The Public Health Intervention Wheel is a practice model for public health nursing that encompasses three levels of practice and 17 public health interventions. We mapped three public health nurse-led workstreams against the Public Health Intervention Wheel to help us describe the scope of our nursing practice and highlight areas for further development, whilst also testing the Wheel. The Wheel was a successful tool for evaluating the components of our work and helped us identify the strength and weaknesses of our workstreams. By using our work to test the Wheel, we identified that research and evaluation could be considered as a public health intervention within future iterations of the model.

We linked data from His Majesty's Prison and Probation Service, Welsh Demographic Service and the Office for National Statistics using deterministic matching to assign ICD-10 codes. Of 290 deaths (2018–2021), 92% were matched. ICD-10 coding expanded Ministry of Justice categories, identifying leading causes: drug poisoning ( n = 99), intentional self-harm ( n = 36) and circulatory diseases ( n = 34). The data generated by the surveillance model on leading causes of death provided evidence from a public health perspective, and informed justice services of information not routinely available. The practical application of this new evidence was used to inform the Deaths Under Supervision Strategy in Wales.

Early diagnosis and treatment of Sexually Transmitted Infections (STIs) and Blood Borne Viruses (BBVs) remain strategic priorities for health services in the UK. Reaching those at high risk, including people in contact with the justice system, remains a key challenge in the diagnosis and treatment of STIs and BBVs. One setting that is yet to be used in the UK to identify STIs and BBVs is probation. Our objective was to examine whether a probation site (PS) is an acceptable and accessible setting for the provision of STI and BBV tests. Intervention. Testing for STIs and BBVs was offered to probation users attending a local probation setting in Wales, UK. Testing was offered via three methods: a finger-prick dried blood spot test, Rapid POCT oral swab, or finger-prick PCR micro-capillary finger prick test. Evaluation. Semi-structured interviews were used to provide insights from the testing team and probation staff who delivered and supported the testing service. The programme was offered to all service users attending the PS over 18 working days. In total, 439 people were tested, 56

BACKGROUND:UK prisons were profoundly affected by the COVID-19 pandemic. Despite this, uptake of the COVID-19 vaccination remained low in these settings. Social roles, relationships, and freedoms influence vaccine uptake. Prisons are isolated by design and may foster mistrust that negatively influences vaccine uptake. Prisons are also unique communities with their own social networks and relationships. METHODS:We undertook a questionnaire survey across all six prisons in Wales, UK, to gather data on vaccine behaviour, attitudes, and other influencing factors. We fitted binomial generalised linear mixed effects models to identify predictors of vaccination. RESULTS:Surveys were completed by 727 prison residents. We found low vaccination uptake in younger cohorts, those serving short sentences, and those who perceived themselves to be in poorer health. Those reporting low levels of trust towards others and those reporting fewer sources of social support in prison were less likely to be vaccinated. CONCLUSION:Our findings suggest that building a prosocial atmosphere in prison and strengthening relationships and trust between prison staff and residents would positively influence vaccine uptake. Specific message framing should be considered to address the beliefs and motivations most prevalent in this population group, rather than focussing simply on enhancing the opportunity for vaccination.

Objectives:Chest X-ray (CXR) is recommended by the World Health Organization as a TB screening tool on admission to prison. We piloted the offer of CXR on admission to prison to understand if it was acceptable to residents, feasible to deliver within 48 h of admission, and to inform TB epidemiology. Study design:Cross-sectional. Methods:Between 1 September 2023 and 31 March 2024, CXRs were offered to new prison admissions. We measured the numbers accepting, numbers completed and the results. For each person accepting the CXR we undertook an assessment of clinical and social TB risks. We measured the time taken to deliver the CXR and receive results. Results:CXR was acceptable to those in prison with 61.0 % (n = 310) of new admissions accepting the offer. Of those accepting the offer, 226 (72.9 %) went on to receive a CXR, equating to 44.5 % of all new arrivals within the pilot period. A quarter of those accepting the CXR offer did not attend their first appointment and needed further appointment offers. We observed that as the number of rearranged appointments increased the number of men attending decreased. The total median number of days from arrival at the prison to completion of CXR was 17 [IQR 13-20 days]. We did not identify any respiratory TB, however nine (4.0 %) CXRs were abnormal. Conclusions:CXR screening was acceptable to prison residents but we could not achieve delivery within 48 h of arrival to prison. We identified other respiratory abnormalities suggesting CXR screening could be used as a wider respiratory health screen of which TB would be included.

