Who We Are

Mission
Rogue Librarians for Women's Health Literacy is a non-profit group staffed by librarians and volunteers who are dedicated to helping women from disadvantaged or underserved communities access and understand prevention, treatment and other facets of information related to women's health.

We strive to provide health information that is easy to understand using formats and interfaces that are appropriate for our audience. We select materials that:

• are current
• are easily accessible
• present balanced viewpoints
  
• are relevant to the diverse communities that we serve

Health literacy means having the ability to obtain, process and understand basic health information and services needed to make appropriate health decisions (Burnham, 2005). We believe that all people have the right to health information literacy.

Use and Users

For our first project, Rogue Librarians have created a collection of health resources for female prisoners who are currently serving time in a small (pop. 500) minimum-security prison for non-violent offenders. We worked with the prison librarian to develop a collection that will adequately address the relevant health issues at an appropriate reading level. This collaboration has also been integral to creating an interface that works with prison regulations to ensure that all prisoners have access to a variety of resources and formats. Although, we have developed this plan with a particular facility in mind, we hope to use the model as a template for other similar facilities with modifications as needed.

Since the prison librarian has not had the opportunity to conduct user studies and surveys on her users, she was not privy to the particular health issues that prisoners might need information about. However, she was able to confirm, through annual reports, that the prisoners’ demographic profile was similar to that of national averages. We were able to find information on the prisoner health issues nationwide through the Centers for Disease Control and other sources. From this, we were able to identify several health topics that are important to be aware of for women living among prison populations.

Female Prisoners U.S.A.
First, we will give a high-level view of what the female prison population looks like from a national perspective. Then we will give information specific to state of Illinois prisoners. As of June 2006, more than 203,000 women were in state or federal prisons or local jails.

• They comprise just under 10 percent of the total U.S. prison and jail population (more than 2 million)
• From 1995 to 2006, the number of women inmates in state and federal prisons nationwide increased by 64%
• 47 percent of women in state or federal prisons or local jails were white, almost 34 percent are African American, and 16 percent are Latina (though African-American women are incarcerated at 3.8 times the rate for white women and Latinas at 1.6 times the rate for white women)
• More than 70% of women inmates were incarcerated for non-violent drug, property or public order offenses.
• Nationally, more than 65 percent of women in state prisons report being parents of children under 18 (women and prison.org).
  

In Illinois (claim-il.org):

• The number of women in Illinois state prisons rose to 2,821 as of June 30, 2005
• About 73% of Illinois women prisoners are women of color
• About 61% of women prisoners in Illinois serve sentences for property (32%) and drug (29%) offenses
• About 82.5% of women incarcerated in Illinois are mothers
  

Special Issues in Prison Populations
Once we found the demographic information on our user group, we identified other issues that would affect the content of the collection and how the collection would be accessed. These included prisoner education levels, limitations on access to information technologies, and specific health conditions and issues that affect prisoners.

Education Levels
Most prisoners have not completed high school and some have never reached high school, so the materials provided to them must be at a reading level appropriate for people of that education level. For this reason, we will not be using journal articles or other scholarly publications.

Some statistics (Harlow, 2003):

• 40 percent have GED or high-school equivalent
• 30 percent have some high school
• 15 percent have 8th grade or less
• 15 percent have post-secondary education
• The rate of illiteracy among adults is more than four times higher in prison populations (prison policy.org)
  

Technology access limitations
We found at least one research study that shows most librarians (61%) have increased their use of automated technology over the last ten years and four-fifths of librarians said computers were available at their facilities. Despite this, Internet access for prisoners is usually non-existent or supervised by staff. However, more than half of prison libraries are using databases on CD-ROM (Payne, 2007). This limited-access model is consistent with the conditions described by the librarian at the facility we worked with.

With that in mind, we decided that our format (described in further detail in later sections) would have to be available largely in print. We also recommended the CD-ROM database format for a couple of reasons. First, prison administration would not be required to create a security policy since it’s an offline database. Second, we felt that our users would benefit from the practice of searching a database on a computer. Many will have limited job opportunities upon their re-entry into the workforce. This will be exacerbated by a lack of skills and knowledge of information and communication technologies. Even using a computer offline could improve technology literacy for some prisoners.

On the other hand, there will be those who do not feel comfortable using a computer because they are intimidated or don’t feel confident in their searching skills. Our solution will be to provide equivalent material in print so that the needs of these users can be met. Also, our group will work to train prison librarians on how to give basic instruction on the database for users who need it.

