PRuNUS: design and validation of a questionnaire among prisoners – data of pilot study in the Penitentiary Institute of Perugia, Italy

• Date: 08 November 2019
• Pages: 165-183
• Published date: 08 November 2019
• DOI: https://doi.org/10.1108/IJPH-01-2019-0001
• Author: Daniele Nucci,Letizia Licitra,Serena Sciara,Massimo Moretti,Vincenza Gianfredi
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

PRuNUS: design and validation of a

questionnaire among prisoners –data of

pilot study in the Penitentiary Institute of

Perugia, Italy

Daniele Nucci, Letizia Licitra, Serena Sciara, Massimo Moretti and Vincenza Gianfredi

Abstract

Purpose –The PRison NUtrition Surveillance (PRuNUS) questionnaire aimed to assess the eating

behaviour, diet knowledgeand lifestyle of Italian prisoners. The purpose of this paperis to present both

data fromthe validation process and from the cross-sectionalstudy.

Design/methodology/approach –In order to perform the validationprocess, the authors evaluated the

reproducibility and the consistency of the questionnaire, using Cohen’s kand Cronbach’s

a

,the

agreement between the twoadministrations was evaluated by the Landis and Koch score. The authors

performedthe study in the ‘‘Capanne’’ Prison, Perugia. A multivariablelogistic regression model adjusted

for age and gender was used.

Findings –Out of 300 men, 11 participated in the validation process and 68 in the survey. Among 47

women, 11 participated in the validation and 17 in the survey, with a 26.2 per cent(85/325) cumulative

responserate. The questionnaire obtained a good concordancewith a k-value ¼0.61 and 74.48 per cent

of agreement and a high level of inter-correlations among items with

a

¼0.8452. Half of the prisoners

were overweight/obese and 68.6 per cent were smokers. Moreover, smoking habits were statistically

associated with a low educational level, duration of conviction, body mass index and coffee

consumption.

Originality/value –The results highlightedthe need for an educational programme in prison. Detention

period couldbe a good opportunity to promote healthyhabits.

Keywords Italy, Survey, Prison, Diet, Questionnaire, Lifestyle

Paper type Research paper

Introduction

Health is a fundamental human right, as stated by Article 32 of the Italian Constitution. In

terms of prevention, diagnosis, treatment and rehabilitation, treatment provided for

prisoners should be equal to that providedfor the general population (Law number 230/99).

More than 10.2m people are held in penal institutions all over the world: almost half of them

are in the USA (2.2m), China (1.6m) and Russia(0.7m). In addition, many of them appear to

be in pre-trial or “administrative” detention, at least 650,000 in China and 150,000 in North

Korea (Walmsley, 2013). In Italy, in 2017, there were 56,436 people (19,268 foreigners)

detained in 190 penitentiary institutions, which have a regulatory capacity of 50,044 people

(Ministero della Giustizia, 2017).This overcrowding has the potential to impact on prisoners’

health. European prisoners’ physical, mental and social health status is poor compared to

the general population (Møller et al.,2007). Health inequality can be associated with socio-

economic and behavioural factors such as low household income and education;

Daniele Nucci is based at

Digestive Endoscopy Unit,

Istituto Oncologico Veneto,

Istituto di Ricovero e Cura a

Carattere Scientifico,

Padova, Italy. Letizia

Licitra, Serena Sciara and

Massimo Moretti are all

based at the Department of

Pharmaceutical Sciences,

Universita

`degli Studi di

Perugia, Perugia, Italy.

Vincenza Gianfredi is

based at the Dipartimento

di Medicina Sperimentale,

Post-Graduate School of

Hygiene and Preventive

Medicine, Universita degli

Studi di Perugia, Perugia,

Italy.