BACKGROUND:The health needs of those under probation are likely high, but they have received very little public health attention. Limited evidence exists on the public health needs and interventions to support this cohort. METHODS:Surveys were completed by 257 people on probation as part of a local health needs assessment. Results were compared with the general population responses from the National Survey for Wales (2021-22). RESULTS:People on probation were 4.2 times more likely to self-report not-good general health (fair, bad or very bad) than the general population (adjusted Odds Ratio [aOR] 4.2, 95% Confidence Intervals [CI] 3.2-5.4). The odds of having a mental health condition were over eight times higher than the general population (aOR 8.8, 95% CI 6.8-11.4). Prevalence of smoking (52%), drug use (60%), attention-deficit hyperactivity disorder (21%), autism (4%) and dyslexia (15%) were all higher than the general population. General Practitioner usage and hospital stays were higher, but dentist or optician usage lower than the general population (P < 0.05). Emergency departments were accessed by 35%, with 9% frequenting them three or more times. CONCLUSIONS:People on probation have poorer self-reported health, higher prevalence of unhealthy behaviours and higher accessing of reactive health services than the general population.

Aim: Data suggest mortality rates of those under community justice services such as probation or parole have been increasing year on year. Little is known about why and how these individuals are dying. This scoping review explores the causes and contributing factors of mortality in those under community justice supervision. Methods: Studies published between 2011 and 2021 were identified across CINAHL, Embase, Global Health, Ovid Medline and PsycINFO. Articles were included if they presented original data on either mortality rates among those under community justice supervision or risk factors associated with the mortality of those under community justice supervision. Results: Searches identified 101 unique articles of which 13 were included in the review. Articles were representative of five countries. All articles were either retrospective reviews or retrospective cohort studies. The studies fell into the categories of all-cause mortality, self-inflicted deaths or drug-related deaths. Conclusion: Mortality rates of those under community justice supervision were found to be consistently higher than mortality rates for the general population regardless of cause of death. Factors identified as affecting mortality included history of drug use, history of self-harm and previous imprisonment including length of time in custody and experience of hospitalisation or solitary confinement while in custody.

Objectives: Cardiovascular disease (CVD) and associated risk factors within the prison population often present at a younger age in this cohort. Given CVD is largely preventable, it warrants investigation to fully quantify this risk. This study explored the relative predicted 10-year CVD risk and examined the calculated heart age in a representative sample of male individuals aged 25-84 years within the prison environment. Study design: This was a cross-sectional study. Methods: Data were collected on 299 men who underwent a cardiometabolic risk assessment in HMP Parc, Bridgend. The QRISK2 algorithm was used to calculate 10-year CVD risk, relative risk (to general population) and the predicted heart age of an individual. Between-group differences (prison population vs general community) in cardiovascular risk predictions (10-year CVD risk and heart age) were assessed. Results: We observed that at all age groups, the relative risk of predicted 10-year CVD scores in the prison population was double that of the community risk (2.1 +/- 0.6), and this was most apparent in the oldest age group (>= 50 years: 17.0% compared to 8.8%; P < 0.001). Overall, the heart age of the sample was 7.5 (6.7-8.2) years higher than their own chronological age, and this difference increased to above 9 years in those aged >= 40 years. Conclusions: This study provides quantifiable evidence to the elevated CVD risk in prison. Heart age predictions were almost a decade higher in those aged >= 40 years. Lowering the screening age for CVD by around 5 years in the prison population should be considered. (c) 2023 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

