Ruth Elwood Martin

• MD
• Professor at University of British Columbia

Background In many jurisdictions, policies restrict access to Opioid Agonist Treatment (OAT) in correctional facilities. Receipt of OAT during incarceration is associated with reduced risk of fatal overdose after release but little is known about the effect on nonfatal overdose. This study aimed to examine the association between OAT use during inc...

Purpose Governance models are a defining characteristic of health-care systems, yet little research is available about the governance of health-care delivered in correctional facilities. This study aims to explore the perspectives of correctional services leaders in British Columbia, Canada, on the motivations for transferring responsibility for he...

Background The growing use of primary human papillomavirus (HPV) cervical cancer screening requires determining appropriate screening intervals to avoid overtreatment of transient disease. This study examined the long-term risk of cervical precancer after HPV screening to inform screening interval recommendations. Methods This longitudinal cohort...

In 2017, British Columbia (BC) transferred responsibility for healthcare services in provincial correctional facilities from the Ministry of Public Safety and Solicitor General to the Ministry of Health. This study explored how healthcare leadership perceived the impact of the transfer on services, work-life, and job satisfaction. We conducted one-...

Background Shifting from cytology to human papillomavirus (HPV)-based cervical cancer screening will initially increase colposcopy referrals. The anticipated impact on health systems has been raised as a concern for implementation. It is unclear if the higher rate of colposcopy referrals is sustained after initial HPV-based screens or reverts to ne...

To explore the transition from correctional facilities to community among women living with HIV in Vancouver, Canada, we interviewed 19 recently incarcerated women and 6 service providers. Findings highlighted heightened risk of violence at release, a lack of immediate supports, challenges accessing safe housing and addictions treatment, and interr...

Women living with HIV are increasingly incarcerated and experience suboptimal HIV health outcomes post release from incarceration. Drawing on cohort data with cisgender and trans women living with HIV (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment), we used path analysis to investigate pathways from recent incarceration to optim...

Purpose: Due to the increased sensitivity but reduced specificity of HPV testing compared to cytology to detect cervical lesions, a shift from cytology to HPV-based screening will initially raise population colposcopy referrals rates, which could put a strain on the healthcare system. However, it is unclear if this increase persists past the initia...

Self-collection may provide an opportunity for innovation within population-based human papillomavirus (HPV) cervical cancer screening programs by providing an alternative form of engagement for all individuals. The primary objective was to determine willingness to self-collect a vaginal sample for primary HPV screening and factors that impact will...

While cervix screening using cytology is recommended at 2‐ to 3‐year intervals, given the increased sensitivity of human papillomavirus (HPV)‐based screening to detect precancer, HPV‐based screening is recommended every 4‐ to 5‐years. As organized cervix screening programs transition from cytology to HPV‐based screening with extended intervals, the...

Given sub-optimal HIV care outcomes for people living with HIV (PLWH) post-release from incarceration, we systematically searched peer-reviewed literature (2010–2021) describing controlled trial interventions aimed at improving Antiretroviral Therapy (ART) adherence and care linkage following release from correctional facilities for PLWH. Of 392 st...

Objective To study participant’s acceptability of and attitudes towards human papillomavirus (HPV) testing compared with cytology for cervical cancer screening and what impact having an HPV positive result may have in future acceptability of screening. Design Cross-sectional online survey of clinical trial participants. Setting Primary care, popu...

Objectives Given the gender disparities in HIV outcomes for women living with HIV (WLWH) who experience incarceration, and the impact of HIV-related stigma on HIV care, this qualitative study investigated how HIV-related stigma within prison settings shapes HIV care for WLWH.Methods Drawing from SHAWNA (Sexual Health and HIV/AIDS: Women’s Longitudi...

Background Interruptions in healthcare services contribute to an elevated risk of overdose in the weeks following release from incarceration. This study examined the association of use of community healthcare with nonfatal and fatal overdose in the 30 days following release. Methods We conducted a retrospective cohort study using linked administra...

Purpose This study aims to describe knowledge of Canada’s Good Samaritan Drug Overdose Act (GSDOA) and take home naloxone (THN) training and kit possession among people being released from provincial correctional facilities in British Columbia. Design/methodology/approach The authors conducted surveys with clients of the Unlocking the Gates Peer H...

