Leaving Big Man's Jail: The health-related experiences of young people transitioning out of adult prison

Van Dooren, Susan (2011). Leaving Big Man's Jail: The health-related experiences of young people transitioning out of adult prison PhD Thesis, School of Population Health, The University of Queensland.

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Author Van Dooren, Susan
Thesis Title Leaving Big Man's Jail: The health-related experiences of young people transitioning out of adult prison
School, Centre or Institute School of Population Health
Institution The University of Queensland
Publication date 2011-10-01
Thesis type PhD Thesis
Supervisor Dr Stuart Kinner
Dr Andrew Page
Dr Fernanda Claudio
Total pages 193
Total colour pages 1
Total black and white pages 192
Language eng
Subjects 11 Medical and Health Sciences
Abstract/Summary ABSTRACT Internationally, prisoners experience poor physical and mental health, and socioeconomic disadvantage; they also engage in risky health-related behaviours, and under-use health and social services in the community. To improve their short- and long-term health outcomes during the transition out of adult prison, young prisoners (defined in this thesis as those aged under 25 years) may need specific, age-appropriate support. However, based on extant evidence it is difficult to determine what the health-related needs of young prisoners are, and where such supports should be targeted. This thesis proposes to address this research gap by describing the health-related experiences of young people as they transition out of adult correctional facilities. This is the first research study specific to young prisoners in Australia, and one of few international studies to focus on this largely overlooked group. The thesis: (1) presents a review of the literature relating to the health of young prisoners, (2) draws on multiple data sets to generate exploratory, policy-relevant evidence about Australian young people involved in the adult correctional system, and (3) applies a framework to understand health outcomes for ex-prisoners. The literature reviews presented in Chapters 2 and 3 demonstrated that very little evidence is available to help inform policy-makers and practitioners about the health-related needs of young prisoners and ex-prisoners. A peer-reviewed evidence base relating to this group is needed. Study 1 used data from the 2001 NSW Inmate Health Survey to contrast the health of young prisoners with that of their older counterparts. Relative to their older peers, young prisoners reported similarly poor mental health outcomes. Despite a lower prevalence of BBVs, including hepatitis C, young prisoners reported a higher prevalence of injecting drug use. Older prisoners reported the poorest physical health outcomes. Study 2 used data arising out of the Passports to Advantage study to estimate the prevalence of, and compare the risk factors for, hepatitis C in young and older soon-to-be-released prisoners with a history of injecting drug use. The prevalence of hepatitis C was significantly lower in young prisoners than in older prisoners. Risk factors for hepatitis C differed across the two groups, indicating a need for age-specific preventive interventions. Study 3 also used data from the Passports study to describe overlapping health-related needs among young soon-to-be-released prisoners across four domains. Nearly all young people reported morbidity in at least one of the four evaluated health domains and almost one in five reported morbidity across all evaluated domains. Study 4 drew on data arising out of the Mortality After Release from Custody study to compare rates and patterns of mortality among young and older ex-prisoners. One year following release from adult prison, young people experienced markedly increased risk of death compared with the general population. This elevation in risk was greater than that experienced by older ex-prisoners. Among young ex-prisoners, the majority of deaths were due to preventable causes, particularly injury and poisoning, and suicide. Study 5 used qualitative interviews with 10 ex-prisoners to develop and test the usefulness of a framework to understand post-release health outcomes. The resulting framework has four components: (1) stages of re-entry; (2) factors impacting health and wellbeing, across different stages of re-entry; (3) health-related outcomes; (4) factors affecting risk and vulnerability. The final chapter used this framework to synthesise research findings and critically appraise the contributions of the thesis as an exploratory body of work that has the potential to set the future research agenda relating to young (ex-) prisoners. Findings suggest that this thesis has contributed valuable descriptive evidence relating to the health-related issues of young people transitioning out of adult prison; however, due to limitations inherent to this exploratory body of work, future research is critical to better understand the health-related needs of this group. Overall, the findings of this thesis suggest that young people are a distinct subgroup among the (ex-) prisoner population, who have specific health-related needs. Interventions targeting young injecting drug users and young females should be prioritised given the increased risk of poor health-related outcomes − including death − for these groups. The future research agenda for young prisoners should focus on:  describing post-release health  comparing health-related outcomes between international jurisdictions  establishing longitudinal studies that measure associations between pre-incarceration circumstances and post-release outcomes among young ex-prisoners  identifying risk factors for post-release mortality among young ex-prisoners  evaluating the effectiveness of youth specific interventions during the transition out of prison. The health of young people transitioning out of adult prison is a critical public health concern, and should become a focus for prisoner health and youth health researchers. With appropriate support and assistance, young prisoners may be able to avoid long-term health-related harm and the revolving door of prison that is, in itself, health-depleting. Keywords Prisoners, illicit drugs, public health, qualitative research, mortality, young adult, risk-taking, hepatitis C, drug use, correctional health care Australian and New Zealand Standard Research Classifications (ANZSRC) 100% 111799, Public Health and Health Services not elsewhere classified.
Keyword Prisoners, illicit drugs, public health, qualitative research, mortality, young adult, risk-taking, hepatitis C, drug use, correctional health care
Additional Notes LANDSCAPE 184-192 (page 203 - 209 of the PDF) 107 (page 124 of the PDF) 86 (page 103 of the PDF) COLOUR colour page - 145 (page 163 of the PDF)

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Created: Thu, 02 Feb 2012, 21:47:24 EST by Ms Susan Van Dooren on behalf of Library - Information Access Service