PRS-20: a protocol for identifying the needs related to drug use, health and social (re)integration of people living in prison within five European countries

PRS-20: a protocol for identifying the needs related to drug use, health and social (re)integration of people living in prison within five European countries | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Study protocol PRS-20: a protocol for identifying the needs related to drug use, health and social (re)integration of people living in prison within five European countries Els Plettinckx, Nadine Berndt, Rita Seixas, Stefaan De Smet, Jérôme Antoine, and 16 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4822245/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Oct, 2024 Read the published version in Archives of Public Health → Version 1 posted 11 You are reading this latest preprint version Abstract Background: Compared to the general population, people living in prison experience substantially more poor (mental) health issues. Moreover, delinquency and drug use have many risk factors in common. Therefore, a need exists for extensive knowledge about health, drug use patterns, related needs of people with a detention background and the coverage of drug-related interventions in prison within Europe. The current protocol describes the design of a study in prison about wellbeing, drug use and related care. Methods/design: A multicentre mixed method design is implemented in five European countries (Belgium, Cyprus, Greece, Lithuania and Luxembourg). Qualitative and quantitative data collection tools are combined in order to generate complementary and comprehensive results. First, a cross-sectional survey among people living in prison is conducted. This survey is based on a model questionnaire, EQDP, developed by the European Monitoring Centre for Drug and Drugs Addiction. Second, people living in prison and people who have been recently released from prison are involved in qualitative semi-structured face-to-face interviews. The main topics of interest are the use of drugs and other health related topics such as loneliness, anxiety, depression, infectious diseases, suicide and treatment. Third, data about service provision in prison is collected through a quantitative survey addressed to the prison authorities. Discussion: This study protocol allows to address potential harms of drug use among people with a prison history and drug-related interventions inside prison at an international level. The strength of this study is that it builds on a common methodology that can be implemented in the same period of time. At the same time, sufficient flexibility is guaranteed so that every participating country in the study has the possibility to adapt the common methodology to its own specific legal requirements and practical circumstances. Nevertheless, this approach comes also with some limitations. Comparability and generalizability of the results are difficult to reach. People living in prison Drug use Health Social (re)integration needs Mixed methods Europe Study protocol Contributions to the literature This study protocol addresses the critical and often overlooked issue of health and drug use among people living in prison. Compared to the general population, people living in prison experience substantially higher rates of poor (mental) health, necessitating extensive research and targeted interventions. Given the overlapping risk factors for delinquency and drug use, this study protocol addresses a pressing public health need. This study protocol is designed to provide a robust framework that can be used by other researchers in order to conduct similar studies, offering flexibility while maintaining methodological consistency. 1. Background The estimated number of people living in prison (PLIP) in Europe is 1,243,714 ( 1 ). Overall, an increased risk exists to start drug use or to start the use of different substances once people are admitted to prison. The lifetime prevalence of illicit drug use of people living in prisons (PLIP) prior to prison is on average 61% in Europe ( 2 ). Drug-related offences are the most common reason for which PLIP are sentenced to prison (excluding other unspecified offences) ( 3 ). Worldwide, it is estimated that 23.8% (95% CI 21.0–26.7) of people meet diagnostic criteria for alcohol use disorder on arrival to prison, and 38.9% (31.5–46.2) for drug use disorder. Half of PLIP with major depression or psychotic illness also have a comorbid substance use disorder ( 4 ). Cannabis is most frequently reported, followed by powder cocaine. Nevertheless, some studies report the highest prevalence of use for crack cocaine among newly admitted PLIP ( 2 ). Compared to the general population, PLIP experience substantially more poor (mental) health issues such as cognitive impairments, (non-)communicable diseases and drug use ( 5 , 6 ). More PLIP have experience with injecting drug use compared to people without a prison history ( 5 ). Delinquency and drug use have many risk factors in common, including social vulnerability, economic deprivation, school dropout, unemployment, child neglect and suicide ( 2 , 7 – 13 ). Consequently, these people have health care needs that require specific attention when entering prison, during detention and after release. Providing continuity of care as people move between prison and the community is key in achieving sustainable and effective treatment outcomes, and it is likely to have a significant impact on public health within the broader society ( 2 , 4 ). Accordingly, prisons and the criminal justice system are indispensable in the chain of drug-related interventions including prevention and treatment ( 5 , 14 ). Despite the abovementioned context, significant differences in prevalence by country exist. Therefore a need for additional research about health related needs and intervention among people in prison in European countries still exist ( 2 , 4 ). Consequently, the current study protocol is developed within 5 different countries, namely Belgium, Cyprus, Greece, Lithuania and Luxembourg. As comparability of different studies is challenging, the aim is to harmonise the data collection about drug use among PLIP with respect to the specific characteristics of the different countries. In addition, health and safety related needs during detention and the use of certain services are studied. This study protocol enhances the monitoring and research in prisons. It generate knowledge which is essential to inform about drug use and the necessary interventions in prisons to overcome drug use and reduce related morbidity or mortality. Hence, the study improves the knowledge about coverage and accessibility of prevention and treatment responses which is essential to design planning instruments for implementing evidence-based drug-related interventions inside prisons in relation to social (re)integration. The study has started in 2021 and has a timespan of three years. 2. Methods/design 2.1 Study design The current study protocol consists of a multicentre mixed method design to be commonly conducted in Belgium, Cyprus, Greece, Lithuania and Luxembourg. Qualitative and quantitative data are collected in order to generate complementary and comprehensive results. The integration process of this design occurs during data collection, analysis and the presentation of results ( 15 ). The study comprises three different components. One component consists of a cross-sectional survey among PLIP. A second component consists of qualitative semi-structured face-to-face interviews among PLIP and people who have been recently released from prison. A third component, which is the prison facility survey, gathers data about service provision through a quantitative survey addressed to the prison administration. 2.1.1 Setting and target population PLIP have health care needs that require specific attention when entering prison, during detention and after release ( 2 ). For this reason, both people in community and in prisons are targeted within this study protocol. Belgium and Greece are the largest countries involved in the study, followed by Lithuania, Cyprus and Luxembourg (Table 1 ). The number of prisons ranges in the participating countries from 1 in Cyprus to 35 in Greece, respectively. The size of the prison population ranges from about 560 in Luxemburg to about 11,200 in Greece. The lowest prison rate per 10,000 population is observed in Cyprus ( 37 ) and the highest in Lithuania (186). The prison density, which is the ratio between the total number of PLIP and the total capacity of prisons in a country, is the lowest in Lithuania and the highest in Greece ( 16 ). Table 1 Number of prisons and total population in the participating countries in 2021 General population N Prisons Prison population Prison population rate per 100,000 inhabitants Prison density per 100 places Belgium 11,522,440 34 10,374 90 108.4 Cyprus 888,005 1 571 37 110.5 Greece 10,718,565 35 11,266 106 114.4 Lithuania 2,794,090 8 5,188 186 72.6 Luxembourg 626,108 2 557 88 78.3 The mean age of the PLIP in the different countries varies between 37 and 39 years old and 95% of the prison population is male, which is in line with the average age and gender distribution in the European prisons ( 16 ). As data is collected within prisons and in community in order to reach the research objectives, two target groups are identified, namely PLIP and people recently released from prison: PLIP are defined as every person aged 18 or older serving a sentence or being on remand in prison in the participating countries during the period of the data collection. This definition excludes (i) juveniles, (ii) people who committed a crime and held in other institutions than penal institutions or those for whom an alternative to imprisonment is applied, (iii) PLIP with mental illness who have committed a crime but who are deemed to have not being responsible for their behaviour and (iv) PLIP in isolation for health reasons (e.g. due to Covid-19) or security issues. Consequently, juvenile detention centres and open prisons are excluded from this study. In addition, some participating countries also excluded (i) illiterate PLIP (in Luxembourg and Cyprus), (ii) people sentenced to life imprisonment (in Cyprus) and (iii) people sentenced because of a sex offences (in Cyprus) due to their difficult accessibility and safety reasons. People recently released from prison are involved in the qualitative part of the research to better understand the impact of drug use, health and security related needs during detention and on reintegration. The inclusion criteria are i) being ≥ 18 years of age, ii) being released from prison within the last 12 months and iii) having used drugs. Exclusion criteria were language limitations and mental or cognitive impairments that would impede participation in an interview. A convenience sample of 10 participants per country is defined. The corresponding sample size of PLIP is estimated within the framework of the quantitative data collection. It is determined for every participating country separately according to the prison population size of 31st of January of 2021 as described above in Table 1 . In addition to the prison population size, also a margin of error of 5% and the confidence interval of 95% is taken into account ( 17 ). This results in a sample size calculation of 228 respondents for Luxembourg, 230 respondents for Cyprus, 358 respondents for Lithuania, 372 respondents for Greece and 371 respondents for Belgium. 