Prepared for: Maternity Care Coalition Prepared by: Kali Hackett
TABLE OF CONTENTS
EXECUTIVE SUMMARY
4
INTRODUCTION
5
LITERATURE REVIEW
6
DESIGN OF EVALUATION
8
KEY FINDINGS
11
DISCUSSION
18
REFERENCES
20
EXECUTIVE SUMMARY
BACKGROUND
In implementing the MOMobile Riverside program over the years, a concern over maternal obesity and extreme weight gain for women during incarceration led to the creation of Fit Beginnings for Mom program within Riverside Correctional Facility (RCF). The goal of Fit Beginnings for Mom is to empower incarcerated pregnant and parenting women to improve their cardiovascular health by creating a healthy lifestyle environment for themselves and their children.
OBJECTIVE
This formative evaluation was designed to provide more insight into the nutritional, physical activity, and stress management experiences of incarcerated pregnant and parenting women, in order to better tailor and/or adjust the Fit Beginning’s programming, procedures, and advocacy efforts to meet the needs of MOMobile Riverside clients.
DESIGN
Inductive qualitative evaluation. Face-to-face semi-structured interviews.
PARTICIPANTS
Interviews were collected from ten MOMobile Riverside clients who currently receive and had received MCC services while incarcerated at RCF
RESULTS
Analysis of the interviews identifies that the physical and mental health of MOMobile Riverside clients is impacted by an intricate web of interrelated conditions that include: eating habits, nutritional value of available food, availability of physical activity mechanisms, drug use recovery, and deteriorated mental health, among others.
CONCLUSION
INTRODUCTION
OVERVIEW
The mission of Maternity Care Coalition (MCC) is to improve maternal and child health and wellbeing through the collaborative efforts of individuals, families, providers, and
communities. Since 1980, MCC has used a comprehensive approach to serve pregnant and postpartum women, and families with children ages 0-3 who live in some of
Southeastern Pennsylvania’s poorest neighborhoods. Throughout the region, MCC’s home visiting program “MOMobile” works to provide family support by ensuring that underserved families have the resources, knowledge, and support to build a healthy foundation for life success.
In 2006, MCC implemented the MOMobile at Riverside program inside Philadelphia County’s jail for women, Riverside Correctional Facility (RCF), in response to the growing number of pregnant and newly parenting women in the Philadelphia Department of Prisons (PDP). The overarching goal of the program is to improve the health of pregnant and postpartum incarcerated women and their babies, and to help women acquire the resources and parenting skills they need to establish healthy families as they make the transition from prison to home. The MOMobile Riverside program is an innovative approach to addressing the problems faced by women in jail who are pregnant or mothers of young children. In implementing this program over the years, a concern over maternal obesity and extreme weight gain for women during incarceration led to the creation of Fit Beginnings for Mom as a component of the MOMobile Riverside program.
The goal of Fit Beginnings for Mom is to empower incarcerated pregnant and parenting women to improve their cardiovascular health by creating a healthy lifestyle environment for themselves and their children. The program uses a “two-generational” approach,
hypothesizing that leaving jail and successfully returning to the community benefits two generations—the mother andher child. The objectives of the project are to: 1) improve the knowledge of participants–and their child’s caregiver–so they can make healthy decisions; 2) improve health behavior by providing enhanced support to overcome barriers to health and wellness; 3) prepare women for healthy behavior upon re-entry to the community; and 4) address environmental challenges inherent in accessing healthy nutrition and physical activity in a jail setting.
regards to nutrition, physical activity, and stress management of women participating in MOMobile Riverside, who were recently released. This formative evaluation was designed to provide more insight into the nutritional experiences of incarcerated pregnant and parenting women in order to better tailor and/or adjust the Fit Beginning’s programming, procedures, and advocacy efforts to meet the needs of MOMobile Riverside clients. Overall, MCC would like to better understand: What are MOMobile Riverside clients’ perspectives and perceptions on nutrition, physical activity, and stress management while they were incarcerated at RCF?
FIT
BEGINNINGS
PROGRAM GOALS
The specific outcomes that Fit Beginnings hopes to achieve are as follows:
Knowledge
1. 90% of program participants will know their weight and target weight. 2. 90% of program participants will know their waist circumference. 3. 90% of program participants will have their blood pressure checked.
