Hepatitis B vaccines.

OBJECTIVES: This article reviews the evidence on the adverse health consequences of low socioeconomic status, homelessness, and incarceration among drug users. OBSERVATIONS: Social and economic factors shape risk behavior and the health of drug users. They affect health indirectly by shaping individual drug-use behavior; they affect health directly by affecting the availability of resources, access to social welfare systems, marginalization, and compliance with medication. Minority groups experience a disproportionately high level of the social factors that adversely affect health, factors that contribute to disparities in health among drug users. CONCLUSION: Public health interventions aimed at improving the health of drug users must address the social factors that accompany and exacerbate the health consequences of illicit drug use. Language: en

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Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration.

The approximately 1.2 million inmates in U.S. correctional institutions have a high prevalence of communicable diseases, such as human immunodeficiency virus (HIV) infection, tuberculosis, hepatitis B virus infection, and gonorrhea. Before their incarceration, most inmates had limited access to health care, which, together with poor compliance because of lifestyle, made them difficult to identify and treat in the general community. Because of the high yearly turnover (approximately 800% and 50% in jails and prisons, respectively), the criminal justice system can play an important public health role both during incarceration and in the immediate postrelease period. A public policy agenda for criminal justice should include an epidemiologic orientation, as well as resources for education, counseling, early detection, and treatment. Taking advantage of the period of confinement would serve both the individual and society by controlling communicable diseases in large urban communities.

Correctional Health Care: A Public Health Opportunity

Acknowledging the fact that the criminal justice system is currently awash with drug abusers and that prison drug abuse treatment has had a varied history in the United States, this article explores possible directions for the future of drug abuse treatment in prisons and jails The current status of drug abuse treatment is reviewed, and selected treatment approaches are highlighted In addition, evaluation issues are presented, and special issues are reviewed including case management, community follow-up, and methodological considerations Finally, recommendations are suggested for treatment, research, evaluation, demonstrations, management information, community linkage, training, and technical assistance

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Drug abuse treatment in prisons and jails

There were three main objectives of this cross-sectional study of Maryland State correctional health care workers. The first was to evaluate compliance with work practices designed to minimize exposure to blood and body fluids; the second, to identify correlates of compliance with universal precautions (UPs); and the third was to determine the relationship, if any, between compliance and exposures. Of 216 responding health care workers, 34% reported overall compliance across all 15 items on a compliance scale. Rates for specific items were particularly low for use of certain types of personal protective equipment, such as protective eyewear (53.5%), face mask (47.2%) and protective clothing (33.9%). Compliance rates were highest for glove use (93.2%) waste disposal (89.8%), and sharps disposal (80.8%). Compliance rates were generally not associated with demographic factors, except for age; younger workers were more likely to be compliant with safe work practices than were older workers (P < 0.05). Compliance was positively associated with several work-related variables, including perceived safety climate (i.e., management's commitment to infection control and the overall safety program) and job satisfaction, and was found to be inversely associated with security-related work constraints, job/task factors, adverse working conditions, workplace discrimination, and perceived work stress. Bloodborne exposures were not uncommon; 13.8% of all respondents had at least one bloodborne exposure within the previous 6 months, and compliance was inversely related to blood and body fluid exposures. This study identified several potentially modifiable correlates of compliance, including factors unique to the correctional setting. Infection-control interventional strategies specifically tailored to these health care workers may therefore be most effective in reducing the risk of bloodborne exposures.

Compliance with universal precautions in correctional health care facilities.

To develop a protocol for prevention of hepatitis B virus (HBV) transmission in Wisconsin prisons, we interviewed 619 male prisoners at incarceration to obtain information on hepatitis B risk factors. We defined previous infections by the presence of hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), or antibody to hepatitis B core antigen (anti-HBc). Logistic regression was used to develop a model of relative risk (RR) of HBV infection. Use of illicit intravenous (IV) drugs was the most important risk factor because of a high prevalence of IV drug use and an RR which ranged from 2.93-7.47. Other important risk factors were: prior hepatitis or jaundice (RR = 6.28), race (RR = 2.54 for Blacks, RR = 3.28 for Latinos), transfusion (RR = 3.00), and age. Previous imprisonment was not an independent risk factor for HBV, hence selective serologic screening and vaccination of prisoners are justified rather than mass screening and vaccination. Based upon prevalence of hepatitis B markers in subgroups, it is necessary to screen prisoners with prior hepatitis or jaundice, prior transfusion, and users of IV drugs. The identification of HBsAg carriers by such screening could prevent infection of "household" contacts. Users of IV drugs who are susceptible to HBV infection should be vaccinated. The remaining prisoners constitute a low-risk group for HBV infection and do not require serologic screening or vaccination.

https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.75.10.1182

J P Davis

Papers

Hepatitis B in Wisconsin male prisoners: considerations for serologic screening and vaccination.