Publications by authors named "Luke Grant"

24 Publications

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Evaluation of hepatitis C treatment-as-prevention within Australian prisons (SToP-C): a prospective cohort study.

Lancet Gastroenterol Hepatol 2021 Jul 7;6(7):533-546. Epub 2021 May 7.

The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia. Electronic address:

Background: Limited empirical evidence exists for the effectiveness of hepatitis C virus (HCV) treatment-as-prevention. The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study aimed to assess the effect of HCV treatment-as-prevention in the prison setting.

Methods: SToP-C was a prospective study, including a before-and-after analysis, within a cohort of people incarcerated in two maximum-security prisons (male) and two medium-security prisons (one male, one female) in New South Wales, Australia. All prison inmates aged at least 18 years were eligible for enrolment. After HCV testing, participants were monitored for risk behaviours and HCV infection, among three sub-populations: uninfected (HCV antibody-negative); previously infected (HCV antibody-positive, HCV RNA-negative); and infected (HCV antibody and HCV RNA-positive). Uninfected participants were followed up every 3-6 months to detect HCV primary infection and previously infected participants were followed up every 3-6 months to detect re-infection. Participants with HCV infection were assessed for treatment, initially standard-of-care treatment (administered by prison health services) from 2014 to mid-2017, then direct-acting antiviral (DAA) treatment scale-up from mid-2017 onwards (12 weeks of sofosbuvir plus velpatasvir, administered through SToP-C). Participants were followed up until study closure in November, 2019. The primary study outcome was HCV incidence before and after DAA treatment scale-up among participants at risk of HCV primary infection or re-infection. This study is registered with ClinicalTrials.gov, NCT02064049.

Findings: Between Oct 30, 2014, and Sept 30, 2019, 3691 participants were enrolled in the SToP-C study. 719 (19%) participants had detectable HCV RNA, 2240 (61%) were at risk of primary HCV infection, and 725 (20%) were at risk of re-infection at baseline. DAA treatment was initiated in 349 (70%) of 499 eligible participants during the treatment scale-up period. The HCV incidence analysis comprised 1643 participants at risk of HCV infection or re-infection during longitudinal follow-up (median age 33 years [IQR 27-42]; 1350 [82%] male). 487 (30%) of 1643 participants reported injecting drugs in prison. HCV incidence decreased from 8·31 per 100 person-years in the pre-treatment scale-up period to 4·35 per 100 person-years in the post-treatment scale-up period (incidence rate ratio [IRR] 0·52 [95% CI 0·36-0·78]; p=0·0007). The incidence of primary infection decreased from 6·64 per 100 person-years in the pre-treatment scale-up period to 2·85 per 100 person-years in the post-treatment scale-up period (IRR 0·43 [95% CI 0·25-0·74]; p=0·0019), whereas the incidence of re-infection decreased from 12·36 per 100 person-years to 7·27 per 100 person-years (0·59 [0·35-1·00]; p=0·050). Among participants reporting injecting drugs during their current imprisonment, the incidence of primary infection decreased from 39·08 per 100 person-years in the pre-treatment scale-up period to 14·03 per 100 person-years in the post-treatment scale-up period (IRR 0·36 [95% CI 0·16-0·80]; p=0·0091), and the incidence of re-infection decreased from 15·26 per 100 person-years to 9·34 per 100 person-years (0·61 [0·34-1·09]; p=0·093). The adjusted analysis (adjusted for age, Indigenous Australian ethnicity, duration of stay in prison, previous imprisonment, injecting drug use status, and prison site) indicated a significant reduction in the risk of HCV infection between the pre-DAA treatment scale-up and post-DAA treatment scale-up periods (adjusted hazard ratio 0·50 [95% CI 0·33-0·76]; p=0·0014).

Interpretation: DAA treatment scale-up was associated with reduced HCV incidence in prison, indicative of a beneficial effect of HCV treatment-as-prevention in this setting. These findings support broad DAA treatment scale-up within incarcerated populations.

Funding: Australian National Health and Medical Research Council Partnership Project Grant and Gilead Sciences.
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http://dx.doi.org/10.1016/S2468-1253(21)00077-7DOI Listing
July 2021

The effect of omega-3 long chain polyunsaturated fatty acids on aggressive behaviour in adult male prisoners: a structured study protocol for a multi-centre, double-blind, randomised placebo-controlled trial and translation into policy and practice.

Trials 2021 May 2;22(1):318. Epub 2021 May 2.

Corrective Services NSW, 20 Lee St, Haymarket, NSW, 2000, Australia.

Background: Interventions to better manage aggressive behaviour and reduce recidivism are a primary concern for corrective services. Nutritional interventions to correct prisoner behaviour have been largely overlooked in the literature. Emerging evidence suggests that dietary intake influences aggressive behaviours and that nutritional supplementation with omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) could attenuate both the severity and frequency of aggressive behaviour.

