment experiences are associated with alterations of biological stress systems in maltreated children with PTSD. An improved psychobiological understanding of trauma in childhood may eventually lead to better treatments of childhood PTSD.
The right of incarcerated prison and jail inmates to health care is protected by the 8th and the 14th amendments of the Constitution, respectively. Does the right to health care include access to clinical trials? At the time of this writing, clinical trials have become part of the fabric of HIV/AIDS care, allowing patients to participate in studies of new and often lifesaving treatments. Participation in trials can also be dangerous, as illustrated by the recent death of a subject in a gene therapy trial. This danger is compounded by ethical dilemmas that can arise from the large amount of financial support for clinical trials (greater than 75%) that is derived from for-profit corporations. Indeed, clinical trials are the subject of grave concern on the part of the United States Government, which has recently taken steps to shore up human subject safeguards. Following a conference on the conduct of clinical trials in correctional settings, the Office for Human Research Protections suspended prison research conducted by 4 prestigious academic institutions.
This study assessed HIV risk behaviors and their association with psychiatric disorders among women prisoners.
HIV risk behaviors practiced in the five years before incarceration were ascertained with the Risk Behavior Assessment interview for 177 inmates at the Maryland Correctional Institution for Women. The Structured Clinical Interview for the DSM-IV was used to determine the occurrence of posttraumatic stress disorder (PTSD), major depression, and dysthymic disorder among the women. Regression models were used to determine the association between HIV risk behavior and psychiatric disorders.
HIV risk behaviors in the five years before incarceration included never or rarely having used condoms (56 percent of the women), injection drug use (42 percent), sexual intercourse with a partner who used injection drugs (42 percent), prostitution (30 percent), needle sharing (30 percent), receptive anal sex (19 percent), and having more than 100 sex partners (7 percent). After the analysis adjusted for age, education, race, HIV status, and addictive disorders, a lifetime occurrence of PTSD was associated with the practice of anal sex (odds ratio=1.7; 95 percent confidence interval=1.26 to 2.16; p<.02) and prostitution (OR=1.56; 95% CI=1.17 to 1.95; p<.03).
HIV risk behaviors before incarceration were highly prevalent among the women in this study. Rates of PTSD, depression, and dysthymic disorder were also high. PTSD was associated with prostitution and receptive anal sex, and the disorder may contribute to high rates of risky sexual behavior. Targeted HIV risk reduction efforts among women prisoners should include evaluation for PTSD; conversely, women prisoners with a diagnosis of PTSD should be evaluated for prior HIV sexual risk behaviors.
In this review, a developmental traumatology model of child maltreatment and the risk for the intergenerational cycle of abuse and neglect using a mental health or posttraumatic stress model was described. Published data were reviewed that support the hypothesis that the psychobiological sequelae of child maltreatment may be regarded as an environmentally induced complex developmental disorder. Data to support this view, including the descriptions of both psychobiological and brain maturation studies in maltreatment research, emphasizing the similarities and differences between children, adolescents, and adults, were reviewed. Many suggestions for important future psychobiological and brain maturation research investigations as well as public policy ideas were offered.
Discrete item purchasing is the traditional approach for hospitals to obtain consumable supplies for theatre procedures. Although most items are relatively low cost, the management and co-ordination of the supply chain, raising orders, controlling stock, picking and delivering to each operating theatre can be complex and costly. Customized procedure packs provide a solution.
This article sets the stage for future discussions of expanding prisoners' access to clinical trials in an effort to move from commentary and recommendations to changes in practice. It describes barriers to access to clinical trials, the demographics of HIV/AIDS in prisons, the unique situation posed by the potential for HIV-related research in prisons, and examines briefly the history of prisoner research in the U.S. The article considers both ethical and legal responses to clinical trials in prisons, noting the potential for and limitations of legal actions. Finally, it makes recommendations for conditions necessary to conduct ethical research in prisons and calls for more cooperation between prison systems and HIV/AIDS clinical trials researchers to make expanded access to clinical trials a reality.
Biobehavioral research, especially that which is conducted with prisoners, has become much more closely regulated in the last 30 years. State and federal law, as well as professional standards, regulate the conduct of many types of research; in the case of prisoners, this regulation is even more stringent. However, currently no mandatory, uniform, national regulatory or oversight process exists, and many privately funded research endeavors are operating in a regulatory void. In response to this, the National Bioethics Advisory Commission has argued for the creation of a single, national, independent regulatory body to oversee all human participant research, regardless of funding source. As ethicolegal research standards evolve alongside advances in science and technology, an appreciation of the history of prisoner research and an awareness of current standards is critical to conducting ethical prison research.
