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Tuberculosis (TB) is a contagious infectious disease caused by and is a leading source of preventable morbidity and mortality worldwide (Maher & Raviglione, 2005). In 1993, the World Health Organization declared TB a global health emergency. Over a decade later, despite TB control efforts, TB cases continued to rise. An estimated two billion people, or one-third of the world’s population, are believed to be infected with and are at risk for developing active TB disease during their lifetime. Annually, worldwide, eight to nine million people develop active TB and nearly two million die from the disease. The expanding human immunodeficiency virus (HIV) epidemic and the emergence of multi- and extensively drug resistant TB contribute greatly to the global burden of TB disease (CDC, 2006b, 2007). TB is a major public health concern in correctional facilities throughout the world. Incarcerated populations are at disproportionately high risk for developing TB infection and disease compared to general populations (MacNeil, Lobato, & Moore, 2005; Hammett, Harmon, & Rhodes, 2002). Numerous TB outbreaks have occurred in correctional facilities and transmission of TB from inmates to persons within such facilities has been well documented (MacIntyre, Kendig, Kummer, Birago, Graham, & Plant, 1999; Jones, Craig, Valway, Woodley, & Schaffner, 1999; Valway, Richards, Kovacovich, Greifinger, Crawford, & Dooley, 1994; & CDC, 2004b). In the past 20 years, the number of ex-offenders released from U.S. prisons has increased fourfold, presenting significant public health challenges to the communities into which they are released (Jones, Woodley, Fountain, & Schaffner, 2003; Bur et al., 2003; Re-Entry Policy Council, 2003). This chapter is intended to provide an overview of current strategies and recommendations for the prevention and control of TB in correctional facilities, with an emphasis on discharge planning for soon-to-be-released inmates. The strengthening of TB prevention and control efforts worldwide is imperative if transmission of TB is to be prevented and elimination of TB is to be achieved (CDC, 1999a).

Sexually transmitted infections (STI) include a broad category of bacterial, viral, protozoan, and fungal infections and ectoparasitic infestations. For three of these bacterial infections, chlamydia, gonorrhea, and syphilis, there is substantive evidence that screening and treatment in correctional settings could play a critical role in their control. We will describe the epidemiology of these infections, the appropriate populations to target for screening, methods to increase treatment of identified infections, evidence of the impact of detention screening in controlling them, and the cost-effectiveness of detention screening. Correctional settings might also play a critical role in controlling HIV, another STI, among some populations, as discussed in Chapter 8.

According to the World Health Organization, health promotion describes the “process of enabling people to increase control over and to improve their health.” Health promotion seeks to bring about changes in individuals, groups, institutions, and policies in order to improve population health. The Ottawa Charter for Health Promotion, adopted by the WHO in 1986, identifies five critical activities for health promotion: developing personal skills for health, creating supportive environments, strengthening community action for health, reorienting health services, and building healthy public policy (Ottawa Charter for Health Promotion, World Health Organization, 1986). At first sight, this expansive conception of health promotion seems too idealistic to serve as a useful guide for the consideration of its role in prisons and jails. However, in this chapter, we make the case that a comprehensive definition of health promotion can serve as a useful paradigm that links correctional health care to the larger public health system, expands the focus of correctional health services from medical care during custody to preparation for healthy living after release, and provides a rationale for expanding the goals of incarceration to include not only punishment but also rehabilitation. In this chapter, we consider health promotion as both a set of activities within the five categories identified by the World Health Organization and as a mindset that views CHS as an integral element of public health that is judged by its contribution to improved population health. We distinguish this perspective from the more traditional view that CHS simply provide care that meets minimal legal standards to those in custody.

Jail and prison screening procedures have developed to rapidly identify patients with acute illness or communicable disease to protect the health of other inmates and staff. But the period of incarceration is also an opportune moment to impact public health via evidence-based screening of high-risk individuals who do not otherwise access routine preventive care. Given the dynamic exchange between correctional facilities and medically underserved communities, effective screening in jails and prisons is generally a costeffective approach to improving population health.

This chapter will discuss the development and assessment of written health education and discharge planning materials as a low-cost and effective tool to supplement the continuation of health care at discharge. In no way is one naive enough to suggest, however, that written information is a cure-all to increase adherence to a discharge plan. Nonadherence to a medical regimen and lack of utilization of community health services on release results both from macro and micro level factors: lack of funds or insurance to pay for health services, inconvenient locations of the health services, adverse effects of medication, ineffective health education, and personal or cultural beliefs (Centers for Disease Control and Prevention [CDC], 1999b). Nevertheless, research also suggests that adherence to treatment and utilization of services is higher when written materials are incorporated in the discharge plan. This chapter will argue that the research is unequivocal on the need for easily understandable discharge plans. This chapter will also provide a template that correctional personnel can use when developing their own written materials for a correctional population.

