Female Inmates with Diabetes: Results from Changes in a Prison Food Environment.
OBJECTIVE
The prevalence of diabetes among Oregon prison inmates has increased by 50% in the last 5 years. The Healthy Food Access Project (HFAP) was implemented in the minimum-security facility at the Oregon Coffee Creek Correctional Facility to reduce the risk of chronic disease (including diabetes) and improve nutrition among female prison inmates. The intervention reduced the menu from 3,000 to 2,200 calories per day and provided nutrition education. We evaluated the effectiveness of HFAP on female inmates with diabetes on two outcomes: the effect of the reduced calorie menu on glycemic control and other biometric measures, and the calories purchased from commissary foods.


METHODS
We conducted a quasiexperimental study among all female inmates with diabetes living at the prison on August 28, 2013. Exposed inmates resided in the minimum-security facility for a minimum of 90 days after August 1, 2012 (when a reduced calorie menu was implemented); unexposed inmates resided primarily or exclusively in the medium-security facility. Medical chart abstractions were conducted to collect biometric data and mixed effects models described the differences in biometric trends between exposed and unexposed participants. Commissary receipts were collected to measure calories purchased.


RESULTS
Of the 63 female inmates with diabetes, 24 were exposed to the intervention and 39 were unexposed. Exposed inmates reduced their hemoglobin A1c levels by 0.04 percentage points per month compared with 0.01 percentage points per month among unexposed inmates. Changes in body mass index depended on the amount of time they had served at the prison. Participants purchased an average of 1,094 calories from the commissary per day. Exposed inmates did not purchase more calories from the commissary after HFAP implementation.


CONCLUSIONS
Exposure to HFAP supported modest improvement in glycemic control among female inmates with diabetes, and inmates exposed to HFAP did not purchase more calories from the commissary.
Program Design and Evaluation Services, Multnomah County Health Department and Oregon Public Health Division, Portland, Oregon. Electronic address: caislin.l.firth@state.or.us.
Caislin Leah
CL
Firth
Health Services Division, Coffee Creek Correctional Facility, Wilsonville, Oregon.
Elizabeth
E
Sazie
Oregon Public Health Division, Portland, Oregon.
Katrina
K
Hedberg
Program Design and Evaluation Services, Multnomah County Health Department and Oregon Public Health Division, Portland, Oregon.
Linda
L
Drach
Program Design and Evaluation Services, Multnomah County Health Department and Oregon Public Health Division, Portland, Oregon.
Julie
J
Maher
D015992:Body Mass Index; D016022:Case-Control Studies; D002784:Cholesterol; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000178:diet therapy*; D002149:Energy Intake; D005260:Female; D006442:Glycated Hemoglobin; D038321:Glycemic Index; D006801:Humans; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D009922:Oregon; D011329:Prisoners; D011330:Prisons; D016896:Treatment Outcome; D015431:Weight Loss
D002784:Cholesterol; D006442:Glycated Hemoglobin