4. 80% of program participants will increase general nutrition and physical activity knowledge. This indicator is measured using MCC’s “Nutrition and Activity Scale,” a comprehensive 42-item survey developed and validated as part of the Postpartum Weight Management Study.
Behavior
1. 100% of program participants will implement a Health and Wellness Goal plan. 2. 90% of program participants will increase healthy behavior by reaching at least one
target goal on their individualized plan.
3. Program participants will maintain their baseline level of self-efficacy, measured using three questions from the Nutrition and Activity Scale
4. 70% of program participants will initiate breastfeeding.
LITERATURE REVIEW
WOMEN AND INCARCERATION
The United States has one of the highest incarceration rates in the world.1 While the
majority of prisoners in the US are men, incarcerated women are an often overlooked and under resourced population. With over 200,000 women currently behind bars, the United States leads the world in the rate of female incarceration.1,2 Within this population, the
offenders awaiting sentencing, and sentenced offenders.3 The female local jail population
increased by 48% between 1999 and 2013, from 68,100 to 100,940, accounting for 14% of all confined inmates.3 The general demographics of incarcerated women show that they
are more likely to be poor, have less education, have poorer work histories, have a history of violence/abuse, and be of a non-white ethic group.4,5,6
Female inmates face a unique set of challenges, many of which have yet to be addressed by correctional systems on a policy nor programmatic level. Considering that the majority of incarcerated women are parents of minor children and frequently the primary caregiver, they often experience greater distress in this area than incarcerated fathers.7,8 Many women fear
that mother-child attachment will deteriorate and that their children are not being properly cared for.9 Additional stressors come from the pain of not being involved in their children’s
everyday lives and the lost time that cannot be regained.10
While women’s families are a major concern during incarceration, many of them are also battling addiction. More than half of incarcerated women report using drugs at the time of their arrest and 66.1% have a history of substance use disorders.11 Women are 10% more
likely to than men to be serving sentences for drug-related offenses, and the literature has documented that these women often have a history of poverty, abuse, mental health problems, and victimization.12,13 These histories necessitate that jails and prisons create
programs that address the complexities and interconnected challenges that incarcerated women face. Jails, especially as the point of entry into the correctional system, are a prime location to reach vulnerable populations. Jail stays are typically shorter so women can return home and enact behavioral changes sooner, and they are often situated in communities where inmate’s families can more readily visit.14 Conversely, jails also pose
implementation challenges due to the transient nature of their population.14 The limited
literature has shown jail programs to be successful in the areas of parenting, addiction, education, anxiety, and depression.15
In MCC’s MOMobile Riverside program, the target population is pregnant and parenting women. Incarcerated pregnant women have to cope with all of the stressors of
incarceration, while also managing their pregnancy. While the actual number of incarcerated pregnant women is unknown, estimates suggest that approximately 6 percent to 10
percent of incarcerated women are pregnant.16,17 There is a dearth of research available on
pregnancy and incarceration, but the existing literature shows conflicting evidence on pregnancy outcomes. Howard et al., found that women who were incarcerated during the first trimester delivered infants with higher birth weights18; however, this finding was not
women experience apprehension, grief and loss when anticipating birth and separation from their child after delivery.21
FOODWAYS & NUTRITION DURING INCARCERATION
Foodways describes the constellation of behaviors related to the acquisition, production, distribution, and consumption of food.22 Gaining a better understanding of foodways in jails
and prisons can provide details about the dynamics of relationships, attitudes, and behaviors of incarcerated individuals. Research on foodways in women’s prisons has shown that they are used to build and negotiate relationships, cultivate social power, and assist in navigating the formal and informal rules of prison or jail.22 Considering the central
role food can play in the lives of incarcerated women, it is important to further explore how modification of food behavior while incarcerated could change inmate relationships and life after incarceration.22
Recognizing that foodways are central to understanding the dynamics of incarcerated life, research has also shown that nutrition and diet while in jail or prison is substandard and can lead to weight gain and put inmates at an increased risk for many diseases and health conditions.23 While there is limited recent research on obesity and weight gain among
incarcerated female populations, researchers have found that over a two-week period, incarcerated women gained an average of 1.1 lbs/week, with 71% of women gaining weight.23 Prior studies have echoed similar sentiments, asserting that weight gain is
significant and can be attributed in part to starchy meals, lack of exercise, boredom, and stress.24 The problem of weight gain during incarceration is especially problematic for
pregnant women, as mothers who gain weight excessively during pregnancy are more likely to deliver by c-section, develop pre-eclampsia, and become overweight or obese later in life.25,26,27 Infants born to women who gain excessively during pregnancy are more likely to
be born preterm an become overnight or obese throughout the life course.28,29 The
evidence, research and anecdotally, that is available makes it clear that weight gain is an unaddressed and pressing problem among incarcerated women.
