Health, mental health, substance use, and service utilization among rural and urban incarcerated women

Childhood and Adult Sexual Violence Exposures as Predictors of PTSD, Dissociation, and Substance Use in Women in Jail

Women involved in the criminal legal system report high rates of interpersonal violence, particularly sexual violence, and mental health problems. Although existing research has linked experiences of interpersonal violence to multiple negative mental health outcomes, few researchers have examined concurrent psychopathology as an outcome of child and adult sexual violence in system-involved women. The purpose of this study was to examine child sexual abuse (CSA) and adult sexual violence, while controlling for other forms of interpersonal violence, as predictors of current symptoms of posttraumatic stress disorder (PSTD), substance use disorder (SUD), and dissociation in women in jail in the Mountain West. Randomly selected participants (N = 146) completed clinician-administered measures of trauma histories and mental health symptoms. The majority of the women (73%) reported experiences of CSA and about half reported experiences of adult sexual violence. Over half of the women reported symptoms consistent with current probable PTSD, about 20% reported dissociation symptoms in a clinical range, and over 70% met criteria for a SUD in the past year. The proposed model was tested with path analysis. CSA significantly predicted current symptoms of PTSD while adult sexual violence exposure predicted symptoms of SUD and dissociation. These results illustrate the high rates of sexual violence exposure as well as the complexity of mental health needs associated with these exposures in system-involved women. Findings highlight the need to comprehensively assess incarcerated women's trauma exposure and psychological distress to better meet the needs of this population.

Discriminant Function Analyses: Classifying Drugs/Violence Victimization Typologies Among Incarcerated Rural Women

This study examined the relationship between drug use and violence victimization among incarcerated women in Appalachian Kentucky. The purpose of this study was to test the utility of Goldstein's tripartite conceptual framework among rural incarcerated women, by examining whether distinct drugs/violence nexus groups could be classified based on psychopharmacological, economic-compulsive, and systemic factors. This study used secondary data from a National Institute on Drug Abuse (NIDA)-funded grant focused on risk reduction among high-risk incarcerated women in Appalachia (N = 400). Predicted drugs/violence groups were developed using a series of discriminant function analyses. The data yielded three statistically significant discriminant models. Findings of the classified groupings indicated support for three distinct drugs/violence victimization subgroups. The psychopharmacological group showed the greatest prevalence (n = 181; Wilks's λ = .389, F = 3.94, p < .001), followed by the economic-compulsive group (n = 77; Wilks's λ = .584, F = 11.86, p < .001) and systemic group (n = 55) significant (Wilks's λ = .994, F = 2.247, p < .035). To date, this is the first study to report a relationship between systemic violence victimization among rural communities. These findings could offer novel considerations for theory development and implications for clinical practice regarding the drug-related risks for violence victimization among rural incarcerated women.

Pregnancy in incarcerated women: need for national legislation to standardize care

OBJECTIVES

This review examined prenatal care provided to incarcerated women to identify areas where improvement is needed, and examined current legislative gaps such that they can be addressed to ensure uniform templates of care be instituted at women's prisons.

METHODS

Data were compiled from 2000-2021 citations in PubMed and Google Scholar using the keywords: prison AND prenatal care AND pregnancy.

RESULTS

Although the right to health care of inmates is protected under the Eight Amendment to the United States Constitution, the literature suggests that prenatal care of incarcerated individuals is variable and would benefit from uniform federal standards. Inconsistency in reporting requirements has created a scarcity of data for this population, making standardization of care difficult. Although incarceration may result in improved access to care that women may not have had in their community, issues of shackling, inadequate prenatal diet, lack of access to comprehensive mental health management, and poor availability of opioid use disorder (OUD) management such as Medication Assisted Therapy (MAT) amd Opioid Treatment Programs (OTP), history of post-traumatic stress disorder (PTSD) are just a few areas that must be focused on in prenatal care. After birth, mother-baby units (MBU) to enhance maternal-fetal bonding also should be a prison standard.

CONCLUSIONS

In addition to implementing templates of care specifically directed to this subgroup of women, standardized state and federal legislation are recommended to ensure that uniform standards of prenatal care are enforced and also to encourage the reporting of data regarding pregnancy and neonatal outcomes in correctional facilities.

Intimate Partner Violence and Structural Violence in the Lives of Incarcerated Women: A Mixed-Method Study in Rural New Mexico

Intimate partner violence (IPV) is a common feature in the lives of incarcerated women returning to rural communities, enhancing their risk of mental ill-health, substance use, and recidivism. Women's experiences of IPV intersect with challenges across multiple social-ecological levels, including risky or criminalizing interpersonal relationships, geographic isolation, and persistent gender, racial, and economic inequities. We conducted quantitative surveys and qualitative interviews with 99 incarcerated women in New Mexico who were scheduled to return to micropolitan or non-core areas within 6 months. Quantitative and qualitative data were analyzed separately and then triangulated to identify convergences and divergences in data. The findings underscore how individual and interpersonal experiences of IPV, substance use, and psychological distress intersect with broad social inequities, such as poverty, lack of supportive resources, and reluctance to seek help due to experiences of discrimination. These results point to the need for a more proactive response to the mutually constitutive cycle of IPV, mental distress, incarceration, and structures of violence to improve reentry for women returning to rural communities. Policy and treatment must prioritize socioeconomic marginalization and expand community resources with attention to the needs of rural women of color.

