Fiona Kouyoumdjian

McMaster University | McMaster · Department of Family Medicine

Background While Indigenous people are overrepresented in Canada's prisons and in the toxic drug supply crisis, we lack data on the harms related to opioids for Indigenous people with experiences of incarceration. We aimed to examine opioid toxicity deaths in Indigenous peoples who experienced incarceration and to compare opioid toxicity mortality...

Background: While correctional systems often function separately from academic and community-based organizations, there is opportunity for mutually beneficial collaborative partnerships to strengthen services and relationships. Community–academic partnerships (CAPs) are a well-established model in implementation science and in scientific literature...

The acute toxicity (sometimes called "overdose" or "poisoning") crisis has affected Canadians across all stages of life, including youth, adults and older adults. Our biological risks and exposures to substances change as we age. Based on a national chart review study of coroner and medical examiner data on acute toxicity deaths in 2016 and 2017, t...

Introduction There is a complex relationship between housing status and substance use, where substance use reduces housing opportunities and being unhoused increases reasons to use substances, and the associated risks and stigma. Methods In this descriptive analysis of people without housing who died of accidental substance-related acute toxicity...

Worldwide, there is a lack of systematically collected health data on people who are incarcerated. Our objective in this paper was to describe a process model of formative work for a project to strengthen health surveillance for people incarcerated under a Canadian prison authority. We have developed project structures and processes, and we are eva...

Background: Emergency shelters offer temporary sleeping accommodation to people deprived of housing and connect them to services. Service restriction is the practice of limiting or denying someone access to emergency shelters. This parallel convergent mixed methods study describes the characteristics, healthcare utilization, and morbidity of people...

Background Evidence suggests that women who are incarcerated desire access to contraception while incarcerated, and that this need is not currently being met. Our objective in this study was to explore the perspectives and experiences of women in prisons regarding contraception and contraception access using data from focus groups with women in a p...

Introduction Substance-related acute toxicity deaths (ATDs) are a public health crisis in Canada. Youth are often at higher risk for substance use due to social, environmental and structural factors. The objectives of this study were to understand the characteristics of youth (aged 12–24 years) dying of accidental acute toxicity in Canada and exami...

Over the last decade, Canada has experienced a substantial increase in people dying from substance-related acute toxicity. Examining mortality rates by area-level characteristics can identify disproportionately affected populations and inform strategies to reduce substance-related acute toxicity deaths (ATDs). Using area-based methods, this study s...

Background International studies show that adults with intellectual and developmental disabilities (IDD) are disproportionately represented in the criminal justice and forensic mental health systems; however, it is difficult to capture their involvement across systems in any one jurisdiction. Aims The current study aimed to estimate the prevalence...

Background To inform preparedness and population health action, we need to understand the effects of COVID-19 on health inequities. In this study, we assess the impact of COVID-19 on opioid toxicity deaths among people who experience incarceration compared to others in the general population in Ontario, Canada. Methods We conducted a retrospective...

Objective: Individuals with chronic psychotic disorders are overrepresented in correctional facilities, but little is known about factors that increase the risk of correctional involvement. The objective of this study was to compare individuals with chronic psychotic disorders who were released from correctional facilities in Ontario to individual...

BACKGROUND Canada continues to experience a national overdose crisis. While studies are available at the regional and provincial/territorial (P/T) levels, detailed national data regarding the burden and context of substance-related acute toxicity deaths is limited, particularly in sub-populations. In response to the overdose crisis, the Public Heal...

The cancer disparities between people with incarceration histories compared to those who do not have those histories are vast. Opportunities for bolstering cancer equity among those impacted by mass incarceration exist in criminal legal system policy, carceral, community, and public health linkages, better cancer prevention, screening, and treatmen...

Objectives To describe mortality due to opioid toxicity among people who experienced incarceration in Ontario between 2015 and 2020, during the fentanyl-dominant era. Design In this retrospective cohort study, we linked Ontario coronial data on opioid toxicity deaths between 2015 and 2020 with correctional data for adults incarcerated in Ontario p...

Background: There is mixed evidence on the link between mental health and addiction (MHA) history and recidivism. Few studies have examined post-release MHA care. Our objective was to examine the association between prior (pre-incarceration) MHA service use and post-release recidivism and service use. Methods: We conducted a population-based coh...