Methods: Adult male prisoners who have a history of aggressive behaviour (n = 600) will be recruited from at least 6 Correctional Centres and randomised to receive either n-3 LCPUFA or placebo supplementation for a 16-week duration. Treatment will be with either 1 g/day of n-3 LCPUFA (694 mg DHA and 397 mg EPA) or placebo capsules, which are a corn/soy oil blend and are identical in size and colour. The primary outcome measure is the Inmate Behavioural Observation Scale (IBOS): an objective measure of aggressive behaviour. Secondary outcome measures include questionnaires (including aggression, attention deficit disorder, impulsivity, depression/anxiety/stress scales), engagement in programmes, recidivism and quality of life. Baseline and post-intervention assessments include the IBOS, questionnaires and blood to measure the levels of n-3 LCPUFA.

Discussion: To conclusively test the potential that increasing n-3 LCPUFA intakes can improve rates of prisoner aggression and associated mental health and violence-related social system management costs, we propose an adequately powered multi-centre, double-blind, randomised controlled trial, examining the effects of n-3 LCPUFA supplementation on aggressive behaviour in adult male prisoners. If successful, this study will inform prisoner policy with respect to nutrition and by inference contribute to a broader community approach to preventative mental health practices.

Trial Registration: Australian New Zealand Clinical Trial Registry (ANZCTR) ACTRN12618001665224 . Registered on 10 October 2018.
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http://dx.doi.org/10.1186/s13063-021-05252-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088826PMC
May 2021

Phenological shifts in lake stratification under climate change.

Nat Commun 2021 04 19;12(1):2318. Epub 2021 Apr 19.

Centre for Freshwater and Environmental Studies, Dundalk Institute of Technology, Dundalk, Ireland.

One of the most important physical characteristics driving lifecycle events in lakes is stratification. Already subtle variations in the timing of stratification onset and break-up (phenology) are known to have major ecological effects, mainly by determining the availability of light, nutrients, carbon and oxygen to organisms. Despite its ecological importance, historic and future global changes in stratification phenology are unknown. Here, we used a lake-climate model ensemble and long-term observational data, to investigate changes in lake stratification phenology across the Northern Hemisphere from 1901 to 2099. Under the high-greenhouse-gas-emission scenario, stratification will begin 22.0 ± 7.0 days earlier and end 11.3 ± 4.7 days later by the end of this century. It is very likely that this 33.3 ± 11.7 day prolongation in stratification will accelerate lake deoxygenation with subsequent effects on nutrient mineralization and phosphorus release from lake sediments. Further misalignment of lifecycle events, with possible irreversible changes for lake ecosystems, is also likely.
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http://dx.doi.org/10.1038/s41467-021-22657-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055693PMC
April 2021

Lessons learned from keeping NSW's prisons COVID-free.

Int J Prison Health 2021 03;ahead-of-print(ahead-of-print)

Executive Director at Clinical Operations, Justice Health and Forensic Mental Health Network, Malabar, Australia.

Purpose: New South Wales (NSW) correctional system houses 30% of prisoners in Australia and at this time has only had a single documented case of COVID-19 amongst its prisoner population. The coordinated response by Justice Health and Forensic Mental Health Network (The Network) undertaken with the support of NSW Ministry of Health, in partnership with Corrective Services NSW (CSNSW), Youth Justice and private jails has ensured that the NSW correctional system has remained otherwise COVID-free.

Design/methodology/approach: A research study of how a range of partners which support the operations of NSW Correctional System developed an effective approach for the prevention a COVID-19 epidemic amongst its inmates.

Findings: Establishment of effective partnerships, early coordination of representatives from all aspects of the NSW correctional system, limited access to the correctional environment, reduced prison population and strict isolation of all new receptions have all contributed to maintaining this COVID-free status despite other NSW settings with similar risk profiles, such as aged care facilities and cruise ship arrivals, experiencing serious outbreaks.

Research Limitations/implications: Although Australia/New Zealand context of suppressed community infection rates for COVID-19 (which are approaching elimination in some jurisdictions) is in contrast to the situation in other parts of the world, the principles described in this paper will be useful to most other correctional systems.

Practical Implications: Modelling was used to underline our approach and reinforced the veracity of following this approach.

Originality/value: The Network and CSNSW has been able to mount an effective, integrated response to the COVID-19 pandemic, which has been sustainable through the first peak of COVID-19 cases. This case study catalogues the process of developing this response and details each intervention implemented with inventive use of tables to demonstrate the impact of the range of interventions used.
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http://dx.doi.org/10.1108/IJPH-09-2020-0073DOI Listing
March 2021

The Effect of Dietary Supplementation on Aggressive Behaviour in Australian Adult Male Prisoners: A Feasibility and Pilot Study for a Randomised, Double Blind Placebo Controlled Trial.

Nutrients 2020 Aug 27;12(9). Epub 2020 Aug 27.

School of Medicine, Lipid Research Centre, Molecular Horizons, University of Wollongong, Wollongong, NSW 2522, Australia.