DESIGN OF EVALUATION
BACKGROUND AND DESIGN OF PROCESS
qualitative data and uncover a variety of unknown themes. As this evaluation focused on the overall jail environment, participants were not required to have been involved with Fit Beginnings while at RCF. Any formerly incarcerated women currently enrolled in the RCF MOMobile program were eligible to participate in the evaluation. Verbal informed consent was collected from all participants and approval of the evaluation was obtained from MCC’s director of research and director of evaluation. Additionally, an IRB application was
submitted, and UNC Chapel Hill’s Office of Human Research Ethics determined that the evaluation did not constitute human subjects research and did not require IRB approval.
The evaluation was conducted using an inductive approach, so no measures or themes were created prior to completing the interviews. The questions posed to the participants focused on their experiences while incarcerated at RCF, including aspects of their nutritional, social, physical activity, and stress management experiences. Interviews with participants lasted 25 to 45 minutes. The interviews were taped, with participant consent, and process notes were completed at the conclusion of the interview.
RECRUITMENT OF PARTICIPANTS
Using the reentry case management program within MOMobile Riverside, participants were recruited by their case mangers, known as advocates within MCC. MOMobile Riverside advocates continue to work with their clients up to two years after their release, depending on need. As such, the advocates reached out to their current clients and discussed the purpose of the evaluation and inquired about their participation. The advocates made it clear that participation was voluntary and would not affect current or future services. There were limited exclusion criteria, participants solely needed to have been apart of the
MOMobile program while they were incarcerated and currently receiving services.
DESCRIPTION OF PARTICIPANTS
Ultimately, interviews were collected from ten MOMobile Riverside clients. Of those who participated, 80% were African American, 100% were single and had never been married, and the average age was 27.5. Additionally, 60% were pregnant while incarcerated and 30% also gave birth during that time. A summary of key demographic characteristics of the mothers who participated in the evaluation is presented in Table 1, below.
MEASUREMENT
physical activity, and stress management while they were incarcerated at RCF. Interviews with the clients lasted 30-45 minutes and were taped, with the consent of the participants.
TABLE 1 - DEMOGRAPHIC CHARACTERISTICS OF PARTICIPANTS (N=10)
Age - yr. 27+/-5.44
Sex - no. (%)
Female 10 (100%)
Race - no. (%)
Caucasian/White 2 (20%)
African American/Black 8 (80%)
Ethnicity - no. (%)
Latino or Hispanic 1 (10%)
Non Latino or Hispanic 9 (90%)
Length of Time in Jail - no. (%)
1-3 months 2 (20%)
4-6 months 1 (10%)
7-9 months 1 (10%)
10-13 months 5 (50%)
Highest Education Level - no. (%)
Some High Scohool 3 (30%)
Graduated High School/GED 4 (40%)
Post High School 3 (30%)
Number of Children - no. (%)
1 5 (50%)
2 2 (20%)
3 3 (30%)
4+ 1 (10%)
Marital Status - no. (%)
Single, Never Married 10 (00%)
Pregnant While Incarcerated - no. (%)
Yes 6 (60%)
No 4 (40%)
Delivered While Incarcerated
Yes 3 (50%)
DATA ANALYSIS
The transcribed interview data was analyzed using the Nueman three phase coding system (2000). In the first phase of coding, the evaluator preformed an initial scan of the data and highlighted words or phrases used by participants and began pinpointing initial themes. A single evaluator conducted the process of selecting core themes. Once the initial themes were clear, the second phase focused on connecting the themes and finding links in the data. Lastly, after the data was reviewed again, excerpts were selected to illustrate the final themes. NVivo software was utilized during this process.