BACKGROUND:Despite little fluctuation in the numbers of people under community justice supervision in England and Wales, the number of deaths in this population has more than doubled between 2013-14 and 2020-21, from 560 to 1343 deaths. Contributing factors and causes of mortality are somewhat unknown. The aim of this study was to understand the number and the leading causes of people dying while under community justice supervision in Wales, UK, between April 1, 2018, and March 31, 2021. METHODS:Public Health Wales in collaboration with HM Prison and Probation Service in Wales were provided with identifiable data (name, date of birth, date of death, and the Probation Delivery Unit) of 306 individuals (aged ≥18 years) who had died during this time period while under community justice supervision. Following de-duplication and matching of National Health Service (NHS) numbers using the Welsh Demographic System, 266 deaths were linked to the live Office for National Statistics (ONS) Death Registry to obtain the cause of death. Deaths were grouped based on the International Classification of Diseases (ICD)-10 code assigned as their underlying cause of death. FINDINGS:In this cross-sectional study, the mortality rate overall was higher in women than in men (7·5 vs 5·6 deaths per 1000 population), despite the majority of deaths being in men, with less than 40 deaths in women. Mortality rates were nearly double in those aged 50 years and older (9·4 deaths per 1000 population) than in those aged 18-49 years (5·0 deaths per 1000 population). Drugs or alcohol were considered a primary cause of death for just under half of all deaths (n=115; 43%), with opiates being the most commonly named substance (n=63; 24%). 70 drug-related deaths involved poly-drug use. Accidental drug-related deaths were four times higher in those aged 18-49 years than in those aged 50 years and older (2·3 vs 0·6 deaths per 1000 population). Diseases of the circulatory system accounted for 13% (n=34) of all deaths and were 5 times higher in those aged 50 years and older than those aged 18-49 years (2·2 vs 0·4 deaths per 1000 population). INTERPRETATION:This study provides valuable insight into the leading causes of death among this cohort, notably deaths associated with substance misuse in younger age groups and with circulatory disease in older age groups. The increase in substance misuse-related deaths reflects recent national UK trends. Further research is required to understand which of these deaths were preventable. FUNDING:None.

BACKGROUND:Since 2015, the risks of dying due to drug-related causes are higher in prison than in the general population, with opiates and psychoactive substances being the most common substances recorded on death certificates in prison. Many individuals use drugs before entering the prison environment, it is not clear which individuals continue to use drugs while in prison. This study is a first step towards identifying characteristics of those who use drugs in prison, while exploring substances commonly used. METHODS:This retrospective cross-sectional analysis was performed on 299 men (mean age 38 years [SD 11]) in a long-stay UK prison in South Wales who participated in a research study exploring cardiometabolic risk in prison, in which substance misuse was included as a risk variable. All men aged 25 years or older with no previous diagnosis of cardiometabolic illness were eligible to participate. Data were collected between Oct 7 and Oct 23, 2019. Participants were asked details about their substance use before and since entering the prison. Mental wellbeing was assessed using the short Warwick Edinburgh Mental Wellbeing Score and low mental wellbeing calculated as 1 SD below the population mean score. To examine associations between characteristics (age groups, mental wellbeing, exposure to prison environment) and drug use, we used binary logistic regression (adjusted for characteristics such as age group, mental wellbeing, and exposure to prison environment ). FINDINGS:Overall, 195 (65%) of 299 participants reported a history of drug use before entering prison. Since entering prison 49 (16%) participants reported using drugs including methadone, and 24 (8%) reported using drugs excluding methadone. The next leading substances used in prison were spice (11 [4%] participants) and cannabis (six [2%] participants). All those who used drugs in prison had a history of drug use. Individuals more likely to continue using drugs in prison were aged 39 years and younger (adjusted odds ratio [aOR] 4·72, 95% CI 1·88-11·89; p=0·0009), with reported low mental wellbeing (3·38, 1·54-7·41; p=0·002), and had spent collectively more than 2·5 years in the prison environment (4·77, 2·09-10·91; p=0·0002). INTERPRETATION:This study, from a limited sample, describes the characteristics of those who use drugs in prison. Harm reduction interventions targeted to these individuals could reduce the risk of prison drug-related deaths. These findings should be interpreted with some caution, as this is a single site and may not reflect the wider UK prison environment. FUNDING:Public Health Wales.

