2009 NSW Inmate Health Survey: Key Findings Report - Executive Summary

Given the service model described above, the health issues identified in this report cannot be solved or improved by Justice Health alone. Justice Health’s primary focus remains on screening, assessment and referral and release planning.

Partnerships with the criminal justice system and health services in the community will be critical to improving the health status of the inmate population in NSW.

Methodology

The 2009 NSW Inmate Health Survey was conducted using a stratified random sample of all inmates from 30 adult correctional centres (26 male centres and 4 female centres).

Of the 1,166 inmates randomly selected and invited to participate, 996 agreed, equating to a response rate of 85.4%. Women and Aboriginal people were over-represented in the sample to ensure better estimates of health issues for these populations. The sample was also stratified by age groups (18-24 years, 25-44 years and 45 years or more) to ensure adequate representation of older and younger inmates. Participants were provided with a comprehensive health check (including any referrals for further healthcare) and were reimbursed with $10 for their involvement.

The methodology for the 2009 NSW Inmate Health Survey was different from the 1996 and 2001 Surveys which were conducted using face-to-face interviews. The questionnaire component of the IHS was conducted via Computer Assisted Telephone Interviewing technology at Hunter New England Population Health with each of the scripted interview questions displayed on computer monitors and data collected from the inmates by the telephone interviewers entered directly into a database. A key concept supporting the use of this technology was the provision of continuous real-time data for immediate surveillance capacity.

Telephone interviews took an average of 73 minutes (median of 70 minutes, range 21 to 198 minutes) to conduct.

Key Findings

Social Determinants

• Over half (52%) of men and just under half (45%) of women did not finish year 10 of schooling.

• Just over one in ten (11%) participants were living in unsettled accommodation or had no fixed abode prior to their current incarceration, a slight increase since 1996 (8%).

Half (50%) of men and two-thirds (67%) of women were unemployed in the 6 months before their incarceration.

Much of this unemployment was long-term with 30% of men and 44% of women being unemployed for five years or longer.

• An increased proportion (30%) of 2009 participants had a history of being placed in care before the age of 16 years compared to 2001 (21%).

• Just under one in five (18% of men, 17% of women) had a history of parental incarceration during their childhood.

Offending behaviour

• Twice as many men (42%) as women (22%) had a history of juvenile detention.

• The proportion of men who had previously been incarcerated remained stable from 1996 to 2009 at just under two-thirds.

Among women, the proportion steadily decreased from 63% in 1996 to 55% in 2001 to 46% in 2009.

• Men were less likely to have their own cell in 2009 (35%) compared with 1996 (60%), a finding which also held for women where 56% had their own cell in 2009 compared to 77% in 1996.

Physical health

Over half (56%) of participants were overweight or obese in 2009, representing a small increase from 1996 and 2001 (both 49%). The largest increase in overweight and obesity was found among women who increased from 42% in 1996 to 44% in 2001 to 58% in 2009.

• High blood pressure decreased among men from 24% in 1996 to 22% in 2001 to 15% in 2009. High blood pressure increased slightly for women from 7% in 2001 to 12% in 2009.

• Despite the average age of the sample being 35 years, a high proportion (20%) had been told by a doctor that they had a heart problem such as chest or angina pain, heart murmur or palpitations. This steadily increased from 16% in 1996 to 20% in 2009, with a higher proportion of women (24%) reporting heart problems than men (19%).

• Over half (54%) of women and just under half (46%) of men reported a disability or illness that had impacted on their health for six months or more, which represented a steady increase from 1996 (34%) to 2001 (41%) to 2009 (47%) for all participants.

• Half (52%) of men and 35% of women had a history of a head injury resulting in unconsciousness. The prevalence of head injuries has decreased among women from 39% in 2001 to 35% in 2009, but increased among men from 45% in 2001 to 52% in 2009. Most of these head injuries (47%) occurred over ten years previously and involved only a short period of unconsciousness (51% less than ten minutes).

Access to healthcare

One in six (17%) men and 4% of women had never accessed healthcare outside of prison. Women were more likely to have ever accessed a range of health services than men, but were particularly more likely to have accessed a general practitioner (80% compared with 59% of men) or a medical centre (61% compared with 40% of men).

Infectious diseases

There were substantial drops between 2001 and 2009 in the proportion of participants who were hepatitis C antibody positive, from 64% to 45% among women, and 40% to 28% among men.

• Just over a third (38%) of inmates demonstrated vaccine conferred immunity to Hepatitis B infection, which was a slight increase from 2001 (35%).

Smoking, alcohol and other drugs

Over three quarters of participants (75% of men and 80% of women) were current tobacco smokers (compared to 17% of the general population in Australia). This rate of smoking has not changed much from 1996 to 2009, in contrast to steady decreases in the community.

• However, a high proportion (85%) of current smokers indicated they would like to quit smoking. Desire to quit was higher among men (89%) than among women (74%) in 2009.

Risky alcohol consumption in the year before incarceration was much higher than the community average, with 63% of men and 40% of women drinking alcohol at hazardous/harmful levels in the year before prison. In particular, a high proportion (35% of men, 16% of women) were drinking at levels suggestive of alcohol dependence.

• The majority (84%) of participants had used illicit drugs, compared to just over a third (38%) in the general community. The proportion of women who had used illicit drugs decreased slightly between 1996 and 2009 (from 82% to 78%), while use of drugs increased among men from 69% in 1996 to 86% in 2009.

• Cannabis was the most common drug ever used (81%), followed by amphetamines (57%), cocaine (45%) and ecstasy (44%). The use of heroin decreased from 2001 to 2009 (from 49% to 41%), while the use of crystalline methamphetamine (ice) increased over this same time period from 11% to 42%, which reflect changes in illicit drug markets during this time.

• There was a decrease in the proportion of participants indicating daily/near daily use of drugs in the year before prison between 2001 (68%) and 2009 (44%) which may reflect the decreased use of heroin noted above. Similarly, there was a decrease in ever using drugs in prison from 48% in 2001 to 43% in 2009.

• A striking finding from the Survey was the substantial drop in the proportion of participants who had ever injected drugs from 2001 (57%) to 2009 (43%). This decline was evident among both men (53% to 40%) and women (74% to 52%). There was a major decrease in heroin injection from 47% in 2001 to 32% in 2009, and an increase in crystalline methamphetamine injection from 4% in 2001 to 23% in 2009, again reflecting changes in Australia’s drug markets.

Mental health

The proportion of participants who had ever been assessed or treated by a doctor or psychiatrist for a mental health problem increased steadily from 39% in 1996 to 43% in 2001 to 49% in 2009. This increase was mostly due to an increasing proportion of men being treated for mental health problems (from 35% in 1996 to 41% in 2001 to 47%), as the proportion of women remained steady at around 54%. The three most common mental health conditions were depression, anxiety and drug dependence.

Similarly, an increasing proportion of participants reported ever having been admitted to a psychiatric unit from 13% in 1996 to 14% in 2001 to 16% in 2009. A higher proportion of women (20%) than men (15%) reported this in 2009.

• There was a steady decline in participants who had ever thought about committing suicide (from 42% in 1996 to 36% in 2001 to 33% in 2009). This drop was most notable among women, decreasing from 60% in 1996 to 38% in 2009.

• There was also a small decrease in the proportion of participants who had ever attempted suicide (from 24% in 1996 to 22% in 2001 to 21% in 2009), with a higher proportion of women (27%) than men (19%) reporting having attempted suicide in 2009.

• The rates of self-harm remained relatively stable from 1996 to 2009, at around 15% for all participants. However, a steady decline was observed among women, from 23% in 1996 to 21% in 2001 to 17% in 2009.

Conclusions

Meeting the health needs of the inmate population in NSW constitutes a significant challenge. Prison health care is not only provided in a complex environment but, as the results of the 2009 IHS demonstrate, prison inmates are a complex, high-needs population. However, the correctional environment also provides a unique opportunity to improve the health status of a group who suffer poor health and may have minimal contact with health services in the community.

Importantly, the 2009 IHS provides Justice Health, its key stakeholders and the community with reliable evidence of the health needs of individuals incarcerated in NSW. As such, the key findings from the 2009 IHS provide all agencies and sectors involved in the provision of services to patients in custody with evidence to guide policy and practice.

In 1996 (Butler, 1997) and again in 2001 (Butler & Milner, 2003), the (then) New South Wales (NSW) Corrections Health Service successfully conducted the Inmate Health Surveys (IHSs) to investigate the health status of the NSW prison population.

The IHSs are referenced in international literature as being the most comprehensive descriptions of prisoner health. Results from the Surveys have been published in peer reviewed medical journals on areas as diverse as drug use; blood borne viruses and other infectious diseases; mental health; the relationship between physical and mental health; cardiovascular disease and diabetes; Aboriginal health; intellectual disability; access to health services; smoking; and oral health. The Surveys thus established an evidence base appropriate for the development and evaluation of health service delivery; and, in addition, allowed for an examination of trends over time in the health status of this disadvantaged group.

Given the success of previous IHSs, funding was provided to the Centre for Health Research in Criminal Justice (CHRCJ), the specialist research centre of Justice Health (formerly Corrections Health Service), to conduct the third IHS. To ensure comparability with the previous surveys, the majority of the 2009 Survey is directly comparable to the 2001 IHS. The only amendments to the questions asked in the 2001 IHS were to fix instances where response options overlapped (e.g., 1-2 years, 2-3 years) and other minor changes of this nature.

This report presents the main findings of the cross-sectional component of the 2009 IHS, drawing from a random sample of 996 participants, with results presented separately for men and women. Where possible and appropriate, comparable findings from all three IHSs (1996, 2001 and 2009) are also presented, to depict changes over time in important health and social indicators describing the NSW prison population.

Introduction

2009 NSW Inmate Health Survey: Key Findings Report 19

The methodology for the 2009 NSW Inmate

Health Survey was different from the 1996

and 2001 Surveys which were conducted using

face-to-face interviews. Drawing on the success

of the 2007 NSW Sexual Health in Australian

Prisons Study (Richters et al., 2008) which used

a Computer-Assisted Telephone Interviewing

(CATI) strategy, the questionnaire for the 2009

IHS was implemented using CATI. A key concept

supporting the use of this technology was

the provision of continuous real-time data for

immediate surveillance capacity.

As occurred in the 2001 IHS, the 2009 IHS included two

components: a cross-sectional, random sample of inmates; and

a longitudinal component, in which targeted efforts were made

to recruit inmates who participated in one of the two previous

Surveys and were currently in custody. Note that these individuals

may have been in custody continuously since the time of their

previous IHS participation, or may have been released to the

community on one or more occasions since that time.

The NSW prisoner population has increased at a rate of 5%

per annum over the last decade or so, and the proportion of

the population of Aboriginal origin has increased (Corben,

2008). Aboriginal men increased from 12% of the NSW

inmate population in 1996 to over 20% in 2008, while

Aboriginal women increased from 17% to 30% over the

same time period (Table i).

Table i NSW prisoner population characteristics,

1996 to 2008

Full-time custody

1996

(N=7,691)

2001

(N=8,780)

2008

(N=9,859)

% Men 94.3 93.2 92.7

% Women 5.7 6.8 7.3

% Aboriginal Men 12.1 14.5 20.4

% Aboriginal Women 16.9 23.3 29.6

Sampling and recruitment

Between May 2008 and March 2009, 1128 inmates of 30 NSW

adult correctional centres (26 male and 4 female) participated

in the 2009 IHS. A total of 996 randomly selected inmates

participated in the cross-sectional component of the Survey, 51

of whom had, by chance, participated in one or both of the

previous surveys. A further 132 inmates who were targeted

specifically because they had participated in one or both of the

earlier IHSs (at which time they were randomly selected) also

completed the most recent Survey. This group, together with

the 51 participants who had participated previously but were

also randomly selected to participate in the cross-sectional

component, comprise the 2009 IHS longitudinal sample

(N=183). The results presented in this report relate to the 996

randomly selected inmates. Where appropriate, comparable

results from the 1996 and 2001 Surveys are also presented.

The sampling framework employed in the 2009 IHS was

comparable to that used in the previous IHSs. The design

represents a cross-sectional random sample of inmates,

stratified by gender, age (18-24 years, 25-44 years and

45+ years) and Aboriginality (Table ii). The age ranges for

the strata were altered between 2001 and 2009; in 2001,

the three age groups were 18-24 years, 25-40 years, and

40+ years. Due to the ageing of the prisoner population,

it was decided to increase the age of the older strata to

45 years and over to better identify the health issues of

older inmates. Stratification involved deliberately oversampling

both women and Aboriginal inmates in order

to derive adequate sample sizes for credible estimates of

low prevalence health conditions. The exclusion criteria for

participation included: those who did not speak sufficient

English, were under 18 years, or had an intellectual

disability or mental illness that prevented them from

consenting to participate in the research.

Table ii Target random stratified sample for the 2009

Inmate Health Survey

Age

Non-

Aboriginal

Men

Aboriginal

Men Women Total

18-24 years 180 90 80 350

25-44 years 180 90 80 350

45+ years 180 90 80 350

Total 540 270 240 1050

Methods

20 2009 NSW Inmate Health Survey: Key Findings Report

Prior to the beginning of the IHS, a list of all inmates of NSW

prisons was obtained from Corrective Services New South

Wales (CSNSW, formerly Department of Corrective Services).

The list contained inmates’ demographic data, and was used

to develop a fixed sampling fraction proportional to the

number of inmates in each prison. This allowed the calculation

of the number and demographic characteristics (gender, age

range, Aboriginal status) of inmates required in each Centre

in order to meet the random sample stratification targets

depicted in Table ii. Subsequently, several days prior to the

research team visiting a given Centre, a list of inmates at that

Centre was again obtained from CSNSW. The administrative

data were entered into SPSS for Windows, Release 17.0 (SPSS

Inc., 2008), the software used to randomly select the required

number of inmates in each stratum. Reserve lists of inmates

for each stratum were also drawn in order that any inmate

who declined to participate or was otherwise unavailable for

interview was replaced by an inmate of the same gender, age

range and Aboriginal status.

Thus, Aboriginal participants were selected based on the

information provided by CSNSW. Participants were also

asked during the Survey whether they identified as being

of Aboriginal and/or Torres Strait Islander origin. There was

approximately 6% disagreement between CSNSW-provided

and participant self-reported Aboriginality, which followed no

particular pattern. Stratified sampling proceeded based on the

information provided by CSNSW. Nevertheless, participants’

self-reported status was used to divide the sample into

Aboriginal and non-Aboriginal participants; and all reporting

of Aboriginality in this report is based on self-reported

status. Please note that reporting by Aboriginality has been

deliberately kept to a minimum in this report. A separate

report focused on Aboriginal and non-Aboriginal key findings

will be released in the near future.

Response rates

In some Centres it proved impossible to access the targeted

number of inmates for each stratum for a number of reasons

including: selected inmates’ employment (either within the

prisons or in the community in the case of transitional centres);

industrial action by CSNSW officers; unscheduled “lockdowns”

(in which all inmates are locked in their cells and cannot leave);

or the inability to locate the selected inmates (i.e., they may not

have heard their names called on the loudspeaker requesting that

they come to the health centre). In instances where a Centre’s

recruitment numbers fell short of targets, efforts were made to

randomly select and recruit inmates with the same characteristics

from other Centres. Accordingly, there was variation in the

number of participants recruited from each Centre from the

original estimates. Additional confounding factors on reaching the

initial sample estimates are the changes to the population sizes

and distributions of Centres during the survey implementation

(i.e. closure of John Morony II and a significant reduction in the

Silverwater prison population). Table iii outlines the random

sample achieved for the IHS.

Table iii Random sample achieved for the 2009 Inmate

Health Survey

Age

Non-

Aboriginal

Men

Aboriginal

Men Women Total

18-24 years 180 96 54 330

25-44 years 184 102 89 375

45+ years 174 61 56 291

Total 538 259 199 996

Response rates were calculated on the number of participants

divided by the number of participants added to the number

of inmates who specifically refused to participate. Response

rates varied between Correctional Centres from 65% (Malabar

Special Programs Centre in Long Bay where there was ongoing

industrial action during the weeks the research team was

recruiting) to 100% (Compulsory Drug Treatment Centre,

Dawn de Loas, Glen Innes, Grafton and Tamworth Centres)

(Table iv). A total of 1,166 randomly selected inmates were

invited to participate in the 2009 IHS, of whom 996 agreed,

equating to a response rate of 85.4%.

2009 NSW Inmate Health Survey: Key Findings Report 21

Table iv Number of randomly selected participants and

response rates by Correctional Centres

Centre

Number of

participants

Response

rate (%)

Proportion

of sample

(%)

Bathurst 80 70 8

Berrima 22 92 2

Brewarrina 6 86 <1

Broken Hill 12 92 1

Cessnock 34 92 3

Compulsory Drug Treatment Centre 12 100 1

Cooma 12 92 1

Dawn de Loas 5 100 <1

Dilwynnia 75 95 8

Emu Plains 56 88 6

Glen Innes 14 100 1

Goulburn 15 94 2

Grafton 30 100 3

Ivanhoe 3 75 <1

John Morony 1 23 88 2

Junee 74 90 7

Kirkconnell 42 98 4

Lithgow 36 92 4

Malabar Special Programs Centre 35 65 4

Mannus 12 86 1

Metropolitan Reception and

Remand Centre 128 75 13

Mid North Coast 45 92 5

Oberon 28 85 3

Parklea 43 84 4

Parramatta 26 87 3

Silverwater 26 94 3

Silverwater Women’s 31 84 3

St Heliers 22 96 2

Tamworth 6 100 <1

Wellington 43 88 4

Total 996 85.4% 100%

The CSNSW administrative lists were also used to identify 316

inmates currently in custody who had taken part in one or

both previous IHSs in 1996 and/or 2001. As noted above, 183

of these 316 previous participants (58%) were successfully

recruited to the 2009 IHS. Note, however, it was not possible

to access all of the 316 previous participants to invite them to

participate. Among the 219 previous participants who were

successfully accessed and invited to take part, a response rate

of 83.6% was achieved. The combined overall response rate

for both the cross-sectional and longitudinal components of

the Survey was 84.6%.

Procedures

Full Survey procedures included:

1. Recruitment and provision of informed consent;

2. Conduct of a physical health examination by a trained

Justice Health nurse;

3. Collection, also by a trained Justice Health nurse, of blood

and urine samples for serological testing for blood borne

viruses (BBVs) and sexually transmitted infections (STIs),

including pre-test counselling;

4. Administration of a detailed telephone interview covering

a broad range of areas (see Measures, below); and

5. Provision of health referrals and post-test counselling.

The particular order in which the various components of the

Survey were undertaken depended on a range of factors

specific to each Centre, such as the availability of CSNSW

officers to escort inmates to and from the research team; the

number of telephone lines and room space allocated to the

research team (including any time limitations on using these

resources) and so on.

The research team included Justice Health nurses who

visited each Centre to coordinate the survey and to conduct

physical assessments. The questionnaire component of

the IHS was conducted via CATI technology at Hunter

New England Population Health with each of the scripted

interview questions displayed on computer monitors

and data collected from the inmates by the telephone

interviewers entered directly into a database. All telephone

interviewers were trained extensively in the delivery and

administration of the questionnaire with regular team

meetings organised to support the interviewers and provide

opportunities to debrief as necessary. Telephone interviews

took an average of 73 minutes (median of 70 minutes,

range 21 to 198 minutes) to conduct.

22 2009 NSW Inmate Health Survey: Key Findings Report

Inmates selected to participate in the IHS were retrieved from

within the Centre by custodial CSNSW officers or attended

themselves if they were able to directly access the location

of the research team. In cases where the research team were

unable to locate a particular inmate, the inmate was replaced

with an inmate drawn from the reserve recruitment lists. It

was not feasible to provide translation services for non-English

speaking inmates; therefore, inmates without sufficient

English language skills to understand the informed consent

and interview procedures were excluded from participation

and replaced with an inmate drawn from the reserve lists.

Potential participants received a full explanation of the project

before written informed consent to participate was obtained.

The following features of the Survey were explained prior to

the provision of informed consent:

• Participation was voluntary;

• Names had been selected at random by a computer

program;

• There was no obligation to answer any questions

deemed intrusive;

• Participants could withdraw their consent at any time

during the interview;

• Information would be treated with the utmost confidentiality

except in situations where clinical referrals were required;

• Participants’ names would not be recorded on any of the

Survey materials;

• $10 would be paid into participants’ prison accounts to

compensate them for their time and any loss of income; and

• Written consent to participate would be required.

The consent form included a space for participants to indicate

that they declined to have their blood samples tested for HIV

antibodies, an option taken up by seven participants.

Once the phone interview was completed, a participant was

debriefed by a Research Nurse. If a participant was distressed

as a result of the interview, or by certain questions, counselling

was provided. This was a rare event. Referrals were made

to CSNSW psychologists or to Justice Health clinical staff for

further follow-up. CATI interviewers contacted the clinical

coordinator immediately after the interview if they identified

that a participant was distressed as a result of the interview or

if they were concerned about a participant due to responses

indicating a participant may have a mental illness but had not

been seen by a clinician whilst in custody.

Hunter New England Population Health also provided a

weekly automated report on identified questions/response

options that required notification to health staff by the clinical

coordinator. This included responses that indicated concerns

about suicidality or self-harm or requests for assistance related

to their healthcare. Referrals were subsequently made to the

appropriate clinical stream by Justice Health nurses.

Measures

The questionnaire used in the 2009 IHS was based closely on

the instruments used in the previous two IHSs in order to allow

reliable comparisons to be drawn between the results of the

three Surveys. It covered a broad range of areas, including

socio-demographics, physical and mental health issues,

medications, risk behaviours, sexual health, diet and nutrition,

head injury, and access to and satisfaction with health services.

Several sections of the questionnaire targeted specific groups such

as women (breast self-examination, pregnancy, cervical screening),

men (testicular examination) and Aboriginal inmates (use of

Aboriginal health services and removal from families). Validated

standardised screening instruments were also included as part of

the interview schedule, including the Beck Depression Inventory

(Beck et al., 1961), the Short Form 12 (Ware et al., 1996), and the

Alcohol Use Disorders Identification Test (Saunders et al., 1993)

(see Appendix for a copy of the questionnaire).

The 2009 IHS had a strong focus on physical health which

included additional diagnostic testing as specified below. The

Inmate Access Survey (assessing access to healthcare in prison

and in the community) was also included in the 2009 IHS,

having previously been conducted as a separate survey in 2001

and 2004. To reduce the survey length, a number of sections

from the 2001 IHS were removed including the following: the

Hayes Ability Screening Index (an Intellectual Disability screen),

Symptom Checklist, Dental Health, Tuberculosis, Gambling,

Referral Decision Scale and the Beck Hopelessness Scale. In

addition, the SF-12 was substituted for the SF-36 and due to the

recent completion of the NSW Sexual Health in Australian Prisons

study (Richters et al., 2008), the Sexual Health section was

2009 NSW Inmate Health Survey: Key Findings Report 23

also reduced including removing the Childhood Sexual Abuse

section. Lastly, the psychiatric assessment using the Composite

International Diagnostic Interview was not conducted.

The Survey protocol was updated following amended ethical

approval about halfway into its implementation to include a

short impulsivity screening tool (the Barratt’s Impulsivity Scale;

Barratt & Stanford, 1995), which was administered to 273

participants (27%). This tool was administered on paper by the

research nurses, and these data were entered separately and

linked to the data collected in the CATI system.

Physical health examination

The following physical measures were recorded for each

participant by a Justice Health nurse trained in the Survey

methodology:

• Height (centimetres)

• Weight (kilograms)

• Waist measurement (centimetres)

• Hip measurement (centimetres)

• Blood pressure (mmHG)

• Peak flow (L/min)

• Test of visual acuity (Snellen chart)

• Random (non-fasting) blood glucose level (mmol/L) –

(finger-prick and serum)

• Skin integrity and MRSA nasal and wound swabs

Blood and urine testing

Blood was collected by nurses who were accredited in

venepuncture by Justice Health. Pre-test counselling was

conducted for all BBV and STI testing in accordance to Justice

Health Policy. If a participant reported engaging in behaviours

that would increase risks of contracting a BBV or STI, referral was

made to Public/Sexual Health Nurse for an assessment and followup.

BBV results were given back to participants by an accredited

Public/Sexual Health nurse. Post-test counselling was provided

and if a participant was identified as being involved in risky activity

within the window period, a further referral was made for an

assessment and retesting. Participants were educated on harm

minimisation strategies and informed of services available in

custody and in the community if they needed further information.

All test results were reviewed by medical officers and abnormal

results were referred for appropriate follow-up and treatment.

Urine samples were collected from 80% of participants (N=795)

and were screened for:

• General – dipstick

• Renal – microalbustix

• Chlamydia Polymerase Chain Reaction (PCR)

• Gonorrhoea PCR

Non-fasting blood samples were collected from 78% (N=775)

of participants and were tested for:

• Full Blood Count (FBC)

• Electrolytes (EUC)

• Liver Function Test (LFT)

• Glycated haemoglobin: (HbA1c)

• Prostate Specific Antigen (PSA) in men >50 years

• Blood Sugar Level (BSL)

Blood samples were screened for indicators of exposure,

and, where appropriate, vaccination, to the following

infectious diseases:

• Human Immunodeficiency Virus (HIV)

• Hepatitis B virus (HBV) – including Hepatitis B core

antibody and surface antigen

• Hepatitis C virus (HCV)

• Herpes Simplex Virus (HSV1 and HSV2)

• Syphilis

Ethics approval

Ethical approval to conduct this study was provided by the Justice

Health Human Research Ethics Committee, the Department of

Corrective Services Ethics Committee, and the Aboriginal Health

and Medical Research Council Ethics Committee.

24 2009 NSW Inmate Health Survey: Key Findings Report

Data entry, cleaning and analysis

Participant responses were recorded directly into GEIS

(Generalized Electronic Interviewing System), a flexible

CATI system developed by Hunter New England Population

Health which enabled the data to be provided back to the

investigators in real-time and programmed in SAS 8.2 (SAS

Institute, 2003). Data extracts were provided on a weekly

basis to the Chief Investigator and a one page key indicator

report was provided to key Justice Health and CSNSW staff at

each participating Centre within a week of Survey completion

to provide feedback on the key findings. Having immediate

access to the data enabled preliminary findings to be used for

a number of policy development and operational purposes

while the Survey was underway. Once participant recruitment

was complete, data entry of the physical health testing results

was included in a separate SPSS 17.0 database (SPSS, 2008)

and linked into the broader CATI SAS database. Data entry

was also conducted separately for the impulsivity screening

tool which was collected on paper.

The information provided by CSNSW for the sample included

a number of administrative and offending-related data items

such as: Master Index Number, name, date of birth, Aboriginal

status, postcode of usual address, correctional facility, wing,

security classification, charged most serious offence for current

imprisonment, convicted most serious offence for current

imprisonment, most serious historical offence, arrival date in

correctional centre, admission date in prison, sentence date,

earliest possible release date, and sentence expiry date. This

data was de-identified (names were removed) and linked to

the CATI and physical health datasets using the MIN number.

An extensive data cleaning process was undertaken to amend

skip patterns, address any logical errors, and recode responses

in the ‘other specify’ field. The data depicted in this report

were analysed using SAS v9.1.3 (SAS Institute, 2007).

Summary

The 2009 NSW Inmate Health Survey follows

largely the methods of the 2001 Inmate Health

Survey in order to make valid comparisons. A new

telephone survey and data recording method (CATI)

was implemented. There were some changes to

the survey content, screening tools and physical

health assessments.

2009 NSW Inmate Health Survey: Key Findings Report 25

1. Social determinants

1.1 Demographics

As mentioned in the Methods section, the 2009 IHS was

sampled according to three age strata: 24 years and under,

25 to 44 years and 45 years and over. As a result of this, the

age distribution of the sample contains a large proportion

of people aged 18 to 24 years, including 35% of men and

27% of women (Table 1.1.1). The sample was fairly evenly

distributed in the five-year categories among the 25 to 44

year old participants. Few participants (4% of men, 3% of

women) were aged 60 years or older.

Table 1.1.1 Participant age by age groups

Men Women Total

n % n % n %

18-24 years 276 34.6 54 27.1 330 33.1

25-29 years 80 10.0 26 13.1 106 10.6

30-34 years 66 8.3 21 10.6 87 8.7

35-39 years 73 9.2 19 9.5 92 9.2

40-44 years 67 8.4 23 11.6 90 9.0

45-49 years 87 10.9 29 14.6 116 11.6

50-59 years 115 14.4 22 11.1 137 13.8

60+ years 33 4.1 5 2.5 38 3.8

Total 797 100.0 199 100.0 996 100.0

The mean age of the 2009 IHS sample was 35.5 years (SD 12.9;

range 19-84), with no difference between the average age of

men and women (Table 1.1.2). The age of our sample appears

consistent with the population of inmates in full-time custody in

NSW: the NSW Inmate Census 2008 (Corben, 2009) indicated

that the majority of men in custody on June 30, 2008 were

aged between 25 and 34 years (36%) or 35 to 44 years (27%).

A similar age distribution was also recorded among women,

with the majority aged between 25 and 34 years (39%) or 35

and 44 years (30%).

Table 1.1.2 Participant age characteristics

Men Women Total

N 797 199 996

Mean (± sd) 35.5 (± 13.2) 35.6 (± 12.0) 35.5 (± 12.9)

Median 32.0 34.0 33.0

Range 19 - 84 19 - 66 19 - 84

Consistent with both the 1996 and 2001 Surveys, around 81%

of the 2009 IHS sample were born in Australia, with a slightly

lower proportion of women (77%) than men (81%) reporting

Australia as their country of birth (Table 1.1.3). The overall

proportion of Australian-born IHS participants (81%) is slightly

higher than among the inmate population as a whole; the NSW

Inmate Census 2008 (Corben, 2009) reported that 73% of the

inmate population was Australian-born (74% of men and 70%

of women), with the country of birth of a further 5% of inmates

recorded as unknown. Given that proficiency in the English

language was an essential criterion for participation in the IHS,

it is perhaps not surprising that Australian-born inmates were

slightly over-represented among the Survey sample.

Table/Fig 1.1.3 Born in Australia

0

20

40

60

80

100

78.0 76.7 76.9

82.0 79.9 81.4

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 506 617 82.0 595 745 79.9 649 797 81.4

Women 92 118 78.0 125 163 76.7 153 199 76.9

Total 598 735 81.4 720 908 79.3 802 996 80.5

Results

1. Social determinants

26 2009 NSW Inmate Health Survey: Key Findings Report

After Australia, the most common region of birth among

women was Oceania (mostly New Zealand, Fiji and Tonga),

followed by Asia, Europe and the Americas (Table 1.1.4).

Among men, the most common birth regions after Australia

were Oceania, Europe, Asia and the Middle East. These figures

are also broadly consistent with the population of inmates

in full-time custody in NSW: the NSW Inmate Census 2008

(Corben, 2009) indicated that among inmates in full-time

custody as at June 30 2008, 7% were born in Asia, 5% in

Oceania, 3% in Europe, 3% in the Middle East, 1% in Africa,

and 1% in the Americas. The proportions are also broadly

consistent with the countries of birth of the general population

of NSW: the 2006 Census indicated that 74% of the general

resident population of NSW were born in Australia, while

7% were born in Asia, 7% in Europe, 2% in Oceania, 1% in

the Middle East, 0.5% in Africa, and 0.4% in the Americas

(Population Health Division, NSW Health, 2008).

Table 1.1.4 Region of birth

Men Women Total

n % n % n %

Australia 649 81.4 153 76.9 802 80.5

Oceania 40 5.0 13 6.5 53 5.3

Asia 33 4.1 19 9.6 52 5.2

Europe 35 4.4 5 2.5 40 4.0

Middle East 25 3.1 1 0.5 26 2.6

Americas 11 1.4 5 2.5 16 1.6

Africa 4 0.5 3 1.5 7 0.7

Total 797 100.0 199 100.0 996 100.0

More than half of all 2009 IHS participants who were born

overseas reported having lived in Australia for more than 20

years (Table 1.1.5), and a further quarter of overseas-born

participants had lived in Australia for between 10 and 19

years. Just one in 10 overseas-born men, and slightly less

than one in five overseas-born women, had lived in Australia

for less than five years.

Table 1.1.5 Number of years in Australia (if born

overseas)

Men Women Total

n % n % n %

< 5 years 14 9.5 8 18.2 22 11.5

5 - 9 years 15 10.2 6 13.6 21 11.0

10 - 19 years 42 28.6 6 13.6 48 25.1

20+ years 76 51.7 24 54.5 100 52.4

Total 147 100.0 44 100.0 191 100.0

The mean number of years for which overseas-born 2009

IHS participants had lived in Australia was 21.0, with men

who were born overseas having lived in Australia for an

average of three years longer than women born overseas.

These results are consistent with earlier IHSs; overseas-born

participants in the 1996 and 2001 IHSs had also lived in

Australia for a substantial period of time, with an average

of 21.9 years among 1996 IHS participants and 18.3 years

among 2001 IHS participants (Table 1.1.6).

Table/Fig 1.1.6 Mean number of years in Australia (if

born overseas)

0

5

10

15

20

25

30

20.4 19.4 18.4

22.3

18.0

21.8

1996 2001 2009

Men Women

MEAN

YEAR

1996 2001 2009

n Mean (± sd) n Mean (± sd) n Mean (± sd)

Men 101 22.3 (± 11.0) 93 18.0 (± 10.4) 147 21.8 (± 13.8)

Women 23 20.4 (± 10.6) 25 19.4 (± 14.5) 44 18.4 (± 11.8)

Total 124 21.9 (±10.9) 118 18.3 (± 11.4) 191 21.0 (± 13.4)

1. Social determinants

2009 NSW Inmate Health Survey: Key Findings Report 27

The majority (67%) of 2009 IHS participants reported that

their mothers were born in Australia, with a slightly higher

proportion of men (68%) than women (63%) reporting this

to be the case (Table 1.1.7). Among the 329 participants who

reported that their mothers were born overseas, 32% were

born in a European country, followed by 20% from Oceania

(mostly New Zealand), 20% from Asia, and 16% from the

Middle East. The proportion of participants whose mothers

were born in Australia was virtually identical to the findings of

the 2001 IHS (68% of the total sample), which represented a

decrease from the 1996 IHS (74%).

Table/Fig 1.1.7 Mother was born in Australia

0

10

20

30

40

50

60

70

80

90

75.2

63.0 63.3

73.9

68.6 67.9

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 456 617 73.9 485 707 68.6 541 797 67.9

Women 88 117 75.2 97 154 63.0 126 199 63.3

Total 544 734 74.1 582 861 67.6 667 996 67.0

The majority (63%) of 2009 IHS participants also reported

that their fathers were born in Australia, again with a slightly

higher proportion of men (64%) than women (60%) reporting

this to be the case (Table 1.1.8). Among the 365 participants

who reported that their fathers were born overseas, 33% were

born in a European country, followed by 20% from Oceania

(mostly New Zealand), 17% from Asia, and 16% from the

Middle East. The proportion of participants whose fathers were

born in Australia was identical to the findings of the 2001 IHS

(63% of the total sample), which represented a decrease from

the 1996 IHS (70%).

Table/Fig 1.1.8 Father was born in Australia

0

10

20

30

40

50

60

70

80

64.1

56.2

60.3

70.9

64.7 64.1

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 437 616 70.9 453 700 64.7 511 797 64.1

Women 75 117 64.1 86 153 56.2 120 199 60.3

Total 512 733 69.8 539 853 63.2 631 996 63.4

Consistent with the preponderance of Australian-born

IHS participants, 80% of the sample reported that English

was the language spoken in the home in which they grew

up (Table 1.1.9), with a slightly higher proportion of men

(81%) than women (77%) reporting this to be the case. This

figure continued the gradual decline in the proportion of

earlier IHS samples who reported growing up in an Englishspeaking

household, from 87% in 1996 to 84% in 2001. The

proportion is also consistent with the population of inmates

in full-time custody in NSW: the NSW Inmate Census 2008

(Corben, 2009) indicated that 79% of all inmates in full-time

custody as at June 30 2008 grew up in an English-speaking

home, whereas 17% grew up in a non-English speaking

home. This information was unknown for 5% of inmates in

the Inmate Census 2008.

1. Social determinants

28 2009 NSW Inmate Health Survey: Key Findings Report

Table/Fig 1.1.9 Spoke English growing up

0

20

40

60

80

100

87.3 84.7

77.4

86.5 84.2 81.2

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 530 613 86.5 593 704 84.2 647 797 81.2

Women 103 118 87.3 127 150 84.7 154 199 77.4

Total 633 731 86.6 720 854 84.3 801 996 80.4

Among 2009 IHS participants who grew up speaking a

language other than English, the most commonly reported

languages were Arabic, Chinese, Vietnamese, Spanish and

Italian, with men more likely to report speaking Arabic, and

women more likely to report speaking Chinese or Vietnamese

(Table 1.1.10). This pattern of results reflects the languages

spoken among the resident general population of NSW: the

2006 Census reported that 78.7% of the NSW population

spoke only English at home, while 4% spoke Chinese at home,

2.7% spoke Arabic, 1.4% spoke Italian, 1.4% spoke Greek,

1.2% spoke Vietnamese, and 0.8% spoke Spanish (Population

Health Division, NSW Health, 2008).

Table 1.1.10 Language spoken growing up

Men Women Total

n % n % n %

English 647 81.2 154 77.4 801 80.4

Arabic 33 4.1 3 1.5 36 3.6

Chinese 12 1.5 5 2.5 17 1.7

Vietnamese 7 0.9 5 2.5 12 1.2

Spanish 7 0.9 4 2.0 11 1.1

Italian 7 0.9 3 1.5 10 1.0

Other 84 10.5 25 12.6 109 10.9

Total 797 100.0 199 100.0 996 100.0

Consistent with the over-representation of Aboriginal and

Torres Strait Islander people among NSW prison inmates,

together with deliberate over-sampling of Aboriginal

inmates in this Survey as described in the Methods, close

to one third (31%) of participants in the 2009 IHS selfreported

during the telephone interview that they were of

Aboriginal and/or Torres Strait Islander origin (Table 1.1.11).

A higher proportion of men than women reported this

to be the case (33% versus 27%). The overall proportion

represented a slight increase from the proportion of 2001

IHS participants who identified as Aboriginal (28%),

which itself represented a slight decrease from the 1996

IHS sample (30%). Just 6% of the 312 participants who

identified as Aboriginal Australians indicated that they were

of Torres Strait Islander origin.

Table/Fig 1.1.11 Aboriginal and/or Torres Strait

Islander origin

0

5

10

15

20

25

30

35

40

23.5

15.6

26.6

31.1 30.3

32.5

1996 2001 2009

Men Women

PERCENT YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 204 657 31.1 215 710 30.3 259 797 32.5

Women 31 132 23.5 24 154 15.6 53 199 26.6

Total 235 789 29.8 239 864 27.7 312 996 31.3

1. Social determinants

2009 NSW Inmate Health Survey: Key Findings Report 29

According to the NSW Inmate Census 2008 (Corben 2009),

21% of inmates (20% of men, 28% of women) held in

full-time custody on 30 June 2008 were of Aboriginal and/or

Torres Strait Islander origin. This report indicates that Corrective

Services NSW records an inmate as an Aboriginal and/or Torres

Strait Islander if they have identified as such (by self-report)

in any current or previous imprisonment episode. Data on the

Aboriginality of IHS participants was also contained in the

administrative records provided by CSNSW from which our

sampling frame was derived. Although the overall proportion

of participants recorded as being of Aboriginal origin was

similar for the self-report and administrative data items (31.3%

by self-report compared with 30.9% using CSNSW data), there

was disagreement for 6.3% (N=62) with no particular pattern

of over or under-reporting.

Although just 27% of 2009 IHS participants described

themselves as currently married or living in a de facto marriage

(Table 1.1.12), a much higher proportion (75%) of participants

reported a history of marriage or a de facto relationship.

The relatively small proportion of married IHS participants is

consistent with the documented characteristics of Australian

inmate populations (e.g., Borzycki, 2005), and is much lower

than among the NSW resident adult population. The 2008

NSW Population Health Survey reported that 58% of men and

57% of women aged 16 years and older in NSW are currently

married or in de facto relationships (Centre for Epidemiology

and Research, NSW Department of Health, 2009).

Table 1.1.12 Legal marital status

Men Women Total

n % n % n %

Never married 360 45.2 73 36.7 433 43.5

Married / De-facto 209 26.2 60 30.2 269 27.0

Separated 77 9.7 24 12.1 101 10.1

Regular partner 73 9.2 16 8.0 89 8.9

Divorced 63 7.9 19 9.5 82 8.2

Widowed 15 1.9 7 3.5 22 2.2

Total 797 100.0 199 100.0 996 100.0

Consistent with previous IHS findings, a higher proportion of

women than men described themselves as currently married

or in a de facto relationship (30% versus 26%). Likewise,

a smaller proportion of women than men reported never

having been married (37% versus 45%). The proportion of

married/de facto IHS participants decreased from 32% in

1996 to 27% in 2001, then remained steady between 2001

and 2009 (Table 1.1.13).

Table/Fig 1.1.13 Legal marital status “married” or “de

facto”

0

5

10

15

20

25

30

35

40

45

40.7

30.3 29.2 30.2

26.5 26.2

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 186 614 30.3 188 710 26.5 209 797 26.2

Women 46 113 40.7 45 154 29.2 60 199 30.2

Total 232 727 31.9 233 864 27.0 269 996 27.0

1. Social determinants

30 2009 NSW Inmate Health Survey: Key Findings Report

1.2 Childhood care experiences

Just half (49%) of the 2009 IHS sample reported that they

had been raised by both biological parents for their entire

childhood (defined for this purpose as birth to 16 years of

age), with women slightly less likely to report this than men

(45% versus 50%) (Table 1.2.1). Conversely, more than

one-third of participants reported not having been raised by

both biological parents for any of their childhood, with no

difference between the proportion of men and women who

reported this to be the case (34% versus 36%).

Table 1.2.1 Raised by both biological parents

Men Women Total

n % n % n %

Yes (full childhood) 400 50.2 90 45.2 490 49.2

Yes, 0 - 10 years only 115 14.4 33 16.6 148 14.9

Yes, 11 - 16 years only 10 1.3 5 2.5 15 1.5

None of childhood 272 34.1 71 35.7 343 34.4

Total 797 100.0 199 100.0 996 100.0

A history of being raised outside of the family unit is

more prevalent among inmate populations than among

the general population (see review by Borzycki, 2005).

Consistent with this, almost one third (30%) of the 2009 IHS

sample reported having been placed in care before the age

of 16 years (Table 1.2.2), with little difference between the

proportion of men and women who reported such a history

(32% versus 30%). This figure represented an increase from

the 21% of the 2001 IHS sample who reported a history

of being placed in childhood care (these data were not

collected in the 1996 IHS). Childhood care experiences were

defined as “spending any part of your childhood living away

from your natural parents,” excluding juvenile detention,

which clearly leaves some room for interpretation.

Table/Fig 1.2.2 Ever placed in care before the age of

16 years

0

5

10

15

20

25

30

35

40

22.9

32.2

21.0

29.6

2001 2009

Men Women

PERCENT

YEAR

2001 2009

n Total % n Total %

Men 149 709 21.0 236 797 29.6

Women 35 153 22.9 64 199 32.2

Total 184 862 21.3 300 996 30.1

Some participants specified they had been placed in care because

of family breakdown, abusive parents, and drug and alcohol

problems (both the participant and their parents).

Specific comments included:

• ‘Mum and dad split up and mum couldn’t afford to look after me.’

• ‘Mother’s partner sexually assaulted me and my sister.’

• ‘My father had an accident and lost his leg and my mother had

a breakdown.’

• ‘I started basically getting into trouble with the police, running amok.

My mum was going through difficulties as she’s a heavy drinker.’

• ‘I was classed with ADD and was uncontrollable.’

• ‘Taken away from parents (stolen generation) by government

order/policy.’

Among participants who reported having been placed in care

before the age of 16 years, the most common experience was

being cared for by extended family (Table 1.2.3), followed by

being placed in foster care. Twenty two percent of men and 13%

of women reported having been placed “in a home,” although

this term was not defined and presumably meant different things

to different participants. Note that participants could nominate

more than one form of childhood care placement.

1. Social determinants

2009 NSW Inmate Health Survey: Key Findings Report 31

Table 1.2.3 Type of care (if ever placed in care before

the age of 16 years)

(Multiple response)

Men Women Total

n % n % n %

With an extended family 91 38.6 20 31.3 111 37.0

Foster care 76 32.2 26 40.6 102 34.0

In a home 53 22.5 8 12.5 61 20.3

Other 42 17.8 20 31.3 62 20.7

The majority of those who reported having been placed in

care before the age of 16 years had undergone just one such

experience (Table 1.2.4), although 9% of participants had

been placed in care between two and five times, and 4% of

the sample had been placed in care six or more times before

the age of 16 years.

Table 1.2.4 Number of childhood care placements

(before the age of 16 years)

Men Women Total

n % n % n %

0 561 70.4 135 67.8 696 69.9

1 133 16.7 41 20.6 174 17.5

2 – 5 72 9.0 18 9.0 90 9.0

6+ 31 3.9 5 2.5 36 3.6

Total 797 100.0 199 100.0 996 100.0

One quarter (26%) of 2009 IHS participants who reported

having been placed in care before the age of 16 years reported

that they were first placed in care at the age of 4 years or

younger (Table 1.2.5), whereas close to half (47%) were first

placed in care at the age of 10 years or older. There was no

difference between men and women in the age at which they

were first placed in care; among men, the mean age was 8.4

years (SD 4.8; range 0-17) and among women, the mean age

was 8.2 years (SD 5.0; range 0-16).

Table 1.2.5 Age first placed in care (if ever placed in

care before the age of 16 years)

Men Women Total

n % n % n %

0 - 2 years 37 16.2 12 19.7 49 16.9

3 - 4 years 21 9.2 4 6.6 25 8.6

5 - 9 years 63 27.5 16 26.2 79 27.2

10+ years 108 47.2 29 47.5 137 47.2

Total 229 100.0 61 100.0 290 100.0

For many 2009 IHS participants who reported a history of

childhood care placements, such experiences were long-term:

41% of those ever in care reported having been in care for a

total of more than five years of their childhood, and a further

22% had been in care for between two and five years (Table

1.2.6). Just 14% of men and 17% of women with a childhood

care history had spent less than a total of six months of their

childhood in care, and for only 25% was the total time spent

in care less than twelve months.

Table 1.2.6 Total time spent in childhood care (if ever

placed in care before the age of 16 years)

Men Women Total

n % n % n %

< 6 months 32 13.6 11 17.2 43 14.3

6 - < 12 months 29 12.3 4 6.3 33 11.0

1 - < 2 years 26 11.0 5 7.8 31 10.3

2 - < 5 years 49 20.8 18 28.1 67 22.3

5+ years 99 41.9 24 37.5 123 41.0

Don’t know 1 0.4 2 3.1 3 1.0

Total 236 100.0 64 100.0 300 100.0

1. Social determinants

32 2009 NSW Inmate Health Survey: Key Findings Report

1.3 Parents in prison or in care

Eighteen percent of the 2009 IHS sample reported that

during their childhood, at least one of their parents had

been imprisoned (Table 1.3.1), most commonly their father

(13%), but also their mother (2%) or both parents (2%).

Such rates of parental incarceration are consistent with

the literature demonstrating elevated prevalence of family

criminal involvement among Australian and international

inmate populations (see review by Borzycki, 2005).

Table 1.3.1 Parents ever imprisoned during childhood

Men Women Total

n % n % n %

None 622 78.0 156 78.8 778 78.2

Father only 114 14.3 18 9.1 132 13.3

Mother only 11 1.4 11 5.6 22 2.2

Both parents 18 2.3 5 2.5 23 2.3

Don’t know 32 4.0 8 4.0 40 4.0

Total 797 100.0 198 100.0 995 100.0

Ten percent of 2009 IHS participants reported that one or

both parents had been placed in care during their own (the

parents’) childhood, most commonly their mothers (6%) but

also their fathers (4%) and in four instances, both parents

(Table 1.3.2).

Table 1.3.2 Parents ever placed in care during their own

childhoods

Men Women Total

n % n % n %

None 606 76.0 150 75.8 756 76.0

Father only 32 4.0 8 4.0 40 4.0

Mother only 37 4.6 19 9.6 56 5.6

Both parents 3 0.4 1 0.5 4 0.4

Don’t know 119 14.9 20 10.1 139 14.0

Total 797 100.0 198 100.0 995 100.0

1.4 Education

Consistent with the poor educational attainment of Australian

and international prison populations (see review by Borzycki,

2005), more than half of the 2009 IHS sample left school prior

to attaining Year 10 (school certificate), the minimum level of

education required by law in NSW (Table 1.4.1), including four

participants who reported having never attended school at all,

and 37 who reported only having attended primary school.

A further 29% of the sample reported having left school before

the end of Year 10, and less than one in ten completed their

higher school certificate (Year 12). Men were more likely than

women to report having left school before completing Year 10

(49% versus 39%). Post-high school qualifications were

attained by only small minorities of this sample, with women

again more likely to report post-school educational attainment.

Table 1.4.1 Highest educational qualification

Men Women Total

n % n % n %

Never attended school 1 0.1 3 1.5 4 0.4

Primary school only 29 3.6 8 4.0 37 3.7

Left school no qualification 387 48.6 78 39.2 465 46.7

School certificate 237 29.7 51 25.6 288 28.9

HSC/VCE/Leaving certificate 63 7.9 22 11.1 85 8.5

College certificate / Diploma 31 3.9 18 9.0 49 4.9

Technical or trade qualification 32 4.0 5 2.5 37 3.7

Degree / tertiary qualification 15 1.9 14 7.0 29 2.9

Don’t know 2 0.3 0 0.0 2 0.2

Total 797 100.0 199 100.0 996 100.0

Among 2009 IHS participants who left school with no

qualification (i.e. prior to completing Year 10), the average

age at which both men and women left school was around

14.5 years (Table 1.4.2). Note that this excludes the four

participants who never attended school.

Table 1.4.2 Age left school characteristics (if not

complete Year 10)

Men Women Total

N 413 85 498

Mean (± sd) 14.6 (± 1.2) 14.4 (± 1.4) 14.5 (± 1.3)

Median 15.0 15.0 15.0

Range 9 - 19 8 - 17 8 - 19

1. Social determinants

2009 NSW Inmate Health Survey: Key Findings Report 33

The proportion of the 2009 IHS sample who failed to attain

the minimum level of education was consistent with both

the 1996 and 2001 IHS results: just over half of all three

samples reported having left school before completing Year

10 (Table 1.4.3). However, the proportion of women who did

not complete Year 10 declined slightly from 49% in 1996 to

45% in 2009.

Table/Fig 1.4.3 Left school prior to completing Year 10

0

10

20

30

40

50

60

70

48.7

45.5 44.7

52.5 53.4 52.3

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 321 612 52.5 376 704 53.4 417 797 52.3

Women 56 115 48.7 70 154 45.5 89 199 44.7

Total 377 727 51.9 446 858 52.0 506 996 50.8

Disrupted educational histories were evident among 2009 IHS

participants, with less than one third of participants reporting that

they had attended only Two or Three schools (Table 1.4.4). Women

were more likely than men to report having attended only one or

two schools (37% versus 30%). A total of 31% of participants

reported having attended five or more schools, including 15%

who reported having attended seven or more schools.

Table 1.4.4 Number of schools attended

Men Women Total

n % n % n %

1 – 2 238 30.1 70 36.8 308 31.4

3 – 4 310 39.2 61 32.1 371 37.8

5 – 6 124 15.7 34 17.9 158 16.1

7+ 119 15.0 25 13.2 144 14.7

Total 791 100.0 190 100.0 981 100.0

Likewise, a high rate of school expulsions was also reported

by 2009 IHS participants, with 37% of men and 27% of

women – equating to a total of 35% of the overall sample

– reporting that they had been expelled from at least one

school during their educational history. Men were more likely

than women to report having been expelled from two or

more schools (18% versus 8%). Eighteen percent of men and

8% of women reported having attended a “special school,”

although this term was not defined and presumably meant

different things to different participants.

Educational opportunities are also offered to many inmates

during their incarceration, an important aspect to seeking to

equip inmates with the life skills to avoid re-offending and reincarceration

after their release to the community. Forty two

percent of 2009 IHS participants reported having completed

an educational course during their present incarceration,

most commonly TAFE (Technical and Further Education)

(19%) and AVETI courses (12%) (Table 1.4.5). AVETI

courses refer to those provided by the Adult Vocational and

Education Training Institute (AVETI), located at the Silverwater

Correctional Centre. AVETI offers training courses in areas

such as Adult Literacy and Numeracy, English as a Second

Language, Communications, Computers, Job-seeking Skills

and Small Business Management.

Table 1.4.5 Completed educational courses during

current incarceration

Men Women Total

n % n % n %

No 473 59.3 106 53.3 579 58.1

Yes, TAFE 151 18.9 42 21.1 193 19.4

Yes, AVETI 94 11.8 22 11.1 116 11.6

Yes, other 79 9.9 29 14.6 108 10.8

Total 797 100.0 199 100.0 996 100.0

1. Social determinants

34 2009 NSW Inmate Health Survey: Key Findings Report

1.5 Employment

A history of poor employment and unemployment is

characteristic of Australian and international inmate

populations (e.g., see review by Borzycki, 2005). Consistent

with the characteristics of both the 1996 and 2001 IHS

samples, around half (53%) of the 2009 sample reported that

they had been unemployed in the six months prior to their

present incarceration (Table 1.5.1). Also consistent with earlier

findings was the substantially higher proportion of women

than men who reported having been unemployed before

prison (67% versus 50%).

Table/Fig 1.5.1 Unemployed in the six months prior to

incarceration

0

10

20

30

40

50

60

70

80

90

75.9

63.6

67.3

53.6

45.1

49.9

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Male 331 617 53.6 320 710 45.1 398 797 49.9

Women 88 116 75.9 98 154 63.6 134 199 67.3

Total 419 733 57.2 418 864 48.4 532 996 53.4

Among the 53% of 2009 IHS participants who reported having

been unemployed in the six months prior to prison, more

than half (56%) reported having been unemployed for two

or more years before prison, including almost one in five who

reported not having worked for ten or more years (Table 1.5.2).

The duration of unemployment was longer among women,

who were substantially more likely than men to have been

unemployed for five or more years (44% versus 30%).

Table 1.5.2 Duration of unemployment (if unemployed

in six months prior to incarceration)

Men Women Total

n % n % n %

< 1 year 114 28.6 28 20.9 142 26.7

1 - <2 years 76 19.1 18 13.4 94 17.7

2 - <5 years 88 22.1 29 21.6 117 22.0

5 - <10 years 59 14.8 26 19.4 85 16.0

10+ years 61 15.3 33 24.6 94 17.7

Total 398 100.0 134 100.0 532 100.0

The proportion of IHS participants who were unemployed

in the six months prior to their incarceration and who

reported not having worked for two or more years increased

from 33% among the 1996 IHS sample to 40% in 2001,

and declined again to 56% in 2009 (Table 1.5.3). Women

had consistently higher rates of unemployment than men,

including nearly two-thirds (66%) in 2009 compared with

just over half (52%) of men.

Table/Fig 1.5.3 Unemployed for two or more years

(if unemployed in six months prior to

incarceration)

0

10

20

30

40

50

60

70

43.2

59.2

65.7

30.5

33.8

52.3

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 101 331 30.5 108 320 33.8 208 398 52.3

Women 38 88 43.2 58 98 59.2 88 134 65.7

Total 139 419 33.2 166 418 39.7 296 532 55.6

1. Social determinants

2009 NSW Inmate Health Survey: Key Findings Report 35

Participants in the 2009 IHS who had been employed for

at least part of the six months preceding their current

incarceration were most likely to report that the job they had

held most recently was as a labourer (44%), a tradesperson

(13%) or as a sales person or personal service worker (12%)

(Table 1.5.4). Jobs held most recently were often different

from participants’ reported ‘usual’ occupation, but are

presented in this report as an indication of participants’

lifestyles directly prior to imprisonment.

Some participants specified their occupation was a ‘career criminal’

or that they ‘had never worked in their life’.

Table 1.5.4 Last job prior to current incarceration

Men Women Total

n % n % n %

Labourer and related

workers 189 47.4 15 23.1 204 44.0

Tradespeople 59 14.8 1 1.5 60 12.9

Salespeople / service worker 38 9.5 19 29.2 57 12.3

Self-employed 37 9.3 12 18.5 49 10.6

Plant / machine operators

/ drivers 35 8.8 1 1.5 36 7.8

Manager / Administrator /

Professionals 21 5.3 6 9.2 27 5.8

Other 20 5.0 11 16.9 31 6.7

Total 399 100.0 65 100.0 464 100.0

Many inmates have the opportunity to work for Corrective

Services Industries during their incarceration. This commercial

industrial aspect of the prison system manufactures a range of

products including textiles and furniture. A higher proportion

of 2009 IHS participants reported having a job in prison than

had had a job in the community during the six months prior

to their current incarceration (62% versus 47%). Nevertheless,

the proportion of IHS samples who reported having a prison

job declined steadily from 82% in 1996 to 76% in 2001, and

again to 62% in 2009 (Table 1.5.5). Consistent with previous

IHS findings, a higher proportion of women than men

reported having a prison job (72% versus 60%).

Table/Fig 1.5.5 Have a job in prison during current

incarceration

0

20

40

60

80

100 92.3

81.6

72.4

80.4

74.2

59.6

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 484 602 80.4 526 709 74.2 475 797 59.6

Women 108 117 92.3 124 152 81.6 144 199 72.4

Total 592 719 82.3 650 861 75.5 619 996 62.1

Participants in the 2009 IHS who were employed in prison

reported a range of prison jobs, with some differences between

men and women. Men were most likely to be employed as

“sweepers” (trusted inmates who conduct domestic work in

clinics and administration areas), in maintenance roles, in the

kitchens or in the timber industry (Table 1.5.6). Women were

most likely to be employed in maintenance roles, in the kitchens,

in clerical roles or in agriculture.

Table 1.5.6 Type of prison job (if employed in prison)

Men Women Total

n % n % n %

Sweeper 104 21.9 11 7.6 115 18.6

Maintenance 66 13.9 20 13.9 86 13.9

Kitchen / cook 46 9.7 18 12.5 64 10.3

Timber shop 43 9.1 0 0.0 43 6.9

Garden /Farmers /Nursery 26 5.5 15 10.4 41 6.6

Clerical work 19 4.0 16 11.1 35 5.7

Storeman / packer 14 2.9 12 8.3 26 4.2

Textile 23 4.8 0 0.0 23 3.7

Laundry 17 3.6 4 2.8 21 3.4

Other CSNSW industry 28 5.9 25 17.4 53 8.6

Other 89 18.7 23 16.0 112 18.1

Total 475 100.0 144 100.0 619 100.0

1. Social determinants

36 2009 NSW Inmate Health Survey: Key Findings Report

1.6 Pension or benefit

Welfare reliance, associated with both poor educational

attainment and a lack of employment and training

opportunities, is another highly prevalent feature of

Australian and international inmate populations (Borzycki,

2005). Consistent with this characteristic, many 2009 IHS

participants reported having received some form of pension

or benefit for substantial periods of time. The proportion

of participants reporting receiving a pension or benefit in

the six months prior to incarceration increased from 43%

in 1996 to 54% in 2001 to 66% in 2009 (Table 1.6.1).

Women were more likely than men to report receiving a

pension or benefit across all Surveys.

Table/Fig 1.6.1 Pensions or benefits received in the six

months prior to incarceration

0

10

20

30

40

50

60

70

80

90

62.9

70.7

77.9

39.1

49.7

63.4

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 257 657 39.1 371 747 49.7 505 797 63.4

Women 83 132 62.9 118 167 70.7 155 199 77.9

Total 340 789 43.1 489 914 53.5 660 996 66.3

Two-thirds of participants reported that they had received at

least one form of pension or benefit in the six months prior to

their current incarceration (Table 1.6.2), with unemployment

(34%), disability (14%) and student/youth allowances (9%) the

most commonly reported payment received. “Other” forms of

pension or benefits had reportedly been received by 11% of

the sample in the six months prior to incarceration, including

both the aged pension and the widow’s pension. Note that

participants could nominate more than one form of pension or

benefit received.

Table 1.6.2 Type of pensions or benefits received in the

six months prior to incarceration

(Multiple response)

Men Women Total

n % n % n %

Any pension or benefit 505 63.4 155 77.9 660 66.3

Unemployment 280 35.1 57 28.6 337 33.8

Disability support 107 13.4 36 18.1 143 14.4

Student/youth 67 8.4 26 13.1 93 9.3

Supporting parent 13 1.6 36 18.1 49 4.9

Carers 12 1.5 10 5.0 22 2.2

Sickness 16 2.0 2 1.0 18 1.8

Other 80 10.0 32 16.1 112 11.2

No pension or benefit 292 36.6 44 22.1 336 33.7

Receipt of pensions or benefits was a relatively longstanding

occurrence for many 2009 IHS participants. Almost half (49%) of

those who received at least one form of pension or benefit in the

six months prior to incarceration reported having received that

pension or benefit for two or more years (Table 1.6.3), including

10% who had received the payment for ten or more years. One

third (35%) of those who had been in receipt of pensions or

benefits had received their payments for less than one year.

Table 1.6.3 Time on pension or benefit (if on pension or

benefit in six months prior to incarceration)

Men Women Total

n % n % n %

< 1 year 184 38.0 40 26.5 224 35.3

1 - <2 years 83 17.1 19 12.6 102 16.1

2 - <5 years 105 21.7 39 25.8 144 22.7

5 - <10 years 73 15.1 27 17.9 100 15.7

10+ years 39 8.1 26 17.2 65 10.2

Total 484 100.0 151 100.0 635 100.0

1.7 Accommodation and living situation

Consistent with the literature demonstrating strong associations

between transient accommodation and incarceration (e.g.,

Baldry et al., 2003), 11% of IHS participants were homeless or

residing in unsettled accommodation such as hostels, squats or

caravans immediately prior to their current incarceration (Table

1.7.1). Half of the sample reported that they lived in rental

accommodation prior to their imprisonment, and more than

one-third reported having lived in their own or the family home.

1. Social determinants

2009 NSW Inmate Health Survey: Key Findings Report 37

Table 1.7.1 Accommodation immediately prior to

current incarceration

Men Women Total

n % n % n %

Renting 390 48.9 110 55.3 500 50.2

Own home / family 314 39.4 66 33.2 380 38.2

Unsettled lodgings 70 8.8 16 8.0 86 8.6

Sleeping rough \

(no fixed abode) 20 2.5 4 2.0 24 2.4

Hospital 3 0.4 3 1.5 6 0.6

Total 797 100.0 199 100.0 996 100.0

The proportion of 2009 IHS participants who reported

unsettled accommodation or no fixed abode immediately

prior to their current incarceration was equivalent to that of

the 2001 IHS sample, and a slight increase compared to the

1996 sample (Table 1.7.2).

Table/Fig 1.7.2 Unsettled or “no fixed abode”

accommodation prior to incarceration

0

3

6

9

12

15

9.7

11.2

10.1

7.2

10.4

11.3

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 44 613 7.2 73 700 10.4 90 797 11.3

Women 11 113 9.7 17 152 11.2 20 199 10.1

Total 55 726 7.6 90 852 10.6 110 996 11.0

Among the majority of 2009 IHS participants, accommodation

arrangements prior to their incarceration appeared relatively

stable: 60% of the sample reported having lived in only

one residence in the six months preceding their current

incarceration, and a further 10% reported having moved

once during that period (Table 1.7.3). However, one quarter

had moved two or more times in the preceding six months,

including 4% who reported having moved six or more times.

Three percent reported that they had no fixed accommodation

during the six months before imprisonment.

Table 1.7.3 Changes of accommodation in the six

months prior to current incarceration

Men Women Total

n % n % n %

None, lived in same place 495 62.1 105 52.8 600 60.2

Moved once 74 9.3 25 12.6 99 9.9

Moved 2-3 times 140 17.6 35 17.6 175 17.6

Moved 4-5 times 39 4.9 13 6.5 52 5.2

Moved 6+ times 26 3.3 13 6.5 39 3.9

No fixed accommodation 23 2.9 8 4.0 31 3.1

Total 797 100.0 199 100.0 996 100.0

Among participants in the 2009 IHS with a history

of previous incarceration, 30% reported that they

had experienced problems with their accommodation

arrangements within six months of their last release into

the community (Table 1.7.4). These findings are consistent

with research demonstrating the strong likelihood of exinmates

being re-incarcerated if they move house often

in the immediate post-release period (Baldry et al., 2003).