Both physical and emotional traumas have been related to neurologic and neuroendocrine abnormalities that may be associated with violent behavior.
A modified case-control design was used for blinded comparison of 113 female inmates convicted of violent and nonviolent crimes. History of having been physically or sexually abused, neurologic history and physical examination, basal salivary cortisol levels, and associated variables were investigated to identify possible risk factors for violent compared to nonviolent criminal convictions.
Of all inmates studied, 95% had neurologic histories predating the current crime and/or neurologic examination abnormalities. Logistic regression revealed morning cortisol levels, number of years since last abuse, number of prior suicide attempts, and traumatic brain injuries with loss of consciousness to be significantly associated with current violent convictions, with a mean of two brain injuries with loss of consciousness per subject in the violent group.
A greater number of traumatic brain injuries with loss of consciousness and suicide attempts, more recent abuse, and low morning basal salivary cortisol levels could be associated with dangerous violent criminal behavior, including murder, in female prison inmates. Future research should investigate neuroendocrine challenges, more psychiatric and violence measures, and different populations with longitudinal designs.
This study reports on the continued development of the Secondary Trauma Scale (STS) and the establishment of cutoff scores. Cutoff scores are unavailable for existing secondary trauma scales. Participants were 118 young adult volunteers who reported having had close and continued exposure to a person or persons who had been traumatized. Sub-samples were drawn from the initial pool, and these sub-samples showed mild to severe anxiety and depression along with problematic levels of intrusion and avoidance. STS scores of 38 or higher were associated with mild to severe anxiety and depression and with problematic intrusion and avoidance symptoms. It was suggested that at STS scores of 45 or higher, clinicians and researchers should be particularly concerned. The STS demonstrated strong psychometric characteristics and was significantly correlated with known measures of emotional distress and dissociation.
Incarcerated populations have disparities in health risks and illness conditions meriting study, but the history of prison research is marred by unethical conduct. Ethical participation strategies are discussed in the context of studies implemented by the author in a state prison system. This study used ethnographic approaches, observed adherence to federal and institutional review board regulations and corrections department directives, and maintained continuous communication with vested interests to provide entry and long-term access for studies on female prisoners and their civilian infants. A culture clash between the punitive restrictive environment that serves the custody-control-care mission of corrections systems and the open inquiry environment needed for conduct of health research exists. Federal regulations protect prisoners as human subjects but additional vigilance and communication by researchers are required. Gaining and maintaining access to prison inmates for nursing research are leadership challenges that can be met within the caring and collaborative paradigm of nursing.
Records of 186 suicides among male prisoners in England between 1958 and 1971 emphasize the differences between the prison population and the population at large. The suicide rate may well be three times greater. The records show that sentence of more than 18 months' duration, whether anticipated or actually received, is associated with a greater risk of suicide than shorter sentence, and that suicide is most likely to be committed during the first few weeks in custody.
A team of academic researchers, clinicians, prison administrators and undergraduate and graduate students came together to conduct an evaluation of a pre-release discharge planning program in a women's prison facility. This paper describes differences between academic and corrections systems, adaptations needed in order to work within the correctional system, pragmatic and ethical issues addressed by our team, and the joys and benefits we experienced doing the project. Team members who had not previously worked in a prison setting found it an extraordinary, transformative learning experience in spite of the challenges.
The purpose of this study was to explain relationships between neurological dysfunction, HIV serological status, and HIV risk behaviors that have not been well understood. A secondary analysis was conducted on data from 117 female prison inmates. Another 18 female inmates from the same prison were further evaluated with more specific neurological, neuropsychological, and HIV risk behavior Risk Assessment Battery (RAB) measures. Neurological function, defined by valid, reliable quantitative measures of cognition, behavior/mood, cranial nerves, motor, reflexes, and sensation, was significantly correlated with HIV RAB scores (.743, p = .006), and RAB scale scores (.824, p = .001) in HIV-negative, but not HIV-positive, inmates. Specifically, the reflex deficits subscale correlated with RAB scores (.779, p = .003) and RAB scale scores (.682, p = .015) in the HIV-negative group. These findings combined with subjects' histories suggest cerebral dysfunction possibly contributes to HIV risk behaviors in certain high-risk female inmates predating HIV infection. These findings further suggest that HIV risk reduction should target neurologically impaired females as a high-risk group. Larger studies are needed to validate these findings.
Acres of Skin: Human Experimentation at Holmesburg Prison [book review].
- Bigby