2.1.2 Stakeholders involvement In each country, partnerships are established with both prisons and low-threshold community care initiatives in order to recruit respondents. Therefore, individual informative meetings between the researchers on the one hand and the prisons and low-threshold community care initiatives on the other hand are organised to explain the data collection tools and methodologies (survey and interview guidelines). The detailed procedures to guarantee confidentiality and data protection of the participants are discussed as well. A safe context during data collection is the first priority in order to avoid both refusals and socially desirable answers due to fear of retaliation. Therefore any kind of possible pressure and interference of third parties, e.g. prison staff, are prevented to the maximum extent possible. In this respect it is agreed that only aggregated data and final results can be shared with the stakeholders. In Lithuania and Belgium the data collection is fully performed by independent researchers. In Luxembourg, the survey in prison is conducted by nursing staff. In Greece, a collaboration is established between independent researchers and social care services of the prisons. In Cyprus, the coordinator of the education department of the prison and custodial staff are involved in the data collection. These involved staff are bound by professional secrecy. Separate trainings concerning the procedure of data collection are specifically organised for the nursing staff in Luxembourg (i.e. interviews and surveys cf. 2.2. Data collection). It involves (i) the procedure of informing participants about the study and its objectives, (ii) the procedure of conducting the survey and (iii) practical arrangements to conduct the interview, the provision of the written informed consent form, and the interview guide. 2.2 Data collection 2.2.1 Quantitative cross-sectional survey 2.2.1.1 Measures Self-reported data is collected. The data collection of the survey among PLIP is based on the European Model Questionnaire on Drug use in Prisons (EQDP) developed by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) ( 18 ). The questionnaire contains a set of variables that have to be mandatorily included in the survey. This set of variables contains questions about the (i) socio-demographic characteristics, (ii) prison context, (iii) substance use (including alcohol, illicit drugs, prescription drugs that are not prescribed by a doctor, and injecting drug use) outside and inside prison, (iv) health problems that may be related to drug use such as mental health issues, overdoses, infectious diseases or suicide, (v) treatment in prison and (iv) social reintegration (Table 2 ). A few additional topics are optional to integrate in the survey at national level. Table 2 List of mandatory topics included in the survey among PLIP in all participating countries Socio-demographic characteristics Substance use outside and inside prison Year of birth Prevalence of substance use Gender Frequency of use Housing Injecting drug use Household composition Sharing (injection) equipment Employment status Onset of substance use during detention Highest education level Occurrence of overdose Prison context Treatment in prison Prison history Treatment visit Duration of detention Prescription of medication Detention status Drug related treatment Health Availability of interventions Mental health Social reintegration Overdose Housing Infectious diseases Housing conditions Suicide Employment Within the survey, the current detention period is defined as a reference period. A list of 18 substances is covered within the survey including alcohol, cannabis, cocaine, crack, (meth)amphetamine, ecstasy, ketamine, hallucinogens, GHB/GBL, heroine, other opioids, sedatives, inhalants, new psychoactive substances, anabolic steroids and other substances. Individuals are defined as having used any drug when they respond positively to one of the selection questions concerning drug use before or during the current detention period. Accounting for differences in origin of PLIP both across and within countries, the survey is translated in 15 languages, including Lithuanian, Greek (including Greek Cypriot), English, French, German, Dutch, Portuguese, Turkish, Albanian, Russian, Arabic, Italian, Spanish, Polish and Romanian. An overview of the languages used in the specific countries is given in Table 3 . The completion of the survey is estimated to take between 20 and 40 minutes. Table 3 Availability of the survey among PLIP in different language by participating country Participating countries Belgium Cyprus Greece Lithuania Luxembourg Lithuanian x Greek x x English x x x x French x x x German x x Dutch x Portuguese x x Turkish x Albanian x x Russian x x x Arabic x x Italian x Spanish x Polish x Romanian x The prison facility survey is based on the European Facility Survey Questionnaire on Prisons (EFSQP) developed by EMCDDA. This survey among the prison administrations enables to draw a baseline to indicate what interventions exist in the participating prisons over a period of one year. The questionnaire contains questions about the prison characteristics, yearly statistics of the prison population, availability of drug-related interventions or treatment, drug testing, involvement of prison staff within these interventions and quality assurance measures (Table 4 ). This facility survey is made available in the official languages of the countries concerned. These results will be compared afterwards with the responses given through the survey among PLIP. Table 4 List of topics included in the facility survey in the participating countries Prison characteristics Drug tests Name of the prison Performance of drug tests Type of the prison Type of drug tests performed Available sections in the prison Number of people tested Prison population Total number of drug tests Capacity of the prison Number of positive tests by substance Average daily number of people in prison (by age, sex and status) Consequences of a positive drug test Drug-related interventions Prison staff in drug-related interventions Availability of the interventions Type of prison staff involved Capacity of the interventions Number of prison staff involved Number of people accessing the interventions Quality assurance Screening of health related aspects Mechanisms for quality control Drug treatment Trainings about drug-related interventions Total number of people in treatment Contact details Number of people in treatment by substance e-mail address responding prison service 2.2.1.2 Recruitment procedures A non-probability, purposive sampling approach (convenience sample based on self-nomination) is used for the recruitment of PLIP in Luxembourg, Lithuania, Greece and Cyprus (Table 5 ). In Belgium, a random sampling based on the list of PLIP present in the participating prisons is executed. However, it is not possible to involve all prisons in Belgium. The number of prisons in which data can be collected is restricted due to resource and time restrictions. Therefore, a choice was made to include at least one prison per region. In line with the approval of the prison administration, a brief introduction about the research project is provided orally to the eligible PLIP by the researchers or the prison staff in Belgium, Cyprus, Greece and Lithuania. In Luxembourg, PLIP are informed by flyers and posters that were distributed to all PLIP a few days before the data collection took place. Both approaches allows eligible PLIP to ask questions before their actual decision to participate in the study. In Cyprus, Greece, Luxembourg and Lithuania, the self-administered questionnaire is filled out in a pencil-paper format. In Belgium the survey is administrated using an offline survey app on electronic tablets (Sydney, 2022). The availability of electronic tablets creates more confidentiality and more autonomy because questions are presented gradually on the screen and automatic consistency checks are executed whereby inconsistencies could be corrected immediately. The questionnaire is made available either individually in each cell (in Luxembourg), in a separate private room for sequential individual completion (in Greece) or in groups of 5 to 15 people in a separate room for individual completion (in Belgium, Cyprus and Lithuania). The EU General Data Protection Regulation is addressed. Confidential and voluntary participation is guaranteed. Participants of the pencil-paper questionnaires are asked to put the completed questionnaire in one envelope, to close the envelope and to deliver it in one box. In addition, they have to put the informed consent form in another envelope, to close this envelope as well and to deliver it separately in a different box. In Belgium and Greece, structured face-to-face interviews are conducted in case the PLIP have issues with reading or in case difficulties to fill out the questionnaire are observed. In Greece, mediators translate the questions orally in case PLIP are not familiar with the Greek language. In Cyprus, Belgium, Greece and Lithuania, all respondents who complete the survey get an incentive. In Luxembourg, this permission is not obtained. Table 5 Recruitment procedure of the survey among PLIP by participating country Participating countries Belgium Cyprus Greece Lithuania Luxembourg Non-probability sampling x x x x Random sampling x Availability of researchers for further questions x x x x x Pencil-paper survey x x x x Digital survey x Survey completion in cell x Survey completion in separate room x x x x Guarantee of confidential and voluntary participation x x x x x The prison facility survey is available for each prison in which also PLIP are involved in the study. This facility survey is made available either digitally or on paper format. Only one survey per prison have to be filled out. The survey can be completed by several staff members accordingly to their expertise. The questions in both quantitative surveys are not mandatory which allow the respondents to skip one or more questions. 2.2.2 Qualitative semi-structured interviews 2.2.2.1 Measures The qualitative interviews in the participating countries are conducted by a common semi-structured interview guide. Topics are designed to explore the individual perspectives and needs of the participants, including health, psycho-social wellbeing, substance use before imprisonment, substance use during imprisonment, motives of use and the context of substance use, drug-related needs and opportunities to get support/treatment. The interviews are planned to last about 1 hour. The interviews can be conducted in a (limited) number of languages, according to the interviewers’ linguistic competences (Dutch, English, French, German, Greece and Lithuanian). 2.2.2.2 Recruitment procedure In all countries only PLIP who complete the survey and who reports drug use during imprisonment are invited to participate to a semi-structured interview. The recruitment of recently released PWUD (< one year) occurs in Belgium and in Luxembourg by flyers and posters in low-threshold community care initiatives. In Lithuania, Greece and Cyprus, NGO’s and probation workers are involved as mediators to bring PWUD in contact with the research teams. The interview is scheduled on a day and time convenient to the participant. Both PLIP and PWUD have the opportunity to ask further questions before their inclusion in the interview. In Belgium, the interviews are recorded, whereas in the remaining countries voice recordings are not allowed and the researchers have to take notes during the face-to-face in-depth interviews. In accordance with the survey, all respondents, except in Luxembourg, receive an incentive. 