Accommodation issues were substantially more likely to

have been experienced by women after release from prison

than men (51% versus 26%). This finding is consistent

with Australian research demonstrating that ex-inmates are

more likely to avoid re-incarceration if they return to live

with their partner, parents or close family post-release, and

proportionally fewer female ex-inmates are provided with

such an opportunity (Baldry et al., 2003).

1. Social determinants

38 2009 NSW Inmate Health Survey: Key Findings Report

Table 1.7.4 Accommodation problems within six

months of most recent release (if ever

previously incarcerated)

Men Women Total

n % n % n %

Yes 132 25.9 46 50.5 178 29.6

No 378 74.1 45 49.5 423 70.4

Total 510 100.0 91 100.0 601 100.0

Thirty five percent of 2009 IHS participants reported that

they had been living with their partner prior to their current

incarceration (Table 1.7.5). A further 20% reported living

alone, while living with parents (19%), siblings or other

family (15%), or friends (9%) were also relatively common.

Note that this question specifically requested that participants

exclude any children whom they might have lived with.

Table 1.7.5 People lived with (excluding children) prior

to current incarceration

Men Women Total

n % n % n %

Alone 150 18.8 48 24.1 198 19.9

Partner 276 34.6 71 35.7 347 34.8

Parent (s) 163 20.5 29 14.6 192 19.3

Siblings / Other family 118 14.8 28 14.1 146 14.7

Friends 68 8.5 17 8.5 85 8.5

Other 22 2.8 6 3.0 28 2.8

Total 797 100.0 199 100.0 996 100.0

In the twelve months preceding their current incarceration,

more than 90% of the 2009 IHS sample had spent the most

time in a location within NSW (Table 1.7.6). Dividing the

sample into the geographical NSW Health Area Health Services

(AHS) of the location where they spent the most time in the

year preceding their imprisonment indicates that participants

were most likely to have resided in the Sydney metropolitan

area such as Sydney South West (22%), Sydney West (16%),

or South Eastern Sydney and Illawarra (15%) Area Health

Services. The majority of participants who were not living in

NSW prior to incarceration were living in the bordering states

of Queensland (35%) or Victoria (20%).

Table 1.7.6 NSW Area Health Service of residence in

the year prior to incarceration

Men Women Total

n % n % n %

Sydney Southwest AHS 164 20.6 53 26.6 217 21.8

Sydney West AHS 131 16.4 24 12.1 155 15.6

South Eastern Sydney

Illawarra AHS 123 15.4 30 15.1 153 15.4

Hunter New England AHS 100 12.5 24 12.1 124 12.4

Greater Western AHS 63 7.9 15 7.5 78 7.8

Greater Southern AHS 61 7.7 7 3.5 68 6.8

Northern Sydney Central

Coast AHS 53 6.6 13 6.5 66 6.6

North Coast AHS 43 5.4 15 7.5 58 5.8

Outside NSW /

International / No fixed

address 59 7.4 18 9.0 77 7.7

Total 797 100.0 199 100.0 996 100.0

1.8 Children of participants

Close to half (45%) of the 2009 IHS sample reported that they

were the parent of at least one child under the age of 16 years,

including both foster children and step-children (Table 1.8.1), with

a higher proportion of women (49%) than men (43%) reporting

that they were parents. Note that participants were not asked

if they were the parent of children 16 years or older. Thirty two

percent of the sample reported being the parent of Two or Three

children aged less than 16 years, while 13% reported having

three or more. There was no difference between the proportion

of men (13%) and women (14%) who reported being the parent

of three or more children aged less than 16 years.

In 2006–7, 65% of Australia’s general population aged 18 years

or older and living in private dwellings (excluding very remote

parts of Australia) reported that they had natural children,

although no information about the age of these children is

available, and these data refer specifically to biological children,

excluding foster and step-children (ABS, 2008). It is not possible

to determine whether inmates were more or less likely to be

parents than the general community since they were only asked

about children aged less than 16 years. Among Australia’s

parents, 41% reported that they had two children, and 39%

reported that they had three or more.

1. Social determinants

2009 NSW Inmate Health Survey: Key Findings Report 39

Table 1.8.1 Number of children (including foster and

step-children) aged less than 16 years

Men Women Total

n % n % n %

0 450 56.6 101 50.8 551 55.4

1 138 17.4 44 22.1 182 18.3

2 107 13.5 26 13.1 133 13.4

3 48 6.0 14 7.0 62 6.2

4 24 3.0 6 3.0 30 3.0

5+ 28 3.5 8 4.0 36 3.6

Total 795 100.0 199 100.0 994 100.0

Whereas a consistently higher proportion of women than men

reported being the parents of at least one child aged less than

16 years (Table 1.8.2), the overall proportion of IHS participants

who reported being parents declined from 58% in 1996 to

51% in 2001, and again to 45% in 2009. Such results may

reflect social trends in the broader Australian community, with

increasing proportions of Australian women and their partners

not having children (ABS, 2002); estimates for 2000 suggested

that 24% of women currently in their child-bearing years would

never have children. The ABS (2002) reports that this trend is

also seen in other developed countries, with recent estimates of

permanent childlessness for women in the United Kingdom and

the United States of 20% and 22%, respectively.

Table/Fig 1.8.2 Parent of at least one child aged less

than 16 years (including foster and

step-children)

0

10

20

30

40

50

60

70

80

65.9

57.1

49.2

56.6

49.3

43.4

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 372 657 56.6 337 684 49.3 345 795 43.4

Women 87 132 65.9 84 147 57.1 98 199 49.2

Total 459 789 58.2 421 831 50.7 443 994 44.6

Twenty seven percent of the 2009 IHS sample reported that

at least one of their children aged less than 16 years was

dependent on them immediately prior to their incarceration

(Table 1.8.3). There was little difference between the proportion

of men and women who reported having dependent children

(26% versus 30%).

Table 1.8.3 Have dependent child aged less than 16

years (including foster and step-children)

prior to incarceration

Men Women Total

n % n % n %

Yes, have dependent

children 207 26.0 60 30.2 267 26.9

No, have children

(non dependent) 138 17.4 38 19.1 176 17.7

Not have any children 450 56.6 101 50.8 551 55.4

Total 795 100.0 199 100.0 994 100.0

1.9 Contact with family during

incarceration

Prison inmates who maintain close links with their families

and/or close friends during incarceration have lower rates of

post-release recidivism than inmates who do not maintain

these ties (Hairston, 2003; Visher & Travis, 2003). Close to

half (47%) of 2009 IHS participants reported that they had

not received any visits from family and/or friends in the four

weeks preceding the Survey (Table 1.9.1), with men more

likely than women to report that this was the case (49%

versus 39%). Women were also more likely than men to

report having received two or more visits during that period

(43% versus 34%).

Table 1.9.1 Number of visits from family and/or friends

in the previous four weeks

Men Women Total

n % n % n %

0 382 48.6 72 38.7 454 46.7

1 136 17.3 34 18.3 170 17.5

2 - 4 189 24.0 64 34.4 253 26.0

5+ 79 10.1 16 8.6 95 9.8

Total 786 100.0 186 100.0 972 100.0

1. Social determinants

40 2009 NSW Inmate Health Survey: Key Findings Report

The proportion of IHS participants who reported having

received no visits from family and/or friends during the four

weeks preceding the Survey increased from 41% in 1996

to 48% in 2001, and then remained steady at 47% in 2009

(Table 1.9.2). In all Survey years, women were more likely than

men to report receiving at least one visit during that period,

suggesting that women may be more likely than men to

maintain family and social networks during incarceration to

which they can return post-release.

Table/Fig 1.9.2 No visits from family and/or friends in

the previous four weeks

0

10

20

30

40

50

60

31.6

42.8

38.7

42.8

48.8 48.6

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 262 612 42.8 341 699 48.8 382 786 48.6

Women 37 117 31.6 65 152 42.8 72 186 38.7

Total 299 729 41.0 406 851 47.7 454 972 46.7

One in ten (11%) 2009 IHS participants reported having

received no phone calls or letters from family and/or friends

during the two weeks preceding the Survey (Table 1.9.3).

Women were slightly more likely than men to report that

they had received at least one phone call or letter during

this period (93% versus 88%); and a higher proportion of

women reported receiving at least two phone call or letters

during that period (87% versus 80%).

Table 1.9.3 Number of phone calls or letters from family

and/or friends in the previous two weeks

Men Women Total

n % n % n %

0 93 11.8 13 7.0 106 10.9

1 68 8.7 13 7.0 81 8.3

2-4 159 20.2 50 26.9 209 21.5

5+ 466 59.3 110 59.1 576 59.3

Total 786 100.0 186 100.0 972 100.0

The proportion of IHS participants who reported having received

no phone calls or letters from family and/or friends during the two

weeks preceding the Survey remained steady at 15% between

1996 and 2001, then decreased to 11% in 2009 (Table 1.9.4).

Consistent with the findings on visits from family and friends

reported above, in all Survey years, women were more likely than

men to report receiving at least one phone call or letter during

that period. Once again, these results may indicate that women

may be more likely than men to maintain during incarceration

family and social networks to which they can return post-release.

Table/Fig 1.9.4 No phone calls or letters from family

and/or friends in the previous two weeks

0

5

10

15

20

9.4

10.7

7.0

16.4 15.7

11.8

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 101 614 16.4 110 700 15.7 93 786 11.8

Women 11 117 9.4 16 150 10.7 13 186 7.0

Total 112 731 15.3 126 850 14.8 106 972 10.9

1. Social determinants

2009 NSW Inmate Health Survey: Key Findings Report 41

2. Offending behaviour

2.1 Juvenile detention

Juvenile detention is a strong predictor of continuing

involvement in both the juvenile and adult criminal justice

systems. Detaining a child diminishes their chances of

becoming a productive citizen and increases the likelihood of

future incarceration. Incarceration exposes children to violence

and negative peer influence and limits opportunities for them

to return to their communities. In particular, the majority of

young people released from detention face serious obstacles

in re-enrolling in school and finding employment (Faruquee,

2002). Crime is committed disproportionately by 15-25 year

olds, peaking between the ages of 15 and 18 and declining

by the late 20s. A study of 33,900 young offenders in NSW

showed that the average age of first criminal appearance was

16, with 70% appearing only once before the Children’s Court

(Coumarelos, 1994). Boys are about seven times more likely to

be charged for offending than girls.

Among 2009 IHS participants, 38% reported a history of

juvenile detention (Table 2.1.1), with substantially more men

than women reporting such a history (42% versus 22%).

These results are consistent with the histories reported by the

2001 IHS sample; juvenile detention history was not examined

in the 1996 IHS.

Table/Fig 2.1.1 Ever been in juvenile detention

0

10

20

30

40

50

25.9

21.6

40.7 42.0

2001 2009

Men Women

PERCENT

YEAR

2001 2009

n Total % n Total %

Men 279 686 40.7 335 797 42.0

Women 37 143 25.9 43 199 21.6

Total 316 829 38.1 378 996 38.0

Similar proportions of 2009 IHS participants reported having been

detained in juvenile detention on one occasion (13%) and on five

or more occasions (13%) (Table 2.1.2). Women were more likely

than men to report fewer occasions of detainment in a juvenile

detention facility; just 8% of women reported having been in

juvenile detention on three or more occasions, compared to 22%

of men. Twenty four percent of women with a history of juvenile

detention were aged 12 years or younger at their first detention

episode, compared with 17% of men. There was, however, no

difference in the mean age at which men (14.2 years; SD 2.0;

range 7-17) and women (14.3 years; SD 1.9; range 10-17) were

first detained in a juvenile detention facility.

Table 2.1.2 Number of times in juvenile detention

Men Women Total

n % n % n %

0 462 58.0 156 78.4 618 62.0

1 110 13.8 20 10.1 130 13.1

2 53 6.6 7 3.5 60 6.0

3 - 4 58 7.3 4 2.0 62 6.2

5+ 114 14.3 12 6.0 126 12.7

Total 797 100.0 199 100.0 996 100.0

Among all 2009 IHS participants with a juvenile detention

history, the most serious offence which led to their first juvenile

detention episode was robbery (52% of men, 37% of women),

followed by assault (Table 2.1.3). Other offences included

property crimes, driving offences and breaches of court orders.

Table 2.1.3 Most serious offence leading to first time

in juvenile detention (if ever in juvenile

detention)

Men Women Total

n % n % n %

Robbery 174 51.9 16 37.2 190 50.3

Assault 60 17.9 7 16.3 67 17.7

Property 24 7.2 3 7.0 27 7.1

Driving 19 5.7 0 0.0 19 5.0

Order breaches 10 3.0 0 0.0 10 2.6

Sexual offences 7 2.1 0 0.0 7 1.9

Homicide 5 1.5 2 4.7 7 1.9

Drugs 3 0.9 2 4.7 5 1.3

Other 33 9.9 12 27.9 45 11.9

Total 335 100.0 43 100.0 378 100.0

2. Offending behaviour

42 2009 NSW Inmate Health Survey: Key Findings Report

2.2 Previous incarceration

Sixty percent of 2009 IHS participants (64% of men and 46% of

women) reported that they had been previously incarcerated, a

lower proportion than the total inmate population as indicated

by the records held by CSNSW. According to the NSW Inmate

Census 2008 (Corben, 2009), 68% of inmates held in full-time

custody by CSNSW on June 30, 2008, had a history of prior

adult imprisonment (including remand). For the purposes of the

Census, full-time custody inmates include those held in gazetted

correctional centres, transitional centres and police/court

complexes in NSW. In the 2001 and 2009 IHSs, the proportion

of participants reporting previous imprisonment was the same

(60%), following a decline from 66% in 1996 (Table 2.2.1).

The decline in the proportion of IHS participants with histories

of previous imprisonment has been more substantial among

women, falling from 63% in 1996 to 55% in 2001 and again to

46% in 2009.

Table/Fig 2.2.1 Previous adult incarceration

0

10

20

30

40

50

60

70

80

62.9

55.2

45.7

66.2

61.4 64.0

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 406 613 66.2 436 710 61.4 510 797 64.0

Women 73 116 62.9 85 154 55.2 91 199 45.7

Total 479 729 65.7 521 864 60.3 601 996 60.3

The majority of men (67%) and almost half of women (48%)

reported having been first imprisoned between the ages of 18

and 24 years (Table 2.2.2); together, this group accounted for

64% of the total 2009 IHS sample. Just over 5% of participants

indicated they were under age 18 when they were first

imprisoned, which suggests they were in juvenile detention.

Table 2.2.2 Age of first imprisonment

Men Women Total

n % n % n %

< 18 years 46 5.8 5 2.5 51 5.1

18 - 19 years 344 43.2 40 20.1 384 38.6

20 - 24 years 193 24.2 55 27.6 248 24.9

25 - 29 years 45 5.6 19 9.5 64 6.4

30 - 39 years 67 8.4 30 15.1 97 9.7

40 - 49 years 61 7.7 34 17.1 95 9.5

50+ years 41 5.1 16 8.0 57 5.7

Total 797 100.0 199 100.0 996 100.0

A higher proportion of women (40%) than men (21%)

reported having been first imprisoned at the age of 30 years

or older; together, this group accounted for 25% of the

overall sample. Although a male participant reported the

oldest age of first imprisonment (82 years), women had, on

average, been first imprisoned at an older age than men

(around 30 years versus 25 years; Table 2.2.3).

Table 2.2.3 Age of first imprisonment characteristics

Men Women Total

N 797 199 996

Mean (± sd) 24.8 (± 10.9) 29.6 (± 11.9) 25.7 (± 11.3)

Median 19.7 24.0 20.0

Range 13 - 82 15 - 64 13 - 82

Thirty-six percent of men and 54% of women were in adult

prison for the first time. Around one-fifth of IHS participants

were currently serving their second custodial sentence

(Table 2.2.4); and 3% had been imprisoned more than 10

times. Ninety two percent of women had been imprisoned on

five or fewer occasions, compared with 83% of men.

2. Offending behaviour

2009 NSW Inmate Health Survey: Key Findings Report 43

Table 2.2.4 Number of previous incarcerations

Men Women Total

n % n % n %

1 287 36.0 108 54.3 395 39.7

2 173 21.7 42 21.1 215 21.6

3 - 5 203 25.5 33 16.6 236 23.7

6 - 10 109 13.7 12 6.0 121 12.1

11+ 25 3.1 4 2.0 29 2.9

Total 797 100.0 199 100.0 996 100.0

The proportion of IHS samples reporting a history of three

or more incarcerations in adult prison (including the current

episode) decreased from 48% in 1996 to 45% in 2001,

and again to 39% in 2009 (Table 2.2.5). The decline in

the proportion of women with a history of three or more

incarcerations (from 44% in 1996 to 43% in 2001 and

25% in 2009) has been far greater than the decline in the

proportion of men reporting such a history (from 48% in

1996 to 45% in 2001 to 42% in 2009).

Table/Fig 2.2.5 History of three or more incarcerations

0

11

22

33

44

55

44.0 42.9

24.6

48.1

45.2

42.3

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

3 or

more

times Total %

3 or

more

times Total %

3 or

more

times Total %

Men 295 613 48.1 321 710 45.2 337 797 42.3

Women 51 116 44.0 66 154 42.9 49 199 24.6

Total 346 729 47.5 387 864 44.8 386 996 38.8

Participants were asked to estimate how much time they had

spent in adult prisons throughout their lifetime. Twenty nine

percent estimated that they had been in prison for a total of

less than one year, and a further 40% estimated their total

time in prison at between one and five years (Table 2.2.6).

Thirty percent reported having been in prison for more than

five years, of whom half (15% of the total sample) reported a

total of more than 10 years’ imprisonment. On average, men

reported having spent more time in prison than women; and

were more than twice as likely to have been imprisoned for a

total of more than five years (34% versus 16%).

Table 2.2.6 Total time spent in adult prisons (lifetime)

Men Women Total

n % n % n %

> 6 months 118 14.8 61 30.7 179 18.0

6 months - < 1 year 81 10.2 31 15.6 112 11.2

1 - < 2 years 132 16.6 40 20.1 172 17.3

2 - < 5 years 195 24.5 36 18.1 231 23.2

5 - < 10 years 130 16.3 24 12.1 154 15.5

10+ years 141 17.7 7 3.5 148 14.9

Total 797 100.0 199 100.0 996 100.0

Although the proportion of IHS participants reporting a

history of three or more incarcerations decreased between

1996 and 2009, this was not accompanied by a decrease in

the proportion of participants having spent a total of five

or more years in prison. In fact, the opposite pattern was

observed: the overall proportion of IHS samples reporting

having spent a total of five or more years in adult prisons

increased from 10% in 1996 to 21% in 2001 to 30% in

2009 (Table 2.2.7). This substantial increase was reflected

among both men and women, with the proportion of men

with a history of five or more years of imprisonment rising

from 12% in 1996 to 23% in 2001 to 34% in 2009; and

the proportion of women with such a history increasing

from 4% in 1996 to 12% in 2001 to 16% in 2009.

2. Offending behaviour

44 2009 NSW Inmate Health Survey: Key Findings Report

Table/Fig 2.2.7 Spent five or more years incarcerated

during lifetime

0

5

10

15

20

25

30

35

40

45

3.8

12.0

15.6

11.7

22.6

34.0

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 77 657 11.7 169 747 22.6 271 797 34.0

Women 5 132 3.8 20 167 12.0 31 199 15.6

Total 82 789 10.4 189 914 20.7 302 996 30.3

2.3 Current incarceration

Over one quarter of men (26%) and nearly a third of

women (32%) indicated they were currently on remand.

This means that they had been charged with an offence

but the court had not reached a final verdict resulting in a

sentence or being deemed ‘not guilty.’ The proportion of

men on remand increased from 17% in 2001 to 26% in

2009, while the proportion of women on remand decreased

from 53% in 2001 to 32% in 2009 (Table 2.3.1).

Table/Fig 2.3.1 Currently on remand

0

10

20

30

40

50

60

53.3

32.2

16.6

26.3

2001 2009

Men Women

PERCENT

YEAR

2001 2009

n Total % n Total %

Men 124 747 16.6 210 797 26.3

Women 89 167 53.3 64 199 32.2

Total 213 914 23.3 274 996 27.5

Close to one quarter (24%) of 2009 IHS participants reported

having served less than three months during their current

incarceration (Table 2.3.2); and a total of 58% of participants

reported having been in prison during their current episode for

less than twelve months (56% of men and 70% of women).

Around one third (32%) of participants reported having served

between one and five years during their current imprisonment.

Compared to women, men were more likely to report that they

had served more than five years during their current sentence

(11% versus 5%). Among the 274 participants currently on

remand, 27% had been in prison for six months or longer.

2. Offending behaviour

2009 NSW Inmate Health Survey: Key Findings Report 45

Table 2.3.2 Amount of time served (current

incarceration) at time of interview

Men Women Total

n % n % n %

<3 months 181 22.7 53 26.6 234 23.5

3 - <6 months 132 16.6 49 24.6 181 18.2

6 - <12 months 129 16.2 37 18.6 166 16.7

1 - <2 years 124 15.6 27 13.6 151 15.2

2 - <5 years 141 17.7 24 12.1 165 16.6

5 - <10 years 60 7.5 7 3.5 67 6.7

10+ years 30 3.8 2 1.0 32 3.2

Total 797 100.0 199 100.0 996 100.0

Among sentenced inmates, sentence lengths were calculated

from administrative data provided by CSNSW by subtracting

the date of admission to prison from the sentence expiry date

(Table 2.3.3). Although approximately equivalent proportions of

men and women had sentences of between one and less than

10 years (69% versus 71%), a higher proportion of women

than men had been sentenced to periods of incarceration

of less than twelve months (20% versus 12%); and a higher

proportion of men than women had been sentenced to periods

of incarceration of 10 years or more (19% versus 10%).

Table 2.3.3 Sentence length for current incarceration

Men Women Total

n % n % n %

< 6 months 11 1.9 6 4.8 17 2.4

6 - <12 months 58 10.1 19 15.1 77 11.0

1 - <2 years 118 20.6 27 21.4 145 20.8

2 - <5 years 165 28.9 32 25.4 197 28.2

5 - <10 years 113 19.8 30 23.8 143 20.5

10+ years 106 18.6 12 9.5 118 17.0

Total 571 100.0 126 100.0 697 100.0

* Note: excluded if on remand; Sentence expiry data was not available for

25 inmates.

On average, men had been sentenced to longer periods of

incarceration than women (Table 2.3.4). This was reflected in

both the mean (6.1 years for men compared to 4.4 years for

women) and the median sentence length (4.0 years for men

and 2.7 years for women).

Table 2.3.4 Sentence length for current incarceration

characteristics

Men Women Total

N 571 126 697

Mean (± sd) 6.1 (± 6.4) 4.4 (± 5.0) 5.8 (± 6.2)

Median 4.0 2.7 3.7

Range 0.2 – 37.1 0.2 – 36.0 0.2 – 37.1

The most serious offence for which IHS participants were currently

incarcerated was derived from administrative data provided by

CSNSW, based on the Australian Standard Offence Classification

(ASOC) (ABS, 1997). Although an inmate may be held by

CSNSW for a number of different offences, these data refer to

only the characteristics of the most serious of all offences in the

current imprisonment episode if the inmate has been sentenced.

Generally, the most serious offence is selected as the offence for

which the longest sentence was imposed for a single count of the

offence, regardless of the possible result of any appeals.

Among IHS participants who had been sentenced, the most

common class of most serious offences were assault, followed

by robbery; break, enter and steal offences; and drug offences

(Table 2.3.5). Homicide was the most serious offence among 10%

of sentenced IHS participants. There were clear gender differences

in some offences, with men more likely to have been sentenced

for assault, robbery and sexual offences, and women more likely

to have been sentenced for break, enter and steal offences, and

for drug offences. Twenty-one sentenced participants did not

have a most serious offence recorded by CSNSW.

Table 2.3.5 Convicted most serious offence (if sentenced)

Men Women Total

n % n % n %

Assault 119 20.7 15 11.8 134 19.1

Robbery 114 19.9 11 8.7 125 17.8

Break, enter &

steal 59 10.3 26 20.5 85 12.1

Drugs 52 9.1 25 19.7 77 11.0

Homicide 56 9.8 12 9.5 68 9.7

Driving 47 8.2 12 9.5 59 8.4

Sexual 50 8.7 3 2.4 53 7.6

Order breaches 30 5.2 11 8.7 41 5.8

Other 47 8.2 12 9.5 59 8.4

Total 574 100.0 127 100.0 701 100.0

2. Offending behaviour

46 2009 NSW Inmate Health Survey: Key Findings Report

For inmates where no sentence had been imposed at the

time of participation in the IHS (i.e., those on remand orders),

the most serious offence is that with which they have been

charged, although it should be remembered that they are yet

to be found guilty and sentenced. Reflecting similar patterns

to the offence classifications of sentenced inmates, among IHS

participants who were on remand, the most common class

of most serious offences were assault, followed by robbery;

break, enter and steal offences; and drug offences (Table 2.3.6).

Homicide was the most serious offence among 2% of men

and 5% of women on remand. Similar gender differences to

sentenced inmates were evident, with men more likely to have

been charged with assault, robbery and sexual offences, and

women more likely to have been charged with break, enter and

steal offences, and for drug offences.

Table 2.3.6 Charged most serious offence charged (if

on remand)

Men Women Total

n % n % n %

Assault 47 22.4 8 12.5 55 20.1

Robbery 42 20.0 7 10.9 49 17.9

Break, enter &

steal 20 9.5 13 20.3 33 12.0

Drugs 18 8.6 14 21.9 32 11.7

Order breaches 19 9.1 1 1.6 20 7.3

Driving 8 3.8 5 7.8 13 4.7

Sexual 10 4.8 2 3.1 12 4.4

Homicide 4 1.9 3 4.7 7 2.6

Other 42 20.0 11 17.2 53 19.3

Total 210 100.0 64 100.0 274 100.0

Based on administrative data provided by CSNSW, 2009 IHS

participants were assigned a security classification current

at the time of their participation in the Survey. Close to

two thirds of men (63%) and almost all women (98%)

were assigned a minimum security classification; while

21% of men and 2% of women were assigned a medium

security classification (Table 2.3.7). Sixteen percent of

men, and no women, were assigned a maximum security

classification. These figures broadly reflect the overall

security classifications of the NSW inmate population. The

NSW Inmate Census 2008 (Corben, 2009) indicates that

19% of men and 0.3% of women inmates are subjected to

a maximum security classification. Twenty three percent of

men and 17% of women are classified as medium security;

while 51% of men and 80% of women are classified as

minimum security. Note that classification was not available

for 70 participants.

Table 2.3.7 Security classification

Men Women Total

n % n % n %

Maximum 118 16.1 0 0.0 118 12.7

Medium 155 21.2 3 1.6 158 17.1

Minimum 459 62.7 191 98.4 650 70.2

Total 732 100.0 194 100.0 926 100.0

At the time of the interview, 39% of 2009 IHS participants

reported having their own cell, with a substantially higher

proportion of women (56%) than men (35%) reporting having

a private cell (Table 2.3.8). The proportion of men with their

own cell declined steadily, from 60% in 1996 to 48% in 2001

to 35% in 2009. Among women, the decline from 77% in

1996 to 49% in 2001 was followed by an increase to 56% in

2009. Overall, the proportion of IHS samples with their own

cell decreased in recent years, from 62% in 1996 to 48% in

2001 and again to 39% in 2009.

Table/Fig 2.3.8 Have own cell (current incarceration)

0

10

20

30

40

50

60

70

80

90

76.7

49.0

59.5 56.3

47.5

35.0

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 342 575 59.5 318 670 47.5 279 797 35.0

Women 89 116 76.7 73 149 49.0 112 199 56.3

Total 431 691 62.4 391 819 47.7 391 996 39.3

2. Offending behaviour

2009 NSW Inmate Health Survey: Key Findings Report 47

Overall, the proportion of IHS samples who reported sharing

their cell with two or more people remained relatively low and

stable between 1996 and 2009 (Table 2.3.9), increasing from 6%

to 7% during that period. The increase occurred primarily among

women rather than men, however. The proportion of women

who reported sharing a cell with two or more people, more than

doubled from 3% in 1996 to 6% in 2001 to 8% in 2009.

Table/Fig 2.3.9 Sharing cell with two or more people

0

1

2

3

4

5

6

7

8

9

10

3.4

6.0

8.0

6.3

5.5

6.4

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 36 575 6.3 37 670 5.5 51 797 6.4

Women 4 116 3.4 9 149 6.0 16 199 8.0

Total 40 691 5.8 46 819 5.6 67 996 6.7

Some comments from participants on offending and release:

• ‘If spend less time on trying to punish people and more time on

rehabilitation and educating people, there would be less re-offenders.

Because they can’t read and write their options are limited.’

• ‘Worrying about having no money when I leave gaol and how to

get the medical and dental care and psychologist care that will

need with no money to pay for anything.’

• ‘I’m innocent and they should let me out.’

2. Offending behaviour

48 2009 NSW Inmate Health Survey: Key Findings Report

3. Health status

3.1 Self-reported health status/SF-12

IHS participants were asked whether a doctor had ever told

them they had any of the conditions listed in Table 3.1.1;

there was no limit to the number of conditions participants

could report. Infection with hepatitis B (HBV) and C (HCV)

viruses were included in the list of conditions provided to

participants, but results are not reported here due to the

consistent finding that self-reports of these infections lack

sufficient validity to be considered useful (see, for example,

Best et al., 1999; Hagan et al., 2006; Stein et al., 2007;

Topp et al., 2009).

Women were more likely than men to report at least one of

the conditions listed for participants (92% of women versus

81% of men). These figures are somewhat higher than the

75% of Australia’s general population who reported in the

2007‑08 National Health Survey (ABS, 2009) having one or

more current long term medical conditions, although because

the questions asked in the National Health Survey and the

IHS are not exactly the same, these data are indicative rather

than directly comparable. The NHSs are serial cross-sectional

surveys conducted by the Australian Bureau of Statistics (ABS)

which assess the health of Australia’s general population. The

National Health Survey 2007-2008 included approximately

20,800 respondents.

The most prevalent conditions reported by women were

poor eyesight (41%), asthma (40%) and back problems

(34%). The same three conditions were also the most

prevalent among men, but were reported by smaller

proportions (poor eyesight 33%; asthma 26%; back

problems 25%). Hypertension (16%) and arthritis (15%)

were also reported by more than one in ten participants.

These results appear to reflect the health of Australian

society more broadly, though the proportion of inmates

with each health condition was higher than found in the

community. The National Health Survey 2007‑08 found that

the most commonly reported long-term condition among

Australia’s general population was poor eyesight (52%),

followed by arthritis (15%), back problems (14%), asthma

(10%) and hypertensive disease (9%).

Among 52 participants who reported that a doctor had told

them they had epilepsy or seizures (5% of the sample), five

women (56%) and 16 men (37%) reported that their last

episode of seizures occurred while they were withdrawing

from drugs and/or alcohol. Among participants who reported

that they had been told they had diabetes (4%), six men

(14%) and two women (22%) reported that they took insulin

for their diabetes. The prevalence of self-reported diabetes

among the 2009 IHS sample is equivalent to that reported

in the National Health Survey 2007-08 (4% of the general

population; 5% of men and 3% of women) (ABS, 2009).

Just 43 (4%) participants indicated they had ever been told

they had cancer, with a higher proportion of women than men

reporting this to be the case (9% versus 3%). The most common

form of cancer mentioned by participants was skin cancer; a

small number of women also mentioned cervical cancer.

Table 3.1.1 Ever told by a doctor had any of the

following physical health conditions

(Multiple response)

Men Women Total

n % n % n %

Poor eyesight 263 33.0 82 41.4 345 34.7

Asthma 210 26.3 80 40.4 290 29.1

Back problems 197 24.7 67 33.8 264 26.5

Hypertension 122 15.3 35 17.7 157 15.8

Arthritis 107 13.4 37 18.7 144 14.5

Chest / Angina pain 82 10.3 17 8.6 99 9.9

Haemorrhoids 69 8.7 23 11.6 92 9.2

Palpitations / Rapid

heartbeat 66 8.3 23 11.6 89 8.9

Kidney problems 43 5.4 26 13.1 69 6.9

Other heart conditions 50 6.3 14 7.1 64 6.4

Heart Murmur 43 5.4 19 9.6 62 6.2

Epilepsy / Seizures 43 5.4 9 4.5 52 5.2

Diabetes 34 4.3 9 4.5 43 4.3

Cancers / tumours 25 3.1 18 9.1 43 4.3

Gall stones 21 2.6 25 12.6 46 4.6

Peptic ulcers 40 5.0 5 2.5 45 4.5

Hepatitis A 21 2.6 5 2.5 26 2.6

Prostate problems 22 2.8 – – – –

Other condition 282 35.4 85 42.9 367 36.9

No condition 148 18.6 17 8.5 165 16.6

3. Health status

2009 NSW Inmate Health Survey: Key Findings Report 49

One quarter (24%) of women, and 19% of men, reported that

a doctor had told them they had a heart problem (Table 3.1.2),

which included chest or angina pain, heart murmurs, and/or

palpitations or rapid heartbeat. This prevalence estimate of

20% of the total 2009 sample continues the increase in the

proportion of earlier IHS samples who reported having a heart

problem, which rose from 16% in 1996 to 19% in 2001.

Table/Fig 3.1.2 Ever told by a doctor had a heart

problem

0

5

10

15

20

25

30

24.8 24.3 24.1

13.8

18.1 18.8

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 85 615 13.8 127 702 18.1 150 797 18.8

Women 29 117 24.8 37 152 24.3 48 199 24.1

Total 114 732 15.6 164 854 19.2 198 996 19.9

The majority of both men (58%) and women (73%)

reported multiple health problems, including 26% of men

and 38% of women who reported four or more conditions

(Table 3.1.3). Over a third (37%) of participants specified

another health condition separate to the list of conditions

provided. The most common other conditions reported were

mental health problems; these are not reported here nor

considered in calculations of the number of self-reported

physical health conditions. Mental health problems are

instead discussed in section 6.

Table 3.1.3 Number of self-reported health conditions

Men Women Total

n % n % n %

0 148 18.6 17 8.5 165 16.6

1 190 23.8 36 18.1 226 22.7

2 145 18.2 36 18.1 181 18.2

3 105 13.2 35 17.6 140 14.1

4+ 209 26.2 75 37.7 284 28.5

Total 797 100.0 199 100.0 996 100.0

Perceived health status (SF-12)

Perceived health status was measured using the Short-Form 12

Health Survey (SF-12), a widely used, psychometrically validated,

generic measure of health status that incorporates measures of

well-being and role functioning and generates summary scores

for both physical and mental health (Ware et al., 1996). It can

be considered as a measure of disability because it addresses

limitations due to physical and mental health. The SF-12 is

derived from the SF-36, a 36-item ‘parent’ health questionnaire.

Eight scale scores are generated from responses to SF-36 items:

(1) physical functioning; (2) role limitations due to physical health

problems; (3) bodily pain; (4) social functioning; (5) general mental

health (psychological distress and psychological well-being);

(6) role limitations due to emotional problems; (7) vitality (energy

and fatigue); and (8) general health perceptions. The SF‑36 can

also be divided into two aggregate summary measures, the

Physical Component Summary (PCS) and the Mental Component

Summary (MCS). The SF-12 includes 12 questions from the SF-36,

including at least one item from each of the eight scales, and is

designed to allow calculation of the PCS and MCS scores of the

SF-36 using only one third of the items. Thus, the SF-12 is an

appropriate substitute for the SF-36 when the summary scales

are of interest but a briefer instrument is required (Sanderson &

Andrews, 2002).

SF-12 items refer to the four weeks preceding administration

of the questionnaire. The PCS and MCS are scored using

norm-based methods derived from surveys of the US general

population. Both scales are transformed to have a mean of

50 and a standard deviation of 10. A lower score on either

scale indicates a greater degree of disability; conversely, higher

scores indicate better health. In norm-based scoring the general

population norm is built into the scoring algorithm. Therefore, all

scores above or below 50 can be interpreted as above or below

the general population norm (US 1998 general population norm).

3. Health status

50 2009 NSW Inmate Health Survey: Key Findings Report

Across 1996 to 2009, the mean PCS score was slightly above

the 50% mark for male IHS participants, suggesting the male

prisoner population in NSW demonstrated a slightly better

physical component summary than the corresponding norm

in the general population (Table 3.1.4). Women recorded

a slightly lower average score but still on par with the

community norm of 50%.

Table/Fig 3.1.4 SF-12 Physical Component Summary

score characteristics

0

10

20

30

40

50

60

70

49.1 51.0 49.5

52.9 53.2 51.9

1996 2001 2009

Men Women

MEAN

YEAR

1996 2001 2009

n Mean (± sd) n Mean (± sd) n Mean (± sd)

Men 610 52.9 (±9.9) 670 53.2 (± 9.4) 794 51.9 (±10.0)

Women 115 49.1 (±11.7) 142 51.0 (±11.0) 198 49.5 (±11.5)

Total 725 52.3 (±10.3) 812 52.8 (±9.7) 992 51.4 (±10.4)

The mental health of IHS participants was substantially less

than the community norm score of 50, reflective of their

worse mental health (Table 3.1.5). However, for both men and

women there was a substantial and significant increase in the

mean mental component summary from 1996 to 2009. The

improvement in women (27% in 1996 to 38% in 2009) was

not as pronounced as found among men (28% in 1996 to

44% in 2009).

Table/Fig 3.1.5 SF-12 Mental Component Summary

score characteristics

0

10

20

30

40

50

60

38.4 37.8 37.7

45.8 43.9 44.4

1996 2001 2009

Men Women

MEAN

YEAR

1996 2001 2009

n Mean (± sd) n Mean (± sd) n Mean (± sd)

Men 610 45.8 (±13.1) 670 43.9 (±12.8) 794 44.4 (±14.5)

Women 115 38.4 (±13.1) 142 37.8 (±12.9) 198 37.7 (±15.4)

Total 725 44.7 (±13.4) 812 42.9 (±13.0) 992 43.1 (±14.9)

The first item of the SF-12 asks respondents to rate their

health “in general” on a five-point scale ranging from

poor to excellent. Fewer than one in ten (9%) 2009 IHS

participants perceived their own health as excellent,

although a further 24% described their health as very good

(Table 3.1.6). Women were less likely than men to rate their

health as excellent or very good (23% versus 35%), and

were more likely to describe it as fair or poor (33% versus

23%), although similar proportions of women and men

described their health as good (43% versus 42%).

Table 3.1.6 Self-rated general health status

Men Women Total

n % n % n %

Excellent 73 9.2 12 6.1 85 8.6

Very good 203 25.5 34 17.2 237 23.9

Good 334 42.0 86 43.4 420 42.3

Fair 142 17.9 48 24.2 190 19.1

Poor 43 5.4 18 9.1 61 6.1

Total 795 100.0 198 100.0 993 100.0

3. Health status

2009 NSW Inmate Health Survey: Key Findings Report 51

The same general health rating question was included in the

National Health Survey 2007-2008 (ABS, 2009). Comparison

of these general population results with those of the IHS

clearly demonstrates that inmates rate their health much

less positively. The National Health Survey demonstrated

that 56% of Australians aged 15 years and over considered

their overall health to be very good or excellent (compared

with 33% of IHS participants). A further 29% stated

that their health was good (compared with 42% of IHS

participants), whereas 15% of people aged 15 years or more

rated their health as fair or poor (compared with 25% of

IHS participants). Nevertheless, the proportion of 2009 IHS

participants who rated their health as fair or poor decreased

slightly (25%) in 2009 compared with 30% among both the

1996 and 2001 IHS samples (Table 3.1.7).

Table/Fig 3.1.7 Fair/poor self-rated health

0

5

10

15

20

25

30

35

40

45

39.7

37.3

33.3

28.0 28.1

23.3

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 173 617 28.0 196 697 28.1 185 795 23.3

Women 46 116 39.7 56 150 37.3 66 198 33.3

Total 219 733 29.9 252 847 29.8 251 993 25.3

3.2 Disability and illness

Almost half (47%) of 2009 IHS participants reported that they

currently suffered from an illness or disability that had troubled

them for six months or more (Table 3.2.1). This prevalence

estimate represents a continued increase in the proportion of

earlier IHS samples reporting such an illness or disability, which

rose from 34% in 1996, to 41% in 2001. It is also considerably

higher than the 36% of Australia’s general population who

reported a disability or long term restrictive condition in the

2007-08 National Health Survey (ABS, 2009), although once

again, the questions asked in the National Health Survey and

the IHS are not exactly the same, so these data are indicative

rather than directly comparable to the present results.

Table/Fig 3.2.1 Current disability or illness that had

troubled you for six months or more

0

10

20

30

40

50

60

70

44.4

36.2

53.5

32.3

41.5

45.8

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 196 607 32.3 295 710 41.5 365 797 45.8

Women 52 117 44.4 55 152 36.2 106 198 53.5

Total 248 724 34.3 350 862 40.6 471 995 47.3

Women were more likely than men to report at least one such

chronic illness or disability (54% versus 46%). Women were

also more likely to report that they suffered from two or more

such illnesses or disabilities (22% versus 12%) (Table 3.2.2).

Some examples of the disabilities mentioned included:

• ‘Teeth problems. Waiting two and a half years to have my teeth out.’

• ‘Residual symptoms of drug induced psychosis. I hear voices.’

3. Health status

52 2009 NSW Inmate Health Survey: Key Findings Report

Table 3.2.2 Number of current disabilities or illnesses

Men Women Total

n % n % n %

0 432 54.2 92 46.5 524 52.7

1 271 34.0 63 31.8 334 33.6

2 64 8.0 28 14.1 92 9.2

3+ 30 3.8 15 7.6 45 4.5

Total 797 100.0 198 100.0 995 100.0

IHS participants were asked in open-ended questions to nominate

up to three illnesses or disabilities that had troubled them for six

months or more. The myriad responses received were categorised

into overarching classes (Table 3.2.3). The most common class of

disabilities among all participants was musculoskeletal problems,

followed by psychological problems, which were endorsed by a

substantially higher proportion of women than men (17% versus

8%) but were nevertheless the second most common class of

disability among both genders. Neurological, respiratory and

cardiovascular conditions were the next most common classes of

conditions causing disability among both men and women.

Table 3.2.3 Type of current disabilities or illnesses

(Multiple response)

Men Women Total

n % n % n %

No illness / disability 432 54.2 92 46.2 524 52.6

Musculoskeletal 176 22.1 48 24.1 224 22.5

Psychological 64 8.0 34 17.1 98 9.8

Neurological 47 5.9 14 7.0 61 6.1

Respiratory 40 5.0 10 5.0 50 5.0

Digestive 28 3.5 10 5.0 38 3.8

Cardiovascular 24 3.0 9 4.5 33 3.3

Eye 16 2.0 3 1.5 19 1.9

General (not specified) 15 1.9 3 1.5 18 1.8

Skin 10 1.3 3 1.5 13 1.3

Ear 10 1.3 2 1.0 12 1.2

Reproductive system 9 1.1 3 1.5 12 1.2

Endocrine 4 0.5 5 2.5 9 0.9

Urinary tract 7 0.9 1 0.5 8 0.8

Other 17 2.1 4 2.0 21 2.1

For all chronic conditions or disabilities thus reported, 2009

IHS participants were asked to describe the way in which the

condition(s) limited their activities, and could nominate more

than one type of disability. Responses ranged broadly, including

29 participants who reported at least one chronic condition or

disability but found that this did not limit their activities in any

way. The most common type of disability caused by chronic

illness or conditions was pain, reported by 32% of women

and 27% of men. Restriction of movement, reduced physical

activity, problems lifting, fatigue and lethargy, being unable to

work and poor concentration were all relatively common types

of disabilities caused by chronic conditions or illnesses, and

all were reported by higher proportions of women than men

(Table 3.2.4). The biggest gender differences reported in the

type of disability caused by chronic conditions or illnesses were

in psychological problems, reported by 23% of women and

10% of men, and a reduction or cessation of social activities,

reported by 21% of women and 7% of men.

Table 3.2.4 Limiting problem caused by disabilities or

illnesses

(Multiple response)

Men Women Total

n % n % n %

No illness / disability 432 54.2 92 46.5 524 52.7

Pain 214 26.9 63 31.8 277 27.8

Restricts movement 144 18.1 46 23.2 190 19.1

Physical activity 105 13.2 37 18.7 142 14.3

Problems lifting 98 12.3 33 16.7 131 13.2

Psychological problems 83 10.4 46 23.2 129 13.0

Fatigue/lethargy 68 8.5 31 15.7 99 9.9

Stops socialising 57 7.2 41 20.7 98 9.8

Unable to work 54 6.8 27 13.6 81 8.1

Poor concentration 55 6.9 22 11.1 77 7.7

Problems walking 45 5.6 30 15.2 75 7.5

Breathlessness 46 5.8 13 6.6 59 5.9

Problems eating 27 3.4 17 8.6 44 4.4

Vision and hearing 33 4.1 8 4.0 41 4.1

Dizziness 21 2.6 13 6.6 34 3.4

Problems sleeping 22 2.8 9 4.5 31 3.1

Problems reading and

writing 20 2.5 7 3.5 27 2.7

Problems going to the toilet 14 1.8 9 4.5 23 2.3

Other 72 9.0 35 17.7 107 10.8

Not limiting 23 2.9 6 3.0 29 2.9

3. Health status

2009 NSW Inmate Health Survey: Key Findings Report 53

Some examples of the how disability limits participants:

• ‘I can’t sleep for the pain. It restricts my work.’

• ‘I can’t play with my kids.’

For all disabilities/illnesses reported, participants were asked

whether they had cut down any activities in the preceding two

weeks as a result of that disability (Table 3.2.5). Of participants

who identified a persistent illness or disability, just under half

(46%) indicated they had cut down activities in the past two

weeks because of their health problem(s). A higher proportion

of women (52%) than men (44%) had cut down on activities.

Table 3.2.5 Cut down activities in past two weeks as a

result of disabilities or illnesses

Men Women Total

n % n % n %

Yes, cut down 160 43.8 56 52.3 216 45.8

Not cut down 205 56.2 51 47.7 256 54.2

Total 365 100.0 107 100.0 472 100.0

3.3 Medications

Close to three quarters (71%) of the 2009 IHS sample reported

having taken medications prescribed for them in the preceding

two weeks (Table 3.3.1). This proportion represented a slight

increase compared to the 1996 (67%) and 2001 (68%) Surveys.

Note that ‘prescribed medications’ in this context does not

necessarily refer to scheduled medications, as all medications

received in prison, scheduled or otherwise, must be prescribed

by a doctor; inmates must attend the prison health centres to

access medications taken for granted in the community. Thus,

at least some proportion of the figures in Table 3.3.1 would be

accounted for by over-the-counter medication.

Across all three IHSs, women were more likely than men to report

that they had taken prescribed medications in the preceding two

weeks, with the differential between the two genders becoming

more pronounced over time. In 1996, 72% of women had taken

prescribed medications in the preceding two weeks, compared to

66% of men, but by 2009, the corresponding proportions were

86% of women and 67% of men.

Table/Fig 3.3.1 Taken medications prescribed for you in

the past two weeks

0

20

40

60

80

100

72.0

80.8

85.9

66.2 64.7 67.1

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 435 657 66.2 483 747 64.7 535 797 67.1

Women 95 132 72.0 135 167 80.8 170 198 85.9

Total 530 789 67.2 618 914 67.6 705 995 70.9

Participants in the 2009 IHS were provided with a list of

medications and asked which they had been prescribed in

the preceding two weeks, with no limit to the number they

could report having been prescribed and taken. The most

commonly mentioned prescribed medication taken was

analgesics (pain-killer/headache tablets), which had been

taken by 37% of the 2009 IHS sample (54% of women and

33% of men), followed by methadone (11% of men, 32%

of women), skin ointments (13% of men, 18% of women)

and asthma medications (11% of men and 22% of women).

Women were more likely than men to report having taken

all of the most common medications in the preceding two

weeks (Table 3.3.2), and were also substantially more likely

to report having taken vitamins (19% versus 6%) and

laxatives (10% versus 2%).

3. Health status

54 2009 NSW Inmate Health Survey: Key Findings Report

Table 3.3.2 Taken medications prescribed for you in

the past two weeks by medication type

(Multiple response)

Men Women Total

n % n % n %

No medications 262 32.9 28 14.1 290 29.1

Pain-killer/headache

tablets 265 33.2 107 54.0 372 37.4

Methadone 88 11.0 63 31.8 151 15.2

Skin ointment 105 13.2 36 18.2 141 14.2

Asthma medications 86 10.8 44 22.2 130 13.1

Stomach medications 66 8.3 21 10.6 87 8.7

Vitamins/minerals 47 5.9 37 18.7 84 8.4

Antibiotics 52 6.5 20 10.1 72 7.2

Blood pressure 40 5.0 16 8.1 56 5.6

Sleeping tablets 45 5.6 9 4.5 54 5.4

Allergy medication 36 4.5 10 5.1 46 4.6

Heart problems 30 3.8 9 4.5 39 3.9

Laxatives 16 2.0 20 10.1 36 3.6

Anti-coagulants 28 3.5 7 3.5 35 3.5

Cough mixture 25 3.1 7 3.5 32 3.2

Anti-epileptic 22 2.8 6 3.0 28 2.8

Other diabetes medication 23 2.9 4 2.0 27 2.7

Nicotine patches 15 1.9 2 1.0 17 1.7

Insulin for diabetes 5 0.6 4 2.0 9 0.9

Angina patches 4 0.5 2 1.0 6 0.6

Other 219 27.5 79 39.9 298 29.9

Just under one third of participants (30%) mentioned another

type of prescribed medication taken in the preceding two weeks.

These were often psychiatric medications. Eleven percent of

participants (17% of women and 9% of men) reported taking

anti-depressants, 6% (10% of women and 4% of men) reported

taking anti-psychotics, 2% reported taking benzodiazepines

and 1% reported taking other psychiatric medications. Five

percent of the sample (7% of women and 5% of men) reported

taking anti-inflammatories, 3% (4% of women and 3% of men)

reported taking cholesterol-lowering drugs and less than 1%

reported taking thyroid medications.

Fewer than one in ten (9%) 2009 IHS participants reported

having taken medications which were not prescribed for them

in the two weeks preceding the Survey, with no difference

between the proportion of men and women who reported this

was the case (8% versus 9%) (Table 3.3.3). The proportion of

IHS samples having recently taken non-prescribed medications

remained relatively stable between 1996 (11%) and 2009

(9%). Among the 84 participants who reported taking nonprescribed

medication in 2009, the majority took psychiatric

medication such as sedatives, anti-depressants and other

psychiatric medication.

Table/Fig 3.3.3 Taken medications not prescribed for

you in the past two weeks

0

3

6

9

12

15

12.1

10.2

9.1

10.7

7.2

8.3

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 70 657 10.7 54 747 7.2 66 796 8.3

Women 16 132 12.1 17 167 10.2 18 198 9.1

Total 86 789 10.9 71 914 7.8 84 994 8.5

As a result of the careful control of medications within the

prison system (as noted above), it is likely that an inmate who

takes medication that is not prescribed for him or herself has

been given or has paid for medication which was prescribed

for another inmate.

3. Health status

2009 NSW Inmate Health Survey: Key Findings Report 55

3.4 Diabetes

Diabetes Australia recommends that healthy adults with no risk

factors for diabetes undertake a fasting plasma glucose test on

an annual basis from the age of 55 years, to monitor their risk

of developing diabetes as they get older. Among people with

one or more risk factors for diabetes, the recommendation

is for annual fasting plasma glucose tests from the age of 45

years. Risk factors for diabetes include a family history of the

condition; obesity; high cholesterol; hypertension; a history of

cardiovascular events; polycystic ovarian syndrome; ethnicity

(people of Asian, Pacific Island and Aboriginal Australian

backgrounds); and a history of gestational diabetes. Among

people aged less than 45 years, there is no recommended

frequency of testing for plasma glucose levels.

Thirty six percent of 2009 IHS participants (34% of men and

48% of women) reported having had a blood glucose test in the

preceding year in addition to the one undertaken as part of this

Survey. No detail was requested in terms of whether this was a

random or fasting blood glucose test. The great majority of this

testing was undertaken in the prison system, with just 6% of

men and 12% of women reporting a blood glucose test only in

the community in the preceding year (Table 3.4.1).

Table 3.4.1 Location of blood glucose testing

undertaken in the last year

Men Women Total

n % n % n %

None 529 66.4 104 52.5 633 63.6

Prison only 204 25.6 64 32.3 268 26.9

Community only 48 6.0 24 12.1 72 7.2

Both prison and community 16 2.0 6 3.0 22 2.2

Total 797 100.0 198 100.0 995 100.0

Eight percent of 2009 IHS participants (8% of men and 11%

of women) reported having been told by a doctor or nurse that

they had “high blood sugar” (Table 3.4.2). Women were first

informed they had high blood sugar at a mean age of 33.0 years

(SD 14.4; range 2-56), whereas men were first informed at a

mean age of 37.9 years (12.7; range 13-61 years).

Table 3.4.2 Ever told by a doctor or nurse had “high

blood sugar”

Men Women Total

n % n % n %

Yes 61 7.7 21 10.6 82 8.2

No 736 92.3 177 89.4 913 91.8

Total 797 100.0 198 100.0 995 100.0

When combined with the blood sugar test results reported

later (see section 4.9) and using a cut-off of 8 mmol/L for high

blood sugar (detected either through a finger-prick or venous

reading), serological evidence of high blood sugar was found

among 15% of participants who indicated they had ever been

told they had high blood sugar, compared with less than 2% of

participants who had never been told by a doctor or nurse that

they had high blood sugar.

Four percent of the 2009 IHS sample (4% of men and 5% of

women) reported having been told by a doctor or nurse that

they had diabetes. This is similar to the proportions of the

1996 (4%) and 2001 (3%) IHS samples who reported having

been told that they had diabetes (Table 3.4.3). Women with

diabetes had first been diagnosed at a mean age of 32.9 years

(SD 17.7; range 11‑56 years), whereas men with diabetes had

first been diagnosed at a mean age of 40.1 years (SD 11.9;

range 10-60 years).

Table/Fig 3.4.3 Ever told have diabetes

0

1

2

3

4

5

6

7

8

7.1

3.3

4.5

2.8

3.2

4.3

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 17 600 2.8 23 710 3.2 34 797 4.3

Women 8 112 7.1 5 153 3.3 9 198 4.5

Total 25 712 3.5 28 863 3.2 43 995 4.3

3. Health status

56 2009 NSW Inmate Health Survey: Key Findings Report

When combined with the blood sugar test results reported

later (see section 4.9) and using a cut-off of 8mmol/L for high

blood sugar, serological evidence of high blood sugar was

found for 28% of participants who indicated they had ever

been told they had diabetes, compared with less than 2% of

participants who had never been told by a doctor or nurse that

they had diabetes.

Diabetes is managed in a range of ways depending on the

nature and progression of the disorder. Type 1 diabetes is

an auto-immune disorder that cannot be prevented but can

be effectively managed with insulin replacement through

lifelong insulin injections (up to six per day), healthy eating,

regular exercise and regular monitoring of blood glucose

levels (up to six times per day). Type 2 diabetes is a lifestylerelated

disorder that is initially treated through lifestyle

modification including healthy diet and regular exercise.

However, as the disease progresses, people with Type 2

diabetes are often prescribed tablets to control their blood

glucose levels. Due to the progressive nature of Type 2

diabetes, it may eventually be necessary to start taking

insulin injections to control blood glucose levels.

Among 2009 IHS participants who reported having been told

that they had diabetes (N=43), just three (two men and one

woman) reported not currently receiving any treatment or

undertaking any management strategies for the condition

(Table 3.4.4). The most common management strategy

reported by inmates who reported having diabetes was the use

of tablets (63%), which tends to suggest that they had Type 2

diabetes. Just under a third (30%) reported eating special

diets; and injections (19%) were also management strategies

reported by some participants. Among 2009 IHS participants

who reported having been told that they had diabetes, 76%

reported being satisfied with the diabetes treatment they

received in prison. There was a strong gender difference here,

with 90% of men reporting satisfaction with the treatment of

their diabetes, compared to just 14% of women.

Table 3.4.4 Current diabetes treatment/management

(if ever told have diabetes)

(Multiple response)

Men Women Total

n % n % n %

Yes, tablets 23 67.6 4 44.4 27 62.8

Yes, special diet 9 26.5 4 44.4 13 30.2

Yes, injections 6 17.6 2 22.2 8 18.6

No treatment/management 2 5.9 1 11.1 3 7.0

Among the 4% of Australia’s general population who

reported having diabetes in the 2007-08 National Health

Survey (ABS, 2009), a range of management strategies

were reported. The majority (77%) reported that they had

discussed strategies to self-manage their condition with

a GP or specialist in the preceding year. Three quarters

(75%) of people with diabetes reported taking some form

of pharmaceutical medication to manage their condition,

including 21% who reported taking insulin. Seventy five

percent reported following a healthy eating plan to help

manage their condition, 17% reported having lost weight,

and 27% reported that they exercised on most days. Almost

half (46%) checked their blood glucose levels at least once

a day; just 2% had not checked their blood glucose in the

year preceding the Survey.

3. Health status

2009 NSW Inmate Health Survey: Key Findings Report 57

3.5 Asthma

More than one quarter (29%) of 2009 IHS participants

reported that they had been told by a doctor that they had

asthma (Table 3.5.1), with a substantially higher proportion

of women than men (40% versus 26%) reporting this to be

the case. The National Health Surveys demonstrate that the

prevalence of asthma is also higher among women than men

among Australia’s general population (11% versus 9%; ABS,

2009), although the overall general population prevalence

(10%) is markedly lower than that reported by 2009 IHS

participants. Asthma is most common among young people

aged 0-14 years and 15-24 years (ABS, 2009).

Rates of reported asthma increased among male IHS participants,

from 18% in 1996 to 21% in 2001 to 26% in 2009, whereas

the proportions of women who reported suffering from asthma

remained relatively stable during this period (Table 3.5.1). Among

the general population, the prevalence of asthma increased from

8% in 1989-90 to 11% in 1995, then more recently decreased,

from 12% in 2001 to 10% in 2004-05 and again in 2007-08

(ABS, 2009). Thus, patterns of self-reported asthma among

IHS participants appear to diverge quite markedly from those

reported by Australia’s general population, although because the

questions asked in the National Health Survey and the IHS are

not exactly the same, these data should be considered indicative

rather than directly comparable.

Table/Fig 3.5.1 Ever told by a doctor had asthma

0

10

20

30

40

50

60

39.8

43.8

40.4

17.5

20.6

26.3

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 108 616 17.5 146 708 20.6 210 797 26.3

Women 47 118 39.8 67 153 43.8 80 198 40.4

Total 155 734 21.1 213 861 24.7 290 995 29.1

Half (51%) of 2009 IHS participants who reported that a doctor

had told them they had asthma reported that they had not

suffered an asthma attack in the three months preceding the

Survey (Table 3.5.2), with women substantially more likely to have

suffered at least one attack during that period (64% versus 43%).

Sixteen percent of self-reported asthma sufferers (20% of women

and 14% of men) reported having experienced six or more

attacks in the preceding three months.

Table 3.5.2 Number of asthma attacks in the past three

months (if ever told have asthma)

Men Women Total

n % n % n %

0 118 56.7 29 36.3 147 51.0

1 20 9.6 10 12.5 30 10.4

2 20 9.6 12 15.0 32 11.1

3 – 5 20 9.6 13 16.3 33 11.5

6+ 30 14.4 16 20.0 46 16.0

Total 208 100.0 80 100.0 288 100.0

Among 2009 IHS participants who reported that a doctor had

told them that they had asthma, 71% reported that they did

not have a current asthma management plan (Table 3.5.3).

Women (35%) were more likely than men (27%) to report

having a current management plan. The 2007-08 National

Health Survey (ABS, 2009) found that among the 10% of

Australia’s general population with asthma, 21% reported

having a written asthma action plan (as is recommended

by the National Asthma Council Australia). These data are

indicative rather than directly comparable to the findings of

the IHS, because the relevant IHS question did not specify

that the management plan must be written.

Table 3.5.3 Current asthma management plan (if ever

told have asthma)

(Multiple response)

Men Women Total

n % n % n %

No management plan 153 72.9 52 65.0 205 70.7

Yes, medication 53 25.2 28 35.0 81 27.9

Yes, reduced smoking 11 5.2 9 11.3 20 6.9

Yes, breathing exercises 11 5.2 5 6.3 16 5.5

Yes, exercise 11 5.2 3 3.8 14 4.8

Other 2 1.0 2 2.5 4 1.4

3. Health status

58 2009 NSW Inmate Health Survey: Key Findings Report

Components of IHS participants’ current asthma management

plans included medication (28% of participants who reported

having been told by a doctor that they had asthma), reductions

in smoking (7%), breathing exercises (6%) and exercise

(5%). Women were more likely than men to report that their

management plans included medication (35% versus 25%)

and reduced smoking (11% versus 5%).

Fifty eight percent of 2009 IHS participants who reported that

a doctor had told them that they had asthma reported using

a salbutamol (Ventolin®; a short-acting bronchodilator) puffer

at least sometimes (Table 3.5.4), with frequency of use ranging

from less than once per month (13% of self-reported asthma

sufferers) to daily or more often (25% of self-reported asthma

sufferers). Among participants in the 2007-08 National Health

Survey (ABS, 2009) who self-reported suffering from asthma,

39% reported having used salbutamol for their asthma in the

two weeks preceding the Survey.

Table 3.5.4 How often use salbutamol (Ventolin®)

puffers (if ever told have asthma)

Men Women Total

n % n % n %

Daily / more than daily 41 19.5 31 38.8 72 24.8

More than weekly but

not daily 20 9.5 12 15.0 32 11.0

Less than weekly

(1-4 times per month) 20 9.5 8 10.0 28 9.7

Less than once a month 30 14.3 7 8.8 37 12.8

Never 99 47.1 22 27.5 121 41.7

Total 210 100.0 80 100.0 290 100.0

Peak expiratory flow (PEF) is a measure of maximum expiratory

flow occurring just after the start of a forced expiration from

the point of maximum inspiration (total lung capacity). PEF

is used to provide a measure of airway calibre or airflow. It

is dependent not only on airway calibre, but on lung elastic

recoil, patient effort and patient cooperation. PEF is measured

by a peak flow meter. The National Asthma Council Australia

advises that monitoring of asthma control based on PEF

may have the greatest benefit in patients with more severe

or difficult-to-manage asthma, or those who cannot readily

perceive symptoms of airflow limitation. They suggest that selfmonitoring

based on PEF might help some patients detect the

onset of potentially severe exacerbations earlier, but there is no

strong evidence that this offers any advantage over symptom

monitoring for most patients; thus, only a small number of

patients may benefit from long-term PEF monitoring.

The majority (61%) of 2009 IHS participants who reported that

a doctor had told them they had asthma reported that they

had not had their breathing measured with a peak flow meter

in the past year (Table 3.5.5). Women were more likely than

men to have had their PEF measured at least once in the past

year (52% versus 34%).

Table 3.5.5 How often measure breathing with peak

flow meter in past year (if ever told have

asthma)

Men Women Total

n % n % n %

Never 139 66.2 38 47.5 177 61.0

Once only 36 17.1 27 33.8 63 21.7

Less than quarterly 15 7.1 8 10.0 23 7.9

Quarterly 14 6.7 5 6.3 19 6.6

Monthly or more often 6 2.9 2 2.5 8 2.8

Total 210 100.0 80 100.0 290 100.0

High levels of satisfaction with the treatment they received in

prison for their asthma was reported by 2009 IHS participants

who reported that a doctor had told them that they had

asthma (Table 3.5.6). Among participants who indicated they

had asthma, 85% of women and 88% of men reported that

they were satisfied with their asthma treatment in prison.

Table 3.5.6 Satisfied with asthma treatment in prison

(if ever told have asthma)

Men Women Total

n % n % n %

Yes 184 87.6 68 85.0 252 86.9

No 26 12.4 12 15.0 38 13.1

Total 210 100.0 80 100.0 290 100.0

3.6 Vaccination

Australia’s National Immunisation Program, an initiative of the

Commonwealth Department of Health and Ageing, seeks to have

all children between birth and 4 years of age vaccinated against

a range of infections and in accordance with the Australian

Standard Vaccination Schedule. Adequate vaccination is just as

important for adults as it is for children. Some vaccines given

during childhood require boosters to ensure they still offer

3. Health status

2009 NSW Inmate Health Survey: Key Findings Report 59

protection. Many people miss essential vaccines in childhood and

so are not protected against specific diseases. Just 4% of 2009

IHS participants reported that they never received any vaccinations

at all (Table 3.6.1), with a slightly higher proportion of women

than men reporting this to be the case (7% versus 4%).