Health Status of Females Who Experience Incarceration: A Population-Based Retrospective Cohort Study

Background: People who experience incarceration have poor health across a variety of indicators, but we lack population-level data on the health of females in particular. We examined the health status of females released from provincial prison, and compared their data with data for males released from provincial prison and females in the general population in Ontario, Canada in 2010. Methods: We conducted a retrospective cohort study using linked correctional and health administrative data. We compared sociodemographic data, morbidity, mortality, and use of health care for (1) females released from provincial prison in 2010, (2) males released from provincial prison in 2010, and (3) age-matched females in the general population. Results: Females in the incarceration group (N = 6,107) were more likely to have higher morbidity and specific psychiatric conditions compared with the male incarceration group (N = 42,754) and the female general population group (N = 24,428). Their mortality rate postrelease was several times higher than that for the female general population group. They used primary care more often than both comparator groups across all time periods, and they used emergency departments more often compared with the female general population group and in most periods postrelease compared with the male incarceration group. They also tended to have higher rates of medical-surgical and psychiatric hospitalization. Conclusion: Females who experience incarceration have worse health overall than males who experience incarceration and females in the general population. Efforts should be made to reform programs and policies in the criminal justice and health care systems to support and promote health for females who experience incarceration.

A Latent Profile Analysis of Rural Women who Use Drugs and Commit Crimes

The majority of rural Appalachian women in jail meet criteria for a drug use disorder and need treatment. Using a latent profile analysis of a random sample of rural women in Appalachian jails (N=400), the current study established groups of women based on criminal history, drug use in the commission of crimes, and role of the partner's drug use in the commission of crimes. Analysis found five distinct profiles of rural women based on involvement of criminal activities as a function of drug use severity. Results suggest that among criminally involved rural women, severity of drug use is a critical factor in the criminal career. Findings can be used to better inform treatment approaches and tailor treatment to meet the needs of this vulnerable population.

Sexual Victimization and Mental Illness Prevalence Rates Among Incarcerated Women: A Literature Review

Incarcerated women evidence high rates of both interpersonal trauma and mental illness. In particular, the rates of sexual violence victimization are so high that some researchers have suggested that sexual abuse may be a pathway to prison for women, likely through the development of mental illness, including substance abuse. This review article summarizes the literature on sexual victimization (n = 32 articles; 28 independent studies) and mental illness (n = 11 articles; 8 independent studies) prevalence among samples of incarcerated women (Ns ≥ 100) in context of methodological choices within included articles. Best estimates for sexual victimization from studies using established survey methods were as follows: 50-66% for child sexual abuse, 28-68% for adult sexual abuse, and 56-82% for lifetime sexual assault. Although data directly comparing prevalence of sexual victimization among incarcerated women to prevalence for other groups are limited, the existing data indicate that incarcerated women have significantly greater exposure than incarcerated men and community samples of women. Moreover, compared to findings from the National Comorbidity Survey-Replication, incarcerated women evidence greater prevalence of most lifetime and current mental illnesses, especially depressive disorders, post-traumatic stress disorder, and substance use disorders. Surprisingly, only two independent studies have investigated the overlap between sexual victimization and mental illness in samples of incarcerated women. Both studies found disproportionally high rates of mental illness among victims of sexual violence. Suggestions and implications for research, policy, and practice are discussed.

The importance of shared language in rural behavioral health interventions: An exploratory linguistic analysis

A focus on the use of shared language to enhance congruence in interventionist-client dialogue is missing from traditional research on evidence-based practices and rural behavioral health. This study incorporates qualitative interactional sociolinguistics, which includes discourse analysis (typically written or audio recordings of face-to-face encounters with 11 clients and a study interventionist), to describe those speech patterns in a broad sense (dialect), as well as more specific use of communicative strategies to increase parity in the interaction between a rural interventionist delivering an evidence-based practice in the context of a research study with rural women opioid users in a non-therapeutic context. Study findings indicated that in the context of delivering the intervention, use of a shared language, language pattern congruence, and communication styles can greatly augment the intent of the approach with vulnerable populations. In addition, other communicative strategies connected with traditional Appalachian values - such as religion, home, and family - were also important. This study makes an important contribution to behavioral health research and practice by understanding critical factors that may influence evidence-based practice delivery, particularly in real-world settings with vulnerable populations. These findings have important implications for the utilization of creative approaches to understand critical components of the clinical interaction as indicators of fidelity.