2.3 Analytic plan 2.3.1 Quantitative data analysis Each participating country enters the national data in a national database in order to import the data for further cleaning and analysing at country level. For the pencil-paper questionnaires, the responses are first compiled by scanning the survey forms or by manually entering the responses to the questions into a national database ( 19 ). In the database, each record corresponds to an individual respondent. Quality checks to inspect for multiple and partial responses are performed, yielding higher quality data ( 18 ). Based on primary outcome measures, the questions about ever drug use outside and inside prison are defined as key questions. In case respondents do not answer these key questions, the respondent is not taken into account for further data analyses. Consistency checks are conducted. E.g. when some of the answers for the use of specific drugs are missing but at least an answer is given for one of these drugs, we assume that the missing value is ‘never used’. When the prevalence of all these drugs is missing, these answers remain missing. Once the data are cleaned, new variables are created. The data is analysed for the different countries separately. In order to analyse the quantitative data coherently among the different countries, a common codebook is developed and used. No individual respondent can be identified based on the analyses. The location of the prison is not taken into account within the data-analyses. Variables such as age and duration of the detention are aggregated in broader categories. 2.3.2 Analyses of the semi-structured interviews For the qualitative data analyses, the data are first transcribed verbatim in case the in-depth interviews have been audio-recorded (Belgium). In case of the absence of voice recordings, the notes taken during the in-depth interviews are completed immediately after each interview. This is done preferably on the same day in order to minimise recall bias ( 20 ). Based on these transcriptions and notes, the research teams of the different countries use iterative and simultaneous analysis to identify themes and key codes within the data. Comparative analysis and multiple coding are conducted. On this basis a common decision tree is defined. To ensure a high level of inter-coder reliability, the coding structure is designed to be simple and straightforward ( 21 ). These qualitative results are used to interpret and refine the survey findings within the context of lived experiences of participants. This approach is proven effective in generating an understanding of the social dimensions underpinning quantitative outcomes ( 22 , 23 ). 3. Discussion This protocol and rationale of the study is an important contribution to the literature because it provides full study transparency and useful information for researchers who plan to conduct a similar study in the future. To the best of our knowledge, this research is the first to study commonly drug use and related topics among PLIP in 5 different countries within a single methodological framework and time period. The described study protocol target a maximum harmonisation and comparability with respect for the specificities of each country. The triangulation of quantitative and qualitative data increase available evidence on (i) the prevalence of drug use before and during detention, (ii) the harms and needs of PLIP and PWUD regarding health and drug-related problems, and (iii) the interventions targeting them. Consequently, the obtained results can eliminate knowledge gaps and raise awareness on the importance of continued and harmonized monitoring of drug use and health aspects in prison settings in relation to treatment needs ( 24 – 26 ). Appropriate measures should be taken within the prison environment to specifically assure the health and well-being, as well as the social (re)integration and security of PLIP who use drugs. Although in Europe the mean prison density per 100 places is decreasing from 99.1 in 2011 to 84.8 in 2022, overcrowding is still a reality in 10 countries which makes the implementation of social and health related interventions even more difficult in the prison setting ( 3 , 27 , 32 – 38 ). This study provide transversal recommendations for policy and practice that can be implemented among other national communities and countries in Europe. Consequently, it contributes to the improvement of existing prison healthcare programs by triangulating data from the period before, during and after detention. This protocol enables a more effective, innovative and agile approach to the growing complexity of health and drug use among PLIP. Moreover, it increases the preparedness to respond to future challenges and crises in the EU member states ( 39 ). These practices can be a starting point for developing innovative actions within prisons and improve the health situation among countries across Europe. This information is socially significant because prisons present an opportunity to treat drug use and related health needs ( 13 , 27 ). The provision of treatment is associated with a range of positive outcomes which improve both the health who experience detention and the health of the community in which to return. Moreover, this contributes to the equivalence of care which is one of the United Nations’ Standard Minimum Rules for the Treatment of Prisoners, the Nelson Mandela Rules ( 28 ). It is essential to reduce health inequalities within prison and in community. It is well-known that the conditions of data collection in prisons require more adaptability of researchers and prison staff, than equivalent research activities in non-prison environments ( 2 , 29 ). In this European project, the heterogeneity of conditions between the participating countries is caused by specific legal and practical circumstances. Limitations concerning the implementation of the study and the data collection are inevitable. First of all, the unique setting of a prison affects the course of the data collection. Researcher are dependent from the participation of prisons. They have to negotiate the way in which the initial introduction and communication about the research to the respondents occurs. Also little flexibility exist in the timing and setting in which the research takes place (e.g. available rooms, background noise, security checks, respondent availability, etc.). Secondly, the results will not be generalisable due to the convenience sample. A limitation of convenience sampling is that only participants with certain characteristics present themselves to participate (e.g. a more stable psychological situation, a trustful relationship with the health team, a particular interest or sensitivity to the topic). This might result in a sample which do not represent the defined target population. In addition, we can also expect that not all eligible PLIP are reached by the researchers due to work schedules or when PLIP are still sleeping in their cell when approached by the researchers. Moreover, the restrictions of the coronavirus pandemic influenced the composition of the prison population because people with short-term prison sentences were released from prison during this period. Consequently, the proportion of long-term PLIP increased in the daily prison population ( 30 ). Thirdly, even though the survey is translated in several languages and assistance for the respondents who have difficulties to read or write is available in different countries, the researchers cannot avoid that certain eligible people are not able to fill out the questionnaire. The knowledge of certain languages, the level of literacy or perhaps cognitive capacities of the respondents might have an impact on the final results. Consequently the risk of certain selection bias should be taken into account. Fourthly, the study is prone to response bias because of the self-reported nature of the collected data. This can be particularly due to social desirability as the restricted nature of the prison setting is challenging to protect the privacy and confidentiality of participants. Hence, an over- and underestimation risk of certain issues exist ( 25 , 26 ). In some countries this risk might be even bigger due to the fact that the presence of prison staff during the data collection cannot be fully excluded ( 2 ). Fifthly, as the majority of the answers are filled out in paper-pencil format, this might have an impact on the data quality and efficiency. The use of electronic tablets to fill out the survey in prison could only be implemented in one country. It is known that data collection through an electronic devise is more easy to handle which results in fewer errors ( 31 ). Sixthly, recall bias or misinterpretation of the questions might have an impact on the results of the current study. In this respect comparability and generalizability of the results are restricted. Abbreviations PLIP People Living in Prison PWUD People Who Use Drugs EMCDDA European Monitoring Centre for Drugs and Drug Addiction EQDP European Model Questionnaire on Drug use in Prisons EFSQP European Facility Survey Questionnaire on Prisons NGO Non-governmental organisation EU European Union Declarations Ethics approval and consent to participate In each country the planned research activities received the required national ethical approvals. In Lithuania, the Lithuanian bioethics committee was consulted. Confirmation was given that permission of this committee was not mandatory in Lithuania for this study. In Belgium, review and approval is completed by the Commission of medical ethics of the Ghent University hospital (BC-10088). The Committee of Medical Ethics of the University Mental Health, Neurosciences, & Precision Medicine Research Institute gave approval to conduct this study in Greece (1983-23/12/2021). In Cyprus, the Cyprus National Bioethics Committee gave permission (EEBK EΠ 2021.01.171) to perform the study in Cyprus. al number we received is and in Luxembourg, ethics approval was given by the Comité national d’éthique de recherché (202110/03). To participate to the survey and/or the interview, eligible participants were informed about the specific part of the study, the objectives, the data collection procedures, and the confidentiality and data protection rules by the informed consent and they were asked to agree with it. Consent for publication Not applicable. We provided the participants with the information that the study will only publish results on an aggregated level and that we will not publish about individual patient data. Availability of supporting data and materials Further documentation and information that is used or analysed during the current study (such as the questionnaire, the interview guideline, codebook of the database and decision tree) are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding JUST-2019-AG-DRUGS European Commission. The project started in 2021 and has a timespan of three years. Authors' contributions EP took the lead to draft the manuscript. All authors gave input in order to be able to draft the manuscript. NB, RS, AP, IB, AF, JA, KF and HB gave feedback and helped to improve the manuscript. All authors agreed to submit the manuscript. Acknowledgements The research consortium would like to thank the participating prisons, low threshold services and individual participants for their engagement. Without this involvement, it was not possible to conduct this research. 