KEY FINDINGS
CLIENT PERSPECTIVES ON NUTRITIONAL CONDITIONS
Overall Distaste With Philadelphia Department Of Prisons (PDP)
Provided Meals
It was evident that many clients were extremely dissatisfied with the meals provided by PDP and RCF. Nearly all the clients interviewed discussed how these meals, also known as “trays”, were inadequate, poor tasting, nutritionally insufficient, and repetitious.
They always used to give us these burgers and they was not even burgers like it will be cold or it wouldn't be cooked right. A lot of people got sick off of it. Most of the food there people get sick off of it because it's not, you know, it's not cooked. Or it isn't even good to eat. Half of the time we go into the nurse because we throwing up or we get the stomach viruses because of the food. (Client 4)
By the time you get it, like I was saying, it's probably cold. And it's probably got... My kids eat more than the portion that they give you. It's just horrible… There is no favorite food in jail. (Client 9)
Consistently, clients were able to identify many of the grievances they had in regards to the food quality.
The portions are very small. It will actually make you hungrier. If they had something it would come with beans, but they wouldn't be cooked all the way, or the noodles wouldn't be cooked all the way. The potatoes. It was just like dinner was never cooked all the way. It was just like, eh. (Client 10)
Grossed out. That's why I didn't eat it. If I had to starve, I would have starved. I was not eating their food. (Client 6)
Clients generally agreed that the food options were not only poor quality, but there was also a lack of healthy food options in both the commissary and trays. Their comments reflected a further discontentment with the choices available.
The like the pregnant girls. That's why I never understood it, like we're pregnant. We're here you know they was giving us the programs and stuff. And they wasn't giving us like things like fruit just healthy things for a baby. And you know and then we was breastfeeding in there. So was like I thought they would give us something like you know to eat healthy because were breastfeeding we send them this milk home to our children. (Client 3)
There is no way what can you eat that's healthy. There's nothing in there. Nothing. Not that I know of. I've been there 14 15 times and I never seen anything healthy. (Client 6)
However, while there was consensus that the PDP provided meals were unhealthy, many clients enjoyed the commissary options, which heavily included processed foods.
Oh, the commissary is popping… You order from commissary, you getting cakes, candy, chips, whatever that you want from commissary. When you eating, you're getting fish. They got fish there. They got chicken. They got pork. They got clams, like you got so much things there. Octopus, like they had everything. It was really everything there. (Client 5)
Oh they [commissary] food was good because I made it. You can make fake pizza. Fake Stromboli. We can make peanut butter and jelly, noodles, lasagna. It’s different stuff. (Client 4)
Nearly all of the clients interviewed purchased commissary food items on a weekly basis. The amount of money spent each week on food, ranged from $30-$100. Despite enjoying the comfort, familiarity, and sense control of commissary purchases, some clients still wished that there were healthier options available.
So if I don't have enough to eat on the trays, I just had my commissary. And commissary is not really healthy food on there either. It is all junk food. It will be mostly like junk food like chips, cakes, candy… A lot of people in there would be asking like wow I wish we get like fruit and healthy stuff. I wish could. Like that's what I like to eat, like fruit and stuff like that. And getting the apples and oranges doesn't really do it. (Client 3)
WEIGHT FLUCTUATIONS
Weight Gain, Food Options, & Physical Activity
… A bunch of cheese curls mushed up with meat, sausage that you purchase in packaged food. You just put it all together in a bowl, wrap it up, and eat it because it's pretty much your meal. It gets you full. And it makes you gain a lot of weight. It's nothing but starch. So, that's all they mainly feed you in jail anyway. Both from commissary and off the trays, it's just starch on top of starch. (Client 9)
I gained 60 pound. Mainly I think because of starch and what we were eating. A lot of bread. (Client 1)
Probably eating. I noticed that a lot like in the jail. You gain a lot of weight. And I guess its because you can't go no where, you can walk anywhere. From you sitting down all day or just walking a little bit you gain a lot. We're seeing people come in here like this [skinny] and come out like huge. And then the food is that's the biggest thing that makes you gain weight. It is not healthy food is all fattening. (Client 3)
Consistently, clients are able to identify many of the concrete and significant aspects that contributed to their weight fluctuations. Aside from food options, mental health and physical activity may have also played a role.
