Sexual Coercion, Trauma, and Sex Work in Justice-Involved Women with Substance Use Disorders

Sexual victimization is strongly associated with mental health problems, traumatic responses, earlier onset of substance use and criminal justice involvement. It is well known that multiple forms of sexual victimization and aggression have been experienced by most incarcerated women. 

Two hundred women with a substance use disorder and involvement with the criminal justice system within the previous two years (parole, probation, arrest, or incarceration) were recruited from multiple sites in metropolitan Chicago. 

We examined whether empowerment moderates the relationship between trauma symptoms, trading sex and the experience of being forced or coerced to have sex. There was a significant three-way interaction between sexual coercion, trading, and empowerment scores on trauma symptoms. 

For individuals who have not traded sex, lower levels of empowerment were associated with a larger difference in trauma symptomatology between individuals who have been coerced and those who have not been coerced. For individuals who had been coerced to engage in sexual activity, lower levels of empowerment were associated with a larger difference in trauma symptomatology between those who have traded and those who have not traded. 

The promotion of empowerment beliefs and attitudes in women disproportionately impacted by violence and sexual trauma may reduce the harm that results from being victimized. Furthermore, providing specific interventions that educate women regarding gender roles and cultural values may help women avoid situations that result in exploitation and coercion.

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By: Salina DD1, Ram D2, Jason LA2.

• 1Northwestern University.
• 2DePaul University.
• J Aggress Maltreat Trauma. 2016;25(3):254-268. Epub 2016 Apr 6.

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Substance Use, Disordered Eating, and Weight Gain: Describing the Prevention and Treatment Needs of Incarcerated Women

Weight-related concerns are associated with women's substance use and treatment relapse. The prevalence of overweight, obesity, disordered eating behavior, and substance abuse history was assessed among female inmates incarcerated for 6 to 24 months at an Oregon state prison, using a self-administered survey and physical measurements. 

Average weight gain was 20 pounds, 87% of women were overweight (39%) or obese (48%), and 24% reported using one or more unhealthy strategies to lose weight in the past 6 months. Women who used tobacco and illicit substances before incarceration gained more weight. 

Integrating nutrition and weight gain issues into substance abuse treatment could benefit incarcerated women-both soon after entering prison to prevent weight gain and close to release to prevent relapse into substance use.

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By:  Drach LL1, Maher JE2, Braun MJ3, Murray SL4, Sazie E5.

• 1Program Design and Evaluation Services, Multnomah County Health Department and Oregon Public Health Division, Portland, OR, USA linda.drach@state.or.us.
• 2Program Design and Evaluation Services, Multnomah County Health Department and Oregon Public Health Division, Portland, OR, USA.
• 3Oregon Youth Authority, Portland, OR, USA Oregon Department of Corrections (formerly), Portland, OR, USA.
• 4Oregon Public Health Division, Portland, OR, USA.
• 5Oregon Department of Corrections (formerly), Portland, OR, USA. 
• J Correct Health Care. 2016 Apr;22(2):139-45. doi: 10.1177/1078345816634692.

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Making Fatty Girl Cakes: Food and Resistance in a Women’s Prison

This article builds on existing knowledge of inmate resistance by analyzing formerly incarcerated women’s narratives about prison food. 

Participants described trying to secure extra cafeteria portions, hoarding food, smuggling and stealing food, and cooking and eating in the cells—all to resist prison power and gain some control over their lives by managing what, how, when, and with whom they ate. 

These data shed light on prison life and suggest changes to food policy to curb inmate resistance and bolster the rehabilitative potential of correctional facilities.

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By:  Amy B. Smoyer

Assistant Professor, Department of Social Work, Southern Connecticut State University, 501 Crescent St., New Haven, CT 06515, USA. Email:smoyera1@southernct.edu

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Incarcerated Black Women in the Southern U.S.: A Narrative Review of STI and HIV Risk and Implications for Future Public Health Research, Practice, and Policy

Incarcerated black women in the southern USA are understudied despite the high prevalence of sexually transmitted infections (STI) and human immunodeficiency virus (HIV). These incarceration and health disparities are rooted in centuries of historically inequitable treatment. 

Amidst the current dialogue on mass incarceration in the south and its relationship to the health of the black community, individual and environmental risk factors for STI/HIV transmission are seldom paired with discussions of evidence-based solutions. 

A narrative review of the literature from January 1995 to May 2015 was conducted. This sample of the literature (n = 18) revealed that partner concurrency, inconsistent condom use, sex work, previous STI, and drug abuse augmented individual STI/HIV risk. 

Recommended interventions include those which promote healthier relationships, cultural competence, and gender specificity, as well as those that enhance prevention skills. Policy recommendations include improving cultural sensitivity, cultural competence, and cultural humility training for clinicians, as well as substantially increasing funding for prevention, treatment, and rehabilitative services. 