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Auld GW, Diker A, Bock MA, Boushey CJ, Bruhn CM, Cluskey M, et al. Development of a Decision Tree to Determine Appropriateness of NVivo in Analyzing Qualitative Data Sets. J Nutr Educ Behav. 2007;39(1):37–47. Agar M. Toward a Qualitative Epidemiology. Qual Health Res. 2003;13(7):974–86. Lopez AM, Bourgois P, Wenger LD, Lorvick J, Martinez AN, Kral AH. Interdisciplinary mixed methods research with structurally vulnerable populations: Case studies of injection drug users in San Francisco. Int J Drug Policy. 2013;24(2):101–9. Kilpeläinen K, Koponen P, Tolonen H, Koskinen S, Borodulin K, Gissler M. From monitoring to action: utilising health survey data in national policy development and implementation in Finland. Arch Public Health. 2019;77(1):48. Bukten A, Lund IO, Kinner SA, Rognli EB, Havnes IA, Muller AE, et al. Factors associated with drug use in prison – results from the Norwegian offender mental health and addiction (NorMA) study. Health Justice. 2020;8(1):10. Carpentier C, Royuela L, Montanari L, Davis P. The global epidemiology of drug use in prison. Drug use in prisoners: Epidemiology, implications, and policy responses. New York, NY, US: Oxford University Press; 2018. pp. 17–41. Fazel S, Yoon IA, Hayes AJ. Substance use disorders in prisoners: an updated systematic review and meta-regression analysis in recently incarcerated men and women: Substance use disorder in prisoners. Addiction. 2017;112(10):1725–39. United Nations General Assembly. Resolution adopted by the General Assembly on 17 December 2015 [on the report of the Third Committee (A/70/490)] 70/175. United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules) [Internet]. 2016 [cited 2024 Apr 26]. https://undocs.org/Home/Mobile?FinalSymbol=A%2FRES%2F70%2F175&Language=E&DeviceType=Desktop&LangRequested=False Carpentier C, Royuela L, Noor A, Hedrich D. Ten Years of Monitoring Illicit Drug Use in Prison Populations in Europe: Issues and Challenges: Ten Years of Monitoring Illicit Drug Use in Prison Populations in Europe. Howard J Crim Justice. 2012;51(1):37–66. Rautanen M, Harald K, Tyni S. Health and Wellbeing of Prisoners 2023: The Wattu IV Prison Population Study Finland [Internet]. Finnish Institute for Health and Welfare = Terveyden ja hyvinvoinnin laitos THL; 2024 [cited 2024 Apr 29]. https://www.julkari.fi/handle/10024/148796 Zeleke AA, Worku AG, Demissie A, Otto-Sobotka F, Wilken M, Lipprandt M, et al. a Public Health Survey in a Health and Demographic Surveillance Site, Ethiopia: Randomized Controlled Crossover Health Care Information Technology Evaluation. JMIR Mhealth Uhealth. 2019;7(2):e10995. Evaluation of Electronic and Paper-Pen Data Capturing Tools for Data Quality in. Aebi MF, Burkhardt C, Tiago M. SPACE I - Council of Europe Annual Penal Statistics: Prison populations. Survey 2015. Strassbourg: Council of Europe; 2017. Aebi MF, Tiago M, Kolopp LB. SPACE I - Council of Europe Annual Penal Statistics: Prison populations. Survey 2016. Strassbourg: Council of Europe; 2018. Aebi MF, Delgrande N. SPACE I - Council of Europe Annual Penal Statistics: Prison populations. Survey 2011. Strassbourg: Council of Europe; 2013. Aebi MF, Delgrande N. SPACE I - Council of Europe Annual Penal Statistics: Prison populations. Survey 2012. Strassbourg: Council of Europe; 2014. Aebi MF, Delgrande N. SPACE I - Council of Europe Annual Penal Statistics: Prison populations. Survey 2013. Strassbourg: Council of Europe; 2015. Aebi MF, Tiago MM. Prisons and Prisoners in Europe 2018: Key Findings of the SPACE I report. Strassbourg: Council of Europe and University of Lausanne; 2019. Aebi MF, Tiago MM. Prisons and Prisoners in Europe 2020: Key Findings of the SPACE I report. Strassbourg: Council of Europe and University of Lausanne; 2021. Council of the European Union. EU drug strategy 2020–2025 [Internet]. 2020 [cited 2022 Aug 10]. https://www.emcdda.europa.eu/system/files/attachments/13642/ Council%20of%20the%20EU%20%282020%29%20EU%20Drugs%20Strategy%202021-25.pdf Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4822245","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Study protocol","associatedPublications":[],"authors":[{"id":343367385,"identity":"d9b371ee-f3e3-4cd7-8462-f2d015cca63b","order_by":0,"name":"Els 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(Belgium)","correspondingAuthor":false,"prefix":"","firstName":"Lies","middleName":"","lastName":"Gremeaux","suffix":""},{"id":343367402,"identity":"20590bcb-3e98-4682-8e21-3dbe375b1d0f","order_by":17,"name":"Nicky Dirkx","email":"","orcid":"","institution":"University College Ghent","correspondingAuthor":false,"prefix":"","firstName":"Nicky","middleName":"","lastName":"Dirkx","suffix":""},{"id":343367403,"identity":"9bfacfc2-b663-40e9-8f2f-4fc1cdf2dd4a","order_by":18,"name":"Karin De Ridder","email":"","orcid":"","institution":"Sciensano (Belgium)","correspondingAuthor":false,"prefix":"","firstName":"Karin","middleName":"","lastName":"De Ridder","suffix":""},{"id":343367404,"identity":"c3f3d7bc-699a-4769-b5de-0b3a39616d49","order_by":19,"name":"Ioanna Yiasemi","email":"","orcid":"","institution":"Cyprus National Addictions Authority","correspondingAuthor":false,"prefix":"","firstName":"Ioanna","middleName":"","lastName":"Yiasemi","suffix":""},{"id":343367405,"identity":"bfead8c7-acbe-428f-8d5f-89b120663fca","order_by":20,"name":"Josefina Mavrou","email":"","orcid":"","institution":"Cyprus National Addictions Authority","correspondingAuthor":false,"prefix":"","firstName":"Josefina","middleName":"","lastName":"Mavrou","suffix":""}],"badges":[],"createdAt":"2024-07-29 13:09:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4822245/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4822245/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13690-024-01405-2","type":"published","date":"2024-10-08T15:58:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":66597301,"identity":"40519b05-4032-4bc6-9810-ee20a002e911","added_by":"auto","created_at":"2024-10-14 16:09:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":749230,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4822245/v1/6783568c-a261-43e5-abbf-67b0d7b86945.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"PRS-20: a protocol for identifying the needs related to drug use, health and social (re)integration of people living in prison within five European countries","fulltext":[{"header":"Contributions to the literature","content":"\u003cul\u003e\n \u003cli\u003eThis study protocol addresses the critical and often overlooked issue of health and drug use among people living in prison. Compared to the general population, people living in prison experience substantially higher rates of poor (mental) health, necessitating extensive research and targeted interventions.\u003c/li\u003e\n \u003cli\u003eGiven the overlapping risk factors for delinquency and drug use, this study protocol addresses a pressing public health need.\u003c/li\u003e\n \u003cli\u003eThis study protocol is designed to provide a robust framework that can be used by other researchers in order to conduct similar studies, offering flexibility while maintaining methodological consistency.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"1. Background","content":"\u003cp\u003eThe estimated number of people living in prison (PLIP) in Europe is 1,243,714 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Overall, an increased risk exists to start drug use or to start the use of different substances once people are admitted to prison. The lifetime prevalence of illicit drug use of people living in prisons (PLIP) prior to prison is on average 61% in Europe (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Drug-related offences are the most common reason for which PLIP are sentenced to prison (excluding other unspecified offences) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Worldwide, it is estimated that 23.8% (95% CI 21.0\u0026ndash;26.7) of people meet diagnostic criteria for alcohol use disorder on arrival to prison, and 38.9% (31.5\u0026ndash;46.2) for drug use disorder. Half of PLIP with major depression or psychotic illness also have a comorbid substance use disorder (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Cannabis is most frequently reported, followed by powder cocaine. Nevertheless, some studies report the highest prevalence of use for crack cocaine among newly admitted PLIP (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCompared to the general population, PLIP experience substantially more poor (mental) health issues such as cognitive impairments, (non-)communicable diseases and drug use (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). More PLIP have experience with injecting drug use compared to people without a prison history (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Delinquency and drug use have many risk factors in common, including social vulnerability, economic deprivation, school dropout, unemployment, child neglect and suicide (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Consequently, these people have health care needs that require specific attention when entering prison, during detention and after release. Providing continuity of care as people move between prison and the community is key in achieving sustainable and effective treatment outcomes, and it is likely to have a significant impact on public health within the broader society (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Accordingly, prisons and the criminal justice system are indispensable in the chain of drug-related interventions including prevention and treatment (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the abovementioned context, significant differences in prevalence by country exist. Therefore a need for additional research about health related needs and intervention among people in prison in European countries still exist (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Consequently, the current study protocol is developed within 5 different countries, namely Belgium, Cyprus, Greece, Lithuania and Luxembourg. As comparability of different studies is challenging, the aim is to harmonise the data collection about drug use among PLIP with respect to the specific characteristics of the different countries. In addition, health and safety related needs during detention and the use of certain services are studied. This study protocol enhances the monitoring and research in prisons. It generate knowledge which is essential to inform about drug use and the necessary interventions in prisons to overcome drug use and reduce related morbidity or mortality. Hence, the study improves the knowledge about coverage and accessibility of prevention and treatment responses which is essential to design planning instruments for implementing evidence-based drug-related interventions inside prisons in relation to social (re)integration. The study has started in 2021 and has a timespan of three years.