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INTRODUCTION: More than 30 million adults are released from incarceration globally each year. Many experience complex physical and mental health problems, and are at markedly increased risk of preventable mortality. Despite this, evidence regarding the global epidemiology of mortality following release from incarceration is insufficient to inform the development of targeted, evidence-based responses. Many previous studies have suffered from inadequate power and poor precision, and even large studies have limited capacity to disaggregate data by specific causes of death, sub-populations or time since release to answer questions of clinical and public health relevance. OBJECTIVES: To comprehensively document the incidence, timing, causes and risk factors for mortality in adults released from prison. METHODS: We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration representing 29 cohorts of adults who have experienced incarceration from 11 countries. Findings across cohorts will be analysed using a two-step, individual participant data meta-analysis methodology. RESULTS: The combined sample includes 1,337,993 individuals (89% male), with 75,795 deaths recorded over 9,191,393 person-years of follow-up. CONCLUSIONS: The consortium represents an important advancement in the field, bringing international attention to this problem. It will provide internationally relevant evidence to guide policymakers and clinicians in reducing preventable deaths in this marginalized population. KEY WORDS: Mortality; incarceration; prison; release; individual participant data meta-analysis; consortium; cohort.
RESUMEN
OBJECTIVE: To ascertain whether a new indoor smoking ban law in North Carolina correctional facilities was successfully implemented and whether the indoor air quality has improved as a result. METHOD: Before the law came into effect, we tested the air quality of 22 dormitory and common areas within six North Carolina prisons using standard protocols for testing particulate matter. We measured particulate matter 2.5 microm in diameter (PM(2.5)) using state of the art TSI SidePak monitors. After the law went into effect, the same locations within each prison were tested again. Written inmate surveys were also conducted at two prisons, one with partial smoking ban (indoors only) and one with a total smoking ban (indoors and outdoors). RESULTS: The findings indicate that, on average, levels of respirable suspended particulates (RSPs), an accepted marker for secondhand smoke (SHS) levels, decreased 77% in these prisons after the law took effect compared to levels obtained before ban implementation. Several areas were tobacco-free before the implementation of this ban. In those areas no significant decreases in RSPs were noted. CONCLUSION: Laws banning tobacco use in correctional facilities can significantly reduce indoor SHS exposure among inmates, visitors and staff and potentially lead to reduced use. To date, 24 US states have enacted 100% smoke-free correctional facility policies for all indoor areas even though inmates and staff have much higher tobacco use prevalence rates than the general population. With an estimated nine million people incarcerated worldwide, prison smoking bans could have a substantial impact in terms of health outcomes and long-term costs if they can effectively reduce exposure to secondhand smoke.