Hepatitis C antibody reactivity among high-risk rural women: opportunities for services and treatment in the criminal justice system

Purpose The purpose of this paper is to examine the drug use and criminal justice factors related to hepatitis C virus (HCV) antibody reactivity among rural women in the USA recruited from local jails. Design/methodology/approach Analyses included 277 women with a history of injection drug use from three rural jails in Kentucky. Participants completed health and drug use questionnaires and received antibody testing for HCV. Findings The majority of women tested reactive to the HCV antibody (69 percent). Reactivity was associated with risk factors, such as unsterile needle use. Criminal justice variables, including an increased likelihood of prison incarceration, an earlier age of first arrest, and a longer incarceration history, were associated with HCV reactive tests. Participants also endorsed several barriers to seeking healthcare before entering jail that were more prevalent in women testing HCV reactive regardless of HCV status awareness before entering jail. Originality/value Injection and high-risk sharing practices as well as criminal justice factors were significantly associated with HCV reactivity. Future research and practice could focus on opportunities for linkages to HCV treatment during incarceration as well as during community re-entry to help overcome real or perceived treatment barriers. The current study highlights the importance of the criminal justice system as a non-traditional, real-world setting to examine drug use and related health consequences such as HCV by describing the association of high-risk drug use and criminal justice consequences with HCV among rural women recruited from local jails.

Criminal Justice Contact and Health Service Utilization among Women across Health Care Settings: Analyzing the Role of Arrest

BACKGROUND

It is well-established in the United States that incarceration negatively influences women's health, and researchers have called for examinations of the health effects of criminal justice contact more broadly. This study uses the behavioral model for vulnerable populations to document the prevalence of illness and health risks for recently arrested women, and examines potential ways that illness and health risks are associated with health service use across health care settings.

METHODS

We conducted a mediation analysis using pooled data from the National Survey on Drug Use and Health (2010-2014).

RESULTS

These findings reveal that recent arrest is associated with different types of health care use among women. Specifically, women recently arrested are hospitalized and seek care at the emergency department at higher rates than non-recently arrested women and this may be associated with their vulnerable mental and behavioral health status.

CONCLUSIONS

The findings suggest an increasing overlap between criminal justice and public health sectors. Increased access to appropriate health services is a necessary strategy to reduce resource intensive hospitalizations and emergency department use among women experiencing a recent arrest.

What Role Can Community Health Workers Play in Connecting Rural Women with Depression to the "De Facto" Mental Health Care System?

The prevalence of depression among rural women is nearly twice the national average, yet limited mental health services and extensive social barriers restrict access to needed treatment. We conducted key informant interviews with community health workers (CHWs) and diverse health care professionals who provide care to Appalachian women with depression to better understand the potential roles that CHWs may play to improve women's treatment engagement. In the gap created by service disparities and social barriers, CHWs can offer a substantial contribution through improving recognition of depression; deepening rural women's engagement within existing services; and offering sustained, culturally appropriate support.

Staying Out: Reentry Protective Factors Among Rural Women Offenders

The current study examines protective factors for women who transition from county jails to rural Appalachian communities, areas with limited health and behavioral health services. The study included drug-using women recruited from three jails in rural Appalachia and were followed 12-months post-release. Analyses focused on differences between women who remained in the community and those who returned to custody, as well as a multivariate model to determine protective factors for re-entry success. At the bivariate level, staying out of jail was associated with being older, having a job, not using drugs, stable housing, receiving health treatment, and having prosocial peers. In the multivariate model, the most robust predictors of staying out of jail were drug use abstinence, health care utilization, and prosocial peers. Most research on criminogenic needs associated with re-entry success have focused on men, and most focused on re-entry to urban communities where services and resources are more accessible. These findings have important implications for criminal justice systems to implement re-entry programs for women offenders during the transition to the community.

HIV Prevention in Rural Appalachian Jails: Implications for Re-entry Risk Reduction Among Women Who Use Drugs

Rural women are at risk for health consequences (such as HIV) associated with substance misuse, but targeted interventions are limited for this population. Jails provide an underutilized opportunity for outreach to high-risk women in rural Appalachian communities. Rural women were randomized to either the NIDA Standard education intervention (n = 201) or the NIDA Standard plus motivational interviewing (MI-HIV; n = 199) while in jail. Outcomes focused on HIV risk behaviors 3 months post-release from jail. Decreases in HIV risk behaviors were observed at follow-up across conditions. Although participants in the MI-HIV group showed reductions in outcomes compared to the NIDA Standard group (OR = 0.82-0.93), these estimates did not reach significance (p values > .57). HIV education interventions can be associated with risk-reduction behaviors. These findings support the need for increased access to prevention education in criminal justice venues, particularly in rural communities.

Drug Use and Incarceration among Rural Appalachian Women: Findings From a Jail Sample

BACKGROUND/OBJECTIVE

The purpose of this paper is to examine drug use and incarceration history among rural Appalachian women.