\u003c/p\u003e"},{"header":"2. Methods/design","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe current study protocol consists of a multicentre mixed method design to be commonly conducted in Belgium, Cyprus, Greece, Lithuania and Luxembourg. Qualitative and quantitative data are collected in order to generate complementary and comprehensive results. The integration process of this design occurs during data collection, analysis and the presentation of results (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The study comprises three different components. One component consists of a cross-sectional survey among PLIP. A second component consists of qualitative semi-structured face-to-face interviews among PLIP and people who have been recently released from prison. A third component, which is the prison facility survey, gathers data about service provision through a quantitative survey addressed to the prison administration.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003e2.1.1 Setting and target population\u003c/h2\u003e \u003cp\u003ePLIP have health care needs that require specific attention when entering prison, during detention and after release (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). For this reason, both people in community and in prisons are targeted within this study protocol. Belgium and Greece are the largest countries involved in the study, followed by Lithuania, Cyprus and Luxembourg (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The number of prisons ranges in the participating countries from 1 in Cyprus to 35 in Greece, respectively. The size of the prison population ranges from about 560 in Luxemburg to about 11,200 in Greece. The lowest prison rate per 10,000 population is observed in Cyprus (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) and the highest in Lithuania (186). The prison density, which is the ratio between the total number of PLIP and the total capacity of prisons in a country, is the lowest in Lithuania and the highest in Greece (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNumber of prisons and total population in the participating countries in 2021\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral population\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN Prisons\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrison population\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrison population rate per 100,000 inhabitants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePrison density per 100 places\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelgium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11,522,440\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10,374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e108.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCyprus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e888,005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e110.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreece\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10,718,565\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11,266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e114.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLithuania\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,794,090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5,188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e72.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLuxembourg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e626,108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e78.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eThe mean age of the PLIP in the different countries varies between 37 and 39 years old and 95% of the prison population is male, which is in line with the average age and gender distribution in the European prisons (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). As data is collected within prisons and in community in order to reach the research objectives, two target groups are identified, namely PLIP and people recently released from prison:\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003col style=\"list-style-type:lower-alpha;\"\u003e\n \u003cspan\u003e \u003cli\u003e \u003cp\u003ePLIP are defined as every person aged 18 or older serving a sentence or being on remand in prison in the participating countries during the period of the data collection. This definition excludes (i) juveniles, (ii) people who committed a crime and held in other institutions than penal institutions or those for whom an alternative to imprisonment is applied, (iii) PLIP with mental illness who have committed a crime but who are deemed to have not being responsible for their behaviour and (iv) PLIP in isolation for health reasons (e.g. due to Covid-19) or security issues. Consequently, juvenile detention centres and open prisons are excluded from this study. In addition, some participating countries also excluded (i) illiterate PLIP (in Luxembourg and Cyprus), (ii) people sentenced to life imprisonment (in Cyprus) and (iii) people sentenced because of a sex offences (in Cyprus) due to their difficult accessibility and safety reasons.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePeople recently released from prison are involved in the qualitative part of the research to better understand the impact of drug use, health and security related needs during detention and on reintegration. The inclusion criteria are i) being \u0026ge;\u0026thinsp;18 years of age, ii) being released from prison within the last 12 months and iii) having used drugs. Exclusion criteria were language limitations and mental or cognitive impairments that would impede participation in an interview. A convenience sample of 10 participants per country is defined.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe corresponding sample size of PLIP is estimated within the framework of the quantitative data collection. It is determined for every participating country separately according to the prison population size of 31st of January of 2021 as described above in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. In addition to the prison population size, also a margin of error of 5% and the confidence interval of 95% is taken into account (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). This results in a sample size calculation of 228 respondents for Luxembourg, 230 respondents for Cyprus, 358 respondents for Lithuania, 372 respondents for Greece and 371 respondents for Belgium.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.1.2 Stakeholders involvement\u003c/h2\u003e \u003cp\u003eIn each country, partnerships are established with both prisons and low-threshold community care initiatives in order to recruit respondents. Therefore, individual informative meetings between the researchers on the one hand and the prisons and low-threshold community care initiatives on the other hand are organised to explain the data collection tools and methodologies (survey and interview guidelines). The detailed procedures to guarantee confidentiality and data protection of the participants are discussed as well. A safe context during data collection is the first priority in order to avoid both refusals and socially desirable answers due to fear of retaliation. Therefore any kind of possible pressure and interference of third parties, e.g. prison staff, are prevented to the maximum extent possible. In this respect it is agreed that only aggregated data and final results can be shared with the stakeholders. In Lithuania and Belgium the data collection is fully performed by independent researchers. In Luxembourg, the survey in prison is conducted by nursing staff. In Greece, a collaboration is established between independent researchers and social care services of the prisons. In Cyprus, the coordinator of the education department of the prison and custodial staff are involved in the data collection. These involved staff are bound by professional secrecy. Separate trainings concerning the procedure of data collection are specifically organised for the nursing staff in Luxembourg (i.e. interviews and surveys cf. 2.2. Data collection). It involves (i) the procedure of informing participants about the study and its objectives, (ii) the procedure of conducting the survey and (iii) practical arrangements to conduct the interview, the provision of the written informed consent form, and the interview guide.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Data collection\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Quantitative cross-sectional survey\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section4\"\u003e \u003ch2\u003e2.2.1.1 Measures\u003c/h2\u003e \u003cp\u003eSelf-reported data is collected. The data collection of the survey among PLIP is based on the European Model Questionnaire on Drug use in Prisons (EQDP) developed by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The questionnaire contains a set of variables that have to be mandatorily included in the survey. This set of variables contains questions about the (i) socio-demographic characteristics, (ii) prison context, (iii) substance use (including alcohol, illicit drugs, prescription drugs that are not prescribed by a doctor, and injecting drug use) outside and inside prison, (iv) health problems that may be related to drug use such as mental health issues, overdoses, infectious diseases or suicide, (v) treatment in prison and (iv) social reintegration (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A few additional topics are optional to integrate in the survey at national level.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eList of mandatory topics included in the survey among PLIP in all participating countries\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocio-demographic characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubstance use outside and inside prison\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear of birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrevalence of substance use\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency of use\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInjecting drug use\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold composition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSharing (injection) equipment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnset of substance use during detention\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest education level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOccurrence of overdose\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrison context\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTreatment in prison\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrison history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTreatment visit\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of detention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrescription of medication\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDetention status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDrug related treatment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAvailability of interventions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSocial reintegration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverdose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfectious diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousing conditions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuicide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWithin the survey, the current detention period is defined as a reference period. A list of 18 substances is covered within the survey including alcohol, cannabis, cocaine, crack, (meth)amphetamine, ecstasy, ketamine, hallucinogens, GHB/GBL, heroine, other opioids, sedatives, inhalants, new psychoactive substances, anabolic steroids and other substances. Individuals are defined as having used any drug when they respond positively to one of the selection questions concerning drug use before or during the current detention period. Accounting for differences in origin of PLIP both across and within countries, the survey is translated in 15 languages, including Lithuanian, Greek (including Greek Cypriot), English, French, German, Dutch, Portuguese, Turkish, Albanian, Russian, Arabic, Italian, Spanish, Polish and Romanian. An overview of the languages used in the specific countries is given in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The completion of the survey is estimated to take between 20 and 40 minutes.