Opioid agonist treatment (OAT) is the primary intervention for opioid use disorder (OUD) in Canada and the USA. Yet, a number of barriers contribute to sub-optimal treatment uptake and retention, including daily-supervised medication administration. Thus, clients are eventually granted access to take-home OAT doses (i.e., ‘carries’) to reduce this...

Background Acute vaso-occlusive crisis (VOC) in sickle cell disease (SCD) often leads patients to seek emergency department (ED) care. The landscape of SCD ED care within Canada’s universal and publicly funded healthcare system remains largely undefined. Here, we sought to address this knowledge gap by characterizing the quality of SCD VOC ED and i...

As rates with which women are incarcerated have risen around the world, research examining how incarceration affects the health of people who are pregnant, their newborns, and their family members has burgeoned. Lived experience is seldom accounted for in this research, however, highlighting a gap with relevance to advocates, policy makers, researc...

Background: Syphilis rates are of public health concern in Canada, with multiple jurisdictions reporting outbreaks over the past five years. The objective of this article is to describe trends in infectious and congenital syphilis in Canada 2011-2020. Methods: Routine surveillance of syphilis is conducted through the Canadian Notifiable Disease Su...

Background The prison setting and health status of people who experience imprisonment increase the risks of COVID-19 infection and sequelae, and other health impacts of the COVID-19 pandemic. Objectives To conduct a mixed methods systematic review on the impacts of the COVID-19 pandemic on the health of people who experience imprisonment. Data so...

People with opioid use disorders are overrepresented in correctional facilities, and are at high risk of opioid overdose. Despite the fact that buprenorphine/naloxone is the first line treatment for people with opioid use disorder, there are often institutional, clinical, and logistical barriers to buprenorphine/naloxone initiation in correctional...

Background: There is little research with people who experience intellectual/developmental disabilities and imprisonment. Methods: The study linked health and correctional data to examine prevalence of intellectual/developmental disabilities and health and correctional characteristics among adults experiencing their first federal incarceration b...

People with intellectual/developmental disabilities (IDD) are reportedly intensive users of forensic inpatient services. Using administrative data, we identified people with and without IDD in forensic inpatient settings in Ontario, Canada over a ten-year period. We compared them on sociodemographic, clinical, and admission characteristics and post...

Objective: Little is known about the health care costs of individuals with chronic psychotic disorders who experience incarceration. This study sought to address this knowledge gap. Methods: The authors analyzed linked 2007-2010 correctional and administrative health care data on sex- and age-matched individuals with chronic psychotic disorders...

Objective Individuals with mental illness and addiction are overrepresented in prisons. Few studies have assessed mental health and addiction (MHA)-related service use among individuals experiencing incarceration using health administrative data and most focus on service use after prison release. The objective of this study was to determine the pre...

Objective To describe opioid agonist treatment prescribing rates in provincial prisons and compare with community prescribing rates. Design We used quarterly, cross-sectional data on the number and proportion of people prescribed opioid agonist treatment in prison populations. Trends were compared with Ontario surveillance data from prescribers, r...

Prison health research focuses on the health of people who experience imprisonment. Prison health research represents a means to improve the health status of this population and to achieve health equity. To advance this field, we need to strengthen instrumental factors such as the research workforce, funding, and legislation, policy, and ethics gui...

Objective To explore women’s experiences and perspectives of reproductive healthcare in prison. Methods We conducted a qualitative study using semi-structured focus groups in 2018 with women in a provincial prison in Ontario, Canada. We asked participants about their experiences and perspectives of pregnancy and contraception related to healthcare...

Racially disaggregated incarceration data are an important indicator of population health and well-being, but are lacking in the Canadian context. We aimed to describe incarceration rates and proportions of Black people who experienced incarceration in Ontario, Canada during 2010 using population-based data. We used correctional administrative data...

Background: People who experience incarceration have poor health across a variety of indicators, but we lack population-level data on the health of females in particular. We examined the health status of females released from provincial prison, and compared their data with data for males released from provincial prison and females in the general po...

Objective To examine the effect of a Housing First (HF) intervention and health-related risk factors on incarceration among adults with experiences of homelessness and mental illness.Methods Participants (N = 508) were recruited at the Toronto site of the At Home/Chez Soi study. The outcome was incarceration in Ontario from 2009 to 2014. Exposures...

Background: Acute vaso-occlusive crisis (VOC) in sickle cell disease (SCD) frequently leads patients to seek emergency department (ED) care. Whether or not health inequities exist, and their exact nature, is poorly understood in ED visits for SCD VOC within a universal publicly funded healthcare system. In this study, we aimed to address this knowl...

