Health Self Efficacy and African American Male Inmates Prior Substance Use Treatment History: Implications for STI Risk Reduction

Research Article

J Fam Med. 2017; 4(3): 1114.

Health Self Efficacy and African American Male Inmates Prior Substance Use Treatment History: Implications for STI Risk Reduction

Stephens S*, Holmes T-K and Allen A

Department of Psychology, Clark Atlanta University, Georgia, USA

*Corresponding author: Torrance Stephens, Department of Psychology, Clark Atlanta University, Georgia, USA

Received: February 20, 2017; Accepted: March 15, 2017; Published: March 21, 2017


Objective: This study examines health self-efficacy in a sample of African American adult male inmates in Georgia as a function of past self-reported history of having received treatment for a drug problem prior incarceration.

Methods: Data were collected at baseline by trained interviewers inside selected correctional facilities. There were 126 African American male respondents included in our investigation. The mean age for offenders who selfreported prior drug abuse treatment was 27.62 years (SD = 3.37). Chi Square test for consistency was employed to investigate the significance between the observed frequencies for all dichotomous the distributions and significance tests were conducted using univariate logistic regressions to examine the independent associations of lifetime self-reported past drug abuse treatment history and dichotomized Health Self-efficacy correlates prior to incarceration.

Results: Analysis revealed that inmates with a history of prior substance use treatment reported higher levels of health self-efficacy with respect to doing things in moderation [X2 (1) = 3.51, p < .05], avoiding over working [X2 (1) = 3.39, p < .05], and limiting the consumption of foods that contained fats and sugars [X2 (1) = 5.15, p < .02]. Moreover, African American male inmates with a past history of participating and/or receive some form of substance abuse treatment were more than 2.5 times more likely to report being more likely to use health protective information (OR = 2.46, 95% CI = 0.94–6.42) and almost two and a half times more likely to indicate they would avoid drinking and partying too much upon release from prison if they had been part of a substance use treatment program prior (OR = 2.41, 95% CI = 1.04–5.87).

Conclusions: This study has clinical relevance in the development of substance use treatment and patient education materials on STI risk reduction for offender populations. In particular because of since the correctional setting presents an opportunity to access a significant subset of this population and provide ethical, evidence-based interventions.

Keywords: Inmates; Sexually Transmitted Infections (STI); Substance Use; Health Self Efficacy; African Americans


African American men are disproportionately represented in the U.S. correctional system; evince exceptionally high rates of infectious diseases such as HIV/AIDS [1-4] and like many inmate populations, problem behaviors associated with drug and alcohol use [5-12]. According to the US Bureau of Justice Statistics (BJS) in 2013 there were 2,220,300 adults incarcerated in US federal and state prisons, and county jails with 4,751,400 adults in 2013 being on probation or on parole [13]. Of this number, approximately 35% of jail inmates, and 37% of prison inmates of the 2.2 million male inmates as of 2014 are African American [14] albeit around 12–13% of the American population is African-American [15].

Many factors contribute to these disparities but what cannot be ignored is that both recidivism and substance abuse can be reduced considerably through interventions designed specifically for inmate populations that address health efficacious practices and substance use treatment. In particular since in the U.S. substance abuse is a major influence on risk practices associated with the transmission of infectious disease. For example, nearly one quarter of all HIV-positive individuals pass through the correctional system each year, of which a sizable percentage have self-reported substance use problems [16-17]. This makes the study of health behaviors among inmate populations an issue of major significance for public health, given the majority of all inmates are released back into their home communities.

Notwithstanding, as a parameter of inmate populations, African American inmates have been shown to be at even greater risk than the general inmate population, with the rate of among jail populations, African American men being 5 times more likely as white men, and twice as likely as Hispanic/Latino men, to be diagnosed with HIV [18]. Consequently, substance use treatment, when effective, not only reduces problem behaviors that increase incarceration, but also reduces the level of sexual risk taking. Specifically because drug use inclusive of injection drug use, enhance infectious disease risk of inmate populations since harm reduction methods, such as condoms and needle sterilization equipment, is limited and rarely practiced in U.S. correctional facilities [19-21].

Theoretical Framework

Research on drug use among incarcerated populations is extensive; however, it often fails to examine theoretical issues associated with enhancing behaviors that encourage inmates to seek health treatment for problems such as substance abuse and misuse. One theoretical behavioral construct that has attracted a significant amount of attention in research regarding health self-protective behaviors and practices is self-efficacy [22-31]. The concept of self-efficacy is based on social cognitive theory, which describes the interaction between behavioral, personal, and environmental factors in health and health behaviors [32]. Self-efficacy asserts that individual’s confidence in their ability to perform health behaviors influences which behaviors they will engage in [32-35].