I lost a lot of weight being in there and it’s crazy because ate like a loaf a bread, two loaves of bread a day, oodles of noodles, plus chips… Stressing. I didn't want to be in there and I lost a baby in there, so I really didn't want to be in there. (Client 5)
I came in like 175 and left at probably like 223… Because I worked in the kitchen, every meal I always had a second. Eating and laying down all the time [contributed to the weight gain]. (Client 7)
Yeah, so I could have stopped eating more when I was gone, but there wasn't nothing to do so I just kept eating… It’s cause I was depressed (Client 1).
Weight Gain & Addiction
In addition to diet and physical activity, clients also referred more specifically to the discontinuation of drug use and how that changed their appetite and weight.
I always loved food but when I was out there getting high, it curved my appetite. Like if I wanted to have ice cream or wanted to have pancakes with bacon, I was high so I didn't want it. I always had the appetite, but now that I'm sober I always wanted the food. (Client 7)
CHALLENGES IN GETTING PHYSICAL ACTIVITY
Availability Of Physical Activity Mechanisms
Evaluation participants lamented a need and a desire to have been more physically active while they were incarcerated, but expressed that the environment was not conducive to those goals. They described the jail and yard as depressing, small, and a reminder that they are incarcerated.
Or go on the yard when you can. I only went about 3 times my whole stay because it was depressing. Walls around the walls all around us. (Client 1)
I didn’t like being outside because if I can’t be out there and go where I want to go, I’d rather not be out there. (Client 6)
But the yard is literally like is not that big. OK. It's like very small is not big enough to really do any like... when is it with people out there like you don't have much room after that to do much activity. Now the bigger unit that I was on when I first came in general population that yard was kind of big like it had a basketball court. (Client 2)
While the yard was not a space that many of the clients interviewed utilized, walking was a common theme.
When I got to jail, I was on A unit, so small, so there was nowhere to walk. So the only exercise I was getting was like if I walk around the room or I walk in the yard, which the yard is probably smaller than this, so like I wasn't really getting exercise. (Client 3)
…The pedometer. I would count my steps, I would wake up in the morning. Since I would wake up, I would place it on myself and I would walk maybe like 7,000, sometimes up to 8. (Client 7)
As far as exercise, you know, I would be like, you know, you can walk around if you walk around you'll keep your energy up. It'll help you clear your head. You can think better. You'll feel better. You'll sleep better at night. (Client 10)
Jobs As An Opportunity For Physical Activity
When discussing the clients’ physical activity capabilities while they were at RCF, their involvement with jobs frequently was a topic of conversation. Many of their job involved physical labor and provided an opportunity for more movement than usual.
I always was always working. And then I was always moving around for at least eight hours a day. And you know those crazy jobs are very labor, labor intensive. Like you were doing something, so it was not like I wasn't doing anything at all. That was my real physical activity every day. (Client 2)
When you’re pregnant, you ain’t really gonna do too many physical activities. I mean, you are a unit worker. They allow you to go to the gym, once or twice out of the month.. I was a unit worker. I would mop the tables and floors. (Client 9).
The pregnant girls they couldn't go outside. Like the other workers they work like outside and we couldn't do that because we was pregnant. (Client 3)
NAVIGATING STRESSORS AND STRESS MANAGEMENT
Frustrations With Being Away From Children And Family
The clients MCC serves at Riverside are all mothers. As such, when discussing some of the cause of stress while they were incarcerated, being away from their children and loved ones was a reoccurring theme.
You got women in there that's missing their family… They can't make no money. They can't have sex. They be with their kids, be with their family. As a guy, a guy is okay sometimes. Whether it's a good day or a bad day, they don't care about being without their kids, because that's their mentality. They're men. You got to put food on the table. Women don't leave their kids unless you got a trifling female, but a mother is not going to leave their kid's side. A mother got routines, whether she write them down, whether she know them or not, you got a routine. When you get to jail all that ceases. (Client 5)
… That, my son and thinking about my children’s father. Then my son tried to kill himself. He tried to kill my mom.. He threw my daughter down the steps. (Client 7)
I didn't start stressing until I got in jail, because reality started to set in. So real life came into play. So then I started stress. I started worrying about, alright who gonna take care my mom? ... stuff like that. These are the things that when you got a sober head, these are the things that you think about. More so the drugs were clouding your judgment, you're not really thinking or nothing. (Client 9)
Tools For Stress Management
Many clients spoke of the tools they were taught to cope with the stress of being incarcerated. There were mixed opinions about the effectiveness of those tools and suggestions for what should be changed. Many clients discussed, reading, going for a walk, and listening to music as stress management techniques.
