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      Substance Use During Imprisonment in Low- and Middle-Income Countries

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          Substance use disorders are among the most common health problems of people involved with the criminal justice system. Scaling up addiction services in prisons is a global public health and human rights challenge, especially in poorly resourced countries. We systematically reviewed the prevalence of substance use in prison populations in low- and middle-income countries. We searched for studies reporting prevalence rates of nicotine, alcohol, illicit drug, and injection drug use during imprisonment in unselected samples of imprisoned people in low- and middle-income countries. Data meta-analysis was conducted and sources of heterogeneity were examined by meta-regression. Prevalence of nicotine use during imprisonment ranged from 5% to 87%, with a random-effects pooled estimate of 56% (95% confidence interval (CI): 45, 66) with significant geographical heterogeneity. Alcohol use varied from 1% to 76% (pooled prevalence, 16%, 95% CI: 9, 25). Approximately one-quarter of people (25%; 95% CI: 17, 33; range, 0–78) used illicit drugs during imprisonment. The prevalence of injection drug use varied from 0% to 26% (pooled estimate, 1.6%, 95% CI: 0.8, 3.0). Lifetime substance use was investigated in secondary analyses. The high prevalence of smoking in prison suggests that policies regarding smoking need careful review. Furthermore, the findings underscore the importance of timely, scalable, and available treatments for alcohol and illegal drug use by people involved with the criminal justice system.

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          Most cited references 105

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            Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.

             T Sipe,  D Rennie,  D Stroup (2000)
            Because of the pressure for timely, informed decisions in public health and clinical practice and the explosion of information in the scientific literature, research results must be synthesized. Meta-analyses are increasingly used to address this problem, and they often evaluate observational studies. A workshop was held in Atlanta, Ga, in April 1997, to examine the reporting of meta-analyses of observational studies and to make recommendations to aid authors, reviewers, editors, and readers. Twenty-seven participants were selected by a steering committee, based on expertise in clinical practice, trials, statistics, epidemiology, social sciences, and biomedical editing. Deliberations of the workshop were open to other interested scientists. Funding for this activity was provided by the Centers for Disease Control and Prevention. We conducted a systematic review of the published literature on the conduct and reporting of meta-analyses in observational studies using MEDLINE, Educational Research Information Center (ERIC), PsycLIT, and the Current Index to Statistics. We also examined reference lists of the 32 studies retrieved and contacted experts in the field. Participants were assigned to small-group discussions on the subjects of bias, searching and abstracting, heterogeneity, study categorization, and statistical methods. From the material presented at the workshop, the authors developed a checklist summarizing recommendations for reporting meta-analyses of observational studies. The checklist and supporting evidence were circulated to all conference attendees and additional experts. All suggestions for revisions were addressed. The proposed checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion. Use of the checklist should improve the usefulness of meta-analyses for authors, reviewers, editors, readers, and decision makers. An evaluation plan is suggested and research areas are explored.
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              Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.


                Author and article information

                [1 ]Medical Faculty, Universidad Diego Portales, Santiago, Chile
                [2 ]Medical School, Universidad San Sebastián, Puerto Montt, Chile
                [3 ]Center for Research on Environment Society and Health, School of Geosciences, University of Edinburgh, Edinburgh, United Kingdom
                [4 ]Institute and Polyclinic for Occupational and Social Medicine, Technische Universität Dresden, Germany
                [5 ]Department of Psychiatry and Psychotherapy Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
                [6 ]Department of Psychiatry, Oxford University, Oxford, United Kingdom
                Author notes
                Correspondence to Seena Fazel, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX2 7LB, United Kingdom (e-mail: ).
                Epidemiol Rev
                Epidemiol Rev
                Epidemiologic Reviews
                Oxford University Press
                June 2018
                23 March 2018
                23 March 2018
                : 40
                : 1
                : 70-81
                29584860 5982797 10.1093/epirev/mxx016 mxx016
                © The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                Pages: 12
                Funded by: Wellcome Trust 10.13039/100004440
                Award ID: 202836/Z/16/Z

                Public health

                alcohol, illicit drugs, injection drug use, nicotine, prevalence, substance use, prison


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