Objective The stigmatisation of incarceration has significant negative effects on the health and well-being of individuals and communities. At the University of British Columbia in Canada, an undergraduate course on prison health included instruction by people with lived experience of incarceration as part of a teaching approach aimed to reduce sti...

The Human Papillomavirus FOr CervicAL cancer (HPV FOCAL) trial is a large randomized controlled trial comparing the efficacy of primary HPV testing to cytology among women in the population‐based Cervix Screening Program in British Columbia, Canada. We conducted a cost‐effectiveness analysis based on the HPV FOCAL trial to estimate the incremental...

Purpose: Currently, people leaving prisons face concurrent risks from the COVID-19 pandemic and the overdose public health emergency. The closure or reduction of community services people rely on after release such as treatment centres and shelters has exacerbated the risks of poor health outcomes and harms. This paper aims to learn from peer heal...

This study describes long-term viral load (VL) trajectories and their predictors among women living with HIV (WLWH), using data from Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment (SHAWNA), an open prospective cohort study with linkages to the HIV/AIDS Drug Treatment Program. Using Latent Class Growth Analysis (LCGA) on a sample...

Background: Long-term safety of a single negative human papillomavirus (HPV) test for cervical cancer screening is unclear. The HPV FOr cerviCAL Cancer Trial (FOCAL) was a randomized trial comparing HPV testing with cytology. The FOCAL-DECADE cohort tracked women who received one HPV test during FOCAL, and were HPV negative, for up to 10 years to...

Background: Women involved with the criminal justice system are often marginalized or vulnerable and may face oral health inequities. Through a community-engaged program at a Canadian university, dental hygiene students provided preventive care at an organization supporting this population. This study explored the impact of these oral care service...

Women living with HIV (WLWH) are over-represented in corrections in Canada, yet little is known about women’s experiences post-release. We used CHIWOS cross-sectional data from WLWH to estimate associations between social determinants of health and HIV-related care outcomes among WLWH with recent (within past year) or ever (before past year) incarc...

Despite women living with HIV (WLWH) being disproportionately criminalized and overrepresented within correctional facilities, there remains limited longitudinal research with WLWH examining factors that make WLWH vulnerable to incarceration. Data are drawn from SHAWNA (Sexual health and HIV/AIDS: Women's Longitudinal Needs Assessment), a community...

The large and growing population of people who experience incarceration makes prison health an essential component of public health and a critical setting for reducing health inequities. People who experience incarceration have a high burden of physical and mental health care needs and have poor health outcomes. Addressing these health disparities...

Background: During the transition between prison and community, people are at greatly increased risk for adverse health outcomes. This study describes a peer health mentoring program that supports women in the first 3 days after their release from a provincial correctional facility in British Columbia. Methods: We used a participatory health res...

This article embodies two key narratives among many that have emerged from a 14-year research project. The first narrative is of a community-engaged solution, a peer health mentor program, which was imagined during a prison participatory health and university research project, as described in Arresting Hope. The second is the narrative of Releasing...

Objectives: To explore the perceptions of oral health and access to care experiences of men with a history of incarceration and to identify factors contributing to current oral health inequities within their community. Methods: A qualitative approach was used via focus group discussions among 18 men with a history of incarceration and 10 staff m...

HPV FOCAL is a randomized control trial of cervical cancer screening. The intervention arm received baseline screening for high‐risk human papillomavirus (HPV) and the control arm received liquid‐based cytology (LBC) at baseline and 24 months. Both arms received 48‐month exit HPV and LBC cotesting. Exit results are presented for per‐protocol eligib...

Background Globally, cervical screening is moving from cytology (Pap) to HPV-based testing. Cytology-based screening has occurred for decades; therefore, engaging the screened population is critical to success of this significant paradigm shift. HPV FOCAL, a large clinical trial, compared primary HPV testing every 4 years to liquid-based cytology (...

Background HPV FOCAL, a large clinical trial conducted within an organized screening program setting, compared high-risk human papillomavirus (HPV) testing (Liquid based cytology (LBC) triage for HPV positives) to LBC for primary screening for cervical cancer. Primary endpoints included detection of high grade cervical intraepithelial neoplasia (CI...

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...