Received 2 January 2019

Revised 20 May 2019

30 June 2019

24 September 2019

30 September 2019

Accepted 3 October 2019

DOI 10.1108/IJPH-01-2019-0001 VOL. 16 NO. 2 2020,pp. 165-183, ©Emerald Publishing Limited, ISSN 1744-9200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 165

(Binswanger et al.,2009) use of intravenous drugs, smoking and alcohol habits that

account respectively for the higher risk of infectious and mental diseases, (Fazel et al.,

2009) and cardiovascular diseasesand tumours (Ski et al.,2015;DeSouza et al., 2016).

A poor diet is a further risk factor (Curd et al., 2013). Social theory posits that eating is a

personal choice, deeply affected by social context and living arrangements (Delormier

et al.,2009

). Penal institutions must providefood to detainees; however, prisoners also have

the opportunity to buy further food withoutbeing monitored. In Italy, penal institutions do not

have canteens that provide food to prisoners. Instead, prisoners are in charge of cooking

their own meals: several pre-selected teams are provided with ingredients and are in

charge of cooking for a group of prisoners assigned to them. Nevertheless, prisoners may

also decide not to eat this food and buy different meals from an approved list. This may

explain why prisoners have a poor nutritional status compared to the general population

(Agozino and Volpe, 2009). In particular, emerging evidence shows several vitamin

deficiencies among prisoners, including vitamin D, A, C and thiamine (Doyle et al.,2018;

Gould et al.,2013;Zhao et al., 2012;Monlezun et al.,2015;Barnett et al., 2010). A study

conducted in Papua New Guinea highlighted how a low intake of fruits and vegetables was

a contributory factor to the lack of several micronutrients (Gould et al.,2013). De facto,

vitamin D deficiency is associated with skeletal deformation, weight control, falls,

disabilities, low bone mineral density, osteoporosis and fractures (Nwosu et al.,2014),

whereas deficiency of thiamine and vitamin A could be responsible for permanent optic

nerve dysfunction and blindness (Sharma and Sharma, 2011). Recently, in Italy, a multi-

centre study was conducted in order to assess the prevalence of chronic diseases among

prisoners (Voller et al.,2016). Digestive system disorders ranked second (14.5 per cent),

after psychiatric pathologies, in terms of the number of diagnoses. Approximately 40 per

cent of disorders, within this large group of diseases, were dental and oral diseases, due

especially to poor oral hygiene and unhealthy lifestyles (smoking, alcohol and drugs use).

Around 37.5 per cent of diseases were represented by esophagitis, gastritis and gastro-

duodenal ulcers, often linked to stress, unbalanced diet and excessive use of some drugs,

such as non-steroidal anti-inflammatories, smoking and alcohol consumption. The

prevalence of tobacco smoking was more than 70 per cent, considerably higher compared

to the general population.

Gaining a better knowledge of prisoners’ lifestyle and diet would be helpful in planning

public health policies. In Italy, previous studies have focused on the prevalence of chronic

diseases (Voller et al.,2016;Rocca, 2018) and physical activity (Mannocci et al.,2015;

O’toole et al., 2018) but none have evaluated food intake among detainees. Having a

validated questionnaire, able to assess lifestyle and nutritional habits among prisoners, is

extremely important in order to increase knowledge concerning these aspects that highly

influence health. Due to the lack of descriptions of dietary habits in prison, we designed and

validated a questionnaire and then conducted a pilot cross-sectional study in the

“Capanne” Prison in Perugia, Italy. The aim of the study was to develop and validate a

questionnaire able to estimate nutritional knowledge, food intake and factors influencing it,

among prisoners. In this paper, we discuss results obtained from the pilot study, focusing

on food consumption before and after incarceration.

Method

The aim of the PRison NUtrition Surveillance (PRuNUS) questionnaire was to assess the

eating behaviour, diet knowledge and lifestyle of prisoners. Throughout this paper, we

present both data from the validation process and from the cross-sectional study

performed. The study was carried out between May and October 2017. All data refer to the

Perugia Penitentiary, whichhosts 347 prisoners (47 women and 300 men).

The validation procedure followed the standard steps: literature search and questionnaire

design. The development of the questionnairewas based on several phases: assortment of

PAGE 166 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jVOL. 16 NO. 2 2020