Background The present authors lack data on the prevalence of developmental disabilities in people who experience imprisonment and on their characteristics. Methods The present authors identified adults with developmental disabilities who were released from Ontario provincial prisons in 2010 and a general population comparator group using administ...

Objectives Individuals with schizophrenia are overrepresented in correctional facilities relative to their population-based prevalence. The purpose of this study was to determine the rate and predictors of reincarceration of individuals with schizophrenia after release from correctional facilities. Methods This was a retrospective cohort study tha...

Importance Women who experience imprisonment have high morbidity and an increased risk of adverse pregnancy outcomes. Antenatal care could modify pregnancy-related risks, but there is a lack of evidence regarding antenatal care in this population. Objectives To examine antenatal care quality indicators for women who experience imprisonment and to...

We aimed to explore continuity of health care and health barriers, facilitators, and opportunities for people at the time of release from a provincial correctional facility in Ontario, Canada. We conducted focus groups in community-based organizations in a city in Ontario, Canada: a men’s homeless shelter, a mental health service organization, and...

People who experience imprisonment have worse health status than other Ontarians - about 40% lack access to primary care in the community, and the period after release from prison is associated with high risks of adverse health outcomes. Population-based correctional and health administrative data suggest that access to quality healthcare in prison...

IntroductionMore than 30 million adults are released from incarceration globally each year. Many experience complex physical and mental health problems, and are at markedly increased risk of preventable mortality. Despite this, evidence regarding the global epidemiology of mortality following release from incarceration is insufficient to inform the...

Objective: To describe the population-level risk of infant and maternal outcomes for women who experience imprisonment and compare outcomes with the general population. Methods: We conducted a retrospective cohort study. We used linked correctional and health data for women released from provincial prisons in 2010. We defined three exposure grou...

We aimed to compare 30-day readmission after medical-surgical hospitalization for people who experience imprisonment and matched people in the general population in Ontario, Canada. We used linked population-based correctional and health administrative data. Of people released from Ontario prisons in 2010, we identified those with at least one medi...

Background: Accessing HIV-related care is challenging for formerly incarcerated people with HIV. Interventions informed by the perspectives of these individuals could facilitate engagement with care and address competing priorities that may act as barriers to this process. Methods: We used concept mapping to identify and prioritize the main obst...

We examined HIV care and treatment in prison and after release for people with HIV in Ontario, Canada, and compared HIV care and treatment with the general population. We used administrative data to identify people with HIV released from provincial prison in 2010 and in the general population. We calculated the proportion of people with HIV who acc...

Objective: To examine attachment to primary care and team-based primary care in the community for people who experienced imprisonment in Ontario, and to compare these attachment data with data for the general population. Design: Population-based retrospective cohort study. Setting: Ontario. Participants: All persons released from provincial...

Objectives The aims of this study were to describe emergency department (ED) utilization by people in provincial prison and on release, and to compare with ED utilization for the general population. Methods We linked correctional and health administrative data for people released from provincial prison in Ontario in 2010. We matched each person by...

The Acknowledgements section was inadvertently omitted from this article; it appears in its entirety below.

Objective To estimate the prevalence of HIV infection in persons released from Ontario prisons in 2010 using administrative health data, and to compare this observed prevalence with the expected prevalence based on the most recently available biological sampling data. Methods We linked identifying data for all adults released from Ontario provinci...

Objective We aimed to describe interactions between police and persons who experience homelessness and serious mental illness and explore whether housing status is associated with police interactions. Method We conducted a secondary analysis of 2008 to 2013 data from the Toronto, Canada, site of the At Home/Chez Soi study. Using police administrat...

Approximately 25% of people in Canadian correctional facilities have been previously exposed to hepatitis C virus (HCV). Despite being a high-prevalence setting, most Canadian prisons have thus far failed to engage the majority of those with chronic HCV infection in care. Several factors, including the lack of systematic screening programs, lack of...

Approximately 25% of people in Canadian correctional facilities have been previously exposed to hepatitis C virus (HCV). Despite being a high-prevalence setting, most Canadian prisons have thus far failed to engage the majority of those with chronic HCV infection in care. Several factors, including the lack of systematic screening programs, lack of...

The United Nations states that prisoners should enjoy the same standards of health care that are available in the community. Despite this, persons in prison experience barriers to care and face unique health challenges. Given the ways in which prisons shape health outcomes for incarcerated persons, it is important to interrogate how the provision o...