Prisoner-Specific Health Issues
Women living in prison have many of the same health issues as women living in the general population. However, their risk factors are much higher for certain conditions due to inadequate access to health care, prison living conditions and other factors. It is important to make information available about prevention and treatment of diseases, especially for a population that is unable to access media where news about medical developments and research is being disseminated.

Health issues affecting women in this group include reproductive health issues, fitness and nutrition, mental health and communicable diseases identified by the CDC as being common to prisoner populations. The collection will focus mainly on:

• Communicable diseases such as Hepatitis and drug-resistant Staph. aureus infection
• Reproductive health topics such as childbirth and pregnancy, STIs (especially HIV/AIDS) and menopause/menstruation
• Diseases such as cervical and breast cancer and osteoporosis
• Mental health including depression and related issues
  

CDC research has found that an unusually high percentage of woman prisoners suffer from traumatic brain injury (TBI), which leads to depression and other emotional problems. In addition, prisoners are at a much higher risk for substance abuse, which also increases their risk for TBI (CDC). The Illinois Department of Corrections estimates that more than 80 percent of female prisoners require treatment for drug or alcohol abuse, but it is available to only 20 percent. Woman prisoners are also more likely to be victims of domestic violence and sexual/physical abuse. A 1994 study reported that 80% of women prisoners had experienced physical and sexual abuse, often beginning in childhood. As such there is a great need for mental health treatment. However, human rights watch group Amnesty International reports very few prison systems provide counseling, opting to medicate mental health conditions instead (amnestyusa.org).

In addition, those living in prison populations are at a much higher risk for contracting communicable diseases. A CDC study from 2006 reported that 12%–39% of all Americans with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections were released from jail during the previous year (CDC, 2003). At year-end 2000, 3.6% of female state prison inmates were HIV-positive (CDC). The rate of confirmed AIDS cases in state and federal prisoners (50 per 10,000 prison inmates) was more than three times higher than in the total U.S. population (15 per 10,000 persons) (Bureau of Justice).

We believe we have a responsibility to provide prisoners with information resources on these topics and others that affect all women in order to empower them to be their own health advocates.

Collection Issues

Since we intend for our collection to serve women in prison, we needed to consider what types of materials they will even be allowed to access, according to the regulations of their correctional facility. Computer access may be limited or non-existent at a facility-wide level or for individual prisoners. At the prison we are working with, restricted computer access is available to most prisoners, but Internet access is not allowed. Individuals may not have experience or feel comfortable using computers, and time to browse materials may be limited even if they do have access. However, computer skills are increasingly necessary in the modern job market and for communication, so part of our project should involve efforts to educate users in computer literacy. Internet access is highly restricted, and health websites will likely be inaccessible, so electronic sources should be available on local intranets or CD-ROM databases (Shirley, 2004).

Hardcover books may not be allowed in prison libraries, so titles which are available in softcover editions are preferable (Shirley, 2007 "Censorship and Prison Libraries"). Books should come from well-respected, well-known authors and/or have high ratings from readers on various sites such as Amazon.com and LibraryThing.com

Periodicals may also be useful for this population, since there are some magazines which are targeted directly to specific health issues or general women's health, as well as to women of color or readers who read other languages such as Spanish or French.

Another useful source of health information we considered for our collection was preprinted or printable pamplets/handouts from authoritative sources such as the CDC or the National Institute of Mental Health. Additional copies would need to be re-ordered or reprinted from original sources by the librarian as the information becomes outdated or as supplies in the library are used. Due to the challenges posed by storing and accessing PDF files on a computer system, or maintaining and preserving a full collection of small, unbound paper documents like pamphlets, we decided to avoid using these as a significant part of our collection. The librarian may choose to add these items later if demand for them develops or if there is a convenient way to organize and access them.

Some examples of health pamphlets/fact sheets:

• http://www.cdc.gov/std/HealthComm/the-facts.htm

• http://www.cdc.gov/hiv/topics/perinatal/1test2lives/materials.htm

• http://www.cdc.gov/cancer/gynecologic/ (links to PDFs on the right side of the page)

Materials are subject to review of prison administration, so we must be sure health materials in the collection cannot be interpreted to be obscene or pornographic. This can be difficult for materials about sexual health. Materials which discuss specific sexual practices in any depth, or have explicit (even if not obscene) photographs or illustrations of certain areas of the human body might not be permitted. Glennor Shirley cites reports from prison librarians who were requested to remove graphic novels from collections "because some show skimpily dressed women and it may affect sex treatment programs" (Shirley, 2007 "Censorship and Prison Libraries").