As part of a participatory health research project seeking to support men in achieving their health goals during the transition from prison to community, a workshop program was developed and piloted in a Community Residential Facility in British Columbia, Canada. The pilot program was evaluated through feedback surveys at each of the 16 workshops a...

Objective: The Changing Childbirth in British Columbia study explored women's preferences and experiences of maternity care, including women's role in decision-making. Methods: Following content validation by community members, we administered a cross-sectional online survey exploring novel topics, including drivers for interventions, and experienc...

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...

(Abstracted from JAMA 2018;320:43–52) There are only limited data in North American populations on the relative diagnostic effectiveness of cervical cancer screening with primary human papillomavirus (HPV) testing alone compared with cytology.

Objective: To systematically review the literature on gendered implications of incarceration for HIV outcomes and engagement in care for women living with HIV (WLWH). Design: We systematically searched 7 bibliographic databases, for peer-reviewed English-language studies, published between 2007 and 2017 reporting on: Incarceration, Women (transg...

People who use illicit substances that use their lived experience to inform their work, or ‘peers,’ are increasingly hired in community-based work internationally. However, this group is disproportionately affected by stigma and discrimination that contributes to inequitable compensation of their work. A narrative review of the literature was condu...

More than 11 million people are currently imprisoned worldwide, with the vast majority of incarcerated individuals being male. Hypermasculine environments in prison are often tied to men’s health risks, and gathering information about mental health is fundamental to improving prison as well as community services. The purpose of the current study wa...

Objective: To work collaboratively with women accessing an integrated program for women with substance use in pregnancy to learn how services can be improved. Design: Qualitative design using focus groups within a participatory action framework. Setting: Sheway, a program located in the Downtown Eastside of Vancouver, BC. Participants: A tot...

Introduction and objectives: Understanding the details of one individual's experience with pain, opioid use and withdrawal may generate insights into possible relationships between opioid-induced hyperalgesia and withdrawal-associated injury site pain (WISP). Methods: This case study was extracted from a mixed methods study that characterized WI...

Background: In Canada, the number of women sentenced to prison has almost doubled since 1995. In British Columbia, the rate of reincarceration is 70% within 2 years. Our aim was to identify factors associated with recidivism among women in British Columbia. Methods: We prospectively followed women after discharge from provincial corrections cent...

In 2014, we published the book Arresting Hope: Women Taking Action in Prison Health Inside Out, which narrates a story about women in a provincial prison in Canada, about how creative leadership fostered opportunities for transformation and hope, and about how engaging in research and writing contributed to healing. Arresting Hope reminds us that p...

Background: The HPV FOCAL Trial is a RCT comparing human papilloma virus (HPV) with Liquid Based Cytology (LBC) screening for cervical cancer. Results are presented for the comparison of the Safety and Control arms after two rounds. Methods: HPV FOCAL included randomisation of women aged 25-65 into the Safety arm, where they were initially scree...

Objectives: The intervention objectives were to evaluate and describe the feasibility of using a community-based research (CBR) approach to adapt and implement HIV-prevention materials and tools with incarcerated men. We found no prior published reports about CBR HIV-prevention education in Canadian correctional facilities. Methods: Twelve membe...

Objectives: Adverse Childhood Experiences (ACE) such as parental incarceration can have a negative effect on health related Quality of Life (QOL) outcomes in adulthood. It is unclear how these experiences influence oral-health in childhood and throughout the life-course. This study explores: 1) the oral-health and dental care experiences, perceptio...

Objectives: This study, in collaboration with The John Howard Society of the Lower Mainland (JHSLM) and the Elizabeth Fry Society of Greater Vancouver (E-Fry), aims to explore access to oral health care issues faced by individuals with a history of incarceration, and to identify contributing factors for current oral health inequalities and unmet or...

Withdrawal pain can be a barrier to opioid cessation. Yet, little is known about old injury site pain in this context. We conducted an exploratory mixed-methods descriptive case series using a web-based survey and in-person interviews with adults recruited from pain and addiction treatment and research settings. We included individuals who self-rep...

Complete Round 1 data (baseline and 12-month follow-up) for HPV FOCAL, a randomized trial establishing the efficacy of HPV DNA testing with cytology triage as a primary screen for cervical cancer are presented. Women were randomized to one of three arms: Control arm - Baseline liquid-based cytology (LBC) with ASCUS results triaged with HPV testing;...