This study aimed to assess the feasibility of conducting a nutrition trial in adult male prisoners. Adult male prisoners were recruited for a 16-week randomised control trial comparing the effect of ingestion of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) and multivitamin supplements versus placebo on aggressive behaviour. The baseline and post-intervention assessments from the participant blood samples were the erythrocyte n-3 LCPUFA levels as well as measures of aggressive behaviour determined through institutional records of misconduct (IRM), the Inmate Behaviour Observation Scale (IBOS), and questionnaires. A total of 136 adult male prisoners consented to the study with a retention rate of 60%, and 93% of blood samples were successfully collected. The IRM and IBOS scores were collected for 100% of participants, whilst 82-97% of participants completed the questionnaires. From the baseline data, the Odds Ratio shows that prisoners are 4.3 times more likely to have an IBOS >2 if they are below the 6% cut off on the omega-3 index. Both groups improved across all outcome measures and, at the current sample size, no significant differences were seen between them. A power calculation suggests a total sample size of 600 participants is required to detect the effects of this dietary supplementation, and that this supplementation study is feasible in a Correctional Centre. Important criteria for the exclusion and consideration of logistics and compliance are presented.
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http://dx.doi.org/10.3390/nu12092617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551402PMC
August 2020

Association Between Early Contact With Mental Health Services After an Offense and Reoffending in Individuals Diagnosed With Psychosis.

JAMA Psychiatry 2020 Nov;77(11):1137-1146

Kirby Institute, University of New South Wales, Sydney, Australia.

Importance: Psychosis is a known risk factor for offending behavior, but little is known about the association between clinical contact with mental health services after an offense and reoffending.

Objective: To examine the association between early contact with mental health services and reoffending after an index offense in individuals with psychosis.

Design, Setting, And Participants: In this cohort study, individuals diagnosed with psychosis before their index offense from July 1, 2001, to December 31, 2012, and who received a noncustodial sentence were identified by linking health and offending databases in New South Wales, Australia. The incidence of and risk factors for reoffending and time to reoffending within 2 years from the index offense were examined using Cox proportional hazards regression and Kaplan-Meier survival estimates. Specifically, the association between contact with mental health services within 30 days after an offense and reoffending was examined. Data were analyzed from July 1, 2019, to March 5, 2020.

Exposures: Hospital admission, emergency department presentation, and contact with community mental health services associated with psychosis.

Main Outcomes And Measures: Reoffending within 2 years of the index offense was compared in individuals with and without clinical contact with mental health services within 30 days after an offense, with adjustment for potential confounders.

Results: Of the 7030 offenders with psychosis (4933 male [70.2%]; median age at the index offense, 34 [interquartile range, 26-42] years), 2605 (37.1%) had clinical contact with mental health services within 30 days after the index offense. The risk of reoffending was significantly lower in those with vs without clinical contact (adjusted hazard ratio [AHR], 0.83; 95% CI, 0.76-0.91). The risk of reoffending was 30% less in male offenders with 5 or more clinical contacts compared with male offenders with no clinical contact (AHR, 0.71; 95% CI, 0.59-0.84). Reoffending in both male and female offenders was associated with younger age (eg, AHR for male offenders aged <18 years, 3.31 [95% CI, 2.39-4.59]; AHR for female offenders aged <18 years, 2.60 [95% CI, 1.69-3.99]) and offending history (eg, AHR for male offenders with ≥4 prior offenses, 2.28 [95% CI, 1.98-2.64]; AHR for female offenders with ≥4 prior offenses, 2.22 [95% CI, 1.67-2.96]).

Conclusions And Relevance: In this cohort, early and frequent clinical contact with mental health services after an offense in individuals with psychosis was associated with reduced risk of reoffending in this group. More support may be needed for early treatment of those with serious mental illness who are at risk of reoffending.
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http://dx.doi.org/10.1001/jamapsychiatry.2020.1255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364339PMC
November 2020

Disengagement from mental health treatment and re-offending in those with psychosis: a multi-state model of linked data.

Soc Psychiatry Psychiatr Epidemiol 2020 Dec 10;55(12):1639-1648. Epub 2020 May 10.

Kirby Institute, University of New South Wales, Sydney, Australia.

Background And Aims: Individuals with psychosis are over-represented in the criminal justice system and, as a group, are at elevated risk of re-offending. Recent studies have observed an association between increased contacts with mental health services and reduced re-offending, as well as reduced risk of re-offending in those who are ordered to mental health treatment rather than punitive sanctions. In furthering this work, this study examines the effect of disengagement from mental health treatment on probability of re-offence in offenders with psychosis over time.

Methods: Data linkage was conducted with judicial, health and mortality datasets from New South Wales, Australia (2001-2015). The study population included 4960 offenders with psychosis who received non-custodial sentences and engaged with community-based mental health treatment. Risk factors for leaving treatment and/or reconviction were examined using multivariate cox regression. Further, a multi-state model was used to observe the probabilities associated with individuals moving between three states: conviction, disengagement from mental health treatment and subsequent re-conviction.

Results: A threefold increase was observed in the risk of re-offending for those who disengaged from treatment compared to those who did not (aHR = 2.76, 95% CI 1.65-4.62, p < 0.001). The median time until re-offence was 195 days, with the majority (67%) being convicted within one year of leaving treatment. A higher risk of leaving treatment was found for those born outside of Australia, with substance-related psychosis, and a history of violent offence.

