Management of female prisoners with abnormal cervical cytology

Perceived healthcare quality and contraception utilization among persons recently incarcerated

Purpose

Previously incarcerated women have specific gender and physiologic needs that are poorly addressed on community re-entry. The objective of this study is to evaluate the relationship between contraception use and perceived healthcare quality post-incarceration. Additionally, we examine the association between social determinants of health and contraception use post-incarceration.

Methods

A secondary analysis of a cross-sectional study of reproductive-aged women with a history of criminal-justice involvement in three cities (n = 383) was performed. Questions related to demographics, social determinants of health, sexual and reproductive health practices, health services use, and healthcare quality were analyzed. Bivariate analysis and logistic regression examined associations between these variables and contraception utilization among persons recently incarcerated.

Results

35% of the participants used a method to prevent pregnancy. There were no significant differences noted between contraceptive users and non-users in perceived healthcare quality. Participants who were not using a contraceptive method were more likely to lack health insurance and experience food insecurity when compared to contraceptive users.

Conclusions

Although there was no difference in perceived healthcare quality between contraceptive users and non-users, significant barriers to contraceptive access on community re-entry exist. More studies are warranted to explore the sexual and reproductive health of previously incarcerated women.

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

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

Prevalence of human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer in imprisoned women worldwide: a systematic review and meta-analysis

Background and objectives

Imprisoned women have higher rates of abnormalities at cervical screening and some studies suggest that cervical cancer is the most common cancer in this population. The aim of this work was to summarise the current evidence on the prevalence of human papilloma virus (HPV) infection, cervical cancer and precancerous lesions in women in prison worldwide and to compare these rates with the general population.

Methods

We systematically searched and reviewed published and unpublished data reporting the prevalence of any HPV infection, cervical intraepithelial neoplasia (CIN) and cervical cancer in imprisoned women. We created forest plots with prevalence estimates from studies with comparable outcomes and of prevalence ratios using data from national screening programmes as a comparison group.

Findings

A total of 53 533 imprisoned women from 10 countries and 35 studies were included in the review. The prevalence of HPV among prisoners ranged from 10.5% to 55.4% with significant heterogeneity. The prevalence of CIN diagnosed by cytology in prisoners ranged from 0% to 22%. Ratios comparing the prevalence of CIN in imprisoned women to that in the community ranged from 1.13 to 5.46. Cancer prevalence estimates were at least 100 times higher than in populations participating in national screening programmes.

Conclusion

Imprisoned women are at higher risk of cervical cancer than the general population. There is a high prevalence of HPV infection and precancerous lesions in this population. Targeted programmes for control of risk factors and the development of more effective cervical screening programmes are recommended.

PROSPERO registration number

CRD42014009690.

Cervical Cancer Screening Access, Outcomes, and Prevalence of Dysplasia in Correctional Facilities: A Systematic Review

Background: Incarcerated women often access health care primarily through contact with correctional systems. Cervical cancer screening within the correctional system can address the preventable outcome of cervical dysplasia and cancer in this high-risk population. Materials and Methods: A search of PubMed, EMBASE, CINAHL, and ClinicalTrials.gov was conducted for articles published between January, 1966 and December, 2018. All studies on a population of jailed or incarcerated females and at least one of the following outcomes: cervical cancer or dysplasia, pap smear screening, knowledge about screening, treatment of cervical dysplasia, and compliance with follow-up were analyzed. Results: Forty-two studies met inclusion criteria. All 21 studies with prevalence outcomes described a higher prevalence of cervical dysplasia and cancer in the women involved with corrections, compared to a variety of different sources that served as community control groups. The data on screening outcomes were inconsistent. Follow-up compliance for abnormal results was poor, with a study finding that only 21% of women were rescreened within 6 months of the recommended time period. Knowledge about cervical cancer and screening was evaluated in eight studies and was poor across all studies. Conclusion: Women involved in correctional systems have a higher prevalence of cervical dysplasia and cancer than women in the general population. Acceptance of screening varies, and no published interventions have been shown to improve screening within the prison system. Treatment and compliance with follow-up recommendations are extremely poor and should be a focus of future research.

