Authors : Susan Zinner and Monica Solinas-Saunders School of Public and Environmental Affairs

1. The Association between Health Screening Tests at Admission and Work Program Participation in Prison: A Look at Gender and Race Differences Authors: Susan Zinner and Monica Solinas-Saunders School of Public and Environmental Affairs

2. Background of the problem • Access to health care in prison presents disparities by race and gender (Braithwaite et al., 2005; Massoglia, 2008). • Women inmates are more likely than their male counterpart to suffer from a variety of health issues, often related to their experience of abuse, drugs use, mental health conditions, and poverty (Maruschak & Beck, 1997; Taylor, 2001; Braithwaite et al., 2005). • Similarly, minorities in prison are more likely than non-minorities to suffer from a range of medical problems, most often associated to the poor living conditions that they experience in the outside world and recidivism (that is, they are more likely to churn in and out of prison) (London & Meyers, 2006; Massoglia, 2008; Williams et al., 2010; Dumont et al., 2012).

3. Theoretical framework: the Aristotelian notion of virtue ethics • Aristotle finds all lives to be of equal value, yet the current U.S. healthcare system is not designed to serve those who are not employed or able to advocate for themselves. Furthermore, anyone who is not utilizing the full range of their skills and abilities should be allowed to do so and the current system is clearly not designed to allow this process to occur. • To address these disparities, Aristotle would allow different responses from the healthcare community. “This principle of proportional justice applied to health requires society to reduce barriers to good health by weighing the needs of the worse-off and the mid-level health groups, in proportion to their difference. Aristotle introduced the concept of “disproportionate” effort, which aims to bring disadvantaged people as close to a threshold level of functioning as their circumstances permit” (Ruger, 2006, p. 1000).

4. Theoretical framework: Feminism as a theory of Difference • Weedon’s feminist approach focuses on the American politics of difference across all layers of society (Weedon, 1999). • In Weedon’s theory, differences occur because of the complexity of structural materialism that still limits women’s and minorities’ political power. • As a consequence of reduced political power, both women and minorities are marginalized in our society (Weedon, 1999).

5. Prison health disparities in the literature and proposed study. • Program participation is most often considered a predictor of both adaptation to prison and positive reentry post-incarceration (Zamble & Porporino, 1988; Lynch, 2001; Travis & Petersilia, 2001; Seiter & Cadela, 2003; Western, 2009). • Although the impact of medical assistance in prison is known in the literature (Binswanger et al., 2007;), questions on how medical screening tests (especially at admission) influence inmates’ participation in prison programs (such as work programs) remain, for the most part, unanswered in the existing literature (Massoglia, 2008). • Drawing upon both the Aristotelian virtue ethics and the feminist models, we investigate whether (1) receiving health screening tests at admission has a significant impact on work program participation and (2) whether such impact varies between the two gendersand by race.

6. Research Questions and Hypotheses Research Questions: • Does receiving health screening tests at admission increase/decrease inmates access to work programs? • Do sex and race influence an’ inmates’ likelihood to receive health screening tests and to participate in work programs? Hypotheses: 1. H0: Inmates who receive health screening tests at admission are more likely than those who do not to participate in work programs during incarceration. 2. H0: Women and minorities are less likely than men and whites to receive health screening tests in prison and to participate in work prison programs.

7. Data We use data from the Bureau of Justice Statistics (BJS) Survey of Inmates of State Correctional Facilities, 1991, 1997 and 2004. *BJS researchers are not responsible for the views highlighted in this presentation.

11. Work by Gender

12. Work by Race

13. Screen by Gender

14. Screen by Race

16. Findings • Although the variable Blood Test (as proxy for use of screening tests) was correlated to the variable Work (as proxy for adaptation & rehabilitation) in the descriptive analysis, the multivariate regression results show that Blood Test is not associated to Work (as the inmate’ ability to become employed inside/outside the prison) when controlling for other variables (therefore, the analysis does not support our initial hypothesis). • The variable Sex is significantly associated to Work during incarceration with women being more likely than men to work during confinement (the analysis does not support our initial hypothesis). When an interaction term was added to the analysis (not reported), the interaction between Sex and Blood test was not significantly associated to the outcome variable Work. • Race is not significantly associated to Work during incarceration (the analysis does not support our initial hypothesis). When an interaction term was added to the analysis (not reported), the interaction between Race and Blood test was not significantly associated to the outcome variable Work.

17. Findings ..cont. • The control variables Married and Age are statistically significant in the multivariate analysis with married inmates being more likely to work than unmarried inmates; also, older inmates are more likely to work than younger inmates. • The control variable Treatment (Drug Treatment) is also statistically significant, indicating that inmates who are in treatment programs are also more likely to work. It is not uncommon that State facilities that use therapeutic communities also use work as a form of rehabilitation within the program.

18. Contact information • Susan Zinner, J.D. Associate Professor of Health Services, School of Public and Environmental Affairs (SPEA), Indiana University Northwest, Gary, IN. Email: szinner@iun.edu • Monica Solinas-Saunders, Ph.D. Assistant Professor of Criminal Justice, School of Public and Environmental Affairs (SPEA), Indiana University Northwest, Gary, IN Email: msolinas@iun.edu

19. Questions?