Since extreme risk taking associated with excessive substance use places inmate populations are at risk for a multitude of negative health outcomes which involve behavioral, personal, and environmental factors, understanding behavioral constructs such as self-efficacy is relevant if the goal is to improve health outcomes affiliated with substance use practices. This has been documented in the scientific literature as it pertains to self-management interventions designed to improve health by enhancing individual self-efficacy for many chronic health conditions [36-38].

The issue is that among inmate populations, aspects of Bandura’s (1977) social cognitive theory has yet to be examined in relation to substance use treatment, but there is some limited research exploring self-efficacy among inmate populations. Loeb and Steffensmeier (2006) examined the relationships between health status and selfefficacy beliefs in a convenience sample survey of 51 older male prisoners with multiple chronic health conditions and found that Inmates with greater self-efficacy in their health self-management abilities were significantly more likely to rate their health as better, and engage in more health-promoting behaviors since incarceration [39]. With these exceptions, most studies that look at self-efficacy among inmate populations with respect to STIs and associated skills including but not limited to condom use [40].

Investigations of efficacy expectancy (the belief that one can successfully execute behaviors needed to produce a desired outcome) with respect to substance use treatment outcomes although wellreceived, has never been examined of an exclusive sample of African American offenders. What has been demonstrated is that self-efficacy is a predictor of treatment outcome in terms of the amount of alcohol or drugs used [41,42] and that higher self-efficacy predicted less cocaine use only after 3 months but not after 6 months [43]. Others have reported that self-efficacy levels were strongly associated with the amount of subsequent alcohol and crack cocaine use and also the amount of participation in continuing substance treatment programs [44].

Given the aforementioned, this study will examine health selfefficacy in a sample of African American adult male inmates in Georgia as a function of past self-reported history of having received treatment for a drug problem prior incarceration. Our analysis was designed to evaluate the null hypothesis that there would be no differences between male offender’s levels of self-efficacy as a function self-reported having received treatment for a drug problem prior incarceration. If differences are evinced, we anticipate that adult male offenders that have sought or received treatment for a drug problem prior incarceration will show higher levels of health selfefficacy. This study is significant because it extends the current body of scientific information regarding health self-efficacy with respect to substance use treatment seeking behaviour specific to data collected from a random sample of African American adult male inmates, a population consider at extreme risk for substance misuse and abuse. The goal is to use this information such to enhance substance abuse treatment protocols in concert with STI risk reduction.


This investigation was part of a study designed to implement a health education intervention to soon-to-be-released adult male inmates. Pilot testing of interview materials occurred in a fifth medium security facility not included in the baseline. The university institutional review board approved all study protocols.

Data were collected at baseline (prior to implementing the intervention), at release, and at three, six, and nine months postrelease. However, only baseline data are presented in the current study. Trained interviewers and peer educators collected data inside the correctional facility. After explaining the purpose of the study and obtaining written informed consent, the interviewer reviewed the data collection instrument with each participant. The instrument was written on a fourth grade reading level and, as noted previously, pre-tested prior to actual data collection. Inmates received monetary incentives and personal kits (including materials related to the intervention) when participating in the follow-up interviews.


The study target population was soon-to-be released adult male inmates enrolled in a randomized trial of a human immunodeficiency virus/ recidivism prevention program. Eligibility for this study required that inmates be at a point between 60 and 90 days prior to release from the facility and returning to the metropolitan area of a major southeastern city. Participants were recruited from a population of inmates at three medium securities correctional institutions for men located in middle Georgia and a transitional center located in a major southeastern city.

All study participants who had completed a baseline survey at the time and self-described as African American were included in this analysis. The basis of the health education curriculum provided participants with information related to health, infectious disease transmission, substance use behavior, personal health empowerment and community reintegration methods unrelated to sexual risk behaviors.


Demographic Variables: Participants were asked to provide descriptive and scale information on several variables using standard response formats. Socio-demographic variables on the data collection instrument included: ethnicity, marital status, educational level, income prior to incarceration, and incarceration history. Several individual items represented incarceration status. Length of incarceration was an open ended item that asked participants to write the total years served during their recent incarceration. Prior or first time incarceration was measured with a dichotomous response item worded: “Was this your first time being incarcerated?” (Table 1).