Substance abuse is strongly associated with both high-risk sexual and drug-related behaviors and incarceration. Methamphetamine in particular has been associated with high-risk behavior and violence. Jails provide primary care to the incarcerated and may be a setting for interventions. Those who self-identify as substance users may benefit from interventions in jail, and the description the target population is critical to development of appropriate services. The purpose of this study is to measure methamphetamine use and associated risk behaviors, health status, health service use and recidivism, in a jailed population. This study is an initial step toward the long-term goal of identifying and testing interventions to improve substance abuse treatment and outcomes.
The specific aims of this project are to measure the prevalence of self-reported methamphetamine use and correlate its use with sexual and drug-use risk behaviors;describe the health conditions of and health services provided to inmates by methamphetamine use;and compare length of jail stay and recidivism over a one-year period by methamphetamine use. The project will take place at the Santa Clara County, California, Jail and includes two approaches: one is a cross-sectional study, by interview and medical record at jail entry. A random sample of 200 inmates, 100 men and 100 women, will be drawn. Consenting participants will be interviewed for socio-demographic information (age, race/ethnicity, education, living situation before jail, social and family support), information related to substance use, health status, risk factors including sexual practices, healthcare access and use including prior experience with substance abuse treatment services, perceived stigma and barriers to care, and past and perceived needs for services and care after release. Analyses will describe the sample and evaluate the association between methamphetamine use and high-risk sexual and drug behaviors. The second approach is a historical cohort study, by medical record review, of healthcare services provided and recidivism over time. A random sample of 300 inmate records, 150 men and 150 women, of inmates seen by Adult Custody Health Services during a six-month period in 2007 will be drawn. Information for one year following the 2007 healthcare visit will be extracted, including: socio-demographic data, health conditions (including substance use) and services received and outcome of care, and subsequent jail terms. Analyses for each gender will describe, by methamphetamine use: the use of services, number and prevalence of conditions, and will test the hypothesis that methamphetamine users have less time to re-arrest;have more arrests and longer time in jail in the one-year follow-up.
The relevance of this study to public health is in its focus on the incarcerated and on the unanswered questions about methamphetamine use and associated health risks and conditions. Well-known barriers to care that face marginalized persons in the community are removed when persons enter jails, which serve as primary care providers for the incarcerated;thus jails have increasingly become settings for identification of health conditions and initiation of treatment, and sometimes have become the only source of healthcare for this population. Knowledge gained in this setting is likely to provide insight to other jails in the assessment, management, and provision of programs to incarcerated methamphetamine abusers.