Objectives We aimed to determine the prevalence of adverse maternal and infant outcomes for women with a history of imprisonment in Canada, and to compare these data with the general population. Methods We linked correctional and health data for women released from provincial prison in Ontario in 2010. We defined three exposure groups for deliveri...

Introduction: Primary care represents an opportunity to improve health for people who experience imprisonment, and screening for colorectal and breast cancer indicate primary care quality. The study objectives were to examine the proportion of people released from provincial correctional facilities who were overdue for colorectal or breast cancer...

Background. A history of childhood abuse may affect people’s health and criminal justice system involvement. Understanding the prevalence of childhood abuse among individuals in prison is important to inform effective and appropriate correctional services. Objectives. To review and summarize data on the prevalence of childhood abuse among people ex...

Introduction Task shifting interventions have been implemented to improve health and address health inequities. Little is known about how inequity and vulnerability are defined and measured in research on task shifting. We conducted a systematic review to identify how inequity and vulnerability are identified, defined and measured in task shifting...

Limited evidence suggests that at the time of release from prison, people with HIV face barriers to health care, which may contribute to worsening HIV clinical outcomes. We aimed to describe health care utilization for people with HIV released from provincial prison in Ontario in 2010, and to compare rates of use with prisoner and general populatio...

Importance Women who experience imprisonment have higher rates of cervical cancer. Lack of access to cervical cancer screening in the community or in prison may contribute to increased cervical cancer incidence. Objectives To determine cervical cancer screening rates for women in provincial prison in Ontario, Canada, and to compare these data with...

Background: Access to primary care is an important determinant of health, and data are sparse on primary care utilization for people who experience imprisonment. We aimed to describe primary care utilization for persons released from prison, and to compare utilization with the general population. Methods: We linked correctional data for all pers...

We aimed to determine if a history of recent imprisonment affects access to primary care. Using patient roles, we telephoned to request an initial appointment with all family physicians (n = 339) who were accepting new patients in British Columbia, Canada. We sequentially assigned patient scenarios: male or female recently released from prison; mal...

A recent article in The Lancet establishing the principles of inclusion health, highlighted substantial gaps in our understanding of the drivers of health inequalities in socially excluded groups such as people with a history of incarceration, people who experience homelessness, sex workers, people with mental illness, and people who inject drugs1....

Background Many people experience imprisonment each year, and this population bears a disproportionate burden of morbidity and mortality. States have an obligation to provide equitable health care in prison and to attend to care on release. Our objective was to describe health care utilization in prison and post-release for persons released from pr...

Background Many people experience imprisonment each year, and this population bears a disproportionate burden of morbidity and mortality. States have an obligation to provide equitable health care in prison and to attend to care on release. Our objective was to describe health care utilization in prison and post-release for persons released from p...

Comparison of characteristics of persons released for 1 or more days in 2010 who were linked and not linked to an IKN. (DOCX)

Completed RECORD statement. (DOCX)

Flow chart for linkage of data. (DOCX)

Introduction Task shifting interventions are intended to both deliver clinically effective treatments to reduce disease burden and address health inequities or population vulnerability. Little is known about how health equity and population vulnerability are defined and measured in research focused on task shifting. This systematic review will addr...

Background: While the burden of chronic hepatitis C virus (HCV) infection is significantly higher among people in prisons compared to the general population, testing and treatment uptake remain suboptimal. The aim of this systematic review was to synthesize evidence on the effectiveness of interventions to increase HCV testing, linkage to care and...

Background: People with mental illness and substance use disorder are over-represented in prisons. Injury-related mortality is elevated in people released from prison, and both mental illness and substance use disorder are risk factors for injury. Effective care coordination during the transition between criminal justice and community service prov...

Background Substance use and substance use disorders are common in people who experience detention or incarceration in Canada, and opioid agonist treatment (OAT) may reduce the harms associated with substance use disorders. We aimed to define current physician practice in provincial correctional facilities in Ontario with respect to prescribing OAT...

Background Understanding the size of a population is necessary to define the burden of disease, evaluate opportunities to improve health, inform service planning and assess demographic trends over time. Methods In this article, we described available data on the number of admissions and number of people admitted to custody in Canada. We identified...

Objectives We aimed to explore whether mortality data are consistent with the view that aging is accelerated for people with a history of incarceration compared to the general population, using data on mortality rates and life expectancy for persons in Ontario, Canada. Methods We obtained data from the Ontario Ministry of Community Safety and Corr...