Table 3.6.1 History of vaccinations against specific

infections

(Multiple response)

Men Women Total

n % n % n %

No vaccinations 30 3.8 13 6.6 43 4.3

Tetanus 674 84.6 155 78.3 829 83.3

Measles 321 40.3 101 51.0 422 42.4

Hepatitis B 403 50.6 125 63.1 528 53.1

Hepatitis A 92 11.5 27 13.6 119 12.0

Rubella (German measles) 162 20.3 101 51.0 263 26.4

Tetanus vaccination is included in the Australian Standard

Vaccination Schedule with a primary course for infants

followed by a booster at 4 years of age and a second

booster between the ages of 15 and 17 years, intended

to help maintain immunity into adulthood. Adults who

have their primary course as an adult are recommended

to have boosters 10 and 20 years after their primary

course. However, the Schedule recommends that all adults

should receive a booster at 50 years of age, unless they

have had one in the previous 10 years. Adults receiving a

wound that may become infected with tetanus, such as a

gardening wound or a nail puncture, should have a booster

if they haven’t had one within five years. Eighty three

percent of 2009 IHS participants (85% of men and 78% of

women) reported having been vaccinated against tetanus

(Table 3.6.1). Of these, 39% indicated they had received a

vaccination within the preceding five years; 63% indicated

had received it within the last ten years; and 28% were

unsure when they last received a tetanus vaccination.

Rubella (German measles) and measles vaccines are usually

given as part of a combination vaccine called MMR (measles,

mumps, rubella). MMR is included in the Australian Standard

Vaccination Schedule and is given as two doses in childhood.

Rubella infection in early pregnancy results in damage to the

unborn baby in a high proportion of affected pregnancies.

Women of child-bearing age who missed vaccination or who

are not immune after vaccination should be vaccinated unless

they are pregnant, and must not become pregnant for 28

days after vaccination. The Schedule also recommends that

men born during or after 1966 who have no record of rubella

immunisation should be vaccinated. Twenty six percent of 2009

IHS participants reported having been vaccinated against rubella

(Table 3.6.1), with a markedly higher proportion of women than

men reporting this to be the case (51% versus 20%).

An ongoing hepatitis B vaccination program for infants and

adolescents aims to control hepatitis B virus (HBV) infection in

Australia. Population groups at risk of HBV infection, such as

injecting drug users and sexual contacts of infected persons,

are also recommended to undertake HBV vaccination. Among

adults and children who have not been vaccinated or who are

not immune following vaccination, a course of three injections

will provide several years’ protection. Just over half (53%) of

2009 IHS participants reported that they had received at least

one dose of HBV vaccine (Table 3.6.1), with substantially more

women than men reporting this to be the case (63% versus

51%). Among participants who reported having received a

HBV vaccination, 76% further reported that they had received

the full course of three injections. Nevertheless, among

participants who reported receiving the full course and who

provided a blood sample (N=295), just 55% had serological

evidence of vaccine-conferred immunity (see section 4.6). This

finding is consistent with the literature which clearly indicates

that concordance between self-reported and serological

markers of HBV status is poor (Topp et al., 2009a).

Vaccination against Hepatitis A virus (HAV) infection is included

in the Australian Standard Vaccination Schedule for Aboriginal

and Torres Strait Islander children in high-risk areas, and is also

a risk for travellers. It is contracted from shellfish, water, ice or

food that has been contaminated with human faeces, or directly

from an infected person. Thus, HAV vaccination is not universally

recommended, which may account for the low proportion of

2009 IHS participants who reported having received at least one

dose of vaccine (Table 3.6.1). Just 14% of women and 12% of

men reported that they had received a dose of HAV vaccine, the

majority (82%) of whom further reported that they had received

the full course of two injections.

3. Health status

60 2009 NSW Inmate Health Survey: Key Findings Report

3.7 Injury and head injury

Around 365,000 cases of community injury – those typically

sustained in the home, workplace, public places etc – resulted in

hospitalisation in Australia in 2004-05 (Bradley & Harrison, 2008),

with injury the fourth most common cause of hospitalisation

in that year. The majority (86%) of hospitalised injuries were

documented as unintentional injuries, with the remainder

considered to be intentional (such as those resulting from assaults

or incidents of self-harm). Unintentional falls, the leading cause

of hospitalised injury in 2004-05, accounted for more than onethird

of all community injury cases. Unlike most other types of

community injury, women outnumbered men in unintentional fall

injury cases (55% to 45%). Transport accidents were the second

most common cause of hospitalised community injuries (14% or

51,000 cases), followed by sport-related injuries, which accounted

for around 37,300 cases, with football injuries (Australian Rules,

soccer, rugby league and rugby union) being by far the most

prevalent (13,600 cases overall, 12,700 for men). There were

an estimated 23,900 hospitalised injury cases due to self-harm.

Female cases outnumbered male cases by 14,900 to 9,000.

Nearly 1.5 million patient-days were attributed to hospitalised

community injury in 2004–05 and the average length of stay per

community injury case was 4.0 days (Bradley & Harrison, 2008).

The most common place of occurrence of community injury

cases was the home, with more than a quarter of all hospitalised

cases occurring here (26%), while 10% occurred on public

streets and highways. Injuries reported to occur in streets

and highways, as well as sports and athletics areas, trade and

construction areas and farms, accounted for higher proportions

of cases involving men than of cases involving women. One

in ten community injury cases occurred while the person was

engaged in sporting activities (11%). Men were more commonly

injured while playing sport (14% of cases involving men) than

women (6%). Another ten per cent of community injury cases

occurred while the person was engaged in work of some kind

(either for income or not; 10% of cases). Men were more

commonly injured while working for income than women (9%

versus 2%), while similar proportions of men and women were

injured while engaged in ‘other types of work’ (3.5% vs. 3.4%).

These observations about injury requiring hospitalisation

among the general population provide some context within

which to interpret data relating to injury among prison

inmates. Overall, the proportion of IHS participants who

reported having sustained an injury within the preceding

three months that required them to see a doctor or nurse or

to go to hospital remained relatively stable between 1996

and 2009, at just under one in five participants (Table 3.7.1).

The overall proportion, however, masks a gender difference

over time, whereby the proportion of men reporting such an

injury increased slightly, from 15% in 1996 to 17% in 2009,

whereas the proportion of women reporting such an injury

decreased slightly, from 21% in 1996 to 18% in 2009. Note

that injuries in the preceding three months may have included

those that occurred in the community as well as in prison.

Table/Fig 3.7.1 Injury requiring medical intervention in

the past three months

0

5

10

15

20

25

20.5

19.2

17.7

15.2

17.6 17.2

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 87 574 15.2 123 700 17.6 137 796 17.2

Women 23 112 20.5 28 146 19.2 35 198 17.7

Total 110 686 16.0 151 846 17.8 172 994 17.3

The majority (85%) of 2009 IHS participants who reported

having sustained an injury requiring them to present to a

doctor, nurse or hospital in the preceding three months

further reported that they had sustained a single such injury

(Table 3.7.2). However, 21 participants (twelve men and nine

women) reported sustaining two such injuries in the preceding

three months, and four participants (three men and one

woman) reported having sustained three or more.

3. Health status

2009 NSW Inmate Health Survey: Key Findings Report 61

Table 3.7.2 Number of injuries requiring medical

intervention in the past three months

Men Women Total

n % n % n %

0 659 82.8 163 82.4 822 82.7

1 122 15.3 25 12.6 147 14.8

2 12 1.5 9 4.5 21 2.1

3+ 3 0.4 1 0.5 4 0.4

Total 796 100.0 198 100.0 994 100.0

Participants who reported having sustained one or more injuries

within the preceding three months were asked further details

about those injuries. Data are presented regarding only the first

such injury among participants who reported having sustained

more than one within that period. The most common type of

injuries were lacerations or cuts (Table 3.7.3), which women

were slightly more likely to report having sustained (31% versus

29%), closely followed by strains or sprains, which men were

slightly more likely to report having sustained (29% versus

26%). Fractures had been sustained by 28 participants in the

three months preceding the Survey.

Table 3.7.3 Type of injury requiring medical intervention

in the past three months (first injury)

Men Women Total

n % n % n %

Laceration / cut 39 28.5 11 31.4 50 29.1

Sprain / strain 40 29.2 9 25.7 49 28.5

Fracture 23 16.8 5 14.3 28 16.3

Superficial 11 8.0 0 0.0 11 6.4

Dislocation 5 3.6 1 2.9 6 3.5

Other 19 13.9 9 25.7 28 16.3

Total 137 100.0 35 100.0 172 100.0

The most common cause of the injuries requiring medical

intervention sustained within the preceding three months was

being struck by a person or object (Table 3.7.4). Men were

substantially more likely than women to report that their injury

was caused by a low fall (20% versus 11%) or machinery (5%

versus 0%), whereas women were more likely to report the

cause to be cutting or piercing (9% versus 2%).

Table 3.7.4 Cause of injury requiring medical

intervention in the past three months

(first injury)

Men Women Total

n % n % n %

Struck by object / person 40 29.2 12 34.3 52 30.2

Fall (low) 28 20.4 4 11.4 32 18.6

Fall (high) 6 4.4 1 2.9 7 4.1

Machinery 7 5.1 0 0.0 7 4.1

Cutting / piercing 3 2.2 3 8.6 6 3.5

Other 53 38.7 15 42.9 68 39.5

Total 137 100.0 35 100.0 172 100.0

The majority (82%) of 2009 IHS participants who reported having

sustained an injury requiring medical intervention in the preceding

three months further reported that this injury was unintentional

(Table 3.7.5). This is consistent with the results of a pilot project

examining the feasibility of a system of injury surveillance in

NSW male prisons, which recorded 68% of injury presentations

to prison health clinics as unintentionally caused (Butler et al.,

2004a). In the 2009 IHS, men were slightly more likely than

women to report that their injury was caused by another person

who intended to hurt them (17% versus 14%), whereas women

were slightly more likely to report that their injury was a result

of intentional self-harm (3% versus 1%). The higher prevalence

of self-harm among women is consistent with previous research

examining injuries among both prison inmates (Butler et al.,

2004a) and the general population (Bradley & Harrison, 2008).

Other specific causes of injury mentioned included:

• ‘From not stretching properly before playing football.’

• ‘Assault in cell by other inmate.’

• ‘Blacked out. Had been drinking. Ended up in hospital.’

Table 3.7.5 Intentional nature of injury requiring

medical intervention in the past three

months (first injury)

Men Women Total

n % n % n %

Accidental 112 81.8 29 82.9 141 82.0

Intentional harm (others) 23 16.8 5 14.3 28 16.3

Intentional self-harm 1 0.7 1 2.9 2 1.2

Other 1 0.7 0 0.0 1 0.6

Total 137 100.0 35 100.0 172 100.0

3. Health status

62 2009 NSW Inmate Health Survey: Key Findings Report

Prisons are violent environments with a high risk of exposure

to physical and sexual assaults, self-harm and unintentional

injuries (Butler et al., 2004a). The most common locations

in which men reported sustaining the injury which required

medical intervention in the preceding three months were

in the athletics and sports areas of the prison (25%), a

prison workplace (15%), or in their own prison cell (12%)

(Table 3.7.6). These results are in line with the results of a

pilot project examining the feasibility of a system of injury

surveillance in NSW male prisons, which found that injuries

arising from sporting activities and assaults were the most

common presentations to prison health clinics (Butler et

al., 2004a). Among women, the most common locations in

which injuries were sustained were in their own prison cell

(26%), a prison workplace (20%), or the prison yard (11%).

Table 3.7.6 Location where injury requiring medical

intervention in the past three months

occurred (first injury)

Men Women Total

n % n % n %

Prison: athletics / sports 34 24.8 2 5.7 36 20.9

Prison: workplace 21 15.3 7 20.0 28 16.3

Prison: cell 16 11.7 9 25.7 25 14.5

Prison: yard 15 10.9 4 11.4 19 11.0

Prison: (other) 12 8.8 4 11.4 16 9.3

Community: street / highway 16 11.7 1 2.9 17 9.9

Community: home 16 11.7 4 11.4 20 11.6

Other 7 5.1 4 11.4 11 6.4

Total 137 100.0 35 100.0 172 100.0

Men who had sustained an injury requiring medical

intervention within the preceding three months were most

likely to report being engaged in leisure activities at the

time (50%), followed by sporting activities (23%) and work

(18%) (Table 3.7.7). Women were most likely to report

being engaged in leisure (43%) or work (34%) activities at

the time of sustaining their injury.

Table 3.7.7 Activities being undertaken at the time of

injury requiring medical intervention in the

past three months (first injury)

Men Women Total

n % n % n %

Leisure 68 49.6 15 42.9 83 48.3

Work 24 17.5 12 34.3 36 20.9

Sporting 32 23.4 2 5.7 34 19.8

Other 13 9.5 6 17.1 19 11.0

Total 137 100.0 35 100.0 172 100.0

The most common action taken by 2009 IHS participants who

reported sustaining an injury requiring medical intervention was

to present to the prison clinic for treatment of the injury by the

nurse (Table 3.7.8), an action undertaken by 66% of women

and 45% of men who had sustained an injury. The next most

common option was to see a doctor, with men more likely to

see a doctor (20%) than women (6%). Men were also more

likely to be admitted to hospital (14%) than women (3%) as a

result of their injuries.

Table 3.7.8 Action taken following the injury requiring

medical intervention in past three months

(first injury)

Men Women Total

n % n % n %

Saw clinic nurse 61 44.5 23 65.7 84 48.8

Saw doctor 27 19.7 2 5.7 29 16.9

Hospital: not admitted 23 16.8 6 17.1 29 16.9

Hospital: admitted 19 13.9 1 2.9 20 11.6

Self-treated 5 3.6 3 8.6 8 4.7

Other 2 1.5 0 0.0 2 1.2

Total 137 100.0 35 100.0 172 100.0

More than one quarter (27%) of 2009 IHS participants

who reported having sustained an injury requiring medical

intervention in the preceding three months reported that their

injury had caused them a lasting disability, with men more

likely than women to report that this was the case (28% versus

23%). Women were slightly more likely than men to report

that they were unsure whether their injury was associated with

a lasting disability (9% versus 7%).

3. Health status

2009 NSW Inmate Health Survey: Key Findings Report 63

Fifteen percent of 2009 IHS participants reported having sustained

a physical injury in the preceding year that was deliberately

caused by another individual (Table 3.7.9), with no gender

difference in the proportion of participants reporting this to be the

case. Women were slightly more likely than men to report having

sustained an injury deliberately caused by an intimate partner

(3% versus <1%) or another inmate (6% versus 4%), whereas

men were more likely to report having sustained an injury caused

by a stranger (5% versus 2%). Twenty three participants (twenty

men and three women) reported having sustained an injury

deliberately caused by the police within the preceding year.

Table 3.7.9 Physical injuries sustained in the past year

deliberately caused by specific individuals

(Multiple response)

Men Women Total

n % n % n %

None 677 85.1 168 84.8 845 85.0

Inmate 29 3.6 12 6.1 41 4.1

Stranger 37 4.6 3 1.5 40 4.0

Police 20 2.5 3 1.5 23 2.3

Friend/acquaintance 19 2.4 4 2.0 23 2.3

Parent/other family 9 1.1 2 1.0 11 1.1

Intimate partner 2 0.3 5 2.5 7 0.7

Other 13 1.6 3 1.5 16 1.6

Head injury

The most common type of community injury resulting in

hospitalisation in Australia in 2004-05 was a head injury (18%

of cases) (Bradley & Harrison, 2008). Head injuries were the

most common principal diagnosis for both men (21% of cases)

and women (15%). Head injuries were common for people of

all ages, and were the most frequent type of principal diagnosis

for young Australians aged 15 – 24 years.

In an Australian community survey undertaken across three

birth cohorts, the lifetime prevalence of head injury resulting in

a loss of consciousness of at least 15 minutes ranged between

5% and 6% (Buttersworth et al., 2004). As noted previously,

correlates of violence are common in the prison environment,

including a high proportion of inmates from economically and

socially deprived backgrounds. Perhaps unsurprisingly, studies

have consistently found levels of head injury and traumatic

brain injury among prison inmates which far exceed those

documented among the general population, leading some

to postulate causal links between such injuries, behavioural

sequelae, and offending behaviour (Schofield et al., 2006).

Consistent with such research, a strikingly high proportion

of IHS participants reported a lifetime history of head injury

resulting in a loss of consciousness in all years in which the

Survey has been conducted, from 44% in 2001 to 49% in

2009 (Table 3.7.10). In the most recent Survey, a substantially

higher proportion of men than women reported such a history

(52% versus 35%), which is a higher differential than found in

2001 (45% of men and 39% of women).

Table/Fig 3.7.10 Ever have head injury resulting in a loss

of consciousness

0

10

20

30

40

50

60

39.2

34.8

45.2

52.3

2001 2009

Men Women

PERCENT

YEAR

2001 2009

n Total % n Total %

Men 315 697 45.2 416 796 52.3

Women 56 143 39.2 69 198 34.8

Total 371 840 44.2 485 994 48.8

Among 2009 IHS participants, men were not only more likely

to report a lifetime history of at least one head injury resulting

in a loss of consciousness, but were also more likely to report

more than one such injury (Table 3.7.11). Close to one third

(32%) of men reported having sustained two or more head

injuries that resulted in a loss of consciousness, whereas the

equivalent figure for women was 21%. Likewise, 11% of men

reported having sustained five or more such injuries, whereas

5% of women reported this to be the case.

3. Health status

64 2009 NSW Inmate Health Survey: Key Findings Report

Some participants provided details about their head injury including:

• ‘I had a hit on the head with an iron bar. I was in hospital and

had to learn to walk and talk again. I had two operations at Royal

North Shore Hospital. I lost a bit of my brain and had fragments

in my skull.’

• ‘I have 10% brain damage from a truck accident in 1988. If I

have a week off work, they have to retrain me because I can’t

remember.’

• ‘I have two fractures in my head from playing rugby league. They

said it would take 2 years to heal but it still hurts. It happened

when I was 18 years old.’

• ‘I had a stack off a skateboard, hit a rail and it went partially into

my head at the temple.’

• ‘I was in the back of the police wagon. They hit the brakes and I

fell back and hit my nose on the door and fell to the ground.’

• ‘I was weight training and burst a blood vessel in my brain.’

Table 3.7.11 Lifetime number of head injuries resulting

in a loss of consciousness

Men Women Total

n % n % n %

0 380 47.7 129 65.2 509 51.2

1 162 20.4 27 13.6 189 19.0

2 102 12.8 20 10.1 122 12.3

3-4 67 8.4 12 6.1 79 7.9

5-6 53 6.7 2 1.0 55 5.5

7+ 32 4.0 8 4.0 40 4.0

Total 796 100.0 198 100.0 994 100.0

Among 2009 IHS participants who reported a history of head

injury resulting in loss of consciousness, half (51%) reported that

following their most severe head injury they were unconscious

for a relatively brief time (less than ten minutes), with men more

likely than women to report such a period of unconsciousness

(52% versus 45%) (Table 3.7.12). Women, on the other hand,

were substantially more likely than men to report that they did

not know for how long they had been unconscious (26% versus

15%). A total of 34 participants (equating to 7% of both men

and women with a history of head injury resulting in a loss of

consciousness) reported having been unconscious for more than

24 hours following their most severe head injury.

Table 3.7.12 Time unconscious for most severe head injury

Men Women Total

n % n % n %

< 10 minutes 216 52.1 31 44.9 247 51.0

10 - <30 minutes 55 13.3 8 11.6 63 13.0

30 minutes - <24 hours 54 13.0 7 10.1 61 12.6

24 hours or more 29 7.0 5 7.3 34 7.9

Don’t know 61 14.7 18 26.1 79 16.3

Total 415 100.0 69 100.0 484 100.0

Close to half (47%) of head injuries resulting in a loss of

consciousness sustained by 2009 IHS participants were

reported to have occurred ten or more years before the

Survey, and a further 22% had occurred between five and

ten years earlier (Table 3.7.13). A relatively small proportion

(4%, equating to head injuries among sixteen men and two

women) had occurred within the preceding six months;

while a total of 13% of head injuries resulting in a loss of

consciousness had occurred within the preceding two years.

Table 3.7.13 Time since most severe head injury

Men Women Total

n % n % n %

< 6 months ago 16 3.9 2 2.9 18 3.7

6 months - <2 years ago 40 9.6 4 5.8 44 9.1

2 - <5 years ago 76 18.3 15 21.7 91 18.8

5 - <10 years ago 90 21.7 14 20.3 104 21.5

10+ years ago 193 46.5 34 49.3 227 46.9

Total 415 100.0 69 100.0 484 100.0

There was little gender difference in the causes reported

by 2009 IHS participants of their most severe head injury

resulting in a loss of consciousness (Table 3.7.14), with more

than half of such head injuries caused by being struck by

an object or person among both men and women (54%

and 52%, respectively). Women were, however, more likely

to report that their most severe head injury was caused by

a fall (25% versus 17%), while men were more likely to

describe a motorcycle accident as the cause of their head

injury (5% versus 2%).

3. Health status

2009 NSW Inmate Health Survey: Key Findings Report 65

Table 3.7.14 Cause of most severe head injury

Men Women Total

n % n % n %

Struck by object / person 222 53.5 36 52.2 258 53.3

Fall 70 16.9 17 24.6 87 18.0

Motor vehicle accident 62 14.9 10 14.5 72 14.9

Motorcycle accident 21 5.1 1 1.5 22 4.5

Other 40 9.6 5 7.2 45 9.3

Total 415 100.0 69 100.0 484 100.0

Schofield et al. (2006) found that among their study of 200

men entering the NSW criminal justice system, almost 20% of

those who reported a history of head injury further reported

that this injury had resulted in a skull fracture. Among 2009 IHS

participants, men who reported having sustained a head injury

that resulted in a loss of consciousness were more likely than

women to further report that this head injury resulted in a skull

fracture (15% versus 12%) (Table 3.7.15). Women were slightly

more likely than men to report that they did not know whether

this was the case (10% versus 8%). Notwithstanding this high

prevalence of reported skull fractures, more than three quarters

of head injuries among both men and women were reported not

to have resulted in skull fracture (77% and 78%, respectively).

Table 3.7.15 Most severe head injury resulted in a

skull fracture

Men Women Total

n % n % n %

Yes 62 14.9 8 11.6 70 14.5

No 319 76.9 54 78.3 373 77.1

Don’t know 34 8.2 7 10.1 41 8.5

Total 415 100.0 69 100.0 484 100.0

Likewise, the majority (68%) of most severe head injuries

were reported not to have resulted in an intracranial bleed

(Table 3.7.16). A higher proportion of men than women,

however, reported that they had sustained internal head

bleeding following their most severe head injury (25%

versus 17%). Eight percent of participants were uncertain

whether their most severe head injury had resulted in

internal head bleeding.

Table 3.7.16 Most severe head injury resulted in

intracranial bleeding

Men Women Total

n % n % n %

Yes 104 25.1 12 17.4 116 24.0

No 278 67.0 52 75.4 330 68.2

Don’t know 33 8.0 5 7.3 38 7.9

Total 415 100.0 69 100.0 484 100.0

Sixteen percent of 2009 IHS participants with a history of head

injury resulting in a loss of consciousness reported that they

had required surgery following their most severe head injury,

with a higher proportion of men reporting this to be the case

than women (16% versus 12%).

Three quarters (73%) of IHS participants who reported having

sustained a head injury resulting in a loss of consciousness

reported experiencing at least one neuropsychiatric sequela

immediately following their most severe head injury

(Table 3.7.17), with women substantially more likely than

men to report at least one such symptom (84% versus 71%).

Headaches (50%), problems with coordination or balance

(27%), poor concentration (24%), problems retrieving the

appropriate words when speaking (22%) and psychiatric

symptoms such as anxiety and/or depression (22%) were the

most common neuropsychiatric sequelae of head injuries

resulting in a loss of consciousness. Women were substantially

more likely than men to report having suffered headaches

(68% versus 48%) and anxiety and/or depression (33%

versus 21%), and were somewhat more likely to report poor

concentration (30% versus 23%) and coordination or balance

problems (30% versus 26%).

3. Health status

66 2009 NSW Inmate Health Survey: Key Findings Report

Table 3.7.17 Immediate sequelae following most severe

head injury

(Multiple response)

Men Women Total

n % n % n %

None 118 28.5 11 15.9 129 26.7

Headaches 197 47.6 47 68.1 244 50.4

Memory loss 128 30.9 21 30.4 149 30.8

Coordination / balance

problems 108 26.1 21 30.4 129 26.7

Poor concentration 93 22.5 21 30.4 114 23.6

Anxiety / depression 85 20.5 23 33.3 108 22.3

Problems finding right

words when speaking 91 22.0 17 24.6 108 22.3

Weakness in body 70 16.9 13 18.8 83 17.1

Personality change 55 13.3 11 15.9 66 13.6

Other 52 12.6 15 21.7 67 13.8

Among 2009 IHS participants who reported having

experienced at least one neuropsychiatric sequela of their most

severe head injury resulting in a loss of consciousness, two

thirds (67%) further reported that all such sequelae had since

resolved (Table 3.7.18), with men somewhat more likely to

report the resolution of all such symptoms than women (68%

versus 62%). Headaches (18%), anxiety and/or depression

(11%) and memory loss (10%) were the sequelae most likely

to be reported as unresolved. There was a consistent gender

difference whereby men were more likely than women to

report the resolution of every individual symptom. These rates

of persistent sequelae are lower than those reported in a

study of 200 men entering the NSW criminal justice system in

2003 and 2004 (Schofield et al., 2006), among whom 82%

reported a history of head injury, 79% of which involved a loss

of consciousness. Among participants who had experienced

a head injury, 52% reported unresolved consequences of that

injury, including 45% who continued to suffer neurological

effects, 32% who still experienced psychological symptoms,

and 17% who reported ongoing social sequelae.

Table 3.7.18 Unresolved sequelae from most severe

head injury

(Multiple response)

Men Women Total

n % n % n %

All effects resolved 283 68.4 43 62.3 326 67.4

Headaches 70 16.9 18 26.1 88 18.2

Anxiety / depression 45 10.9 10 14.5 55 11.4

Memory loss 41 9.9 9 13.0 50 10.3

Problems finding right words

when speaking 32 7.7 7 10.1 39 8.1

Poor concentration 29 7.0 8 11.6 37 7.6

Personality change 22 5.3 6 8.7 28 5.8

Coordination / balance

problems 21 5.1 4 5.8 25 5.2

Weakness in body 10 2.4 3 4.4 13 2.7

Other 9 2.2 4 5.8 13 2.7

More than one-fifth (23%) of 2009 IHS participants with

a history of head injury resulting in a loss of consciousness

reported that they had had tests or scans that confirmed

they had brain damage as a result of their head injury, with

men more likely than women to report that this was the case

(23% versus 19%). Two men and three women were unsure

whether they had undergone such tests.

3.8 Men’s health

Testicular cancer is an uncommon cancer, with an estimated

incidence of approximately 6.8 in every 100,000 men

(Cancer Council Australia, 2008). Young men are more

commonly affected by testicular cancer, with about half of

new diagnoses being made in men under the age of 33

years. Testicular cancer represents 0.1% of all cancer deaths.

Across Australian in 2004, there were 675 cases and 14

deaths related to testicular cancer (Cancer Council Australia,

2008). The exact cause remains unknown, but factors that

may increase a man’s risk include undescended testes or

a family history of testicular cancer. In more than 90% of

cases, testicular cancer is curable, particularly in cases of early

diagnosis and treatment (Cancer Council NSW, 2009a). Most

testicular tumours are discovered through self-examination,

and health authorities recommend that men check their

testicles regularly from puberty onwards.

3. Health status

2009 NSW Inmate Health Survey: Key Findings Report 67

Half (51%) of men reported having examined their testicles for

lumps at least once, an increase compared to the 2001 (45%)

and 1996 (44%) IHS results (Table 3.8.1). Less than half (41%)

of men reported that they knew how to properly examine their

testicles for lumps. A similar proportion (43%) expressed a

desire for more information about how to do so.

Table/Fig 3.8.1 Ever examined testicles for lumps

0

10

20

30

40

50

60

70

44.4 45.4

50.8

1996 2001 2009

Men

PERCENT

YEAR

1996 2001 2009

n % n % n %

Yes 273 44.4 318 45.4 403 50.8

No 342 55.6 383 54.6 390 49.2

Total 615 100.0 701 100.0 793 100.0

Frequency of reported testicle self-examination among men

ranged from weekly checks (18%) through to monthly (17%)

or less frequent (14%) checks. Three percent of men reported

having examined their testicles for lumps on a sole occasion

(Table 3.8.2).

Table 3.8.2 Frequency examine testicles for lumps

n %

Never 390 49.2

Once only 20 2.5

Less than monthly 111 14.0

Monthly 132 16.6

Weekly 140 17.7

Total 793 100.0

Please also see section 4.8 which reports information about

prostate cancer screening among male IHS participants.

3.9 Women’s health

Breast self-examination

Breast cancer is a common cancer diagnosed in women. About

one in eleven women will develop breast cancer by the age

of 75 (NSW Cancer Council, 2009b). In NSW, around 4000

women are diagnosed with breast cancer each year. Men can

also develop breast cancer, although this is rare. Around 30

men are diagnosed each year in NSW, accounting for about

1% of all breast cancer. Breast cancer is more common among

women aged over 60; nevertheless, around one quarter of

women diagnosed with breast cancer are younger than 50

(NSW Cancer Council, 2009b). For women aged between 50

and 69, regular screening mammograms are the best way to

detect breast cancers, and Australian women of these ages

are invited to participate in a government-funded biannual

mammography screening program. Relatively few incarcerated

women are old enough to qualify for this program.

Regular breast self-examination (BSE) may be performed

to check for breast lumps that may be indicative of

cancerous changes. BSE is not an alternative to screening

mammography because it will not usually detect tumours

smaller than a grape. Nevertheless, BSE is a low-cost,

simple, non-invasive means of detecting breast changes,

and the NSW Breast Cancer Institute recommends all

women perform breast self examination monthly.

More than half (60%) of women reported having undertaken

breast self-examination at least once, a decrease compared to the

2001 (66%) and 1996 (64%) IHS results (Table 3.9.1).

3. Health status

68 2009 NSW Inmate Health Survey: Key Findings Report

Table/Fig 3.9.1 Ever examined breasts for lumps

0

10

20

30

40

50

60

70

80

63.8 65.8

59.6

1996 2001 2009

Women

PERCENT

YEAR

1996 2001 2009

n % n % n %

Yes 74 63.8 98 65.8 118 59.6

No 42 36.2 51 34.2 80 40.4

Total 116 100.0 149 100.0 198 100.0

The frequency of reported BSE among women ranged from

monthly checks (17%) through to approximately six monthly

(11%) or annual (10%) checks. Four percent of women reported

having undertaken BSE on a sole occasion (Table 3.9.2).

More than half (59%) of women reported that they knew

how to properly examine their breasts for lumps. A smaller

proportion (44%) expressed a desire for more information

about how to do so.

Table 3.9.2 Frequency examine breasts for lumps

n %

Never 80 40.4

Once only 7 3.5

About once a year 20 10.1

About twice a year 21 10.6

Monthly 33 16.7

Other 37 18.7

Total 198 100.0

Cervical cancer and screening

Cervical cancer is caused by a common virus called Human

Papillomavirus (HPV), which over half of the population will

contract at some time in their life (Dunne & Markowitz, 2006).

An HPV vaccine to protect against cervical cancer has recently

become available and protects against 80% of cervical cancer

cases. The Pap test is a simple test that checks for changes to the

cells of the cervix that may lead to cervical cancer. In Australia, it

is recommended that all women aged between 18 and 70 years

who have ever been sexually active have a Pap test every two

years, including women who have had the HPV vaccine.

Table 3.9.3 Ever have a Pap test

n %

Yes 182 91.9

No 15 7.6

Don’t know 1 0.5

Total 198 100.0

Ninety two percent of women reported having had at least one

Pap test (Table 3.9.3); and 80% reported having had their most

recent Pap test within the preceding two years (Table 3.9.4).

Twelve percent of women reported having had their most recent

Pap test more than two years previously, including 4% who had

last had a Pap test more than six years previously.

Table 3.9.4 Time since most recent Pap test

n %

Never 16 8.1

<6 months 69 34.8

6 - <12 months 51 25.8

1 - <2 years 38 19.2

2 - <4 years 14 7.1

4 - <6 years 2 1.0

6+ years ago 8 4.0

Total 198 100.0

Among women who reported having had at least one Pap

test, 76% reported that the results of their most recent Pap

test were normal (Table 3.9.5). A higher proportion of women

reported being unsure of their most recent Pap test results than

reported that the results were abnormal (17% versus 8%).

3. Health status

2009 NSW Inmate Health Survey: Key Findings Report 69

Table 3.9.5 Result of most recent Pap test

n %

Normal 138 75.8

Abnormal 14 7.7

Don’t know 30 16.5

Total 182 100.0

Among women who reported having undertaken at least one Pap

test, 76% reported having them at the recommended frequency

of once every two years or more often (Table 3.9.6), whereas

9% reported having them less often than is recommended. Eight

percent of women with a history of Pap testing reported having

had just a single Pap test.

Table 3.9.6 Frequency of Pap testing

n %

Once only 15 8.2

Less often than once every

two years 17 9.3

Once every two years 96 52.7

Yearly 34 18.7

Twice a year or more often 9 4.9

Other 11 6.0

Total 182 100.0

Pregnancy

Eighty two percent of women reported having been pregnant

at least once in their lives (Table 3.9.7), including 27% of

women who reported having had five or more pregnancies.

Women had been pregnant a median of three times in their

lives (range 0-20). Seven women (4%) reported being pregnant

at the time of the interview, while a further two women (1%)

reported being unsure of their current pregnancy status.

Table 3.9.7 Lifetime number of pregnancies

n %

0 35 17.7

1 21 10.6

2 39 19.7

3 21 10.6

4 29 14.6

5 20 10.1

6+ 33 16.7

Total 198 100.0

Forty percent of women reported having had at least one

miscarriage (Table 3.9.8). Close to one fifth (18%) of women

reported a history of two or more miscarriages, including

3% who reported having had four or more such experiences.

Women with a history of miscarriage reported a mean age

of 22.5 years (SD 7.0; range 13-41) at their first experience

of miscarriage, and a mean age of 26.4 years (SD 7.3; range

16-42) at their most recent experience.

Table 3.9.8 Lifetime number of miscarriages

n %

Never pregnant 35 17.8

0 84 42.6

1 43 21.8

2 24 12.2

3 6 3.0

4+ 5 2.5

Total 197 100.0

Fewer than half (43%) of women reported having undergone at

least one pregnancy termination (Table 3.9.9). One fifth (20%) of

women reported a history of two or more terminations, including

2% who reported having had four or more such experiences.

Women with a history of termination reported a mean age of

20.8 years (SD 6.1; range 14-38) at their first experience of

termination, and a mean age of 25.1 years (SD 6.9; range 16-39)

at their most recent termination.

Table 3.9.9 Lifetime number of terminations

n %

Never pregnant 35 17.8

0 77 39.1

1 46 23.4

2 27 13.7

3 8 4.1

4+ 4 2.0

Total 197 100.0

Nearly two-thirds (66%) of women reported having given

birth to at least one child, including 21% who reported having

given birth to four or more children (Table 3.9.10). The mean

number of children to whom women had given birth was 2.3

(SD 2.0; range 0-15).

3. Health status

70 2009 NSW Inmate Health Survey: Key Findings Report

Table 3.9.10 Number of children given birth to

Women

n %

Never pregnant 35 17.7

0 32 16.2

1 36 18.2

2 32 16.2

3 21 10.6

4+ 42 21.2

Total 198 100.0

Women with a history of childbirth reported a mean age of 20.3

years (SD 4.6; range 13-37) at their first experience of childbirth.

Just over half (51%) of women gave birth before they were 20

years old (Table 3.9.11). The mean age of women’s most recent

experience of childbirth was 29.1 years (SD 6.7; range 16-50).

Table 3.9.11 Age first gave birth (if ever gave birth)

n %

<18 years 39 29.8

18-19 years 28 21.4

20-24 years 43 32.8

25-29 years 14 10.7

30+ years 7 5.3

Total 131 100.0

Domestic violence and abuse

Recent experience of relationships characterised by power

imbalances were relatively common among women: 45% of

women reported that a partner or spouse had engaged in

at least one form of abuse or control in the year preceding

their current incarceration (Table 3.9.12). The most common

experience reported by women was verbal abuse (40%),

followed by being physically hurt (25%), having contact with

family or friends limited (25%), and having knowledge of and/

or access to money restricted (20%). Being forced by a partner

or spouse to participate in unwanted sexual activity in the year

preceding incarceration was reported by 9% of women.

Table 3.9.12 Domestic violence and abuse experienced

(Multiple response) n %

Verbally abused you 80 40.4

Physically hurt you 50 25.3

Tried to limit contact with family or friends 49 24.7

Stopped you knowing about or having access to money 39 19.7

Forced you to take part in unwanted sexual activity 18 9.1

None of the above 109 55.1

General comments about women’s health:

• ‘Basically that Justice Health is a very important aspect of women

in prison. Sometimes it is the only opportunity women get to

address their health issues.’

3. Health status

2009 NSW Inmate Health Survey: Key Findings Report 71

4. Physical health tests

4.1 Height and weight

For each participant, the following measures were recorded:

height in centimetres (cm), weight in kilograms (kg), and

waist and hip circumferences in centimetres. These measures

were used to calculate Body Mass Index (BMI) according to

World Health Organization (WHO, 2000) guidelines, and to

assess the risk of type 2 diabetes, cardiovascular diseases and

some lifestyle-related cancers according to recommendations

made by Australian federal, State and Territory governments

in their current joint Measure Up public health campaign (see

www.measureup.gov.au), part of the Australian Better Health

Initiative approved in 2006 by the Council of Australian

Governments.

The BMI is calculated by dividing a person’s weight in

kilograms by the square of their height in metres. Ranges on

the continuous BMI score have been identified to classify an

individual as normal weight, overweight or obese based on

associations between BMI and chronic disease and mortality.

Although widely used, the BMI has limitations, including

that it cannot distinguish fat mass from lean muscle mass

and thus may overestimate overweight and obesity among

muscular individuals. Further, BMI does not necessarily

reflect body fat distribution, with the accumulation of

intra-abdominal fat more predictive of ill health and

chronic disease than fat accumulated in other parts of the

body, such as the hips and thighs. BMI also varies across

different population groups (NHMRC, 2003a; WHO, 2000).

Accordingly, both the NHMRC (2003a) and the WHO

(2000) recommend using a combination of both waist

circumference and BMI to assess the risk of chronic disease

such as type 2 diabetes and cardiovascular disease.

The mean height of men in the 2009 IHS was 177 cm

(range 120-197 cm), and the mean weight was 81.4 kg

(range 46-197kg). Among women, the mean height was

164 cm (range 148-184 cm) and mean weight was 73.9 kg

(range 48-138 kg).

Using these measurements to calculate BMI according to

WHO (2000) guidelines, close to one half of participants

(44%) were classified as having a BMI in the healthy weight

range (BMI of 18.5-24.9) (Table 4.1.1); 37% were classified

as having a BMI indicative of overweight (BMI of 25.0-29.9);

and 19% were classified as obese according to the BMI

(BMI of 30 or higher). There were also five men who were

classified as being underweight. Although the proportions

of males and females classified in the healthy weight range

were similar, a higher proportion of males than females

was classified as overweight (39% versus 29%), whereas a

higher proportion of females was classified as obese (29%

versus 16%).

Rates of overweight and obesity among prison inmates

can be compared to those of the general population by

comparison of these figures with those from the National

Health Survey (NHS) 2007-08 (ABS, 2009). BMI results from

the 2007-08 NHS indicate that 37% of Australian adults have

a BMI in the healthy weight range; 37% are classified in the

overweight range; and 25% are classified as obese. A higher

proportion of adult males in the general population are

overweight or obese (68%) than adult females (55%). Thus,

compared to the general population, IHS participants were

more likely to be of a healthy weight (44% versus 37%), and

less likely to be obese (19% versus 25%), but equally likely to

be overweight (37% versus 37%).

Table 4.1.1 Body Mass Index category

Men Women Total

n % n % n %

Underweight (<18.5) 4 0.6 0 0.0 4 0.5

Healthy weight

(18.5 - 24.9) 301 44.3 77 42.3 378 43.9

Overweight (25.0 - 29.9) 266 39.1 53 29.1 319 37.0

Obese (30+) 109 16.0 52 28.6 161 18.7

Total 680 100.0 182 100.0 862 100.0

4. Physical health tests

72 2009 NSW Inmate Health Survey: Key Findings Report

More than half (56%) of the 2009 IHS sample were

classified as overweight or obese according to the BMI.

Compared to both the 1996 (49%) and 2001 (49%)

Surveys, this finding represents an increase in the proportion

of overweight and obese participants (Table 4.1.2). The

increase is consistent with the patterns of overweight and

obesity among Australia’s general population, as reported

in the 2007-08 NHS (ABS, 2009). Among the general adult

population, the proportion of overweight or obese males

increased from 64% in 1995 to 68% in 2007-08, and the

proportion of overweight or obese females increased from

49% to 55% over the same period.

Table/Fig 4.1.2 Overweight or obese (BMI of 25.0 or

higher)

0

10

20

30

40

50

60

70

42.2 44.2

57.7

50.9 49.8

55.1

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 327 643 50.9 356 715 49.8 375 680 55.1

Women 54 128 42.2 73 165 44.2 105 182 57.7

Total 381 771 49.4 429 880 48.8 480 862 55.7

As noted above, both the NHMRC (2003a) and the WHO

(2000) recommend also using waist circumference as a

measure of risk of chronic disease. According to NHMRC

(2003a) guidelines, a waist circumference of less than 80 cm

in women and 94 cm in males is associated with a low risk

of chronic disease; between 80 and 88 cm in women and

94 and 102 cm in men is associated with an increased risk;

and greater than 88 cm in women and 102 cm in men is

associated with substantially increased risk. According to

those guidelines, 23% of men and 21% women had waist

circumferences indicating that they were at increased risk;

and 15% of men and 54% of women were at substantially

increased risk (Table 4.1.3). Thus, consistent with BMI

measurements, a higher proportion of women than men

recorded a waist circumference indicative of substantially

increased risk of chronic disease.

Table 4.1.3 Waist circumference

Men Women Total

n % n % n %

Low risk (<94 cm males,

<80 cm females) 421 62.7 44 24.6 465 54.6

Increased risk (94-102 cm

males, 80-88 cm females) 152 22.6 38 21.2 190 22.3

Substantially increased risk

(>102 cm males, >88 cm

females) 99 14.7 97 54.2 196 23.0

Total 672 100.0 179 100.0 851 100.0

The waist-to-hip ratio (waist circumference in cm divided by

hip circumference in cm) has recently been shown to be the

strongest predictor of cardiovascular disease and coronary heart

disease death, superior to waist circumference which in turn

is superior to BMI (Welborn et al., 2003). The NHMRC (2003)

reviewed evidence indicating that a waist to hip ratio of <0.96

for males and <0.81 for females is associated with a low risk of

chronic disease. Among 2009 IHS participants, a substantially

higher proportion of men than women recorded a waist-to-hip

ratio in the low risk category (72% versus 20%) (Table 4.1.4);

conversely, a substantially higher proportion of women were

classified in the high risk category (64% versus 15%).

Table 4.1.4 Waist-to-hip ratio

Men Women Total

n % n % n %

Low risk

(<0.96 males, <0.81 females) 479 72.1 36 20.0 515 61.0

Moderate risk (0.96-1.0 males,

0.81-0.85 females) 84 12.7 28 15.6 112 13.2

High risk

(>1.0 males, >0.85 females) 101 15.2 116 64.4 217 25.7

Total 664 100.0 180 100.0 844 100.0

Women were substantially more likely than men to perceive

themselves as overweight or very overweight (42% versus

22%), whereas men were more likely to perceive their weight

as normal (65% versus 51%) or underweight/very underweight

(13% versus 7%) (Table 4.1.5). As reported previously, BMI

calculations indicated that more than half (56%) of participants

were overweight or obese. Among these 482 participants,

4. Physical health tests

2009 NSW Inmate Health Survey: Key Findings Report 73

women were more likely to perceive themselves as overweight

or very overweight than men (66% of obese/overweight

women compared with 37% of men).

Table 4.1.5 Self-perceived body weight

Men Women Total

n % n % n %

Very overweight 11 1.4 18 9.1 29 2.9

Overweight 166 20.9 66 33.3 232 23.3

Normal weight 515 64.7 100 50.5 615 61.9

Underweight 91 11.4 13 6.6 104 10.5

Very underweight 9 1.1 1 0.5 10 1.0

Don’t know 4 0.5 0 0.0 4 0.4

Total 796 100.0 198 100.0 994 100.0

Five women (3%) reported that they had purposely caused

themselves to vomit in the preceding four weeks specifically

in order to control their body weight. Two women reported

that they had taken pills to control their body weight in the

last four weeks. More than half (55%) of women reported

dissatisfaction with their body shape, with 35% indicating

that they would prefer to be much thinner.

4.2 Blood pressure

The WHO updated its guidelines on the management of

hypertension (high blood pressure) in 2003, indicating that

high blood pressure can be diagnosed in an individual who:

• records a systolic blood pressure of 140 mmHg

or more; and/or

• records a diastolic blood pressure of 90 mmHg

or more; and/or

• is prescribed medication to treat high blood pressure.

The mean systolic blood pressure among male 2009 IHS

participants was 118 mmHg (range=90-178 mmHg), and

among women was 110 mmHg (range=85-160 mmHg).

A total of 40 men and six women recorded a systolic blood

pressure of 140 mmHg or higher. The mean diastolic blood

pressure among men was 72.3 mmHg (range=40-124 mmHg),

and among women was 68.5 mmHg (range=40-110 mmHg).

A total of 43 men and five women recorded a diastolic blood

pressure of 90 mmHg or higher.

A total of 121 of the 864 participants (14%, including 15%

of men and 12% of women) for whom results were available

were classified as having high blood pressure according to

the WHO (2003) guidelines. This figure represents a decrease

in the overall proportion of participants with high blood

pressure, from 22% in 1996 and 19% in 2001, although the

decrease occurred among male rather than female participants

(Table 4.2.1). Of those classified as having high blood pressure

in 2009, 73 (60%) self-identified the condition during the

telephone interview.

Table/Fig 4.2.1 High blood pressure

0

5

10

15

20

25

30

10.1

7.0

11.5

24.3

22.0

14.7

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 157 645 24.3 158 718 22.0 100 682 14.7

Women 13 128 10.1 11 157 7.0 21 182 11.5

Total 170 773 22.0 169 875 19.3 121 864 14.0

4. Physical health tests

74 2009 NSW Inmate Health Survey: Key Findings Report

4.3 Peak flow and spirometry

Peak expiratory flow (PEF) is a measure of maximum

expiratory flow occurring just after the start of a forced

expiration from the point of maximum inspiration (total

lung capacity). PEF is used to provide a measure of airway

calibre or airflow. Single PEF measures have wide ranges of

normal and are no longer considered useful in the diagnosis

of asthma, rather are used in monitoring to measure

variation (National Asthma Council of Australia, 2006).

Peak flow measurements were taken from 862 participants,

including 682 men and 180 women. Of these, 32% of men

and 48% of women returned a reading below the normal

range (using a cut off of 80% or higher to indicate normal

function and an algorithm using height, age and gender)

(Partners Asthma Centre, 2009). See section 3.5 (Asthma)

for more information.

The 2001 IHS report did not specify how below normal peak

flow was calculated, so the data was re-analysed using the

2009 algorithm. This change resulted in a higher proportion

of 2001 participants recording a below normal peak flow

result, from 30% (in the 2001 IHS report) to 42% among

men, and from 17% (in the 2001 IHS report) to 36%

among women (Table 4.3.1).

Table/Fig 4.3.1 Below normal (<80%) peak flow reading

0

10

20

30

40

50

60

36.4

48.3

42.2

31.6

2001 2009

Men Women

PERCENT

YEAR

2001 2009

Men

N=708

Women

N=162

Men

N=682

Women

N=180

Below normal range (<80%) 42.2 36.4 31.6 48.3

Normal range (80+%) 57.8 63.6 68.4 51.7

When compared with the proportion of participants who

indicated they had ever been told they had asthma, 49% of

those with asthma had below normal peak flow readings,

compared with 29% of those who did not have asthma.

Spirometry is the most useful Pulmonary Function Test in the

management of lung disease. It allows reliable measurement

of airflow limitation compared with normal predicted air

flow and reversibility of airflow limitation (National Asthma

Council of Australia, 2006). Spirometry testing is performed

using a spirometer, which produces results in the form of

graphs. Among 2009 IHS participants, spirometry testing was

conducted in 216 men (42%) and 38 women (33%). As a

result of the graphical format of the results, they are not easily

summarised and are not presented in this report.

4.4 Vision

Among participants who underwent a physical health

examination, 362 (42%) indicated they wore glasses or contact

lenses, with the majority (93%) of these people indicating they

wore both glasses and contacts. Just over one-third (34%)

of these participants did not self-report that they had poor

eyesight in the phone interview. By contrast, 50 people selfreported

that they had poor eyesight but didn’t currently have

glasses or contacts.

When tested for their vision using both eyes (allowing

participants to use their glasses or contacts), 78% had at

least 6/9 vision (Table 4.4.1). Normal vision (6/6) was found

in 25% of men and 37% of women.

Table 4.4.1 Eyesight test (both eyes)

(Multiple response)

Men Women Total

n % n % n %

Line 1 (6/60) 654 99.7 173 99.4 827 99.6

Line 2 (6/36) 651 99.2 171 98.3 822 99.0

Line 3 (6/24) 638 97.3 165 94.8 803 96.8

Line 4 (6/18) 627 95.6 159 91.4 786 94.7

Line 5 (6/12) 605 92.2 149 85.6 754 90.8

Line 6 (6/9) 517 78.8 127 73.0 644 77.6

Line 7 (6/7.5) 376 57.3 104 59.8 480 57.8

Line 8 (6/6) 161 24.5 64 36.8 225 27.1

Total 656 100.0 174 100.0 830 100.0

4. Physical health tests

2009 NSW Inmate Health Survey: Key Findings Report 75

4.5 Wounds and MRSA

Participants in the 2009 IHS who underwent a physical health

examination (N=830) were asked whether they currently had

any cuts or sores. A small proportion (31 men and six women)

reported that they were currently suffering from a wound or

sore, including cuts, scratches, boils, burns, a dog bite and a

surgical wound. The majority (81%) of the 37 participants who

reported sores or cuts further reported currently suffering a

single such sore or cut, although up to three were reported by

small numbers of participants. Most sores and cuts appeared

to be of a relatively superficial nature, with the majority (61%)

of participants reporting that they had suffered their cuts or

sores within just the preceding week, and a smaller proportion

nominating a duration of between one and two weeks; although

four men reported having had a wound that had lasted for a

month or longer. Almost all participants who reported currently

suffering cuts or sores reported that they had sustained these

injuries in prison rather than the community.

Methicillin-resistant Staphylococcus aureus (MRSA) infection is

caused by Staphylococcus aureus bacteria, a strain of “staph”

that is resistant to the broad-spectrum antibiotics commonly

used to treat it. Most MRSA infections occur in hospitals or

other health care settings, such as nursing homes and dialysis

centres. Older adults and people with weakened immune

systems are at greatest risk.

Of the 37 participants with a current cut or sore mentioned

above, a MRSA swab was conducted on the open wounds

of 16 participants (13 men and three women). Among

these participants a MRSA culture (with varying sensitivities

and resistances among antibiotics) was isolated in two

individuals (13%).

Approximately 10-30% of people are colonised with

Staphylococcus aureus with a smaller sub-group colonised

with MRSA (approximately 0.8%) (Kuehnert et al., 2006,

Abudu et al., 2001). MRSA transmission is more likely among

athletes and in institutions such as prisons characterised by

increased skin-to-skin contact, frequent skin wounds and

poor cleaning and hygeine (Rihn et al., 2005, Marcotte &

Trzeciak, 2008). This poses a potential threat to those at

increased risk of systemic MRSA infection and the potential

for outbreaks of MRSA in prison populations (Pan et al.,

2003; Baillargeon et al., 2004).

Nasal swabs for MRSA were conducted among 805 participants,

including 625 men and 180 women. MRSA culture was detected

in seven of these nasal swabs (0.9%).

4.6 Blood borne viruses

Inmate populations are characterised by increased risk of exposure

to infectious diseases including blood borne viruses (BBVs) and

sexually transmissible infections (STIs) (e.g., Butler, Boonwaat et

al., 2007; Butler, Donovan et al., 2000; Butler, Kariminia et al.,

2004b; Butler, Robertson et al., 2001; Butler, Spencer et al., 1999;

Levy et al., 2007). Consequently, participation in the IHS, which in

2009 involved testing for exposure to Human Immunodeficiency

Virus (HIV), herpes, hepatitis B (HBV) and C (HCV) viruses, syphilis,

chlamydia, and gonorrhoea, can provide inmates with a valuable

screening opportunity.

HIV

Exposure to the Human Immunodeficiency Virus (HIV) is assessed

by the presence of HIV antibodies, the body’s immunological

response to the virus. In 2009, one male IHS participant tested

positive to HIV antibody. This participant was a known HIV case,

and self-reported his HIV positive status during the telephone

interview. An additional five participants (all men) self-reported

being HIV positive, but serological testing indicated no evidence of

exposure to HIV among these participants. HIV therefore appears

not to be a substantial public health concern among prison

inmates, reflecting the epidemiology of the broader Australian

population, among whom HIV prevalence has remained low and

stable (NCHECR, 2008). Nevertheless, the absence of complete

concordance between self-reported and serological HIV infection

status indicates that ensuring that inmates receive appropriate

post-test counselling and clearly understand the results of their

tests remains an important outcome to pursue.

The 2009 results are similar to those found in the 2001 IHS,

when one male participant who self-reported being HIV positive

was serologically confirmed to have been exposed to the virus.

The serological status of a further eight 2001 participants (all

men) who self-reported being HIV positive indicated that they

had not been exposed to the virus. Likewise, in the 1996 IHS,

two male and two female participants, all of whom self-reported

being HIV positive, tested positive to HIV antibody, while a

further three participants who self-reported exposure to the virus

tested negative to HIV antibody.

4. Physical health tests

76 2009 NSW Inmate Health Survey: Key Findings Report

Hepatitis C virus

Close to one-third of the 2009 IHS sample tested positive to

Hepatitis C virus (HCV) antibody, a measure of exposure to the

virus, with a higher proportion of women than men testing

positive (Table 4.6.1). The gender difference is consistent with

findings of both the 1996 and 2001 IHSs. Of particular note,

prevalence of antibodies decreased substantially since 2001

among both men and women, and, consequently, among

the samples as a whole. This included a drop from 64% of

women in 2001 to 45% of women in 2009 and 40% of

men to 28% of men. The primary reason for this is that the

proportion of injecting drug users also decreased significantly

since 2001 (see section 5.6 for more details). Among the 229

participants who tested positive to HCV antibody in 2009,

62 (27%) were newly diagnosed cases that were previously

unaware of their HCV infection.

Table/Fig 4.6.1 Hepatitis C antibody positive

0

10

20

30

40

50

60

70

80

66.4 63.6

45.4

33.2

40.1

28.0

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 209 629 33.2 281 700 40.1 160 571 28.0

Women 79 119 66.4 96 151 63.6 69 152 45.4

Total 288 748 38.5 377 851 44.3 229 723 31.7

Hepatitis B virus (HBV)

Hepatitis B virus (HBV) serological testing may detect a range

of markers (Hoofnagle, 1981):

• Hepatitis B surface antigen (HBsAg) is a marker of

active infection;

• Hepatitis B surface antibody (HBsAb) appears when a

person has cleared the virus or has responded to HBV

vaccination. A positive HBsAb result indicates that a

person is immune to HBV (cannot get re-infected) and is

no longer infectious;

• Hepatitis B core antibody (HBcAb), the most common test

in surveillance research, is a marker of exposure to HBV

(previous or current infection). Testing positive for both

HBcAb and HBsAg indicates current (acute or chronic)

infection. Testing positive to both HBcAb and HBsAb

indicates recovery from prior infection.

Twenty six per cent of 2009 IHS participants tested positive to

HBcAb, indicating exposure to the virus and either past or present

infection. This finding constituted a continuation of the decrease

in the prevalence of exposure to HBV noted among both male

and female participants between 1996 and 2001 (Table 4.6.2).

Also consistent with findings of previous surveys was the higher

prevalence of HBcAb among women (34%) than men (23%).

Table/Fig 4.6.2 Hepatitis B core antibody positive

0

10

20

30

40

50 46.2

31.1

33.1 33.8

28.0

23.2

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 208 629 33.1 197 704 28.0 125 539 23.2

Women 55 119 46.2 47 151 31.1 51 151 33.8

Total 263 748 35.2 244 855 28.5 176 690 25.5

4. Physical health tests

2009 NSW Inmate Health Survey: Key Findings Report 77

The decrease in prevalence of exposure to HBV was also

reflected in decreases between 1996 and 2009 in the

proportion of IHS participants who tested positive to HBsAg,

the marker of active infection (Table 4.6.3). Less than 2% of

the 2009 sample had serological indicators of current infection,

a decrease from around 3% in both 1996 and in 2001.

Table/Fig 4.6.3 Hepatitis B surface antigen positive

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0.8

2.0

0.0

3.5

3.1

2.2

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 22 629 3.5 22 703 3.1 13 585 2.2

Women 1 119 0.8 3 150 2.0 0 152 0.0

Total 23 748 3.1 25 853 2.9 13 737 1.8

A higher proportion of 2009 IHS participants tested positive

to HBsAb in 2009 than in 2001 (Table 4.6.4), indicating that

more inmates are immune to HBV infection than has been the

case in the past. Consistent with the 2001 results, a higher

proportion of women (65%) than men (57%) tested positive.

Note that this marker was not included in serological screening

conducted in the 1996 Survey.

Table/Fig 4.6.4 Hepatitis B surface antibody positive

0

10

20

30

40

50

60

70

80

90

54.3

65.1

45.7

56.5

2001 2009

Men Women

PERCENT

YEAR

2001 2009

n Total % n Total %

Men 322 705 45.7 324 573 56.5

Women 82 151 54.3 99 152 65.1

Total 404 856 47.2 423 725 58.3

Vaccine-conferred immunity to HBV is demonstrated when an

individual tests positive for HBsAB (10 mIU/ml) while testing

negative for core antibody. The overall proportion of IHS

participants with vaccine-conferred immunity increased from

2001 to 2009 (35% to 38%), although this increase was only

evident in males (Table 4.6.5).

Table/Fig 4.6.5 Vaccine-conferred immunity to

Hepatitis B virus

0

10

20

30

40

50

60

41.1 39.7

33.8

37.7

2001 2009

Men Women

PERCENT

YEAR

2001 2009

n Total % n Total %

Men 238 704 33.8 200 530 37.7

Women 62 151 41.1 60 151 39.7

Total 300 855 35.1 260 681 38.2

4. Physical health tests

78 2009 NSW Inmate Health Survey: Key Findings Report

4.7 Sexually transmissible infections

Chlamydia

Chlamydia is a common STI, caused by the bacterium

Chlamydia trachomatis and occurring most frequently among

young people (under 25 years of age). Most infected women

have no signs or symptoms, but if left untreated, chlamydia

can lead to pelvic inflammatory disease (PID), complications

of which include ectopic pregnancy and infertility. Pregnant

women with chlamydia may pass the infection to their baby

during childbirth, causing lung or eye infections. The majority

of infected men also experience few symptoms, but if the

infection spreads from the urethra to the epididymis, it may

cause significant pain (Victorian Department of Health,

2009a). When detected early, chlamydia can be effectively

treated with a single dose of antibiotics.

Chlamydia is the most frequently notified infection in Australia,

with 51,867 newly diagnosed cases notified in 2007 (NCHECR,

2008). The rate of testing for chlamydial infection has increased

over time and is likely to be partly responsible for the ongoing

increase in the numbers of cases. Age- and gender-specific

patterns may also be influenced by differential testing rates

(NCHECR, 2008).

Among participants in the 2009 IHS, chlamydia was detected

among twelve male participants (2%) and one female participant.

These results mirrored exactly those of the 2001 IHS, when

chlamydia was detected among twelve male participants and one

female participant. Participants in the 1996 IHS were not tested

for chlamydia.

Gonorrhoea

Gonorrhoea is an STI caused by the bacterium Neisseria

gonorrhoeae. Among women, symptoms are generally

mild and may be so unspecific that gonorrhoea may go

undetected for long periods. If left untreated among

women, gonorrhoea may lead to PID. Likewise, some men

experience no symptoms of gonorrhoea, whereas some may

experience pus-like penile discharge and burning sensations

during urination. Gonorrhoea can cause epididymitis, a

painful condition of the ducts attached to the testes that

can lead to infertility if left untreated (CDC, 2007).

Gonorrhoea is more commonly diagnosed among men than

women, among Aboriginal than non-Aboriginal Australians, and

among 15-39 year olds than other age groups. Australia’s general

population rate of diagnosis of gonorrhoea increased steadily

between 1998 and 2006, followed by a 15% decline between

2006 and 2007 among men, to a rate of 47.9 per 100,000

population, and a 6% decline among women, to a rate of 24.5

per 100,000 population. The decline occurred first among 15-19

year olds, followed by 20-29 and 30-39 year olds (NCHECR,

2008), and occurred primarily in Victoria, NSW and Queensland.

Among 2009 IHS participants, gonorrhoea was detected in

one male and in no female participants. In comparison, among

2001 IHS participants, gonorrhoea was detected in three male

and in no female participants. Participants in the 1996 IHS

were not tested for gonorrhoea.

Syphilis

Syphilis is an STI caused by the bacterium Treponema pallidum.

It is transmitted through close skin-to skin contact and is highly

contagious when the associated skin inflammation is present.

Those most at risk of syphilis are homosexually active men and

people who have engaged in sexual activity in countries with high

prevalence of syphilis. Pregnant women may also pass syphilis to

their unborn baby (Victorian Department of Health, 2009b).

Syphilis is more commonly diagnosed among men than women,

and among Aboriginal than non-Aboriginal Australians. Among

Australia’s general population, the rate of diagnosis of syphilis

more than doubled, from 3.1 per 100,000 in 2004, to 6.6 in

2007 (NCHECR, 2008). The increases occurred in NSW, Victoria

and Queensland and were almost completely confined to

homosexually active men (NCHECR, 2008).

Among 2009 IHS participants, syphilis was detected among eight

men (1%) and three women (2%), all of whom were cases with

no history of previous diagnosis. These findings were similar to

those of the 2001 IHS, when syphilis was detected among twelve

male (2%) and one female (<1%) participant. Participants in the

1996 IHS were not tested for syphilis.

4. Physical health tests

2009 NSW Inmate Health Survey: Key Findings Report 79

Herpes

Herpes is a common infection passed on through skin-to-skin

contact and caused by the herpes simplex virus (HSV). HSV

causes blisters and sores, usually around the mouth, nose,

genitals, and buttocks, but they may occur almost anywhere

on the skin. There are two types of HSV, Type 1 and Type 2.

Often referred to as cold sores, HSV Type 1 infections are tiny,

clear, fluid-filled blisters that most often occur on the face.

Less frequently, Type 1 infections can occur in the genital area.

Type 1 may also develop in wounds on the skin. Most people

acquire HSV1 in infancy or childhood through close contact

with an infected person, but it can be acquired at any age,

through kissing, sharing utensils or towels (AAD, 2009). HSV1

infections may be primary or recurrent. Although most people

acquire the infection when exposed to the virus, only around

ten percent will subsequently develop sores.

Although it may occur in other locations, infection with HSV

Type 2 usually results in sores on the buttocks, penis, vagina,

or cervix, two to twenty days after contact with an infected

person. Sexual intercourse is the most frequent means of

acquiring the infection. Both primary and recurrent attacks

can cause a minor rash or itching, painful sores, fever, aching

muscles, and a burning sensation with urination. As with

Type 1, sites and frequency of repeated bouts vary. The initial

episode can be so mild that a person does not realize that he

or she has an infection. Years later, when HSV recurs, it may

be mistaken for an initial attack.

The laboratories that screened for antibodies to the herpes virus

unfortunately did not distinguish between HSV1 and HSV2, so

the results below cannot easily be compared to the previous

IHS or community samples. Among 2009 IHS participants

who were screened for HSV, 88% of men (N=208) and 98%

of women (N=126) tested positive for antibodies to the virus.

These findings are similar to the findings of the 2001 IHS, in

which 85% of men and 89% of women tested positive for

antibodies to HSV1. The prevalence of HSV1 among Australia’s

general adult population is also relatively high, at 76%, with

prevalence higher among women than among men (80%

versus 71%) (Cunningham et al., 2006).