Conclusions: The findings argue for an emphasis on continued engagement with mental health services following release for offenders with psychosis and identify subgroups within this population for whom concentrated efforts regarding treatment retention should be targeted.
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http://dx.doi.org/10.1007/s00127-020-01873-1DOI Listing
December 2020

First diagnosis of psychosis in the prison: results from a data-linkage study.

BJPsych Open 2019 Oct 14;5(6):e89. Epub 2019 Oct 14.

Program Head, Justice Health Research Program, Kirby Institute, University of New South Wales, Australia.

Background: Psychosis is more prevalent among people in prison compared with the community. Early detection is important to optimise health and justice outcomes; for some, this may be the first time they have been clinically assessed.

Aims: Determine factors associated with a first diagnosis of psychosis in prison and describe time to diagnosis from entry into prison.

Method: This retrospective cohort study describes individuals identified for the first time with psychosis in New South Wales (NSW) prisons (2006-2012). Logistic regression was used to identify factors associated with a first diagnosis of psychosis. Cox regression was used to describe time to diagnosis from entry into prison.

Results: Of the 38 489 diagnosed with psychosis for the first time, 1.7% (n = 659) occurred in prison. Factors associated with an increased likelihood of being diagnosed in prison (versus community) were: male gender (odds ratio (OR) = 2.27, 95% CI 1.79-2.89), Aboriginality (OR = 1.81, 95% CI 1.49-2.19), older age (OR = 1.70, 95% CI 1.37-2.11 for 25-34 years and OR = 1.63, 95% CI 1.29-2.06 for 35-44 years) and disadvantaged socioeconomic area (OR = 4.41, 95% CI 3.42-5.69). Eight out of ten were diagnosed within 3 months of reception.

Conclusions: Among those diagnosed with psychosis for the first time, only a small number were identified during incarceration with most identified in the first 3 months following imprisonment. This suggests good screening processes are in place in NSW prisons for detecting those with serious mental illness. It is important these individuals receive appropriate care in prison, have the opportunity to have matters reheard and possibly diverted into treatment, and are subsequently connected to community mental health services on release.

Declaration Of Interest: None.
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http://dx.doi.org/10.1192/bjo.2019.74DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854362PMC
October 2019

Disclosing sexuality: Gay and bisexual men's experiences of coming out, forced out, going back in and staying out of the 'closet' in prison.

Cult Health Sex 2020 11 9;22(11):1222-1234. Epub 2019 Oct 9.

The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.

Many papers have been written on the process of coming out by individuals with predominantly same-sex sexual orientation but few of these papers have explored the concept of how people negotiate the idea of coming out in prison. We conducted in-depth interviews with 13 prisoners and one ex-prisoner in New South Wales, Australia, who self-identified as gay, homosexual or bisexual men. Data was collected and analysed using an inductive or grounded theory framework since very little was known on the sexual behaviours and identities of Australian prisoners prior to the study and elsewhere. We examined and discussed the lived experiences of prisoners whose disclosure stories were seen to fall under four thematic categories: 'coming out', 'forced out', 'going back in' and 'staying out of the closet' on entering prison. Respondents were required continuously and contextually to manage their sexual identities and disclosure to different audiences while incarcerated. Findings suggest that the prison environment and its attendant heteronormative values and hyper-masculine culture, apply significant pressure on gay and bisexual men on how to manage their sexual identities and disclose their sexuality in prison.
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http://dx.doi.org/10.1080/13691058.2019.1668963DOI Listing
November 2020

Prison cell spatial density and infectious and communicable diseases: a systematic review.

BMJ Open 2019 07 23;9(7):e026806. Epub 2019 Jul 23.

Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.

Objective: To summarise the extent and quality of evidence on the association between prison cell spatial density (a measure of crowding) and infectious and communicable diseases transmission among prisoners.

Design: Systematic review.

Data Sources: Embase, PubMed, Medline, Scopus, Web of Science, PsycINFO, PsycExtra, ProQuest Databases, ProQuest Dissertations and Theses Global, Index to Legal Periodicals, InformitOnline, Cochrane Library, Criminal Justice Abstracts and ICONDA were searched to 31 December 2018.

Eligibility Criteria: Studies that reported on the association between prison cell spatial density (measured in square feet or square metres of cell floor area per person) and infectious and communicable diseases in juvenile and adult populations incarcerated in a correctional facility.

Data Extraction And Synthesis: A review protocol was developed in consultation with an advisory panel. Two reviewers independently extracted data and used the Australian National Health and Medical Research Council's (NHMRC) checklist to critically appraise individual studies. An assessment of the overall body of the evidence was conducted using the NHMRC's Evidence Scale and Statement Form.

Results: A total of 5126 articles were initially identified with seven included in the review from Pakistan (2003), Chile (2016), Nigeria (2012, 2013) and the USA (1980s). Infectious and communicable disease outcomes included pneumococcal disease/acute pneumonia, , latent tuberculosis infection, infectious skin conditions and contagious disease reporting to the prison clinic. Five articles reported statistically significant positive associations but were countered by associations possibly being explained by chance, bias or confounding factors. Heterogeneity prevented meta-analysis.

