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

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

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

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

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%.

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

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.

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

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.

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

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

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)

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.

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

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

1.2 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.

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

1.3 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

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

1.5 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

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

1.6 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.

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).

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.

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

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

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

2.2 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.

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.

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.

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

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

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.’

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

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).

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

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.’

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

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%).

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.

3.4 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

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.

3.5 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

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

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

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.

3.7 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.

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

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%).

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.

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%).

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%).

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.

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).

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%).

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).

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.’

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

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

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,

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

4.3 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

4.5 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.

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

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

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

4.7 Sexually transmissible infections

Chlamydia

Chlamydia is a common STI, caused by the bacterium

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

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

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.

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.

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

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.

4.10 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

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

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

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

Total 572 100.0 159 100.0 731 100.0

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

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

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

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 %

Below normal

(<60 ml/min) 7 1.2 9 5.6 16 2.2

Total 564 100.0 158 100.0 722 100.0

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

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

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

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

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

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

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

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

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

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.

(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

(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.”

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%).

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.

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.

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

is defined in this context as a minimum of 600 minutes of

activity during the preceding four weeks (four weeks at

defined as less than 600 minutes of activity.

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

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