4.8 Prostate specific antigen

Prostate-specific antigen (PSA) is a protein produced by the

cells of the prostate gland. PSA is present in small quantities

in the blood of healthy men, but is often elevated in the

presence of prostate cancer and in other prostate disorders.

A temporary rise in PSA can be caused by a number of

conditions. Urinary infection, prostatitis (inflammation of

the prostate), or a biopsy of the prostate can cause large

rises, while small rises can be caused by ejaculation and

even bicycle riding. Nevertheless, a blood test to measure

PSA is considered the most effective test currently available

for the early detection of prostate cancer. Because PSA

levels tend to increase with age, there is no specific cut-off

for possible prostate cancer. Current guidelines indicate

using a PSA level of greater than or equal to 3.0 ng/ml

for men aged 50 to 59 years, 4.0 ng/ml for men aged 60

to 69 years and 5.5 ng/ml for men aged 70 years or more

(Repatriation General Hospital, 2005).

In the 2009 IHS, the blood samples of 77 men aged 50

years or older were screened for PSA. Using the age-specific

categories above, eleven men (14%) had elevated PSA levels.

Depending on the degree of elevation and other findings,

this may indicate further investigation for prostate cancer.

4.9 Blood glucose and HbA1c

Finger-prick and venous blood glucose testing

The plasma glucose levels of random (non-fasting, nonglucose-

challenged) blood samples provided by participants

through a finger-prick were tested. It was not possible to

ensure that participants fasted prior to their participation

in this Survey, and thus it was not possible to request

fasting blood sugar tests. According to the guidelines on

detection and management of Type 2 diabetes produced

by the NHMRC (2009a), 60% of the sample recorded

plasma glucose levels under 5.5mmol/L, indicating that

diabetes was unlikely among the majority of participants

(Table 4.9.1). Forty percent of the sample recorded plasma

glucose levels within the range where diabetes is considered

possibly present, including a higher proportion of female

(47%) than male (38%) participants, whereas plasma

glucose levels considered to indicate that diabetes is likely

were recorded by less than 1% of the sample.

4. Physical health tests

80 2009 NSW Inmate Health Survey: Key Findings Report

Among the 37 participants who self-reported that they had

diabetes, 27% (N=10) recorded plasma glucose levels of less

than 5.5 mmol/L; 60% (N=22) recorded plasma glucose levels

between 5.5 and 11 mmol/L; and 14% (N=5) recorded levels

higher than 11.0 mmol/L.

Table 4.9.1 Blood sugar (random plasma glucose) level

by finger-prick test

Men Women Total

n % n % n %

Diabetes unlikely

(<5.5 mmol/L) 415 61.4 94 52.2 509 59.5

Diabetes possible

(5.5 - 11.0 mmol/L) 255 37.7 85 47.2 340 39.7

Diabetes likely

(>11.0 mmol/L) 6 0.9 1 0.6 7 0.8

Total 676 100.0 180 100.0 856 100.0

Non-fasting venous blood samples provided by 2009 IHS

participants were also tested for plasma glucose levels. The

majority of participants (92%) recorded glucose levels in

the normal range. Approximately N=43 men and 13 women

had blood glucose readings indicative of possible diabetes

(Table 4.9.2).

Table 4.9.2 Blood sugar (random plasma glucose) level

by venous blood sample

Men Women Total

n % n % n %

Diabetes unlikely

(<5.5 mmol/L) 515 92.3 147 91.9 662 92.2

Diabetes possible

(5.5 - 11.0 mmol/L) 37 6.6 13 8.1 50 7.0

Diabetes likely

(>11.0 mmol/L) 6 1.1 0 0.0 6 0.8

Total 558 100.0 160 100.0 718 100.0

HbA1c

HbA1c is a test that measures the amount of glycated

haemoglobin in the blood. In the normal 120-day life span of

the red blood cell, glucose molecules react with haemoglobin,

forming glycated haemoglobin. The level of glycated

haemoglobin within red blood cells therefore reflects the

average level of glucose to which the cell has been exposed

during its life cycle. Thus, HbA1c provides an average measure

of blood glucose levels during the preceding two weeks to

three months. In individuals with poorly controlled diabetes,

the quantities of glycated haemoglobins are much higher

than in people with normal blood glucose regulation. The

International Diabetes Federation Clinical Guidelines Taskforce

(2005) recommends HbA1c levels of below 6.5%; this is the

cut-off used in the table below. Five percent of 2009 IHS

participants recorded HbA1c levels above normal, including

5% of men and 4% of women (Table 4.9.3).

Table 4.9.3 Glycated haemoglobin (HbA1c results)

Men Women Total

n % n % n %

Normal (<6.5%) 524 94.8 130 96.3 654 95.1

Above normal

(6.5%) 29 5.2 5 3.7 34 4.9

Total 553 100.0 135 100.0 688 100.0

Glucose in urine

Urine samples were collected from N=795 IHS participants

(78% of men, 86% of women). Urine dipsticks were used

to test for the presence of a range of substances (including

leukocytes, protein, glucose, ketones, bilirubin, blood and

microalbumin). The results below are provided related to the

finding of glucose in the urine; some results (e.g. protein,

bilirubin and microalbumin) are presented later, while results

for others are not shown in this report.

Normally, little glucose is present in the urine. The presence

of glucose in urine, called glycosuria, may be an indicator

of diabetes, glucose release from the kidneys into the urine

(called renal glycosuria), or pregnancy. Further testing is

required to determine the cause of abnormal urine glucose

results. Among 209 IHS participants who were screened,

the urine samples of six men and three women contained

abnormal levels of glucose.

4. Physical health tests

2009 NSW Inmate Health Survey: Key Findings Report 81

4.10 Liver function

The blood samples provided by 2009 IHS participants were

analysed for a range of measures of liver function. Bilirubin is

the yellow waste product of the catabolism of haem, which

is found in haemoglobin, a principal component of red blood

cells. Bilirubin is excreted in bile, and its levels are elevated

in certain diseases, in particular, in relation to biliary disease

(intra or extra-hepatic), but sometimes with haemolysis

(unconjugated). Total and direct bilirubin are usually measured

to screen for or to monitor liver or gallbladder problems.

An accepted upper cut-off for bilirubin levels is 17 umol/L

(Deepak et al., 2007). According to this cut-off, 6% of 2009

IHS participants had bilirubin levels that were above normal

(Table 4.10.1), including 7% of men and 3% of women.

Table 4.10.1 Bilirubin levels

Men Women Total

n % n % n %

Normal

(<17 umol/L) 531 93.3 154 96.9 685 94.1

Above normal

(17 umol/L) 38 6.7 5 3.1 43 5.9

Total 569 100.0 159 100.0 728 100.0

A range of other common liver function tests (LFTs) were

conducted. Gamma-glutamyltransferase (GGT) is an

enzyme found in many bodily tissues, but most notably the

liver. GGT levels are elevated in cholestatic liver disease,

hepatacellular disease, diabetes, chronic excessive alcohol

intake and with drug-related enzyme induction (especially

phenytoin) (RCPA, 2009). According to the results provided

by the laboratories which analysed the blood samples

of 2009 IHS participants, GGT levels were above normal

among 25% of men and 21% of women (Table 4.10.2)

(Reynaud et al., 2000).

Table 4.10.2 Gamma-glutamyltransferase (GGT) levels

Men Women Total

n % n % n %

Normal (<40 u/L) 427 74.8 125 79.1 552 75.7

Above normal

(40 u/L) 144 25.2 33 20.9 177 24.3

Total 571 100.0 158 100.0 729 100.0

Like GGT, alkaline phosphatase (ALP) is an enzyme found in

many bodily tissues, but particularly concentrated in the liver.

Increased ALP levels are seen in liver disease (particularly with

cholestasis), bone disease (e.g. Paget’s disease), with bony

metastases and some non-liver, non-bone malignancies (RCPA,

2009). According to the results provided by the laboratories

which analysed the blood samples of 2009 IHS participants,

the ALP levels of 13% of men and 12% of women were

elevated (Table 4.10.3) (University of Michigan, 2009).

Table 4.10.3 Alkaline phosphatase (ALP) levels

Men Women Total

n % n % n %

Normal (<118 u/L) 479 87.1 134 87.6 613 87,2

Above normal

(118 u/L) 71 12.9 19 12.4 90 12.8

Total 550 100.0 153 100.0 703 100.0

Alanine aminotransferase (ALT) is an enzyme more

specifically associated with the liver. Significantly elevated

levels of ALT often suggest the existence of hepatocellular

damage, such as viral hepatitis, auto-immune hepatitis

and drug and other toxicity. When elevated ALT levels are

detected, the possible underlying causes can be further

narrowed down by measuring other enzymes. Among 2009

IHS participants, the ALT levels of 12% of men and 20% of

women were elevated (Table 4.10.4) (Jamal et al., 2003).

These findings may be consistent with the relatively high

rates of HCV infection among this sample, as well as the

high rates of illicit and prescribed use of drugs with liver

toxicity side effects (Martin et al., 2008).

Table 4.10.4 Alanine aminotransferase (ALT) levels

Men Women Total

n % n % n %

Normal

(<53 u/L women;

<73 u/L men) 502 87.8 128 80.5 630 86.1

Above normal

(53 u/L women;

73 u/L men) 70 12.2 31 19.5 101 13.8

Total 572 100.0 159 100.0 731 100.0

4. Physical health tests

82 2009 NSW Inmate Health Survey: Key Findings Report

Aspartate aminotransferase (AST) is another transaminase

indicative of liver disease, although also elevated in cardiac and

skeletal muscle disease. The ratio of AST to ALT is an indicator of

alcohol consumption and associated liver damage. For example,

AST/ALT ratio is typically >1 in alcoholic liver disease and <1 in

non-alcoholic liver disease (RCPA, 2009). According to the results

provided by the laboratories which analysed the blood samples of

2009 IHS participants, the AST levels of 37% of men and 38% of

women were elevated (Table 4.10.5) (Berk & Korenblat, 2007).

Table 4.10.5 Aspartate aminotransferase (AST) levels

Men Women Total

n % n % n %

Normal (<35 u/L) 361 63.1 99 62.3 460 62.9

Above normal

(35 u/L)) 211 36.9 60 37.7 271 37.1

Total 572 100.0 159 100.0 731 100.0

4.11 Renal function

The general biochemistry of 2009 IHS participants was examined

using the blood samples provided by 568 men and 160 women.

Three tests are measures of renal function, namely the levels of

urea and creatinine, and the estimated glomerular filtration rate.

Urea is a waste product generated during the breakdown

of proteins. Urea is usually excreted in the urine by the

kidneys. Abnormally high levels of urea may indicate kidney

impairment. Other possible causes include blockage of the

urinary tract by a kidney stone or tumour; heart attack or

congestive heart failure; dehydration; fever; shock; or bleeding

in the digestive tract. According to the results provided by the

laboratories which analysed the blood samples of 2009 IHS

participants, abnormal urea levels were detected in 4% of

men and 3% of women (Table 4.11.1) (RCPA, 2009).

Table 4.11.1 Urea levels

Men Women Total

n % n % n %

Normal (<8 mmol/L) 545 96.0 155 96.9 700 96.2

Above normal

(8 mmol /L) 23 4.0 5 3.1 28 3.8

Total 568 100.0 160 100.0 728 100.0

Creatinine is a waste product generated during muscle

metabolism that is filtered by the kidneys and excreted in urine.

Creatinine blood levels remain relatively stable because the muscle

mass in the body is relatively constant. Creatinine blood levels will

rise in kidney impairment due to poor clearance; thus, abnormal

levels of creatinine may indicate possible kidney malfunction or

failure. Other causes of high creatinine include muscle conditions

such as rhabdomyalysis. According to the results provided by

the laboratories which analysed the blood samples of 2009 IHS

participants, abnormal creatinine levels were detected in six men

(1%) and two women (1%) (Table 4.11.2) (RCPA, 2009).

Table 4.11.2 Creatinine levels

Men Women Total

n % n % n %

Normal

(110 umol/L women/

120 umol/L men) 562 98.9 158 98.8 720 98.9

Above normal

(>110 umol/L

women/

>120 umol/L men) 6 1.1 2 1.2 8 1.1

Total 568 100.0 160 100.0 728 100.0

The glomerular filtration rate (GFR) measurement is based on

determining the volume of plasma from which a substance is

removed by glomerular filtration during its passage through

the kidney, or in other words, the “clearance” of that

substance. The estimated GFR (eGFR) is calculated based

on blood creatinine levels, and measures the efficiency with

which the kidneys filter waste products from the blood for

excretion and is a key measure in chronic kidney disease.

According to the results provided by the laboratories which

analysed the blood samples of 2009 IHS participants, the

eGFR of seven men (1%) and nine women (6%) were below

normal levels (Table 4.11.3) (Kidney Health Australia, 2009).

Table 4.11.3 Glomerular Filtration Rate (GFR) levels

Men Women Total

n % n % n %

Normal (60 ml/min) 557 98.8 149 94.3 706 97.8

Below normal

(<60 ml/min) 7 1.2 9 5.6 16 2.2

Total 564 100.0 158 100.0 722 100.0

4. Physical health tests

2009 NSW Inmate Health Survey: Key Findings Report 83

Microalbumin and protein in urine

The urine dipstick test was used to detect small quantities

of the protein albumin in the urine samples of 2009 IHS

participants. The detection of albumin in the urine may be

an early marker of kidney function problems, and may occur

with certain immune disorders, diabetes, high blood pressure

and some lipid problems. Among 2009 IHS participants who

were screened, the urine samples of 41 men and 14 women

contained abnormal levels of albumin.

The urine dipstick test was also used to detect the presence

of protein in participants’ urine. Normally, protein is not

excreted in urine because protein molecules are too large to

pass through the filtering membranes in the kidneys. If these

filtering structures are damaged, protein escapes. The presence

of protein in the urine can thus be an important indicator

of kidney disease. Among 2009 IHS participants who were

screened, the urine samples of 13 men and two women

contained abnormal levels of protein.

4.12 Full blood count

In addition to the information reported below, the full blood

count test included results for red blood cells, haematocrit,

mean cell haemoglobin, mean corpuscular haemoglobin

concentration, red blood cell distribution width, monocytes,

eosinophils and basophils.

Red blood cells

Measuring the concentration of haemoglobin and the red

blood cell count can help diagnose anaemia, a condition

caused by a deficiency of haemoglobin. Anaemia can arise

for a number of reasons, including: inadequate production of

red blood cells in the bone marrow; inadequate iron intake;

inadequate folate or vitamin B12 intake; microscopic bleeding

or other blood loss; blood cell destruction; a chronic illness; or

a defect in the haemoglobin molecule itself. Abnormally high

blood concentrations of haemoglobin may occur in people

with chronic lung disease, as an adaptation to high altitudes,

or because of an abnormal increase in red cell production by

the bone marrow (polycythaemia vera).

According to the results provided by the laboratories which

analysed the blood samples of 2009 IHS participants, the

majority of both men (98%) and women (93%) recorded

haemoglobin levels in the normal range (Table 4.12.2) (RCPA,

2009). A higher proportion of women (7%) had below normal

haemoglobin levels than men (1%).

Table 4.12.1 Haemoglobin levels

Men Women Total

n % n % n %

Below normal

(<130 g/L men,

<115 g/L women) 7 1.3 8 6.6 15 2.2

Normal

(130-179 g/L men,

115-164 g/L women) 543 97.8 114 93.4 657 97.0

Above normal

(180 g/L men,

165 g/L women) 5 0.9 0 0.0 5 0.7

Total 555 100.0 122 100.0 677 100.0

The majority of both men (95%) and women (96%) were

found to have red blood cell counts in the normal range

(Table 4.12.2) (RCPA, 2009). A higher proportion of men

(5%) than women (3%) had below normal red blood cell

counts, while only two men and two women had above

normal red blood cell counts.

Table 4.12.2 Red blood cell count

Men Women Total

n % n % n %

Below normal

(<4.5 1012/L men,

<3.8 1012/L women) 25 4.5 3 2.5 28 4.1

Normal

(4.5-6.5 1012/L men,

<3.8-5.8 1012/L

women) 528 95.1 117 95.9 645 95.3

Above normal

(>6.5 1012/L men,

>5.8 1012/L women) 2 0.4 2 1.6 4 0.6

Total 555 100.0 122 100.0 677 100.0

4. Physical health tests

84 2009 NSW Inmate Health Survey: Key Findings Report

Mean corpuscular volume (MCV) is an estimate of the volume,

or size, of red blood cells; and is one of a number of red

blood cell indices tested in a full blood count. A low MCV

may indicate iron deficiency, chronic disease, pregnancy, a

haemoglobin disorder such as thalassaemia, anaemia due to

blood cell destruction or bone marrow disorders. A high MCV

may indicate anaemia due to nutritional deficiencies, bone

marrow abnormalities, liver disease, alcoholism, chronic lung

disease, or therapy with certain medications.

According to the results provided by the laboratories which

analysed the blood samples of 2009 IHS participants, the

great majority of both men and women had MCV counts in

the normal range (Table 4.12.3). Just over 2% of males and

nearly 10% of women (equating to 4% of the whole sample)

recorded MCV counts below normal, while four men (<1%)

and no women recorded MCV counts above the normal range

(RCPA, 2009). The higher rates of low haemoglobin and low

MCV in women is consistent with the higher rate of iron

deficiency and anaemia due to menstrual and childbirth blood

loss and iron demands of pregnancy.

Table 4.12.3 Mean corpuscular volume levels

Men Women Total

n % n % n %

Below normal

(<80 g/L) 12 2.2 12 9.8 24 3.5

Normal (80-100 g/L) 539 97.1 110 90.2 649 95.9

Above normal

(>100 g/L) 4 0.7 0 0.0 4 0.6

Total 555 100.0 122 100.0 677 100.0

White blood cells

White blood cells (leukocytes) are a fundamental component

of the immune system, and thus help to defend the body

against infectious organisms and foreign substances. The

number of white blood cells in a given volume of blood is

expressed as cells per microlitre of blood. The total white blood

cell count normally ranges between 4,000 and 11,000 cells

per microlitre. The proportion of each of the five major types

of white blood cells and the total number of cells of each type

can also be determined in a given volume of blood (Merck,

2009). Leukopenia, in which the blood contains fewer than

normal white blood cells, makes people more susceptible to

infections. Leukocytosis, in which the blood contains excessive

white blood cells, may result from the normal response of the

body to help fight an infection. Other causes of a raised white

cell count include an acute inflammatory allergic reaction or

it may occur in some malignancies. Low white cell counts

may occur as a result of bone marrow disease, chemotherapy,

radiotherapy or other drug side effects.

According to the results provided by the laboratories which

analysed the blood samples of 2009 IHS participants, 8% of

male 2009 IHS participants, and 9% of women, recorded white

blood cell counts above normal (Table 4.12.4) (RCPA, 2009).

Table 4.12.4 White blood cell count

Men Women Total

n % n % n %

Normal (<11 109/L) 509 92.0 111 91.0 620 91.9

Above normal

(11 109/L) 44 8.0 11 9.0 55 8.1

Total 553 100.0 122 100.0 675 100.0

Neutrophils are one of the five types of white blood cells that

normally appear in the blood. An important component of the

immune system, the neutrophil has a lifespan of about three

days. Neutrophlia, an increased proportion of neutrophils in

the blood, is a common finding with acute bacterial infections,

but may also be associated with eclampsia, gout, rheumatoid

arthritis, rheumatic fever, thyroiditis, acute stress or trauma.

Neutropenia, a decreased proportion of neutrophils, may be

observed with viral infections, widespread bacterial infection,

and after radiotherapy or chemotherapy. Neutropenia lowers the

immune barrier to bacterial and fungal infection. The cut‑off for

neutrophil levels to be below normal is 2.0, normal is 2.1‑7.5

and above normal is greater than 7.5 109/L (RCPA, 2009).

Fewer than 4% of IHS participants had below normal levels

of neutrophils and 6% had above normal levels, with minimal

differences between men and women (Table 4.12.5).

Table 4.12.5 Neutrophil levels

Men Women Total

n % n % n %

Below normal

(2.0 109/L) 19 3.5 4 3.6 23 3.5

Normal

(2.1-7.5 109/L) 498 90.4 102 91.1 600 90.5

Above normal

(>7.5 109/L) 34 6.1 6 5.4 40 6.0

Total 551 100.0 112 100.0 663 100.0

4. Physical health tests

2009 NSW Inmate Health Survey: Key Findings Report 85

Lymphocytes

Lymphocytes are another type of white blood cell important

in establishing the body’s immune responses. There are two

main types of lymphocytes. B cells make antibodies that attack

bacteria and toxins, while T cells attack body cells themselves

when they have been taken over by viruses or have become

cancerous. These cells account for immunological “memory,”

a faster and stronger response to a second encounter with the

same antigen. Lymphocytes secrete products (lymphokines)

that modulate the functional activities of many other types of

cells and are often present at sites of chronic inflammation. An

increase in the proportion of lymphocytes in the blood may be

due to chronic bacterial infection, viral hepatitis, glandular fever,

viral infection such a mumps or measles, or recovery from a

bacterial infection. A decreased proportion of lymphocytes may

be caused by chemotherapy, HIV infection, leukemia, radiation

therapy or exposure, or sepsis. The cut-off for lymphocyte

levels to be below normal is 1.5, normal is 1.6-4.0 and above

normal is greater than 4.0 109/L (RCPA, 2009). Nearly one in

ten (9%) participants had below normal lymphocyte levels. The

proportion of women with above normal lymphocyte levels was

twice as high as men (7% compared to 3%) (Table 4.12.6).

Table 4.12.6 Lymphocytes levels

Men Women Total

n % n % n %

Below normal

(1.5 109/L) 50 9.1 9 8.0 59 8.9

Normal

(1.6-4.0 109/L) 484 87.8 95 84.8 579 87.3

Above normal

(>4.0 109/L) 17 3.1 8 7.1 25 3.8

Total 551 100.0 112 100.0 663 100.0

Platelets

Platelets, or thrombocytes, are involved in haemostasis.

If the number of platelets is too low (thrombocytopenia),

excessive bleeding can occur. If the number of platelets is too

high (thrombocytosis), blood clots can form (thrombosis),

which may result in events such as a stroke, heart attack, or

pulmonary embolism. The platelet count is an estimation of

the number of platelets per litre of blood. Abnormally low

numbers of platelets is known as thrombocytopenia, while an

abnormally high level of platelets is known as thrombocytosis.

Platelet counts are often used to monitor medications that

can have toxic effects on bone marrow, or conditions such

as ideopathic thrombocytopenia, as well as in diagnosing

problems associated with abnormal bleeding or bruising.

According to the results provided by the laboratories which

analysed the blood samples of 2009 IHS participants, the great

majority of both men (94%) and women (91%) had platelet

counts in the normal range (Table 4.12.7). Four percent of

males and 2% of women (equating to 4% of the whole

sample) recorded platelet counts below normal, while 2% of

men and 7% of women recorded platelet counts above the

normal range (RCPA, 2009).

Table 4.12.7 Platelet count levels

Men Women Total

n % n % n %

Below normal

(<150 109/L) 23 4.2 2 1.7 25 3.7

Normal

(150-400 109/L) 521 94.2 111 91.7 632 93.8

Above normal

(>400 109/L) 9 1.6 8 6.6 17 2.5

Total 553 100.0 121 100.0 674 100.0

4. Physical health tests

86 2009 NSW Inmate Health Survey: Key Findings Report

5. Health behaviours

5.1 Diet and nutrition

Diet is an important contributor to a range of health conditions

including obesity, type 2 diabetes, hypertension, cardiovascular

diseases, cancer, dental disease, and osteoporosis (Nishida et

al., 2004). Evidence continues to accumulate that consumption

of fresh fruit and vegetables reduces the risk of a variety of

cancers (Bode & Dong, 2009; Vainio & Weiderpass, 2006;

vant Veer et al., 2000); stroke (He et al., 2006); cardiovascular

(Hung et al., 2004; vant Veer et al., 2000) and coronary heart

(Dauchet et al., 2006; He et al., 2007) disease. Indeed, there

appears to be a dose-response relationship between vegetable

and fruit consumption and protection from ill health (CPHN,

2003). A widely cited randomised controlled trial conducted in

the UK found that young prison inmates provided with dietary

supplements including vitamins, minerals and essential fatty

acids showed a 26% reduction in prison offences, including

violence, compared with inmates administered placebo

capsules (Gesch et al., 2002). These authors suggested that

their results have direct implications for offenders consuming

nutritionally poor diets in the community.

Australia’s most recent adult National Nutrition Survey was

conducted in 1995 in conjunction with the National Health

Survey. Given the extent of public health education regarding

sound nutrition since that time, it was not considered viable

to include those results here for comparative purposes.

Instead, the limited data on nutrition collected through the

2007‑08 National Health Survey (ABS, 2009) are included.

The Commonwealth Department of Health and Ageing is

currently planning the development and implementation

of an ongoing National Nutrition and Physical Activity

Survey Program. The Survey Program will collect data on

the food intake, physical activity participation and physical

measurements of the Australian population through periodic

surveys. The first survey is expected to commence in late

2009 and is expected to focus on Australian adults. The

Department is also planning that the Survey Program will

collect data on biomedical and other nutrition and physical

activity indicators.

The NHMRC Dietary Guidelines for Australian Adults

(NHMRC, 2003b) recommend that adults eat at least two

pieces of fruit per day. Among 2009 IHS participants, men

appeared to eat fruit more often than women: 67% of men,

and 56% of women, reported eating fruit one or more times

per day (Table 5.1.1). A further 16% of men and 19% of

women reported eating fruit on at least three days per week.

Three percent of men and 6% of women reported eating

fruit less than monthly, including 15 men and eight women

who reported eating fruit “never” or “rarely.”

The 2007-08 National Health Survey (ABS, 2009) found

that among Australia’s general population, females aged

15 years and older were more likely than men of the

same age to meet the recommended daily intake of fruit:

56% of women and 46% of men reported eating two

or more pieces of fruit per day, whereas a total of 8% of

men and 5% of women reported not eating fruit at all.

It is important to remember that the questions asked in

the National Health Survey and the IHS are not exactly the

same, such that these data are indicative rather than directly

comparable. Nevertheless, whereas in the community, men

appear to eat less fruit than women, this pattern may in fact

be reversed among prison inmates.

Table 5.1.1 Frequency of fruit consumption

Men Women Total

n % n % n %

More than daily 149 18.7 24 12.1 173 17.4

Once a day 384 48.3 86 43.4 470 47.3

3 - 6 days per week 129 16.2 37 18.7 166 16.7

1 - 2 days per week 101 12.7 24 12.1 125 12.6

At least monthly 11 1.4 16 8.1 27 2.7

Less than monthly 6 0.8 3 1.5 9 0.9

Rarely / never 15 1.9 8 4.0 23 2.3

Total 795 100.0 198 100.0 993 100.0

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 87

The NHMRC Dietary Guidelines for Australian Adults

(NHMRC, 2003b) recommend that adults eat at least five

serves of vegetables per day. There appeared to be no gender

difference in the frequency with which 2009 IHS participants

reported eating vegetables or salad, with 51% of men and

50% of women reporting eating vegetables/salad at least

once per day (Table 5.1.2). Five percent of men and 4% of

women reported eating vegetables/salad less than monthly,

including 31 men and four women who reported eating

vegetables or salad “never” or “rarely.”

The 2007-08 National Health Survey (ABS, 2009) found

that among Australia’s general population, females aged

15 years and older were more likely than men of the same

age to meet the recommended daily intake of vegetables:

10% of women and 7% of men reported eating five or

more serves of vegetables per day, whereas a total of 0.8%

of men and 0.6% of women reported not eating vegetables

at all. Women in the community were also more likely

than men to meet the recommended daily intake of both

fruit and vegetables (8% versus 5%). General population

surveys also indicate that, generally, as adults become

older, their intake of both fruit and vegetables increases

(e.g., ABS, 2009; CPHN, 2003). It is important to remember

that the questions asked in the National Health Survey and

the IHS are not exactly the same, such that these data are

indicative rather than directly comparable. Nevertheless,

whereas in the community, men appear to be less likely to

eat vegetables than women, this gender difference may be

eliminated among prison inmates.

Table 5.1.2 Frequency of vegetable/salad consumption

Men Women Total

n % n % n %

More than daily 54 6.8 10 5.1 64 6.4

Once a day 352 44.3 89 44.9 441 44.4

3-6 days per week 167 21.0 44 22.2 211 21.2

1-2 days per week 160 20.1 42 21.2 202 20.3

At least monthly 23 2.9 6 3.0 29 2.9

Less than monthly 8 1.0 3 1.5 11 1.1

Rarely / never 31 3.9 4 2.0 35 3.5

Total 795 100.0 198 100.0 993 100.0

Among 2009 IHS participants, men reported consuming

bread more frequently than women: 76% of men reported

eating bread or rolls on a daily basis, compared to 52%

of women (Table 5.1.3). The majority of both men (95%)

and women (87%) reported eating bread at least one day

per week. A higher proportion of women than men (10%

versus 3% of men) reported “rarely” or “never” eating

bread or rolls.

Table 5.1.3 Frequency of bread or rolls consumption

Men Women Total

n % n % n %

More than daily 232 29.2 34 17.2 266 26.8

Once a day 372 46.8 68 34.3 440 44.3

3-6 days per week 81 10.2 27 13.6 108 10.9

1-2 days per week 72 9.1 43 21.7 115 11.6

At least monthly 11 1.4 4 2.0 15 1.5

Less than monthly 5 0.6 3 1.5 8 0.8

Rarely / never 22 2.8 19 9.6 41 4.1

Total 795 100.0 198 100.0 993 100.0

In the 2009 IHS, 83% of men and 80% of women reported

“usually” adding a sweetener to their tea or coffee; note

that “usually” may have included behaviours both while

imprisoned and in the community. Forty five percent of men

and 41% of women reported “usually” adding salt to their

food without tasting it first. Almost half (48%) of men,

and a slightly smaller proportion (45%) of women reported

“usually” spreading butter or margarine on their bread either

“medium” or “thickly”, while 12% of men and 16% of

women reported not using butter or margarine at all.

Consumption of fries/hot chips by 2009 IHS participants was

reportedly much less frequent than consumption of either fruit

or vegetables. No women and less than 1% of men reported

consuming hot chips on a daily basis (Table 5.1.4); indeed, the

majority of both men and women reported eating hot chips

less than monthly, including 79% of men and 75% of women

whose reported frequency of consumption of hot chips was

“rarely” or “never.”

5. Health behaviours

88 2009 NSW Inmate Health Survey: Key Findings Report

Just over 13% of participants (13% of men, 16% of women)

reported eating biscuits or cakes on a daily basis. A further

54% of men and 57% of women ate biscuits or cakes at least

once a week, while only 18% of participants reported rarely

or never eating them. Just over one in ten (11%) participants

indicated eating sweets or lollies on a daily basis, while 40%

of men and 47% of women ate them at least weekly. Just over

a quarter (27%) indicated they rarely or never ate sweets or

lollies, with a higher proportion of men (28%) reporting this

than women (21%). It should be noted that these questions

did not specify whether consumption of nutritionally poor food

was in prison or in the community.

Table 5.1.4 Daily consumption of nutritionally poor

foods

(Multiple response)

Men Women Total

n % n % n %

Biscuits/Cakes 100 12.6 31 15.6 131 13.2

Sweets/Lollies 73 9.2 39 19.7 112 11.3

Hot chips/Fries 6 0.7 0 0.0 6 0.6

Total 795 100.0 198 100.0 993 100.0

Prison inmates have little control over the food they are

provided and its preparation. Inmates can, however, use

their own funds to buy a range of items each week from

a “buy up” list, which includes a number of foodstuffs.

Participants in the 2009 IHS were asked to nominate the

three most common food items purchased from the buy up

list. The foodstuffs most commonly purchased by women

tended to be sweet items, including biscuits/cakes (29%),

noodles (29%), lollies (23%), eggs (19%), soft drinks (18%)

and chocolate (17%) (Table 5.1.5). Among men, the most

commonly purchased foodstuffs were more likely to be staple

food items, including rice (27%), seafood (26%), noodles

(25%), eggs (23%), meat (21%) and pasta (15%).

Table 5.1.5 Most common food items purchased from

the prison buy-up list

(Multiple response)

Men Women Total

n % n % n %

Noodles 198 24.9 57 28.8 255 25.7

Rice 212 26.7 27 13.6 239 24.1

Eggs 186 23.4 37 18.7 223 22.5

Seafood 208 26.2 14 7.1 222 22.4

Meat 166 20.9 5 2.5 171 17.2

Biscuits / cakes 107 13.5 58 29.3 165 16.6

Soft drinks 102 12.8 35 17.7 137 13.8

Pasta 118 14.8 8 4.0 126 12.7

Lollies 68 8.6 45 22.7 113 11.4

Vegetables 80 10.1 16 8.1 96 9.7

Chocolate 49 6.2 33 16.7 82 8.3

Milk 68 8.6 10 5.1 78 7.9

Chips 39 4.9 28 14.1 67 6.7

Bread 21 2.6 26 13.1 47 4.7

Cereal 34 4.3 13 6.6 47 4.7

Cheese 17 2.1 24 12.1 41 4.1

Spreads 20 2.5 3 1.5 23 2.3

Condiments 19 2.4 2 1.0 21 2.1

Crackers 6 0.8 13 6.6 19 1.9

Coffee / Tea 11 1.4 3 1.5 14 1.4

Nuts 8 1.0 5 2.5 13 1.3

Fruit 10 1.3 0 0.0 10 1.0

Milo 6 0.8 2 1.0 8 0.8

Butter / Margarine / Oil 5 0.6 1 0.5 6 0.6

Yoghurt 0 0.0 4 2.0 4 0.4

Cans of soup 1 0.1 1 0.5 2 0.2

The majority of both men (74%) and women (71%) reported

dissatisfaction with the food they received in prison (Table 5.1.6).

The proportion of IHS samples reporting dissatisfaction with

prison food increased from 61% in 1996 to 65% in 2001 to

73% in 2009, although the increase has been far more dramatic

among women (from 41% in 1996 to 71% in 2009) than

among men (64% to 74%).

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 89

Table/Fig 5.1.6 Dissatisfaction with prison food

0

10

20

30

40

50

60

70

80

90

41.0

47.0

71.2

64.4

68.2

73.7

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 396 615 64.4 478 701 68.2 586 795 73.7

Women 48 117 41.0 70 149 47.0 141 198 71.2

Total 444 732 60.7 548 850 64.5 727 993 73.2

Among 2009 IHS participants who reported being unhappy

with the food they received in prison, a range of reasons

were offered, with no limit on the number of specific issues

dissatisfied participants could raise (Table 5.1.7). Chief among

the concerns of both men and women included that the food

is of poor quality (74% of those who reported dissatisfaction)

and is poorly prepared (63%), with specific concerns raised

about the “cook-chill” method used to prepare prison food

(63%), under which food is cooked to a “just done” state then

immediately chilled (not frozen) for storage and later reheating.

Women were more likely than men to consider that the food

they were served lacked variety (70% versus 48%); that it was

culturally insensitive (15% versus 10%); that they disliked fish

(29% versus 22%); and/or that they were unhappy about their

lack of control over eating times (27% versus 21%). Men were

more likely than women to report that they bought and cooked

their own food (34% versus 29%) and/or that insufficient

quantity of food was provided (44% versus 39%).

Table 5.1.7 Reasons for dissatisfaction with prison food

(Multiple response)

Men Women Total

n % n % n %

Poor quality 436 74.4 104 73.8 540 74.3

Poorly prepared 373 63.7 88 62.4 461 63.4

Concerned about 'cook-chill'

method 367 62.6 89 63.1 456 62.7

Lacks variety 268 45.7 98 69.5 366 50.3

Unhealthy 243 41.5 73 51.8 316 43.5

Insufficient quantity 256 43.7 55 39.0 311 42.8

Buy and cook own food 200 34.1 41 29.1 241 33.1

Dislike fish 131 22.4 41 29.1 172 23.7

Lack of control over eating

times 121 20.6 38 27.0 159 21.9

Food tampered with 124 21.2 26 18.4 150 20.6

Culturally insensitive 60 10.2 21 14.9 81 11.1

Some specific comments about the prison food included:

• ‘A lot of rice, bread and cereal and not enough fresh vegetables.

The meat is full of fat and puts fat on you.’

• ‘All veg overcooked and the chicken is not cooked properly. The

meat is old and tastes as if repeatedly frozen.’

• ‘Just a big tray of slop.’

• ‘Meals served too early then get hungry through the night.’

• ‘Not enough fresh veggies and salad. Would like more variety of

fruit and some dried fruit.’

• ‘Scared about whether someone might have done something to it.’

• ‘The fish is purple when you get it. Not good for your health.’

• ‘Need fresh fruit and vegetables on buy-up list. Can’t eat the supplied

meals, have been gaining weight from 65kg to 111kg. My meds and

heart problems are leading to a worsening depression.’

The majority of both men (60%) and women (65%)

considered that the prison “buy up” list contained about the

right number of “healthy” items (defined as foods that were

low in fat, salt and sugar and high in fibre). One third (35%)

of men and 26% of women perceived that there were too

few healthy items available on the “buy up” list, while just

19 participants thought there were too many.

5. Health behaviours

90 2009 NSW Inmate Health Survey: Key Findings Report

A majority of both men (59%) and women (62%) perceived

prison food as “too unhealthy.” Around one third (34%)

considered that prison food was “about right” in terms of

healthfulness, and just 20 participants (2% of the sample)

reported that prison food was “too healthy”. In keeping with

the 60% of 2009 IHS participants who perceived the food they

received in prison as “too unhealthy,” just 36% of participants

indicated they were satisfied with the range of healthy foods

available in prison. Healthy foods were defined as those that

are low in fat, salt and sugar and high in fibre. Women were

more likely than men to report being unsatisfied with the range

of healthy foods available in prison (62% versus 56%); while

7% of the sample were unsure whether they were satisfied.

One in eight (12%) 2009 IHS participants reported that they

were on a special diet, with women more likely to report this

was the case than men (16% versus 11%). Among those who

reported being on a special diet in prison, the most common

types of diets were low fat/low cholesterol (Table 5.1.8), with

men substantially more likely to report being on such a diet

than women (21% versus 13%). Vegetarian diets were the

next most common type, with women substantially more likely

to report being on a vegetarian diet than men (28% of women

on a special diet versus 11% of men). Women were also more

likely to report being on a diabetic diet (16% versus 9%),

whereas men were substantially more likely than women to

report not eating seafood (14% versus 0%). Fifteen percent of

the total sample reported being on a pork-free diet.

Table 5.1.8 Types of special diets in prison (if on

special diet)

(Multiple response)

Men Women Total

n % n % n %

Low fat / low cholesterol 19 21.3 4 12.5 23 19.0

Vegetarian 10 11.2 9 28.1 19 15.7

Pork free 13 14.6 5 15.6 18 14.9

Diabetic 8 9.0 5 15.6 13 10.7

Seafood free 12 13.5 0 0.0 12 9.9

Other 40 44.9 13 40.6 53 43.8

More than half (55%) of 2009 IHS participants who reported

being on a special diet also reported that they had problems

receiving this diet in prison, with women substantially more

likely to report this was the case than men (72% versus 48%).

Among participants who reported problems in having their

dietary requirements met while in prison, a range of problems

were reported, with no limits on the number of problems that

participants could report.

The most common issue reported by both men and women

was that they simply did not receive their special diet, with

women substantially more likely to report this was the case

than men (74% versus 49%). Women were also more likely

than men to report being unhappy with the food they were

provided on their special diets (44% versus 30%); that they

had problems obtaining approval for their special diets (26%

versus 16%); that CSNSW officers made receipt of their special

diets difficult (30% versus 14%); and that there were problems

receiving their diets as a result of their being moved between

prisons (35% versus 26%). Men were slightly more likely than

women to report that the portion sizes they received on their

special diets were too small (16% versus 13%).

5.2 Physical activity

The numerous benefits of physical activity are well-documented.

Sufficient physical activity decreases the risk of morbidity and

mortality from a range of causes including coronary heart disease,

cerebrovascular disease, colorectal cancer, Type 2 diabetes, chronic

kidney disease, osteoarthritis and osteoporosis (AIHW, 2008a).

Insufficient physical activity is closely associated with overweight

and obesity, which are themselves risk factors for a range of

chronic lifestyle diseases and conditions.

Sufficient physical activity is defined by the NSW Centre for

Physical Activity and Health (Chau et al., 2007) as at least

150 minutes of walking, moderate and/or vigorous activity

per week over at least five occasions. The IHS includes a

series of questions about physical activity during the four

weeks preceding the Survey; thus, sufficient physical activity

is defined in this context as a minimum of 600 minutes of

activity during the preceding four weeks (four weeks at

150 minutes per week); and insufficient physical activity is

defined as less than 600 minutes of activity.

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 91

There was a decrease in the proportion of IHS participants, both

men and women, who reported insufficient physical activity

during the four weeks preceding the Survey, from 38% of the

1996 IHS sample, to 36% of the 2001 IHS sample, to 28% of

the 2009 IHS sample (Table 5.2.1). The decrease appears to

have been more marked among women (64% in 1996 to 49%

in 2009) than among men (32% in 1996 to 23% in 2009).

Table/Fig 5.2.1 Insufficient physical activity during the

past four weeks

0

10

20

30

40

50

60

70

80

64.1

50.3 48.7

32.3 33.3

22.8

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 211 654 32.3 249 747 33.3 180 788 22.8

Women 82 128 64.1 84 167 50.3 95 195 48.7

Total 293 782 37.5 333 914 36.4 275 983 28.0

Thus, as depicted in Table 5.2.1, the proportion of IHS

participants who reported undertaking sufficient physical

activity in the four weeks preceding the Survey increased from

62% in 1996 to 72% in 2009. This may reflect increases in

physical activity among Australia’s general population. For

example, the proportion of people aged 16 years and over in

NSW who undertook sufficient physical activity increased from

48% in 1998 to 51% in 2004, a change attributed largely to

greater participation in walking (Chau et al., 2007).

Male 2009 IHS participants reported having undertaken

substantially more physical activity in the four weeks preceding

the interview than women (Table 5.2.2). Men reported having

undertaken a median of 1980 minutes of activity in the preceding

four weeks (equating to around 70 minutes per day or 8.25 hours

per week). Women reported having undertaken a median of 620

minutes of physical activity in the preceding four weeks (equating

to around 22 minutes per day or 2.6 hours per week).

Table 5.2.2 Physical activity duration (in minutes)

during the past four weeks characteristics

Men Women Total

N 788 195 983

Mean (± sd) 2838.5 (± 3108.8) 1072.2 (± 1459.4) 2488.1 (± 2943.3)

Median 1980.0 620.0 1680.0

Range 0 - 28080 0 - 10685 0 - 28080

Gender differences were also apparent in the types of

physical activity that 2009 IHS participants had undertaken

in the four weeks preceding the interview, with higher

proportions of men undertaking more vigorous activities

such as jogging, team sports, weight training and tennis

or squash (Table 5.2.3). Among women, the most common

types of physical activity undertaken were moderate walking

(defined as continuous walking for at least ten minutes;

74% of women); vigorous walking (defined as sufficient to

make participants “puff and pant”; 37%); stationary cycling

on an exercise bike (25%); circuit training or aerobics (24%)

and weight training (19%). Among men, the most common

types of physical activity undertaken in the preceding four

weeks were moderate walking (81%), weight training

(50%), circuit training or aerobics (44%), vigorous walking

(39%) and vigorous team activities such as football, soccer

or cricket (39%).

Table 5.2.3 Types of physical activity during the past

four weeks

(Multiple response)

Men Women Total

n % n % n %

No exercise 36 4.6 24 12.3 60 6.1

Moderate walking 648 81.4 146 74.1 794 80.0

Weight training 401 50.4 38 19.2 439 44.2

Circuit training / aerobics 350 44.0 48 24.2 398 40.0

Vigorous walking 310 38.9 73 37.1 383 38.6

Football / soccer / cricket 309 38.8 14 7.1 323 32.5

Running / jogging 259 32.6 29 14.6 288 29.0

Exercise bike 137 17.2 49 24.7 186 18.7

Tennis / squash 112 14.1 6 3.0 118 11.9

Basketball / netball 83 10.4 8 4.0 91 9.2

Other 216 27.1 78 39.4 294 29.6

5. Health behaviours

92 2009 NSW Inmate Health Survey: Key Findings Report

Men also reported a longer duration of an average session of

all types of physical activity undertaken during the preceding

four weeks except for basketball/netball, which men reported

engaging in for a median of 30 minutes per average session,

while women reported a median of 38 minutes; and tennis or

squash, in which women engaged for a median of 60 minutes

per average session, compared to men’s median duration of

45 minutes (Table 5.2.4). Compared to women, men reported

undertaking substantially longer sessions of weight training

(50 versus 25 minutes) and running/jogging (30 minutes

versus 20 minutes).

Table 5.2.4 Median duration (in minutes) by types of

physical activity during the past four weeks

(Multiple

response)

Men Women Total

n Median n Median n Median

Football / soccer

/ cricket 308 60.0 14 30.0 322 60.0

Tennis / squash 112 45.0 6 60.0 118 45.0

Weight training 401 50.0 38 25.0 439 45.0

Circuit training /

aerobics 349 45.0 48 30.0 397 45.0

Vigorous walking 310 40.0 73 30.0 383 30.0

Moderate

walking 644 30.0 146 30.0 790 30.0

Running / jogging 259 30.0 29 20.0 288 30.0

Basketball /

netball 83 30.0 8 37.5 91 30.0

Exercise bike 137 20.0 49 15.0 186 20.0

Other 215 30.0 77 30.0 292 30.0

Although these results are not directly comparable to any

Australian or NSW general population survey of physical

activity, they nevertheless appear relatively reflective of

general patterns of physical activity. The 2007-08 National

Health Survey (ABS, 2009) found that 65% of participants

aged 15 years or older had exercised for fitness, sport

or recreation in the two weeks preceding the Survey.

Forty eight percent had walked in the preceding two

weeks, whereas 36% did some form of moderate exercise

(exercise which caused a moderate increase in heart rate

or breathing) and 15% did some form of vigorous exercise

(causing a large increase in heart rate or breathing). Women

were more likely to report having walked for exercise than

men (51% versus 44%), whereas men were more likely than

women to do moderate (38% versus 33%) and vigorous

(19% versus 11%) exercise. One quarter (24%) of those

who exercised at a moderate level, and 21% of those

who exercised vigorously, exercised seven times or more

in the preceding two weeks. Eighty percent of moderate

exercisers, and 85% of vigorous exercisers, reported that

the average duration of each session was 30 minutes or

more. Among those who walked for exercise, 37% did so

seven times or more in the preceding two weeks, and 79%

did so for an average of 30 minutes or more.

Just 6% of 2009 IHS participants reported having undertaken

no physical activity during the four weeks preceding the

Survey, a substantial decrease compared to the 2001 (21%)

and 1996 (24%) IHS results (Table 5.2.5). Although the

proportion of participants who reported having undertaken

no physical activity decreased among both men and women,

across all three IHSs, women were more likely than men to

report this; for example, among 2009 IHS participants, 12%

of women reported having undertaken no physical activity,

compared with just 5% of men.

Table/Fig 5.2.5 No physical activity during the past

four weeks

0

10

20

30

40

50

45.3

35.9

12.3

19.9

17.0

4.6

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 130 654 19.9 127 747 17.0 36 788 4.6

Women 58 128 45.3 60 167 35.9 24 195 12.3

Total 188 782 24.0 187 914 20.5 60 983 6.1

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 93

The 2007-08 National Health Survey (ABS, 2009) reported

that one third (34%) of Australians aged 15 years or older had

undertaken no physical activity at all in the two weeks preceding

the interview. The questions asked in the National Health Survey

and the IHS are not exactly the same, such that these data are

indicative rather than directly comparable. The comparison

nevertheless indicates that prison inmates may be substantially

more physically active than Australia’s general population.

Among 2009 IHS participants who had not undertaken any

physical activity in the four weeks preceding the Survey, the most

frequent reason given was for health reasons (62%), followed by

“laziness” (27%). Women were more likely to cite health reasons

for their lack of physical activity (71% versus 56%), whereas men

were more likely to cite laziness (33% versus 17%).

Some specific reasons why participants did not exercise in

prison included:

• ‘The area to walk in prison is too boring.’

• ‘The gym is not available when I have time.’

• ‘My physical disability restricts me.’

• ‘Nothing to do in the centre and feel too depressed to exercise.’

• ‘Need more room for walking. Stuck in one little compound; can

only walk round in circles. Need to walk on an oval at least twice

a week. There is nothing to do, just sit around and go mad.’

Three quarters (74%) of 2009 IHS participants described

themselves as “fairly” or “very” physically active in the year

preceding their incarceration (Table 5.2.6), with men slightly

more likely than women to describe themselves in this

manner (75% versus 72%).

Table 5.2.6 Physical activity in the year prior to

incarceration

Men Women Total

n % n % n %

Very active 224 28.1 58 29.3 282 28.4

Fairly active 370 46.5 84 42.4 454 45.7

Not very active 146 18.3 36 18.2 182 18.3

Not at all active 56 7.0 20 10.1 76 7.6

Total 796 100.0 198 100.0 994 100.0

The proportion of IHS participants who described themselves

as “not very” or “not at all” physically active in the year before

their current incarceration remained relatively stable between

1996 and 2009, at around a quarter of participants (Table

5.2.7). Although women were substantially less likely than men

to describe themselves in this manner in the 2001 IHS (18%

versus 27%), the gender differential was much less marked in

both 1996 and in 2009.

Table/Fig 5.2.7 Not very or not at all physically active in

the year prior to incarceration

0

5

10

15

20

25

30

35

23.7

18.4

28.3

24.3

27.0

25.4

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 148 610 24.3 185 684 27.0 202 796 25.4

Women 28 118 23.7 26 141 18.4 56 198 28.3

Total 176 728 24.2 211 825 25.6 258 994 26.0

Just over half (52%) of 2009 IHS participants reported that

they were as active, or more active, currently (i.e., during

their present incarceration) than they were before they were

imprisoned (Table 5.2.8). Women were substantially more likely

than men to report being less active during their incarceration

than prior to their imprisonment (64% versus 44%); conversely,

men were substantially more likely to report that they were

currently more active (41% versus 22%).

Table 5.2.8 Current physical activity rating in prison

compared to the community

Men Women Total

n % n % n %

More active now 326 41.0 43 21.7 369 37.1

About the same 121 15.2 28 14.1 149 15.0

Less active now 349 43.8 127 64.1 476 47.9

Total 796 100.0 198 100.0 994 100.0

5. Health behaviours

94 2009 NSW Inmate Health Survey: Key Findings Report

Forty five percent of 2009 IHS participants reported a history

of participation in competitive contact sports (Table 5.2.9),

with a substantially higher proportion of men than women

reporting this to be the case (53% versus 12%). Various codes

of football (39%) and amateur boxing (11%) were the most

common competitive contact sports reported. Such high rates

of participation may account, at least in part, for the striking

prevalence of head injuries resulting in unconsciousness

reported by this sample (see section 3.7).

Table 5.2.9 Ever participate in competitive contact sports

(Multiple response)

Men Women Total

n % n % n %

No competitive contact

sports 373 47.0 175 88.4 548 55.2

Any competitive contact

sports 421 53.0 23 11.6 444 44.8

Football 370 46.6 20 10.0 390 39.3

Amateur boxing 105 13.2 3 1.5 108 10.9

Professional boxing 14 1.8 1 0.5 17 1.7

Wrestling 13 1.6 0 0.0 13 1.3

5.3 Sun protection

Skin cancer is Australia’s most common cancer, and Australia

has the highest incidence of skin cancer in the world. In 2002,

374,000 Australians were treated for non-melanoma skin

cancer, representing a more than 100 per cent increase since

1985. The risk of skin cancer can be dramatically reduced

through decreased sun exposure, which can be achieved

through simple measures such as wearing protective clothing,

applying sunscreen, and avoiding the sun, particularly during

peak ultraviolent radiation (UVR) hours in the middle of the

day. The prison environment is such that inmates may spend

prolonged periods in the sun in exercise yards and other

outdoor areas.

Just under half (46%) of 2009 IHS participants reported

deliberately wearing less clothing in order to get the

sun on their skin at least sometimes (Table 5.3.1), with

a substantially higher proportion of men than women

reporting engaging in this behaviour (49% versus 34%).

Men were also more likely to report deliberately wearing

less clothing ‘most of the time’ in the sun (28% versus

11%). The National Sun Protection Survey 2006-07, which

documented Australian adults’ sun protective behaviours and

sunburn during peak UVR times on summer weekends in

2006–07 (Dobbinson et al., 2008), found that among adults

aged 18-69 years, 11% reported intentionally attempting

to obtain a suntan during the 2006-07 summer. Although

these figures are not directly comparable to IHS results due

to the use of different questions, they do provide some

context within which to interpret inmates’ self-reported sun

protection behaviours, and suggest that IHS participants

may be less knowledgeable and/or concerned about the

damaging effects of the sun than the broader population of

Australian adults.

Table 5.3.1 Deliberately wear less clothing in order to

get the sun on skin

Men Women Total

n % n % n %

Most of time 219 27.5 21 10.6 240 24.1

Sometimes 169 21.2 47 23.7 216 21.7

Rarely / never 408 51.3 130 65.7 538 54.1

Total 796 100.0 198 100.0 994 100.0

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 95

Just 39% of 2009 IHS participants reported wearing a hat or

cap while in the sun ‘most of the time’ (Table 5.3.2). Women

were more likely than men to report ‘rarely’ or ‘never’ wearing

a hat or cap in the sun (55% versus 42%), while men were

more likely to report wearing a hat or cap ‘most of the time’

(42% versus 25%). In the National Sun Protection Survey 2006-

07 (Dobbinson et al., 2008), 50% of Australian adults aged

18-69 years reported wearing a hat or cap during their main

outdoor activity during peak UVR hours. Men were more likely

than women to report wearing such headwear (60% versus

38%). Again, these figures are not directly comparable to IHS

results due to the use of different questions in the two Surveys.

Nevertheless, the indication is that IHS participants may be less

likely to engage in this important sun protection behaviour than

the broader population of Australian adults, but that across

both populations, men seem more likely to do so than women.

Table 5.3.2 Wear a hat or cap while in the sun

Men Women Total

n % n % n %

Most of time 336 42.2 50 25.3 386 38.8

Sometimes 126 15.8 39 19.7 165 16.6

Rarely / never 334 42.0 109 55.1 443 44.6

Total 796 100.0 198 100.0 994 100.0

Just 36% of 2009 IHS participants reported wearing sunglasses

in the sun ‘most of the time’ (Table 5.3.3). Men were more likely

than women to report ‘rarely’ or ‘never’ wearing sunglasses in the

sun (50% versus 40%), while women were more likely to report

wearing sunglasses ‘most of the time’ (43% versus 33%). In the

National Sun Protection Survey 2006-07 (Dobbinson et al., 2008),

58% of Australian adults aged 18-69 years reported wearing

sunglasses during their main outdoors activity during peak UVR

hours on weekends of the 2006-07 summer. Women were more

likely to report wearing sunglasses than men (63% versus 54%).

Again, these figures are not directly comparable to IHS results due

to the use of different questions in the two Surveys. Nevertheless,

the indication is that IHS participants may be less likely to engage

in this important sun protection behaviour than the broader

population of Australian adults, but that across both populations,

women may be more likely to do so than men.

Table 5.3.3 Wear sunglasses while in the sun

Men Women Total

n % n % n %

Most of time 268 33.7 85 42.9 353 35.5

Sometimes 132 16.6 33 16.7 165 16.6

Rarely / never 396 49.7 80 40.4 476 47.9

Total 796 100.0 198 100.0 994 100.0

Just 12% of 2009 IHS participants reported using sunscreen to

protect their skin from the sun ‘most of the time’ (Table 5.3.4).

Men were more likely than women to report ‘rarely’ or ‘never’

using sunscreen (75% versus 59%), while women were more

likely to report using sunscreen ‘most of the time’ (22% versus

10%). In the National Sun Protection Survey 2006-07 (Dobbinson

et al., 2008), 37% of Australian adults aged 18-69 years reported

using 15+ sunscreen during their main outdoors activity during

peak UVR hours on weekends of the 2006-07 summer. Women

were more likely than men to report using 15+ sunscreen (49%

versus 29%). Again, these figures are not directly comparable

to IHS results due to the use of different questions in the two

Surveys. Nevertheless, the indication is that IHS participants

may be substantially less likely to engage in this important sun

protection behaviour than the broader population of Australian

adults, but that across both populations, women may be more

likely to do so than men.

Table 5.3.4 Use sunscreen to help protect skin from

the sun

Men Women Total

n % n % n %

Most of time 80 10.1 43 21.7 123 12.4

Sometimes 118 14.8 38 19.2 156 15.7

Rarely / never 598 75.1 117 59.1 715 71.9

Total 796 100.0 198 100.0 994 100.0

The majority (76%) of 2009 IHS participants reported having

access to sunscreen in their Correctional Centre (Table 5.3.5).

Just under 10% of the 2009 IHS sample were unaware

of whether they were able to access sunscreen in their

Correctional Centre.

5. Health behaviours

96 2009 NSW Inmate Health Survey: Key Findings Report

Table 5.3.5 Have access to sunscreen in Correctional

Centre

Men Women Total

n % n % n %

No 117 14.7 27 13.6 144 14.5

Yes 610 76.6 146 73.7 756 76.1

Don’t know 69 8.7 25 12.6 94 9.5

Total 796 100.0 198 100.0 994 100.0

Of concern is the length of time 2009 IHS participants reported

spending in the sun each day (Table 5.3.6), particularly given the

relatively low proportions of participants who reported engaging

in simple sun protection behaviours such as wearing hats and

using sunscreen. More than one third (38%) of participants

reported spending an average of four or more hours in the

sun each day, with a slightly higher proportion of women than

men reporting this to be the case (41% versus 37%). Just 33%

of men and 35% of women reported spending an average

of less than two hours in the sun each day. Reported amount

of time spent in the sun was substantially higher than among

Australian adults aged 18-69 years responding to the National

Sun Protection Survey 2006-07, who reported a mean of less

than two hours (116 minutes) spent outdoors during peak UVR

hours on at least one day of the weekend preceding the Survey

(Dobbinson et al., 2008). In this Survey, a higher proportion of

men than women reported they were outdoors on the weekend

(75% versus 59%). In addition, men spent a greater amount

of time outdoors (127 minutes on average) than women (102

minutes). Seventeen male 2009 IHS participants indicated they

spent no time in the sun on an average day, which may be

due to prolonged cell time. These individuals may be at risk of

developing Vitamin D deficiency.

Table 5.3.6 Time spent in the sun on an average day

Men Women Total

n % n % n %

None 17 2.1 0 0.0 17 1.7

< 1 hour 92 11.6 29 14.6 121 12.2

1 - < 2 hours 157 19.7 41 20.7 198 19.9

2 - < 4 hours 232 29.1 47 23.7 279 28.1

4 - < 6 hours 193 24.2 59 29.8 252 25.4

6+ hours 105 13.2 22 11.1 127 12.8

Total 796 100.0 198 100.0 994 100.0

Given the amount of time spent in the sun and the relatively low

rates of reported sun protection behaviours among 2009 IHS

participants, it is somewhat reassuring that more than half (56%)

of participants reported that they did not get sunburnt during

the summer preceding the Survey (Table 5.3.7). A substantially

higher proportion of men than women reported having been

sunburnt at least once during the preceding summer (46% versus

35%). Nineteen percent of men and 16% of women reported

having been sunburnt three or more times during that period.

Among respondents to the National Sun Protection Survey 2006-

07 (Dobbinson et al., 2008), 14% of adults aged 18-69 years

reported being sunburnt on at least one day of the weekend prior

to the Survey. Sunburn on summer weekends was slightly more

common among men than women (15% versus 12%).

Table 5.3.7 How often sunburnt last summer

Men Women Total

n % n % n %

Not at all 428 53.8 128 64.6 556 55.9

Once 104 13.1 20 10.1 124 12.5

Twice 109 13.7 19 9.6 128 12.9

3 - 4 times 71 8.9 19 9.6 90 9.1

5+ times 79 9.9 12 6.1 91 9.2

Don’t know 5 0.6 0 0.0 5 0.5

Total 796 100.0 198 100.0 994 100.0

The majority (76%) of 2009 IHS participants reported that

their skin had not been checked (by themselves or anyone else)

for pre-cancerous changes in the year preceding the Survey

(Table 5.3.8). There was no difference in the proportion of men

and women who reported this to be the case (76% versus

74%). Among respondents to the National Sun Protection

Survey 2006-07 (Dobbinson et al., 2008), 42% of adults aged

18-69 years reported that a doctor had checked their skin for

pre-cancerous changes. The majority (67%) of those who had

a check reported that it was done by a general practitioner,

while 22% had their skin checked at a specialist skin cancer

clinic, 9% had their skin checked by a dermatologist, 0.9% at

a public hospital, and 1.6% elsewhere. Again, these figures

are not directly comparable to IHS results due to the use of

different questions in the two Surveys. Nevertheless, the

indication is that IHS participants may be substantially less

likely to engage in this important screening exercise than the

broader population of Australian adults.

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 97

Table 5.3.8 How often checked skin for pre-cancerous

changes in the last year

Men Women Total

n % n % n %

Not at all 606 76.1 147 74.2 753 75.8

Once 61 7.7 24 12.1 85 8.6

Twice 37 4.6 9 4.5 46 4.6

3 - 4 times 20 2.5 5 2.5 25 2.5

5+ times 71 8.9 12 6.1 83 8.4

Don’t know 1 0.1 1 0.5 2 0.2

Total 796 100.0 198 100.0 994 100.0

5.4 Smoking

Tobacco smoking is the single most preventable cause of ill health

and death. As a major risk factor for coronary heart disease,

stroke, peripheral vascular disease, cancer and a variety of other

diseases and conditions (AIHW, 2008b), it is estimated to be

responsible for 7.8% of the burden of disease of Australians:

around 10% of the total burden of disease in men and 6% in

women (Begg et al., 2007). The tangible costs of tobacco use in

Australia were estimated to be $12.0 billion in 2004 – 05 (Collins

& Lapsley, 2008), equating to about 1.3% of gross domestic

product. Major gains in reducing the prevalence of smoking

among Australia’s general population have been made in the last

two decades; however, smoking rates are markedly higher among

some population groups, including Aboriginal and Torres Strait

Islander people, people from culturally and linguistically diverse

backgrounds, people suffering from mental and substance use

disorders, prison inmates (Baker et al., 2006), and people of lower

socio-economic status (AIHW, 2008b). The continued high rates

of smoking among such sub-populations underlie the assertion

that tobacco use, more than any other lifestyle factor, contributes

to the gap in healthy life expectancy between those most

advantaged and those most in need (MCDS, 2004).

Smoking habits

Among 2009 IHS participants, 91% of men and 90% of

women reported having smoked a full cigarette at some time

in their lives. Although not directly comparable, some context

to these prevalence estimates is provided by the 2007 National

Drug Strategy Household Survey (NDSHS; AIHW, 2008c), a

survey on drug use knowledge, attitudes and behaviours of a

stratified random sample of Australian households, based on

a sample of 23,356 participants. The 2007 NDSHS found that

45% of Australians aged 14 years and older had smoked at

least 100 cigarettes or the equivalent amount of tobacco in

their lifetime, a decline from the 2004 level of 47%.

The proportion of IHS participants who reported being a current

cigarette smoker remained relatively stable across the years in

which the Surveys have been conducted, at around three quarters

of each sample (Table 5.4.1). In all IHSs, a higher proportion of

women than men reported current smoking; in 2009, this gender

differential translated to 75% of men versus 80% of women.

The current smoking prevalence estimate among inmates is

around four times higher than among the general population of

Australian adults. The 2007 NDSHS (AIHW, 2008c) found that

19% of Australians aged 14 years or older had used tobacco

in the preceding year, and that 17% smoked daily in 2007.

This rate of daily smoking continued the substantial decline

observed since the inception of the Household Surveys, from

25% in 1993 to 17% in 2004. Thus, not only are the rates of

smoking higher among prison inmates than among the general

population, rates among inmates have also failed to reflect the

substantial decline observed among the general population in

recent decades. In the 2007 NDSHS, males were generally more

likely to be daily smokers than females across all age groups

except among 14-19 year olds, where females were more likely

than males to be daily smokers (9% versus 6%).