Conclusion: Overall, the body of evidence provides some support for an association between prison cell special density and infectious and communicable diseases, but care should be taken in the interpretation and transferability of the findings. Future research and policy responses should adequately consider prospective mediating factors implicated in associations between cell spatial density and health effects.
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http://dx.doi.org/10.1136/bmjopen-2018-026806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661645PMC
July 2019

Factors Associated With Sexual Coercion in a Representative Sample of Men in Australian Prisons.

Arch Sex Behav 2016 07 23;45(5):1195-205. Epub 2015 Nov 23.

The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia.

Very little research has focused on men or prisoners as victims of sexual violence. This study provides the first population-based analysis of factors associated with sexual coercion of men in Australian prisons, and the first to use a computer-assisted telephone interview to collect this information in a prison setting. A random sample of men in New South Wales and Queensland prisons were surveyed using computer-assisted telephone interviewing. We asked participants about sexual coercion, defined as being forced or frightened into doing something sexually that was unwanted while in prison. Associations between sexual coercion in prison and sociodemographics, sexual coercion history outside of prison, and prison-related factors were examined. Logistic regression was used to estimate adjusted odds ratios in examining factors associated with sexual coercion in prisons. Of 2626 eligible men, 2000 participated. Participants identifying as non-heterosexual and those with a history of sexual coercion outside prison were found to be most at risk. Those in prison for the first time and those who had spent more than 5 years in prison ever were also more likely to report sexual coercion. Although prison policies and improving prison officer training may help address immediate safety and health concerns of those at risk, given the sensitivity of the issue and likely under-reporting to correctional staff, community-based organizations and prisoner peer-based groups arguably have a role too in providing both preventive and trauma-focused support.
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http://dx.doi.org/10.1007/s10508-015-0653-7DOI Listing
July 2016

Baseline omega-3 index correlates with aggressive and attention deficit disorder behaviours in adult prisoners.

PLoS One 2015 20;10(3):e0120220. Epub 2015 Mar 20.

Corrective Services New South Wales, Sydney, Australia.

Background: There is emerging evidence that the supplementation of omega-3 contributes to a decrease in aggressive behaviour in prison populations. A challenge of such research is achieving statistical power against effect sizes which may be affected by the baseline omega-3 index. There are no published data on the blood omega-3 index with studies of this kind to assess the variability of the blood omega-3 index in conjunction with aggression and attention deficit assessments.

Objective: To determine if the variance of the omega-3 index is correlated with aggressive and attention deficit behaviour in a prison population.

Design: 136 adult male prisoners were recruited from South Coast Correctional Centre (SCCC), NSW Australia. A 7 point categorisation was used to quantify levels of aggressive behaviour (4 weeks) from individual SCCC case notes, whereby higher scores correspond to increasingly aggressive behaviour. Study participants completed the Aggression Questionnaire (AQ) and the Brown's Attention Deficit Disorder Scales (BADDS), provided a blood sample for erythrocyte fatty acid analysis using gas chromatography and the omega-3 index was calculated.

Results: The baseline omega-3 index ranged from 2.3% to 10.3%, indicating that some participants already had substantial omega-3 intake, however a median of 4.7% indicated a lower overall omega-3 intake than the general Australian population. Assessment of aggressive and attention deficit behaviour shows that there were negative correlations between baseline omega-3 index and baseline aggression categorisation scores (r = -0.21, P = 0.016); total AQ score (r = -0.234, P = 0.011); Anger (r = -0.222 p = 0.016); Hostility AQ (r = -0.239, P = 0.009); indirect aggression (r = -0.188 p = 0.042); total BADDS (r = -0.263, p = 0.005); Activation (r = -0.224, p = 0.016); Attention (r = -0.192, p = 0.043); Effort (r = -0.253, p = 0.007); Affect (r = -0.330, p = 0.000) and Memory (r = -0.240, p = 0.010).

Conclusions: There is a high variability in omega-3 status of a NSW prison population, and inmates with lower omega-3 index were more aggressive and had higher ADD scores.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0120220PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4368577PMC
February 2016

Penile implants among prisoners-a cause for concern?

PLoS One 2013 11;8(1):e53065. Epub 2013 Jan 11.

Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.

Background: We report the prevalence of penile implants among prisoners and determine the independent predictors for having penile implants. Questions on penile implants were included in the Sexual Health and Attitudes of Australian Prisoners (SHAAP) survey following concerns raised by prison health staff that increasing numbers of prisoners reported having penile implants while in prison.

Methods: Computer-Assisted Telephone Interviewing (CATI) of a random sample of prisoners was carried out in 41 prisons in New South Wales and Queensland (Australia). Men were asked, "Have you ever inserted or implanted an object under the skin of your penis?" If they responded Yes: "Have you ever done so while you were in prison?" Univariate logistic regression and logistic regression were used to determine the factors associated with penile implants.