Examples of items for our collection

Many resources we have listed are books, and some are PDFs. Due to concerns about organizing, maintaining, and preserving a lot of small, unbound paper documents, or organizing a collection of digital files, our collection will likely not include health pamphlets. However, much of the information available in these resources is similar to that which could be accessible on the CD ROM databases we will provide to the prison library. Librarians who have a somewhat different library setting or user group may find them useful for their needs.

The full list can be accessed here.

Preservation

As with any collection, the types of materials and the plan for the future of the materials must be considered first and foremost. Our collection holds health information, which changes frequently, and we expect our materials to be updated with the information. Therefore, we do no anticipate many extra preservation measures than the library already employs. That being said, there are some issues to think about to ensure that our collection is properly weeded and cared for so that our users will always be able to find the information that they need.

Print Materials
As mentioned, our print collection will only require the basic preservation steps that the prison library already uses for it’s regular collection, even if that means no extra preservation at all. While we expect that our health collection will be needed and used, we think it will sustain the same amounts of wear and tear as the regular collection.

There are a few ways to think about keep (preserve) and what to weed out of the collection. Richards and McClure (1989) give an overview of some of these methods as they pertain to academic libraries, but some apply to our library, as well.

First, the Collection Development Manual of the National Library of Medicine tries to place materials in one of four categories: core, related, peripheral, or out of scope. While these categories are useful when thinking about the most important subjects to keep, they miss out on other important factors to keep in mind. For example, Hazen provides a fuller list of considerations including user demand, cost of material, and availability of alternatives. Richards and McClure add their own suggestions of quality, and type of publication. Together, these authors show that a well-rounded approach must be taken when making decisions of preservation, especially with a topic as important as health information.

CD-ROMs
All of the information contained in the CD-ROM database will be essential to our completed collection. As we can all attest to, CDs are easily scratched, nicked, or smudged in everyday handling and these small imperfections can lead to problems accessing the data on the discs. In an effort to keep all information available to the users at all times, here is a list of tips for the proper handling of CDs provided by King (1991):

• Only handle the CDs by the edges
• Do not bend the CDs
• While not in use, keep the CDs in cases
• Regularly check for scratches
• Regularly check for dust and clean with a soft cloth
• Never use cleaners on the CDs
• Check the return policy with the vendor. If possible, replace damaged discs as soon as the damage is found.

We recommend a tip sheet is printed out and posted next to the computers in the library, or that basic CD handling is discussed during any training sessions that the librarian might have with the users.

Organization and Access

Organization and Access Constraints in Prison Libraries:
Prison libraries face a variety of constraints particular to their situation within correctional facilities. In working with the prison population and the librarians who serve them, it is necessary to consider more than the professional responsibilities of librarians as outlined by the American Library Association (Lehmann, 2000). The organization and access of prison library materials are determined by the procedures and policies of the correctional institution and as a result a prison librarian may be at odds at times with security personnel. Censorship of the types and quality of information delivered to the inmates, limitations on library technology (such as the use of the internet or automation), and perceived fraternization in the relationships between the librarian and their patrons are only some of the issues that affect a prison librarian’s ability to fulfill their professional responsibilities (Singer, 2000). Beyond these institutional concerns, prison libraries must also address limited physical space and funding which therefore precludes large collections of physical materials beyond the popular literature, nonfiction, and law materials the inmates require (Singer, 2000). Shelving is often restricted to a predetermined height for security reasons which also limits the shelving space available for materials (Singer, 2000).

Possible Interfaces for a Women's Health Collection:
Due to these unique concerns, Rogue Librarians for Women's Health Literacy have chosen to create a CD-ROM database, similar to the Mayo Clinic Family Health Medical Reference, containing articles on the women’s health issues, namely communicable diseases such as Hepatitis and drug-resistant Staph. aureus infection, reproductive and sexual health topics such as childbirth and pregnancy, STIs (especially HIV/AIDS) and menopause/menstruation, diseases such as cervical and breast cancer and osteoporosis, and mental health issues such as depression and related issues. In the section of this blog entitled "Collection Item Examples," we discuss the difficulties of including portable document format (PDF) files in this collection. In spite of these difficulties, we have provided examples of PDFs which contain content similar to that which we hope to include on the CD-ROM database.

We like the simplicity and ease of access presented by the CDC Women’s Health Topics A-Z interface. As many of a prison library’s patrons demonstrate lower than average levels of functional and information literacy, we feel that it is important to insure access is as straightforward and non-threatening as possible. We are also interested in the possibility of incorporating a more simplified version of the WebMD Symptom Checker as a way to mitigate illiteracy concerns.

Additionally, in conjunction with our fundamental misssion of improving literacy, we aim to provide prison librarians with the resources and training to teach patrons how to use our interfaces. With this in mind, we have tried to find simple, straightforward, easy to use interfaces so as not to overwhelm our users with unfamiliar technologies.