METHODS

This study involved random selection, screening, and interviews with rural women from local jails in Appalachia.

RESULTS

Of the women randomly selected and screened, 97% met criteria for substance use intervention. Significant factors associated with incarceration history included age, education, custody status, and mental health. A significant interaction was observed between male sex partners and drug use on incarceration history.

CONCLUSIONS

Study findings suggest that the drug/crime relationship among rural Appalachian women is associated with their high-risk home environment, partner relationships, and mental health. Specifically, in addition to drug use, factors such as family and child relationships, anxiety, victimization, and relationships with partners should also be considered in the trajectory of criminal careers among rural Appalachian women.

Appalachian Women's Use of Substance Abuse Treatment: Examining the Behavioral Model for Vulnerable Populations

The Gelberg-Andersen Behavioral Model for Vulnerable Populations was applied to understand vulnerable Appalachian women's (N = 400) utilization of addiction treatment. A secondary data analyses included multiple multivariate analyses. Strongest correlates of treatment utilization included ever injecting drugs (OR = 2.77), limited availability of substance abuse treatment facilities (OR = 2.03), and invalidated violence abuse claims (OR = 2.12). This study contributes theory-driven research to the greater social work addiction literature by confirming that vulnerable domains related to substance abuse treatment utilization warrant unique considerations compared to non-vulnerable domains. Findings also highlight the importance of understanding the unique role that cultural factors play in treatment utilization among Appalachian women. Inferences relevant to clinicians and policymakers are discussed.

Correlates of Injection Drug Use Among Rural Appalachian Women

BACKGROUND

Limited research has focused on correlates of injection drug use (IDU) among high-risk subgroups of drug users, particularly women, who may be at increased risk for transmission of infectious diseases such as HIV and Hepatitis C. The purpose of this study is to better understand the contextual and health correlates of IDU among women living in rural Appalachia by examining (1) differences between injectors and noninjectors, and (2) the unique correlates of recent IDU and past IDU.

METHODS

This study involved random selection, screening, and face-to-face interviews with 400 rural Appalachian women from jails in one state. Analyses included descriptive statistics, multinomial logistic regression, and stepwise regression to identify significant correlates of recent IDU and past IDU compared to never injecting.

RESULTS

Findings indicated that 75.3% of this randomly selected sample reported lifetime injection of drugs. Contextual factors including drug use severity (RRR = 8.66, P < .001), more male sex partners (RRR = 1.01, P < .05), and having injecting partners (RRR = 7.60, P < .001) were robust correlates of recent injection practices.

CONCLUSIONS

This study makes an important contribution to understanding factors associated with IDU among rural Appalachian women drug users, which are strongly associated with both relational and health factors. Study findings on the specific factors associated with IDU risk have important implications for tailoring and targeting interventions that should include a focus on the relationship context reducing high-risk injection practices.

Community-Based Mental Health Treatment Preceding Jail Detention among Adults with Serious Mental Illness

Research on the effectiveness of community-based mental health treatment for offenders with a serious mental illness (SMI) has lacked specifics on the type and intensity of services received. This study examined the detailed lifetime and past-year community mental health treatment use of 431 (282 men; 149 women) jail detainees with SMI. Whereas a majority of participants reported high lifetime rates of mental health treatment they believed effective, treatment in the year and month prior to arrest and detention was accessed by only a minority of the sample. Where gender differences were found, women were less likely to receive treatment than men and more likely to leave treatment against medical advice in the year preceding arrest. Both substance use disorders and post-traumatic stress disorder (PTSD) were significantly undertreated for both genders, and care was provided predominantly by psychiatrists suggesting an underuse of other mental health professionals. The implications for expanding treatment availability for offenders, particularly women, with an emphasis on broadening access to ancillary but critical services such as literacy training, housing and employment services, and case management provided by mental health professionals in conjunction with services provided by psychiatrists are discussed.

Violent Victimization and Substance Dependency: Comparing Rural Incarcerated Heterosexual and Sexual Minority Women

This exploratory study examines the relationship between sexual identity and violent victimization experiences as predictors of differences in illicit substance and alcohol use and substance use problems among a sample of incarcerated women in rural Appalachia (N = 400). Results indicated that, compared to heterosexual women, sexual minority women were more likely to have a lifetime history of weapon, physical, and sexual assault, and were younger at the time of their first violent victimization. Sexual minority women were younger than heterosexual women at the age of onset for intravenous drug use and at the time they first got drunk, and were more likely to report having overdosed. Multivariate analysis found violent victimization to be the strongest predictor of a history of overdose and substance use problems.