Results: A total of 2,018 male prisoners were surveyed, aged between 18 and 65 years, and 118 (5.8%) reported that they had inserted or implanted an object under the skin of their penis. Of these men, 87 (73%) had this done while they were in prison. In the multivariate analysis, a younger age, birth in an Asian country, and prior incarceration were all significantly associated with penile implants (p<0.001). Men with penile implants were also more likely to report being paid for sex (p<0.001), to have had body piercings (p<0.001) or tattoos in prison (p<0.001), and to have taken non-prescription drugs while in prison (p<0.05).

Conclusions: Penile implants appear to be fairly common among prisoners and are associated with risky sexual and drug use practices. As most of these penile implants are inserted in prison, these men are at risk of blood borne viruses and wound infection. Harm reduction and infection control strategies need to be developed to address this potential risk.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0053065PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543437PMC
July 2013

Sexual behaviour and sexual health of Australian prisoners.

Sex Health 2013 Mar;10(1):64-73

The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.

Objective: To describe prisoners' sexual experiences and sexual practices while in the community, sexual identities, and sexual health (e.g. self-reported exposure to sexually transmissible infections (STIs) and female reproductive outcomes) using data from the Sexual Health and Attitudes of Australian Prisoners (SHAAP) survey.

Methods: This study used a computer-assisted telephone interview to screen randomly selected prisoners using a questionnaire based on the Australian Study of Health and Relationships survey.

Results: 2351 men and women prisoners from New South Wales and Queensland took part in the survey. Most men identified as heterosexual (95.7%) and reported sexual attraction (91.0%) and sexual experiences (86.6%) only with the opposite sex, but 28.5% of women prisoners identified as bisexual. Sexual attraction correlated with sexual experience (men: r=0.63; women: r=0.84) more than with sexual identity (men: r=0.53; women: r=0.54). Male prisoners reported more lifetime opposite-sex partners than women prisoners (median 24 v. 10). Women prisoners were more likely than men to report a prior STI (35.1% v. 20.0%).

Conclusions: Prisoners are a high-risk group with regard to sexual health. There is a need for a better understanding of the sexual health of this population group so that education campaigns and interventions specific to this population group can be developed.
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http://dx.doi.org/10.1071/SH12104DOI Listing
March 2013

Attitudes towards sex: a comparison of prisoners and the general community.

Sex Health 2011 Sep;8(3):355-62

National Drug Research Institute, Curtin University, Perth, WA 6008, Australia.

Background: National population surveys of attitudes towards sexual issues typically exclude prisoners and little is known about their attitudes compared with the community.

Methods: Using computer-assisted telephone interviews, we compared a representative sample of 2289 prisoners (men=1960, women=329), aged 18-59 years, from two Australian states against a national community sample of 6755 participants (men=3333, women=3421).

Results: Overall, prisoners were slightly more conservative in their attitudes towards sex than the community. They were more likely than the community to agree with the statement that abortion is wrong (men: adjusted odds ratio (AOR)=3.3, 95% confidence interval (CI): 2.8-3.9; women: AOR=1.7, 95% CI: 1.2-2.4) and that male homosexuality is wrong (men: AOR=2.6, 95% CI: 2.2-3.1; women: AOR=1.7, 95% CI: 1.2-2.3); these differences were more pronounced for men than women. The attitudes of prisoners and the community varied with age. Attitudinal differences between prisoners and the community tended to be larger than the differences between women and men (agree that abortion is wrong: prisoners, AOR=0.5, 95% CI: 0.4-0.7; community, AOR=0.8, 95% CI: 0.7-0.9; agree that male homosexuality is wrong: prisoners, AOR=0.4, 95% CI: 0.3-0.5; community, AOR=0.6, 95% CI: 0.5-0.7).

Conclusion: Prisoners have either similar or less accepting attitudes towards sex than the general population. These attitudes contrast with the higher engagement in risk behaviours reported by prisoners.
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http://dx.doi.org/10.1071/SH10113DOI Listing
September 2011

Psychological distress and experience of sexual and physical assault among Australian prisoners.

Crim Behav Ment Health 2011 Dec 14;21(5):333-49. Epub 2011 Jun 14.

The Kirby Institute, University of New South Wales, Sydney, Australia.

Background: Prison populations are made up of individuals from disadvantaged, often abusive backgrounds, who are more likely to suffer from psychological problems than the general community.

Aim: This study aimed to determine associations between current psychological distress and history of having experienced sexual coercion and/or physical assault among prisoners in two Australian states (Queensland and New South Wales).

Methods: We conducted a random sample survey of prisoners by computer-assisted telephone interview. Prisoners were asked about forced sexual encounters in or outside prison, and physical assault in prison. Psychological distress was estimated using a dichotomised score obtained from the Kessler 6-Item Psychological Distress Scale (K6), and a logistic regression analysis was employed to investigate associations.

Results: A total of 2426 prisoners were interviewed of 3055 prisoners invited to participate, a response rate of 79%. We categorised 236 men (12%) and 63 women (19%) as 'severely' psychologically distressed according to the K6, and 13% of the men and 60% of the women reported that they had been sexually coerced prior to imprisonment. Physical assault in prison was common, reported by 34% of the men and 24% of the women. On multivariate analysis, prisoners were more likely to be psychologically distressed if they had ever been threatened with sexual assault in prison or physically assaulted in prison. Sexual coercion outside prison was an important associate of psychological distress among men but not among women.

