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Downloaded from https://academic.oup.com/aje/article/187/6/1137/4987844 by DeepDyve user on 19 July 2022 American Journal of Epidemiology Vol. 187, No. 6 © The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. DOI: 10.1093/aje/kwx375 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons. Advance Access publication: org/licenses/by/4.0), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. April 27, 2018 Editorial Editorial: Synthesizing the Evidence on Prisoner Health—Taking Stock and Moving Forward Seena Fazel* * Correspondence to Seena Fazel, University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK (e-mail: Seena.email@example.com). More important than the fact that 10 million people are cur- primary articles and reports was limited by country or region. rently estimated to be in prison at any point is that approximately This is reasonable when clinical heterogeneity is substantial and 30 million persons enter and leave prisons every year (1). The can be informative by focusing on clinical, research, and policy public health opportunities arising from these large numbers implications speciﬁc to the country or region. Hence, in the review have been outlined in many articles in the most recent issue of on substance use in low- and middle-income countries (11), inves- Epidemiologic Reviews; namely, that individuals entering cor- tigators reported differences by subregions and also focused on rectional settings are typically from marginalized groups who substance use rather than diagnostic categories because of the do not access health care in the community and who have a nature of the data collected in the primary studies. In another high prevalence of many communicable and noncommunic- review, the authors studied the increasingly important question of able diseases and incidence of risky behaviors. Furthermore, the health of older prisoners and restricted their search to US stud- being incarcerated increases the risks of morbidity and mortality, ies (4). Despite this restriction, 21 studies were identiﬁed, and, re- especially from conditions secondary to infectious diseases and ﬂecting the review’s focus, there was a discussion of US national substance misuse, and thus prison affords an important oppor- policies. At the same time, this US-centric approach meant that tunity to address unmet health-care needs with substantial con- the review did not draw on high-quality research in other high- sequences for public health (2, 3). income countries, which have similar proportions of incarceration The current issue of Epidemiologic Reviews comprises a num- by age group (12, 13). For example, Skarupski et al. (4) found no ber of systematic reviews and meta-analyses in which the authors research on cognitive problems, although there has been recent address emerging challenges for prison health—delineating the relevant research on cognitive impairment from a large sample health problems of the growing number of older prisoners (4), in the United Kingdom (12). Some of the papers, however, in- understanding the adverse effects of incarceration on the fami- cluded more individual approaches. One inclusion criterion used lies of those in custody (5), and mitigating risky behaviors in by Wildeman et al. was that a primary study should have been prison (6, 7)—and synthesize the latest evidence on health pro- published in certain “peer-reviewed journals that are well- blems that remain central in prison, such as the prevalence of regarded in their respective ﬁelds” (5, p. 148). Arguably, this treatable mental disorders (8), interventions for and the model- breaks with one of the key features of a systematic review (as ing of infectious diseases (9), treatments for substance misuse compared with a narrative review), which aims to provide a com- (10), and health needs of prisoners in low- and middle-income prehensive and transparent selection process. Many reviews were countries (11). The 2 overriding themes that are apparent from limited to English-language articles, which may have led the reading these papers are 1) the methodological issues that cut authors to miss important negative studies because these are more across the different reviews and 2) the various implications aris- likely to be published in non–English-language journals. Another ing from them. issue that is that some of the systematic reviews contained a small Many of the systematic reviews in this issue follow meth- number of studies, with one including 5 primary studies and odological guidelines (such as the Preferred Reporting Items another including 7 publications. This is not in itself problem- for Systematic Reviews and Meta-Analyses) and utilize excel- atic because it can highlight the need