Purpose Smoking rates are known to be higher amongst those committed to prison than the general population. Those in prison suffer from high rates of comorbidities that are likely to increase their risk of cardiovascular disease (CVD), making it more difficult to manage. In 2016, a tobacco ban began to be implemented across prisons in England and Wales, UK. This study aims to measure the effect of the tobacco ban on predicted cardiovascular risk for those quitting smoking on admission to prison. Design/methodology/approach Using data from a prevalence study of CVD in prisons, the authors have assessed the effect of the tobacco ban on cardiovascular risk, using predicted age to CVD event, ten-year CVD risk and heart age, for those who previously smoked and gave up on admission to prison. Findings The results demonstrate measurable health gains across all age groups with the greatest gains found in those aged 50 years and older and who had been heavy smokers. Quitting smoking on admission to prison led to a reduced heart age of between two and seven years for all participants. Originality/value The data supports tobacco bans in prisons as a public health measure to reduce risk of CVD. Interventions are needed to encourage maintenance of smoking cessation on release from prison for the full health benefits to be realised.

Prisons are susceptible to outbreaks. Control measures focusing on isolation and cohorting negatively affect wellbeing. We present an outbreak of coronavirus disease 2019 (COVID-19) in a large male prison in Wales, UK, October 2020 to April 2021, and discuss control measures.We gathered case-information, including demographics, staff-residence postcode, resident cell number, work areas/dates, test results, staff interview dates/notes and resident prison-transfer dates. Epidemiological curves were mapped by prison location. Control measures included isolation (exclusion from work or cell-isolation), cohorting (new admissions and work-area groups), asymptomatic testing (case-finding), removal of communal dining and movement restrictions. Facemask use and enhanced hygiene were already in place. Whole-genome sequencing (WGS) and interviews determined the genetic relationship between cases plausibility of transmission.Of 453 cases, 53% (n = 242) were staff, most aged 25-34 years (11.5% females, 27.15% males) and symptomatic (64%). Crude attack-rate was higher in staff (29%, 95% CI 26-64%) than in residents (12%, 95% CI 9-15%).Whole-genome sequencing can help differentiate multiple introductions from person-to-person transmission in prisons. It should be introduced alongside asymptomatic testing as soon as possible to control prison outbreaks. Timely epidemiological investigation, including data visualisation, allowed dynamic risk assessment and proportionate control measures, minimising the reduction in resident welfare.

Background: The health of people in prisons is a public health issue. It is well known that those in prison experience poorer health outcomes than those in the general community. One such example is the burden of non-communicable diseases, more specifically cardiovascular disease (CVD), stroke and type 2 diabetes (T2DM). However, there is limited evidence research on the extent of cardiometabolic risk factors in the prison environment in Wales, the wider UK or globally. Methods: Risk assessments were performed on a representative sample of 299 men at HMP Parc, Bridgend. The risk assessments were 30 min in duration and men aged 25-84 years old and free from pre-existing CVD and T2DM were eligible. During the risk assessment, a number of demographic, anthropometric and clinical markers were obtained. The 10-year risk of CVD and T2DM was predicted using the QRISK2 algorithm and Diabetes UK Risk Score, respectively. Results: The majority of the men was found to be either overweight (43.5%) or obese (37.5%) and/or demonstrated evidence of central obesity (40.1%). Cardiometabolic risk factors including systolic hypertension (25.1%), high cholesterol (29.8%), low HDL cholesterol (56.2%) and elevated total cholesterol: HDL ratios (23.1%) were observed in a considerable number of men. Ultimately, 15.4% were calculated at increased risk of CVD, and 31.8% predicted at moderate or high risk of T2DM. Conclusions: Overall, a substantial prevalence of previously undiagnosed cardiometabolic risk factors was observed and men in prison are at elevated risk of cardiometabolic disease at a younger age than current screening guidelines.