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAvailability of the survey among PLIP in different language by participating country\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eParticipating countries\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelgium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCyprus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGreece\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLithuania\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLuxembourg\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLithuanian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreek\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnglish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrench\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGerman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDutch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePortuguese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTurkish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbanian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRussian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArabic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItalian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpanish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRomanian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe prison facility survey is based on the European Facility Survey Questionnaire on Prisons (EFSQP) developed by EMCDDA. This survey among the prison administrations enables to draw a baseline to indicate what interventions exist in the participating prisons over a period of one year. The questionnaire contains questions about the prison characteristics, yearly statistics of the prison population, availability of drug-related interventions or treatment, drug testing, involvement of prison staff within these interventions and quality assurance measures (Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). This facility survey is made available in the official languages of the countries concerned. These results will be compared afterwards with the responses given through the survey among PLIP.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eList of topics included in the facility survey in the participating countries\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrison characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDrug tests\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eName of the prison\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerformance of drug tests\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of the prison\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType of drug tests performed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvailable sections in the prison\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of people tested\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrison population\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal number of drug tests\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCapacity of the prison\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of positive tests by substance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage daily number of people in prison\u003c/p\u003e \u003cp\u003e(by age, sex and status)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsequences of a positive drug test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrug-related interventions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePrison staff in drug-related interventions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvailability of the interventions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType of prison staff involved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCapacity of the interventions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of prison staff involved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of people accessing the interventions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eQuality assurance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScreening of health related aspects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMechanisms for quality control\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrug treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrainings about drug-related interventions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal number of people in treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eContact details\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of people in treatment by substance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ee-mail address responding prison service\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section4\"\u003e \u003ch2\u003e2.2.1.2 Recruitment procedures\u003c/h2\u003e \u003cp\u003eA non-probability, purposive sampling approach (convenience sample based on self-nomination) is used for the recruitment of PLIP in Luxembourg, Lithuania, Greece and Cyprus (Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). In Belgium, a random sampling based on the list of PLIP present in the participating prisons is executed. However, it is not possible to involve all prisons in Belgium. The number of prisons in which data can be collected is restricted due to resource and time restrictions. Therefore, a choice was made to include at least one prison per region. In line with the approval of the prison administration, a brief introduction about the research project is provided orally to the eligible PLIP by the researchers or the prison staff in Belgium, Cyprus, Greece and Lithuania. In Luxembourg, PLIP are informed by flyers and posters that were distributed to all PLIP a few days before the data collection took place. Both approaches allows eligible PLIP to ask questions before their actual decision to participate in the study. In Cyprus, Greece, Luxembourg and Lithuania, the self-administered questionnaire is filled out in a pencil-paper format. In Belgium the survey is administrated using an offline survey app on electronic tablets (Sydney, 2022). The availability of electronic tablets creates more confidentiality and more autonomy because questions are presented gradually on the screen and automatic consistency checks are executed whereby inconsistencies could be corrected immediately. The questionnaire is made available either individually in each cell (in Luxembourg), in a separate private room for sequential individual completion (in Greece) or in groups of 5 to 15 people in a separate room for individual completion (in Belgium, Cyprus and Lithuania). The EU General Data Protection Regulation is addressed. Confidential and voluntary participation is guaranteed. Participants of the pencil-paper questionnaires are asked to put the completed questionnaire in one envelope, to close the envelope and to deliver it in one box. In addition, they have to put the informed consent form in another envelope, to close this envelope as well and to deliver it separately in a different box. In Belgium and Greece, structured face-to-face interviews are conducted in case the PLIP have issues with reading or in case difficulties to fill out the questionnaire are observed. In Greece, mediators translate the questions orally in case PLIP are not familiar with the Greek language. In Cyprus, Belgium, Greece and Lithuania, all respondents who complete the survey get an incentive. In Luxembourg, this permission is not obtained.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRecruitment procedure of the survey among PLIP by participating country\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eParticipating countries\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelgium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCyprus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGreece\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLithuania\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLuxembourg\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-probability sampling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRandom sampling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvailability of researchers for further questions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePencil-paper survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDigital survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvey completion in cell\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvey completion in separate room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuarantee of confidential and voluntary participation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe prison facility survey is available for each prison in which also PLIP are involved in the study. This facility survey is made available either digitally or on paper format. Only one survey per prison have to be filled out. The survey can be completed by several staff members accordingly to their expertise. The questions in both quantitative surveys are not mandatory which allow the respondents to skip one or more questions.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Qualitative semi-structured interviews\u003c/h2\u003e \u003cdiv id=\"Sec11\" class=\"Section4\"\u003e \u003ch2\u003e2.2.2.1 Measures\u003c/h2\u003e \u003cp\u003eThe qualitative interviews in the participating countries are conducted by a common semi-structured interview guide. Topics are designed to explore the individual perspectives and needs of the participants, including health, psycho-social wellbeing, substance use before imprisonment, substance use during imprisonment, motives of use and the context of substance use, drug-related needs and opportunities to get support/treatment. The interviews are planned to last about 1 hour. The interviews can be conducted in a (limited) number of languages, according to the interviewers\u0026rsquo; linguistic competences (Dutch, English, French, German, Greece and Lithuanian).