Conclusions: As psychological distress and experiences of assault are closely statistically linked among male prisoners and both are very common among female prisoners, their screening for psychological distress should include efforts to find out about sexual and violent assaults against them both before and during imprisonment. Further, longitudinal research with prisoners is required to establish causal relationships.
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http://dx.doi.org/10.1002/cbm.816DOI Listing
December 2011

The decline in sexual assaults in men's prisons in New South Wales: a "systems" approach.

J Interpers Violence 2011 Oct 30;26(15):3157-81. Epub 2011 Jan 30.

School of Public Health and Community Medicine,University of New South Wales, Sydney, NSW 2052, Australia.

Male prison rape and sexual assaults remains a serious and sensitive issue in many countries. Human rights groups claim that sexual assaults among male prisoners have reached pandemic proportions and need to be stopped. Researchers for many years have studied the causes of male sexual assault in prison and offered numerous recommendations on its prevention. Few, however, have presented evidence for a decline in male prisoner sexual assaults and investigated the reasons for the decline. This article provides evidence from population-based surveys of a steady decrease in male prisoner sexual assaults in New South Wales (NSW) between 1996 and 2009. The authors conducted in-depth interviews with former and current inmates, and using a "systems" approach they discuss the complexity of sexual assaults in prison, incorporating a multiplicity of perspectives. In particular, they bring together different sources of data and discuss this in relation to changes in power structures and control in a modern prison, the attitudes of older and younger prisoners, the concept of "duty of care," introduction of prison drug programs, and prisoner attitudes toward gender and sexuality. In anthropology, the term "system" is used widely for describing sociocultural phenomena of a given society in a holistic manner without reducing the complexity of a given community.
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http://dx.doi.org/10.1177/0886260510390961DOI Listing
October 2011

Establishing a compulsory drug treatment prison: Therapeutic policy, principles, and practices in addressing offender rights and rehabilitation.

Int J Law Psychiatry 2010 Nov-Dec;33(5-6):341-9

Compulsory Drug Treatment Correctional Center, Corrective Services NSW, Australia.

A Compulsory Drug Treatment Correctional Center (CDTCC) was established in Australia in 2006 for repeat drug-related male offenders. Compulsory treatment law is inconsistent with a therapeutic jurisprudence approach. Despite the compulsory law, a normative offender rehabilitation framework has been established based on offender moral rights. Within moral rights, the offender rehabilitation framework addresses the core values of freedom (supporting autonomous decision-making) and well-being (supporting support physical, social, and psychological needs). Moral rights are underpinned by a theory or principle which, in this instance, is a humane approach to offender rehabilitation. While a law that permits offenders to choose drug treatment and rehabilitation is preferable, the article discusses the establishment of a prison based on therapeutic policy, principles, and practices that respond to participants as both rights-violators and rights-holders. The opportunity for accelerated community access and a therapeutic alliance with staff has resulted in offenders actively seeking to be ordered into compulsory drug treatment and rehabilitation.
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http://dx.doi.org/10.1016/j.ijlp.2010.09.006DOI Listing
April 2011

Consensual sex between men and sexual violence in Australian prisons.

Arch Sex Behav 2012 Apr 31;41(2):517-24. Epub 2010 Aug 31.

School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.

Estimates of the incidence of sexual coercion in men's prisons are notoriously variable and fraught with conceptual and methodological problems. In 2006-2007, we conducted a computer-assisted telephone survey of a random sample of 2,018 male prisoners in New South Wales and Queensland. Of 2,626 eligible and available inmates, 76.8% consented and provided full responses. We asked about time in prison, sexual experience, attraction and (homo/bi/heterosexual) identity, attitudes, sexual contact with other inmates, reasons for having sex and practices engaged in, and about sexual coercion, including location and number of perpetrators. Most men (95.1%) identified as heterosexual. Of the total sample, 13.5% reported sexual contact with males in their lifetime: 7.8% only outside prison, 2.8% both inside and outside, and 2.7% only inside prison. Later in the interview, 144 men (7.1% of total sample) reported sexual contact with inmates in prison; the majority had few partners and no anal intercourse. Most did so for pleasure, but some for protection, i.e., to avoid assault by someone else. Before incarceration, 32.9% feared sexual assault in prison; 6.9% had been sexually threatened in prison and 2.6% had been sexually coerced ("forced or frightened into doing something sexually that [they] did not want"). Some of those coerced reported no same-sex contact. The majority of prisoners were intolerant of male-to-male sexual activity. The study achieved a high response rate and asked detailed questions to elicit reports of coercion and sex separately. Both consensual sex and sexual assault are less common than is generally believed.
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http://dx.doi.org/10.1007/s10508-010-9667-3DOI Listing
April 2012

Consensual sex between men and sexual violence in Australian prisons.