Suicide continues to be a leading cause of death in jails across the country, where well over 400 inmates take their lives each year (Hayes, 1989). The rate of suicide in county jails is estimated to be approximately four times greater than that of the general population (Mumola, 2005). Overall, most jail suicide victims were young white males who were arrested for nonviolent offenses and intoxicated on arrest. Many were placed in isolation and dead within 24 hours of incarceration (Hayes, 1989; Davis & Muscat, 1993). The overwhelming majority of victims are found hanging by either bedding or clothing. Research specific to suicide in urban jail facilities provides certain disparate findings. Most victims of suicide in large urban facilities are arrested for violent offenses and are dead within 1 to 4 months of incarceration (DuRand, Burtka, Federman, Haycox, & Smith, 1995; Marcus & Alcabes, 1993). Due to the extended length of confinement prior to suicide, intoxication is not always the salient factor in urban jails as it is in other types of jail facilities. Suicide victim characteristics such as age, race, gender, method, and instrument remain generally consistent in both urban and nonurban jails.

There are challenges in providing adequate mental health services to prisoners, but the task is not insurmountable. This chapter focuses on the issues related to full and accurate psychiatric diagnoses as an underpinning to comprehensive treatment. Another focus is on the attitudes and biases about mental disorders held by correctional staff, health professionals, and the inmates themselves. These are inextricably bound to a contemporary understanding of the complexities of multiple coexisting psychiatric diagnoses in a given individual These attitudes can lessen the acceptance of mental disorders as disorders of brain function. The reality of budgetary constraints is an additional difficulty that needs to be redressed, but not here. This chapter aims at the importance of accurate delineation of the mental disorders that bring suffering to those patients and the correctional staff in the form of inner mental anguish and outwardly disordered and disruptive behavior. I posit that a fuller awareness, understanding, and acceptance of this issue could provide an impetus for change in the allocation of resources toward accurate mental health diagnosis leading to more effective treatment. Going beyond the correctional system to any psychiatric care setting, accurate psychiatric diagnosis in each mental health care recipient is the gateway to comprehensive and effective treatment. Throughout this chapter, the term , unless otherwise specified, is used in its broadest context to include all mental health care personnel involved in the process of screening, assessment, and treatment of individuals with mental disorders. Secondarily involved are all health care providers in any system where mental disorders are prevalent. All may be blinded to varying degrees from a truly comprehensive view of the impact of mental disorders on the behavior and emotional distress of the persons for whom they have clinical responsibility. These blinders may prevent appropriate referral for a psychiatrist’s scrutiny.

Most juveniles behind bars move in and out of facilities with short lengths of stay. Relatively few have longer sentences for more serious crimes; they all return to the community. In 2003, law enforcement agencies reported 2.2 million arrests of persons under age 18 (Snyder & Sickmund, 2006). The most serious charges in almost half of all juvenile arrests were for larceny-theft, simple assault, drugs, disorderly conduct, or liquor law violations (Snyder & Sickmund, 2006). The brevity and frequency of these contacts with correctional institutions create challenges and opportunities for health promotion and intervention during incarceration and in preparation for reentry. As the character of juvenile populations varies by region, the services must be customized to the developmental, cultural, and linguistic needs of the local inmate population. To do this, it is essential to understand the background of these young men and women, where they come from, and what circumstances contributed to their incarceration.

The rapidly rising prison, jail, and probation population is clearly a concern for the entire criminal justice system, but this is especially true in the case of female prisoners. Arrests over the last 20 years have increased for the general population, but the increase is significantly larger among females. A 1998 Justice Department study reported that since 1990 the female adult jail population grew 7.0% while the male adult jail population grew 4.5% during the same time period (BJS, 1999b). Between midyear 2004 and midyear 2005 the number of women under the jurisdiction of the state and federal prison systems grew by 3.4% while the number of men grew by 1.3% (BJS, 2006) Despite these significant changes in the incarcerated population, there has not been a commensurate increase in research devoted to the needs of these women, nor in designing discharge and reentry programs specifically for female prisoners. As concern over this growing population within the criminal justice system has increased, it has become clear that there need to be different institutional practices, treatment programs, and systems of discharge planning. Because of less research on women than men, there is still little specific information on the effectiveness of rehabilitation and reentry programs for women. Without addressing these issues, it is unlikely that there will be significant reductions in recidivism statistics. In addition, if these numbers keep on increasing, whole communities, especially children, will suffer from the loss of these women.

In various works of fiction and nonfiction written over time and place [see, e.g., the opening passage of (Magee, 2003)], missing teeth are universally distinguished as the physical markers of having been imprisoned. While few accurate data are available on nonlethal violence behind bars in the United States, missing front teeth in men are a sign of a much larger malignancy in U.S. prisons and jails: physical violence perpetrated by staff against prisoners as well as pervasive assaults among prisoners (Gibbons & Katzanbach, 2006). There is no need to convince the editors of this volume of the importance of oral health and health care to the overall safety and well-being of incarcerated populations. By including this chapter, they have heeded the advice of former Surgeon General David Satcher in his landmark report to reconnect the mouth to the rest of the body (U.S. Department of Health and Human Services, 2000).