Correlates of Preincarceration Health Care Use Among Women and Men in Jail

Although women and men in jails bear a burden of health problems, little is known about factors associated with their health care use. We conducted a cross-sectional survey of preincarceration health care use with 596 jail inmates. Descriptive statistics and correlates of participants' health care use were assessed. A year before incarceration, 54% of participants used an emergency room, 24% were hospitalized, and 39% used primary care. Correlates of health care use included gender, health insurance status, and drug dependence. For participants without mental health problems, use was associated with living in neighborhoods where a higher percentage of residents did not complete high school. Findings suggest individual and community factors that can be targeted by reentry programs to improve health care use after jail.

Trajectories of Health and Behavioral Health Services Use among Community Corrections-Involved Rural Adults

This article seeks to establish time-based trajectories of health and behavioral health services utilization for community corrections-involved (CCI) adults and to examine demographic and clinical correlates associated with these trajectories. To accomplish this aim, the authors applied a latent class growth analysis (LCGA) to services use data from a sample of rural CCI adults who reported their medical, mental health, and substance use treatment utilization behavior every 60 days for 1.5 years. LCGA established 1.5-year trajectories and demographic correlates of health services among rural CCI adults. For medical services, three classes emerged (stable-low users, 13%; stable-intermediate users, 40%; and stable-high users, 47%). For mental health and substance use services, three classes emerged (stable-low, 69% and 61%, respectively; low-baseline-increase, 10% and 12%, respectively; high-baseline decline, 21% and 28%, respectively). Employment, gender, medication usage, and depression severity predicted membership across all services. Results underscore the importance of social workers and other community services providers aligning health services access with the needs of the CCI population, and highlight CCI adults as being at risk of underservice in critical prevention and intervention domains.

Factors Associated with Recidivism among Corrections-Based Treatment Participants in Rural and Urban Areas

The majority of corrections-based treatment outcome studies focus on individuals paroling to urban areas; thus there is a significant gap in the literature on outcomes, including recidivism, among individuals paroling to non-urban and rural communities. This study examines differences in factors associated with recidivism among former corrections-based treatment participants living in urban and rural communities following release. Analyses focused on secondary data collected from treatment participants in one southeastern state over a four year period between July 2006 and June 2010 including both baseline (treatment intake) and follow-up data (12-months post-release). Findings indicated that individuals in urban areas were 2.4 times more likely to recidivate than rural individuals. Other factors identified in separate rural and urban analyses also emerged as significant predictors in the overall model including age, gender, race, employment and drug use. Overall, these findings suggest that corrections-based treatment participants living in urban and rural areas following release may share similar risk factors for recidivism. However, rural areas may be protective for returning to custody despite the presence of some of these risks.

Barriers and Facilitators to Substance Use Treatment in the Rural South: A Qualitative Study

PURPOSE

Little qualitative research has examined factors associated with care in substance abuse treatment agencies in Southeastern rural communities. This study explored client- and agency stakeholder-perceived barriers and facilitators to substance use treatment delivery in southeastern rural communities.

METHODS

Group and individual interviews were conducted with 40 key stakeholders and 40 clients at 9 substance abuse agencies serving rural communities in a southeastern state. Qualitative thematic analysis was used to identify perceived barriers and facilitators to substance abuse services in rural communities.

FINDINGS

Four primary themes emerged from the client and stakeholder interviews as both barriers and facilitators: availability of services for individuals with substance use disorders; access to the current technology for client services and agency functioning; cost of services; and stigma.

CONCLUSIONS

This study identifies novel barriers and facilitators to substance use care in the rural South and highlights essential areas for consideration when developing and implementing substance use care in this geographic region. These findings can be used as guidelines to provide better care to individuals with substance use disorders living in rural communities.

Time Since Release from Incarceration and HIV Risk Behaviors Among Women: The Potential Protective Role of Committed Partners During Re-entry

After release from incarceration, former female inmates face considerable stressors, which may influence drug use and other risk behaviors that increase risk for HIV infection. Involvement in a committed partnership may protect women against re-entry stressors that may lead to risky behaviors. This study measured the association between time since release from incarceration (1-6 months ago, and >6 months ago versus never incarcerated) and HIV risk behaviors and evaluated whether these associations differed by involvement in a committed partnership. Women released within the past 6 months were significantly more likely to have smoked crack cocaine, used injection drugs and engaged in transactional sex in the past month compared to never-incarcerated women and women released more distally. Stratified analyses indicated that incarceration within the past 6 months was associated with crack cocaine smoking, injection drug use and transactional sex among women without a committed partner yet unassociated with these risk behaviors among those with a committed partner.

An exploratory study of mental health and HIV risk behavior among drug-using rural women in jail

OBJECTIVE

Rural women, particularly those in the criminal justice system, are at risk for HIV related to the increasing prevalence of injection drug use as well as limited services. Research on HIV risk correlates, including drug use and mental health, has primarily focused on urban women incarcerated in prisons. The purpose of this exploratory study is to examine dual HIV risk by 3 different mental health problems (depression, anxiety, and posttraumatic stress disorder [PTSD]) among drug-using women in rural jails.