I read. It calmed me down, it put me into thinking about what's going on inside the story so it kind of pushed things to the side and relax my mind. (Client 8)
Other clients mentioned the importance of physical activity and exercising, and how they wished they were able to do more of those activities while they were incarcerated.
They told me when I start stressing, just to write stuff down. That's a good way to handle stress, to write things down. You know, on paper, so you can go back to see what it is that you were stressing about, and how you could fix these ways and stuff. And exercise is a good way to relieve stress. (Client 9)
Like, it's hard to stay focused on one thing too long, for me. So, reading, alright. It's optional. God bless you. You do it, and then what happens when your eyes start hurting, or when you get tired and you don't want to read no more? Then what's next? Alright, color. Okay, now you colored, there's no more to color. Read. For people that have months, so that every day it gets old after a while, so then don't nothing work no more. So, now you just sit there and you just wait your time over, you know, wait your time to leave and come out of there, but I felt like they don't do nothing but put you on like, a depressed mood or something like that, so I feel like the more they call themselves trying to do that's not actual ... That's not like actually, physical, don't work. (Client 5)
I feel like in prison, a stress relief should be something that's physical. Something that you can move around and do, because anything other than that is not really going to relieve stress when you're in a place like that. I don't really know because I don't know what suites other people, but I know for me going to jail, being in jail, if I have to do something for stress or I have to do something for ... Encourage like exercises and stuff like that, it has to be physical. I can't do nothing where I'm just sitting because it's not actually relieving no stress for me. Like, in jail, when you in jail, your mind is somewhere else. Your whole body is somewhere else. Your whole life is somewhere else. Like, every thing that you ever had, once did, or whatever your outside person is, that's not your inside person. (Client 5)
In a similar vein, clients lamented that the activities and tools they are given while at RCF can be useful depending on the effort and interest of the participants.
You know work worked if I wanted it to work. So, I rather like sometimes I just… If I wanted it to work, I mean but it worked with reading the book. (Client 6)
can get your head together and do the things that you really need to do with your life. (Client 7)
SPECIAL CHALLENGES FACING INCARCERATED PREGNANT
WOMEN
Inadequate Food For Pregnant Women
For the most part, clients who were pregnant while incarcerated at RCF discussed how the food and meals they received from the prison were inadequate, unhealthy, and unfulfilling. They received pregnancy bags, but still had to supplement with commissary items in order to feel satisfied.
They need to give you a [pregnancy] bag every day, three times a day, four times a day because three times a day you only get a tray. Then at nighttime you only get that night snack. Them trays is just ridiculous to give to a pregnant woman. (Client 6)
I always, well I get a pregnancy snack. So my snack on weekdays, we'll get cheese sandwich with a mighty shake and orange juice and milk. And on weekends we'll get peanut butter with jelly and bread and the shakes and stuff… That's why I had commissary. Like I didn’t feel like that was enough. (Client 8)
Deteriorated Mental Health
When speaking about the challenges incarcerated pregnant women experienced, many of the clients discussed the distress they endured. Anxiety and depression were common, especially among the women who delivered their children while at RCF.