Background In 1998, the North American Primary Care Research Group (NAPCRG) adopted a groundbreaking Policy Statement endorsing responsible participatory research (PR) with communities. Since that time, PR gained prominence in primary care research. Objectives To reconsider the original 1998 Policy Statement in light of increased uptake of PR, and...

Purpose – This participatory health research project of researchers and women prisoners examined housing and homelessness as perceived by incarcerated women to understand this public health concern and help guide policy. The paper aims to discuss these issues. Design/methodology/approach – A participatory research team designed and conducted a sur...

Objective: To estimate the impact of implementing primary human papilloma virus liquid-based cytology (LBC) screening on four-year rates of referral for colposcopy in the British Columbia screening program. Methods: We used data on referral for colposcopy from an RCT (HPV FOCAL) comparing HPV testing every four years with LBC testing every two y...

Ageing is a common subject in arts and literature as it is a universal experience. The use of the humanities in medical education may have a positive effect on trainees' attitude to caring for seniors and on geriatrics as a career choice. This paper summarizes the role of humanities in medical education and provides some examples and thoughts on ho...

The purpose of this research was to engage, empower and enhance the health and well-being of incarcerated women. The integration of primary health care, community-based participatory research, a settings approach to health promotion, and transformative action research guided the design of this study. A partnership between incarcerated women who bec...

Purpose: Women in prison throughout the world experience higher rates of mental and physical illness compared with the general population and compared with men in prison. The paper finds no published studies that report on men or women in prison engaging in participatory health research to address their concerns about nutrition and fitness. The pu...

Background: Social responsibility and accountability can be important core values in medical education. At the University of British Columbia, undergraduate medical students engage in prison health community service-learning opportunities in regional correctional facilities. Methods: To describe the impact of prison health exposure on pre-clinic...

Background HPV FOCAL Study is a randomised trial evaluating the efficacy of high risk-HPV DNA (hr-HPV) testing, with Liquid Based Cytology (LBC) triage testing of hr-HPV positives, compared to LBC testing alone (with triage hr-HPV testing for ASCUS positives) in an organised screening programme. Round 1 age specific results comparing differences in...

ABSTRACT: The age to begin routine population-based screening for cervical cancer is controversial, with jurisdictions internationally recommending an age between 21 and 30, and many recommending that screening begin when a woman becomes sexually active, regardless of age. A review of the literature suggests four reasons for starting routine screen...

This health promotion project used participatory processes to engage all stakeholders to design and pilot preventive health tools in partnership with and for individuals with incarceration experience. This article outlines the methods of engaging with this marginalized population and interventions conducted to successfully utilize participation in...

About 10% of the prison population in British Columbia is wo­men; the annual number of provincial admissions for women may be as high as 3700. Consistent with the rest of Canada, Aboriginal people are overrepresented in the criminal justice system. There is a greater prevalence of bloodborne infections in incarcerated women. Women in prison tend to...

Several recent collabora­tions between correctional facilities and community health organizations and community education organizations have enabled incarcerated wo­men to access health and education programs that are also available in the community. In addition, health educational programs initiated by in­carcerated women themselves illustrate tha...

Background: Round 1 data of human papillomavirus (HPV) FOCAL, a three-arm, randomised trial, which aims to establish the efficacy of HPV DNA testing as a primary screen for cervical cancer, are presented. Methods: The three arms are: Control arm – liquid based cytology with atypical squamous cells of unknown significance (ASC-US) triage with hrHPV...

Background: Social responsibility and accountability are core values of medical education. Prison health educational opportunities offer learners exposure to diverse medical and social needs including communicable diseases, problematic substance use and mental illness. At the University of British Columbia (UBC), undergraduate and post-graduate med...

Purpose. Housing is a basic determinant of health. Homelessness and unstable housing negatively influence health. During a unique prison participatory research project in a Canadian provincial women's prison, women's homelessness was identified as a cause of their recidivism. In addition, incarcerated women identified housing as a major health go...

Purpose The purpose of this paper is to describe the development, by incarcerated women who were members of a prison participatory health research team, of a survey tool regarding homelessness and housing, the survey findings and recommendations for policy. Design/methodology/approach A survey was developed by incarcerated women in a minimum/mediu...