Table/Fig 5.4.1 Current smoker

0

20

40

60

80

100

83.8 82.9 75.7 77.6 79.5 75.0

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 468 618 75.7 543 700 77.6 591 788 75.0

Women 98 117 83.8 126 152 82.9 151 190 79.5

Total 566 735 77.0 669 852 78.5 742 978 75.9

5. Health behaviours

98 2009 NSW Inmate Health Survey: Key Findings Report

Among 2009 IHS participants who reported currently smoking

tobacco, 94% reported smoking daily (Table 5.4.2), including

94% of men and 96% of women. Women reported heavier

tobacco consumption in terms of number of cigarettes, being

more likely than men to report smoking eleven or more

cigarettes (74% versus 64%).

Table 5.4.2 Number of cigarettes per day (if current

smoker)

Men Women Total

n % n % n %

Occasionally, less than weekly 7 1.2 1 0.7 8 1.1

Occasionally, at least weekly 28 4.7 5 3.3 33 4.4

5 - 10 a day 180 30.5 33 21.9 213 28.7

11 - 20 a day 233 39.4 66 43.7 299 40.3

21 - 30 a day 105 17.8 36 23.8 141 19.0

31+ a day 38 6.4 10 6.6 48 6.5

Total 591 100.0 151 100.0 742 100.0

The great majority (96%) of 2009 IHS participants who

reported currently smoking tobacco further reported

smoking mainly hand-rolled cigarettes, including 97% of

men and 91% of women. This is presumably a function

of the availability of pouches of tobacco in prison relative

to factory-made cigarettes. Seventy-four percent of men,

and 76% of women, reported smoking at least one 50

gram pouch of rolling tobacco per week. These hand-rolled

cigarettes are more likely to be smoked without filters,

thereby increasing the amount of tar inhaled.

Among IHS participants who had smoked a full cigarette,

the mean age of initiation remained relatively stable

between 1996 and 2009, at around 14 years of age for

both men and women (Table 5.4.3). This is somewhat

younger than the mean age of initiation into tobacco

smoking among smokers in the general population, which

in 2007 was reported to be 15.1 years of age among men,

and 16.1 years among women (AIHW, 2008c).

Table/Fig 5.4.3 Mean age of initiation into cigarette

smoking

0

5

10

15

20

13.8

14.3 14.8 14.6 13.9 13.9

1996 2001 2009

Men Women

MEAN

YEAR

1996 2001 2009

n

Mean (± sd)

Range n

Mean (± sd)

Range n

Mean (± sd)

Range

Men 525

14.3 (±4.7)

5 – 46 622

13.9 (±4.7)

4 – 50 710

13.9 (±4.7)

4 – 51

Women 106

13.8 (±4.7)

7 – 48 135

14.8 (±5.4)

5 – 40 170

14.6 (±6.4)

4 – 58

Total 631

14.2 (±4.7)

5 – 48 757

14.1 (±4.8)

4 – 50 880

14.0 (±5.1)

4 – 58

Almost half (49%) of current smokers who participated in the

2009 IHS reported that they smoked more while in prison than

when in the community, with women more likely than men to

report that this was the case (53% versus 48%) (Table 5.4.4).

Twenty three percent of both men and women reported that

they smoked equivalent amounts of tobacco in prison and in

the community, whereas men were more likely than women to

report smoking less in prison (29% versus 25%).

Table 5.4.4 Tobacco consumption in prison relative to

in the community (if current smoker)

Men Women Total

n % n % n %

More now 285 48.2 80 53.0 365 49.2

About the same 136 23.0 34 22.5 170 22.9

Less now 170 28.8 37 24.5 207 27.9

Total 591 100.0 151 100.0 742 100.0

Among current smokers, 46 men and eight women reported

having not smoked tobacco in the year prior to their current

incarceration. Of these, 44 men and eight women reported

having resumed tobacco smoking following their incarceration.

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 99

Smoking cessation (current smokers)

Over two-thirds (70%) of current smokers had attempted to

quit smoking, with slightly more men (63%) having tried than

women (58%). Among 2009 IHS participants who reported

having made at least one attempt to quit smoking in the past,

more than half (55%) further reported that their most recent

quit attempt had occurred within the preceding year (Table

5.4.5). Men were more likely than women to report having

made an attempt to quit within the preceding year (58%

of men who had attempted to quit versus 46% of women).

Twenty one percent of men and 26% of women reported

that their most recent quit attempt was three or more years

preceding the Survey.

Table 5.4.5 Timing of most recent attempt to quit

smoking (if current smoker and ever tried

to quit)

Men Women Total

n % n % n %

In last month 88 20.8 11 11.7 99 19.1

1 - <6 months ago 93 22.0 17 18.1 110 21.3

6 - <12 months ago 62 14.7 15 16.0 77 14.9

1 - <3 years ago 92 21.7 27 28.7 119 23.0

3 - <5 years ago 30 7.1 9 9.6 39 7.5

5+ years ago 58 13.7 15 16.0 73 14.1

Total 423 100.0 94 100.0 517 100.0

Among the 517 IHS participants in 2009 who were current

smokers and who reported having attempted to quit, well

over half (63%) reported having made a quit attempt while

in prison, with a substantially higher proportion of men than

women reporting this to be the case (68% versus 40%).

Among those who had made a quit attempt in prison, 74%

(73% of men and 76% of women) reported that it was harder to

attempt to quit in this environment than while in the community

(Table 5.4.6). On the other hand, 14% (14% of men and 13% of

women) reported that quitting was equally difficult in prison and

in the community; and 12% (13% of men and 11% of women)

reported that they found it easier to quit while in prison.

Table 5.4.6 Easier or harder to quit smoking in prison

than in community (if current smoker and

ever tried to quit smoking in prison)

Men Women Total

n % n % n %

Easier in prison 36 12.5 4 10.5 40 12.3

About the same 41 14.3 5 13.2 46 14.2

Harder in prison 210 73.2 29 76.3 239 73.5

Total 287 100.0 38 100.0 325 100.0

Although 55% of current smokers who had made at least one

attempt to quit reported having done so within the last year

(see Table 5.4.5), 82% reported having implemented at least

one strategy designed to reduce the harm associated with

smoking during that period (Table 5.4.7). More than half (56%)

reported having reduced their quantity of cigarettes per day,

and 46% reported having made an unsuccessful quit attempt.

Eighteen percent had successfully quit for more than one

month and 9% had changed to a lower tar cigarette brand.

A small proportion (4%) reported having attended a prison

Quit Smoking program within the preceding year. Men were

more likely than women to report having successfully stopped

smoking for more than one month (20% versus 10%) and to

have made an unsuccessful quit attempt (49% versus 33%),

whereas women were more likely to report changing to a lower

tar brand of tobacco (16% versus 8%).

Table 5.4.7 Use of strategies in the past year designed

to reduce the harm associated with

smoking (if current smoker and ever tried

to quit smoking)

(Multiple response)

Men Women Total

n % n % n %

Reduced amount smoked

per day 240 56.9 49 52.1 289 56.0

Tried unsuccessfully to give

up smoking 208 49.3 31 33.0 239 46.3

Successfully given up

smoking >1 month 86 20.4 9 9.6 95 18.4

Used nicotine replacement

therapy 53 12.6 11 11.7 64 12.4

Changed to lower tar

cigarette brand 32 7.6 15 16.0 47 9.1

Attended QUIT smoking

program in prison 19 4.5 1 1.1 20 3.9

Other 44 10.4 7 7.4 51 9.9

5. Health behaviours

100 2009 NSW Inmate Health Survey: Key Findings Report

Forty four percent of current smokers who had made an

attempt to quit smoking reported having ever tried nicotine

replacement therapy (NRT), including 44% of both men and

women (Table 5.4.8).

Table 5.4.8 Ever tried nicotine replacement therapy

to quit smoking (if current smoker and

ever tried to quit)

Men Women Total

n % n % n %

Yes 187 44.2 41 43.6 228 44.1

No 236 55.8 53 56.4 289 55.9

Total 423 100.0 94 100.0 517 100.0

Among smokers who had attempted to quit, 63% said they

would try nicotine patches to help them quit while they were

in prison if they were provided free of charge; 43% reported

that they would try them if they were cheaper than cigarettes;

and 27% reported they would try patches if they were the

same price as cigarettes in prison (Table 5.4.9).

Table 5.4.9 Hypothetical NRT cost scenarios (if current

smoker and ever tried to quit)

I would use NRT in prison if

the cost was:

(Multiple response)

Men Women Total

n % n % n %

The same price as cigarettes 103 24.3 34 36.2 137 26.5

Cheaper than cigarettes 174 41.1 48 51.1 222 42.9

Free 272 64.3 56 59.6 328 63.4

The proportion of IHS participants who reported both being

current smokers and that they would like to quit smoking

increased from 77% in 1996 to 85% in 2009, following a

slight decline to 75% in 2001 (Table 5.4.10). In all years in

which the IHS has been conducted, men who currently smoke

have been more likely than women to report a desire to quit

smoking; among 2009 IHS participants, this gender differential

translated to 89% of men compared with 74% of women.

Table/Fig 5.4.10 Like to quit smoking (if current smoker)

0

20

40

60

80

100

74.4

68.8

73.5

77.7 75.9

88.5

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 362 466 77.7 412 543 75.9 523 591 88.5

Women 73 98 74.4 86 125 68.8 111 151 73.5

Total 435 564 77.1 498 668 74.6 634 742 85.4

Two thirds (65%) of 2009 IHS participants who reported

that they would like to quit smoking further reported that

they required assistance to help them achieve this outcome,

including 70% of the 78 women and 64% of the 223 men

who reported wanting to quit.

Eighty six percent of current smokers who participated in the

2009 IHS considered themselves to be “addicted to smoking,”

including 91% of women who currently smoked, and 85% of

men. Women were slightly more likely than men to report feeling

unsure whether they were addicted to smoking (3% versus 1%).

What would assist you to quit smoking:

• ‘A program for people who have heart problems, who can’t use NRT.’

• ‘Bit more exercise. When stuck in one spot, you smoke more.’

• ‘Put me in a place where they don’t sell it. Not being around

people that smoke.’

• ‘Free patches, counselling and support.’

• ‘If a doctor gives me a wake up call telling me if I don’t stop I will

die soon.’

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 101

Non-smokers

Among the 142 current non-smokers who participated in

the 2009 IHS, more than three quarters (78%) were in fact

“ex‑smokers”, defined for the purposes of this Survey as having

smoked at least 100 full cigarettes in their lives (Table 5.4.11).

Men were more likely to be classed as ex-smokers than women

(81% versus 58%). Just 24 men (20% of current non-smoking

men) and 8 women (42% of current non-smoking women) were

classed as having never smoked, defined for the purposes of this

study as having smoked less than 100 cigarettes in their lives.

Table 5.4.11 Smoking history (if non-smoker)

Men Women Total

n % n % n %

Never smoked 24 19.5 8 42.1 32 22.5

Ex-smoker 99 80.5 11 57.9 110 77.5

Total 123 100.0 19 100.0 142 100.0

Among the 110 ex-smokers, equal proportions had quit in the

past year (34%) as had quit more than five years previously

(35%) (Table 5.4.12). However, a greater proportion of women

than men had quit five or more years ago (55% versus 33%).

Table 5.4.12 When quit smoking (if ex-smoker)

Men Women Total

n % n % n %

In last year 33 33.3 4 36.4 37 33.6

1-<3 years ago 23 23.2 1 9.1 24 21.8

3-<5 years ago 11 11.1 0 0.0 11 10.0

5-<10 years ago 11 11.1 2 18.2 13 11.8

10+ years ago 21 21.2 4 36.4 25 22.7

Total 99 100.0 11 100.0 110 100.0

The main factor that helped participants to quit smoking was

concerns for their health, reported by 53% of ex-smokers

(Table 5.4.13). Ten men and no women indicated support from

family and friends was an important aid in quitting smoking.

Table 5.4.13 What helped you to quit smoking (if

ex‑smoker)

(Multiple response)

Men Women Total

n % n % n %

Health concerns 52 52.5 6 54.6 58 52.7

Nicotine replacement therapy 12 12.1 2 18.2 14 12.7

Support family/ friends 10 10.1 0 0.0 10 9.1

Financial concerns 9 9.1 0 0.0 9 8.2

Desire set good example

for kids 5 5.1 1 9.1 6 5.5

Other 34 34.3 4 36.4 38 34.6

Total 99 100.0 11 100.0 110 100.0

What helped you to quit smoking (among ex-smokers):

• ‘50th birthday and wife died of lung cancer.’

• ‘Didn’t like smoking. Could see the difference with my breathing

when I stopped.’

• ‘Looked at my faith in the bible and decided to make a change.’

• ‘Mother made me smoke a whole packet of cigarettes. Never

smoked since.’

• ‘Sick and tired of fingers being yellow and coughing everyday and

people wanting smokes off me.’

More than two-thirds of ex-smokers had made only one or

two quit smoking attempts before they managed to quit

(Table 5.4.14), with women more likely to quit smoking than

men after just Two or Three attempts (82% versus 67%).

Table 5.4.14 Number of quit attempts (if ex-smoker)

Men Women Total

n % n % n %

1 - 2 66 66.7 9 81.8 75 68.2

3 - 5 17 17.2 2 18.2 19 17.3

6 - 10 4 4.0 0 0.0 4 3.6

11+ 6 6.1 0 0.0 6 5.5

Don’t know 6 6.1 0 0.0 6 5.5

Total 99 100.0 11 100.0 110 100.0

5. Health behaviours

102 2009 NSW Inmate Health Survey: Key Findings Report

Environmental tobacco smoke

The majority (72%) of 2009 IHS participants considered that

smoking should be prohibited in enclosed public areas in

prison, such as workplaces, study areas, visiting areas and

study areas, with women more likely than men to report this

opinion (78% versus 71%). Five percent of men and 4% of

women reported being unsure whether smoking should be

prohibited in enclosed public spaces (Table 5.4.15).

Table 5.4.15 Think smoking should be allowed in

enclosed public areas of prison

Men Women Total

n % n % n %

Yes 190 24.1 34 17.9 224 22.9

No 559 70.9 149 78.4 708 72.4

Don’t know 39 4.9 7 3.7 46 4.7

Total 788 100.0 190 100.0 978 100.0

Feelings about increased restrictions on smoking areas in prison:

• ‘Already enough restrictions.’

• ‘As long as I can still smoke in the yard or my cell, that’s OK.’

• ‘Be happy with it. Should be banned altogether in confined spaces.’

• ‘It would mean a lot more people will stop smoking. It’s a

good thing.’

• ‘I’m not sure. Smoking is the only social thing in the gaol.’

• ‘It would piss me off. At the same time it would be good.’

• ‘It’s got to be better for our health but it will stress a lot of people

out and it will cause more tension.’

• ‘Should be able to smoke in cells as there are more deaths in

custody when can’t smoke. Need a cigarette to calm them down.’

• ‘Would cause problems in the gaol but inmates who want to give

up should be in a room by themself. I think the visit area should

be smoke free.’

More than half (55%) of 2009 IHS participants reported

currently sharing a cell with a smoker, including 56% of men

and 54% of women (Table 5.4.16).

Table 5.4.16 Currently share a cell with a smoker

Men Women Total

n % n % n %

Yes 437 55.5 102 53.7 539 55.1

No 351 44.5 88 46.3 439 44.9

Total 788 100.0 190 100.0 978 100.0

Close to one third (32%) of 2009 IHS participants reported that

they had experienced adverse effects from passive smoking

(the effects of other people’s smoke) in the preceding year

(respondents were specifically instructed to exclude experiences

of “just disliking the smoke”) (Table 5.4.17). Women were more

likely than men to report adverse effects from passive smoking

(37% versus 30%), while 6 men and 1 woman (<1% of the

sample) reported being unsure whether they had experienced

adverse effects from passive smoking.

Table 5.4.17 Felt adverse effects from second hand

smoke in last year

Men Women Total

n % n % n %

Yes 238 30.2 71 37.4 309 31.6

No 544 69.0 118 62.1 662 67.7

Don’t know 6 0.8 1 0.5 7 0.7

Total 788 100.0 190 100.0 978 100.0

The great majority (93%) of 2009 IHS participants were of

the opinion that non-smokers should not be forced to share a

cell with a smoker, including 93% of both men and women.

Four percent of men and 2% of women were unsure of their

opinion on this issue (Table 5.4.18).

Table 5.4.18 Think non-smokers should have to share

cells with smokers

Men Women Total

n % n % n %

Yes 22 2.8 9 4.7 31 3.2

No 736 93.4 177 93.2 913 93.4

Don’t know 30 3.8 4 2.1 34 3.5

Total 788 100.0 190 100.0 978 100.0

5.5 Alcohol

The World Health Organization’s Alcohol Use Disorders

Identification Test (AUDIT; Saunders et al., 1993) was used to

assess the risk posed by IHS participants’ self-reported alcohol

consumption in the year prior to their current imprisonment.

The AUDIT categorises alcohol consumption into ‘safe,’

‘hazardous’ and ‘harmful’ levels, using a cut-off score of 8 to

identify hazardous drinking, 16 to identify harmful drinking

and 20 to identify dependent drinking (Babor et al., 2001).

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 103

The proportion of IHS participants who were classified by the

AUDIT as having engaged in hazardous or harmful (scoring

8 or more) alcohol consumption in the year prior to their

imprisonment varied from 52% in 1996 to 45% in 2001 to

58% in 2009 (Table 5.5.1). Excluding considerations of the

2001 prevalence estimates, the overall increase in reports of

hazardous or harmful alcohol consumption between 1996

and 2009 occurred among men (from 54% among 1996

participants to 63% among 2009 participants), but decreased

among women (43% among 1996 participants compared to

40% of 2009 participants).

Table/Fig 5.5.1 Hazardous/harmful alcohol consumption

(AUDIT score 8+) in year before prison

0

10

20

30

40

50

60

70

80

42.7

28.9

39.8

54.1

48.3

62.6

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 329 608 54.1 338 700 48.3 493 788 62.6

Women 50 117 42.7 44 152 28.9 76 191 39.8

Total 379 725 52.3 382 852 44.8 569 979 58.1

The AUDIT scores of 2009 IHS participants were categorised

to examine in more detail the hazards of participants’ selfreported

alcohol consumption levels in the year preceding their

current incarceration. Women were substantially more likely

than men to report not having consumed alcohol at all or low

risk alcohol consumption during that period (60% versus 37%)

(Table 5.5.2). More than one third (35%) of men and one

in six women (16%) reported alcohol consumption at levels

indicative of alcohol dependence.

Table 5.5.2 Risky drinking in year before prison

(AUDIT score categories)

Men Women Total

n % n % n %

0 (non-drinker) 134 17.0 62 32.5 196 20.0

1 - 7 (low risk drinker) 161 20.4 53 27.7 214 21.9

8 - 15 (hazardous drinker) 151 19.2 32 16.8 183 18.7

16 - 19 (harmful drinker) 70 8.9 14 7.3 84 8.6

20+ (dependent drinker) 272 34.5 30 15.7 302 30.8

Total 788 100.0 191 100.0 979 100.0

The proportion of IHS participants who reported no alcohol

consumption in the year prior to their current imprisonment

increased from 28% in 1996 to 32% in 2001, and then declined

to 20% among 2009 participants (Table 5.5.3). A higher

proportion of women than men reported not drinking alcohol

at all in the year prior to their imprisonment in all years in which

the IHS has been conducted; in 2009, this gender differential

translated to 17% of men and 33% of women who reported

not consuming alcohol during this period. If the participant

indicated no alcohol consumption in the year before prison, they

were not asked further AUDIT questions (as per current AUDIT

guidelines), despite some of the questions being focused on

alcohol problems that may have happened over a lifetime.

Table/Fig 5.5.3 No alcohol consumption in the year

before prison

0

10

20

30

40

50

60

29.9

50.0

32.5

27.1 27.4

17.0

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 165 608 27.1 192 700 27.4 134 788 17.0

Women 35 117 29.9 76 152 50.0 62 191 32.5

Total 200 725 27.6 268 852 31.5 196 979 20.0

5. Health behaviours

104 2009 NSW Inmate Health Survey: Key Findings Report

Along with the 20% of 2009 IHS participants who reported

zero alcohol consumption in the year prior to imprisonment,

a further 15% (14% of men and 18% of women) reported

having consumed alcohol monthly or less frequently during that

period, with a similar proportion (15%, including 14% of men

and 17% of women) reporting drinking weekly or less often

over that year (Table 5.5.4). One-fifth (19%) of participants

reported having consumed alcohol on two or three days per

week, with a higher proportion of men than women reporting

this to be the case (21% versus 13%); while 31% (34% of men

and 19% of women) reported having drunk alcohol on 4 or

more days per week in the year prior to their imprisonment.

Table 5.5.4 How often had drink in year before prison

Men Women Total

n % n % n %

Never 134 17.0 62 32.5 196 20.0

Monthly or less 113 14.3 34 17.8 147 15.0

2 - 4 times a month 111 14.1 33 17.3 144 14.7

2 - 3 times a week 164 20.8 25 13.1 189 19.3

4+ times a week 266 33.8 37 19.4 303 30.9

Total 788 100.0 191 100.0 979 100.0

A concerning 41% of the 2009 IHS sample reported drinking

ten or more standard drinks on a typical day they consumed

alcohol in the year prior to their imprisonment (Table 5.5.5),

clearly far in excess of the NHMRC’s (2009) guidelines on

safe drinking levels, which recommend that healthy men and

women who seek to reduce the lifetime risk of harm from

alcohol-related disease and injury should drink no more than

two standard drinks on any one day; and that healthy men

and women who seek to reduce the risk of alcohol-related

injury should drink no more than four standard drinks on any

one day. Men were substantially more likely than women

to report drinking ten or more standard drinks on a typical

drinking day in the year prior to their incarceration (47%

versus 19%). On the other hand, women were substantially

more likely than men to report not drinking at all or low risk

drinking (Two or Three standard drinks per day) during that

period (47% of women versus 25% of men).

Table 5.5.5 Number of drinks on a typical day in year

before prison

Men Women Total

n % n % n %

0 (non-drinker) 134 17.0 62 32.5 196 20.0

1 - 2 64 8.1 27 14.1 91 9.3

3 - 4 91 11.5 24 12.6 115 11.7

5 - 6 78 9.9 26 13.6 104 10.6

7 - 9 54 6.9 15 7.9 69 7.0

10+ 367 46.6 37 19.4 404 41.3

Total 788 100.0 191 100.0 979 100.0

The single AUDIT item shown to be most strongly associated

with alcohol-related harm is that which assesses the

frequency of drinking six or more standard drinks on one

drinking occasion (Reinert & Allen, 2007). Close to one

third (31%) of 2009 IHS participants reported having not

consumed this many standard drinks on a single occasion

at all during the year preceding their imprisonment, with

a substantially higher proportion of women than men

reporting this to be case (49% versus 27%) (Table 5.5.6).

Men were substantially more likely than women to report

engaging in such patterns of alcohol consumption weekly

or more often (50% versus 30%). Of particular concern

was the 31% of men and 17% of women who reported

drinking 6 or more standard drinks on a daily or almost daily

basis in the year prior to imprisonment.

Table 5.5.6 How often have six or more drinks in year

before prison

Men Women Total

n % n % n %

Non-drinker 134 17.0 62 32.5 196 20.0

Never 75 9.5 32 16.8 107 10.9

Less than monthly 98 12.4 20 10.5 118 12.1

Monthly 88 11.2 20 10.5 108 11.0

Weekly 147 18.7 25 13.1 172 17.6

Daily/almost daily 246 31.2 32 16.8 278 28.4

Total 788 100.0 191 100.0 979 100.0

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 105

Other individual AUDIT items demonstrated a similar pattern

of results. A higher proportion of men than women reported

having failed to do what was normally expected of them as a

result of drinking on a weekly or more frequent basis in the

year preceding their incarceration (21% versus 13%). Women

were less likely than men to report this outcome, because they

reported either not drinking at all during that period, or never

having failed to do what was expected of them (75% versus

64%) (Table 5.5.7).

Table 5.5.7 How often failed to do what was

expected of you because of drinking in

year before prison

Men Women Total

n % n % n %

Non-drinker 134 17.0 62 32.6 196 20.0

Never 371 47.1 80 42.1 451 46.1

Less than monthly 62 7.9 16 8.4 78 8.0

Monthly 58 7.4 8 4.2 66 6.7

Weekly 68 8.6 12 6.3 80 8.2

Daily/almost daily 95 12.1 12 6.3 107 10.9

Total 788 100.0 190 100.0 978 100.0

Likewise, a higher proportion of men than women reported

having been unable to stop drinking once they started on

a weekly or more frequent basis in the year preceding their

incarceration (30% versus 15%). Women were again less

likely than men to report this outcome, because they reported

either not drinking at all during that period, or not having

found themselves unable to stop drinking once they started

(75% versus 50%) (Table 5.5.8).

Table 5.5.8 How often unable to stop drinking once

started in year before prison

Men Women Total

n % n % n %

Non-drinker 134 17.0 62 32.6 196 20.0

Never 340 43.1 81 42.6 421 43.0

Less than monthly 41 5.2 8 4.2 49 5.0

Monthly 35 4.4 11 5.8 46 4.7

Weekly 87 11.0 9 4.7 96 9.8

Daily/almost daily 151 19.2 19 10.0 170 17.4

Total 788 100.0 190 100.0 978 100.0

Similarly, a higher proportion of men than women reported

having been unable to remember the events of the night

before as a result of their drinking on a weekly or more

frequent basis in the year preceding their incarceration (21%

versus 8%). Women were less likely than men to report this

outcome, because they reported either not drinking at all, or

not having been unable to remember the events of the night

before (76% versus 58%) (Table 5.5.9).

Table 5.5.9 How often unable to remember what

happened the night before because of

drinking in year before prison

Men Women Total

n % n % n %

Non-drinker 134 17.0 62 32.6 196 20.0

Never 322 40.9 82 43.2 404 41.3

Less than monthly 104 13.2 20 10.5 124 12.7

Monthly 64 8.1 10 5.3 74 7.6

Weekly 82 10.4 9 4.7 91 9.3

Daily/almost daily 82 10.4 7 3.7 89 9.1

Total 788 100.0 190 100.0 978 100.0

Men were also more likely to report needing a drink first

thing in the morning to get themselves going after a heavy

drinking session on a weekly or more frequent basis in the

year preceding their incarceration (18% versus 9%). Women

were less likely than men to report this outcome, because

they reported either not drinking at all, or not having needed

a drink first thing in the morning to get them going after a

heavy drinking session (87% versus 76%) (Table 5.5.10).

Table 5.5.10 How often need a drink first thing in the

morning after a heavy drinking session in

year before prison

Men Women Total

n % n % n %

Non-drinker 134 17.0 62 32.6 196 20.0

Never 461 58.5 104 54.7 565 57.8

Less than monthly 20 2.5 3 1.6 23 2.4

Monthly 29 3.7 4 2.1 33 3.4

Weekly 47 6.0 4 2.1 51 5.2

Daily/almost daily 97 12.3 13 6.8 110 11.2

Total 788 100.0 190 100.0 978 100.0

5. Health behaviours

106 2009 NSW Inmate Health Survey: Key Findings Report

Interestingly, given the consistency of the pattern of results for

the other AUDIT items, men were only slightly more likely than

women to report feeling guilty or remorseful after drinking on

a weekly or more frequent basis during the year preceding their

incarceration (16% versus 11%) (Table 5.5.11). Indeed, excluding

participants who reported not drinking at all during this period,

a higher proportion of men than women reported never feeling

guilty or remorseful after drinking (50% versus 44%).

Table 5.5.11 How often feel guilty or remorseful after

drinking in year before prison

Men Women Total

n % n % n %

Non-drinker 134 17.0 62 32.6 196 20.0

Never 393 49.9 84 44.2 477 48.8

Less than monthly 79 10.0 16 8.4 95 9.7

Monthly 58 7.4 7 3.7 65 6.6

Weekly 61 7.7 8 4.2 69 7.1

Daily/almost daily 63 8.0 13 6.8 76 7.8

Total 788 100.0 190 100.0 978 100.0

A higher proportion of men (43%) than women (17%)

indicated that they or someone else had ever been injured as a

result of their drinking. Both men and women who indicated

causing an alcohol-related injury were more likely to indicate

that this had occurred in the last year (Table 5.5.12).

Table 5.5.12 Have you or someone else ever been

injured as a result of your drinking

Men Women Total

n % n % n %

Non-drinker 134 17.0 62 32.6 196 20.0

No 313 39.7 95 50.0 408 41.7

Yes, but not in year

prior to prison 140 17.8 15 7.9 155 15.8

Yes, during year prior

to prison 201 25.5 18 9.5 219 22.4

Total 788 100.0 190 100.0 978 100.0

A higher proportion of men (40%) than women (21%) had been

encouraged by a friend, relative or doctor to reduce their drinking

(Table 5.5.13). Men were also more likely to report that this had

happened during the year prior to their current incarceration.

Table 5.5.13 Has a relative, friend or doctor ever

been concerned about your drinking and

suggested you cut down

Men Women Total

n % n % n %

Non-drinker 134 17.0 62 32.6 196 20.0

No 340 43.1 88 46.3 428 43.8

Yes, but not in last year 110 14.0 15 7.9 125 12.8

Yes, during last year 204 25.9 25 13.2 229 23.4

Total 788 100.0 190 100.0 978 100.0

Unfortunately a computer programming error meant that 2009

IHS participants who reported not having consumed alcohol at

all in the year prior to their incarceration were not asked whether

they had ever consumed alcohol while in prison. Sixty men (8%)

and nine women (5%) reported having drunk alcohol in prison

(Table 5.5.14). The majority (82%) of those who reported having

consumed alcohol in prison reported having done so less than

monthly, including 80% of men and 89% of women. Two men

and no women reported having consumed alcohol on a daily

basis while in prison, while seven men and one woman reported

having drunk on a weekly basis.

Table 5.5.14 Ever consumed alcohol in prison

Men Women Total

n % n % n %

Non-drinker 134 17.0 62 32.6 196 20.0

Yes 60 7.6 9 4.7 69 7.1

No 594 75.4 119 62.6 713 72.9

Total 788 100.0 190 100.0 978 100.0

More than half (54%) of IHS participants reported perceiving

that at least one significant other in their lives had experienced

problems as a result of their alcohol use, such as problems

with their health, work, relationships or the law (Table 5.5.15).

Participants were most likely to nominate their father as having

problems related to alcohol (30%), followed by other family

members (30%), their mothers (19%) and their own husband/

wife/partner (15%). Women were substantially more likely

than men to report perceiving that their own partner had

problems related to alcohol (28% versus 12%).

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 107

Table 5.5.15 Felt certain people had problems due to

their use of alcohol

(Multiple response)

Men Women Total

n % n % n %

No significant others 374 47.5 75 39.5 449 45.9

Mother 139 17.6 44 23.2 183 18.7

Father 234 29.7 59 31.1 293 30.0

Husband / wife / partner 91 11.5 53 27.9 144 14.7

Children 24 3.0 9 4.7 33 3.4

Other family member 236 29.9 53 27.9 289 29.6

5.6 Illicit drugs

The proportion of IHS participants who reported having ever

used an illicit drug increased from 71% in 1996 to 81%

in 2001, and then increased again slightly to 84% in 2009

(Table 5.6.1). Reported lifetime prevalence of illicit drug use

increased steadily among men (from 69% to 80% to 86%),

while decreasing slightly among women, from 82% in 1996

to 78% in 2009. Indeed, 2009 is the first year in which the

IHS has been conducted that a higher proportion of men

than women reported a history of illicit drug use.

Table/Fig 5.6.1 Ever use any illicit drug

0

20

40

60

80

100

82.1 83.6

77.8

68.6

80.0

85.5

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 420 612 68.6 560 700 80.0 674 788 85.5

Women 96 117 82.1 127 152 83.6 147 189 77.8

Total 516 729 70.8 687 852 80.6 821 977 84.0

The illicit drug classes 2009 IHS participants were most

likely to report having used at some time in their lives were

cannabis (81%), followed by meth/amphetamine powder

and/or paste (57%), cocaine (45%), ecstasy (44%), crystalline

methamphetamine (‘ice’) (42%) and heroin (41%) (Table 5.6.2).

Men were substantially more likely than women to report having

used cannabis (84% versus 71%), steroids (8% versus <1%) and

solvents (7% versus 2%), whereas women were substantially

more likely to report having used heroin (49% versus 39%).

Not surprisingly, given the well-documented associations

between drug use and incarceration (e.g., Butler et al., 2003)

the lifetime prevalence of use of any illicit drugs, as well as

the use of all individual illicit drug classes, was substantially

higher than is reported by Australia’s general population in the

triennial National Drug Strategy Household Survey (NDSHS). For

example, in 2007, 38% of Australians aged 14 years or older

reported having used an illicit drug at some time in their lives,

including 41% of men and 35% of women (AIHW, 2008c).

Australians aged 30 – 39 years were more likely than those in

other age groups to have used an illicit drug in their lifetime.

Following the exclusion of cannabis from these analyses, 18%

of Australians reported having used an illicit drug at some time,

including ecstasy (9%), meth/amphetamines (6%), cocaine

(6%) and heroin and other opiates (2%).

Table 5.6.2 Ever use any illicit drug by drug type

(Multiple response)

Men Women Total

n % n % n %

Cannabis 659 83.6 135 71.4 794 81.3

Meth/amphetamines (powder/

paste) 453 57.5 106 56.1 559 57.2

Cocaine 354 44.9 88 46.6 442 45.2

Ecstasy 361 45.8 73 38.6 434 44.4

Crystalline methamphetamine

(‘ice’) 330 41.9 82 43.4 412 42.2

Heroin 304 38.6 93 49.2 397 40.6

LSD 232 29.4 45 23.8 277 28.4

Benzodiazepines 189 24.0 55 29.1 244 25.0

Other opiates 150 19.0 38 20.1 188 19.2

Other’s methadone/

buprenorphine 125 15.9 28 14.8 153 15.7

Steroids 65 8.2 1 0.5 66 6.8

Solvents/petrol 52 6.6 4 2.1 56 5.7

Amyl nitrate 41 5.2 9 4.8 50 5.1

5. Health behaviours

108 2009 NSW Inmate Health Survey: Key Findings Report

The main changes observed between 2001 and 2009 in

self-reported lifetime use of specific drug classes among

IHS participants were substantial increases in reported use

of crystalline methamphetamine (from 11% to 42%) and

of ecstasy (from 27% to 44%), together with a decline

in the reported use of heroin (from 53% to 41%). All

three changes are entirely consistent with changes in

Australia’s broader illicit drug markets during these years.

The availability and use of crystalline methamphetamine

increased substantially during the early part of this decade

(Topp et al., 2002) although more recently appears to have

stabilised (Stafford et al., 2009); a marked decline in the

availability and use of heroin occurred during the same

period (Topp et al., 2003), with the heroin market yet to

recover to its pre-2001 levels (Stafford et al., 2009); and the

availability and use of ecstasy continuing to increase such

that the drug is now entrenched in Australia’s illicit drug

markets (Degenhardt et al., 2009).

The proportion of IHS participants who reported having

used at least one illicit drug ‘regularly’ in the year preceding

prison – with ‘regularly’ defined as ‘daily or almost daily

use’ – was lower in 2009 than any other year in which the

IHS was conducted, decreasing from 55% in 1996, and

from 68% in 2001, to 44% in the most recent Survey (Table

5.6.3). In all years in which the IHS was conducted, a higher

proportion of women than men reported daily/almost daily

use of illicit drugs in the year prior to their imprisonment; in

2009, this gender differential translated to 54% of women

and 42% of men reporting such use of drugs.

Table/Fig 5.6.3 Daily/almost daily use of any illicit drugs

in the year before prison

0

10

20

30

40

50

60

70

80

90

66.7

73.7

52.6 54.0

66.6

42.1

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 322 612 52.6 466 700 66.6 332 788 42.1

Women 78 117 66.7 112 152 73.7 102 189 54.0

Total 400 729 54.9 578 852 67.8 434 977 44.4

Whereas fewer than half (44%) of 2009 IHS participants reported

having used illicit drugs daily/almost daily in the year before

prison, a further 40% of the sample (43% of men and 24% of

women) reported having used drugs less frequently during this

period (Table 5.6.4). A higher proportion of women than men

reported having never used illicit drugs at all (22% versus 15%).

Table 5.6.4 Frequency of daily/almost daily use of any

illicit drug in the year before prison

Men Women Total

n % n % n %

Never used drugs 114 14.5 42 22.2 156 16.0

Used drugs but not on a

daily/almost daily basis in

year before prison 342 43.4 45 23.8 387 39.6

Used drugs on a daily/

almost daily basis in year

before prison 332 42.1 102 54.0 434 44.4

Total 788 100.0 189 100.0 977 100.0

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 109

The illicit drugs 2009 IHS participants were most likely to

report having used daily/almost daily in the year preceding

their incarceration were cannabis (26%), followed by meth/

amphetamines (16%), crystalline methamphetamine (13%)

and heroin (10%) (Table 5.6.5). Women were twice as likely

as men to report daily/almost daily use of heroin in the

year preceding their incarceration (18% versus 9%), three

times as likely to report the daily/almost daily use of cocaine

(15% versus 5%) or benzodiazepines (14% versus 5%), and

somewhat more likely to report the daily/almost daily use of

both meth/amphetamines (21% versus 14%) and crystalline

methamphetamine (15% versus 12%).

Table 5.6.5 Daily/almost daily use of any illicit drug in

year before prison by drug type

(Multiple response)

Men Women Total

n % n % n %

Cannabis 208 26.4 44 23.3 252 25.8

Meth/amphetamines

(powder/paste) 113 14.3 39 20.6 152 15.6

Crystalline

methamphetamine (‘ice’) 93 11.8 29 15.3 122 12.5

Heroin 67 8.5 34 18.0 101 10.3

Cocaine 42 5.3 28 14.8 70 7.2

Benzodiazepines 42 5.3 27 14.3 69 7.1

Ecstasy 55 7.0 10 5.3 65 6.7

Other’s methadone/

buprenorphine 37 4.7 13 6.9 50 5.1

Other opiates 34 4.3 10 5.3 44 4.5

Steroids 13 1.6 0 0.0 13 1.3

LSD 8 1.0 1 0.5 9 0.9

Amyl nitrate 4 0.5 1 0.5 5 0.5

Solvents/petrol 1 0.1 0 0.0 1 0.1

Self-reported daily/almost daily drug use in the year

preceding incarceration declined among IHS participants

between 2001 and 2009 for all illicit drug classes with the

exception of crystalline methamphetamine, which increased

from 4% of 2001 participants to 12% of the 2009 sample.

The largest decreases were observed in reports of the use of

cannabis (from 49% to 26%), heroin (from 35% to 10%),

and cocaine (22% to 7%).

The proportion of IHS participants who reported having ever

used an illicit drug while in prison remained steady between

1996 (49%) and 2001 (48%) and then declined to 43% in

2009 (Table 5.6.6). The gender difference in reports of illicit

drug use in prison observed in the 1996 IHS has been virtually

absent in more recent Surveys; in 2009, 44% of women and

42% of men reported having ever used a drug in prison.

Table/Fig 5.6.6 Ever use illicit drugs in prison

0

10

20

30

40

50

60

70

59.8

48.7

46.4 43.9 48.1

42.1

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 286 616 46.4 335 696 48.1 332 788 42.1

Women 70 117 59.8 74 152 48.7 83 189 43.9

Total 356 733 48.6 409 848 48.2 415 977 42.5

With 16% of the 2009 IHS sample reporting having never

used drugs at all and 43% reporting having used in prison,

this equates to 42% of the sample who had a history of illicit

drug use who had never used drugs in prison (Table 5.6.7).

Between 2001 and 2009, the declines in reports of illicit drug

use in prison among IHS participants were most marked for

cannabis (44% to 31%) and heroin (24% to 15%).

Table 5.6.7 Ever use illicit drugs in or out of prison

Men Women Total

n % n % n %

Never used drugs 114 14.5 42 22.2 156 16.0

Have used drugs but never

in prison 342 43.4 64 33.9 406 41.6

Have used drugs in prison 332 42.1 83 43.9 415 42.4

Total 788 100.0 189 100.0 977 100.0

5. Health behaviours

110 2009 NSW Inmate Health Survey: Key Findings Report

The drugs that 2009 IHS participants were most likely to

report having used while in prison were cannabis (31% of

the sample), followed by heroin (15%), another person’s

methadone or buprenorphine (10%) and meth/amphetamines

(10%) (Table 5.6.8). Men were more likely than women to

report the use while in prison of cannabis (33% versus 26%),

heroin (16% versus 13%), and another person’s methadone or

buprenorphine (11% versus 7%); whereas women were more

likely than men to report the use of benzodiazepines (12%

versus 8%). Eighteen men, and no women, reported the use

of steroids in prisons.

Table 5.6.8 Ever use illicit drug in prison by drug type

(Multiple response)

Men Women Total

n % n % n %

Cannabis 258 32.7 49 25.9 307 31.4

Heroin 125 15.9 25 13.2 150 15.4

Other’s methadone/

buprenorphine 84 10.7 14 7.4 98 10.0

Meth/amphetamines

(powder/paste) 78 9.9 16 8.5 94 9.6

Benzodiazepines 59 7.5 22 11.6 81 8.3

Crystalline

methamphetamine (‘ice’) 60 7.6 11 5.8 71 7.3

Cocaine 47 6.0 11 5.8 58 5.9

Other opiates 45 5.7 7 3.7 52 5.3

Ecstasy 33 4.2 3 1.6 36 3.7

Steroids 18 2.3 0 0.0 18 1.8

LSD 14 1.8 1 0.5 15 1.5

Solvents/petrol 6 0.8 0 0.0 6 0.6

Amyl nitrate 1 0.1 0 0.0 1 0.1

A total of 32 (31 men and one woman) 2009 IHS participants

reported having initiated heroin use in an adult prison, having

never used it in the community prior to their imprisonment.

Forty one participants (35 men and six women) reported having

specifically used heroin rather than cannabis in prison in order to

avoid drugs being detected in a urine drug screening test (as the

metabolites of heroin are detectable in urine for a significantly

shorter period than the metabolites of cannabis; Wolff et al., 1999).

Forty six participants (41 men and five women) reported that

they had used heroin in prison as a substitute for cannabis and/or

alcohol (due to the lack of availability of these drugs in prison).

The proportion of IHS participants who described it as “quite

easy” or “very easy” to obtain drugs in prison decreased from

77% in 2001 to 48% in 2009 (Table 5.6.9). The decrease appears

to have been more marked among men (dropping from 78% to

47%) than among women (declining from 76% to 54%).

Table/Fig 5.6.9 Quite easy or very easy to obtain drugs

in prison

0

10

20

30

40

50

60

70

80

90

76.4

53.7

77.6

46.8

2001 2009

Men Women

PERCENT

YEAR

2001 2009

n Total % n Total %

Men 433 558 77.6 368 786 46.8

Women 94 123 76.4 101 188 53.7

Total 527 681 77.4 469 974 48.2

Among 2009 IHS participants, men were more likely than women

to describe it as “very” or “quite difficult” to obtain drugs in

prison (29% versus 22%), while, conversely, women were more

likely to describe it as “quite” or “very easy” (54% versus 47%).

A quarter of both men and women reported that they did not

know whether it was easy to get drugs in prison (Table 5.6.10).

Table 5.6.10 Perceived ease to obtain drugs in prison

Men Women Total

n % n % n %

Very difficult 74 9.4 9 4.8 83 8.5

Quite difficult 154 19.6 32 17.0 186 19.1

Quite easy 191 24.3 57 30.3 248 25.5

Very easy 177 22.5 44 23.4 221 22.7

Don’t know 190 24.2 46 24.5 236 24.2

Total 786 100.0 188 100.0 974 100.0

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 111

The proportion of IHS participants who reported a history of

injecting drug use increased from 47% in 1996 to 57% in

2001, then declined to 43% in 2009 (Table 5.6.11). In all years

in which the IHS has been conducted, a higher proportion of

women than men reported a history of injecting drug use; in

2009, this gender differential translated to 52% of women

and 40% of men reporting such a history. The 2007 NDSHS

found that 2% of Australians aged 14 years or older reported

a history of injecting drug use, including 2.5% of men and

1.3% of women (AIHW, 2008c).

Table/Fig 5.6.11 Ever inject drugs

0

10

20

30

40

50

60

70

80

90

72.6 73.5

52.4

42.4

53.1

40.1

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 261 616 42.4 359 676 53.1 316 788 40.1

Women 85 117 72.6 108 147 73.5 99 189 52.4

Total 346 733 47.2 467 823 56.7 415 977 42.5

Together with data reported earlier, the 43% of the 2009

IHS sample who reported a history of injecting drug use

and the 16% who reported having never used drugs at all,

leaves a total of 42% of the sample who reported having

used illicit drugs but never injected them (Table 5.6.12).

Men were more likely than women to report a history of

non-injecting illicit drug use (45% versus 25%).

Table 5.6.12 Drug use by injecting history

Men Women Total

n % n % n %

Never used drugs 114 14.5 42 22.2 156 16.0

Have used drugs but never

injected 358 45.4 48 25.4 406 41.6

Have injected drugs 316 40.1 99 52.4 415 42.5

Total 788 100.0 189 100.0 977 100.0

The drug classes 2009 IHS participants were most likely to report

having injected were heroin (32%) and meth/amphetamines

(32%), followed by crystalline methamphetamine (23%) and

cocaine (21%) (Table 5.6.13). Twelve percent of the sample

reported having injected their own methadone or buprenorphine,

and 8% reported having injected another person’s. Women were

more likely than men to report having injected all of the major

classes of injectable drugs, including heroin (42% versus 29%),

meth/amphetamines (39% versus 30%), cocaine (33% versus

18%) and crystalline methamphetamine (31% versus 21%).

Fifty two men, and no women, reported a history of having

injected steroids. Between 2001 and 2009, the proportion of IHS

participants who reported having injected heroin decreased from

47% to 32%; while the proportion who reported having injected

crystalline methamphetamine increased from 4% to 23%.

Table 5.6.13 Ever inject drugs by drug type

(Multiple response)

Men Women Total

n % n % n %

Heroin 228 28.9 80 42.3 308 31.5

Other opiates 107 13.6 32 16.9 139 14.2

Meth/amphetamines

(powder/paste) 235 29.8 73 38.6 308 31.5

Cocaine 138 17.5 62 32.8 200 20.5

Crystalline

methamphetamine (‘ice’) 167 21.2 58 30.7 225 23.0

Your methadone/

buprenorphine 84 10.7 37 19.6 121 12.4

Ecstasy 57 7.2 19 10.1 76 7.8

LSD 33 4.2 8 4.2 41 4.2

Other’s methadone/

buprenorphine 57 7.2 19 10.1 76 7.8

Benzodiazepines 27 3.4 4 2.1 31 3.2

Steroids 52 6.6 0 0.0 52 5.3

5. Health behaviours

112 2009 NSW Inmate Health Survey: Key Findings Report

The proportion of IHS participants who reported having

injected drugs in prison decreased slightly from 25% in 1996

and in 2001 to 17% in 2009 (Table 5.6.14). In both 1996 and

2001, a substantially higher proportion of women than men

reported having injected in prison, but in 2009, this gender

difference was eliminated, with 16% of men and 17% of

women reporting this behaviour.

Table/Fig 5.6.14 Ever inject drugs in prison

0

5

10

15

20

25

30

35

40

45

35.9 37.4

16.9

22.9 22.8

16.4

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 141 616 22.9 154 676 22.8 129 788 16.4

Women 42 117 35.9 55 147 37.4 32 189 16.9

Total 183 733 25.0 209 823 25.4 161 977 16.5

Together with data reported earlier, the 17% of the 2009

IHS sample who reported a history of injecting drugs in

prison, and the 16% who reported having never used

drugs at all, there was a further 42% of participants who

had used drugs but never injected them and 26% who

had injected drugs but never in prison (Table 5.6.15). Men

were more likely than women to report having used but not

injected illicit drugs (45% versus 25%), while women were

more likely to have injected drugs but never while in prison

(35% versus 24%).

Table 5.6.15 Drug use by injecting and prison use

Men Women Total

n % n % n %

Never used drugs 114 14.5 42 22.2 156 16.0

Used drugs but never

injected 358 45.4 48 25.4 406 41.6

Inject drugs but never

in prison 187 23.7 67 35.4 254 26.0

Injected drugs in prison 129 16.4 32 16.9 161 16.5

Total 788 100.0 189 100.0 977 100.0

The drug that 2009 IHS participants were most likely to

report having injected in prison was heroin (13% of the

sample), followed by meth/amphetamines (7%). Crystalline

methamphetamine (5%), opiates other than heroin (5%) and

cocaine (4%) were also reported by small minorities of the

sample (Table 5.6.16). Four percent of the sample reported

having injected their own methadone or buprenorphine in

prison, while 5% reported having injected someone else’s.

Between 2001 and 2009, the proportion of IHS participants

who reported having injected in prison decreased for heroin

(from 30% to 13%), meth/amphetamines (from 17% to

7%) and cocaine (from 10% to 4%); whereas over the same

period, the proportion who reported having injected in prison

increased for crystalline methamphetamine (from 1% to 5%)

and other opiates (from 2% to 5%).

Table 5.6.16 Ever inject drugs in prison by drug type

(Multiple response)

Men Women Total

n % n % n %

Heroin 102 12.9 23 12.2 125 12.8

Meth/amphetamines (powder/

paste) 59 7.5 10 5.3 69 7.1

Crystalline methamphetamine

(‘ice’) 41 5.2 7 3.7 48 4.9

Other’s methadone/

buprenorphine 38 4.8 10 5.3 48 4.9

Other opiates 40 5.1 6 3.2 46 4.7

Your methadone/

buprenorphine 37 4.7 6 3.2 43 4.4

Cocaine 31 3.9 10 5.3 41 4.2

Steroids 10 1.3 0 0.0 10 1.0

Ecstasy 9 1.1 0 0.0 9 0.9

LSD 3 0.4 0 0.0 3 0.3

Benzodiazepines 3 0.4 0 0.0 3 0.3

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 113

The mean age at which IHS participants with a history of

injecting drug use reported initiating injecting remained relatively

stable, ranging among men from 18.5 years in 1996 to 19.1

years in 2009, and among women from 19.0 years in 1996 and

2009 to 20.0 years in 2001 (Table 5.6.17). This age of initiation

to injecting is consistent with that reported in the annual Needle

and Syringe Program (NSP) survey, cross-sectional surveys of

large samples of public sector NSP clients from all Australian

jurisdictions that monitor changes over time in the prevalence

of blood borne viruses (BBVs) and associated risk behaviours

(MacDonald et al., 1997; 2000). For example, every year

between 2004 and 2008, NSP Survey participants reported a

median age of initiation to injection of 18 years (NCHECR, 2009).

Table/Fig 5.6.17 Mean age first injected drugs

characteristics (if ever injected)

0

5

10

15

20

25

19.0 20.0 18.5 18.8 19.1 19.0

1996 2001 2009

Men Women

MEAN

YEAR

1996 2001 2009

Mean (±sd) range Mean (±sd) range Mean (±sd) range

Men 18.5 (±4.2) 11 - 38 18.8 (±5.6) 8 - 50 19.1 (±6.0) 9 - 49

Women 19.0 (±5.7) 12 - 39 20.0 (±6.8) 11 - 41 19.0 (±5.9) 9 - 40

Total 18.6 (±4.6) 11 - 39 19.1 (±5.9) 8 - 50 19.1 (±5.9) 9 - 49

Thirteen percent of 2009 IHS participants with a history of

injecting drug use reported that their most recent injection

was within the four weeks preceding the Survey, including

2% of the sample (9 men and no women) who reported most

recently injecting within the preceding week (Table 5.6.18).

Women were more likely than men to report a history of more

recent injecting: whereas 66% of men reported that their most

recent injection was 6 or more months preceding the Survey,

the equivalent figure for women was 51%. Eleven percent of

men and 5% of women reported having injected most recently

more than 10 years preceding the Survey.

Table 5.6.18 How long since last injected drugs (if ever

injected)

Men Women Total

n % n % n %

In last week 9 2.8 0 0.0 9 2.2

1 - <2 weeks 13 4.1 1 1.0 14 3.4

2 - <4 weeks 16 5.1 13 13.1 29 7.0

1 - <6 months 69 21.8 35 35.4 104 25.1

6 - <12 months 47 14.9 18 18.2 65 15.7

1 - <2 years 46 14.6 10 10.1 56 13.5

2 - <5 years 58 18.4 10 10.1 68 16.4

5 - <10 years 23 7.3 7 7.1 30 7.2

10+ years 35 11.1 5 5.1 40 9.6

Total 316 100.0 99 100.0 415 100.0

Among the 161 IHS participants in 2009 who reported

having injected drugs in prison, 57% (equating to 22% of

participants with a history of injecting drug use) reported that

their most recent injection occurred in prison (Table 5.6.19).

Although a higher proportion of male than female injectors

reported having injected in prison at some time (41% versus

32%), there was no gender difference in the proportion of

injectors who reported that their most recent injection had

occurred in prison: 22% of male injectors and 21% of female

injectors reported this to be the case.

Table 5.6.19 Was the most recent injection in prison (if

ever injected)

Men Women Total

n % n % n %

Yes 70 22.2 21 21.2 91 21.9

No 59 18.7 11 11.1 70 16.9

Never injected in prison 187 59.2 67 67.7 254 61.2

Total 316 100.0 99 100.0 415 100.0

Among the 34 (27 men and 7 women) 2009 IHS

participants who reported having injected in prison within

the preceding month, five men and no women reported

having injected daily or more often during that period.

The majority (19 participants, comprising 14 men and five

women) reported having injected in prison less often than

weekly in the preceding month.

5. Health behaviours

114 2009 NSW Inmate Health Survey: Key Findings Report

Among 112 IHS participants in 2009 who reported having

injected in prison and for whom these data were available

(unfortunately a computer programming error meant this

question was skipped for 49 participants for whom it was

relevant), just three (3%) reported that on their most recent

occasion of injecting in prison, no other person had used

the needle and syringe to inject before they themselves used

it (Table 5.6.20). Close to one third (31%) reported that

one other person had used the needle/syringe before them,

and one in eight (12%) reported that two other people had

done so. Seventeen percent reported that six or more people

had used the needle/syringe prior to their doing so; while

one quarter of men (26%) and one-third of women (33%)

acknowledged that they did not know how many people

had injected with the needle/syringe before they did.

Table 5.6.20 Number of people who had used the needle/

syringe prior to participants on last injecting

occasion (if ever injected in prison)

Men Women Total

n % n % n %

0 3 3.1 0 0.0 3 2.7

1 27 27.8 8 53.3 35 31.3

2 11 11.3 2 13.3 13 11.6

3-5 12 12.4 0 0.0 12 10.7

6+ 19 19.6 0 0.0 19 17.0

Don’t know 25 25.8 5 33.3 30 26.8

Total 97 100.0 15 100.0 112 100.0

Among the 161 IHS participants in 2009 who reported having

injected in prison, 35% reported having never used any injecting

equipment after another person while injecting in prison, with

women more likely to report that this was the case than men

(44% versus 33%). According to participants’ reports, the item

least likely to be used after another person was a tourniquet

(24%), however, it is more likely that not all injectors used a

tourniquet and that a high proportion used their own. Spoons

(used as a container to mix drugs with water ready for injection),

water, filters (to filter drug solution) and drug solution/mix had

all been used after at least one other person by more than

one-third of those who reported having injected in prison (Table

5.6.21). Men who reported having injected in prison were

substantially more likely than women to report having used a

spoon after another person (60% versus 41%).

Table 5.6.21 Use in prison of drug and injecting

equipment after another person (if ever

injected in prison)

(Multiple response)

Men Women Total

n % n % n %

No use of equipment

after another person 43 33.3 14 43.8 57 35.4

Spoon 77 59.7 13 40.6 90 55.9

Filter 54 41.9 13 40.6 67 41.6

Drug solution/mix 50 38.8 13 40.6 63 39.1

Water 45 34.9 11 34.4 56 34.8

Tourniquet 32 24.8 7 21.9 39 24.2

Total 129 100.0 32 100.0 161 100.0

Among the 161 IHS participants in 2009 who reported having

injected in prison, the great majority (90%) reported that the

last time they injected in prison, the needle/syringe had been

cleaned before they used it, with a higher proportion of men

than women reporting this to be the case (92% versus 84%).

An equal proportion (3%) of men and women reported being

unsure whether the needle/syringe had been cleaned prior to

their using it.

Current U.S. Centres for Disease Control (CDC) guidelines for

the cleaning of injecting equipment are based on the 2x2x2

method, recommending flushing needles/syringes twice with

cool water, twice agitating for 30 seconds with full strength

bleach, and again flushing twice with cool water (Abdala et al.,

2001). However, although bleach contact time of 30 seconds

may deactivate HIV (MMWR, 1998), 10 minutes is recommended

for HCV (Charrel et al., 2001; Sattar et al., 2001), and even

after 10 minutes, the efficacy of bleach in deactivating HCV is

inconclusive (Vlahov et al., 1994; Kapadia et al., 2002; Hagan &

Thiede, 2003). Lack of adherence to suggested decontamination

techniques is prevalent among North American injecting drug

users in real world settings (McCoy et al., 1994; MMWR, 1994;

Siegal et al., 1994), a lack of expertise likely to be compounded

in the prison environment given that all injecting equipment is

contraband, such that inmates are reluctant to be identified by

custodial authorities as possessing it. The presumably hasty and

covert nature of any attempted decontamination of injecting,

tattooing or piercing equipment likely to be reused in prison

seems highly likely to reduce the already low likelihood of

effectively undertaking such techniques.

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 115

A range of cleaning methods were described by 2009 IHS

participants who reported that the last time they injected

in prison, the needle/syringe had been cleaned before they

used it. Half (50%) reported using a variant of the CDC

recommendations, namely the 2x2x2 or 3x3x3 (which

involves three flushes with cool water, three agitations with

full-strength bleach, and three flushes with cool water).

A higher proportion of men than women reported using

such methods (52% versus 44%). Soaking (12%) and

rinsing (10%) with bleach were also reported, while a small

proportion of participants who reported cleaning the needle/

syringe last time they injected in prison further reported

having only used water (hot or cold) to do so.

Among the eleven participants who reported not having

cleaned the needle/syringe prior to using it on the last

occasion on which they injected in prison, four reported

that the equipment was new when they obtained it so they

did not need to clean it, and two reported that only they

had used the needle previously. Three reported not having

enough time to clean the needle/syringe, and another

reported that there was no bleach available.

Among the 415 IHS participants in 2009 who reported a

history of injecting drug use, 17% (18% of men and 16%

of women) reported having bought a “clean” needle/

syringe in prison. Unfortunately, the wording of the

question makes it impossible to determine whether these

participants referred to paying for a brand new (sterile)

needle/syringe or one that had been used but cleaned

before they purchased it.

Access to bleach in prison

Disinfectant was first distributed to NSW prisoners in 1990. In

November 2007, Corrective Services NSW (CSNSW) replaced

the CCF5T bleach previously provided in specific dispensers

in NSW prisons as a blood borne virus prevention strategy

with Fincol, a hospital grade disinfectant. Intended to be

used for the disinfection of injecting, piercing and tattooing

equipment, CSNSW maintains that the advantages of

Fincol over bleach include that it is less toxic and corrosive;

will not deteriorate when stored in hot or cold conditions;

has demonstrated effectiveness against bacteria, fungi

and viruses including HIV, HBV and a surrogate for HCV;

and retains its effectiveness for up to eight hours after it

is mixed with water to the recommended concentration

(Hep C Review, 2008). Given this change in CSNSW policy,

it is important to note that whereas 2009 IHS participants

may have had experience with both bleach and Fincol in

prisons, and thus may have been referring to either or both

substances when responding to questions which included the

generic term ‘bleach,’ 2001 IHS participants would not have

had experience with Fincol in prison.

Fewer than half (44%) of 2009 IHS participants reported being

aware of the CSNSW policy to provide inmates with bleach for

the purposes of disinfecting injecting, piercing and tattooing

equipment. Women were substantially less likely than men to

report awareness of this policy (30% versus 47%).

There was a substantial decrease in the proportion of IHS

participants who reported having ever attempted to access

bleach in prisons, from 31% in 2001 to 18% in 2009 (Table

5.6.22). Although the decline was reported by both men

and women, it was most dramatic among women, among

whom reports of having ever attempted to access bleach

in prison declined from 41% in 2001 to 17% in 2009.

As previously noted, it is not possible to determine if this

decrease is due to the exchange of Fincol for bleach or a

genuine decline.

Table/Fig 5.6.22 Ever attempted to access bleach in prison

0

5

10

15

20

25

30

35

40

45 41.2

17.0

29.2

17.8

2001 2009

Men Women PERCENT

YEAR

2001 2009

n Total % n Total %

Men 199 681 29.2 140 786 17.8

Women 61 148 41.2 32 188 17.0

Total 260 829 31.4 172 974 17.7

5. Health behaviours

116 2009 NSW Inmate Health Survey: Key Findings Report

Among the 140 men and 32 women who reported having

attempted to access bleach in prison, close to two thirds (62%)

described it as “easy” or “very easy” to obtain (Table 5.6.23).

Women reported more difficulty in obtaining bleach, and were

more likely than men to report that bleach was not available at

all (22% versus 18%). A lack of availability of bleach or Fincol

is in contravention of CSNSW policy to provide to inmates the

means to disinfect any equipment potentially contaminated

by blood borne viruses. HCV seroconversion has been

documented among individuals continuously imprisoned in

NSW prisons (Butler et al., 2004b). The provision of the means

by which to penetrate skin with sterile injecting, piercing and/

or tattooing equipment would reduce the continued risk of

BBV transmission between prison inmates.

Table 5.6.23 Ease of obtaining bleach in prison (if ever

tried to obtain bleach)

Men Women Total

n % n % n %

Very easy 46 32.9 10 31.3 56 32.6

Easy 44 31.4 7 21.9 51 29.7

Difficult 25 17.9 8 25.0 33 19.2

Not available 25 17.9 7 21.9 32 18.6

Total 140 100.0 32 100.0 172 100.0

Prior to 1990, a strong objection of custodial staff to the

introduction of bleach was that inmates would use it improperly.

Accordingly, 2009 IHS participants were asked if they were

aware of any inmates using bleach for purposes other than that

for which it was intended, with no limit to the number of such

uses which they could report. Few were aware of such improper

use (Table 5.6.24), with only a handful of participants reporting

that they knew of inmates drinking bleach, throwing it into

another person’s eyes or injecting it. A total of 62 participants

reported that they knew of inmates who injected drugs more

often because bleach was available, with men somewhat more

likely to report this than women (7% versus 4%). Six percent of

participants reported that they knew of inmates being searched

by CSNSW officers after asking for bleach, and 4% reported

that inmates had had their names recorded.

Table 5.6.24 Awareness of uses for bleach in prison

(Multiple response)

Men Women Total

n % n % n %

Injecting more because bleach

was available 55 7.0 7 3.7 62 6.4

Throwing bleach into

someone’s eyes 38 4.8 4 2.1 42 4.3

Injecting bleach 16 2.0 3 1.6 19 2.0

Drinking bleach 16 2.0 1 0.5 17 1.7

Other 42 5.3 12 6.4 54 5.5

Other uses for bleach:

• ‘Soaking whites’

• ‘Swishing it around in mouth when asked for DNA tests’

• ‘Tye dye clothes’

• ‘Using bleach on skin to remove freckles’

Injecting in the community

Among the 415 IHS participants who reported a history of

injecting drug use, 60% (60% of men and 61% of women)

reported having used a new needle/syringe for all injections they

undertook in the month preceding their imprisonment. This

proportion is somewhat lower than that reported by community

Needle and Syringe Program (NSP) clients who participated in

the annual NSP Survey between 2004 and 2008. Among these

samples, 71% – 72% of participants reported having used new

injecting equipment for all injections in the month preceding the

Survey (NCHECR, 2009).

The majority (88%) of 2009 IHS participants who reported any

injecting drug use were aware of NSPs in the community, with

a higher proportion of women (93%) aware of these services

than men (87%) (Table 5.6.25).

Table 5.6.25 Awareness of community NSPs (if ever

injected)

Men Women Total

n % n % n %

Yes 274 86.7 92 92.9 366 88.2

No 42 13.3 7 7.1 49 11.8

Total 316 100.0 99 100.0 415 100.0

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 117

Among the 365 IHS participants in 2009 who were aware

of community based NSPs, more than three-quarters (78%)

had actually used these services (Table 5.6.26). A higher

proportion of women (85%) than men (76%) reported

using NSPs in the community.