Very stressful. Very stressful. And I also had my son, while in jail. I found out I was pregnant and I gave birth to my son in jail. So it was very stressful. I think I went through postpartum depression afterwards. Because I had the crying spells. I would just break down and cry. Because I wanted to go home. I went home three weeks, after I had my son. Depressing. It's one thing if you want it, giving birth, and you've got for guards in your face. It's not like I had my loved ones there, because they wouldn't allow them to be there. And then, I only got to spend three days with my son after birth. And then, I had to go back to jail. And he had to stay in the hospital. So it wasn't good. (Client 9)
I would probably talk to Ms. Sarah who would try to calm me down or ‘ll talk on the phone or write letters. (Client 3)
Everybody was telling me "don't come back, you want to be there for your daughter." Because that was my worry the whole time there, just having my
daughter there and her getting taken away from me or was I going to be able to be home before I gave birth. So that was more my concern really throughout my stay there. (Client 8)
DISCUSSION
The overall goal of this formative evaluation was to gain a better understanding of the nutritional, physical activity, and stress management experiences of MCC MOMobile Riverside clients while they were incarcerated at RCF. The conversations and discussions elicited through these interviews revealed that there is a complex web of interconnected issues that all contribute to the overall trend of weight gain and poorer health during incarcerations. As the Fit Beginnings program seeks to empower incarcerated pregnant and parenting women to improve their cardiovascular health by creating a healthy lifestyle environment for themselves and their children, the results of this evaluation will be useful in further tailoring the program to advocate for, educate, and empower our clients.
It is clear from client comments complied in these interviews that most of these women struggled to maintain their desired nutritional, physical, and emotional health while incarcerated at RCF. While coping with the loss of freedom and autonomy, these women have a clear understanding of the difficulties they faced in receiving adequate, nutritious food, an environment conducive to regular physical activity, and the challenges in managing stress and their mental health. They appear to have a firm grasp on what constitutes healthy or nutritious food and recognize that what is served is poor tasting and plays a role in their weight gain. In that context, it is clear that these women must endure these
efforts, there should also be initiatives to ensure that pregnant women have adequate and nutritionally sound amounts of food.
The conversations revealed that many of the clients are concerned by weight gain during incarceration and are aware of some of the possible culprits. Unfortunately, many of the causes of weight gain, such as poor diet and sedentary activity levels, seem to be
engrained in the RCF environment and culture. While there is little MCC can do to change the physical environment, the work with pedometers that MCC has used in the past, was discussed in the interviews as a successful way to get clients motivated to increase their physical activity. Incorporating this further into the Fit Beginning Program, possibly as a game or competition, may motivate some clients to become more physically active. The information gathered on sobriety and weight gain also reveled that some of the weight gain advocates and managers have witnessed, may be related to the change in appetite among clients who are in recovery. In fact, research has shown that poor eating and excessive weight gain are common among individuals recovering from substance abuse.30,31
Among the critical issues that these dialogues enumerate is the critical importance of supporting clients’ mental health and wellbeing during this period of their lives. Many participants discussed experiences of depression, anxiety, and extreme stress while they were incarcerated. As ascertained from the conversations, mental health and physical health are inextricably linked and must be addressed jointly. During the interviews clients discussed being too depressed to engage in physical activity or overeating because of boredom or stress. As such, the Fit Beginnings program must include skills, tools, and resources that will be useful in managing and/or improving clients’ mental health. Additionally, this evaluation revealed that many clients are aware of effective stress management skills, such as reading, listening to music, and exercising, but there is a disconnect between the use of those skills and the clients’ feeling like they make a difference. Further research and exploration is warranted to better understand stress management interventions that are proven to work among incarcerated, specifically jailed, populations.
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APPENDIX A - INTERVIEW GUIDE
Adapted Interview Instrument, Riverside Correctional Facility Wright, Mogul, Myers, Smoyer
BEFORE
1. Describe how you were eating one day in the week prior to your arrest. a. With whom? What?
b. When? Why?
2. If you are a caregiver, how were you feeding your children on one day in the week prior to your arrest?
a. With whom? What? When? Why? Did you cook at home? Did you cook together with your kids?
b. If breastfeeding, how and when?
3. What was your physical activity on a day in the week prior to prison?
a. Did you exercise in any specific way? Were you doing any sort of scheduled moderate or vigorous exercise and how much (moderate:can talk but not sing, vigorous:can only say a few words)?
b. With whom? When? Why?
4. What was your stress management activity in the week prior to prison? a. With whom? What? When? Why?
b. What were your top three sources of stress in the week prior to prison?