A review of prison health and its implications for primary care nursing in England and Wales: the research evidence

AIMS AND OBJECTIVES

To provide a systematic overview of the policy and practice literature concerned with the primary healthcare needs of prisoners in England and Wales and to address the implications of these health needs for nurses working in prisons.

BACKGROUND

The recent reorganization of the prison healthcare system, which has brought prison health services in England and Wales within the National Health Service, has major implications for the role of prison nurses. Nurses in prisons are increasingly providing services to promote the health of prisoners, in addition to making assessments of health need and treating health problems.

METHODS

The review examined literature from 1995 to date using standard review techniques adapted to be both sensitive and inclusive and with high recall because of the unexplored nature of primary health care in prisons.

RESULTS

Findings are identified in three main areas: the general health needs of prisoners, health promotion and chronic disease management. In all these areas, the health needs of the prison population are much greater than the community as a whole, resulting in a high demand for primary care services in prison. However, the prison setting can militate against providing good primary care services in prison.

CONCLUSIONS

More research has been carried out into the health needs of prisoners than into the provision of primary care nursing services in prisons. Further research is needed into primary care nursing in prison to meet the health needs of prisoners effectively.

RELEVANCE TO CLINICAL PRACTICE

With the reorganization of prison health services, health provision in prisons is increasingly primary care focused. This presents new challenges to nurses working in prison to provide a primary care service, which meets the identified health needs of prisoners.

Health needs of prisoners in England and Wales: the implications for prison healthcare of gender, age and ethnicity

This paper aims to provide evidence of the healthcare needs of prisoners in relation to gender, age and ethnicity, drawing from a larger systematic overview of the policy and research literature concerning primary care nursing in prisons in England and Wales. The literature overview shaped the initial stages of a research project funded by the Department of Health to examine the views and perspectives of prisoners and nurses working in prisons, and to identify good primary care nursing in the prison environment. At total of 17 databases were searched using search terms related to primary healthcare in prisons (health, nurs*, primary care, healthcare, family medicine, prison*, offender*, inmate*) with terms truncated where possible in the different databases. Following this, a sifting phase was employed using inclusion/exclusion criteria to narrow and focus the literature perceived as relevant to the research questions. All papers were critically appraised for quality using standardised tools. Findings from the literature overview show that prisoners are more likely to have suffered some form of social exclusion compared to the rest of society, and there are significantly greater degrees of mental health problems, substance abuse and worse physical health in prisoners than in the general population. Women, young offenders, older prisoners and those from minority ethnic groups have distinct health needs compared to the prison population taken as a whole, with implications for the delivery of prison healthcare, and how these needs are met effectively and appropriately.

High grade squamous intraepithelial lesion in inmates from Ohio: cervical screening and biopsy follow-up

BACKGROUND

Cervical carcinoma remains the second leading cause of cancer death in women worldwide and sexual behavior is regarded as the main contributing factor. We studied cervical cytology screening with surgical biopsy follow-up in women prisoners and compared the findings to those in the general population.

METHODS

We reviewed 1024 conventional cervical smears, 73 cervical biopsies and 2 loop electrosurgical excision procedure (LEEP) specimens referred to us from the Correctional Center in Columbus, Ohio during a 12-month period. The results were compared to 40,993 Pap smears from the general population for the same 12-month period.

RESULTS

High grade squamous intraepithelial lesion (HGSIL) was diagnosed in 1.3% of the cervical smears from the inmate population versus 0.6% in the general population (p < 0.01). The unsatisfactory rate was 1.6% compared to 0.3% in the general population (p < 0.01). Among the study population, follow-up tissue diagnosis was obtained in 24.3% of the abnormal cytology results (ASCUS, LGSIL, and HGSIL). Of the HGSIL Pap smears, 61.5% had a subsequent tissue diagnosis. Thirty-nine biopsies (52% of the all inmate biopsies and LEEP) showed CIN II/III (cervical intraepithelial neoplasia II/III). Eight of these thirty-nine follow-up biopsies diagnosed as CIN II/III had a previous cervical cytology diagnosis of ASCUS. The average age for HGSIL was 30.5 years (S.D. = 5.7) and for low grade squamous intraepithelial lesion (LGSIL) was 27.2 years (S.D. = 6.1).