Although limited, global evidence suggests that the cardiometabolic health of those in prison is poorer than their community peers. Type 2 diabetes (T2DM) is a public health challenge and community rates are continuing to rise. Given that cardiometabolic risk factors are prevalent amongst younger individuals within the prison population, it is reasonable to assume that the prison environment will also experience an increase in new cases of T2DM. Therefore, the aim of this study was, to predict in a current prison population, how many potential new cases of T2DM could develop in the next 10 years. This study used health data collected from a prison sample (n = 299) aged 25-84 years in HMP Parc, UK, and the Diabetes UK Risk Score was used to predict T2DM risk. In terms of projecting new cases, it was estimated that in the next decade 6.4 individuals per 100 would develop T2DM, and this value increased to 16.4 individuals per 100 in those aged 50 years and older. The development of new cases across all age groups is a concern, and it appears that the prison community are a 'target population' for prevention opportunities. (c) 2021 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Purpose Those in prison have expert knowledge of issues affecting their health and wellbeing. The purpose of this paper is to report on work undertaken with male prisoners. This paper presents learning and findings from the process of engaging imprisoned men as peer researchers. Design/methodology/approach The peer researcher approach offers an emic perspective to understand the experience of being in prison. The authors established the peer research role as an educational initiative at a long-stay prison in Wales, UK to determine the feasibility of engaging imprisoned men as peer researchers. Focus groups, interviews and questionnaires were used by the peer researchers to identify the health and wellbeing concerns of men in prison. Findings The project positively demonstrated the feasibility of engaging imprisoned men as peer researchers. Four recurring themes affecting health and wellbeing for men in a prison vulnerable persons unit were identified: communication, safety, respect and emotional needs. Themes were inextricably linked demonstrating the complex relationships between prison and health. Originality/value This was the first prison peer-research project to take place in Wales, UK. It demonstrates the value men in prison can play in developing the evidence base around health and wellbeing in prison, contributing to changes within the prison to improve health and wellbeing for all.

Background Viral hepatitis is a leading cause of death worldwide. The World Health Organisation introduced a target to reduce hepatitis C virus (HCV) as a public health threat by 2030. Testing and treatment of those at elevated risk of infection in prison is key to achieving disease elimination. An opt-out testing policy for those in prison was introduced in Wales, UK, in 2016. Methods We analysed all Wales laboratory data where the testing site was a prison. We analysed numbers tested and positivity for a 14-month period before and after the introduction of opt-out testing policy. Results Between September 2015 and December 2017, 6949 HCV tests were from prison settings in Wales, equating to 29% of admissions to prison (P < 0.001). All but one prison increased testing following the introduction of opt-out policy. Percentage positivity for HCV remained at 11% before and after opt-out policy (P = 0.572). Short-stay prisons saw higher rates of HCV positivity than long stay. Conclusion Data suggest implementation of opt-out policy improved uptake and diagnosis of HCV amongst those in prison; however, further effort is required to fully embed screening for all. Positivity remains high amongst those in prison, particularly in short-stay prisons. Laboratory data can support audit of opt-out policy.

BACKGROUND:Tuberculosis (TB) remains a major global public health issue and in low-incidence countries guidance identifies the need to screen for and treat latent tuberculosis infection (LTBI) with the prison environment recommended as a setting to perform LTBI screening. This study describes the findings of a LTBI screening programme which took place on entry to a remand prison in the UK.METHODS:Testing for LTBI was undertaken alongside screening for blood borne viruses in 567 men. During the screening process, information was collected on demographic variables and also specific risk factors based on World Health Organization recommendations. LTBI analysis was performed using Interferon-Gamma Release Assay (IGRA) technique.RESULTS:In total, 40 men returned an IGRA positive result (7.1%). However, irrespective of IGRA/LTBI status there was a substantial burden of risk factors present including previous prison stay, history of substance misuse and no BCG vaccination. Non-White ethnicity, a history of substance misuse and age over 34 years were the most significant factors in identifying individuals who would require treatment for LTBI (Positive IGRA result).CONCLUSIONS:The study further demonstrates that the prevalence of LTBI remains increased within the prison environment and is a setting that still requires effective LTBI management.

ABSTRACT Background Prison populations experience an increased burden of physical, mental and social health needs compared to the community, further impacted by the prison environment. Surveillance systems to monitor health and well-being trends in prisons are lacking, presenting a challenge to services planners, and policy makers who often lack evidence to inform decisions. Method The Five Nations Health and Justice Collaboration, a body of experts on prison health across the UK and Republic of Ireland (ROI), met to share and discuss challenges and opportunities to developing robust prison health surveillance systems that could inform local provision, guide national policy and enable cross-border comparisons. Results Challenges to robust prison health surveillance systems were shared across the UK and ROI. Methods of surveillance differed across nations and included performance indicators and outcome measures as part of local or national programs. All nations had strong public health infectious disease notification systems. Conclusions The Five Nations Health and Justice Collaboration is proposing a new model for prison health surveillance, based on established guidelines for public health surveillance but with additional features that recognize the uniqueness of the prison environment and need for a whole prison approach, built on collaboration and sharing of data between health and justice sectors.