PRISON ENVIRONMENT, GENERAL
5. Describe the first thing that was served to you and/or that you ate upon entering the criminal justice system. Note: this may have occurred in the local police lock up or at RCF.
a. How was this food acquired?
b. How was this food prepared/cooked? c. Where did this preparation take place? d. With who was the food shared?
e. Where was it eaten? Describe this place & who was in this place (e.g. inmates, COs, other prison staff)?
f. At what time was this food usually eaten?
g. What institutional policies existed regarding this food/meal?
h. Were there any formal or informal consequences or penalties to eating this food/meal? If so, what caused you to take this risk?
i. What did you like about this food/meal? j. Had you ever eaten this food before? k. How did you FEEL during that meal?
6. Describe a typical day of meals in prison.
a. Why did you go to meals? (hunger, social, required to by prison rules) b. Where were these meals served and consumed? (cafeteria, common dorm/
pod area, tray delivery to cell, etc) Describe the conditions & atomosphere in this location (temp, smell, sound, light, emotion)
c. What time were meals served?
e. Was there a person who you ate with on a regular basis? Describe this person. f. What types of food were served on a typical day? Describe this food?
(Temperature, taste, nutrition)
g. How was the food served? (self serve, staff served, limited portions) h. How did you feel after eating? (stuffed, still hungry, etc)
i. Can you tell a story about eating from the trays? j. Can you tell a story about eating at the commissary? k. Tell me about a typical commissary order.
i.What did you buy?
ii.How much did you spend?
iii. Where did you get the money to make these purchases? (e.g. prison job, money sent from family)
iv. Did anyone send you $ for the commissary? How did you feel about that (receiving money or not)?
v.Did you buy the food for your own consumption, or to trade or give to other?
vi. Did you have a consumption schedule? (i.e. one candy today, one tomorrow after school, etc) Storage of extra food, when it would be eaten, how much was stored on a typical day, how much eaten and when on a typical day
vii. Had you eaten this food before?
7. Describe your favorite food/meal while incarcerated. Same probes as Question #4 8. Describe your least favorite food/meal while incarcerated. Same probes as Question
#4
9. Describe a physical activity you do while in prison. a. What? Where?
b. With whom? c. How often?
10.Describe an activity you do for stress management? a. What? Where?
b. With whom? c. How often? COOKING
11.Tell me a story about cooking in your unit or in your cell.
a. Why did you prepare this food? (hungry, bored, depressed, someone asked them to)
b. Who was involved in the preparation of this food? i.People who helped assemble ingredients ii.People who cooked
iii. People who provided formal or informal permission. c. How were ingredients obtained?
d. What time of day or night?
e. Were there any formal or informal consequences to this cooking behavior? f. Was this dish eaten as a substitute for a cafeteria meal?
g. How often did you cook in your cell?
12.If you have breastfed/pumped
a. When did you last breastfeed, where, and for how long? b. Are you currently pumping? Where, how often?
c. Tell me about the experience of pumping at RCF.
DISCIPLINE
13.Describe circumstances when you got a disciplinary write up for a food-related incident a. What food was involved?
b. Where did the incident take place? c. Who else was involved?
d. What time of day was it?
14.In what ways did your weight fluctuate during incarceration? a. What do you think contributed to this weight loss/gain?
b. Ask probing questions about the food practices, exercise practices, or stress management practices to which she attributes her weight gain/loss (What? With whom? Where? How?)
RELEASE
15.Tell me about your release from prison? a. How did you learn about your release?
b. How you “celebrate” this news? Was food involved in this celebration? c. Describe your last meal in the cafeteria.
d. Describe the last thing you ate in prison before your release.
e. If you had any commissary left over, what did you do with it? Who did you give it to?
f. What was the first thing you ate (on the outside) upon release? 16. Describe how you are eating one day this week?
a. With whom? What? b. When? Why?
17.If you are a caregiver, how are you feeding your children on one day this week? a. With whom? What? When? Why? Did you cook at home? Did you cook
together with your kids?
b. If breastfeeding, how and when?
18.What was your physical activity on one day in this past week?
a. Did you exercise in any specific way? Were you doing any sort of scheduled moderate or vigorous exercise and how much (moderate:can talk but not sing, vigorous:can only say a few words)?
b. With whom? When? Why?
19.What was your stress management activity one day this past week? a. With whom? What? When? Why?
b. What are your top three sources of stress this week?
20.What would you tell a new inmate about eating in prison, exercise, and stress management?