CONCLUSION

A significantly higher prevalence of HGSIL cervical cytology and unsatisfactory smears was encountered in female inmates, with tissue follow-up performed in less than two thirds of the patients with HGSIL. These results are in keeping with data available in the literature suggesting that the inmate population is high-risk and may be subject to less screening and tissue follow-up than the general population. Clinicians should proceed with urgency to improve screening and follow-up with treatment. The inmate population should be targeted for HPV vaccination promptly after FDA approval.

Preventive care for women in prison: a qualitative community health assessment of the Papanicolaou test and follow-up treatment at a California state women's prison

Growing evidence indicates that women in prison are particularly vulnerable to many negative health outcomes, including cervical cancer. The Papanicolaou (Pap) test is an effective tool to screen for this disease. To determine what is and is not working with the Pap test and follow-up treatment, we performed qualitative interviews with women prisoners and key informants at a California state women's prison. Our assessment revealed that the process of administering Pap tests at this institution was not meeting the health care needs of the women interviewed. Women reported having negative experiences during the test and with their health care providers. Additionally the prison's culture and infrastructure create obstacles that hinder prisoners from receiving quality care and providers from delivering that care. In response, women prisoners use self-and community advocacy to meet their health care needs and cope with these challenges.

Cancer screening among jail inmates: frequency, knowledge, and willingness

OBJECTIVES

We determined jail inmates' knowledge of cancer screening tests, their frequency of screening, and their willingness to undergo screening in jail in order to assess preventive health services for jail inmates.

METHODS

We performed a cross-sectional interview survey of random samples of county jail inmates (n=133).

RESULTS

Approximately half (53%) the participants were African American, 17% were White, 11% were Latino, and 9% reported multiple ethnicities. Among women aged 18 years and older, 90% had had a Papanicolaou (Pap) test within 3 years, and 94% were willing to be screened in jail. Having ever had a Pap test while incarcerated was significantly associated with being up to date on cervical cancer screening. For women aged 40 years and older, 41% reported having had a mammogram within 2 years, and 88% were willing to have one. Among men (n=51) and women (n=4) aged 50 years and older, 25% had knowledge of colon cancer screening, 31% were up to date, and 69% were willing to be screened. Increased knowledge about colon cancer screening was significantly associated with being White and having insurance. Jail inmates, particularly African Americans, had significantly lower frequency of sigmoidoscopy and colonoscopy than the general population.

CONCLUSIONS

Jail could be an appropriate venue in which to provide cancer screening for a high-risk population. Inmates were receptive to jail-based screening.

Evaluation of a cervical cancer screening intervention for prison inmates

BACKGROUND

Female prison inmates are underscreened and are at higher risk of cervical cancer. The impact of a nurse-led Pap screening intervention was examined, which included information sessions and Pap testing clinics.

METHOD

Pap screening rates for 650 inmates at the Burnaby Correctional Centre for Women were compared both before and during the 20-week intervention period. These rates were determined by record linkage of Correction Branch inmate records and Cervical Cancer Screening Program patient records. Associations between socio-demographic factors and Pap screening rates were also examined.

RESULTS

A higher proportion of inmates was screened during the intervention period (26.9%) than during the preintervention period (21.0%) (although the difference was not statistically significant (p=0.06)). Very short-stay inmates were less frequently screened in the preceding two years before the intervention. Inmates with no high school education and longer lengths of incarceration were significantly more likely to receive Pap testing during the intervention period as compared to the preintervention period.

CONCLUSION

The nurse-led intervention resulted in a modest improvement in the proportion of inmates receiving Pap screening. Unfortunately, the benefit of the nurse clinician did not reach, to a greater extent, inmates who had not been previously screened or who were inadequately screened. There is need for further work to target this hardest-to-reach group.

Factors affecting cervical screening uptake in prisoners

Imprisoned women are at increased risk of cervical cancer but less likely to have been screened for this disease. There is very little information on the situation in prisons in the UK but this study indicates that, as anticipated, these women are less likely to have been screened in the last five years than women generally. Whilst there are no ethnic differences, it appears that women who had been in prison longer than three months were more likely to have had a smear in the last five years compared with those who had been in for three months or less (79.2% vs 37.5%, Chi-squared=9.7, p=0.002) suggesting that the prison health services had been able to use this opportunity to screen this disadvantaged population.