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section4\"\u003e \u003ch2\u003e2.2.2.2 Recruitment procedure\u003c/h2\u003e \u003cp\u003eIn all countries only PLIP who complete the survey and who reports drug use during imprisonment are invited to participate to a semi-structured interview. The recruitment of recently released PWUD (\u0026lt;\u0026thinsp;one year) occurs in Belgium and in Luxembourg by flyers and posters in low-threshold community care initiatives. In Lithuania, Greece and Cyprus, NGO\u0026rsquo;s and probation workers are involved as mediators to bring PWUD in contact with the research teams. The interview is scheduled on a day and time convenient to the participant. Both PLIP and PWUD have the opportunity to ask further questions before their inclusion in the interview. In Belgium, the interviews are recorded, whereas in the remaining countries voice recordings are not allowed and the researchers have to take notes during the face-to-face in-depth interviews. In accordance with the survey, all respondents, except in Luxembourg, receive an incentive.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Analytic plan\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Quantitative data analysis\u003c/h2\u003e \u003cp\u003eEach participating country enters the national data in a national database in order to import the data for further cleaning and analysing at country level. For the pencil-paper questionnaires, the responses are first compiled by scanning the survey forms or by manually entering the responses to the questions into a national database (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In the database, each record corresponds to an individual respondent. Quality checks to inspect for multiple and partial responses are performed, yielding higher quality data (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Based on primary outcome measures, the questions about ever drug use outside and inside prison are defined as key questions. In case respondents do not answer these key questions, the respondent is not taken into account for further data analyses. Consistency checks are conducted. E.g. when some of the answers for the use of specific drugs are missing but at least an answer is given for one of these drugs, we assume that the missing value is \u0026lsquo;never used\u0026rsquo;. When the prevalence of all these drugs is missing, these answers remain missing. Once the data are cleaned, new variables are created. The data is analysed for the different countries separately. In order to analyse the quantitative data coherently among the different countries, a common codebook is developed and used. No individual respondent can be identified based on the analyses. The location of the prison is not taken into account within the data-analyses. Variables such as age and duration of the detention are aggregated in broader categories.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 Analyses of the semi-structured interviews\u003c/h2\u003e \u003cp\u003eFor the qualitative data analyses, the data are first transcribed verbatim in case the in-depth interviews have been audio-recorded (Belgium). In case of the absence of voice recordings, the notes taken during the in-depth interviews are completed immediately after each interview. This is done preferably on the same day in order to minimise recall bias (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Based on these transcriptions and notes, the research teams of the different countries use iterative and simultaneous analysis to identify themes and key codes within the data. Comparative analysis and multiple coding are conducted. On this basis a common decision tree is defined. To ensure a high level of inter-coder reliability, the coding structure is designed to be simple and straightforward (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). These qualitative results are used to interpret and refine the survey findings within the context of lived experiences of participants. This approach is proven effective in generating an understanding of the social dimensions underpinning quantitative outcomes (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eThis protocol and rationale of the study is an important contribution to the literature because it provides full study transparency and useful information for researchers who plan to conduct a similar study in the future. To the best of our knowledge, this research is the first to study commonly drug use and related topics among PLIP in 5 different countries within a single methodological framework and time period. The described study protocol target a maximum harmonisation and comparability with respect for the specificities of each country. The triangulation of quantitative and qualitative data increase available evidence on (i) the prevalence of drug use before and during detention, (ii) the harms and needs of PLIP and PWUD regarding health and drug-related problems, and (iii) the interventions targeting them. Consequently, the obtained results can eliminate knowledge gaps and raise awareness on the importance of continued and harmonized monitoring of drug use and health aspects in prison settings in relation to treatment needs (\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Appropriate measures should be taken within the prison environment to specifically assure the health and well-being, as well as the social (re)integration and security of PLIP who use drugs. Although in Europe the mean prison density per 100 places is decreasing from 99.1 in 2011 to 84.8 in 2022, overcrowding is still a reality in 10 countries which makes the implementation of social and health related interventions even more difficult in the prison setting (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan additionalcitationids=\"CR33 CR34 CR35 CR36 CR37\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). This study provide transversal recommendations for policy and practice that can be implemented among other national communities and countries in Europe. Consequently, it contributes to the improvement of existing prison healthcare programs by triangulating data from the period before, during and after detention. This protocol enables a more effective, innovative and agile approach to the growing complexity of health and drug use among PLIP. Moreover, it increases the preparedness to respond to future challenges and crises in the EU member states (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). These practices can be a starting point for developing innovative actions within prisons and improve the health situation among countries across Europe.\u003c/p\u003e \u003cp\u003eThis information is socially significant because prisons present an opportunity to treat drug use and related health needs (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The provision of treatment is associated with a range of positive outcomes which improve both the health who experience detention and the health of the community in which to return. Moreover, this contributes to the equivalence of care which is one of the United Nations\u0026rsquo; Standard Minimum Rules for the Treatment of Prisoners, the Nelson Mandela Rules (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). It is essential to reduce health inequalities within prison and in community.\u003c/p\u003e \u003cp\u003eIt is well-known that the conditions of data collection in prisons require more adaptability of researchers and prison staff, than equivalent research activities in non-prison environments (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). In this European project, the heterogeneity of conditions between the participating countries is caused by specific legal and practical circumstances. Limitations concerning the implementation of the study and the data collection are inevitable. First of all, the unique setting of a prison affects the course of the data collection. Researcher are dependent from the participation of prisons. They have to negotiate the way in which the initial introduction and communication about the research to the respondents occurs. Also little flexibility exist in the timing and setting in which the research takes place (e.g. available rooms, background noise, security checks, respondent availability, etc.). Secondly, the results will not be generalisable due to the convenience sample. A limitation of convenience sampling is that only participants with certain characteristics present themselves to participate (e.g. a more stable psychological situation, a trustful relationship with the health team, a particular interest or sensitivity to the topic). This might result in a sample which do not represent the defined target population. In addition, we can also expect that not all eligible PLIP are reached by the researchers due to work schedules or when PLIP are still sleeping in their cell when approached by the researchers. Moreover, the restrictions of the coronavirus pandemic influenced the composition of the prison population because people with short-term prison sentences were released from prison during this period. Consequently, the proportion of long-term PLIP increased in the daily prison population (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Thirdly, even though the survey is translated in several languages and assistance for the respondents who have difficulties to read or write is available in different countries, the researchers cannot avoid that certain eligible people are not able to fill out the questionnaire. The knowledge of certain languages, the level of literacy or perhaps cognitive capacities of the respondents might have an impact on the final results. Consequently the risk of certain selection bias should be taken into account. Fourthly, the study is prone to response bias because of the self-reported nature of the collected data. This can be particularly due to social desirability as the restricted nature of the prison setting is challenging to protect the privacy and confidentiality of participants. Hence, an over- and underestimation risk of certain issues exist (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In some countries this risk might be even bigger due to the fact that the presence of prison staff during the data collection cannot be fully excluded (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Fifthly, as the majority of the answers are filled out in paper-pencil format, this might have an impact on the data quality and efficiency. The use of electronic tablets to fill out the survey in prison could only be implemented in one country. It is known that data collection through an electronic devise is more easy to handle which results in fewer errors (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Sixthly, recall bias or misinterpretation of the questions might have an impact on the results of the current study. In this respect comparability and generalizability of the results are restricted.