Table 5.6.26 Used community NSPs (if ever injected and

aware of service)

Men Women Total

n % n % n %

Yes 208 76.2 78 84.8 286 78.4

No 64 23.4 14 15.2 78 21.4

Don’t know 1 0.4 0 0.0 1 0.3

Total 273 100.0 92 100.0 365 100.0

Among IHS participants who had ever injected drugs, nearly

half (49%) had obtained needles and syringes from an NSP

or pharmacy weekly or more often in the month prior to

incarceration, with a higher proportion of female injectors

(57%) reporting this than male injectors (47%) (Table 5.6.27).

Table 5.6.27 Frequency of obtaining needles/syringes

from an NSP or pharmacy in the month

prior to incarceration (if ever injected)

Men Women Total

n % n % n %

Daily/more than daily 59 18.8 26 26.5 85 20.6

More than weekly, but

not daily 87 27.7 30 30.6 117 28.4

Less than weekly

(1 to 4 days) 61 19.4 14 14.3 75 18.2

Never 107 34.1 28 28.6 135 32.8

Total 314 100.0 98 100.0 412 100.0

Reasons not go to NSP:

• ‘Always bought my own. Didn’t want anyone to know I was into

that stuff.’

• ‘Just preferred to go to the chemist.’

• ‘Mobile bus came to local street and that was more convenient.’

• ‘Readily accessible from friends and dealers.’

Attitudes towards blood borne virus risks

Participants in the 2009 IHS who reported a history of injecting

were asked to indicate the extent of their agreement with a range

of statements regarding blood borne virus transmission risk (Table

5.6.28). Reassuringly, the responses of the great majority of both

men and women indicated that they were aware of the risks of

using injecting equipment which had previously been used by

others, and were willing to experience some inconvenience in

order to attempt to access clean equipment at least while in the

community. Ninety one percent of participants with a history of

injecting (92% of men and 89% of women) agreed or strongly

agreed that using clean injecting equipment helps to protect

them from infectious diseases; and 88% (88% of men and 85%

of women) agreed or strongly agreed that they were willing to go

out of their way to access clean equipment in the community. Just

3% of both men and women agreed that there was no point in

their trying to use clean needles/syringes.

Table 5.6.28 Agree/strongly agree with statements

related to blood borne virus transmission

risk (if ever injected)

(Multiple response)

Men Women Total

n % n % n %

Using clean needles / syringes

helps protect me from

infectious diseases 314 91.5 105 89.0 419 90.9

I am willing go out of my way

to get clean needles / syringes

in community 300 87.5 106 84.7 406 88.1

There is no point in me trying

to use clean needles / syringes 10 2.9 4 3.4 14 3.0

All 2009 IHS participants were asked in an open-ended format

to nominate three ways in which it is possible to acquire the

hepatitis C virus (HCV). Thus, they were not provided a list of

specific transmission risks, but instead, had to offer such risks

spontaneously. Seven percent (7% of men and 9% of women)

displayed no knowledge of transmission risks, being either

unable to describe a single risk event, or offering one or more,

all of which were incorrect (Table 5.6.29). Nevertheless, half

the sample (50% of men and 51% of women) were able to

correctly nominate three ways in which it is possible to acquire

HCV, and a further 31% (32% of men and 28% of women)

were able to nominate two ways.

5. Health behaviours

118 2009 NSW Inmate Health Survey: Key Findings Report

Table 5.6.29 Number of correct responses provided to

the question “Can you tell me three ways

in which you can catch hepatitis C?”

Men Women Total

n % n % n %

Unable to describe any 41 5.2 14 7.4 55 5.6

None correct 15 1.9 3 1.6 18 1.8

1 out of 3 correct 89 11.3 23 12.2 112 11.5

2 out of 3 correct 249 31.6 52 27.5 301 30.8

3 out of 3 correct 394 50.0 97 51.3 491 50.3

Total 788 100.0 189 100.0 977 100.0

The two responses provided by more than half of the sample

are in fact the events associated with the greatest risk of HCV

transmission, namely sharing needles and syringes (nominated

by 50% of the same) and blood-to-blood contact (51%). The

third most common response, unprotected sex, is associated

with a relatively small risk of HCV transmission, although the

risk appears to be substantially greater among HIV-positive men

who have sex with men (Topp et al., 2009b). Other common

responses included injecting equipment (25%, associated with

a significant risk), razors (17%, associated with a moderate

risk), saliva (16%, unlikely to be associated with a risk of

transmission), toothbrushes (12%, possibly associated with a

small risk) and tattooing (10%, possibly associated with a small

risk). Small proportions of the sample nominated events which

are not associated with the risk of HCV transmission, including

utensils (5%), toilets/bathroom facilities (2%), personal items

(2%), smoking cigarettes (2%) and kissing (1%). These data

demonstrate good familiarity with high risk HCV transmission

events among half of participants, but also suggest a need for

further education for some inmates.

Drug and alcohol use and offending

Close to two thirds (61%) of 2009 IHS participants reported

that they were intoxicated at the time of the offence for which

they were currently incarcerated, with men substantially more

likely than women to report that this was the case (64% versus

50%) (Table 5.6.30). Men were more likely than women to

report being intoxicated on alcohol alone (21% versus 8%) or

on both alcohol and drugs (21% versus 13%), whereas women

were more likely to report being intoxicated on drugs alone

(29% versus 22%). Fewer than 1% of the sample were unsure

whether they were intoxicated at the time of their offence.

Table 5.6.30 Intoxication at the time of the current

offence

Men Women Total

n % n % n %

No 279 35.5 93 49.5 372 38.2

Alcohol only 166 21.1 15 8.0 181 18.6

Drugs only 170 21.7 54 28.7 224 23.0

Both drugs and alcohol 163 20.8 25 13.3 188 19.3

Don’t know 7 0.9 1 0.5 8 0.8

Total 785 100.0 188 100.0 973 100.0

Among the 592 IHS participants in 2009 who reported being

intoxicated at the time of their offence, the most common

substance that had been used at the time was alcohol (63%),

followed by cannabis (19%), crystalline methamphetamine

(10%), meth/amphetamines (9%) and heroin (9%) (Table

5.6.31). Men were substantially more likely than women

to report having used alcohol (67% of men who reported

intoxication at the time of offence versus 45% of women)

and/or cannabis (21% versus 12%), whereas women were

more likely than men to report having used heroin (15%

versus 8%) and/or cocaine (7% versus 3%).

Table 5.6.31 Intoxication at the time of the current

offence by drug type taken

(Multiple response)

Men Women Total

n % n % n %

Alcohol 331 66.6 42 44.7 373 63.1

Cannabis 164 20.9 23 12.2 187 19.2

Crystalline

methamphetamine (ice) 82 10.4 18 9.6 100 10.3

Meth/amphetamines

(powder/paste) 77 9.8 14 7.4 91 9.3

Heroin 61 7.8 28 14.9 89 9.1

Cocaine 26 3.3 14 7.4 40 4.1

Other 88 11.2 26 13.8 114 11.7

Don’t know 1 0.1 0 0.0 1 0.1

Among 2009 IHS participants who reported having been

intoxicated at the time of the offence for which they were

currently incarcerated, the substance most commonly

reported to be most affecting them at that time was alcohol

(reported by 42% of those who were intoxicated at the

time), followed by crystalline methamphetamine (13%) and

heroin (9%). Eight percent of those who reported having

been intoxicated at the time of offence were unable to

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 119

nominate a single substance which most affected them at

that time. Men were more likely than women to report that

alcohol was the substance that affected them most (46%

versus 26%), while women were more likely to nominate

heroin (17% versus 8%) or cocaine (9% versus 2%).

Three quarters (76%) of 2009 IHS participants reported

that they were not committing the offence for which they

were incarcerated in order to buy drugs and/or alcohol

(Table 5.6.32), with no gender difference in the proportion

of participants who reported this. A higher proportion of

women than men reported that they committed the offence

in order to buy drugs (19% versus 14%).

Table 5.6.32 Committing offence to buy drugs or alcohol

Men Women Total

n % n % n %

No 595 75.7 140 74.5 735 75.5

Yes, to buy alcohol 18 2.3 1 0.5 19 2.0

Yes, to buy drugs 112 14.2 36 19.1 148 15.2

Yes, to buy both

drugs and alcohol 47 6.0 10 5.3 57 5.9

Don’t know 14 1.8 1 0.5 15 1.5

Total 786 100.0 188 100.0 974 100.0

More than half (54%) of 2009 IHS participants perceived that

their current sentence was linked to drugs in some way, with

women substantially more likely than men to report that this

was the case (65% versus 52%) (Table 5.6.33).

Table 5.6.33 Believe that current sentence is somehow

linked to drugs

Men Women Total

n % n % n %

Yes 405 51.5 123 65.4 528 54.2

No 367 46.7 64 34.0 431 44.3

Don’t know 14 1.8 1 0.5 15 1.5

Total 786 100.0 188 100.0 974 100.0

5.7 Drug treatment

The proportion of IHS participants who reported having ever

been engaged in methadone maintenance treatment for

opiate dependence increased from 23% in 1996 to 33% in

2001, and then declined again to 26% in 2009 (Table 5.7.1).

A higher proportion of women than men reported a history

of methadone maintenance treatment in all years in which

the IHS has been conducted; in 2009, this gender differential

translated to 22% of men and 42% of women reporting a

methadone treatment history.

Table/Fig 5.7.1 Ever been on methadone program

0

10

20

30

40

50

60

70

53.0

60.7

41.7

17.6

26.5

21.6

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 108 615 17.6 183 691 26.5 170 786 21.6

Women 62 117 53.0 91 150 60.7 78 187 41.7

Total 170 732 23.2 274 841 32.6 248 973 25.5

Fourteen percent of 2009 IHS participants reported current

engagement in methadone maintenance treatment, that is,

while in prison, including 30% of women and 11% of men

(Table 5.7.2). A further 11% of men and 12% of women

reported having been engaged in methadone treatment in the

past, leaving a total of 78% of men and 58% of women who

reported having never been formally enrolled in methadone

treatment. Among the samples of approximately 900 injecting

drug users who participate in the survey component of the

annual Illicit Drug Reporting System (IDRS), Australia’s illicit drug

market surveillance system, current enrolment in methadone

treatment has remained relatively stable at a national level at

around 30% since 2005 (Stafford et al., 2009).

5. Health behaviours

120 2009 NSW Inmate Health Survey: Key Findings Report

Table 5.7.2 Ever been on methadone program

Men Women Total

n % n % n %

Yes, am on it now 84 10.7 56 29.9 140 14.4

Yes, in the past 86 10.9 22 11.8 108 11.1

No, never 616 78.4 109 58.3 725 74.5

Total 786 100.0 187 100.0 973 100.0

Among 2009 IHS participants who reported current

engagement in methadone maintenance treatment, just over

half (52%) reported that that were enrolled in methadone

in the community immediately prior to their imprisonment,

including 49% of men and 57% of women currently engaged

in methadone treatment. Among these participants, a total

of 21% (24% of men and 16% of women) reported having

been on a daily dose of less than 60mg (12 mls) methadone.

Rigorous systematic reviews suggest that clients receiving

daily doses of greater than 60mg are more likely to remain in

treatment and to reduce or eliminate their use of illicit drugs

(Faggiano et al., 2003).

Eleven percent of 2009 IHS participants (10% of men

and 18% of women) reported a history of engagement in

buprenorphine maintenance treatment, including seven

women (4%) and nine men (1%) who reported currently

being engaged in buprenorphine treatment (Table 5.7.3).

One male participant reported that he was on a waiting list

for buprenorphine. Among the samples of approximately

900 injecting drug users who participate in the annual IDRS,

current enrolment in buprenorphine treatment has remained

relatively stable at a national level at around 8% since 2005

(Stafford et al., 2009).

Table 5.7.3 Ever been on buprenorphine

Men Women Total

n % n % n %

Yes, am on it now 9 1.1 7 3.8 16 1.6

Yes, in the past 66 8.4 26 14.0 92 9.5

No, on waiting list 1 0.1 0 0.0 1 0.1

No, never 710 90.3 153 82.3 863 88.8

Total 786 100.0 186 100.0 972 100.0

Fewer than 3% of 2009 IHS participants (N=26, 2% of

men and 4% of women) reported a history of naltrexone

maintenance treatment, including one woman who reported

currently being on naltrexone. No 2009 IHS participants

reported a history of engagement in LAAM treatment for

heroin dependence.

More than one third (39%) of 2009 IHS participants reported a

history of having sought help or treatment to modify or reduce

their alcohol and/or drug use, including 38% of men and 43%

of women (Table 5.7.4).

Table 5.7.4 Ever sought help to modify or cut down on

your drug and alcohol use

Men Women Total

n % n % n %

Yes 299 38.0 80 43.0 379 39.0

No 487 62.0 106 57.0 593 61.0

Total 786 100.0 186 100.0 972 100.0

According to the findings of the 2007-08 Alcohol and

Other Drug Treatment Services National Minimum Data Set,

which focuses on clients of government-funded alcohol and

other drug treatment services, around 154,000 treatment

episodes were provided by such agencies during 2007-08,

an increase of about 7,000 episodes compared to 2006-07

(AIHW, 2009). Younger clients were more likely to receive

treatment for cannabis use and older clients for alcohol

use. Alcohol remained the most common principal drug

of concern increasing to 44% of all treatment episodes in

2007‑08 compared with 38% in 2002‑03. Treatment for

heroin use declined over time to 11% in 2007‑08 compared

with 18% in 2002‑03; and the actual number of treatment

episodes for heroin also declined. Treatment for cannabis

and meth/amphetamines remained stable, at about 22%

and 11% respectively.

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 121

The drugs for which 2009 IHS participants most commonly

sought treatment were alcohol (54% of those who had sought

assistance), followed by heroin (40%), meth/amphetamines

(25%) and cannabis (23%) (Table 5.7.5). Women were

substantially more likely than men to report having sought

help to modify their use of heroin (60% of women who had

sought help versus 34% of men) and cocaine (14% versus

9%), whereas men were substantially more likely than women

to report having sought help to modify their use of alcohol

(61% of men who had sought help versus 29% of women)

and cannabis (24% versus 18%).

Table 5.7.5 For what drug or alcohol did you seek help

(if ever sought help)

(Multiple response)

Men Women Total

n % n % n %

Alcohol 181 60.5 23 28.8 204 53.8

Heroin 103 34.4 47 58.8 150 39.6

Meth/amphetamines 76 25.4 19 23.8 95 25.1

Cannabis 73 24.4 14 17.5 87 23.0

Cocaine 26 8.7 11 13.8 37 9.8

Other 25 8.4 10 12.5 35 9.2

Among 2009 IHS participants who reported a history of

having sought help or treatment to modify or reduce their

alcohol and/or drug use, the most common agency or

individual from whom help had been sought was a prison

alcohol and other drug (AOD) worker (reported by 36% of

participants who reported having sought help), followed by

residential rehabilitation programs (35%), an AOD organisation

(24%), 12 step programs such as Alcoholics Anonymous or

Narcotics Anonymous (24%), a detoxification facility (22%), a

psychologist or psychiatrist (20%), a general practitioner (17%),

a methadone clinic (16%) and a community drug counsellor

(9%) (Table 5.7.6). Women were substantially more likely than

men to report having sought treatment from a methadone

clinic (30% of women who reported having sought help versus

12% of men), a detoxification facility (29% versus 20%), a GP

(25% versus 14%), an AOD organisation (30% versus 23%)

and a community drug counsellor (14% versus 8%). There

were no interventions for which a markedly higher proportion

of men than women reported having sought help.

Table 5.7.6 Where did you seek help for your drug and

alcohol problem (if ever sought help)

(Multiple response)

Men Women Total

n % n % n %

Prison AOD worker 109 36.5 27 33.8 136 35.9

Rehabilitation 103 34.4 31 38.8 134 35.4

AOD organisation 68 22.7 24 30.0 92 24.3

Alcoholics anonymous/

narcotics anonymous 70 23.4 20 25.0 90 23.7

Detoxification facility 59 19.7 23 28.8 82 21.6

Psychologist/ psychiatrist 61 20.4 14 17.5 75 19.8

General Practitioner 43 14.4 20 25.0 63 16.6

Methadone clinic 35 11.7 24 30.0 59 15.6

Community drug

counsellor 24 8.0 11 13.8 35 9.2

Drug court 11 3.7 1 1.3 12 3.2

Salvation Army 14 4.7 3 3.8 17 4.5

Community health nurse 12 4.0 3 3.8 15 4.0

Other 41 13.7 13 16.3 54 14.2

Among 2009 IHS participants who reported a history of

having sought help or treatment to modify or reduce their

alcohol and/or drug use, half (49%, including 50% of men

who reported having sought help and 49% of women)

further reported having sought such help prior to their

incarceration (Table 5.7.7). Men were substantially more

likely than women to report having sought assistance only

since coming into prison (23% of men who reported having

sought help versus 10% of women), while women were

substantially more likely than men to report having sought

help both in prison and in the community (41% of women

who reported having sought help versus 28% of men).

Table 5.7.7 When did you seek help for your drug and

alcohol problem (if ever sought help)

Men Women Total

n % n % n %

Before coming into prison 148 49.5 39 48.8 187 49.3

Since coming into prison 68 22.7 8 10.0 76 20.1

Both 83 27.8 33 41.3 116 30.6

Total 299 100.0 80 100.0 379 100.0

5. Health behaviours

122 2009 NSW Inmate Health Survey: Key Findings Report

More than one-fifth (23%) of 2009 IHS participants perceived

that they currently needed “help quitting drugs,” with a higher

proportion of women than men reporting this to be the case

(29% versus 22%) (Table 5.7.8).

Table 5.7.8 Do you think you need help quitting drugs

Men Women Total

n % n % n %

Yes 169 21.5 53 28.5 222 22.8

No 617 78.5 133 71.5 750 77.2

Total 786 100.0 186 100.0 972 100.0

Among the 222 IHS participants in 2009 who reported

perceiving that they currently needed help quitting drugs, the

drug or drugs most commonly nominated were opioids (heroin

and/or methadone; 44%), followed by alcohol (37%), meth/

amphetamines (35%), cannabis (32%) and cocaine (14%)

(Table 5.7.9). Men were more likely than women to perceive

that they needed help with quitting alcohol (41% versus 25%),

cannabis (36% versus 21%) and/or meth/amphetamines (37%

versus 26%); whereas women were more likely to perceive that

they needed help quitting opioids (62% versus 38%) and/or

cocaine (19% versus 12%).

Table 5.7.9 For what kind of drugs or alcohol do you

need help quitting (if any)

(Multiple response)

Men Women Total

n % n % n %

Heroin/ methadone 64 37.9 33 62.3 97 43.7

Alcohol 69 40.8 13 24.5 82 36.9

Methamphetamines 63 37.3 14 26.4 77 34.7

Cannabis 60 35.5 11 20.8 71 32.0

Cocaine 21 12.4 10 18.9 31 14.0

Other 24 14.2 10 18.9 34 15.3

Other help required to quit drugs and alcohol:

• ‘Change the people I hang out with.’

• ‘Continue with who I am seeing and get into the drug program.

Support after I leave the system (e.g. job and housing).’

• ‘Counselling and skills for how to live life without drugs.’

• ‘If I could give up the tobacco, I think I could stop the cannabis.’

• ‘Need more things to keep me busy so I don’t think about drinking.’

Twenty three percent of 2009 IHS participants, including 30%

of women and 22% of men, reported a history of having

“overdosed or become unconscious as a result of taking drugs”

(Table 5.7.10). Note that this question did not specify which

drugs caused the overdose.

Table 5.7.10 Ever overdosed or become unconscious

from taking drugs

Men Women Total

n % n % n %

Yes 169 21.5 56 30.1 225 23.1

No 617 78.5 130 69.9 747 76.9

Total 786 100.0 186 100.0 972 100.0

Eight percent of the sample reported having overdosed

once, while 5%, including 4% of men and 7% of women,

reported having overdosed five or more times (Table 5.7.11).

Among the 909 IDUs who participated in the 2008 IDRS,

45% reported a history of heroin overdose. Among IDUs

who reported having overdosed on heroin, a median of

three heroin overdoses were reported (range 1-67) (Stafford

et al., 2009).

Table 5.7.11 Number of times overdose on drugs

Men Women Total

n % n % n %

Never 617 79.7 130 70.3 747 77.9

1 58 7.5 15 8.1 73 7.6

2 38 4.9 19 10.3 57 5.9

3 22 2.8 8 4.3 30 3.1

4 7 0.9 1 0.5 8 0.8

5+ 32 4.1 12 6.5 44 4.6

Total 774 100.0 185 100.0 959 100.0

The great majority (95%) of overdoses reported by 2009 IHS

participants were reported to have occurred in the community,

including 100% of overdoses reported by women. No women

reported having overdosed in prison, compared with twelve men

(equating to 7% of men who reported a history of overdose)

who reported having overdosed either only in prison, or both in

prison and in the community.

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 123

Just over half (51%) of participants who reported a history

of overdose further reported that they had been treated with

Narcan, including 61% of women and 48% of men; while 7%

of the sample, including 8% of men and 5% of women, were

unsure whether they had been treated with Narcan following

their overdose(s).

General comments about alcohol and other drugs:

• ‘I had given up drugs and alcohol before coming into prison and

did program in prison for my own education so can help other

Aboriginals and the younger generation.’

• ‘A course should be set up by older inmates telling younger ones

how it can wreck your life by taking drugs and alcohol.’

5.8 Tattooing and body piercing

Skin penetration procedures such as tattooing and piercing

are biologically plausible modes of blood borne virus (BBV)

transmission due to potential percutaneous blood exposure

following lapses in infection control (Shepard et al., 2005).

Nevertheless, evidence for their role in acquisition of infection

in the community remains equivocal (Topp et al., 2009b).

Tattoos are common among prison inmates and can serve a

range of symbolic functions relating to gang membership,

a degree of individualism in a highly regimented and

homogenous environment, and a form of release from the

prison environment. Notably, research conducted among

military recruits (Ko et al. 1992), non-injecting drug users

(Gyarmathy et al., 2002; Howe et al., 2005), orthopaedic

patients (Haley & Fischer, 2001), hospital attendees (Nishioka

et al., 2002) and currently or previously incarcerated individuals

(e.g. Hellard et al., 2004; Post et al., 2001; Samuel et al.,

2001, 2005), suggests that rather than tattooing per se, the

BBV transmission risk may be specific to receipt of tattoos

performed by non-professionals. In the prison environment,

in which tattooing is illegal, professional tattooists are

rarely available, and tattooing equipment is contraband and

therefore extremely scarce, the risks of BBV transmission

are amplified due to the likelihood that any tattoo received

in prison will be administered by a non-professional using

potentially contaminated equipment. The high background

prevalence of BBVs including HBV and HCV among prison

inmates serves only to increase the risks.

The proportion of IHS participants who reported having

at least one tattoo decreased slightly between 1996 and

2001, from 61% to 58%, and then increased in 2009 to

64% (Table 5.8.1). Men were substantially more likely than

women to report having one or more tattoos (66% versus

56%), a gender differential that was not observed in either

the 1996 or 2001 IHSs.

Table/Fig 5.8.1 Have at least one tattoo

0

10

20

30

40

50

60

70

80

90

58.6 59.9 56.3

61.5 58.1

66.4

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 377 613 61.5 406 699 58.1 523 788 66.4

Women 68 116 58.6 91 152 59.9 107 190 56.3

Total 445 729 61.0 497 851 58.4 630 978 64.4

Men were not only more likely than women to have at least

one tattoo, but were also more likely to have more than one

tattoo (Table 5.8.2). More than one-quarter (29%) of men

reported having five or more tattoos, compared with just

11% of women.

Table 5.8.2 Number of tattoos

Men Women Total

n % n % n %

0 265 33.6 83 43.7 348 35.6

1-4 293 37.2 87 45.8 380 38.9

5-10 141 17.9 18 9.5 159 16.3

11-20 33 4.2 1 0.5 34 3.5

21+ 56 7.1 1 0.5 57 5.8

Total 788 100.0 190 100.0 978 100.0

5. Health behaviours

124 2009 NSW Inmate Health Survey: Key Findings Report

Among 2009 IHS participants who reported having at least

one tattoo, a substantial proportion of both men (39%)

and women (21%) reported that they had obtained at least

one tattoo while in prison (Table 5.8.3), while 16% of men

and 9% of women reported that all of their tattoos had

been administered while they were in prison. Women were

substantially more likely than men to report having obtained

all of their tattoos in the community (79% versus 61%).

Table 5.8.3 Location tattoos obtained (if any tattoos)

Men Women Total

n % n % n %

Community only 318 60.8 85 79.4 403 64.0

Prison only 85 16.3 10 9.3 95 15.1

Both prison and community 120 22.9 12 11.2 132 21.0

Total 523 100.0 107 100.0 630 100.0

Among 2009 IHS participants who reported having obtained

at least one tattoo in the community, close to three quarters

(72%) reported that all of the tattoos they had obtained in

the community were administered by a professional tattoo

artist or in a professional studio (Table 5.8.4). Twenty eight

percent of men and 26% of women with tattoos that

had been administered in the community reported that

at least one such tattoo had been administered by a nonprofessional.

Men with tattoos that had been administered

in the community were slightly more likely than women to

report that all such tattoos had been administered by a nonprofessional

(18% versus 14%).

Table 5.8.4 Who did the tattoos in the community (if

any tattoos)

Men Women Total

n % n % n %

Professional tattoo artist/

studio 315 71.9 72 74.2 387 72.3

Non-professional 79 18.0 14 14.4 93 17.4

Both professional +

non-professional 44 10.0 11 11.3 55 10.3

Total 438 100.0 97 100.0 535 100.0

Among 2009 IHS participants who reported having had at

least one tattoo administered in the community by a nonprofessional,

the majority reported either that new tattooing

equipment was used (41%) or that the tattooing equipment

had been cleaned before their tattoo was administered

(47%). Men were substantially more likely than women to

report that brand new equipment was used (43% versus

32%), whereas women were more likely to report that the

equipment was cleaned prior to use (52% versus 46%) or

that the equipment was neither new nor cleaned prior to

use (12% versus 5%).

It is a policy of Corrective Services NSW to provide the

hospital grade disinfectant Fincol to prison inmates for the

purposes of decontaminating injecting, tattooing and piercing

equipment prior to its reuse in order to reduce the risk of BBV

transmission. Nevertheless, apart from the problems identified

by some IHS participants in accessing Fincol, it also remains

the case that guidelines for the effective decontamination

of tattooing and piercing equipment do not exist. Moreover,

even in the case of injecting equipment, for which cleaning

guidelines do exist (see section 5.6), it is not clear that

inmates are either aware of the guidelines or in a position to

implement them while in prison.

Among 2009 IHS participants who reported having had

at least one tattoo administered in prison (Table 5.8.5),

the majority reported either that the tattooing equipment

had been cleaned before their tattoo was administered

(50%), or that new tattooing equipment was used (34%).

Women were more likely than men to report that brand

new equipment was used (41% versus 34%) or that the

equipment was neither new nor cleaned prior to use

(9% versus 4%). Men were more likely to report that the

equipment was cleaned prior to use (57% versus 50%).

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 125

Table 5.8.5 Cleaning before use of tattooing

equipment in prison

Men Women Total

n % n % n %

Yes 117 57.1 11 50.0 128 56.4

No 9 4.4 2 9.1 11 4.8

Don’t know 10 4.9 0 0.0 10 4.4

Brand new equipment

was used 69 33.7 9 40.9 78 34.4

Total 205 100.0 22 100.0 227 100.0

Among 2009 IHS participants who reported that they had

received a tattoo in prison using equipment that had been

cleaned prior to its use, the majority (62%) reported that

cleaning had consisted of, or included, being soaked in

bleach, with men substantially more likely than women

to report that this was the case (64% versus 44%). Of

all the cleaning methods identified, this is the one most

likely to effectively decontaminate needles and syringes,

dependent upon the contact time between the bleach

and the equipment. Information on contact time was not

sought from IHS participants, preventing an estimation of

the proportion of potentially effective cleaning episodes.

Boiling water (which is not recommended for cleaning of

injecting equipment because warm/hot water causes blood

to coagulate and provides a dry-reservoir for viruses [Harm

Reduction Coalition, 2005]) was reported as a cleaning

method by 13% of both men and women who had received

a tattoo in prison with equipment that had been cleaned

prior to use. Women were substantially more likely than

men to report that they did not know what methods had

been used to clean the tattoo equipment prior to it being

used to administer their tattoo(s).

The proportion of IHS participants who reported having at

least one body piercing (including ear piercing) increased

slightly from 40% in 2001 to 43% in 2009 (Table 5.8.6).

Women were substantially more likely than men to report

having one or more piercings (82% versus 34%), a gender

differential that was also observed in the 2001 IHS.

Table/Fig 5.8.6 Have at least one piercing (including

ear piercing)

0

20

40

60

80

100

88.0

82.1

29.6

33.8

2001 2009

Men Women

PERCENT

YEAR

2001 2009

n Total % n Total %

Men 201 680 29.6 266 788 33.8

Women 125 142 88.0 156 190 82.1

Total 326 822 39.7 422 978 43.1

Women were not only more likely than men to have at least

one piercing, but were also more likely to have more than

one piercing (Table 5.8.7). More than half (52%) of women

reported having three or more piercings, compared with just

10% of men.

Table 5.8.7 Number of piercings (including ear piercing)

Men Women Total

n % n % n %

None 522 66.2 34 17.9 556 56.9

1 116 14.7 12 6.3 128 13.1

2 70 8.9 45 23.7 115 11.8

3 31 3.9 24 12.6 55 5.6

4+ 49 6.2 75 39.5 124 12.7

Total 788 100.0 190 100.0 978 100.0

Unsurprisingly, the most common location of body piercings

among both men and women was in the ear (90% of

participants who reported at least one piercing). Tongues

(23% of women, 11% of men), noses (19% of women, 7%

of men) and nipples (18% of men, 7% of women) were

other common locations for participants who had a piercing.

5. Health behaviours

126 2009 NSW Inmate Health Survey: Key Findings Report

Piercing in prison appears to be somewhat less common than

tattooing. Among 2009 IHS participants who reported having

at least one piercing, relatively small proportions of both men

(14%) and women (14%) reported that they had obtained at

least one piercing while in prison (Table 5.8.8), and just 9%

of men and 3% of women reported that all of their piercings

had been administered while they were in prison. The majority

of both men and women (86%) reported that all of their

piercings had been obtained in the community.

Table 5.8.8 Where were piercings obtained (if any

piercings)

Men Women Total

n % n % n %

Community only 228 85.7 133 85.8 361 85.7

Prison only 24 9.0 6 3.9 30 7.1

Both prison and

community 14 5.3 16 10.3 30 7.1

Total 266 100.0 155 100.0 421 100.0

Among the relatively small number (N=60) of 2009 IHS

participants who reported having had at least one piercing

administered in prison, the majority reported either that the

piercing equipment had been cleaned before their piercing was

administered (70%) or that new piercing equipment was used

(25%). Two men (5%) reported that the equipment had not

been cleaned before use, while just one woman acknowledged

that she did not know whether the piercing equipment had

been cleaned.

5.9 Sexual health

Six 2009 IHS participants (5 men, 1 woman) reported never

having “had sex”, defined for the purposes of this Survey as

engaging in vaginal or anal sex. Remaining participants reported

having first engaged in vaginal or anal intercourse at a median

age of 14 years among men (range 5-30 years) and 15 years

among women (range 7-30 years) (Table 5.9.1). Given the high

prevalence of childhood sexual abuse documented previously

among prison inmates (Butler et al., 2001), some participants’

reported age of first sex may refer to an episode of abuse

involving intercourse; whereas for others it may relate to age

of first consensual sex. In NSW, the age at which it is legal to

engage in sexual relations is 16 years.

Table 5.9.1 Age of first sexual (vaginal or anal)

intercourse characteristics

Men Women Total

N 747 177 924

Mean (± sd) 14.6 (± 2.6) 15.4 (± 2.8) 14.8 (± 2.7)

Median 14.0 15.0 15.0

Range 5 - 30 7 - 30 5 - 30

The median age of the partner with whom 2009 IHS

participants first engaged in anal or vaginal intercourse was

16 years among men (range 7-60 years) and 18 years among

women (range 12-48 years). Seventeen percent of 2009 IHS

participants (13% of men and 33% of women) reported first

having sexual intercourse with a partner five or more years

older (Table 5.9.2). These proportions are higher than among

Australia’s general population, among whom 7% of men and

14% of women reported having experienced their first vaginal

intercourse with a partner five or more years older (Rissel et

al., 2003a). Such comparative differences reflect the sexual

vulnerability of inmate populations when young (Richters et

al., 2008), and particularly among young women who are

subsequently imprisoned as adults.

Table 5.9.2 Partner’s age relative to participant’s age at

first sexual (vaginal or anal) intercourse

Men Women Total

n % n % n %

20+ years older 8 1.1 5 3.0 13 1.4

10 - 19 years older 23 3.1 15 8.9 38 4.2

5 - 9 years older 63 8.5 36 21.3 99 10.9

1 - 4 years older 273 36.9 89 52.7 362 39.9

Same age 311 42.1 22 13.0 333 36.7

1 - 4 years younger 59 8.0 1 0.6 60 6.6

5+ years younger 2 0.3 1 0.6 3 0.3

Total 739 100.0 169 100.0 908 100.0

The great majority of 2009 IHS participants (99% of men and

97% of women) reported first engaging in sexual (vaginal or anal)

intercourse with a partner of the “opposite sex” (we use this

terminology out of convention rather than because we believe

that men and women are sexual opposites) (Table 5.9.3).

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 127

Table 5.9.3 Gender of participant’s partner at first

sexual (vaginal or anal) intercourse

Men Women Total

n % n % n %

Men 8 1.0 174 97.2 182 19.1

Women 764 99.0 5 2.8 769 80.9

Total 772 100.0 179 100.0 951 100.0

The majority (92%) of 2009 IHS participants identified as

heterosexual (Table 5.9.4). Women were substantially more likely

than men to identify as homosexual (5% versus <1%) or bisexual

(18% versus 3%). These results are consistent with those of

the 2005 Sexual Health and Attitudes of Australian Prisoners

(SHAAP) study (Richters et al., 2008), which documented a

substantially higher proportion of lesbian and bisexual women

among female prison inmates when compared to women in

the general population. A similar pattern has been documented

among clients of Australia’s publicly funded needle and syringe

programs, where a relatively high proportion of female clients

identify as bisexual, and bisexual identification among females

is strongly associated with reporting a history of sex work

(NCHECR, 2009; Topp et al., 2008).

Table 5.9.4 Sexual identity

Men Women Total

n % n % n %

Heterosexual 752 96.4 139 75.5 891 92.4

Bisexual 22 2.8 33 17.9 55 5.7

Homosexual 3 0.4 10 5.4 13 1.3

Other 3 0.4 2 1.1 5 0.5

Total 780 100.0 184 100.0 964 100.0

Small proportions of 2009 IHS participants who identified

as heterosexual reported having engaged at some time in

sexual activity with a partner of the same gender during their

lifetime (Table 5.9.5). Among men, whereas 3.6% identified

as homosexual, bisexual or ‘other’, a slightly larger proportion

(4.4%) reported having engaged in male-to-male sexual

activity. Likewise, among women, whereas 24.1% identified

as homosexual, bisexual or ‘other’, 27.2% reported having

engaged in female-to-female sexual activity. Such results

underscore that sexual identity is based on more than the

concrete fact of with whom an individual has engaged in

sexual activity (Richters et al., 2008).

Although participants were not questioned about where

their various forms of sexual activity had occurred (for

example, while in the community or while in prison), results

may also reflect, at least in part, that prison inmates may

feel compelled to resort to sexual activity while in prison

that they would not choose to engage in while in the

community. This may be activity undertaken for pleasure,

but may also be as a result of coercion, as payment for

a prison debt, or for protection (Richters et al., 2008).

Nevertheless, in a detailed study of sexual behaviour and

attitudes among NSW prison inmates, Richters et al. (2008)

found that the great majority of men who reported maleto-

male sexual contact within prison also reported having

engaged in such activity outside of prison; and suggested

that the common impression that most sex between men

in prison is ‘situational’ and occurs between men who have

not had same-sex in other settings, is erroneous.

Table 5.9.5 Sexual activity

Men Women Total

n % n % n %

Exclusively heterosexual 746 95.6 134 72.8 880 91.3

Any homosexual activity 34 4.4 50 27.2 84 8.7

Total 780 100.0 184 100.0 964 100.0

Although a higher proportion of male than female 2009 IHS

participants reported having had no sexual partners (defined

for these purposes as including partners with whom the

participant had engaged in vaginal, anal and/or oral sex) in

the preceding year (44% versus 35%), men were also more

likely to report having had multiple sexual partners during

that period (26% versus 22%); and were twice as likely to

report having had three or more partners within that time

(18% versus 9%) (Table 5.9.6). This pattern, wherein men

report a higher number of sexual partners than women,

is common in sex surveys across a number of populations;

Richters et al. (2008) suggest that men are likely to overreport

their number of sexual partners.

5. Health behaviours

128 2009 NSW Inmate Health Survey: Key Findings Report

Table 5.9.6 Number of sexual partners in past year

Men Women Total

n % n % n %

0 335 43.7 62 34.8 397 42.0

1 231 30.1 76 42.7 307 32.5

2 65 8.5 24 13.5 89 9.4

3 - 4 67 8.7 12 6.7 79 8.4

5 - 9 35 4.6 4 2.2 39 4.1

10+ 34 4.4 0 0.0 34 3.6

Total 767 100.0 178 100.0 945 100.0

Among men who reported having engaged in sexual activity in

the preceding year, the great majority (97%) reported that their

partner(s)’ gender was female (Table 5.9.7). The proportion of

women who reported having engaged in sexual activity in the

preceding year only with men was substantially smaller (74%);

women were substantially more likely than men to report

having engaged in sexual activity with a member of the same

gender (15% versus 2%) or with partners of both genders

(11% versus <1%).

Table 5.9.7 Gender of sexual partners in past year

Men Women Total

n % n % n %

Men 9 2.0 88 73.9 97 17.3

Women 431 97.3 18 15.1 449 79.9

Both 3 0.7 13 10.9 16 2.8

Total 443 100.0 119 100.0 562 100.0

Sixty percent of 2009 IHS participants reported having had 10 or

more lifetime sexual partners (with whom they had engaged in

vaginal, anal and/or oral sexual activity), with men substantially

more likely than women to report that this was the case (65%

versus 35%). Around one in eight men and one in 16 women

reported having had 60 or more sexual partners in their lifetime

(Table 5.9.8). These results are consistent with those of the

SHAAP study (Richters et al., 2008), which demonstrated that

prison inmates report a significantly higher number of lifetime

sexual partners than do the general population.

Table 5.9.8 Number of lifetime sexual partners

Men Women Total

n % n % n %

1 - 4 107 15.4 68 39.8 175 20.2

5 - 9 134 19.3 43 25.1 177 20.5

10 - 19 139 20.0 29 17.0 168 19.4

20 - 39 155 22.3 16 9.4 171 19.8

40 - 59 75 10.8 5 2.9 80 9.2

60+ 84 12.1 10 5.8 94 10.9

Total 694 100.0 171 100.0 865 100.0

Ninety six percent of male 2009 IHS participants reported

having engaged in sexual activity only with women in their

lifetime (Table 5.9.9), whereas less than three quarters (74%)

of women reported having engaged in sexual activity only

with men. Women were substantially more likely than men to

report having engaged in sexual activity with a member of the

same gender (4% versus <1%) or with both genders (22%

versus 4%).

Table 5.9.9 Gender of lifetime sexual partners

Men Women Total

n % n % n %

Men 3 0.4 135 73.8 138 14.3

Women 749 96.1 7 3.8 756 78.6

Both 27 3.5 41 22.4 68 7.1

Total 779 100.0 183 100.0 962 100.0

Among 2009 IHS participants, women were substantially

more likely to report having engaged in sex work at some

time in their lives (14% versus 1%). The proportions of male

and female participants who disclosed participation in sex

work was substantially lower than among respondents to

the SHAAP study (Richters et al., 2008), which documented

a history of sex work among 8% of male inmates and 27%

of female inmates, but were also higher than those reported

among the general population (Rissel et al., 2003b).

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 129

Just a small proportion (4%) of 2009 IHS participants reported

having engaged in vaginal, anal or oral sexual activity with

another inmate, with women substantially more likely than

men to report that this was the case (12% versus 2%) (Table

5.9.10). The great majority of this sexual activity was reported

to be consensual. Among the 16 men who disclosed having

engaged in sexual activity with another inmate, 15 reported

that this sexual activity was consensual; likewise, among the

22 women who disclosed sexual activity with another inmate,

21 described this as consensual.

Table 5.9.10 Had sex with another inmate since coming

into prison

Men Women Total

n % n % n %

Yes 16 2.1 22 12.0 38 3.9

No 764 97.9 162 88.0 926 96.1

Total 780 100.0 184 100.0 964 100.0

One comment about sexual health was:

• ‘Conjugal visits should be looked at for inmates in relationships.’

Condoms/Dental Dams

Condoms (in men’s prisons) and dental dams (in women’s)

were introduced into NSW prisons in 1996 following a legal

challenge instituted in the NSW Supreme Court by 52 inmates

(Yap et al., 2007). Under the 1996 prison policy, condoms

and dental dams were not to be used for any purpose other

than sexual activity with another consenting inmate within a

prison cell. They are distributed through health centres and

vending machines located in prison wings and are dispensed

in a pack containing one condom, a sachet of lubricant and a

plastic Ziplock bag for disposal purposes. By 2005, the condom

program was distributing approximately 30,000 condoms and

dental dams per month to NSW inmates (Yap et al., 2007).

Despite concerns among politicians, prison custodial and health

authorities, and inmates themselves that provision of such

means of protection from BBVs and STIs would (i) encourage

inmates to have sex; (ii) lead to an increase in sexual assaults in

prison; (iii) provide inmates with a means to conceal contraband

items; and (iv) provide inmates with an item that could be used

as a weapon, research has documented no evidence of serious

adverse consequences associated with the distribution of

condoms and dental dams (Yap et al., 2007).

The majority (62%) of 2009 IHS participants reported never

using condoms and/or dental dams with their sexual partners in

the year before their current incarceration (Table 5.9.11), with a

higher proportion of women than men reporting having never

used condoms during that period (69% versus 60%). Men were

slightly more likely than women to report having used condoms

and/or dams “all” or “most of the time” (22% versus 19%).

Table 5.9.11 Frequency of use of condoms and/or dental

dams in the year prior to incarceration

Men Women Total

n % n % n %

All the time 87 11.2 16 8.7 103 10.7

Most of the time 80 10.3 18 9.8 98 10.2

Occasionally 139 17.8 22 12.0 161 16.7

Never 466 59.7 127 69.0 593 61.5

Don’t know 8 1.0 1 0.5 9 0.9

Total 780 100.0 184 100.0 964 100.0

Among 2009 IHS participants who reported never having

used condoms and/or dental dams in the year prior to their

current incarceration, the most common reason offered

by both men and women was that they did not need to

use them because they knew their partners were free from

infections (Table 5.9.12). Men were substantially more likely

than women to report that they never used condoms and/or

dams because they didn’t like the feeling (22% versus 6%).

Apathy, intoxication and a lack of availability of condoms/dams

were also offered as reasons for not using them. A substantial

proportion of women indicated that they were ‘trying to

conceive a baby’ (recorded as an ‘other’ reason).

Table 5.9.12 Reasons never use condoms and/or dental

dams in the year prior to incarceration

(Multiple response)

Men Women Total

n % n % n %

Knew partners were clean 293 62.9 76 59.8 369 62.2

Dislike the feeling 103 22.1 8 6.3 111 18.7

Couldn’t be bothered 35 7.5 7 5.5 42 7.1

Unavailable 17 3.6 0 0.0 17 2.9

Impulsive 12 2.6 1 0.8 13 2.2

Intoxicated on drugs/

alcohol 10 2.1 0 0.0 10 1.7

Other 68 14.6 40 31.5 108 18.2

5. Health behaviours

130 2009 NSW Inmate Health Survey: Key Findings Report

The great majority of both male (95%) and female (90%)

2009 IHS participants reported being aware of the CSNSW

policy to provide prison inmates with condoms and/or dental

dams. A much smaller proportion (15%) of the sample

reported having tried to access condoms and/or dams in

prison, including 16% of males and 12% of females.

Among the 145 IHS participants in 2009 who reported having

attempted to access condoms and/or dams in prison, the

majority (91%) described them as “easy” or “very easy” to

obtain (Table 5.9.13). Women were substantially more likely

than men to consider condoms/dams “difficult” to obtain

(18% versus 3%).

Table 5.9.13 Ease of obtaining condoms and/or dental

dams in prison (if ever tried to obtain them)

Men Women Total

n % n % n %

Very easy 72 58.5 9 40.9 81 55.9

Easy 44 35.8 7 31.8 51 35.2

Difficult 4 3.3 4 18.2 8 5.5

Not available 3 2.4 2 9.1 5 3.4

Total 123 100.0 22 100.0 145 100.0

Overall, 41% of 2009 IHS participants (45% of men and 23%

of women) reported being aware of inmates using condoms and

dams for purposes other than sex. The SHAAP study (Richters

et al., 2008) documented reports of male inmates using

condoms more often as a masturbatory aid (known as ‘Fifi’)

than for anal intercourse. The 2001 IHS (Butler & Milner, 2003)

documented a range of uses of condoms and dental dams

among inmates, including for storage of contraband items,

to make water and/or urine bombs, and for use as hairbands

among the women. The use of lubricant as hair gel was also

documented in the earlier Survey. Although condoms have

been used to conceal contraband items such as tobacco and

illicit drugs, it is important to note that their introduction was

not associated with an increase in the prevalence of injecting

drug use in prisons. As Yap et al. (2007) argue, “(p)risoners

would undoubtedly find any means of storing contraband even

if condoms were unavailable. In a controlled and resource-poor

setting, inmates display great inventiveness in employing any

new resources for a variety of purposes…” (p.221).

Sexually Transmissible Infections

Two thirds (68%) of 2009 IHS participants reported never

having been diagnosed with a sexually transmissible infection

(STI) (Table 5.9.14), with a higher proportion of men than

women reporting this to be the case (69% versus 63%). Men

were more likely than women to report having been diagnosed

with pubic lice (12% versus 4%), syphilis (3% versus 1%) and

gonorrhoea (5% versus 3%); whereas women were more

likely to report having been diagnosed with chlamydia (10%

versus 5%), genital warts (5% versus 3%) and genital herpes

(4% versus 2%). Among women, reports of vaginal candidiasis

diagnosis were relatively common (9%), whereas pelvic

inflammatory disease, bacterial vaginosis and Trichomaniasis

appeared to be less so.

Table 5.9.14 Ever diagnosed with a sexually

transmissible infection

(Multiple response)

Men Women Total

n % n % n %

No STIs 548 68.8 125 62.8 673 67.6

Gonorrhoea 40 5.1 5 2.7 45 4.7

Genital warts 24 3.1 10 5.4 34 3.5

Genital herpes 14 1.8 8 4.3 22 2.3

Chlamydia 41 5.3 18 9.8 59 6.1

Pubic lice 87 11.2 7 3.8 94 9.8

Syphilis 25 3.2 2 1.1 27 2.8

Urethritis 9 1.2 1 0.5 10 1.0

Cold sores 74 9.5 15 8.2 89 9.2

Other STI 7 0.9 1 0.5 8 0.8

Pelvic inflammatory

disease – – 3 1.6 – –

Bacterial vaginosis – – 4 2.2 – –

Candidiasis – – 16 8.7 – –

Trichomaniasis – – 3 1.6 – –

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 131

Sexual Violence

The proportion of IHS participants who reported being aware

of sexual assaults taking place in prison in the preceding

year declined markedly between 1996 and 2001, from 32%

to 17%, and then decreased further in 2009 to 12% of the

sample (Table 5.9.15). Among 2009 participants, there was

little difference in the proportion of males and females who

reported being aware of a recent sexual assault in prison

(12% versus 11%); however, in earlier Surveys, substantial

(and inconsistent) differences between genders in awareness

of sexual assault were documented.

Table/Fig 5.9.15 Awareness of any sexual assaults in

prison in the past year

0

5

10

15

20

25

30

35

21.3

23.5

10.9

33.3

15.2

12.2

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 196 588 33.3 103 676 15.2 95 780 12.2

Women 23 108 21.3 35 149 23.5 20 184 10.9

Total 219 696 31.5 138 825 16.7 115 964 11.9

The majority of 2009 IHS participants who reported

awareness of a sexual assault having occurred in prison

within the preceding year reported being aware of one or

two such assaults; nevertheless, a total of 2% of the sample

(2% of both men and women) reported being aware of four

or more such assaults. Among 2009 IHS participants, 17

men (equating to 2% of men) and 9 women (equating to

5% of women) reported having been sexually harassed or

threatened with sex by another inmate.

Female 2009 IHS participants were substantially more likely

than males to report that since the age of 16 years, they

had been subjected to at least one form of sexual violence

(29% versus 2%) (Table 5.9.16). Women were also more

likely to report that they had been subjected to such sexual

violence on more than one occasion (22% versus 2%).

Twenty two percent of women reported having engaged in

vaginal or anal sexual activity with a partner who threatened

violence (compared with <1% of men); 21% of women

reported having been subjected to actual violence during

sexual activity (versus 1% of men); and 18% of women

reported having had a partner who used their weight or size

to immobilise the participant during sexual activity (versus

2% of men).

Table 5.9.16 Any sexual violence since age of 16 years

Men Women Total

n % n % n %

No 761 97.6 131 71.2 892 92.5

Yes, once 7 0.9 13 7.1 20 2.1

Yes, more than once 12 1.5 40 21.7 52 5.4

Total 780 100.0 184 100.0 964 100.0

Two thirds (66%) of female 2009 IHS participants reported

having been involved in at least one violent relationship,

compared with 28% of males (Table 5.9.17). Women were

also substantially more likely than men to report having

been involved in two or more violent relationships (28%

versus 10%).

Table 5.9.17 Number of violent relationships involved in

Men Women Total

n % n % n %

0 565 72.4 63 34.2 628 65.1

1 134 17.2 70 38.0 204 21.2

2 49 6.3 24 13.0 73 7.6

3+ 32 4.1 27 14.7 59 6.1

Total 780 100.0 184 100.0 964 100.0

5. Health behaviours

132 2009 NSW Inmate Health Survey: Key Findings Report

5.10 Health service utilisation

The majority (86%) of 2009 IHS participants reported having

accessed, at some time, at least one health service in the

community (Table 5.10.1), with women substantially more

likely than men to report that this was the case (96% versus

83%). Women were more likely than men to have accessed

every type of community health service listed, but were

particularly more likely to report having gone to general

practitioners (80% versus 59%) and medical centres (61%

versus 40%). Just over one in six men (17%) had never

accessed healthcare in the community.

Table 5.10.1 Health services accessed in the community

(Multiple response)

Men Women Total

n % n % n %

No health services 135 17.0 8 4.1 143 14.4

General practitioner 471 59.3 156 79.6 627 63.3

Hospital 433 54.5 130 66.3 563 56.9

Medical centre 319 40.2 120 61.2 439 44.3

Community health centre 179 22.5 75 38.3 254 25.7

Home nursing 27 3.4 18 9.2 45 4.5

Other 80 10.1 44 22.4 124 12.5

Fifty seven percent of 2009 Aboriginal and/or Torres Strait

Islander IHS participants reported having accessed Aboriginal

Health Services in the community, with Aboriginal women

slightly more likely than Aboriginal men to report that this was

the case (60% versus 56%) (Table 5.10.2).

Table 5.10.2 Aboriginal Health Services accessed in the

community (if Aboriginal origin)

Men Women Total

n % n % n %

Yes 144 56.0 32 60.4 176 56.8

No 113 44.0 21 39.6 134 43.2

Total 257 100.0 53 100.0 310 100.0

Close to three quarters (73%) of the 2009 IHS sample

reported that they had had at least one HIV test during their

lives (Table 5.10.3), with a higher proportion of women than

men reporting this to be the case (79% versus 71%). This

gender difference is consistent with the findings of earlier

IHSs, although the proportion of participants reporting a

history of HIV testing decreased from 86% in 1996 to 82%

in 2001 and again to 73% in 2009. Between 86% and 88%

of samples of Australian NSP clients report a history of HIV

testing (NCHECR, 2009).

Table/Fig 5.10.3 Ever have HIV Test

0

20

40

60

80

100

90.5 88.2

79.3

84.6 80.7

70.8

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 522 617 84.6 562 696 80.7 564 797 70.8

Women 105 116 90.5 134 152 88.2 157 198 79.3

Total 627 733 85.5 696 848 82.1 721 995 72.5

Half of 2009 IHS participants who reported a history of HIV

testing reported that they had been tested only in prison (as

opposed to the community) (Table 5.10.4), with a greater

proportion of men than women reporting this to be the case

(54% versus 39%). Conversely, women were more likely than

men to report having been tested both in prison and in the

community (36% versus 22%), although similar proportions

of men and women reported having been tested only in the

community (24% versus 26%).

Given that the majority of participants who reported having

been tested for HIV also reported that testing had occurred

in prison (Table 5.10.4), the decline in the proportion of

IHS samples reporting a history of HIV testing may be

related to change in Justice Health screening policies. In

1991, legislation required the mandatory HIV screening

of all prison entrants, which was conducted by the (then)

Corrections Health Service. This program was superseded in

1994 by the Voluntary BBV Screening Program, under which

HIV screening was offered to all those entering custody. In

2002, targeted screening of all inmates, including prison

entrants, who reported high risk behaviour (including

male-to-male sexual activity and injecting drug use), priority

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 133

groups including inmates of Aboriginal origin and those

from culturally and linguistically diverse backgrounds, and

people entering prison for the first time, was introduced.

This program depended on self-referral and referral by

prison health care providers. In 2007, the Early Detection

Program was introduced, as it was recognised that prisoners

as a group were at risk of BBV infection. Entry into this

program is dependent on self-referral and referral by prison

health care providers.

Table 5.10.4 Location of HIV testing (if ever tested)

Men Women Total

n % n % n %

Prison only 302 53.5 61 38.9 363 50.3

Both prison and

community 126 22.3 56 35.7 182 25.2

Community only 134 23.8 40 25.5 174 24.1

Don't know 2 0.4 0 0.0 2 0.3

Total 564 100.0 157 100.0 721 100.0

More than half (54%) of 2009 IHS participants reported

having been screened for at least one BBV (HIV and/or viral

hepatitis) or an STI while in prison (Table 5.10.5), with a higher

proportion of women than men reporting this to be the case

(63% versus 52%).

Table 5.10.5 Ever tested for HIV, hepatitis or STI while

in prison

Men Women Total

n % n % n %

Yes 409 51.7 123 63.4 532 54.0

No 382 48.3 71 36.6 453 46.0

Total 791 100.0 194 100.0 985 100.0

Overall, the proportion of IHS participants who reported having

been admitted as an inpatient to a general or psychiatric hospital

for a stay of at least one night in the past year decreased from

20% in 1996 to 18% in 2001 to 15% in 2009 (Table 5.10.6).

The decline has been gradual and steady among men (from 18%

to 17% to 13%), whereas the pattern for women has been a

little more variable, declining from 28% in 1996 to 22% in 2001

and then increasing to 25% in 2009. The overall results and the

results for men are relatively comparable with those of the NSW

Population Health Survey (Centre for Epidemiology and Research,

2009), which found that in 2008, 14% of adults aged 16 years

or older in NSW were admitted to a hospital for at least one

night, including 11% of men. However, among women aged

16 years or older in the NSW general population, 17% reported

an inpatient hospital admission within the preceding year,

substantially lower than the 25% of female IHS participants who

made equivalent reports.

Table/Fig 5.10.6 Hospital inpatient admissions in the

past year

0

5

10

15

20

25

30

35

28.0

21.7

24.7

18.3

16.8

12.8

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 113 617 18.3 119 708 16.8 101 792 12.8

Women 33 118 28.0 33 152 21.7 48 194 24.7

Total 146 735 19.9 152 860 17.7 149 986 15.1

Twenty-five percent of women and 13% of men reported at least

one hospital inpatient admission in the past year (Table 5.10.7).

The majority reported having only one admission, although

women were more likely than men (5% versus 2%) to have had

three or more hospital admissions in the past year. Further, 37%

of men and 44% of women who reported a hospital admission

in the past year reported that at least one such admission had

occurred while they were in prison.

Table 5.10.7 Number of hospital inpatient admissions in

the past year

Men Women Total

n % n % n %

0 691 87.2 146 75.3 837 84.9

1 63 8.0 24 12.4 87 8.8

2 25 3.2 15 7.7 40 4.1

3+ 13 1.6 9 4.6 22 2.2

Total 792 100.0 194 100.0 986 100.0

5. Health behaviours

134 2009 NSW Inmate Health Survey: Key Findings Report

Among 2009 IHS participants, 19% of men reported a

recent hospital outpatient visit, compared to 36% of women

(Table 5.10.8). Among the 222 participants who reported

having presented to a hospital outpatient clinic within the

preceding year, the majority (53%) reported having done so

just once. Further, 61% of men (N=92) and 80% of women

(N=56) reported that at least one such outpatient visit had

occurred while they were in prison. The 1996 and 2001

Surveys combined hospital outpatient visits with Emergency

Department presentations in the same question; consequently

data over time is not comparable and is not presented here.

Table 5.10.8 Number of hospital outpatient visits in the

past year

Men Women Total

n % n % n %

0 640 80.8 124 63.9 764 77.5

1 84 10.6 34 17.5 118 12.0

2 32 4.0 16 8.2 48 4.9

3+ 36 4.5 19 9.8 55 5.6

Total 792 100.0 194 100.0 986 100.0

Nearly one in five men (19%) and 29% of women indicated

that they had presented to a hospital Emergency Department in

the past year (Table 5.10.9). This proportion of IHS participants

who reported presenting to an Emergency Department was

higher than among the general community, where 17% of

women aged 16 years or older in NSW, and 18% of men,

reported having presented to a hospital Emergency Department

within the preceding year (Centre for Epidemiology and

Research, 2009). Female IHS participants were more likely

than male to report two or more Emergency Department

presentations (15% versus 7%). Further, 41% of men (N=62)

and 46% of women (N=26) reported that at least one such

presentation had occurred while they were in prison.

Table 5.10.9 Number of Emergency Department

presentations in the past year

Men Women Total

n % n % n %

0 639 80.8 138 71.1 777 78.9

1 100 12.6 27 13.9 127 12.9

2 31 3.9 18 9.3 49 5.0

3+ 21 2.7 11 5.7 32 3.2

Total 791 100.0 194 100.0 985 100.0

Over all the years in which the IHS has been conducted,

between 40% and 50% of participants reported regularly

visiting the prison health centre for medications on repeat

prescriptions, such as methadone or insulin (Table 5.10.10),

with a consistently higher proportion of women than men

reporting this to be the case. Among 2009 participants, 64%

of women and 47% of men reported regularly visiting the

prison clinic to acquire such medications.

Table/Fig 5.10.10 Regularly visit the prison health centre

for repeat prescription medications

0

10

20

30

40

50

60

70

80

67.8

57.9

63.9

46.5

37.0

46.5

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 284 611 46.5 262 708 37.0 368 791 46.5

Women 80 118 67.8 88 152 57.9 124 194 63.9

Total 364 729 49.9 350 860 40.7 492 985 49.9

General comments about healthcare in prison:

• ‘Need better access to dental health.’

• ‘The health staff in prisons should be given more time to do their

job properly. To not work under so much pressure.’

• ‘Inmates should get better dental treatment before their teeth rot

away. Methadone affects teeth and they need help quickly.’

• ‘Like to increase the confidentiality. Need to be able to talk to the

medical staff without others listening in and quicker access to

medical staff.’

• ‘Need doctors to be more available. Need doctors who will listen.’

• ‘Staff are overworked and under-paid. They need to be rotated.

Generally, staff are helpful and need more resources. Need to

educate the inmates on health issues and how to call support lines.’

• ‘They could be quicker with their referrals to see the doctor. By the

time you see the doctor, your sickness is over.’

5. Health behaviours

2009 NSW Inmate Health Survey: Key Findings Report 135

6. Mental health

6.1 Psychiatric history

The proportion of IHS participants who reported having ever

received assessment or treatment by a psychiatrist or doctor

for an “emotional or mental problem” steadily increased,

from 39% in 1996, to 43% in 2001, and again to 49% in

2009 (Table 6.1.1). Although in all years in which the IHS has

been conducted, a higher proportion of women than men

reported a history of receiving such assessment or treatment,

the gender differential has steadily narrowed; in 2009, this gap

translated to 54% of women and 47% of men who reported

having received mental health assessment or treatment.

Table/Fig 6.1.1 Ever assessed or treated by a doctor

or psychiatrist for an emotional or

mental problem

0

10

20

30

40

50

60

70

55.9 53.9 54.4

35.2

40.7

47.2

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 218 620 35.2 286 703 40.7 373 790 47.2

Women 66 118 55.9 82 152 53.9 106 195 54.4

Total 284 738 38.5 368 855 43.0 479 985 48.6

Participants in the 2009 IHS who reported having received

assessment or treatment by a doctor or psychiatrist further

specified which of a number of specific mental health

conditions they had been advised by a doctor or psychiatrist

that they suffered (Table 6.1.2). Participants who reported not

having received assessment or treatment are included in the

Table below in the row titled “none of the above” in order

to depict the self-reported prevalence of these mental health

conditions for the total sample, rather than for the subgroup

of participants who reported having received assessment or

treatment. The most common mental health conditions which

a psychiatrist or doctor had advised participants they suffered

were depression (35% of the sample), anxiety (25%) and drug

dependence (21%) disorders, all of which were reported by a

higher proportion of women than men. Of the less prevalent

conditions, personality disorders and manic depressive psychoses

were also more commonly reported among women, whereas

attention deficit/hyperactivity disorders (ADHD) and alcohol

dependence were more commonly reported among men.

Close to one in ten (9%) participants reported having been

advised that they suffered from schizophrenia, with no gender

difference in the self-reported prevalence of this condition.

Table 6.1.2 Self-reported mental health conditions

(Multiple response)

Men Women Total

n % n % n %

Depression 259 33.1 86 44.8 345 35.4

Anxiety 175 22.3 65 33.9 240 24.6

Drug dependence 158 20.2 49 25.5 207 21.3

Alcohol dependence 100 12.8 19 10.0 119 12.2

Personality disorder 70 9.0 29 15.3 99 10.2

ADD/ ADHD 93 11.8 6 3.1 99 10.1

Manic depressive psychosis 65 8.3 24 12.6 89 9.2

Schizophrenia 69 8.8 17 8.9 86 8.8

Other 62 7.9 24 12.6 86 8.8

None of the above 417 52.8 89 45.6 506 51.4

Among 2009 IHS participants who reported having been

told by a doctor or psychiatrist that they suffered from any

of a range of specific mental health conditions, sufferers of

all conditions reported first being advised of the condition

at a mean age in the mid-20s with the exception of ADHD,

of which participants reported first being advised at a mean

age of 12.5 years (SD 9.2; range 1-49) (Table 6.1.3). Women

reported being advised at an earlier mean age than men that

they suffered from the majority of mental health conditions,

with the exceptions of alcohol and drug dependence, for

both of which men reported being advised at an earlier age.

In particular, women reported being advised at an earlier age

than men that they suffered from manic depressive psychosis

(23.3 years versus 27.3 years). There was little difference in the

mean age at which men and women reported having been

advised by a doctor or psychiatrist that they suffered from

schizophrenia (24.3 and 24.0 years of age, respectively).

6. Mental health

136 2009 NSW Inmate Health Survey: Key Findings Report

Table 6.1.3 Mean age first told mental health condition

(Multiple response)

Men Women Total

n

Mean

age

(± sd)

Range n

Mean

age

(± sd)

Range n

Mean

age

(± sd)

Range

Depression 255

26.9

(±11.5)

7 - 58 83

24.0

(±11.2)

8 - 55 338

26.2

(±11.5)

7 - 58

Anxiety 167

28.5

(±11.9)

7 - 65 61

25.6

(±11.1)

8 - 57 228

27.7

(±11.7)

7 - 65

Drug dependence 155

21.6

(±8.3)

10 - 51 49

22.4

(±9.5)

13 - 53 204

21.8

(±8.6)

10 - 53

Alcohol dependence 100

24.0

(±10.5)

12 - 56 18

25.1

(±11.2)

14 - 52 118

24.2

(±10.6)

2 - 56

ADD/ ADHD 87

12.6

(±9.4)

1 - 49 4

11.5

(±1.0)

10 - 12 91

12.5

(±9.2)

1 - 49

Personality disorder 69

27.7

(±12.9)

7 - 56 29

26.5

(±10.8)

15 - 47 98

27.4

(±12.3)

7 - 56

Schizophrenia 68

24.3

(±10.4)

7 - 60 16

24.0

(±8.6)

16 - 42 84

24.2

(±10.0)

7 - 60

Manic depressive

psychosis 57

27.3

(±11.0)

8 - 51 18

23.3

(±8.3)

13 - 42 75

26.4

(±10.5)

8 - 51

As noted above, 51% of 2009 IHS participants reported never

having received assessment or treatment from a doctor or

psychiatrist for an emotional or mental problem. Among those

466 participants who had received mental health treatment,

one in five (20%) had never seen a psychiatrist (Table 6.1.4).