for more research and lent methods. In particular, it is important that gray literature has new recommendations. Nevertheless, a scoping review might been searched, because many relevant studies are published as have identiﬁed the likely small number of primary reports, and reports rather than in peer-reviewed articles, and that there has consideration could have been given to broadening the aims of been correspondence with the authors of the primary studies the review. A ﬁnal issue that cuts across the reviews is the time to clarify results. Furthermore, authors of some reviews preregis- period utilized in the article search. One of the reviews is a 21- tered their protocols (8). In a number of reviews, the search for month update (which extends the search for primary reports 1137 Am J Epidemiol. 2018;187(6):1137–1139 Downloaded from https://academic.oup.com/aje/article/187/6/1137/4987844 by DeepDyve user on 19 July 2022 1138 Editorial from November 2015 to July 2017), and the authors identiﬁed In summary, this collection of articles highlights the public 9 new papers to bring the total to an impressive 82 primary re- health challenges and opportunities in prison health, ﬁlls some ports (14). Methodologists have considered what constitutes important gaps in the correctional health literature, and provides an update for a systematic review, which could be undertaken many thoughtful suggestions for future research. Such research when there is signiﬁcant new work in a particular ﬁeld (15)or should aim to study unselected prison populations and consider a doubling of the available evidence, although treatment re- utilizing innovative designs to overcome the challenges of con- views may require more regular updates (such as required by ducting research in prisons. Looking forward to new systematic the Cochrane Collaboration). Finally, the review by Spauld- reviews in prison health, researchers should include gray liter- ing et al. (7) on smoking in prisons is outstanding on many ature and non–English-language articles, consider protocol reg- istration, and explore heterogeneity carefully using subgroup levels. It has a broad and overlapping aims on prevalence and in- and metaregression analyses. Other considerations for such terventions. The methods are also excellent, including a speciﬁc reviews include checking with authors of primary studies search in a Chinese database, which some have argued should be included for any global systematic review on prevalence of com- whether their data is accurately presented (when possible) and mon conditions (16). The ﬁndings are unexpected, informative, sharing summary data in published supplemental materials (21). and highly relevant, and the importance of the topic is underscored Improvements to prison health will be informed by higher quality and complemented by another paper in the issue on substance use rather than a greater quantity of systematic reviews and meta- in prisoners in low- and middle-income countries, in which inves- analyses. tigators found high rates of smoking inside custody (11). The papers usefully raise many implications for clinicians, researchers, and policy makers. First, they provide more pre- ACKNOWLEDGMENTS cise information on the prevalence of infectious diseases, post- traumatic stress disorder, substance misuse, and, in older US Author afﬁliation: Department of Psychiatry, University prisoners, a range of noncommunicable diseases. Interestingly, of Oxford, Warneford Hospital, Oxford United Kingdom the prevalence estimates for posttraumatic stress disorder among (Seena Fazel). female prisoners in the review by Mundt et al. (8) are at the upper S.F. was a co-author on 2 of the papers in the issue of end of the range from a previous 2007 systematic review (17). Epidemiologic Reviews being discussed (references 8 and 11). Second, there is new information on risky behaviors in prison, Conﬂict of interest: none declared. from smoking to tattooing, piercing, engaging in sexual activities, and syringe sharing (6). Moazen et al. (6) highlighted the lack of evidence-based infection control measures to address these risks; REFERENCES these measures are important for public health and are likely to be cost-effective. Third, the review on dynamic models of the spread 1. UNODC, ILO, UNDP, et al. HIV Prevention, Treatment and of infectious disease in prison is novel, raises helpful methodolog- Care in prisons and Other Closed Settings: A Comprehensive ical pointers, and might interest researchers estimating the direct Package of Interventions. Vienna, Austria: United Nations and indirect effects of interventions for other diseases (9). Finally, Ofﬁce on Drugs and Crime; 2013. http://www.who.int/hiv/ there are a number of systematic reviews in the current issue in pub/prisons/interventions_package/en/. Accessed November 23, which the authors evaluated treatments. Despite not including pooled treatment effect sizes, the review on drug and alcohol in- 2. Fazel S, Baillargeon J. The health of prisoners. Lancet. 