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePLIP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePeople Living in Prison\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePWUD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePeople Who Use Drugs\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEMCDDA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEuropean Monitoring Centre for Drugs and Drug Addiction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEQDP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEuropean Model Questionnaire on Drug use in Prisons\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEFSQP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEuropean Facility Survey Questionnaire on Prisons\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNGO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNon-governmental organisation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEuropean Union\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eEthics approval and consent to participate\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eIn each country the planned research activities received the required national ethical approvals. In Lithuania, the Lithuanian bioethics committee was consulted. Confirmation was given that permission of this committee was not mandatory in Lithuania for this study. In Belgium, review and approval is completed by the Commission of medical ethics of the Ghent University hospital (BC-10088). The Committee of Medical Ethics of the University Mental Health, Neurosciences, \u0026amp; Precision Medicine Research Institute gave approval to conduct this study in Greece (1983-23/12/2021). In Cyprus, the Cyprus National Bioethics Committee gave permission (EEBK E\u0026Pi; 2021.01.171) to perform the study in Cyprus. al number we received is and in Luxembourg, ethics approval was given by the Comit\u0026eacute; national d\u0026rsquo;\u0026eacute;thique de recherch\u0026eacute; (202110/03).\u003c/p\u003e\n\u003cp\u003eTo participate to the survey and/or the interview, eligible participants were informed about the specific part of the study, the objectives, the data collection procedures, and the confidentiality and data protection rules by the informed consent and they were asked to agree with it.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent for publication\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. We provided the participants with the information that the study will only publish results on an aggregated level and that we will not publish about individual patient data.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAvailability of supporting data and materials\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eFurther documentation and information that is used or analysed during the current study (such as the questionnaire, the interview guideline, codebook of the database and decision tree) are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCompeting interests\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eJUST-2019-AG-DRUGS European Commission.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe project started in 2021 and has a timespan of three years.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthors\u0026apos; contributions\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eEP took the lead to draft the manuscript. All authors gave input in order to be able to draft the manuscript. NB, RS, AP, IB, AF, JA, KF and HB gave feedback and helped to improve the manuscript. All authors agreed to submit the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAcknowledgements\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe research consortium would like to thank the participating prisons, low threshold services and individual participants for their engagement. Without this involvement, it was not possible to conduct this research.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUNODC. 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Health Justice. 2020;8(1):10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarpentier C, Royuela L, Montanari L, Davis P. The global epidemiology of drug use in prison. Drug use in prisoners: Epidemiology, implications, and policy responses. New York, NY, US: Oxford University Press; 2018. pp. 17\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFazel S, Yoon IA, Hayes AJ. Substance use disorders in prisoners: an updated systematic review and meta-regression analysis in recently incarcerated men and women: Substance use disorder in prisoners. Addiction. 2017;112(10):1725\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUnited Nations General Assembly. Resolution adopted by the General Assembly on 17 December 2015 [on the report of the Third Committee (A/70/490)] 70/175. 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Howard J Crim Justice. 2012;51(1):37\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRautanen M, Harald K, Tyni S. Health and Wellbeing of Prisoners 2023: The Wattu IV Prison Population Study Finland [Internet]. Finnish Institute for Health and Welfare\u0026thinsp;=\u0026thinsp;Terveyden ja hyvinvoinnin laitos THL; 2024 [cited 2024 Apr 29]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.julkari.fi/handle/10024/148796\u003c/span\u003e\u003cspan address=\"https://www.julkari.fi/handle/10024/148796\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZeleke AA, Worku AG, Demissie A, Otto-Sobotka F, Wilken M, Lipprandt M, et al. a Public Health Survey in a Health and Demographic Surveillance Site, Ethiopia: Randomized Controlled Crossover Health Care Information Technology Evaluation. JMIR Mhealth Uhealth. 2019;7(2):e10995. Evaluation of Electronic and Paper-Pen Data Capturing Tools for Data Quality in.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAebi MF, Burkhardt C, Tiago M. SPACE I - Council of Europe Annual Penal Statistics: Prison populations. Survey 2015. Strassbourg: Council of Europe; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAebi MF, Tiago M, Kolopp LB. SPACE I - Council of Europe Annual Penal Statistics: Prison populations. Survey 2016. Strassbourg: Council of Europe; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAebi MF, Delgrande N. SPACE I - Council of Europe Annual Penal Statistics: Prison populations. Survey 2011. Strassbourg: Council of Europe; 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAebi MF, Delgrande N. SPACE I - Council of Europe Annual Penal Statistics: Prison populations. Survey 2012. Strassbourg: Council of Europe; 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAebi MF, Delgrande N. SPACE I - Council of Europe Annual Penal Statistics: Prison populations. Survey 2013. Strassbourg: Council of Europe; 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAebi MF, Tiago MM. Prisons and Prisoners in Europe 2018: Key Findings of the SPACE I report. Strassbourg: Council of Europe and University of Lausanne; 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAebi MF, Tiago MM. Prisons and Prisoners in Europe 2020: Key Findings of the SPACE I report. Strassbourg: Council of Europe and University of Lausanne; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCouncil of the European Union. EU drug strategy 2020\u0026ndash;2025 [Internet]. 2020 [cited 2022 Aug 10]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.emcdda.europa.eu/system/files/attachments/13642/ Council%20of%20the%20EU%20%282020%29%20EU%20Drugs%20Strategy%202021-25.pdf\u003c/span\u003e\u003cspan address=\"https://www.emcdda.europa.eu/system/files/attachments/ 13642/Council%20of%20the%20EU%20%282020%29%20EU%20Drugs%20Strategy%202021-25.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"People living in prison, Drug use, Health, Social (re)integration needs, Mixed methods, Europe, Study protocol","lastPublishedDoi":"10.21203/rs.3.rs-4822245/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4822245/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Compared to the general population, people living in prison experience substantially more poor (mental) health issues. Moreover, delinquency and drug use have many risk factors in common. Therefore, a need exists for extensive knowledge about health, drug use patterns, related needs of people with a detention background and the coverage of drug-related interventions in prison within Europe. The current protocol describes the design of a study in prison about wellbeing, drug use and related care.\u003c/p\u003e\n\u003cp\u003eMethods/design: A multicentre mixed method design is implemented in five European countries (Belgium, Cyprus, Greece, Lithuania and Luxembourg). Qualitative and quantitative data collection tools are combined in order to generate complementary and comprehensive results. First, a cross-sectional survey among people living in prison is conducted. This survey is based on a model questionnaire, EQDP, developed by the European Monitoring Centre for Drug and Drugs Addiction. Second, people living in prison and people who have been recently released from prison are involved in qualitative semi-structured face-to-face interviews. The main topics of interest are the use of drugs and other health related topics such as loneliness, anxiety, depression, infectious diseases, suicide and treatment. Third, data about service provision in prison is collected through a quantitative survey addressed to the prison authorities.\u003c/p\u003e\n\u003cp\u003eDiscussion: This study protocol allows to address potential harms of drug use among people with a prison history and drug-related interventions inside prison at an international level. The strength of this study is that it builds on a common methodology that can be implemented in the same period of time. At the same time, sufficient flexibility is guaranteed so that every participating country in the study has the possibility to adapt the common methodology to its own specific legal requirements and practical circumstances. Nevertheless, this approach comes also with some limitations. Comparability and generalizability of the results are difficult to reach.\u003c/p\u003e","manuscriptTitle":"PRS-20: a protocol for identifying the needs related to drug use, health and social (re)integration of people living in prison within five European countries","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-27 07:14:49","doi":"10.21203/rs.3.rs-4822245/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-29T13:34:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-29T09:48:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-13T00:54:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"53278145704173846404862015998652359651","date":"2024-08-07T19:24:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-06T08:22:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210851454663377200873430970062746303785","date":"2024-08-05T20:59:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"232905693220727668285897169622772650753","date":"2024-08-04T17:25:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-02T04:34:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-31T11:27:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-31T11:24:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Public Health","date":"2024-07-29T13:08:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e4c0697d-e829-41b2-9f38-dd097bbc7536","owner":[],"postedDate":"August 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-14T16:03:55+00:00","versionOfRecord":{"articleIdentity":"rs-4822245","link":"https://doi.org/10.1186/s13690-024-01405-2","journal":{"identity":"archives-of-public-health","isVorOnly":false,"title":"Archives of Public Health"},"publishedOn":"2024-10-08 15:58:06","publishedOnDateReadable":"October 8th, 2024"},"versionCreatedAt":"2024-08-27 07:14:49","video":"","vorDoi":"10.1186/s13690-024-01405-2","vorDoiUrl":"https://doi.org/10.1186/s13690-024-01405-2","workflowStages":[]},"version":"v1","identity":"rs-4822245","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4822245","identity":"rs-4822245","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}