METHOD

This study involved random selection, screening, and face-to-face interviews with 136 women in 1 Appalachian state. Analyses focused on the relationship between mental health and HIV risk.

RESULTS

Nearly 80% of women self-reported symptoms of depression, and more than 60% endorsed symptoms consistent with anxiety and PTSD symptoms. Mental health significantly correlated with severity of certain types of drug use, as well as risky sexual activity. In addition, for women experiencing anxiety and PTSD, injection drug use moderated the relationship between mental health and risky sexual activity.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Based on these rates of drug use, mental health problems, and the emergence of injection drug use in rural Appalachia, the need to explore the relationships between these issues among vulnerable and understudied populations, such as rural women, is critical. Because of service limitations in rural communities, criminal justice venues such as jails provide opportune settings for screening, assessment, and intervention for drug use, mental health, and HIV education and prevention. (PsycINFO Database Record

Drug use, hepatitis C, and service availability: perspectives of incarcerated rural women

This study examined drug use, hepatitis C, and service availability and use among a high-risk sample of rural women serving time in jails. Data was collected from female offenders (N = 22) who participated in four focus groups in three rural jail facilities located in Appalachia. Findings indicated that drug misuse is prevalent in this impoverished area of the country, and that the primary route of administration of drug use is injection. Findings also indicate that injection drug use is also commonly associated with contracting hepatitis C (HCV), which is also perceived to be prevalent in the area. Despite knowledge associated with HCV risks, women in this sample were seemingly apathetic about the increasing spread of HCV in the area and unconcerned about the long-term consequences of the course of the infection. Implications for future research and practice are discussed.

Who Benefits from Gender Responsive Treatment? Accounting for Abuse History on Longitudinal Outcomes for Women in Prison

This study explores outcome variation among women offenders who participated in gender-responsive substance abuse treatment (GRT). In order to identify subgroups of participants that may differentially benefit from this treatment, secondary analyses examined the interaction between randomization into GRT and a history of abuse (physical/sexual) on depression and number of substances used post- treatment. The sample consisted of 115 incarcerated women assessed at baseline and 6- and 12-months post parole. Longitudinal regression showed that women reporting abuse randomized into GRT had significantly reduced odds of depression (OR = .29, p < .05, 95% CI = .10 - .86) and lowered rates of number of substances used (IRR = .52, p < .05, 95% CI = 0.28-0.98), in comparison to those who reported abuse and were randomized to the non-GRT group. GRT for women offenders who have experienced prior abuse would maximize the benefits of the trauma-informed, gender-sensitive intervention.

Gender disparity in utilization rates of substance abuse services among female ex-offenders: a population-based analysis

BACKGROUND

The use and abuse of substances is common among offender populations. Although the female former offender population has risen substantially in recent decades, relatively little is known about their substance abuse treatment experiences.

OBJECTIVE

This study examines disparities in substance abuse treatment utilization among the US population with special focus upon formerly incarcerated female offenders.

METHODS

Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n = 43,093) collected in 2001-2002 and 2004-2005 the authors compared lifetime rates of substance abuse treatment utilization between female and male ex-offenders with the U.S. general population. The sample population covered inpatient and community based substance use treatment, detoxification and rehabilitation programs. It is a nationally representative sample of noninstitutionalized persons over the age of 18. Multinomial logistic regression was performed and likelihood of using substance use treatment and services was calculated using adjusted odds ratios (AOR).

RESULTS

Compared to male ex-offenders, female ex-offenders were 52% less likely to use substance-abuse treatment services (AOR = 0.48, 95% CI = 0.26-0.89) and 51% less likely to use rehabilitation programs (AOR = 0.49, 95% CI = 0.26-0.93). Compared to females in the general population, female ex-offenders were 10 times more likely to use substance-abuse treatment services (AOR = 10.14, 95% CI = 5.71-18.00), 10.5 times more likely to use substance detoxification programs (AOR = 10. 45, 95% CI = 5.64-19.39); 8 times more likely to use inpatient wards (AOR = 8.05, 95% CI = 4.16-15.59); 9 times more likely to use outpatient wards (AOR = 9.06, 95% CI = 4.89-16.81), and 12 times more likely to use substance-abuse rehabilitation programs (AOR = 12.06, 95% CI = 6.55-22.22).

CONCLUSIONS

While female ex-offenders were more likely to have used a range of substance abuse services when compared to the general population, they were less likely to use substance-abuse treatment services and rehabilitation programs than male ex-offenders.

Criminalized women and the health care system: the case for continuity of services

Drawing upon research with criminalized women in Massachusetts, this article examines barriers to health care before, during, and after incarceration. Although very few of the surveyed women reported having had to forgo medical treatment because of an inability to pay, almost all of them reported being unable to access consistent, ongoing health care services. Typically, the women recalled sequential contact with dozens of providers at dozens of facilities, treatment plans that had been developed but never executed, psychotherapy that opened wounds but was terminated before healing them, and involuntary interruptions in legally prescribed courses of psychiatric medications. Acknowledging that these problems are related to wider structures of health care delivery in the United States, this article ends with a modest proposal for developing a role for health care advocates assigned to coordinate care for those with complicated medical problems to help them manage their health care needs over a long period of time.