2011; 377(9769):956–965. terventions is of considerable interest and presents information 3. Fazel S, Hayes AJ, Bartellas K, et al. Mental health of from 49 studies (10). In the review, the authors used a quality prisoners: prevalence, adverse outcomes, and interventions. rating instrument and included observational studies, which can Lancet Psychiatry. 2016;3(9):871–881. be informative for treatments for which randomized controlled 4. Skarupski KA, Gross A, Schrack JA, et al. The health of trials are not feasible in prison settings.Inkeepingwiththis, America’s aging prison population. Epidemiol Rev. 2018;40: large population-based observational studies have been used to 157–165. study pharmacological treatments to prevent violent reoffending 5. Wildeman C, Goldman AW, Turney K. Parental incarceration in released prisoners, whereas randomized controlled trials have and child health in the United States. Epidemiol Rev. 2018;40: been lacking (18). However, ﬁndings from these designs need to 146–156. carefully consider confounding by indication, and approaches 6. Moazen B, Moghaddam SS, Silbernagl MA, et al. Prevalence such as within-individual designs are increasingly used to account of drug injection, sexual activity, tattooing, and piercing among prison inmates. Epidemiol Rev. 2018;40:58–69. for confounding (18, 19). In their systematic review, de Andrade 7. Spaulding AC, Eldridge GD, Chico CE, et al. Smoking in et al. (10) found evidence in support of opiate maintenance treat- correctional settings worldwide: prevalence, bans, and ment; unexpectedly, they also reported that cognitive behavioral interventions. Epidemiol Rev. 2018;40:82–95. therapy did not reduce recidivism outcomes and that its effects on 8. Baranyi G, Cassidy M, Fazel S, et al. Prevalence of substance use were limited. This is important because cognitive posttraumatic stress disorder in prisoners. Epidemiol Rev. behavioral therapy is widely used in prisons, and their ﬁndings 2018;40:134–145. are consistent with research on psychological treatments for com- 9. Ndeffo-Mbah ML, Vigliotti VS, Skrip LA, et al. Dynamic mon mental health disorders that suggest weaker-than-expected models of infectious disease transmission in prisons and the efﬁcacy for such interventions (20). general population. Epidemiol Rev. 2018;40:40–57. Am J Epidemiol. 2018;187(6):1137–1139 Downloaded from https://academic.oup.com/aje/article/187/6/1137/4987844 by DeepDyve user on 19 July 2022 Editorial 1139 10. de Andrade D, Ritchie J, Rowlands M, et al. Substance use 16. Prince MJ. Dementia in China: east-west collaboration bears and recidivism outcomes for prison-based drug and fruit. Lancet. 2013;381(9882):1967–1968. alcohol interventions. Epidemiol Rev. 2018;40: 17. Goff A, Rose E, Rose S, et al. Does PTSD occur in sentenced 121–133. prison populations? A systematic literature review. Crim 11. Mundt AP, Baranyi G, Gabrysch C, et al. Substance use during Behav Mental Health. 2007;17(3):152–162. imprisonment in low- and middle-income countries. Epidemiol 18. Chang Z, Lichtenstein P, Långström N, et al. Association Rev. 2018;40:70–81. between prescription of major psychotropic medications and 12. Hayes AJ, Burns A, Turnbull P, et al. The health and social violent reoffending after prison release. JAMA. 2016;316(17): needs of older male prisoners. Int J Geriatr Psychiatry. 2012; 1798–1807. 27(11):1155–1162. 19. Molero Y, Lichtenstein P, Zetterqvist J, et al. Varenicline and 13. O’Hara K, Forsyth K, Webb R, et al. Links between depressive risk of psychiatric conditions, suicidal behaviour, criminal symptoms and unmet health and social care needs among older offending, and transport accidents and offences: population prisoners. Age Ageing. 2016;45(1):158–163. based cohort study. BMJ. 2015;350:h2388. 14. Wirtz AL, Yeh PT, Flath NL, et al. HIV and viral hepatitis 20. Yoon IA, Slade K, Fazel S. Outcomes of psychological among imprisoned key populations. Epidemiol Rev. 2018; therapies for prisoners with mental health problems: a 40:12–26. systematic review and meta-analysis. J Consult Clin Psychol. 15. Moher D, Tsertsvadze A, Tricco AC, et al. When and how to 2017;85(8):783–802. update systematic reviews. Cochrane Database Syst Rev. 21. Barnard ND, Willett WC, Ding EL. The misuse of meta-analysis 2008;(1):MR000023. in nutrition research. JAMA. 2017;318(15):1435–1436. Am J Epidemiol. 2018;187(6):1137–1139
American Journal of Epidemiology – Oxford University Press
Published: Jun 1, 2018
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