Evaluation of a cervical cancer screening intervention for prison inmates

BACKGROUND

Female prison inmates are underscreened and are at higher risk of cervical cancer. The impact of a nurse-led Pap screening intervention was examined, which included information sessions and Pap testing clinics.

METHOD

Pap screening rates for 650 inmates at the Burnaby Correctional Centre for Women were compared both before and during the 20-week intervention period. These rates were determined by record linkage of Correction Branch inmate records and Cervical Cancer Screening Program patient records. Associations between socio-demographic factors and Pap screening rates were also examined.

RESULTS

A higher proportion of inmates was screened during the intervention period (26.9%) than during the preintervention period (21.0%) (although the difference was not statistically significant (p=0.06)). Very short-stay inmates were less frequently screened in the preceding two years before the intervention. Inmates with no high school education and longer lengths of incarceration were significantly more likely to receive Pap testing during the intervention period as compared to the preintervention period.

CONCLUSION

The nurse-led intervention resulted in a modest improvement in the proportion of inmates receiving Pap screening. Unfortunately, the benefit of the nurse clinician did not reach, to a greater extent, inmates who had not been previously screened or who were inadequately screened. There is need for further work to target this hardest-to-reach group.

The relationship between self-esteem, health habits, and knowledge of BSE practice in female inmates

This article reports on data derived from an investigation of the self-esteem, health habits, and knowledge of breast self-examination (BSE) practice in female inmates. A descriptive correlational study was conducted with a prison sample of 197 adult females incarcerated in a women's state prison. Major findings of the study suggest that female inmates in general had medium to high self-esteem, poor health habits before incarceration, and minimal knowledge about BSE practice. Only 26% reported correct knowledge related to frequency in BSE practice, and few reported that they knew correct BSE technique. In addition, findings suggest that a correlation does not exist between self-esteem and knowledge of BSE practice, and participants' last grade completed served as a good predictor of women's knowledge of BSE practice.

A review of a prison cervical cancer screening program in British Columbia

OBJECTIVE

To review a 1995 Pap smear screening program at Burnaby Correctional Centre for Women (BCCW).

METHOD

129 inmates (15%), were screened in BCCW in 1995. General population data were obtained from the British Columbia Cervical Cytology Screening Program (BC CCSP) Registry.

RESULTS

BCCW inmates aged 25-29 years were 11 times more likely to have high grade cytologic abnormalities on Pap smear screening compared with age-matched general population (p < 10(-10). In the 20-34 year age group, 47% of BCCW inmates had received at least one Pap smear in 1992-1994, compared with 87% of the general population (p < 0.001). There was no relationship between Pap smear results and BCCW inmate ethnicity (p = 0.85).

CONCLUSIONS

Prison inmates presented with more severe abnormalities on Pap smear screening at a younger age, and had received Pap smear screening less frequently, compared with the general population.

Female sexual health problems in a drug dependency unit

The Government of the United Kingdom has produced a strategic plan called the Health of the Nation aimed at achieving better health in key areas including a reduction in rates of unwanted pregnancies, sexually transmitted diseases and cervical cancer. Conventional health care systems fail some groups with special needs. This cross-sectional interview study was undertaken to determine the level and type of contraceptive use, and the attitudes of female opiate abusers to the use and availability of contraceptives and cytology services. The subjects were 201 opiate-dependent women enrolled in a methadone maintenance programme in a large drug dependency unit: 169 (84.5%) were sexually active and 65 (44.2%) of non-pregnant sexually active women did not use a contraceptive method. Thirty-six (43.9%) of those using a contraceptive were using condoms, with which the majority were dissatisfied. Sixty-one (30.3%) had never had a cervical cytology smear and of those who had, 21.4% reported an abnormal result. The contraceptive practices and uptake of cervical screening services by the women studied are inadequate, reflecting poor use of conventional health care services. In addition to providing information on safer sexual practices, particularly promotion of condom use, we suggest that drug dependency units should expand their role to provide educational and preventative services to include aspects of women's health.