We have also created a list of selected, supplemental print materials which librarians may incorporate into their existing catalog using their preferred classification scheme. Because we are operating outside of prison libraries but in partnership with prison librarians, we feel that it is best to allow each librarian to choose the best way to address description, subject access, and authority control. It would be disruptive to the librarian and the inmate’s level of comfort with the library if we mandated the usage of any schema. Moreover, using metadata or a more sophisticated form of subject access may act as a hindrance to the patrons due to their unfamiliarity with sophisticated search techniques. Instead, we will work with each library to integrate the print materials we provide into their existing collection using the standards previously in place. We realize that due to the physical constraints of prison libraries the creation of a separate women's health collection area may be impossible, but we recommend, however, that if possible this collection should be shelved in an area dedicated to these materials. If this is the case, we suggest that the area be clearly marked with signage pointing patrons to the information they require. Regardless of the location of the materials, we feel that it is important for the titles to be easily identifiable and so we encourage the use of color coding to readily identify titles by subject.

Bibliography

Allison, Melody M. (2007). Women's health: librarian as social entrepreneur. Library Trends 56, 2, p423.
This article is a good resource for librarians interested in providing health information to women based on current gender-specific research in biology and medicine. It also discusses the role of librarians in raising awareness about health issues that may not currently be addressed by health care providers.

Amnesty International. The issue: medical neglect of women in US prisons. Accessed July 21, 2008.
<http://www.amnestyusa.org/women/womeninprison.html>

Beck, Allen J. and Maruschak, Laura M. (2001). "Mental Health Treatment in State Prisons, 2000". Bureau of Justice Statistics.
http://www.ojp.usdoj.gov/bjs/pub/pdf/mhtsp00.pdf
In women-only State prisons during 2000, 26.5% of inmates received psychological therapy or counseling. This indicates a significant need for supplemental mental health materials for prisoners to study in conjunction with professional treatment.

Bureau of Justice. Medical problems of prisoners. Accessed July 14, 2008.
<http://www.ojp.usdoj.gov/bjs/pub/html/mpp/mpp.htm>

Burnham, Erica and Peterson, Eileen B. (2005). Health information literacy: a library case study. Library Trends, 53, 3.
This article gives some definitions for "health literacy" and discusses the library's role in helping people understand diseases and their treatment.

Centers for Disease Control and Prevention. (2007). "Correctional Health".
http://www.cdc.gov/correctionalhealth/
This site provides information about major health issues that affect inmate populations. Problems faced by inmates include HIV/AIDS, drug-resistant Staphylococcus aureus infections, tuberculosis, hepatitis, STIs, traumatic brain injury (which often leads to other problems such as emotional disturbances or cognitive impairments), mental health challenges, and substance abuse.

Centers for Disease Control and Prevention(2003). Prevention and control of infections with hepatitis viruses in correctional settings. MMWR, 52, No. RR-1.

Centers for Disease Control and Prevention. Traumatic Brain Injury: A Guide for Criminal Justice Professionals. Accessed July 14, 2008.
<http://www.cdc.gov/ncipc/tbi/FactSheets/Prisoner_Crim_Justice_Prof.pdf>

Chicago Legal Advocacy for Incarcerated Mothers. Women and prison fact sheet. Accessed July 8, 2008.
<http://www.claim-il.org/thirdcoast//claim-il.org/about.html>

The Correctional Association of New York. (2007). "Women in Prison Fact Sheet". http://www.correctionalassociation.org/WIPP/publications/Women%20in%20Prison%20Fact%20Sheet%202007.pdf
This fact sheet includes statistics about female prisoners in the United States, as well as focusing specifically on women in New York State prisons. Female prisoners in the U.S. tend to be incarcerated for non-violent crimes, and to have a history of physical or sexual abuse. Mental health problems are also common in this population. Many female prisoners are also women of color, and many women have raised children prior to incarceration.

Dixen, Rebecca, Thorson, Stephanie. (2001). How librarians serve people in prison. Computers in Libraries, 21, 9, p. 48-53.
This article follows a prison librarian through a typical day on the job. It mainly addresses legal information, but also technology limitation issues and their effect on preparing inmates for re-entry into the "free" world.

Harlow, Caroline Wolf. "Bureau of Justice Statistics Special Report: Education and Correctional Populations." U.S. Department of Justice. 2003.

Hazen, D.C. “Collection development, collection management, and preservation.” Library resources & technical services. 26 (1) (Jan/Mar 1982) 6-10.
An article that details factors for selecting and preserving materials.