Arch Sex Behav 2012 Apr 31;41(2):517-24. Epub 2010 Aug 31.

School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.

Estimates of the incidence of sexual coercion in men's prisons are notoriously variable and fraught with conceptual and methodological problems. In 2006-2007, we conducted a computer-assisted telephone survey of a random sample of 2,018 male prisoners in New South Wales and Queensland. Of 2,626 eligible and available inmates, 76.8% consented and provided full responses. We asked about time in prison, sexual experience, attraction and (homo/bi/heterosexual) identity, attitudes, sexual contact with other inmates, reasons for having sex and practices engaged in, and about sexual coercion, including location and number of perpetrators. Most men (95.1%) identified as heterosexual. Of the total sample, 13.5% reported sexual contact with males in their lifetime: 7.8% only outside prison, 2.8% both inside and outside, and 2.7% only inside prison. Later in the interview, 144 men (7.1% of total sample) reported sexual contact with inmates in prison; the majority had few partners and no anal intercourse. Most did so for pleasure, but some for protection, i.e., to avoid assault by someone else. Before incarceration, 32.9% feared sexual assault in prison; 6.9% had been sexually threatened in prison and 2.6% had been sexually coerced ("forced or frightened into doing something sexually that [they] did not want"). Some of those coerced reported no same-sex contact. The majority of prisoners were intolerant of male-to-male sexual activity. The study achieved a high response rate and asked detailed questions to elicit reports of coercion and sex separately. Both consensual sex and sexual assault are less common than is generally believed.
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http://dx.doi.org/10.1007/s10508-010-9667-3DOI Listing
April 2012

Consensual sex between men and sexual violence in Australian prisons.

Arch Sex Behav 2012 Apr 31;41(2):517-24. Epub 2010 Aug 31.

School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.

Estimates of the incidence of sexual coercion in men's prisons are notoriously variable and fraught with conceptual and methodological problems. In 2006-2007, we conducted a computer-assisted telephone survey of a random sample of 2,018 male prisoners in New South Wales and Queensland. Of 2,626 eligible and available inmates, 76.8% consented and provided full responses. We asked about time in prison, sexual experience, attraction and (homo/bi/heterosexual) identity, attitudes, sexual contact with other inmates, reasons for having sex and practices engaged in, and about sexual coercion, including location and number of perpetrators. Most men (95.1%) identified as heterosexual. Of the total sample, 13.5% reported sexual contact with males in their lifetime: 7.8% only outside prison, 2.8% both inside and outside, and 2.7% only inside prison. Later in the interview, 144 men (7.1% of total sample) reported sexual contact with inmates in prison; the majority had few partners and no anal intercourse. Most did so for pleasure, but some for protection, i.e., to avoid assault by someone else. Before incarceration, 32.9% feared sexual assault in prison; 6.9% had been sexually threatened in prison and 2.6% had been sexually coerced ("forced or frightened into doing something sexually that [they] did not want"). Some of those coerced reported no same-sex contact. The majority of prisoners were intolerant of male-to-male sexual activity. The study achieved a high response rate and asked detailed questions to elicit reports of coercion and sex separately. Both consensual sex and sexual assault are less common than is generally believed.
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http://dx.doi.org/10.1007/s10508-010-9667-3DOI Listing
April 2012

Do condoms cause rape and mayhem? The long-term effects of condoms in New South Wales' prisons.

Sex Transm Infect 2007 Jun 19;83(3):219-22. Epub 2006 Dec 19.

National Centre in HIV Social Research, University of New South Wales, Robert Webster Building, Sydney, New South Wales 2052, Australia.

Background: Concerns raised by opponents to condom provision in prisons have not been objectively examined and the issue continues to be debated. The long-term effects of the introduction of condoms and dental dams into New South Wales (NSW) prisons in 1996 was examined, focusing on particular concerns raised by politicians, prison officers, prison nurses and prisoners. These groups were worried that (a) condoms would encourage prisoners to have sex, (b) condoms would lead to an increase in sexual assaults in prisons, (c) prisoners would use condoms to hide and store drugs and other contraband and (d) prisoners would use condoms as weapons.

Method: Data sources included the NSW Inmate Health Survey (IHS) from 1996 and 2001 and official reports from the NSW Department of Corrective Services. The 1996 IHS involved 657 men and 132 women randomly selected from all prisons, with a 90% response rate. The 2001 survey involved 747 men and 167 women inmates, with an 85% response rate.

Results: There was a decrease in reports of both consensual male-to-male sex and male sexual assaults 5 years after the introduction of condoms into prisons in 1996. The contents of condom kits were often used for concealing contraband items and for other purposes, but this was not associated with an increase in drug injecting in prison. Only three incidents of a condom being used in assaults on prison officers were recorded between 1996 and 2005; none was serious.

Conclusions: There exists no evidence of serious adverse consequences of distributing condoms and dental dams to prisoners in NSW. Condoms are an important public health measure in the fight against HIV and sexually transmitted diseases; they should be made freely available to prisoners as they are to other high-risk groups in the community.
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http://dx.doi.org/10.1136/sti.2006.022996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659099PMC
June 2007