1. The Smoking and Health Problems of Female Ex-offenders Pamela Valera, PhD Albert Einstein College of Medicine Department of Epidemiology and Population Health Division of Community Collaboration and Implementation Science 3300 Kossuth Avenue Bronx, NY 10467 Tel: 718-920-5682 Email: pamela.valera@einstein.yu.edu

2. Overview Correctional Supervision Characteristics Female Prisoners Inmate Characteristics of NYC Jails Public Health Emergency Examples of Community – Academic Approaches

3. General Characteristics of Adults Under Correctional Supervision Of the 7.3 million adults who are under some form of correctional supervision (e.g., probation, parole, prison and jail inmates), ethnic minority adults are four times as likely as whites to be under correctional supervision (Bureau of Justice Statistics, 2005) Of the 2.2 million incarcerated in the U.S., Black Americans constitute 900,000 of this population (Pew Center on the States, 2009) One in twenty Black Americans is in prison (Bureau of Justice Statistics, 2009) Each year nearly 700,000 men and women are released from prison into the communities across the nation (Sabol, W., Todd, D.M., and Page, 2006)

4. Female Prisoners More than one million women in the United States are currently involved in the criminal justice system (i.e., jail, prison, probation, and parole) (Pew Center on the States, 2009) Women with histories of incarceration are older (35-44 years of age), nearly half have never been married, almost half (44 percent) have not completed high school, and nearly 70 percent have children under the age of 18 ( Bureau of Justice Statistics, 1999) Poorer socioeconomic background and are likely to be burden with mental health problems (The Sentencing Project, 2009) Higher rates of chronic illnesses: cardiovascular diseases, asthma, diabetes, HIV, and cancer

5. Aging Behind Bars: Accelerated Aging Older female prisoners have chronic illnesses and experience disabilities at younger ages (Wright, 2005) Female Inmates age 7 to 10 years faster than the general population Aging female inmates behind bars represent a new challenge In general aging inmates cost two to three times more to care for than do younger ones: incarceration costs for an elderly inmate are $69,000 a year, compared with a national average of $22,000 for all inmates (National Center of Institutions and Alternative, 2009)

6. Inmate Characteristics on Admission in City Jails FY 2009: 13,289 Male: 12,269 Female: 1,019 Length of stay 3 days: 30% 7days: 49% Average for sentenced inmates in FY 2009: 34.8 days

7. Inmate Characteristics in New York City Jails Age % 16-173% 18-2010% 31-4023% 41-5025% 51-608% Race/Ethnicity% Black55% Hispanic34% White (non-Hisp.)8% Other/Unknown3%

8. History (NYC DOHMH, 2009) Previous Incarceration 79% Current Tobacco Use (71%) Current Alcohol Use (16%) Current Other Use (33%) Has Medical Insurance (37%) HIV Test (32%) Mental Health Problems (15%) Dental Problems (12%) Pap Smear (last 12 mths) 74% Mammogram last 12 mths 27% Sick prisoner sleeps in the hospital. (Jan. 5, 2010, Angela Carone/KPBS)

9. Medical and Health Problems Asthma Hypertension Diabetes Hepatitis C Gonorrhea HIV/AIDS Syphilis Chlamydia http://www.comcast.net/slideshow /news-national-jails/21/

10. Public Health Emergency Prison Facilities Are Closing (budget constraints) Inmates are returning to communities in larger numbers (Bronx, Brooklyn) Loss of human capital (serious deficits) Serious health problems, mental health substance abuse, and basic human needs (housing, food, clothing, support) Bronx Ex offender population: 128,313 12 per 1,000 residents newly released each year 41% of all Bronx residents live below the federal poverty level 58% receive public assistance Very limited mental health services Roughly half of the borough is designated as a Mental Health Professional Shortage Area by (HRSA, 2009)

11. Examples of Community- Academic Collaborative Approaches Reentry Working Group (May 25, 2010) Current Reentry Partners (WPA, Fortune Society, Osborne Association, Exponents, Correctional Association of New York) Pending Grants NCI, ACS Better coordinated linkages to care from jail to community (Transitional Health Clinic, Montefiore Hospital)

12. ABSTRACT Objective: The proposed study will examine the smoking behavior among 150 women with mental health problems, ages 35-64, who have extensive criminal justice histories in New York City. Specific Aims: 1) To assess smoking prevalence and behaviors among female ex-offenders; 2) to describe the ways in which contextual beliefs (e.g., culture, religion, social) of socio-economically disadvantaged populations have facilitated and/or impeded effective smoking cessation aids and strategies among female ex-offenders; and 3) to examine community health programs that target female ex- offenders and to assess the types of smoking cessation services and strategies available to these women.

13. Questions for the TTT Meeting Examples of smoking cessation intervention preventions for women? How to tailor these interventions for female ex-offenders with mental health problems? Reentry working group? guidelines of working group Suggestions to keep momentum going How to develop a community preparedness plan Writing, action steps How to develop academic-community collaboration