King, Alan. "The care and feeding of your CD-ROM disk." Database 14 (6) (Dec 1991): 105-108.
A look at CD-ROM technology that includes a handy list of tips for preserving the discs.

Legal Service for Prisoners with Children. (2002). "Access to Medical Care in California Women's Prisons: An Overview".
http://www.prisonerswithchildren.org/pubs/barriers.pdf
Female prisoners face additional barriers to adequate healthcare beyond those experienced by male prisoners. One of these challenges is the frequent lack of "preventative healthcare education which would allow the women to learn how to manage their own medical problems".

Legal Service for Prisoners with Children. (2002). "Women Prisoners: Facts and Figures at a Glance".
http://www.prisonerswithchildren.org/pubs/womgen.pdf
The majority of women prisoners are mothers". Female inmates have gender-specific health concerns which are often not taken into consideration by correctional policies.

Lehmann, Vibeke. "Prison Librarians Needed: A Challenging Career for Those with the Right Professional and Human Skills." IFLA Journal. 26:2 (2000) 123-128.
Can be accessed online here.
Lehmann's background on prison libraries and librarians provides insight into the needs of this underserved demographic. Her discussion of the modern prison library provides a broad overview of the types of materials one might find in a prison library as well as the role of the librarian in these institutions.

Payne, William, Sabath, Michael J. (2007). Trends in the Use of Information Management Technology in Prison Libraries. Behavioral & Social Sciences Librarian, 26, 2.
This article discusses a research survey of prisons on how prison libraries are using technology.

Prison Policy Initiative. Complete illiteracy: prisoners and general public. Accessed July 14, 2008.
<http://www.prisonpolicy.org/graphs/illiteracy.html>

Prison Policy Initiative. (2007). "Factsheets".
http://www.prisonpolicy.org/factsheets.html
This page provides fact sheets on policies and issues affecting prisoners. Several fact sheets specifically address female inmate issues.

Richards, D.T, and L.W. McClure. “Selection fro preservation: considerations for the health sciences.” Bulletin of Medical Library Association. 77 (3) (July 1989): 284-292.
A paper on the issues surrounding weeding and preserving health-related documents.

Schneider, Julia. (1996). Prison libraries change lives. American Libraries, November, 1996, p. 46-48.

Shirley, Glennor. (2007). "Censorship and Prison Libraries". American Library Association. http://www.ala.org/ala/olos/outreachresource/btw0207.cfm
This article cites some of the restrictions and challenges to materials that may be faced in prison libraries. Hardcover books are often restricted due to concerns that they may be used for hiding contraband items. Some content of materials may be forbidden or censored due to concerns that certain information may be inappropriate for the inmates or may encourage future danger to the correctional officers or other inmates.

Shirley, Glennor. (2007). "Materials Selection Policy". Maryland Correctional Education Libraries.
http://ce.msde.state.md.us/library/collections07.htm
(Older, more complete version here): http://web.archive.org/web/20061002015450/http://ce.msde.state.md.us/library/collections.htm
This page covers the materials selection policy for Maryland Correctional Department libraries. Many elements of the policy are common to traditional community or educational libraries, with additional elements specific to prison libraries. Paperback copies of books are preferred, and materials should aid inmates in coping with prison life as well as helping them to prepare for re-integration into society.

Shirley, Glennor. (2004). "Prison Libraries and the Internet". American Library Association. http://www.ala.org/ala/olos/outreachresource/prisoncolumn2.cfm
In 2004, many prison libraries had very restricted or non-existent inmate access to Internet resources. The article also discusses a CD ROM-based training program to help educate inmates on public library and Internet use for their lives after release from prison.

Singer, Glen (2000). Prison libraries inside and out. Education Libraries, 24, 1, p11-16.
Can be accessed online here.
Singer presents an insiders view of the organization and access issues inherent in working in a prison library. His analysis of the affect of the interaction between the prison librarian and the security personnel on library function and professional responsibility is particularly useful.

Stanford, Ann F. (2004). More than just words: women's poetry and resistance at Cook County jail. Feminist Studies, 30, 2, p. 277-301.
This article is about a writing workshop for prisoners led by the author. There is some discussion about mental health issues and women prisoners and also statistics on woman prisoners in Illinois and across the U.S.

Sullivan, Larry E. (2000). The least of our brethren. American Libraries, 31, 5, p. 56.
This article discusses the library's role in prisons and how legislation has affected library service in prisons over the the past few decades.

Women and Prison: A Site for Resistance. Women in prison fact sheet 2008. Accessed July 14, 2008.
<http://www.womenandprison.org/facts-stats.html>