More than one third (38%) of participants had seen a

psychiatrist more than a year prior to their incarceration.

Table 6.1.4 When last see psychiatrist prior to

incarceration (if ever mental health

treatment)

Men Women Total

n % n % n %

Never seen a psychiatrist 72 19.8 19 18.8 91 19.5

In week before prison 12 3.3 5 5.0 17 3.6

1 week - <1 month

before prison 39 10.7 14 13.9 53 11.4

1 - 3 months before prison 27 7.4 13 12.9 40 8.6

4 - <12 months

before prison 43 11.8 14 13.9 57 12.2

1+ years before prison 140 38.4 35 34.7 175 37.6

Don't know 32 8.8 1 1.0 33 7.1

Total 365 100.0 101 100.0 466 100.0

Among participants who had ever been assessed or treated for a

mental health problem, the majority (63%) had no contact with

a community mental health service in the three months prior to

their incarceration, with a higher proportion of men than women

reporting this to be the case (66% versus 52%) (Table 6.1.5).

Women were more likely to indicate they had regular contact

with a mental health service in the community with just under

one in four (24%) indicating that they contacted a mental health

service four or more times in that time period, compared to just

13% of men. A small proportion of the sample (3%) were unsure

whether they had had contact with a mental health service in the

three months prior to their current incarceration.

Table 6.1.5 Frequency contact mental health services in

the three months prior to incarceration (if

ever mental health treatment)

Men Women Total

n % n % n %

Not at all 242 66.1 52 51.5 294 63.0

Once only 38 10.4 8 7.9 46 10.0

Two to three times 29 7.9 14 13.9 43 9.2

Four or more times 47 12.8 24 23.8 71 15.2

Don't know 10 2.7 3 3.0 13 2.8

Total 366 100.0 101 100.0 467 100.0

6. Mental health

2009 NSW Inmate Health Survey: Key Findings Report 137

The proportion of IHS participants who reported ever having been

admitted to a psychiatric unit gradually increased from 13% in

1996 to 14% in 2001 to 16% in 2009 (Table 6.1.6). In 2009, a

higher proportion of women than men reported ever having been

admitted to a psychiatric unit (20% versus 15%).

Table/Fig 6.1.6 Ever admitted to a psychiatric unit

0

5

10

15

20

25

18.2

13.3

19.5

11.4

13.7 14.7

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 75 657 11.4 95 694 13.7 115 782 14.7

Women 24 132 18.2 20 150 13.3 37 190 19.5

Total 99 789 12.6 115 844 13.6 152 972 15.6

Among the 152 IHS participants in 2009 who reported ever

being admitted to a psychiatric unit, a similar proportion had

been admitted once only (43%) or between 2-5 times (45%)

in their lifetime (Table 6.1.7). A slightly higher proportion

of women than men reported having been admitted to a

psychiatric unit on six or more occasions (14% versus 11%).

Table 6.1.7 Number of psychiatric admissions (if ever

admitted to psychiatric unit)

Men Women Total

n % n % n %

1 50 43.5 16 43.2 66 43.4

2 - 5 52 45.2 16 43.2 68 44.7

6+ 13 11.3 5 13.5 18 11.8

Total 115 100.0 37 100.0 152 100.0

The great majority (86%) of 2009 IHS participants who

reported a history of at least one psychiatric admission further

reported that these admissions had occurred in the community,

with higher rates of community-based admissions for women

(95%) than men (83%) (Table 6.1.8). Reports of psychiatric

admissions from prison only were uncommon, having occurred

for just eight participants.

Table 6.1.8 Location of psychiatric admissions (if ever

admitted to psychiatric unit)

Men Women Total

n % n % n %

In community 95 82.6 35 94.6 130 85.5

Both community and prison 13 11.3 1 2.7 14 9.2

In prison 7 6.1 1 2.7 8 5.3

Total 115 100.0 37 100.0 152 100.0

More than half (53%) of participants who had ever been

admitted to a psychiatric unit indicated that they had been

admitted for less than two weeks (Table 6.1.9). A higher

proportion of women than men reported having been

admitted for four or more weeks (41% versus 28%).

Table 6.1.9 Duration of longest psychiatric admission

(if ever admitted to psychiatric unit)

Men Women Total

n % n % n %

<1 week 36 31.3 8 21.6 44 28.9

1 - <2 weeks 24 20.9 12 32.4 36 23.7

2 - <4 weeks 23 20.0 2 5.4 25 16.4

4 - 8 weeks 10 8.7 6 16.2 16 10.5

>8 weeks 22 19.1 9 24.3 31 20.4

Total 115 100.0 37 100.0 152 100.0

The majority (61%) of 2009 IHS participants who reported a

history of at least one psychiatric admission further reported

that they were discharged from their most recent psychiatric

admission more than two years preceding the IHS interview

(Table 6.1.10). Less than a quarter (23%) reported having been

discharged from a psychiatric admission within the preceding

year, with a higher proportion of men than women reporting a

psychiatric discharge during this period (25% versus 16%).

6. Mental health

138 2009 NSW Inmate Health Survey: Key Findings Report

Table 6.1.10 Timing of most recent psychiatric discharge

(if ever admitted to psychiatric unit)

Men Women Total

n % n % n %

<4 weeks 3 2.6 0 0.0 3 2.0

4 - <12 weeks ago 5 4.3 1 2.7 6 3.9

3 - <6 months ago 7 6.1 3 8.1 10 6.6

6 - <12 months ago 14 12.2 2 5.4 16 10.5

1 - <2 years ago 18 15.7 7 18.9 25 16.4

2+ years ago 68 59.1 24 64.9 92 60.5

Total 115 100.0 37 100.0 152 100.0

Among 2009 IHS participants who had been admitted at

least once to a psychiatric unit, the source of referral for

the most recent admission was most likely to be the police

(36%), followed by a doctor (23%) and self-referral (18%)

(Table 6.1.11). Men were more likely than women to be

referred by the police (39% versus 27%), while women

were more likely than men to be referred by doctors (27%

versus 22%).

Table 6.1.11 Source of referral for most recent

psychiatric admission (if ever admitted to

psychiatric unit)

Men Women Total

n % n % n %

Police 45 39.1 10 27.0 55 36.2

Doctor 25 21.7 10 27.0 35 23.0

Self-referral 21 18.3 6 16.2 27 17.8

Family / Friends 12 10.4 5 13.5 17 11.2

Other criminal justice

system 7 6.1 5 13.5 12 7.9

Other government, etc 5 4.3 1 2.7 6 3.9

Total 115 100.0 37 100.0 152 100.0

The proportion of IHS participants who reported currently

taking at least one psychiatric medication steadily increased

from 11% in 1996 to 15% in 2001 to 18% in 2009.

However, the increase has been reported by men, whereas

a decrease in the proportion of women reporting current

psychiatric medications has been observed over the same

years (Table 6.1.12). In all years in which the Survey has been

conducted, a higher proportion of women than men reported

currently taking psychiatric medication, although the gender

differential has decreased over time. In 2009, this difference

translated to 22% of women who reported currently taking

psychiatric medications, compared to 16% of men.

Table/Fig 6.1.12 Current use of psychiatric medications

0

5

10

15

20

25

30

26.3

24.7

22.1

8.6

13.0

16.4

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 53 619 8.6 91 701 13.0 128 782 16.4

Women 31 118 26.3 37 150 24.7 42 190 22.1

Total 84 737 11.4 128 851 15.0 170 972 17.5

As noted above, 18% of 2009 IHS participants reported currently

taking at least one psychiatric medication. Seventeen percent

of women and 13% of men reported currently taking antidepressants,

while 10% of men and 6% of women (equating to

7% of the total sample) reported taking anti-psychotics, a class

which included major tranquilisers of both tablet and injection

form. This should not be taken to imply that 7% of the sample

were currently psychotic; many of these participants were likely

to have been prescribed major tranquilisers for their sedative/

calming effects, rather than their anti-psychotic properties.

Among the 170 participants in 2009 who indicated they were

using prescribed psychiatric medications, 50% of women and

25% of men indicated they always took their medication as

prescribed in the six months prior to being incarcerated.

Around one in eight (13%) 2009 IHS participants reported

having been assessed by a mental health nurse in the courts,

with a slightly higher proportion of women than men reporting

this to be the case (15% versus 12%). Eight participants (<1%

of the sample) reported being unsure whether they had been

seen by a mental health nurse in the courts (Table 6.1.13).

6. Mental health

2009 NSW Inmate Health Survey: Key Findings Report 139

Table 6.1.13 Ever assessed by a mental health nurse in

the courts

Men Women Total

n % n % n %

Yes 95 12.0 29 15.2 124 12.7

No 687 87.1 161 84.3 848 86.5

Don’t know 7 0.9 1 0.5 8 0.8

Total 789 100.0 191 100.0 980 100.0

Among the 124 IHS participants in 2009 who reported

having been assessed by a mental health nurse in the courts,

more than half (61%) further reported that they had been

assessed more than one year preceding the IHS interviews

(Table 6.1.14). Men were more likely than women to report

that such a period of time had elapsed since they were seen

(65% versus 48%).

Table 6.1.14 Time since assessed by a mental health

nurse in the courts (if ever seen)

Men Women Total

n % n % n %

< 1 month ago 4 4.2 5 17.2 9 7.3

1 - 3 months ago 8 8.4 1 3.4 9 7.3

4 - 12 months ago 19 20.0 9 31.0 28 22.6

1 - < 2 years ago 22 23.2 6 20.7 28 22.6

2+ years ago 40 42.1 8 27.6 48 38.7

Don’t know 2 2.1 0 0.0 2 1.6

Total 95 100.0 29 100.0 124 100.0

The majority (85%) of 2009 IHS participants who reported

having been assessed by a mental health nurse in the courts

further reported that the nurse had submitted a mental

health report to the court, with men substantially more

likely than women to report that this was the case (88%

versus 72%). Six participants (two men and four women)

who reported having been seen by a mental health nurse in

the courts were unsure whether a report was subsequently

submitted to the court.

Close to two thirds (62%) of 2009 IHS participants who

reported having been seen by a mental health nurse in the

courts considered that the service had been helpful for

their mental health or legal problems, with a slightly higher

proportion of women than men reporting this perception

(66% versus 61%). Twelve participants were unsure whether

the service had been helpful to them, with men more likely

to report such uncertainty than women (11% versus 7%).

Twenty eight percent of both men and women did not

consider that the service had been helpful.

One third (34%) of 2009 IHS participants reported having

received support, counselling or treatment for a “mental

problem” from a psychologist or counsellor at some time in

their lives, with women substantially more likely to report that

this was the case than men (46% versus 31%) (Table 6.1.15).

Table 6.1.15 Ever receive support, counselling or

treatment for a mental problem from a

psychologist or counsellor

Men Women Total

n % n % n %

Yes 241 30.5 88 46.1 329 33.6

No 548 69.5 103 53.9 651 66.4

Total 789 100.0 191 100.0 980 100.0

Ten percent of 2009 IHS participants reported currently receiving

another form of treatment or support for an “emotional or

mental problem,” with women more likely than men to report

that this was the case (14% versus 9%). Further details provided

in response to open-ended questions indicated that these

participants referred mostly to different forms of counselling.

Among 2009 IHS participants who had previously been

released from prison, 15% reported having been referred

to a community mental health service on their most recent

release into the community, with women almost three times

as likely as men to report that this was the case (31% versus

12%). Of the 43 participants who reported being referred

to a mental health service the last time they were released

from prison, 70% further reported attending the service on

release, with little difference between the proportions of men

and women who reported this to be the case.

6. Mental health

140 2009 NSW Inmate Health Survey: Key Findings Report

General comments about mental health:

• ‘Just want to make sure that I will be alright when released, that my

mental health is cared for and that drugs don’t control my life.’

• ‘Need a psychiatrist here for people suffering from depression. Hard

for other inmates to talk to each other because of gaol politics. More

anger management courses.’

• ‘Want to understand myself better as get stressed and would like

to be able to see psychologist and counsellor for advice for when

get out.’

6.2 Suicide

Prison populations are characterised by a range of variables

associated with suicide, including hopelessness, traumatic

histories, significant loss and grief, social isolation, lack of

support, and poor coping skills (e.g., Finkel & Bout, 2002;

Konrad et al., 2007; Maris et al., 1992; Maris, 2002).

Incarceration itself may precipitate fear of the unknown, fear

of physical or sexual violence, uncertainty and fear about the

future, embarrassment and guilt over the offence, and fear

or stress related to poor environmental conditions, which

may all contribute to increased risk of suicide (Konrad et al.,

2007). The high prevalence of mental illness and/or drug and

alcohol misuse among prison inmates also predisposes many

of them to suicide (Fazel et al., 2006; Hayes, 2006; Kariminia

et al., 2007; Kinner, 2006). Such characteristics are likely to

account for the significantly elevated risk of dying by suicide

among prison inmates and ex-inmates relative to the general

population (Kariminia et al., 2006).

One third (33%) of the 2009 IHS sample reported ever

having “thought about committing suicide” (Table 6.2.1),

with women somewhat more likely to report this was the

case than men (38% versus 32%). This gender differential

decreased markedly since the 1996 IHS, when 60% of women

reported a history of suicidal ideation, compared with 39%

of men. The proportions of overall IHS samples with a history

of suicidal ideation steadily decreased, from 42% in 1996 to

36% in 2001 to 33% in the most recent Survey.

Table/Fig 6.2.1 Ever thought about committing suicide

0

10

20

30

40

50

60

70

60.2

42.8

38.9 38.2

34.2 31.9

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 241 620 38.9 240 702 34.2 252 789 31.9

Women 71 118 60.2 65 152 42.8 73 191 38.2

Total 312 738 42.3 305 854 35.7 325 980 33.2

The majority (70%) of 2009 IHS participants who reported a

history of suicidal ideation further reported that the most recent

instance of such thought patterns was more than twelve months

prior to the Survey (Table 6.2.2). A slightly higher proportion of

women than men reported suicidal thoughts in the four weeks

preceding the Survey (12% versus 9%).

Table 6.2.2 Timing of most recent suicidal thoughts (if

ever thought about suicide)

Men Women Total

n % n % n %

In the past week 9 3.6 4 5.5 13 4.0

1 - <4 weeks ago 14 5.6 5 6.8 19 5.8

1 - <6 months ago 31 12.3 7 9.6 38 11.7

6 - <12 months ago 21 8.3 6 8.2 27 8.3

1+ years ago 177 70.2 51 69.9 228 70.2

Total 252 100.0 73 100.0 325 100.0

A total of 10% of the 2009 IHS sample (N=98) reported

having thought about suicide at least once in the past year,

50% of whom reported having done so less often than

monthly (Table 6.2.3). Twenty participants indicated that

they thought about suicide on a daily or weekly basis in the

preceding year.

6. Mental health

2009 NSW Inmate Health Survey: Key Findings Report 141

Table 6.2.3 Frequency of most recent suicidal thoughts

in the past year (if thought about suicide in

the past year)

Men Women Total

n % n % n %

Daily 11 14.5 3 13.6 14 14.3

Weekly 14 18.4 6 27.3 20 20.4

Monthly 13 17.2 2 9.1 15 15.3

Less than monthly 38 50.0 11 50.0 49 50.0

Total 76 100.0 22 100.0 98 100.0

Among 2009 IHS participants with a history of suicidal ideation,

the majority (62%) reported that relative to their thought

patterns while at liberty in the community, their suicidal

thoughts had decreased since their current incarceration

(Table 6.2.4). This finding may be attributed to the increased

availability of mental health treatment in prison that participants

may not access in the community. A further 20% reported that

their suicidal thoughts had neither increased nor decreased

since their incarceration, whereas 18% reported that they

had experienced an increase in their suicidal thoughts during

incarceration. Women were not only more likely than men to

report a history of suicidal ideation, but were also more likely to

report an increase in suicidal thoughts since their incarceration

(25% of women compared to 16% of men).

Table 6.2.4 Changes in suicidal thoughts since in prison

(if ever thought about suicide)

Men Women Total

n % n % n %

Decreased 161 63.9 41 56.2 202 62.2

Remained the same 52 20.6 14 19.2 66 20.3

Increased 39 15.5 18 24.7 57 17.5

Total 252 100.0 73 100.0 325 100.0

One fifth (21%) of the 2009 IHS sample reported ever having

attempted suicide (Table 6.2.5), with women more likely to report

this was the case than men (27% versus 19%). The proportions

of overall IHS samples who reported a history of suicide attempts

decreased slightly, from 24% in 1996, to 22% in 2001 to 21% in

the most recent Survey. Consistent with the patterns of reported

suicidal ideation described above, the gender differential in

reported history of suicide attempts decreased since the 1996

IHS, when 39% of women reported a history of suicide attempts,

compared with 21% of men.

Women are known to attempt suicide more often than men,

but men have a higher rate of success when they make suicide

attempts. For example, of 1,881 deaths by suicide registered

in Australia in 2007, 77% were men (ABS, 2009); while in the

2007 National Survey of Mental Health and Well-being, 0.3%

of men and 0.5% of women reported having made a suicide

attempt in the previous twelve months. A further 1.8% of men

and 2.7% of women reported having suicidal thoughts in the

previous twelve months (ABS, 2008). Results consistent with

this pattern were observed in a retrospective cohort study of

85,203 adult offenders who had been in full-time custody in

NSW prisons between 1988 and 2002. Kariminia et al. (2007)

documented a higher suicide rate among men than women

both in prison (129 versus 56 per 100,000 person-years) and

after release (135 versus 82 per 100,000 person-years).

Table/Fig 6.2.5 Ever attempt suicide

0

5

10

15

20

25

30

35

40

45

39.4

29.6

27.2

20.7 19.7 19.0

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 136 657 20.7 138 700 19.7 150 788 19.0

Women 52 132 39.4 45 152 29.6 52 191 27.2

Total 188 789 23.8 183 852 21.5 202 979 20.6

Among the 21% of the 2009 IHS sample who reported a

history of at least one suicide attempt, 60% further reported

having made more than one suicide attempt (Table 6.2.6).

An equal proportion (35%) of men and women reported

three or more suicide attempts.

6. Mental health

142 2009 NSW Inmate Health Survey: Key Findings Report

Table 6.2.6 Number of suicide attempts (if ever

attempted suicide)

Men Women Total

n % n % n %

1 61 41.2 19 36.5 80 40.0

2 36 24.3 15 28.8 51 25.5

3 23 15.5 10 19.2 33 16.5

4 6 4.1 2 3.8 8 4.0

5+ 22 14.9 6 11.5 28 14.0

Total 148 100.0 52 100.0 200 100.0

Among women who had attempted suicide, slashing or

stabbing was the most common method chosen (reported by

50% of women with a history of suicide attempts), closely

followed by attempting to overdose using tablets (48%)

(Table 6.2.7). Smaller proportions of women reported having

attempted suicide via overdosing by injection (21%) and

hanging (17%). Among men, the most common methods

were slashing/stabbing (43% of men with a history of suicide

attempts), followed by hanging (36%), overdosing on tablets

(35%) and overdosing by injection (17%). Whereas 9% of

men with a history of suicide attempts had chosen to use

a firearm, no women reported having chosen this method.

Previous research on suicide among prison inmates and

former inmates documented hanging as the most common

fatal suicide method among men after release, and selfpoisoning

the most common among women after release

from prison. Hanging was implicated in 94% of all men’s

suicide deaths, and 100% of women’s, during incarceration

(Kariminia et al., 2007).

Table 6.2.7 Methods used for suicide attempts (if ever

attempted suicide)

(Multiple response)

Men Women Total

n % n % n %

Slashing/stabbing 64 42.7 26 50.0 90 44.6

Overdose - tablets 52 34.7 25 48.1 77 38.1

Hanging 54 36.0 9 17.3 63 31.2

Overdose - injection 26 17.3 11 21.2 37 18.3

Motor vehicle accident 13 8.7 2 3.8 15 7.4

Firearms/gunshot 13 8.7 0 0.0 13 6.4

Jumping 9 6.0 3 5.8 12 5.9

Other 26 17.3 6 11.5 32 15.8

Although suicide was the leading cause of death among

NSW prison inmates between 1995 and 2005 (O’Driscoll

et al., 2007), it is still the case that suicide attempts are far

more likely to be made in the community than in prison

(Kariminia et al., 2007). Consistent with this previous

research, 71% of 2009 IHS participants with a history of

suicide attempts reported having made such attempts only

in the community, compared with 14% of participants who

reported having attempted suicide only while in prison.

Women were more likely than men to have attempted

suicide in the community (83% versus 67%) but less likely

to have done so in prison (8% versus 16%). Fifteen percent

of participants who had attempted suicide reported having

done so both in the community and prison (Table 6.2.8).

Kariminia et al. (2007), who found that the two weeks

post-release period was a time of especially elevated suicide

risk, particularly for men, argue that suicide attempts

may be more likely in the community because suicides

in prison receive considerable attention from authorities.

Programs, policies and even architectural considerations

are implemented to minimise the risk of suicide during

incarceration. In contrast, far less attention is paid to the

post-release period, when the duty of care shifts from

custodial authorities to the community.

Table 6.2.8 Location of suicide attempts (if ever

attempted suicide)

Men Women Total

n % n % n %

In community 101 67.3 43 82.7 144 71.3

Both community and prison 25 16.7 5 9.6 30 14.9

In prison 24 16.0 4 7.7 28 13.9

Total 150 100.0 52 100.0 202 100.0

The majority (64%) of 2009 IHS participants who reported

a history of suicide attempts reported that they “really

wanted to die at the time” (Table 6.2.9). Women were more

likely than men to report that they wanted to die sometimes

(19% versus 9%), whereas men were more likely to report

that they did not know whether they really wanted to die at

the time (10% versus 4%).

6. Mental health

2009 NSW Inmate Health Survey: Key Findings Report 143

Table 6.2.9 ‘Really wanted to die’ (if ever attempted

suicide)

Men Women Total

n % n % n %

Yes, always 97 64.7 32 61.5 129 63.9

Sometimes 13 8.7 10 19.2 23 11.4

Always no 25 16.7 8 15.4 33 16.3

Don’t know 15 10.0 2 3.8 17 8.4

Total 150 100.0 52 100.0 202 100.0

The majority (78%) of 2009 IHS participants who reported

having attempted suicide further reported that they had never

told anybody that they were considering suicide, with no

difference in the proportion of men and women who reported

this was the case (Table 6.2.10). Men were more likely than

women to report that they had always told someone (12%

versus 6%), whereas women were more likely to report that

they had sometimes told someone (17% versus 9%).

Table 6.2.10 Told anyone considering suicide (if ever

attempted suicide)

Men Women Total

n % n % n %

Yes, always 18 12.0 3 5.8 21 10.4

Sometimes 14 9.3 9 17.3 23 11.4

Always no 118 78.7 40 76.9 158 78.2

Total 150 100.0 52 100.0 202 100.0

Among 2009 IHS participants who reported having told someone

they were thinking of committing suicide at least sometimes,

both men and women most commonly reported having told a

family member (Table 6.2.11), with women slightly more likely

than men to report this was the case (12% versus 9%). Men

were more likely to report having told a friend (7% versus 4%)

or custodial staff (4% versus 0%), whereas women were more

likely to report having told a doctor or nurse (6% versus 1%).

Small numbers of participants also reported having told other

inmates, telephone counselling services and psychologists or

psychiatrists that they were contemplating suicide.

Table 6.2.11 Who told considering suicide (if ever

attempted suicide)

(Multiple response)

Men Women Total

n % n % n %

No one 118 78.7 40 76.9 158 78.2

Family member 14 9.3 6 11.5 20 9.9

Friend 10 6.7 2 3.8 12 5.9

Custodial staff 6 4.0 0 0.0 6 3.0

Doctor/nurse 2 1.3 3 5.8 5 2.5

Other inmate 3 2.0 1 1.9 4 2.0

Psychologist/ psychiatrist 3 2.0 1 1.9 4 2.0

Phone counselling service 2 1.3 1 1.9 3 1.5

Reasons not talk to anybody when considering suicide:

• ‘At the time you think there is no point in going on. Life for a

blackfella doesn’t improve. You still get treated like shit no matter

what your name is.’

• ‘Didn’t want anyone to talk to and didn’t want to be stopped.’

• ‘Because if I talk to anyone they strip you to your undies and put

you in a cell where they watch you 24/7 and it’s freezing in there.’

• ‘Alcohol stopped me from thinking clearly.’

• ‘Am a loner. Only person was my partner and he was part of

the problem.’

• ‘Cause they would stop me.’

• ‘Didn’t think anyone would listen.’

• ‘I’d been molested by my family and couldn’t talk to anyone.’

• ‘Just wanted to check out the next life to see if it was any better.’

• ‘The whole point of doing it is not to tell someone.’

• ‘When I get depressed I shut down and talk to no one.’

Half (50%) of the 2009 IHS participants who reported

having attempted suicide further reported that they had

never “thought about committing suicide for some time

before the attempt(s)” (Table 6.2.12). Men were more likely

than women to report not having thought about suicide for

some time before their attempt (51% versus 46%). One in

five (21%) participants reported that they had sometimes

thought about their suicide for some time, and close to one

third (29%) reported that they had always thought about

suicide for some time before attempting it.

6. Mental health

144 2009 NSW Inmate Health Survey: Key Findings Report

Table 6.2.12 Extent of consideration of suicide prior to

its attempt (if ever attempted suicide)

Men Women Total

n % n % n %

Yes, always 43 28.7 16 30.8 59 29.2

Sometimes 30 20.0 12 23.1 42 20.8

Always no 77 51.3 24 46.2 101 50.0

Total 150 100.0 52 100.0 202 100.0

Given the results reported in Table 6.2.12, it is consistent that

almost two-thirds (64%) of 2009 IHS participants who reported

having attempted suicide further reported that at least one of

their suicide attempts was the result of a sudden impulse or

urge. Men were slightly more likely than women to report that

this was the case (65% versus 61%).

Among 2009 IHS participants who reported having attempted

suicide, 36% reported having made a plan to suicide which

ultimately they did not carry out. Women were more likely

than men to report that this was the case (40% versus 34%).

Among 2009 IHS participants who reported having made

a plan to suicide which they did not carry out, the most

common reason for not doing so was due to concerns about

their family and/or friends (58%) (Table 6.2.13). Women were

substantially more likely than men to report that concern for

their loved ones prevented them from carrying out their plan

to suicide (71% versus 53%). The next most common reason

was having a change of heart (31%), with a higher proportion

of men than women reporting this to be the reason that they

did not carry out their plan (33% versus 24%). Men were

also more likely to report that they thought that things would

improve (14% versus 10%). Limited opportunity to commit

suicide in prison was reported as a reason for not carrying

out a plan by only one male participant, and by no women.

Two men and one woman reported that counselling was the

reason they did not carry out their plan to suicide.

Table 6.2.13 Reasons not carry out suicide plans (if ever

made a suicide plan)

(Multiple response)

Men Women Total

n % n % n %

Family / partner concerns 27 52.9 15 71.4 42 58.3

Change of heart 17 33.3 5 23.8 22 30.6

Thought that things would

improve 7 13.7 2 9.5 9 12.5

Counselling 2 3.9 1 4.8 3 4.2

Physically prevented 2 3.9 0 0.0 2 2.8

Lack of courage 1 2.0 1 4.8 2 2.8

Limited opportunities in

prison 1 2.0 0 0.0 1 1.4

Other 8 15.7 3 14.3 11 15.3

The majority (83%) of 2009 IHS participants with a history

of suicide attempts reported that their most recent attempt

had occurred twelve or more months preceding the Survey.

No participants reported having attempted suicide within the

week preceding the Survey (Table 6.2.14), although one male

participant and two women reported that they had attempted

suicide within the preceding four weeks. There was little

gender difference in the timing of the most recent suicide

attempt among 2009 IHS participants.

Table 6.2.14 Timing of most recent suicide attempt (if

ever attempted suicide)

Men Women Total

n % n % n %

In the past week 0 0.0 0 0.0 0 0.0

1 - <4 weeks ago 1 0.7 2 3.8 3 1.5

1 - <6 months ago 9 6.0 3 5.8 12 5.9

6 - <12 months ago 16 10.7 4 7.7 20 9.9

1+ years ago 124 82.7 43 82.7 167 82.7

Total 150 100.0 52 100.0 202 100.0

A total of eight 2009 IHS participants, five men and three

women, described themselves as “likely” or “very likely”

to attempt suicide during their current incarceration. Nine

percent of participants reported that they were “unlikely” to

do so, and 89% (90% of men and 86% of women) reported

that they were “definitely not” likely to do so (Table 6.2.15).

6. Mental health

2009 NSW Inmate Health Survey: Key Findings Report 145

Table 6.2.15 Likelihood of attempting suicide during

current incarceration

Men Women Total

n % n % n %

Very likely 3 0.4 1 0.5 4 0.4

Likely 2 0.3 2 1.0 4 0.4

Unlikely 68 8.6 18 9.4 86 8.8

Definitely not 705 89.5 165 86.4 870 88.9

Don’t know 10 1.3 5 2.6 15 1.5

Total 788 100.0 191 100.0 979 100.0

Reassuringly, just a small proportion (3%) of 2009 IHS

participants reported that they considered it “very likely” or

“likely” that their lives would end by suicide, and the majority

(80%) reported that this was “definitely not” likely to be the

case (Table 6.2.16). Three percent of the sample reported not

knowing the likelihood of their lives ending by suicide.

Table 6.2.16 Likelihood of life ending through suicide

Men Women Total

n % n % n %

Very likely 11 1.4 0 0.0 11 1.1

Likely 11 1.4 4 2.1 15 1.5

Unlikely 109 13.8 35 18.3 144 14.7

Definitely not 636 80.7 146 76.4 782 79.9

Don’t know 21 2.7 6 3.1 27 2.8

Total 788 100.0 191 100.0 979 100.0

Eighty four percent of 2009 IHS participants reported that the

problems they were confronted with would “definitely not” be

resolved if they committed suicide, and a further 6% reported

that they would “probably not” be resolved (Table 6.2.17). Six

percent reported not knowing whether this would be the case,

but 4% of men and 3% of women reported that their problems

would “probably” or “definitely” be resolved by suicide.

Table 6.2.17 Perception that problems would be resolved

by suicide

Men Women Total

n % n % n %

Definitely not 667 84.6 159 83.2 826 84.4

Probably not 44 5.6 11 5.8 55 5.6

Don’t know 47 6.0 15 7.9 62 6.3

Probably yes 17 2.2 4 2.1 21 2.1

Definitely yes 13 1.6 2 1.0 15 1.5

Total 788 100.0 191 100.0 979 100.0

General comment about suicide:

• ‘Most of my suicide attempts were because I was scared of being in

prison, but I realise now that nothing is worth taking our own life.’

6.3 Self harm

There is some overlap between deliberate self-harm and

attempted suicide, and in some cases, the two can be difficult

to distinguish because the person’s intent (to die or not to die)

is ambiguous. Official statistics on self-harm relate to cases of

self-harm requiring hospitalisations, and are therefore almost

certainly underestimates, because an unknown proportion of

cases are treated in private and never come to the attention of

professional services (Steenkamp & Harrison, 2000). Moreover,

most people who contact health services after an episode of

deliberate self-harm present to Emergency Departments. They

may or may not be admitted as hospital inpatients, and the

injury may or not be recorded as intentional.

In 2003-04, there were 24,087 cases of hospitalisation for

self-harm in Australia, accounting for 7% of all hospital

admissions due to injury and poisoning in that year

(Berry & Harrison, 2007). Although the death rates from

suicide are three to four times greater in men than in

women, hospitalisation rates for intentional self-harm are

consistently higher in women than in men. For example,

women accounted for 62% of hospitalised self-harm cases

in 2003-04. This is thought to be because men use more

lethal self-harm methods than women (Population Health

Division, 2008).

6. Mental health

146 2009 NSW Inmate Health Survey: Key Findings Report

Among the general population, self-harm episodes leading

to hospitalisation are most common among young women

aged 15-24 years. In NSW, the numbers of young women

hospitalised for self-harm decreased after a peak in 2005-06

of 483.0 per 100,000 women aged 15-24; nevertheless, the

numbers remain significantly higher than among any other age

group. In 2006-07, women aged 15-24 years were hospitalised

after self-harm at a rate of 435.6 per 100,000 population,

compared to 185.3 per 100,000 among women of all ages,

and 199.0 per 100,000 men aged 15-24 years (Population

Health Division, 2008).

For the purposes of the IHS, self-harm is defined as incidents in

which a person self-inflicts deliberate harm, but does so in the

absence of intent to kill themselves. Questions about self-harm

specified that participants should exclude any consideration of

genuine attempts to take their own lives.

Fifteen percent of 2009 IHS participants reported a history

of deliberate attempts to harm themselves in the absence

of genuine intent to take their own lives (Table 6.3.1), with

a slightly higher proportion of women than men reporting

this to be the case (17% versus 14%). The proportion of IHS

participants who reported a history of self harm remained

relatively stable between 1996 (16%), 2001 (13%) and

2009 (15%). However, the gender differential, whereby a

larger proportion of women than men reported a history of

self-harm, decreased in 2009 relative to the two previous

IHSs, when the proportion of women who reported a

history of self harm was substantially larger than the

proportion of men.

Table/Fig 6.3.1 Ever self-harmed (excluding suicide

attempts)

0

5

10

15

20

25

30

35

23.1

20.5

17.3

14.1

11.7

14.0

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 87 618 14.1 82 701 11.7 110 788 14.0

Women 27 117 23.1 31 151 20.5 33 191 17.3

Total 114 735 15.5 113 852 13.3 143 979 14.6

Among 2009 IHS participants who reported a history of

self-harm, around one-third (34%) reported having harmed

themselves on a single occasion only (Table 6.3.2). One in four

(25%) of those who reported a history of self-harm reported

harming themselves on five or more occasions, with a higher

proportion of women than men reporting this to be the case

(30% versus 23%).

Table 6.3.2 Number of times self-harmed (if any selfharm)

Men Women Total

n % n % n %

1 39 35.5 10 30.3 49 34.3

2 21 19.1 9 27.3 30 21.0

3 11 10.0 3 9.1 14 9.8

4 14 12.7 1 3.0 15 10.5

5+ 25 22.7 10 30.3 35 24.5

Total 110 100.0 33 100.0 143 100.0

6. Mental health

2009 NSW Inmate Health Survey: Key Findings Report 147

Among participants who reported a history of self-harm, the

most common method used by both men and women during

the most recent self-harm episode was slashing or stabbing

(deliberately cutting the body) (Table 6.3.3). Women were

more likely than men to report banging their heads against

or punching walls (21% versus 15%), whereas men were

more likely than women to report burning themselves (9%

versus 6%). Among individuals hospitalised for self-harm in

Australia in 2003-04, self-poisoning was the most common

method, used by 77% of men and 88% of women (Berry &

Harrison, 2007). Men were more likely to have used more

violent methods than women, including sharp objects (15%

of men versus 10% of women), and hanging, strangulation

or suffocation (3% versus <1%).

Table 6.3.3 Method used in most recent self-harm

episode (if any self-harm)

Men Women Total

n % n % n %

Slashing/stabbing 63 57.3 20 60.6 83 58.0

Head banging/ punching walls 16 14.5 7 21.2 23 16.1

Burning 10 9.1 2 6.1 12 8.4

Overdose 4 3.6 2 6.1 6 4.2

Strangulation 4 3.6 1 3.0 5 3.5

Other 13 11.8 1 3.0 14 9.8

Total 110 100.0 33 100.0 143 100.0

Among 2009 IHS participants who reported a history of

self-harm, 71% reported that their most recent episode of

self-harm occurred in the community, while 29% reported

that their most recent episode occurred in prison (Table 6.3.4).

Men were more likely than women to report that their most

recent self-harm episode occurred in prison rather than the

community (32% versus 21%).

Table 6.3.4 Location of most recent self-harm episode

(if any self-harm)

Men Women Total

n % n % n %

In community 75 68.2 26 78.8 101 70.6

Prison 35 31.8 7 21.2 42 29.4

Total 110 100.0 33 100.0 143 100.0

Among women who reported a history of self-harm, the most

common motivation reported for the most recent episode of

self-harm was as a response to personal problems (27% of

women who reported a history of self-harm, compared with

17% of men) (Table 6.3.5). The most common motivation

reported by men was to relieve tension (21%, versus 24%

of women). Such affect-regulating motivations for self-harm

are consistent with those reported in the literature on selfharm

behaviours among both clinical and general population

samples (e.g., Briere & Gil, 1998). Women were more likely

than men to report that their most recent self-harm episode

was associated with drug abuse or detoxification from drugs

(12% versus 6%) whereas men were more likely to report

that they were attempting to make other people listen to

them (7% versus 3%). Consistent with the latter motivation,

self-harm is conceived by some authors and clinicians as a

primitive form of communication, a way to seek help from or

influence others (Favazza & Conterio, 1989).

Table 6.3.5 Motivations for most recent self-harm

episode (if any self-harm)

Men Women Total

n % n % n %

To relieve tension 23 20.9 8 24.2 31 21.7

Personal problems 19 17.3 9 27.3 28 19.6

Depression / Despair 21 19.1 7 21.2 28 19.6

Drug abuse / detox 7 6.4 4 12.1 11 7.7

To make others listen to you 8 7.3 1 3.0 9 6.3

Other 32 29.1 4 12.1 36 25.2

Total 110 100.0 33 100.0 143 100.0

Among 2009 IHS participants who reported a history of

self-harm, 73% reported that their most recent episode of

self-harm had occurred more than twelve months preceding

the Survey (Table 6.3.6). Women were more likely than

men to report that their most recent self-harm episode had

occurred within the preceding twelve months (36% versus

25%); however, men were more likely to report that they

had harmed themselves during their current incarceration

(21% versus 15%).

6. Mental health

148 2009 NSW Inmate Health Survey: Key Findings Report

Reasons for self-harm:

• ‘Anger with depression and the way my life is running.’

• ‘Being silly trying to tattoo myself.’

• ‘Drunk and to get attention and help.’

• ‘Girlfriend was slashing up so I showed her how to do it properly.’

• ‘I was stupid.’

• ‘The voices were telling me to do it.’

• ‘Friends daring to do it and being silly.’

Table 6.3.6 Timing of most recent self-harm episode

(if any self-harm)

Men Women Total

n % n % n %

In the past month 2 1.8 0 0.0 2 1.4

1 - <6 months ago 19 17.3 6 18.2 25 17.5

6 - <12 months ago 6 5.5 6 18.2 12 8.4

1+ years ago 83 75.5 21 63.6 104 72.7

Total 110 100.0 33 100.0 143 100.0

Among 2009 IHS participants who reported a history of selfharm,

the majority (81%) reported that they had not harmed

themselves during their current incarceration (Table 6.3.7). Of

those that reported having done so, more than half (equating

to 11% of all of those with a history of self-harm) further

reported having done so on a single occasion, with men more

likely than women to report having harmed themselves just

once during their current incarceration (12% of men with a

history of self-harm compared to 6% of women). Women with

a history of self-harm were more likely than men to report

having harmed themselves on five or more occasions during

their current incarceration (6% versus 3%).

Table 6.3.7 Number of self-harm episodes during

current incarceration (if any self-harm)

Men Women Total

n % n % n %

0 87 79.8 28 84.8 115 81.0

1 13 11.9 2 6.1 15 10.6

2 3 2.8 1 3.0 4 2.8

3 3 2.8 0 0.0 3 2.1

4 0 0.0 0 0.0 0 0.0

5+ 3 2.8 2 6.1 5 3.5

Total 109 100.0 33 100.0 142 100.0

The majority of 2009 IHS participants who reported a

history of self-harm further reported that they never

thought about self-harming for some time before they

undertook it (Table 6.3.8), with around two-thirds of both

men (66%) and women (70%) with a history of self-harm

reporting this to be the case. A higher proportion of men

than women reported that they always considered self-harm

for some time prior to undertaking it (19% versus 15%);

whereas equal proportions of men and women (around one

in seven participants who reported a history of self-harm)

reported that they sometimes thought about self-harm for

some time prior to undertaking it.

Table 6.3.8 Think about self-harm for some time prior

to its undertaking (if any self-harm)

Men Women Total

n % n % n %

Yes, always 21 19.1 5 15.2 26 18.2

Sometimes 17 15.5 5 15.2 22 15.4

Always no 72 65.5 23 69.7 95 66.4

Total 110 100.0 33 100.0 143 100.0

Consistent with the results reported above, the majority of

2009 IHS participants who reported a history of self-harm

further reported that their self-harm occurred as the result

of a sudden impulse or urge (Table 6.3.9), with women who

reported a history of self-harm more likely than men to report

this was the case (67% versus 58%). Men with a history of

self-harm were more likely than women to report that their

self-harm never occurred as a result of a sudden impulse or

urge (22% versus 12%).

6. Mental health

2009 NSW Inmate Health Survey: Key Findings Report 149

Table 6.3.9 Self-harm occurs as a result of a sudden

impulse or urge (if any self-harm)

Men Women Total

n % n % n %

Yes, always 64 58.2 22 66.7 86 60.1

Sometimes 22 20.0 7 21.2 29 20.3

Always no 24 21.8 4 12.1 28 19.6

Total 110 100.0 33 100.0 143 100.0

Among 2009 IHS participants who reported a history of selfharm,

the majority of both men (84%) and women (76%)

reported that they had not talked to anyone about their

feelings before undertaking self-harm. Despite low rates of

communicating about their feelings among both genders, the

fact that a higher proportion of women than men had talked to

another person might suggest that women may have forms of

social support more readily available to them than men. Women

were more likely than men to report talking to a family member

prior to undertaking self-harm (12% of women who reported a

history of self-harm versus 5% of men). Three percent of men

with a history of self-harm reported having talked to a custodial

staff member, whereas no women reported having done so.

Reason not talk to anyone before self-harm:

• ‘I didn’t feel that anyone would listen or care at the time.’

• ‘Because I’m not a big talker.’

• ‘Don’t know who to speak to about stuff like that.’

• ‘Impulse reaction – no time to talk first.’

• ‘Ever since I was young I never had anyone to talk to. Bottle

things up; when anyone makes me angry I explode. Take my anger

out on others.’

More than half (58%) of 2009 IHS participants who reported

a history of self-harm considered it less likely that they would

harm themselves while in prison than while in the community

(Table 6.3.10), with women substantially more likely than

men to report that they were less likely to harm themselves

in prison than in the community (73% versus 54%). A higher

proportion of men than women reported that they were more

likely to harm themselves while in prison (20% versus 15%);

that the likelihood was about the same (17% versus 12%); or

that they did not know whether they were more likely to harm

themselves while in prison (9% of men and no women).

Table 6.3.10 More likely to self-harm in prison or

community (if any self-harm)

Men Women Total

n % n % n %

More likely in prison 22 20.0 5 15.2 27 18.9

About the same 19 17.3 4 12.1 23 16.1

Less likely in prison 59 53.6 24 72.7 83 58.0

Don’t know 10 9.1 0 0.0 10 7.0

Total 110 100.0 33 100.0 143 100.0

Ninety percent of 2009 IHS participants who reported a

history of self-harm further reported that they did not think

they would harm themselves before their release from their

current incarceration, with a slightly higher proportion of

men than women reporting this to be the case (91% of men

versus 88% of women). Five men (5%) and no women (0%)

reported that they thought they would harm themselves

before their release, whereas women were more likely than

men to report that they did not know whether they would

harm themselves before release (12% versus 5%).

6.4 Beck Depression Inventory

The Beck Depression Inventory Second Edition (BDI-II, 1996) is a

21-item self-report instrument intended to assess the existence

and severity of symptoms of depression as listed in the American

Psychiatric Association’s Diagnostic and Statistical Manual of

Mental Disorders Fourth Edition (DSM-IV) (APA, 1994). All IHS

participants were administered the BDI-II.

The BDI-II scores of the majority (64%) of 2009 IHS participants

were indicative of minimal to mild depression (Table 6.4.1).

Women had notably higher rates than men of moderate to

severe depression.

Table 6.4.1 Beck Depression Inventory score

Men Women Total

n % n % n %

Minimal 267 34.0 47 25.3 314 32.3

Mild 262 33.4 45 24.2 307 31.6

Moderate 207 26.4 62 33.3 269 27.7

Severe 49 6.2 32 17.2 81 8.3

Total 785 100.0 186 100.0 971 100.0

6. Mental health

150 2009 NSW Inmate Health Survey: Key Findings Report

Table 6.4.2 depicts an increasing proportion of IHS participants

who scored in the moderate to severe range between 1996

(24%), 2001 (26%) and 2009 (36%). Of particular note is that

the proportion of women with moderate to severe depression

increased from 35% in 1996 to 38% in 2001 to 51% in 2009.

Table/Fig 6.4.2 Moderate/severe depression

0

10

20

30

40

50

60

34.5

38.3

50.5

22.3 23.1

32.6

1996 2001 2009

Men Women

PERCENT

YEAR

1996 2001 2009

n Total % n Total % n Total %

Men 130 584 22.3 162 700 23.1 256 785 32.6

Women 38 110 34.5 57 149 38.3 94 186 50.5

Total 168 694 24.2 219 849 25.8 350 971 36.0

6.5 Impulsivity

The Barratt Impulsivity Scale (Barratt & Stanford, 1995) is a widely

used measure of impulsive personality traits. An individual who

scores 70 or above on this 30-item self-report questionnaire is

considered to have impulsive tendencies. Impulsivity is associated

with a greater likelihood to offend, and thus is an important

attribute to measure (Krueger et al., 1994).

Amended ethics approval was sought mid-way into the

implementation of the 2009 Inmate Health Survey to include

the Barratt Impulsivity Scale. Following obtainment of ethics

approval from all relevant committees, 273 participants were

administered the questionnaire, the majority of whom were

men (N=257). Half (51%) of participants who completed the

impulsivity scale screened positive for impulsive behaviour, with

a higher proportion of women (56%) found to be impulsive

than men (51%) (Table 6.5.1).

Table 6.5.1 Impulsive personality (Barratt’s Impulsivity

score 70 or more)

Men Women Total

n % n % n %

Yes 130 50.6 9 56.3 139 50.9

No 127 49.4 7 43.4 134 49.1

Total 257 100.0 16 100.0 273 100.0

General comments at the end of the questionnaire:

• ‘Find interview pleasant. Pretty satisfied with what we get around

here. As long as you treat everyone with courtesy and respect,

that’s what you get.’

• ‘I get more satisfaction now because of the treatment and the life

changing steps being taken. Although my imprisonment was hard to

take, it has been the best thing for me to see what my life can be.’

• ‘It’s good, the survey you are conducting. It will benefit us

prisoners in the future. The information gathered should be

helpful. It’s reassuring.’

• ‘Just take it one day at a time and you can get through it. Don’t

push anyone’s buttons.’

• ‘Thank the department that they are doing this survey. Should be

done throughout Australia.’

6. Mental health

2009 NSW Inmate Health Survey: Key Findings Report 151

Meeting the health needs of the inmate population in NSW

constitutes a significant challenge. Prison health care is not only

provided in a complex environment but, as the 2009 Inmate

Health Survey demonstrates, prison inmates are a complex,

high-needs population. However, the correctional environment

also provides a unique opportunity to improve the health status

of a group who suffer poor health and may have minimal

contact with health services in the community. Importantly,

the 2009 Inmate Health Survey provides Justice Health, its key

stakeholders and the community with reliable evidence of the

health needs of individuals incarcerated in NSW. As such, the

key findings from the 2009 Inmate Health Survey provide all

agencies and sectors involved in the provision of services to

patients in custody with evidence to guide policy and practice.

This broad-ranging examination of prisoner health, the third in

the Inmate Health Survey (IHS) series, continues the essential

endeavour of documenting the social determinants of health,

the physical and mental health, and the risk and protective

behaviours, of NSW prison inmates. Conducted among

a stratified random sample of 996 inmates, with an overrepresentation

of women and of Aboriginal Australians, this

study included a detailed physical health assessment, together

with a self-report component covering a number of domains.

The incorporation of a number of indicators included in one or

both of the 1996 and 2001 IHSs has allowed for an examination

of trends over time in a range of aspects of prisoner health, thus

providing an appropriate evidence base from which to develop,

implement, evaluate and refine service and policy advances within

Justice Health. It is imperative that sound empirical evidence of

this nature underlies attempts to target services towards the areas

of greatest need among NSW prison inmates, and to evaluate

interventions designed to improve their health and well-being.

That prison inmates are characterised by manifold

disadvantage has clearly and repeatedly been documented,

with histories of disrupted family and social backgrounds;

abuse, neglect and trauma; poor educational attainment

and consequent limited employment opportunities;

unstable housing; parental incarceration; juvenile detention;

dysfunctional relationships and domestic violence; and

previous episodes of imprisonment, all highly prevalent

among samples of prison inmates, including that described

in the present report. With such multiple risk factors for

poor health, it is hardly surprising that prison inmates are

further characterised by physical and mental health far

below that enjoyed by the general population. The majority

of indicators described in this report were not directly

comparable with measures used in State and national Surveys

of health outcomes and behaviours. Nevertheless, placing

results, where possible, in that broader context, consistently

indicated poorer outcomes among the IHS sample than

among Australia’s general population of adults.

Key findings

A high level of disease burden was evident among 2009 IHS

participants. These findings are entirely in line with those of the

1996 and 2001 Surveys. A selection of results are summarised

below to illustrate this pattern.

Tobacco smoking: More than three quarters of 2009 IHS

participants (75% of men and 80% of women) reported

current tobacco smoking, markedly higher than the 17%

of Australia’s general adult population who reported daily

tobacco smoking in 2007 (AIHW, 2008). The prevalence

of smoking among the general population decreased

steadily from 25% in 1993 to 17% in 2007, whereas the

prevalence of smoking among IHS participants remained

stable between 1996 and 2009 (77% versus 76%).

Alcohol and other drugs: The decline in the proportion of

participants who reported ever having injected drugs, from

57% in 2001 to 43% in 2009, was striking. The reduction

was evident among both men (53% to 40%) and women

(74% to 52%). There was a major decrease in the lifetime

prevalence of heroin injection, from 47% in 2001 to 32%

in 2009, and an increase in the lifetime prevalence of

crystalline methamphetamine injection, from 4% in 2001

to 23% in 2009. Both changes reflect the dynamics of

Australia’s broader illicit drug markets.

Blood borne viruses: A substantial decrease was recorded

between 2001 and 2009 in the proportion of participants

who tested positive to hepatitis C antibodies (indicating

exposure to the virus), from 64% to 45% among

women, and 40% to 28% among men. The proportion

of participants who tested positive to hepatitis B core

antibodies (indicating exposure to the virus) also declined,

from 35% on 1996 to 29% in 2001 and again to 26% in

2009; while the rate of vaccine-conferred immunity to HBV

increased from 35% in 2001 to 38% in 2009.

Summary and Conclusions

152 2009 NSW Inmate Health Survey: Key Findings Report

Mental health: The proportion of inmates who reported

having been assessed or treated by a doctor or psychiatrist

for a mental health problem increased steadily from

39% in 1996 to 43% in 2001 to 49% in 2009. The

most common disorders for which 2009 IHS participants

reported having been assessed or treated were depressive

(35%), anxiety (25%) and drug dependence (21%)

disorders, all of which were reported by a higher

proportion of women than men.

Access to health care: Among 2009 IHS participants,

17% of men and 4% of women reported never having

accessed any form of health care in the community. As

such, the care provided to these individuals during their

incarceration(s) constitutes their first formal access to

the health system. Accordingly, access to Justice Health

clinics and programs may improve the health of inmates

in ways that reach beyond the period of imprisonment,

by presenting an opportunity for people with limited or

no access to health care in the community to become

familiar and comfortable with navigating the broader

health care system. The core business of Justice Health

is to screen, assess and refer patients (inmates), and to

commence treatment wherever possible and appropriate.

Such activity might relieve at least some pressure on the

limited resources of community health services.

The health of the 2009 IHS sample is clearly below that

enjoyed by the broader Australian community. However, it

should be noted that for many Inmates, incarceration does

provide an opportunity to address their health issues in a

relatively stable environment in which access to, and continuity

of, health care may be easier to achieve than in their personal

circumstances in the community.

Implications for policy

The 2009 Inmate Health Survey provides important information

to inform policy and practice across a range of sectors. The

demographic characteristics of the inmate population are

important for the education, housing and employment sectors.

Clearly, disadvantage in these areas is over-represented

among the inmate population. It is beyond the scope of this

report to speculate on appropriate policy responses to such

demographic findings. However, it is clear that whatever the

cause, inability to obtain stable accommodation, ongoing

employment and a minimum standard of education are linked

to incarceration. Likewise, generational incarceration and

contact with the criminal justice system early in life are both

over-represented among the IHS study population. The above

issues have been covered in more depth by other researchers;

however, this survey provides the opportunity to link these

findings with health status.

Health service delivery in custodial settings is influenced by

a range of factors, many of which are outside of the control

of the health sector. There is an acknowledged need for

custodial systems that ensure safety and security of the inmate

population. The model of health service delivery to inmates in

NSW involves two separate organisations with responsibility

for security and health care respectively. There is growing

recognition nationally and internationally that this model

provides the best outcomes for patient care. However, it also

creates added complexity. Many of the substantial health

needs identified in this report require access to patients for

health service delivery. There is variation across NSW in the

daily routines in place at correctional centres. The impact of

both the limitations on access and variations in daily routines

at correctional centres is often more limited opportunities

for health service delivery. As such, a key policy response to

this report would be for the health and social sectors to work

together with the criminal justice sector to maximise access to

patients in custody for the purpose of health service provision.

This is particularly relevant in any attempt to address the

burden of mental illness among inmates. Ongoing access to

mental health nursing and psychiatric care in the least restrictive

environment possible is critical to mental health outcomes.

2009 NSW Inmate Health Survey: Key Findings Report 153

This Survey also demonstrated high rates of smoking within

the study population, together with a high prevalence of

desire to quit smoking. Justice Health has made significant

achievements in reducing smoking rates by establishing a

totally smoke free Forensic Hospital. However, the issue of

smoking within correctional centres remains contentious.

While the management of all correctional centres in NSW

rests with CSNSW, Justice Health has developed a number

of Smoking Cessation programs, including one targeted at

Aboriginal inmates, to assist inmates to quit smoking.

Justice Health has initiated recent service delivery changes

that may begin to address the substantial burden of chronic

disease among prison inmates indicated by IHS results.

Consistent with NSW Health Statewide Directives for Area

Health Services to shift the focus from acute care to the

assessment and management of chronic disease, Justice

Health undertook a comprehensive review of its service

delivery procedures and is in the process of rolling out

three new forms of documentation for the assessment and

management of chronic disease: the Comprehensive Health

Assessment Plan (CHAP), the Annual Health Assessment

(AHA) and the Health Assessment Review Plan (HARP).

Justice Health has a key role in disseminating the findings

of the 2009 NSW Inmate Health Survey. This includes

sharing the information with key stakeholders across

government, non‑government and consumer groups

who work in the health and criminal justice systems. In

particular, provision of findings to the inmates themselves

is essential to empowering them to access health services

in the community, improve their health literacy and make

better choices to improve their health. Justice Health has a

Consumer and Community Group which assists in building

these linkages with prisoners and their advocates.

However, the burden of disease demonstrated in the 2009

IHS should be interpreted cautiously. In particular, although

a substantial majority of the health indicators among the

IHS participants were poorer than comparable indicators in

the community, all the inmates surveyed would have been

assessed and many received treatment from Justice Health

following their entry into custody. It is at the initial assessment

upon entering custody that the most acute health needs are

identified and treatment is commenced. These include acute

mental health, drug and alcohol, infectious diseases and a range

of physical health issues. The implication for the IHS findings

is that study participants may in fact have an improved health

status when compared to those who are entering custody.

Conversely, those interviewed for this study may be more

informed about their health issues as a result of assessment and

treatment provided by Justice Health and as a result more able

to report these health concerns during interview.

The focus of health service provision by Justice Health is

on screening, assessment and referral. This means that the

responsibility for providing health treatment to this patient

group does not commence and conclude with Justice

Health. Depending on the length of stay in custody, Justice

Health provides an avenue for identification of health needs,

an opportunity to commence treatment and assistance in

the establishment of linkages in the community for ongoing

care. The implication is that improvement of the outcomes

of this patient group over the longer term requires

integration, or at a minimum, the development of effective

linkages between the services provided to those in custody

and those services provided pre- and post- custody.

There are already a number of examples of these linkages

being established particularly in the areas of release planning

within mental health, drug and alcohol and population

health. Furthermore, in recent years Justice Health has

expanded court-based services in the community to divert

mentally ill into treatment prior to entering custody. As such

the framework for integration between health services in

the community and health services provided in custody has

been established. The findings of the Survey suggest a key

strategy to improve the health status of this group is to

bolster this integration.

154 2009 NSW Inmate Health Survey: Key Findings Report

Limitations

Limitations of the 2009 IHS data should be kept in mind when

considering the results of this study and their implications. In

particular, the significant change in methodology, from face-toface

interviews with inmates in the 1996 and 2001 IHSs, to the

use of a computer-assisted telephone interview (CATI) system

in 2009, may have impacted on data quality. For example,

despite assurances that CSNSW would not monitor telephone

interviews, it may be possible that participants were less

honest about their responses regarding illegal behaviours such

as using drugs in prison than they may have been in a faceto-

face interview. However, telephone interviews have been

found in health surveys to provide comparable results on data

quality when compared with in-person interviews (Aquilino,

1992; Aquilino & Wright, 1996; Biemer 2001; Cannell et al.,

1981; de Leeuw & van der Zouwen, 1988). Sykes and Collins

(1988) reported higher rates of alcohol consumption through

telephone interviewing versus face to face, attributed to

recipients feeling more comfortable disclosing this information

over the telephone than face to face. The 2000 National

Alcohol Survey (NAS) made a decision to shift the mode of

data collection from face to face to telephone and compared

results. A study was conducted on a subsample of 411

participants, assessing the differences in reports of alcohol

use and alcohol-related harm, using telephone and in-person

interviews. No differences were reported between the two

modes and their findings supported the use of telephone

interviewing in large national surveys to obtain alcohol use and

alcohol-related harms data (Midanik & Greenfield, 2003).

Further, a lower proportion of participants consented

to provide blood samples for serological screening in

2009 compared to 2001 (78% versus 94%, respectively).

Although there is no reason to suspect that participants

who did not provide a blood sample were more likely than

those who did to have been exposed to a blood borne virus

such as hepatitis C, the decrease in the rate of screening

may have affected the representativeness of the serological

findings, and should be noted.

The survey team was not able to meet the recruitment targets

in some correctional centres. However, it should be noted

that the distribution of inmates in the different correctional

centres varied over the 10 months the study was implemented

and rather than revising the recruitment targets, the original

estimates were adhered to. Regular sample checks were

completed to ensure all the age, gender and Aboriginality

strata were adequately represented. If they were not,

additional sampling in the necessary strata was undertaken.

Another possible limitation of the study was the duration of the

interview, which took an average of 73 minutes (range 21 to

198 minutes) to complete. It is possible that participants became

fatigued talking for this long on the telephone and so responded

to some of the later sections in the survey (such as the mental

health and drug and alcohol sections) less carefully. Interviewers

were able to “pause” and subsequently resume a survey if the

participant wanted a break. A further limitation is that translation

services were not available for non-English speaking inmates so

they were not able to be included in the survey.

A limited number of computer programming errors in the

CATI system resulted in not all participants being asked all the

questions relevant to them. These unfortunate instances have

been described in the report where appropriate, or excluded in

instances where the data were considered invalid as a result of

the restricted sample responses.

Future directions

Ongoing developments in and improvements to health service

delivery to individuals in custody in NSW have improved access to

treatment in many areas. The constantly evolving field of health

care and developments in health service delivery nevertheless

ensures the imperative to continue to examine the health status

of this patient population and to continue to expand and refine

the evidence base on which solid policy and practice must

ultimately be built.

Since the conduct of the 2001 IHS, two new hospitals catering

to inmates and the mentally ill have commenced operation;

two new mental health screening units have been established;

and the range and scope of health service delivery within NSW

correctional centres has significantly expanded, with increased

staff numbers employed in Justice Health in the areas of mental

health, drug and alcohol and population health. It is, of course,

impossible to attribute any changes over time in the health of the

inmate population to these service developments through the use

of a cross-sectional study design, as is employed in the serial IHSs.

Rather, the findings of the 2009 IHS provide an evidence base to

inform prioritisation and planning in health service development.

2009 NSW Inmate Health Survey: Key Findings Report 155

Findings that may be particularly informative for the health

sector include the changing nature of drug use among the

inmate population with declines in heroin use and increases in

amphetamine use. Although consistent with experience in the

community, this change needs to be reflected in the models of

care provided to those in custody. Likewise, reductions in the

proportion of participants who tested positive to hepatitis C

antibodies were substantial. Justice Health has one of the

largest hepatitis C treatment programs in Australia.

Future iterations of the IHS will strike a balance between

including questions and measures used in earlier Surveys, and

moving towards using questions directly comparable with

those of State and national surveys of health outcomes and

behaviours. Inclusion of items from epidemiological surveillance

studies of a range of populations will allow IHS results to be

interpreted within the broader public health context.

The present report will be complemented by a second report,

which examines in detail the differentials in the health and

welfare outcomes of Aboriginal and non-Aboriginal prison

inmates in NSW. This second report will provide additional

evidence to guide policies and programs designed to improve

the health of this particularly vulnerable prison sub-population.

The outcomes of the 2009 IHS will also be disseminated

through the preparation and submission of papers to peerreviewed

scientific journals, in which more detailed analyses

will examine the relationships between the various data

presented in this report, and in which hypothesis testing will be

undertaken. Subjecting these data to peer review will ensure

that their utility is maximised through the clear elucidation of

their research, policy and practice implications.

The CHRCJ Strategic Plan 2010-2015 (CHRCJ, 2009) lists

as a key direction for the Centre the evaluation of the

efficacy and cost-effectiveness of clinical interventions and

programs. The IHS will continue to monitor and document

the health of the inmate population, but future service and

program evaluations will provide additional evidence which

Justice Health will be able to utilise in the development and

refinement of frontline clinical services.

Conclusion

Almost all prison inmates are returned to the communities from

which they were incarcerated. The clear implications of this fact

are that (i) good prisoner health is good public health; (ii) good

public health will make good use of the opportunities presented

by the population held captive in prisons; and (iii) prisons can

and should contribute to the health of communities by helping

to improve the health of some of society’s most disadvantaged

and marginalised people. Consistent with this goal, public

health advocates must seek to better educate the public on the

way in which the needs of prison inmates directly impact on

their own needs; and to continue to lobby for the political will,

leadership and funding to design and manage prisons in which

the risks to health are reduced to a minimum; essential prison

duties such as the maintenance of security are undertaken in

a caring atmosphere that recognises the inherent dignity and

the human rights of every inmate; health and preventative

services are provided in a manner equivalent to that provided in

the community; and a whole-of-prison approach to promoting

health and welfare is the norm (WHO, 2007).

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164 2009 NSW Inmate Health Survey: Key Findings Report

2009 NSW

Inmate Health Survey

Justice Health

CONFIDENTIAL

CATI Interviewer to confi rm details below:

ID NUMBER:

Date of birth:

Prison: _______________________________________

Interview time: _______________________________________

Interview date:

Spoken

Introduction:

Hello, my name is

from Justice Health. I’m calling to do the interview.

Before starting, I want to remind you that

everything you tell me will be kept confi dential and

that you are not required to answer any questions

that you don’t want to.

Appendix: Questionnaire

Justice Health 2009 NSW Inmate Health Survey page 1 of 47

1. PRISON HISTORY

I am now going to ask you some questions about

your prison history.

1.1 Is this your fi rst time in prison?

1 = Yes Q1.5

0 = No ............................................................

1.2 If NO, including this sentence how many times

have you been in an adult prison? (Code 999 if

don’t know)

______________________________________

1.3 If NO, during your lifetime, what is the total amount of

time you have spent in adult prisons?

1 = less than 6 months

2 = 6 -<12 months

3 = 1-<2 years

4 = 2-<5 years

5 = 5-<10 years

6 = 10 years plus

7 = Don’t know ..............................................

1.4 If NO, how old were you when you were

fi rst imprisoned? .............................................

1.5 What is your current sentence status?

1 = Sentenced

2 = Remand

3 = Don’t know ..............................................

1.6 How long have you been in prison during this

incarceration?