A reduction in participation rates for cervical cancer screening (CCS) by women aged 20 to 24 in the Canadian province of British Columbia led to this study evaluating young women's knowledge of CCS and identifying barriers to and facilitators of participation in CCS. A qualitative design was used and focus groups were held with a total of 80 women...

A reduction in participation rates for cervical cancer screening (CCS) by women aged 20 to 24 in the Canadian province of British Columbia led to this study evaluating young women's knowledge of CCS and identifying barriers to and facilitators of participation in CCS. A qualitative design was used and focus groups were held with a total of 80 women...

The majority of women serving short-term sentences in provincial prisons in Canada are incarcerated for illegal activities involving alcohol and substance use. Although there is a wealth of research on substance use among those serving sentences within the federal prison system, little of that literature addresses the needs and experiences of women...

See published version in Family Practice (Oxford): Allen ML, Salsberg J, Knot M, Lemaster J, Felzien M, Westfall JM, Herbert C, Vickery K, Culhane-Pera K, Ramsden V, Zittleman L, Martin R, Macaulay AC. Engaging with Communities, Engaging with Patients: Amendment to the NAPCRG 1998 Policy Statement on Ethical Research With Communities. Family Prac...

In the HPV FOCAL trial, we will establish the efficacy of hr-HPV DNA testing as a stand-alone screening test followed by liquid based cytology (LBC) triage of hr-HPV-positive women compared to LBC followed by hr-HPV triage with > or = CIN3 as the outcome. HPV-FOCAL is a randomized, controlled, three-armed study over a four year period conducted in...

The inaugural collaborative Canadian Prison-Academic-Community Health and Education was organized by the Collaborating Centre for Prison Health and Education and supported by the University of British Columbia (UBC), Nicola Valley Institute of Technology (NVIT) and Simon Fraser University (SFU) on 4th and 5th December 2008. The conference objective...

the purpose of this research was to determine the feasibility of engaging incarcerated women in community-based participatory research and to identify, by and with the women, the health concerns to be addressed. the integration of primary health care, community-based participatory research, a settings approach to health promotion and transformative...

This paper describes the development of a unique prison participatory research project, in which incarcerated women formed a research team, the research activities and the lessons learned. The participatory action research project was conducted in the main short sentence minimum/medium security women's prison located in a Western Canadian province....

This study describes rescreening following a prison cervical cancer screening intervention: the numbers of women who received rescreening during the three-year follow-up period; their timing of rescreening in relationship to intervention follow-up recommendations; and socio-demographic factors associated with rescreening. Socio-demographic informat...

To examine patients' perceptions and experiences of having family medicine residents in the office. Descriptive survey; questionnaire completed by patients. Outpatient office of 4 family physicians in the greater Vancouver area, affiliated with the Department of Family Medicine at the University of British Columbia. A total of 265 English-speaking...

To study the feasibility of self-collected specimens for testing human papillomavirus (HPV) status among hard-to-reach women, outreach nurses recruited women in women's centres, shelters and alleys in Vancouver's Downtown Eastside. Of the 151 participants for whom samples were available, 43 (28.5%) tested positive for high-risk HPV. Outreach nurses...

A common strategy for health services research involves linking the records held in administrative databases using personal name data. Studies may also require following individuals over time, again necessitating names. Multiple names became a dilemma in our research of a screening intervention for female prisoners in British Columbia, Canada, suc...

Clinicians working in a women's prison in British Columbia observed hepatitis C sero-conversion among inmates, prompting this study to determine: the characteristics of women who do and do not report illicit drug use in prison; patterns of drug use inside prison; factors associated with illicit drug use that might contribute to bloodborne transmiss...

To develop evidence-based consensus recommendations on the delivery of cervical cancer screening, human papillomavirus (HPV) education, HPV testing, and the optimal tool for cervical cytology within the Canadian health system. Leading up to a forum held in Ottawa on November 21 and 22, 2003, 254 registrants reviewed position papers through a Web-ba...

Objectif : Élaborer des recommandations de consensus fondées sur des données probantes quant à la mise en oeuvre du dépistage du cancer du col utérin, de la sensibilisation au papillomavirus humain (PVH), des tests de détection du PVH et de l'outil optimal en matière de cytologie du col utérin au sein du système de santé canadien.