Finnish female prisoners - heavy consumers of health services

AIMS

Previous prison studies show that female prisoners often have more health problems than male prisoners do and that they have many chronic health conditions. Few studies have been made among offenders concerning the use of health services, and even fewer concerning physical diseases. We studied the self-reported lifetime somatic diseases, the use of health services and the current use of prescription medicines among Finnish female prisoners and compared them with males.

METHODS

The sample consisted of 101 females and 309 male prisoners as controls. The study included several questionnaires and interviews conducted by experienced prison nurses.

RESULTS

The women had more commonly genitourinary, virus hepatitis/HIV infections and group "other diseases" than the men. Over 80% of the women and men have had accidents/injuries. Four out of five women, and half of the men, used some medicine regularly. Of the females, 92% (80% of the males) reported lifetime hospital care and 65% (61%) treatment in surgery department, respectively; 70% of the females (53% of the males) reported lifetime use of any psychiatric service; 66% of the women (46% of the men) had received psychiatric out-patient services, and 43% (31%) psychiatric in-patient hospital care and 38% (30%) substance abuse services, respectively.

CONCLUSIONS

The heavy use of health services among female prisoners resulted mainly from the use of services for substance use and other mental disorders and treatment in surgery department. Compared to men, the difference in using health services was associated with psychiatric services.

Risky relationships: targeting HIV prevention for women offenders

HIV is a health issue for women offenders who are at particularly high risk. Women's prisons can be opportune settings for HIV prevention interventions. How women perceive partner relationships could be central to targeting HIV interventions. Consequently, this study examines changes in women offenders' risky relationships. Baseline and follow-up data are presented from 344 women offenders. Intent-to-treat analysis is used as well as analysis of covariance to control for baseline values. Findings indicate that women released to the community from prison who were randomized into the prevention intervention were significantly more likely to report changes in five of seven risky relationship thinking myths. Findings suggest that a relationship theory-based prevention intervention for reducing HIV risk could be promising for women offenders reentering the community after prison. Additional research is suggested.

The risk behaviors and mental health of detained adolescents: a controlled, prospective longitudinal study

Background

To assess the behavioral risk factors and mental health needs of adolescents in juvenile detention centers (JDC).

Method

A total of 238 boys aged 12–17 years was surveyed who had been admitted to a detention center and compared them with boys from the community (n = 238) matched for sex and age. We assessed behavioral risk factors and mental health problems by using the Youth Risk Behavior Survey questionnaire (YRBS) and the Youth Self-Report questionnaire (YSR).

Results

Young offenders had significantly higher YRBS scores than controls for drug use (odds ratio (OR) 5.16, 95% CI 2.27–7.84), sexual intercourse (OR, 2.51; 95% CI 1.55–2.90), irregular diet (4.78, 2.11–7.51), suicide attempts (1.96, 1.32–5.85), and physical fighting behavior (3.49, 1.60–7.07), but not for tobacco use, alcohol use, and high–risk cycling. Young offenders at the time of admission (6.61, 2.58–15.2), at 6 months (3.12, 1.81–10.1), and at 12 months (5.29, 1.98–13.3) reported statistically higher levels of total mental health problems than adolescents in a community sample.

Conclusions

Young offenders have a high rate of mental and behavioral disorders. In the detention period, aggressive behavior, self–destructive/identity, and externalizing of problems improved while withdrawn, anxious or depressed, and internalizing of problems worsened.

Outcomes following Prison and Jail-Based Treatment among Women Residing in Metro and Non-Metro Communities following Release

This study uses data from the Criminal Justice Kentucky Treatment Outcome Study (CJKTOS) to describe treatment outcomes following prison and jail-based treatment among women residing in metro and non-metro areas following release. The study takes an exploratory look at potential differences in sustained abstinence, community treatment utilization, and recidivism by geographic location (metro/non-metro) and treatment program (jail or prison). Baseline data was collected from women as they entered two prison and two jail-based treatment programs, and follow-up data was collected 12 months post-release in the community. Bivariate group differences were noted with a higher percentage of metro women who participated in prison-based treatment relapsing to cocaine use during the follow-up period compared to non-metro women. In multivariate models, females who participated in jail-based treatment and prison-based treatment fared similarly on study outcomes. There was, however a main effect of residence status in that women living in non-metro areas during the follow-up period were less likely to utilize community-based aftercare treatment and less likely to be re-incarcerated during the follow-up period than women living in metro areas. Findings are discussed with regard to future research and practice implications for women offenders transitioning to geographically different communities following release.