1 = less than 1 month

2 = 1-<3 months

3 = 3-<6 months

4 = 6 months to <1 year

5 = 1 -<2 years

6 = 2-<5 years

7 = 5-<10 years

8 = 10 years plus

9 = Don’t know ..............................................

1.7 How many other people share your cell?

[Interviewer: if none, code as 00] ....................

2. DEMOGRAPHICS

I’m now going to ask you some questions about

where you were born and about your family.

2.1 Which country were you born in?

1 = Australia Q2.3

0 = Other (Specify) .........................................

2.2 If born overseas, how many years have

you lived in Australia? .....................................

2.3 In what country were your parents born?

(Multiple response) [Interviewer: if inmates doesn’t

know code as 999)

______________________ 1. Mother ..............

______________________ 2. Father ................

2.4 What language was spoken at the home you grew

up in?

______________________________________

2.5 Are you of Aboriginal or Torres Strait Islander origin?

1 = No Q2.8

2 = Yes, Aboriginal

3 = Yes, Torres Strait Islander

4 = Yes, Both Aboriginal & Torres Strait Islander

5 = Don’t know

6 = Refused

2.6 If YES, ABORIGINAL person, which part (Location)

of NSW or Australia do you come from (Specify)?

______________________________________

2.7 If Yes, Aboriginal person, what mob or people do

you come from?

______________________________________

2.8 In which suburb and state did you spend most

time in the 12 months before coming into prison?

[Interviewer: ask inmate to spell suburb if unclear]

______________________________________

2.9 Have you ever been married or lived with your

partner as a couple?

1 = Yes

0 = No ............................................................

Justice Health 2009 NSW Inmate Health Survey page 2 of 47

2.10 In terms of your legal marital status are you?

1 = Single (never married)

2 = Regular partner

3 = Married (includes living defacto)

4 = Separated

5 = Divorced

6 = Widowed .................................................

2.11 What type of accommodation were you living in

immediately before coming into prison?

1 = Renting

2 = Own home or with own family

3 = Unsettled lodgings (eg. squat, B&B,

hostel, caravan)

4 = Sleeping rough (no fi xed abode)

5 = Hospital

6 = Other (Specify)

______________________________________

2.12 How many changes in accommodation did you have

in the last six months before coming to prison this

time? (Note: This includes coming in and out of

prison.)

1 = None, lived in same place whole time

2 = Moved once

3 = Moved 2-3 times

4 = Moved 4-5 times

5 = Moved 6 or more times

6 = No fi xed accommodation .........................

2.13 Who were you living with before coming to prison

this time (excluding children)?

1 = Alone

2 = Partner

3 = Parent(s)

4 = Siblings

5 = Other family members

6 = Flat or house mates

7 = Friends

8 = Criminal associates

9 = Other (Specify) .........................................

2.14 Last time you were released from prison, did you

have any problems with your accommodation

within 6 months of being released?

1 = Yes

0 = No ............................................................

3. EDUCATION/OCCUPATION

I’m now going to ask you some questions about your

schooling and employment.

3.1 What is the highest educational qualifi cation you

have completed?

1 = Never attended school (Q3.8)

2 = Completed primary school only

3 = Left school with no qualifi cation

4 = School certifi cate

5 = HSC/VCE/Leaving certifi cate

6 = College certifi cate/Diploma

7 = Technical or Trade qualifi cation

8 = Degree / tertiary qualifi cation

9 = Don’t know ..............................................

3.2 At what age did you leave school?

______________________________________

3.3 Overall, how many different schools did you attend

before you eventually left school? [Interviewer: this

excludes pre-school. If Don’t know code 999]

______________________________________

3.4 Have you ever attended any special schools?

1 = Yes

0 = No Q3.6 ..................................................

3.5 If YES, how many different special schools?

(If don’t know, code 999)

______________________________________

3.6 Have you ever been expelled from a school?

1 = Yes

0 = No Q3.8...............................................

3.7 If YES, how many times were you expelled?

(If don’t know code 999)

______________________________________

3.8 Were you working in the SIX MONTHS before

coming into prison?

1 = Yes

0 = No Q3.10 ................................................

Justice Health 2009 NSW Inmate Health Survey page 3 of 47

3.9 If YES, what was your last job before coming

into prison?

1 = Labourer and related worker

2 = Tradespeople

3 = Salespeople/personal service worker

4 = Professionals

5 = Managers and administrators

6 = Plan and machine operators and drivers

7 = Clerks

8 = Self-employed

9 = Para-professionals

10 = Working for the dole

11 = Other (Specify) ..........................................

3.10 If NO, how long had you been

unemployed (months)? ...................................

3.11 Were you receiving any of the following pensions or

benefi ts in the six months before coming into prison

regardless of whether or not you were working?

(Multiple response) (1=Yes, 0=No)

1. Age pension ...............................................

2. Disability support pension ...........................

3. Widow’s pension ........................................

4. Carer’s pension ...........................................

5. Supporting parent’s benefi t ........................

6. Sickness benefi t ..........................................

7. Unemployment benefi t ...............................

8. Other (Specify) ............................................

9. No pension Q3.13 ..................................

3.12 If YES, receiving a pension or benefi t, how long had

you been on it (months) [Interviewer: if more than

one pension, record longest one]

______________________________________

3.13 What is your usual occupation or trade?

1 = Labourer and related worker

2 = Tradespeople

3 = Salespeople/personal service worker

4 = Professionals

5 = Managers and administrators

6 = Plan and machine operators and drivers

7 = Clerks

8 = Self-employed

9 = Para-professionals

10 = Working for the dole

11 = Other (Specify)

______________________________________

3.14 Do you have a job / occupation in prison?

1 = Yes

0 = No Q3.16.............................................

3.15 If YES, what is your job / occupation in prison?

______________________________________

3.16 Have you completed any education courses during

the current sentence?

1 = Yes

0 = No Q3.18.............................................

3.17 If YES, which course?

1 = AVETI

2 = TAFE

3 = Traineeship

4 = Distance education

5 = Other (Specify)

______________________________________

3.18 Before you were 16 years old, were you ever placed

in care. By this I mean did you spend any part of your

childhood living away from your natural parents.

[Interviewer: this does not include juvenile detention]

1 = Yes

0 = No Q3.28.............................................

3.19 If YES, which type of care?

(Multiple response) (1=Yes, 0=No)

1. Foster care ..................................................

2. With an extended family .............................

3. In a home ...................................................

4. Other (Specify)

______________________________________

3.20 If YES, on how many different occasions were you

placed in care? [Interviewer: this does

not include juvenile detention] ......................

3.21 If YES, thinking about the fi rst time you were placed

in care, how old were you when this happened?

[Interviewer: this does not include

juvenile detention] ..........................................

3.22 If YES, thinking about the fi rst time you were placed

in care, why did this occur? (Specify) [Interviewer: this

does not include juvenile detention]

______________________________________

3.23 If YES, thinking about the fi rst time you were placed

in care, what type of care was this?

1 = Foster family

2 = Adopted family

3 = Child welfare agency

4 = Kinship care (removal to care of relatives)

5 = Other (Specify)

______________________________________

Justice Health 2009 NSW Inmate Health Survey page 4 of 47

3.24 If YES, thinking about the fi rst time you were

placed in care, were you under any of the

following:

1 = Wardship order

2 = Care and protection order

3 = No order

4 = Don’t know

5 = Other (Specify)

______________________________________

3.25 If YES, what was the longest single period in which

you were placed in care?

[Interviewer: record in months] .........................

3.26 (Removed)

3.27 If YES, overall how long did you spend in care

before you were 16? [Interviewer: this does not

include juvenile detention]

1 = <6 months

2 = 6 months - <1 year

3 = 1- <2 years

4 = 2 - <5 years

5 = 5+ years (Entire childhood) .......................

3.28 Did you spend any time in a juvenile detention

centre?

1 = Yes

0 = No Q3.32.............................................

3.29 If YES, how old were you when you fi rst

went to a juvenile detention centre? ..................

3.30 If YES, thinking about the fi rst time you went to a

juvenile detention centre, what was the most serious

offence which caused you to be sent there? (Specify)

______________________________________

3.31 If YES, on how many separate occasions

did you spend time in a juvenile detention

centre? ................................................................

I’m now going to ask you some questions about any

children you may have.

3.32 How many children under the age of 16

do you have including foster children and stepchildren?

[If none, code as 00 Q3.35] ........................

3.33 If HAS CHILDREN, how many of these children were

dependent on you immediately

before coming into prison? .............................

3.34 If HAS CHILDREN, thinking about your children

where are they living now?

(Multiple response) [Interviewer: indicate number

of children in each category should add up to total

number of children in Q3.32]

1. Living with mother/father ...........................

2. Living with other relatives ...........................

3. Juvenile detention centre ............................

4. Foster family ...............................................

5. Adopted family ...........................................

6. On the streets .............................................

7. Child welfare institution..............................

8. Living with you in gaol (women only) .........

9. Don’t know ................................................

10. Other (Specify)

______________________________________

3.35 Thinking about before you were 16 years old, were

you raised by both of your natural parents?

(Multiple response) (1=Yes, 0=No)

1. 0 -10 years ................................................

2. 11 - 16 years .............................................

3.36 Were either of your parents ever sent to prison

when you were a child?

1 = Yes

0 = No Q3.38

3 = Don’t know Q3.38 ...............................

3.37 If YES, which one(s):

(Multiple response) (1=Yes, 0=No)

1. Mother .......................................................

2. Father .........................................................

3.38 Were either of your parents in care when they were

children?

1 = Yes

0 = No Section 4

3 = Don’t know Section 4 ..........................

3.39 If YES, which one(s):

(Multiple response) (1=Yes, 0=No)

1. Mother .......................................................

2. Father .........................................................

Justice Health 2009 NSW Inmate Health Survey page 5 of 47

4. HEALTH STATUS

I’m now going to ask you some questions about

your health.

Have you ever been told by a doctor that you have any of

the following illnesses / conditions?

(1=Yes, 0=No)

4.1 Arthritis ..........................................................

4.2 Epilepsy or Seizures ........................................

4.3 If YES, thinking about the last time this

happened, were you withdrawing from drugs or

alcohol (Specify)?

1. Drugs

2. Alcohol

3. Both

4. Neither .......................................................

4.4 If YES, which drugs were you withdrawing from?

(Specify):

___________________________________________

______________________________________

4.5 Diabetes .........................................................

4.6 If YES, do you take insulin for diabetes

1 = Yes

0 = No ............................................................

4.7 Asthma ..........................................................

4.8 Kidney problems .............................................

4.9 Back problems ................................................

4.10 Haemorrhoids (‘piles’) .....................................

4.11 Cancers / Tumours ..........................................

4.12 If YES, obtain details:

___________________________________________

______________________________________

4.13 High blood pressure / hypertension .................

4.14 Chest / Angina pain ........................................

4.15 Heart murmur ................................................

4.16 Palpitations / rapid heart beat .........................

4.17 Other heart conditions (Specify)

______________________________________

4.18 Poor eyesight ..................................................

4.19 Gall stones .....................................................

4.20 Prostate problems (MEN ONLY) .......................

4.21 Peptic ulcers ...................................................

4.22 Hepatitis

1. Hepatitis A .................................................

2. Hepatitis B ..................................................

3. Hepatitis C .................................................

4. Other hepatitis (Specify) ________________

4.23 Have you ever had an HIV test?

1 = Yes

0 = No Q4.25.............................................

4.24 If YES, where did that take place?

1 = Community only

2 = Prison only

3 = Both Prison and the Community

4 = Don’t know ..............................................

4.25 If YES, what was the result?

1 = Positive

2 = Negative

3 = Don’t know ..............................................

4.26 Are there any other medical problems that haven’t

been mentioned that you would like to tell me

about (Specify)?

1. ____________________________________

2. ____________________________________

3. ____________________________________

Justice Health 2009 NSW Inmate Health Survey page 6 of 47

5. DISABILITY / ILLNESS

I’m now going to ask you some questions about any

illnesses or disabilities that have troubled you for about

SIX MONTHS or more. [Interviewer: record in order of

severity for up to 3 conditions]

CONDITION 1

5.1 Do you now have any illness or disabilities that have

troubled you for about SIX MONTHS or more?

1 = Yes

0 = No Section 6 ........................................

5.2 If YES, what

______________________________________

5.3 How does this illness or disability limit your activities?

[Interviewer: prompt if necessary eg. unable to

exercise. If not limiting, code as 00]

___________________________________________

______________________________________

5.4 In the last TWO WEEKS, did you cut down on

any activities because of the injury or illness?

[Interviewer: if didn’t cut down code as 00]

___________________________________________

______________________________________

CONDITION 2

5.5 Is there another illness or disability you would like to

tell me about?

1 = Yes

0 = No Section 6 ........................................

5.6 If YES, what?

______________________________________

5.7 How does this illness or disability limit your activities?

[Interviewer: prompt if necessary eg. unable to

exercise. If not limiting, code as 00]

___________________________________________

______________________________________

5.8 In the last TWO WEEKS, did you cut down on

any activities because of the injury or illness?

[Interviewer: if didn’t cut down code as 00]

___________________________________________

______________________________________

CONDITION 3

5.9 Is there another illness or disability you would like to

tell me about?

1 = Yes

0 = No Section 6 ........................................

5.10 If YES, what?

______________________________________

5.11 How does this illness or disability limit your activities?

[Interviewer: prompt if necessary eg. unable to

exercise. If not limiting, code as 00]

___________________________________________

______________________________________

5.12 In the last TWO WEEKS, did you cut down on

any activities because of the injury or illness?

[Interviewer: if didn’t cut down code as 00]

___________________________________________

______________________________________

5.13 Are there any other disabilities which you have not

mentioned above (Specify)?

___________________________________________

______________________________________

Justice Health 2009 NSW Inmate Health Survey page 7 of 47

6. MEDICATIONS

I’m now going to ask you about medications you

are on.

6.1 In the last two weeks, did you take any of the

following that were prescribed for you?

TAKEN (1 = Yes, 0 = No)

1. Allergy medication ......................................

2. Skin ointments or creams (such as heat rubs,

Tiger Balm, or creams for rashes) .....................

3. Laxatives .....................................................

4. Medications for your stomach ....................

5. Blood pressure ............................................

6. Heart problems ...........................................

7. Anti-Coagulants .........................................

8. Angina Patches ...........................................

9. Asthma medication ....................................

10. Insulin for diabetes ...................................

11. Other medications for diabetes .................

12. Antibiotics ................................................

13. Vitamins / minerals ...................................

14. Anti-epileptics ..........................................

15. Methadone ..............................................

16. Cough mixtures ........................................

17. Pain-killers ................................................

18. Headache tablets ......................................

19. Sleeping tablets ........................................

20. Nicotine patches .......................................

21. Other (Specify)

______________________________________

6.2 Are there any pills or medications that you have

taken in the last TWO WEEKS that were not

prescribed for you by a doctor that you may have

gotten from another inmate or bought yourself?

TAKEN (1 = Yes, 0 = No)

1. Tranquillisers or sedatives ............................

2. Anti-depressants .........................................

3. Psychiatric medication ................................

4. Other 1. _____________________________

5. Other 2: _____________________________

7. DIABETES

I’m now going to ask you some questions about

diabetes and blood sugar.

7.1 Excluding the blood sugar test given as part of this

survey, have you had a blood sugar test in the last

12 MONTHS?

1 = Yes

0 = No Q7.3...............................................

7.2 If YES, where was this test done?

1 = In prison

2 = In the community

3 = Both prison & community

4 = Can’t remember .......................................

7.3 Excluding the test given as part of this survey, have

you ever been told by a doctor or nurse that you had

high blood sugar?

1 = Yes

0 = No Q7.5...............................................

7.4 If YES, how old were you when told that you had

high blood sugar (yy)?

______________________________________

7.5 Have you ever been told by a doctor or nurse that

you had diabetes?

1 = Yes

0 = No Section 8 ........................................

7.6 If YES, how old were you when told that you had

had diabetes (yy)?

______________________________________

7.7 Are you currently receiving any of the following

treatments for diabetes?

(Multiple response) (1=Yes, 0=No)

1. Special diet .................................................

2. Tablets ........................................................

3. Injections ....................................................

4. No treatment Section 8 ..........................

7.8 If YES, receiving treatment for diabetes, are you

satisfi ed with the treatment you receive in prison?

1 = Yes Section 8

0 = No ............................................................

7.9 If NO, why not?

______________________________________

Justice Health 2009 NSW Inmate Health Survey page 8 of 47

8. ASTHMA

I’m now going to ask you some question about

asthma. You told me earlier that you suffered from

asthma. (If Q4.7=yes)

[Interviewer: if not asthmatic Section 9]

8.1 Approximately how many times have you had

an asthma attack or diffi culty breathing

in the last 3 MONTHS? .................................

8.2 Do you have a current asthma management plan?

1 = Yes

0 = No Q8.4 ...................................…

8.3 If YES, what?

(Multiple response) (1=Yes, 0=No)

1. Exercise ......................................................

2. Reduced smoking .......................................

3. Medication .................................................

4. Breathing exercises .....................................

5. Other (Specify)

______________________________________

8.4 If taking medication for asthma, which ones?

(Specify) (Multiple response)

1. ____________________________________

2. ____________________________________

3. ____________________________________

ASTHMA MEDICATION 1

8.5 How often do you take this medication?

1 = Daily or more than daily

2 = More than weekly but not daily

3 = Less than weekly

(1-4 times per month)

4 = Less than this ...........................................

ASTHMA MEDICATION 2

8.6 How often do you take this medication?

1 = Daily or more than daily

2 = More than weekly but not daily

3 = Less than weekly

(1-4 times per month)

4 = Less than this ...........................................

ASTHMA MEDICATION 3

8.7 How often do you take this medication?

1 = Daily or more than daily

2 = More than weekly but not daily

3 = Less than weekly

(1-4 times per month)

4 = Less than this ...........................................

8.8 How often in the last 12 MONTHS have you

measured your breathing with a peak fl ow meter?

1 = Never

2 = Once only

3 = Monthly

4 = Every three months

5 = Every six months

6 = Other (Specify) .........................................

8.9 Are you satisfi ed with the treatment you receive in

prison for asthma?

1 = Yes Section 9

0 = No ............................................................

8.10 If NO, why not?

______________________________________

9. IMMUNISATION

The next few questions are about any vaccinations

you might have received.

9.1 Have you ever had a tetanus injection?

1 = Yes

0 = No Q9.3

3 = Don’t know ..............................................

9.2 If YES, can you remember when you last had this

tetanus injection (yyyy)?

______________________________________

9.3 Have you ever received an injection/vaccination

against measles?

1 = Yes

0 = No

3 = Don’t know ..............................................

9.4 Have you ever received an injection/vaccination

against Hepatitis B?

1 = Yes

0 = No Q9.6

3 = Don’t know ..............................................

9.5 If YES, did you receive the full course of 3 injections?

1 = Yes

2 = No

3 = Currently receiving course

4 = Don’t know ..............................................

Justice Health 2009 NSW Inmate Health Survey page 9 of 47

9.6 Have you ever received an injection/vaccination

against Hepatitis A?

1 = Yes

0 = No Q9.8

3 = Don’t know ..............................................

9.7 If YES, did you receive the full course of 2 injections

for Hepatitis A?

1 = Yes

2 = No

3 = Currently receiving course

4 = Don’t know ..............................................

9.8 Have you ever received an injection or vaccination

against German measles (Rubella)?

1 = Yes

0 = No

3 = Don’t know ..............................................

10. EXERCISE

I’m now going to ask you some questions about

exercise and sporting activities.

In the last FOUR WEEKS, how many times did you do any

of the following activities (code number of times and how

long spent doing activity)? (Multiple response)

[Interviewer: Vigorous walking refers to activity which

made the subject “puff and pant”. Moderate walking

refers to continuous walking for at least 10 minutes.

Average time is per occasion.]

10.1

Number

of times

10.2

Average

Time (mins)

1. Vigorous walking ............................ .............

2. Moderate walking ........................... .............

3. Running / jogging ........................... .............

4. Circuit training / aerobics / exercises .... .............

5. Exercise bike ................................... .............

6. Weight training ............................... .............

7. Football / soccer / cricket ................. .............

8. Tennis / squash ................................ .............

9. Basketball / netball .......................... .............

10. Other (Specify)

_________________________________ ______

11. None ............................................ .............

10.3 If done NO EXERCISE, why not?

______________________________________

10.4 In the 12 MONTHS before you came into prison,

would you describe yourself as:

1 = Very physically active

2 = Fairly physically active

3 = Not very physically active

4 = Not at all physically active

5 = Don’t know ..............................................

10.5 Compared with before you came into prison, would

you say that you are now:

1 = More active

2 = About as active

3 = Less active

4 = Don’t know ..............................................

10.6 Would you say that you are:

1 = Very overweight

2 = Overweight

3 = Normal weight

4 = Underweight

5 = Very underweight

6 = Don’t know ..............................................

11. SKIN PROTECTION

The next few questions are about protecting your

skin from the sun.

11.1 Do you wear a hat or cap when in the sun?

1 = Most of the time

2 = Sometimes

3 = Rarely / never............................................

11.2 Do you deliberately wear less clothing so as to get

the sun on your skin (eg: take your shirt off when

working or playing sport in the sun)?

1 = Most of the time

2 = Sometimes

3 = Rarely / never............................................

11.3 Do you wear sunglasses when in the sun?

1 = Most of the time

2 = Sometimes

3 = Rarely / never............................................

11.4 Do you use sun block to protect your skin from

the sun?

1 = Most of the time

2 = Sometimes

3 = Rarely / never............................................

Justice Health 2009 NSW Inmate Health Survey page 10 of 47

11.5 Do you have access to sun block or sun creams?

1 = Yes Q11.7

0 = No ............................................................

11.6 If NO, what problems have you had getting it?

___________________________________________

______________________________________

11.7 On average, about how many hours do you spend

outside each day?

1 = None

2 = <1 hour

3 = 1-2 hours

4 = >2 - <4 hours

5 = >4 - <6 hours

6 = >6 hours .................................................

11.8 Thinking of last summer, how often did you get

sunburnt, so your skin was still sore the next day?

1 = Not at all

2 = Once

3 = Twice

4 = 3 or 4 times

5 = 5 or more times

6 = Don’t know .............................................

11.9 In the last 12 MONTHS, how often have you,

or someone else, checked all or most of your

skin for changes that could mean skin cancer?

Don’t include checking you skin after accidentally

noticing something.

1 = Not at all

2 = Once

3 = Twice

4 = 3 or 4 times

5 = 5 or more times

6 = Don’t know .............................................

12.8 Have any of these accidents left you with a lasting

injury or disability?

1 = Yes

0 = No Q12.10

3 = Don’t know Q12.10 .............................

12.9 If YES, what?

___________________________________________

______________________________________

12.10 In the PAST 12 MONTHS have you had a physical

injury that was deliberately caused by:

(Multiple response) (1=Yes, 0=No)

1. Inmate ........................................................

2. Father .........................................................

3. Mother .......................................................

4. Police .........................................................

5. Boyfriend/girlfriend .....................................

6. Other (Specify)

______________________________________

12. INJURY

Next, a few questions about any injuries or accidents. [Interviewer: if necessary, write a text description of

the injury]

In the last THREE MONTHS did you have any accidents or injuries for which you may have seen a doctor or nurse or even

gone to hospital? [interviewer: this includes accidents received before prison. If more than four injuries, include the four

most serious]

1 = Yes

0 = No Q12.10 ..............................

12.1 INJURY:

(fracture,

burn, open

wound (cut),

dislocation.)

12.2 CAUSE:

(car, drug use,

MV passenger,

machinery ,

pedestrian)

12.3 INTENT:

(accidental,

sexual

assault, legal

intervention)

12.4 PLACE:

(prison (say

where), farm,

street, sports

area)

12.5

ACTIVITY:

(sport, work,

leisure, in cell.)

12.6 ACTION:

(doctor, hospital

nurse, treated

self.)

12.7 DATE:

(month)

In prison

Out prison

1 1 1 1 1 1 1

2 2 2 2 2 2 2

3 3 3 3 3 3 3

4 4 4 4 4 4 4

INJURY 1

INJURY 2

INJURY 3

INJURY 4

Justice Health 2009 NSW Inmate Health Survey page 11 of 48

Justice Health 2009 NSW Inmate Health Survey page 12 of 47

12.11 Have you ever had a head injury where you became

unconscious or “blacked out”?

1 = Yes

0 = No Q12.39...........................................

12.12 If YES, how many times has

this happened in your life? .............................

If YES, I want you to give me some more information

regarding the three most severe head injuries you

have suffered. (Skip based on the number reported)

HEAD INJURY 1

12.13 For how long were you unconscious (blacked out)?

1 = Only a brief moment

2 = More than 10 minutes

3 = More than 30 minutes

4 = More than 24 hours

5 = Don’t know ..............................................

12.14 If YES, when did this occur?

1 = Within the past week

2 = Between 1 week - <1 month ago

3 = Between 1 month - <6 months ago

4 = 6 months - < 2 years ago

5 = 2 years -< 5 years

6 = 5 years -< 10 years

7 = Over 10 years ago ....................................

12.15 If YES, what caused you to become unconscious?

(Specify) [Interviewer: if necessary you can prompt

the inmate eg. car crash, struck with object, hit in a

fi ght]

______________________________________

12.16 If YES, did you sustain a skull fracture?

1 = Yes

0 = No

3 = Don’t know ..............................................

12.17 If YES, did you have a bleed in your head?

1 = Yes

0 = No

3 = Don’t know ..............................................

12.18 If YES, did you have a surgical operation on your

head?

1 = Yes

0 = No ............................................................

12.19 If YES, did you experience any of the following effects?

(Multiple response) (1=Yes, 0=No)

1. Weakness in any part of your body .............

2. Poor concentration .....................................

3. Memory loss ...............................................

4. Problems fi nding the right words

when speaking .............................................

5. Problems with co-ordination or balance ......

6. Personality change ......................................

7. Anxiety or depression .................................

8. Other (Specify)

______________________________________

12.20 Which of these effects have not resolved?

(Multiple response; 1=Resolved, 2=Unresolved)

1. Weakness in any part of your body .............

2. Poor concentration .....................................

3. Memory loss ...............................................

4. Problems fi nding the right words

when speaking .............................................

5. Problems with co-ordination or balance ......

6. Personality change ......................................

7. Anxiety or depression .................................

8. Other (Specify)

______________________________________

HEAD INJURY 2

12.21 For how long were you unconscious (blacked out)?

1 = Only a brief moment

2 = More than 10 minutes

3 = More than 30 minutes

4 = More than 24 hours

5 = Don’t know ..............................................

12.22 If YES, when did this occur?

1 = Within the past week

2 = Between 1 week - <1 month ago

3 = Between 1 month - <6 months ago

4 = 6 months - < 2 years ago

5 = 2 years -< 5 years

6 = 5 years -< 10 years

7 = Over 10 years ago ....................................

Justice Health 2009 NSW Inmate Health Survey page 13 of 47

12.23 If YES, what caused you to become unconscious?

(Specify) [Interviewer: if necessary you can prompt the

inmate eg. car crash, struck with object, hit in a fi ght]

___________________________________________

______________________________________

12.24 If YES, did you sustain a skull fracture?

1 = Yes

0 = No

3 = Don’t know ..............................................

12.25 If YES, did you have a bleed in your head?

1 = Yes

0 = No

3 = Don’t know ..............................................

12.26 If YES, did you have a surgical operation on your

head?

1 = Yes

0 = No ............................................................

12.27 If YES, did you experience any of the following effects?

(Multiple response) (1=Yes, 0=No)

1. Weakness in any part of your body .............

2. Poor concentration .....................................

3. Memory loss ...............................................

4. Problems fi nding the right words

when speaking .............................................

5. Problems with co-ordination or balance ......

6. Personality change ......................................

7. Anxiety or depression .................................

8. Other (Specify)

______________________________________

12.28 Which of these effects have not resolved?

(Multiple response; 1=Resolved, 2=Unresolved)

1. Weakness in any part of your body .............

2. Poor concentration .....................................

3. Memory loss ...............................................

4. Problems fi nding the right words

when speaking .............................................

5. Problems with co-ordination or balance ......

6. Personality change ......................................

7. Anxiety or depression .................................

8. Other (Specify)

______________________________________

(If only two head injuries Q12.37)

HEAD INJURY 3

12.29 For how long were you unconscious (blacked out)?

1 = Only a brief moment

2 = More than 10 minutes

3 = More than 30 minutes

4 = More than 24 hours

5 = Don’t know ..............................................

12.30 If YES, when did this occur?

1 = Within the past week

2 = Between 1 week - <1 month ago

3 = Between 1 month - <6 months ago

4 = 6 months - < 2 years ago

5 = 2 years -< 5 years

6 = 5 years -< 10 years

7 = Over 10 years ago ....................................

12.31 If YES, what caused you to become unconscious?

(Specify) [Interviewer: if necessary you can prompt the

inmate eg. car crash, struck with object, hit in a fi ght]

______________________________________

12.32 If YES, did you sustain a skull fracture?

1 = Yes

0 = No

3 = Don’t know ..............................................

12.33 If YES, did you have a bleed in your head?

1 = Yes

0 = No

3 = Don’t know ..............................................

12.34 If YES, did you have a surgical operation on your

head?

1 = Yes

0 = No ............................................................

12.35 If YES, did you experience any of the following effects?

(Multiple response) (1=Yes, 0=No)

1. Weakness in any part of your body .............

2. Poor concentration .....................................

3. Memory loss ...............................................

4. Problems fi nding the right words

when speaking .............................................

5. Problems with co-ordination or balance ......

6. Personality change ......................................

7. Anxiety or depression .................................

8. Other (Specify)

______________________________________

Justice Health 2009 NSW Inmate Health Survey page 14 of 47

12.36 Which of these effects have not resolved?

(Multiple response 1=resolved, 2=unresolved)

1. Weakness in any part of your body .............

2. Poor concentration .....................................

3. Memory loss ...............................................

4. Problems fi nding the right words

when speaking .............................................

5. Problems with co-ordination or balance ......

6. Personality change ......................................

7. Anxiety or depression .................................

8. Other (Specify)

______________________________________

12.37 Have you ever had any tests or scans which have

confi rmed any damage to the brain as a result of

these head injuries?

1 = Yes

0 = No Q12.39...........................................

12.38 If YES, please specify which test(s) were conducted

and the results if you know them:

___________________________________________

___________________________________________

12.39 Have you ever participated in the following sports at

a competitive level?

(Multiple response) (1=Yes, 0=No)

Professional Boxing .........................................

Amateur Boxing .............................................

Wrestling ........................................................

Football ..........................................................

13. DIET & NUTRITION

Next, a few questions about the food you eat.

13.1 Do you usually have sweetener in your tea or coffee?

1 = Yes

0 = No

3 = Don’t drink tea or coffee ..........................

13.2 How do you usually spread the butter or margarine

on your bread?

1 = Thickly

2 = Medium

3 = Thinly

4 = Don’t use butter or margarine

5 = Don’t know ..............................................

13.3 Do you usually add salt to your food without tasting

it fi rst?

1 = Yes

0 = No ............................................................

13.4 How often do you eat fruit?

1 = More than once a day

2 = Once a day

3 = 3 - 6 days a week

4 = 1 - 2 days a week

5 = At least once a month

6 = Less than once a month

7 = Rarely/never..............................................

13.5 How often do you eat vegetables or salad?

1 = More than once a day

2 = Once a day

3 = 3 - 6 days a week

4 = 1 - 2 days a week

5 = At least once a month

6 = Less than once a month

7 = Rarely/never..............................................

13.6 How often do you eat fries/hot chips?

1 = More than once a day

2 = Once a day

3 = 3 - 6 days a week

4 = 1 - 2 days a week

5 = At least once a month

6 = Less than once a month

7 = Rarely/never..............................................

13.7 How often do you eat bread or rolls?

1 = More than once a day

2 = Once a day

3 = 3 - 6 days a week

4 = 1 - 2 days a week

5 = At least once a month

6 = Less than once a month

7 = Rarely/never..............................................

Justice Health 2009 NSW Inmate Health Survey page 15 of 47

13.8 How often do you eat biscuits or cakes?

1 = More than once a day

2 = Once a day

3 = 3 - 6 days a week

4 = 1 - 2 days a week

5 = At least once a month

6 = Less than once a month

7 = Rarely/never..............................................

13.9 How often do you eat sweets/lollies?

1 = More than once a day

2 = Once a day

3 = 3 - 6 days a week

4 = 1 - 2 days a week

5 = At least once a month

6 = Less than once a month

7 = Rarely/never..............................................

13.10 Name the three most common food items you

purchase from the buy-up list?

(Multiple response)

1. _________________________________________

2 . _________________________________________

3. _________________________________________

13.11 Are you happy with the food you receive in prison?

1 = Yes

0 = No

3 = Don’t know ..............................................

13.12 Please explain:

___________________________________________

______________________________________

13.13 Do you think that there are too many or too few

healthy foods available on the buy-up list? By

healthy I mean food that is low in fat, salt, and

sugar and high in fi bre.

1 = Too many

2 = Too few

3 = Don’t know ..............................................

13.14 Do you think that prison food is:

1 = Too healthy

2 = About right

3 = Too unhealthy ..........................................

14. SF-12

These questions are about how you see your own

health, how you feel and how well you are able to do

your usual activities. If you are unsure about how to

answer a question, give the best answer you can.

14.1 In general, would you say your health is:

1 = Excellent

2 = Very good

3 = Good

4 = Fair

5 = Poor .........................................................

The following items are about activities you might do

during a typical day. Does your health now limit you in

these activities? If so, how much?

14.2 First, moderate activities, such as moving a table,

pushing a trolley. Does your health now limit you a

lot, limit you a little or not limit you at all?

1 = Yes, limited a lot

2 = Yes, limited a little

3 = No, not limited at all .................................

14.3 Climbing several fl ights of stairs. Does your health

now limit you a lot, limit you a little or not limit you

at all?

1 = Yes, limited a lot

2 = Yes, limited a little

3 = No, not limited at all .................................

14.4 During the PAST 4 WEEKS, have you accomplished

less than you would like as a result of your physical

health?

1 = Yes

0 = No ............................................................

14.5 During the PAST 4 WEEKS, were you limited in the

kind of work or other regular activities you do as a

result of your physical health?

1 = Yes

0 = No ............................................................

14.6 During the PAST 4 WEEKS, have you accomplished

less than you would like to as a result of any emotional

problems, such as feeling depressed or anxious?

1 = Yes

0 = No ............................................................

14.7 During the PAST 4 WEEKS, did you not do work

or other regular activities as carefully as usual as a

result of any emotional problems, such as feeling

depressed or anxious?

1 = Yes

0 = No ............................................................

Justice Health 2009 NSW Inmate Health Survey page 16 of 47

14.8 During the PAST 4 WEEKS, how much did pain

interfere with your normal work?

1 = Not at all

2 = A little bit

3 = Moderately

4 = Quite a bit

5 = Extremely .................................................

These questions are about how you feel and how

things have been with you during the PAST 4

WEEKS. For each question, please give the one

answer that comes closest to the way you have

been feeling.

14.9 How much during the PAST 4 WEEKS have you felt

calm and peaceful?

1 = All of the time

2 = Most of the time

3 = A good bit of the time

4 = Some of the time

5 = A little of the time

6 = None of the time ......................................

14.10 How much during the PAST 4 WEEKS did you have

a lot of energy?

1 = All of the time

2 = Most of the time

3 = A good bit of the time

4 = Some of the time

5 = A little of the time

6 = None of the time ......................................

14.11 How much during the PAST 4 WEEKS have you

felt down?

1 = All of the time

2 = Most of the time

3 = A good bit of the time

4 = Some of the time

5 = A little of the time

6 = None of the time ......................................

14.12 During the PAST 4 WEEKS, how much of the time

has your physical health or emotional problems

interfered with your social activities?

1 = All of the time

2 = Most of the time

3 = Some of the time

4 = A little of the time

5 = None of the time ......................................

15. MENS’ HEALTH

MALES ONLY

I’m now going to ask you a few questions about

any times that you may have examined yourself for

abnormalities.

15.1 Have you EVER examined your testicles (“balls”) for

abnormal lumps?

1 = Yes

0 = No ............................................................

15.2 If YES, how often do you examine them?

1 = Once only

2 = Weekly

3 = Monthly

4 = Less than this ...........................................

15.3 Do you know how to properly examine your

testicles for lumps?

1 = Yes

0 = No ............................................................

15.4 Would you like more information on this subject?

1 = Yes

0 = No ............................................................

16. WOMEN’S HEALTH

FEMALES ONLY

I’m now going to ask you some questions specifi cally

about women’s health.

16.1 Have you ever examined your breasts for lumps or

abnormalities?

1 = Yes

0 = No Q16.3

3 = Don’t know Q16.3 ...............................

16.2 If YES, how often do you examine them?

1 = Once only

2 = About once a year

3 = About twice a year

4 = Monthly

5 = Other (Specify)

______________________________________

16.3 Do you know how to properly examine your breasts

for lumps?

1 = Yes

0 = No ............................................................

Justice Health 2009 NSW Inmate Health Survey page 17 of 47

16.4 Would you like further information about how to

examine your breasts for lumps?

1 = Yes

0 = No ............................................................

16.5 Have you ever had a PAP smear?

1 = Yes

0 = No Q16.9

3 = Don’t know Q16.9 ...............................

16.6 If YES, was this

1 = In the last six months

2 = 6 months - <12 months

3 = 1 year - <2 years

4 = 2 years - <4 years

5 = 4 years - <6 years

6 = 6 years or more

7 = Can’t remember .......................................

16.7 Do you know what the result was?

1 = Normal

2 = Abnormal

3 = Don’t know ..............................................

16.8 How often do you have PAP smears?

1 = Once only

2 = Yearly

3 = Twice a year

4 = Once every two years

5 = Other (Specify)

______________________________________

16.9 Are you currently pregnant?

1 = Yes

0 = No

3 = Don’t know ..............................................

16.10 How many times have you been pregnant?

[Interviewer: if none, code as 00 Q16.21]

______________________________________

16.11 If YES, previous pregnancies, what is the date you last

found out that you were pregnant (MM.YYYY)

______________________________________

16.12 How many miscarriages have you had? [Interviewer:

if none, code as 00 Q16.15]

______________________________________

16.13 If YES, thinking about the fi rst time you had a

miscarriage, how old were you?

______________________________________

16.14 If YES, thinking about the last time you had a

miscarriage, how old were you? [Interviewer: if

only one miscarriage ignore this question]

......................................................................

16.15 How many abortions/terminations have you had?

[Interviewer: if none code as 00 and Q16.18]

......................................................................

16.16 If YES, thinking about the FIRST time you had an

abortion/termination, how old were you when this

happened?

......................................................................

16.17 If YES, thinking about the LAST time you had an

abortion/termination, how old were you when this

happened? [Interviewer: if only one Abortion skip

this question]

......................................................................

16.18 How many children have you given birth to (include

still-born)? [Interviewer: if no children code as 00

and Q16.21]

......................................................................

16.19 If YES HAD CHILDREN, how old were you when

your fi rst child was born?

......................................................................

16.20 If YES HAD CHILDREN, thinking about the LAST

time you had a child, how old were you when this

happened? [Interviewer: if only one child skip this

question]

......................................................................

16.21 In the last FOUR WEEKS, have you made yourself sick

or vomited to control your body shape or weight or to

counteract the effects of eating?

1 = Yes

0 = No Q16.23...........................................

16.22 If YES, on how many days in the last four weeks

have you done this?

......................................................................

16.23 In the last FOUR WEEKS, have you taken pills to

control your body shape or weight or to counteract

the effects of eating?

1 = Yes

0 = No Q16.26...........................................

16.24 If YES, on how many days in the last four weeks

have you done this?

......................................................................

Justice Health 2009 NSW Inmate Health Survey page 18 of 47

16.25 What pills did you take?

______________________________________

16.26 Are you happy with your weight?

1 = Yes Q16.28

0 = No

3 = Don’t know Q16.28 .............................

16.27 If NO, by how much do you want your weight

to change?

1 = A bit thinner/fatter

2 = Slightly thinner/fatter

3 = Much thinner/fatter ..................................

16.28 In the 12 MONTHS before you came into prison,

did a partner or spouse or someone close to you:

(Multiple response) (1=Yes, 0=No)

1. Physically hurt you (eg: hit, slap or

kick you) ......................................................

2. Forced you to take part in unwanted

sexual activities .............................................

3. Tried to limit your contact with family

or friends .....................................................

4. Verbally abused you (called you names

to put you down or make you feel bad) ........

5. Stopped you knowing about or having

access to money ...........................................

17. ABORIGINAL HEALTH

ABORIGINAL INMATES ONLY

I’m now going to ask you some questions related to

your Aboriginal origin. Some of these questions may

upset you. You do not have to answer if you don’t

want to.

17.1 Were you removed from your parents as a child?

1 = Yes

0 = No Inmate Access survey

3 = Don’t knowInmate Access survey ............

17.2 If YES, at what age were you removed?

......................................................................

17.3 If YES, for how long were you removed? (years)

......................................................................

17.4 If YES, in whose care were you placed?

(Multiple response) (1=Yes, 0=No)

1. Institution (Specify)

______________________________________

2. Other family - Aboriginal ............................

3. Other family - non-Aboriginal .....................

17.5 Were you eventually returned to your family?

1 = Yes

0 = No ............................................................

17.6 Were your parents forcibly removed from their

family as children?

1 = Yes

0 = No Q17.8.............................................

17.7 If YES, which parent(s)?

1 = Yes - mother

2 = Yes - father

3 = Yes - both

4 = Don’t know ..............................................

17.8 Have you used any of the following services for

Aboriginal people since coming into gaol?

(Multiple response) (1=Yes, 0=No)

1. DoCS Aboriginal welfare worker .................

2. DoCS Aboriginal Drug & Alcohol worker ....

3. DoCS Aboriginal psychologist .....................

4. Medical offi cer from Aboriginal medical

Service (AMS) ...............................................

5. Aboriginal health worker from an AMS ........

6. Justice Health Aboriginal health worker ......

7. Other Aboriginal worker (Specify)

______________________________________

17.9 If YES for each service used, were you satisfi ed with

the service you received? (Multiple response)

1 = Yes

0 = No

3 = Don’t know ..............................................

17.10 Please explain why you were or were not satisfi ed

with the service you received.

___________________________________________

______________________________________

Justice Health 2009 NSW Inmate Health Survey page 19 of 47

17.11 Have you participated in any of the Justice Health

Aboriginal health promotion programs, such as the

Vascular Health, Men’s Health, Disease Prevention or

Oral Health programs?

1 = Yes

0 = No Q17.17

3 = Don’t Know Q17.17 ............................

17.12 If YES, which program did you participate in?

(Multiple response item) (1=Yes, 0=No)

1 = Vascular Health ........................................

2 = Men’s Health ............................................

3 = Disease Prevention....................................

4 = Oral Health ...............................................

5 = Other, specify

______________________________________

17.13 If yes for each program specifi ed, did you learn

something from the program? (Multiple response

item)

(1=Yes, 0=No, 3=Don’t know)

1. Vascular Health ...........................................

2. Men’s Health ..............................................

3. Disease Prevention ......................................

4. Oral Health .................................................

5. Other program, specify

______________________________________

17.14 If yes for each program specifi ed, did you change

your behaviour because of what you learned at the

program? (Multiple response item)

(1=Yes, 0=No, 3=Don’t know)

1. Vascular Health ...........................................

2. Men’s Health ..............................................

3. Disease Prevention ......................................

4. Oral Health .................................................

5. Other program, specify

______________________________________

17.15 If yes for each program specifi ed, were you satisfi ed

with the program? (Multiple response item)

(1=Yes, 0=No, 3=Don’t know)

1. Vascular Health ...........................................

2. Men’s Health ..............................................

3. Disease Prevention ......................................

4. Oral Health .................................................

5. Other program, specify

______________________________________

17.16 Do you have any suggestions for how the programs

could be improved?

___________________________________________

___________________________________________

___________________________________________

Justice Health 2009 NSW Inmate Health Survey page 20 of 47

Inmate Access Survey

1. ABORIGINAL HEALTH SERVICES

1.1 If you are of Aboriginal origin, have you ever accessed

Aboriginal Health Services in the Community?

1 = Yes

0 = No Section 2 ........................................

1.2 If YES, how would you compare Aboriginal Health

Services provided in this prison to those provided in

the community?

1 = Excellent

2 = Good

3 = Average

4 = Poor

5 = Very poor .................................................

1.3 Would you like to provide more detail?

___________________________________________

___________________________________________

___________________________________________

Now I’d like to ask you about your experience of

receiving healthcare in prison and the community.

2. HEALTH CARE SERVICES

2.1 Before coming into prison this time have you ever

gone to any of the following types of health care

services?

(Multiple response) (1=Yes, 0=No)

1. Hospital ......................................................

2. Community health centre ...........................

3. General practitioner ....................................

4. Medical centre ............................................

5. Home nursing – community nurse ..............

6. Other, specify

___________________________________________

7. None Section 3 ......................................

2.2 If YES, how does the clinic services at your current

prison compare to the service you received before

you came into prison?

1 = Excellent

2 = Good

3 = Average

4 = Poor

5 = Very poor

6 = Don’t know ..............................................

3. CLINIC SERVICES INFORMATION

3.1 On reception to this prison, were you given

information about the clinic services?

1 = Yes

0 = No Q3.4

3 = Don’t know Q3.4 .................................

3.2 If YES, how would you rate the information that was

given to you at reception by the healthcare staff?

1 = Excellent

2 = Good

3 = Average

4 = Poor

5 = Very poor .................................................

3.3 Would you like to provide more detail?

___________________________________________

___________________________________________

___________________________________________

3.4 How did you fi nd out about the services that this

prison clinic provides?

(Multiple response) (1=Yes, 0=No)

1. Inmate Development Committee ................

2. Other inmates ............................................

3. Offi cers ......................................................

4. Signs ..........................................................

5. Health staff ................................................

6. Family/visitors .............................................

7. Offi cial visitor .............................................

8. Hep C Review .............................................

9. Community Restorative Centre ...................

10. Framed (Prisoner magazine) ......................

11. Other, specify

___________________________________________

4. CLINIC STAFF

4.1 Have you ever visited a prison clinic?

1 = Yes

0 = No Q4.19.............................................

4.2 The last time you wanted to go to the clinic how

long was your name on the prison clinic list before

you were seen by the healthcare staff?

Days ...............................................................

Justice Health 2009 NSW Inmate Health Survey page 21 of 47

4.3 Who is the most helpful when you want to go to

the clinic?

1 = Healthcare staff

2 = Dept of Corrective Services Offi cers

3 = Welfare

4 = Probation and parole

5 = Other inmates

6 = Inmate Development Committee staff

7 = Psychology

8 = Alcohol and other Drug offi cer

9 = Other, specify

___________________________________________

10 = Don’t know

4.4 Who is the least helpful when you want to go to

the clinic?

1 = Healthcare staff

2 = Dept of Corrective Services Offi cers

3 = Welfare

4 = Probation and parole

5 = Other inmates

6 = Inmate Development Committee staff

7 = Psychology

8 = Alcohol and other Drug offi cer

9 = Other, specify

___________________________________________

10 = Don’t know

4.5 Would you like to provide more detail?

___________________________________________

___________________________________________

___________________________________________

4.6 When you came to this prison clinic who did you

want to see?

1 = Doctor

2 = Dentist

3 = Psychiatrist

4 = Nurse

5 = Other, specify

______________________________________

6 = Don’t know

4.7 When you came to this prison clinic who did you

actually see?

1 = Doctor

2 = Dentist

3 = Psychiatrist

4 = Nurse

5 = Other, specify

______________________________________

4.8 How would you rate your level of satisfaction with

the person you saw?

1 = Excellent

2 = Good

3 = Average

4 = Poor

5 = Very poor

4.9 When you saw the staff at the prison clinic did you

feel comfortable talking to them about your health?

1 = Yes

0 = No ............................................................

4.10 Would you like to provide more detail?

___________________________________________

___________________________________________

___________________________________________

4.11 How do you think we can improve the healthcare at

this prison clinic?

___________________________________________

___________________________________________

___________________________________________

4.12 On your last visit to this prison clinic, did you want

to be involved in your treatment decisions?

1 = Yes

0 = No

3 = Don’t know ..............................................

4.13 Were you given the opportunity to do so?

1 = Yes

0 = No ............................................................

4.14 On your last visit to this prison clinic, were you

provided with information about your treatment?

1 = Yes

0 = No ............................................................

4.15 How would you rate the information that was

provided to you?

1 = Excellent

2 = Good

3 = Average

4 = Poor

5 = Very poor

Justice Health 2009 NSW Inmate Health Survey page 22 of 47

4.16 How would you rate the range of healthcare

services provided by this prison clinic?

1 = Excellent

2 = Good

3 = Average

4 = Poor

5 = Very poor

6 = Don’t know

4.17 Do the hours that this prison clinic is open meet

your needs?

1 = Yes Q4.19

0 = No ............................................................

4.18 If NO, can you suggest better hours?

___________________________________________

___________________________________________

4.19 Whilst you have been in prison this time have you

booked into a medical appointment outside the

prison?

1 = Yes

0 = No Section 5 ........................................

4.20 Did you actually attend this appointment?

1 = Yes

0 = No ............................................................

4.21 Whilst you have been in prison this time has a

medical appointment that was made for a service

outside of prison ever been cancelled?

1 = Yes

0 = No Section 5 ........................................

4.22 Did you cancel the appointment?

1 = Yes

0 = No Section 5 ........................................

The next questions are about possible factors that

infl uenced your decision to cancel the appointment.

4.23 You felt that you would lose your prison job.

1 = No infl uence

2 = Minimal infl uence

3 = Moderate infl uence

4 = Major infl uence

4.24 You felt you could lose your cell placement and

your friends.

1 = No infl uence

2 = Minimal infl uence

3 = Moderate infl uence

4 = Major infl uence

4.25 You were concerned about being moved to a

Maximum Security Prison.

1 = No infl uence

2 = Minimal infl uence

3 = Moderate infl uence

4 = Major infl uence

4.26 Would you have gone to Long Bay if there was a

Minimum Security Facility available there?

1 = Yes

0 = No ............................................................

4.27 You were concerned about not being able to receive

visits from family and friends.

1 = No infl uence

2 = Minimal infl uence

3 = Moderate infl uence

4 = Major infl uence

4.28 Your medical condition had improved and you felt

you no longer needed the appointment.

1 = No infl uence

2 = Minimal infl uence

3 = Moderate infl uence

4 = Major infl uence

4.29 You had been waiting a long time for your

appointment.

1 = No infl uence

2 = Minimal infl uence

3 = Moderate infl uence

4 = Major infl uence

4.30 You were concerned about travelling in a prison

transport vehicle.

1 = No infl uence

2 = Minimal infl uence

3 = Moderate infl uence

4 = Major infl uence

4.31 Other factors, please specify

___________________________________________

___________________________________________

___________________________________________

4.32 Do you have any suggestions on how Justice Health

can make it easier for you to keep your medical

appointments in the future?

___________________________________________

___________________________________________

___________________________________________

Justice Health 2009 NSW Inmate Health Survey page 23 of 47

5. BBV TESTING

5.1 Excluding this survey, have you ever been tested

for HIV, hepatitis, or a sexually-transmitted disease

while you were in prison?

1 = Yes

0 = No Section 6 ........................................

5.2 If YES, did you receive any counselling or

information from the nurse or doctor about the test

before it was carried out?

1 = Yes, always

2 = Yes, sometimes

3 = No Q5.4...............................................

5.3 If YES received counselling or information, was it

helpful to you?

1 = Yes

0 = No

3 = Don’t know ..............................................

5.4 If YES, did you receive the results from this test?

1 = Yes, always

2 = Yes, sometimes

3 = NoSection 6 .........................................

5.5 If YES, did you receive information or counselling

from the nurse or doctor about the test when the

results were given back to you?

1 = Yes, always

2 = Yes, sometimes

3 = NoSection 6 .........................................

5.6 If YES received counselling or information, was it

helpful to you?

1 = Yes

0 = No

3 = Don’t know ..............................................

6. AWARENESS

6.1 Who do you think can read your health record?

(Multiple response) (1=Yes, 0=No)

1. Doctor ........................................................

2. Nurse .........................................................

3. Clinic offi cer ...............................................

4. Case worker ...............................................

5. Psychologist ................................................

6. AOD worker ...............................................

7. Welfare offi cer ............................................

8. Probation and parole ..................................

9. Governor ....................................................

10. Lawyer/solicitor .........................................

11. Offi cial visitor ...........................................

12. Other, specify

______________________________________

6.2 Who do you think employs the health staff that

work at this prison clinic.

1 = NSW Health Department

2 = Department of Corrective Services(DCS)

3 = Both NSW Health and DCS

4 = Private owners of the Centre (Junee)

5 = Don’t know

6 = Other, specify

______________________________________

7. HOSPITAL INPATIENT VISITS

7.1 During the last twelve months, have you been

admitted to a general hospital or psychiatric hospital

as an inpatient and stayed overnight or longer?

1 = Yes

0 = No Section 8 ........................................

7.2 If YES, how many times in the last twelve months

were you admitted to a general hospital or

psychiatric hospital as an inpatient and

stayed overnight or longer? ............................

7.3 How many of these admissions happened

while you were in prison? ...............................

Justice Health 2009 NSW Inmate Health Survey page 24 of 47

7.4 Thinking about your most recent admission to

hospital, how would you rate the healthcare you

received?

1 = Excellent

2 = Fairly good

3 = OK

4 = Not too good

5 = Not good at all .........................................

8. OUTPATIENT VISITS

8.1 During the last twelve months, have you visited

the outpatient clinic at a hospital about your own

health but did not stay overnight?

1 = Yes

0 = No Section 9 ........................................

8.2 If YES, how many times in the last twelve months

did you visit the outpatients clinic at a

hospital about your own health but did

not stay overnight? ....................................

8.3 How many of these outpatient visits happened

while you were in prison? ...................................

8.4 Thinking about your last visit to the outpatients,

how would you rate the healthcare you received?

1 = Excellent

2 = Fairly good

3 = OK

4 = Not too good

5 = Not good at all .........................................

9. EMERGENCY DEPARTMENT VISITS

9.1 During the last twelve months, have you attended

an emergency department about your own health?

1 = Yes

0 = No Section 10 ......................................

9.2 If YES, how many times in the last twelve months did

you visit the emergency department about

your own health? .............................................

9.3 How many of these emergency department

visits happened while you were in prison? ..........

9.4 Thinking about your last visit to the emergency

department, how would you rate the healthcare

you received?

1 = Excellent

2 = Fairly good

3 = OK

4 = Not too good

5 = Not good at all .........................................

10. USE OF PRISON CLINIC

10.1 Do you visit the clinic regularly to pick up pills

or medicines for repeat prescriptions such as

methadone or insulin?

1 = Yes

0 = No Q10.3.............................................

10.2 If YES, what do you attend for? (eg. Methadone)

___________________________________________

___________________________________________

10.3 Excluding visits to the clinic for repeat prescriptions,

how many times have you visited the clinic to see the

nurse about your health in the last four weeks?

# times ...........................................................

10.4 Thinking about your most recent visit to the clinic,

how would you rate the healthcare you received?

1 = Excellent

2 = Fairly good

3 = OK

4 = Not too good

5 = Not good at all .........................................

10.5 When was the last time you saw a doctor about

your own health?

1 = In the last week

2 = >1 week and < =1 month

3 = >1 month and <=6 months

4 = >6 months and <=1 year

5 = >1 year and <=5 years

6 = >5 years

7 = Never seen a doctor Section 11

8 = Can’t remember .......................................

10.6 Thinking about this last visit, was this with a

prison doctor?

1 = Yes

0 = No ............................................................

10.7 Thinking about this visit to the doctor, how would

you rate the healthcare you received?

1 = Excellent

2 = Fairly good

3 = OK

4 = Not too good

5 = Not good at all .........................................

Justice Health 2009 NSW Inmate Health Survey page 25 of 47

11. OTHER HEALTH SERVICES

11.1 Have you seen any of these other health professionals

about your own health in the last four weeks?

(Multiple response) (1=Yes, 0=No)

1. Optician/optometrist ...................................

2. Physiotherapist ...........................................

3. Psychologist ................................................

4. Psychiatrist .................................................

5. Social worker/welfare offi cer.......................

6. Podiatrist/chiropodist ..................................

7. Public health nurse .....................................

8. Mental health nurse ...................................

9. Drug and alcohol counsellor .......................

10. Dental nurse .............................................

11. Dentist .....................................................

12. Other health professional, specify

______________________________________

13. None of these Section 12 .....................

11.2 (For each health professional seen in 11.1), Thinking

about your last visit to (Specify), how would you rate

the healthcare you received? (Multiple response)

1 = Excellent ...................................................

2 = Fairly good ...............................................

3 = OK ...........................................................

4 = Not too good ...........................................

5 = Not good at all .........................................

12. HEALTH SERVICE APPRAISAL

The next questions are about your experience

receiving healthcare in prison.

12.1 I am satisfi ed with the healthcare I receive in prison.

1 = Agree

0 = Not sure

3 = Disagree ...................................................

12.2 If I have a health problem, I can easily see a health

professional in prison.

1 = Agree

0 = Not sure

3 = Disagree ...................................................

12.3 Those who provide my healthcare in prison treat me

in a friendly and courteous manner.

1 = Agree

0 = Not sure

3 = Disagree ...................................................

12.4 Those who provide my healthcare in prison are

competent and well-trained.

1 = Agree

0 = Not sure

3 = Disagree ..................................................

12.5 What things do you think could improve healthcare

in prisons?

(Multiple response) (1=Yes, 0=No)

1. Longer hours at the clinic ...........................

2. More access to the doctor ..........................

3. Shorter waiting times to see specialists ...........

4. Shorter waiting time for hospital ................

5. Shorter waiting time to see the dentist ...........

6. Choice of doctors .......................................

7. Less travelling time to see specialists ...........

8. Improved attitude of nurses ........................

9. Improved attitude of doctors ......................

10. Improved attitude of dentists ....................

11. Access to local specialists ..........................

12. More Aboriginal health workers................

13. Other, specify

______________________________________

12.6 Would you say you used the following services:

1=More in prison than in the community

2=About the same in prison as in the community

3=Less in prison than in the community

(Multiple response)

1. Seeing a doctor ..........................................

2. Seeing a specialist doctor ............................

3. Seeing a nurse ............................................

4. Seeing a dentist ..........................................

5. Seeing a psychiatrist ...................................

6. Seeing a drug and alcohol counsellor ..........

7. Seeing a psychologist .................................

8. Seeing an optometrist ................................

9. Seeing an Aboriginal Health worker ............

Justice Health 2009 NSW Inmate Health Survey page 26 of 47

12.7 How would you compare the health services you

receive in prison with health services outside prison?

1 = Better in prison

2 = About the same

3 = Worse in prison

4 = Don’t know

12.8 Any other comments you would like to make?

___________________________________________

___________________________________________

___________________________________________

Justice Health 2009 NSW Inmate Health Survey page 27 of 47

Mental Health Survey

1. PSYCHIATRIC HISTORY

I’m now going to ask you some questions about your

mental health status.

1.1 Have you ever received treatment or assessment

by a psychiatrist or doctor, for an emotional or

mental problem?

1 = Yes

0 = No Q1.15.............................................

1.2

1.2a If YES, have you ever been told by a psychiatrist or

doctor that you have any of the following?

(Multiple response) (1=Yes, 0=No)

1. Depression .................................................

2. Schizophrenia .............................................

3. Manic depressive psychosis .........................

4. Anxiety .......................................................

5. Personality disorder ....................................

6. Alcohol dependence ...................................

7. Drug dependence .......................................

8. ADD/ADHD ................................................

9. Other mental illness (Specify)

______________________________________

1.2b If YES, for each condition specifi ed, how old were

you the fi rst time you were told by a psychiatrist or

doctor that you had this mental problem?

(Multiple response)

1.3 If YES, prior to incarceration, when did you

last see the psychiatrist?

1 = Less than 1 week

2 = Between 1 and 4 weeks prior

3 = Between 1 and 3 months prior

4 = Between 4 and 12 months prior

5 = More than a year prior

6 = Don’t know

7 = Never seen a psychiatrist

1.4 If YES, in the 3 months prior to incarceration, how

often did you have contact with a mental health

service?

1 = Not at all

2 = Once only

3 = Two-three times

4 = Four or more times

5 = Don’t know ..............................................

1.5 If YES, have you ever been admitted to a psychiatric

unit or ward in a hospital?

1 = Yes

0 = NoQ1.12...............................................

1.6 If YES, HOW MANY admissions have you had to a

psychiatric unit or psychiatric ward?

1 = Once only

2 = Between 2 and 5

3 = Over 5 ......................................................

1.7 If YES, WHERE was this:

1 = In the community

2 = In prison

3 = Both community and prison .....................

1.8 If YES, thinking about the LONGEST admission,

how long did you spend in the psychiatric unit or

psychiatric ward?

1 = Less than I week

2 = Between 1 and <=2 weeks

3 = Between 2 and <=4 weeks

4 = Between 4 and <=8 weeks

5 = More than 8 weeks ..................................

1.9 If YES, thinking about the MOST RECENT visit to a

psychiatric unit or psychiatric ward, how long ago

was it since you were discharged?

1 = In the last 2 weeks

2 = 2 -< 4 weeks

3 = 4 - < 12 weeks

4 = 3 -< 6 months

5 = 6 months -< 1 year

6 = 1 -< 2 years

7 = Over 2 years .............................................

1.10 If YES, for this MOST RECENT visit, about how long

did you spend in the hospital / unit?

1 = Less than 1 week

2 = 1-< 2 weeks

3 = 2 -< 4 weeks

4 = 4 -< 8 weeks

5 = Over 8 weeks ...........................................

1.11 If YES, for this most recent admission, how were

you REFERRED to the hospital / unit?

1 = Family or friends

2 = Doctor

3 = Police

4 = Self-referral

5 = Other (Specify)

______________________________________

Justice Health 2009 NSW Inmate Health Survey page 28 of 47

1.12 Are you currently taking any psychiatric medication?

1 = Yes

0 = NoQ1.15...............................................

1.13 If YES, what type of medication?

1. Major Tranquillisers - Tablets .......................

2. Major Tranquillisers - Injections ...................

3. Lithium .......................................................

4. Anti-Depressants ........................................

5. Minor Tranquillisers (eg benzo’s) .................

6. Psychostimulants (eg. Ritalin) ......................

7. Anti-psychotics… .......................................

8. Other (Specify)

______________________________________

1.14 If YES, in the six months prior to incarceration,

were you taking your psychiatric medications as

prescribed (ie, daily or regular pills/injections)?

1 = Yes, always

2 = No, it varied

3 = No, I stopped taking them.

4 = No, I was not on prescribed

medication

5 = Never prescribed

1.15 Have you ever been seen by a mental health nurse

in the courts?

1 = Yes

0 = No Q1.19

3 = Don’t know Q1.19 ...............................

1.16 If YES, approximately how long ago were you seen

by a nurse in the courts?

1 = Less than I month ago

2 = Between 1 and 3 months ago

3 = Between 4 and 12 months ago

4 = Between 1-2 years ago

5 = More than 2 years ago

6 = Don’t know

1.17 If YES, was a report submitted to the court?

1 = Yes

0 = No

3 = Don’t know

1.18 If YES, was the service helpful for your mental

health or legal problems?

1 = Yes

0 = No

3 = Don’t know

1.19 Are you currently receiving any other forms of

treatment or support for an emotional or mental

problem?

1 = Yes

0 = No Q1.21.............................................

1.20 If YES, please specify the treatment

______________________________________

1.21 Have you ever had support, counselling or

treatment for a mental problem from a psychologist

or counsellor?

1 = Yes

0 = No Q1.23.............................................

1.22 If YES, please specify the treatment

___________________________________________

If previous incarcerations, ask the following:

1.23 When you were released from prison last time, were

you referred to a mental health service?

1 = Yes

0 = No Q1.25

3 = Don’t know Q1.25 ...............................

1.24 If YES referred, did you attend?

1 = Yes

0 = No

3 = Don’t know

1.25 If you are NOT currently receiving psychiatric

treatment, do you believe that you should be

receiving it?

1 = Yes

0 = No Section 2 .........................................

1.26 If YES, what for?

(Multiple response) (1=Yes, 0=No)

1. Stress / not coping ......................................

2. Alcohol dependence ...................................

3. Drug dependence .......................................

4. Depression .................................................

5. Anger management ...................................

6. Sexual abuse ..............................................

7. Other (Specify)

______________________________________

Justice Health 2009 NSW Inmate Health Survey page 29 of 47

2. SUICIDE

I’m now going to