Alcoholics Anonymous and hazardously drinking women returning to the community after incarceration: predictors of attendance and outcome

BACKGROUND

The number of women incarcerated within the United States has risen dramatically in recent decades, and high rates of alcohol problems are evident among this population. Although little is known about the patterns of help utilization and efficacy for alcohol problems, preliminary evidence suggests that Alcoholics Anonymous (AA) is a widely available resource for this population.

METHODS

Data were collected as part of a study evaluating the effect of a brief intervention to reduce alcohol use among hazardously drinking (i.e., score of 8 or above on the Alcohol Use Disorders Identification Test or 4 or more drinks at a time on at least 3 days in prior 3 months) incarcerated women. The current study characterized demographic, clinical, and previous AA attendance variables associated with AA attendance in the 6 months following incarceration. Associations between frequency of AA attendance and drinking outcomes following incarceration were also evaluated.

RESULTS

Among the 224 participants who provided data about AA attendance, 54% reported some AA attendance during the follow-up assessment period. AA attendance in the year prior to study entry (OR = 4.02; 95% CI: 3.32 to 4.71) and greater baseline consequences of alcohol use (OR = 2.09; 95% CI: 1.73 to 2.44) were associated with increased odds of higher frequency of AA attendance following incarceration. Weekly or greater AA attendance was associated with reductions in negative drinking consequences (B = -0.45; p < 0.01) and frequency of drinking days (B = -0.28; p < 0.01) following incarceration.

CONCLUSIONS

Findings from this study suggest that AA is frequently utilized by hazardously drinking women following incarceration. Alcohol outcomes may be enhanced by AA attendance at a weekly or greater frequency is associated with better alcohol outcomes relative to lower levels of AA attendance. Evaluation of clinical guidelines for prescribing AA attendance for incarcerated women remains a task for future research.

A women's worker in court: a more appropriate service for women defendants with mental health issues?

AIMS

Court liaison services aim to reduce mental illness in prison through early treatment and/or diversion into care of defendants negotiating their court proceedings. However, liaison services may inadvertently contribute to gender inequalities in mental health in the prison system because women often do not access liaison services. This is attributed to services failing to recognize that women have different needs from men. To address this, it is essential that the needs of women in contact with the criminal justice system (CJS) are clearly articulated. However, there is a dearth of research that considers women's needs at this stage of their journey through the CJS. This paper aims to identify these needs before women enter prison. It does so through an analysis of a pilot Women's Support Service based at a magistrates' court, a response to concerns that women were not accessing the local liaison service.

METHODS

Proformas were completed by a women's specialist worker for 86 women defendants assessed over four months. Information was collected on characteristics including education, domestic violence, accommodation, physical and mental health. This specialist worker recorded the range of needs identified by defendants at assessment and the services to which women were referred.

RESULTS

Access to the Women's Support Service is high, with only 11.3% of women refusing to use the service. Women attending have high levels of physical and mental health issues. Their mental health issues have not being addressed prior to accessing the service. Women often come from single households and environments high in domestic abuse. Women have multiple needs related to benefits, finance, housing, domestic abuse, education and career guidance. These are more frequent than those that explicitly link to mental health. The women's worker providing the service referred women to 68 services from a wide variety of statutory and voluntary organizations.

CONCLUSIONS

The Women's Support Service is accessed by a higher number of women, many more than access the local liaison service. It is suggested that this is due to their multiple and gender-specific needs being adequately addressed by the former service and the organizations to which they are referred. Mental health needs may also be secondary to other more basic needs, which makes the generic service provided by the Women's Support Service more appropriate than a liaison service that deals with mental health support alone.

Self-reported physical health of inmates: impact of incarceration and relation to optimism

This study investigated the relationship between inmates' physical health concerns and optimism. Optimism has been consistently associated with physical health in community samples, but little research has examined this potentially malleable variable in an inmate population. This study of 501 male and female jail inmates attempts to bridge this gap. Results showed optimism was negatively associated with physical health concerns upon entry to jail and prior to release or transfer. Additionally, optimism assessed upon entry to jail predicted modest decreases in physical health concerns over incarceration. Results suggest that optimism is a health-related variable that may be beneficial when optimism-increasing components are integrated into treatment.

Gender-specific factors associated with community substance abuse treatment utilization among incarcerated substance users

This article describes the independent correlates of preincarceration community substance abuse treatment utilization for male and female offenders currently participating in prison-based treatment. As part of the National Institute on Drug Abuse-funded Criminal Justice Drug Abuse Treatment Studies cooperative agreement, this protocol was implemented by four collaborating research centers. Males with a history of treatment utilization were more likely to be older, to have used crack, and to have had a greater number of arrests, and they were less likely to be arrested for a violent charge. Females with previous treatment were more likely to have been hospitalized for a health condition and were significantly more likely to have lived with someone else before prison rather than in their own home. These findings suggest that factors associated with preincarceration treatment utilization differ by gender, which may have important implications for correctional-based treatment assessment, reentry planning, and transitional case management.