These recommendations are timely given the recent national attention to incarceration, STI, and HIV disparities, particularly in the southern USA.

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By:  Pelligrino N1, Zaitzow BH2, Sothern M3, Scribner R4, Phillippi S3.

• 1Department of Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center-New Orleans (http://www.lsuhsc.edu/), School of Public Health, 2020 Gravier Street, 3rd Floor, New Orleans, LA, 70112, USA. npelligrino83@gmail.com.
• 2Department of Government and Justice Studies, Appalachian State University, Boone, NC, USA.
• 3Department of Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center-New Orleans, School of Public Health, 2020 Gravier Street, 3rd Floor, New Orleans, LA, 70112, USA.
• 4Department of Epidemiology, Louisiana State University Health Sciences Center-New Orleans, School of Public Health, New Orleans, LA, USA. 
• J Racial Ethn Health Disparities. 2015 Dec 23

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8 Depressing/Uplifting Things We Learned About Women This Year

Via:   http://goo.gl/QuVg5q 

Motivation to Reduce Risk Behaviors While in Prison: Qualitative Analysis of Interviews with Current and Formerly Incarcerated Women

Prison is an environment in which programs can be implemented to change harmful behaviors among high-risk populations. Incarcerated women experience high rates of HIV and other sexually transmitted diseases (STDs), yet little research has examined women’s motivation to reduce risky behaviors during incarceration. 

In-depth individual interviews were conducted with former and current women prisoners in two North Carolina correctional facilities and analyzed to identify barriers and facilitators of behavior change while in prison. 

Analyses revealed key motivators of behavior change: 

• Viewing prison as a place to recover from past trauma, 
• removing oneself from negative social networks, 
• gaining access to needed mental and physical health services, 
• and engaging in self-care and self-reflection. 

Barriers to behavior change include 

• fear of recidivism, 
• stigma of being in prison, 
• and return to undesirable social networks post-release. 

Moreover, women noted that the provision of mental health services, educational enhancement and housing assistance could help them reduce engagement in high-risk behaviors after their incarceration. 

These findings can be incorporated into HIV/STD risk reduction interventions to facilitate positive behavior change among incarcerated women prisoners.

Prison itself is a tremendous education in the need for patience and perseverance. It is above all a test of one’s commitment.

—Nelson Mandela, 1995

Full article at:   http://goo.gl/a7ymrR

By:   Neetu Abad,* Monique Carry, Jeffrey H. Herbst, and Catherine I. Fogel

Neetu Abad, Centers for Disease Control and Prevention;

Contributor Information.

^*Corresponding Author: Neetu Abad, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-37, Atlanta, GA 30333 USA, vog.cddc@3xjv

 

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Incarcerated Women’s Relationship-based Strategies to Avoid Drug Use After Community Re-Entry

While recent research has stressed the supportive role that family and friends play for incarcerated persons as they re-enter the community, drug-using incarcerated women re-entering the community often have to rely on family, community, and intimate relationships that have played a role in their substance abuse and criminalization. 

This study conducted qualitative analysis of clinical sessions with rural, drug-using women (N = 20) in a larger prison-based HIV risk reduction intervention in Kentucky during 2012-2014 to examine incarcerated women’s perceptions of the role of their family, community, and intimate relationships in their plans to decrease their substance abuse upon community re-entry. 

Women stressed the obstacles to receiving support in many of their family and drug-using relationships after community re-entry. Nonetheless, they asserted that changes in their relationships could support their desires to end their substance abuse by setting limits on and using their positive relationships, particularly with their children, to motivate them to change. Interventions to promote incarcerated women’s health behavior changes—including substance abuse—must acknowledge the complex social environments in which they live.

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By:  Claire Snell-Rood PhD^a*, Michele Staton-Tindall PhD, MSW^b &Grant Victor MSW^b

• ^a University of Kentucky College of Medicine, Department of Behavioral Science, 108 Medical Behavioral Science Building, Lexington, KY 40536-0086
• ^b University of Kentucky College of Social Work, 619 Patterson Office Tower, Lexington, Kentucky, 40506-0027 

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"The Vagina is a Very Tricky Little Thing Down There": Cervical Health Literacy among Incarcerated Women

The objective of this study was to understand factors associated with women's ability to engage in cervical cancer prevention and follow-up care given ongoing criminal justice involvement. 

We conducted four focus groups with 45 incarcerated women to assess barriers to cervical health promotion, and used a grounded theory method to analyze data. We administered the Short Test of Functional Health Literacy in Adults to assess general health literacy as a standalone factor related to cervical health promotion. 

Ninety-one percent of participants had adequate health literacy scores. However, we found that the women had varying levels of cervical health literacy, which we operationalized as knowledge, beliefs, and self-efficacy related to cervical health promotion. 

Practitioners should establish broader interventions to empower women with criminal justice histories to take control of their own cervical health and focus on communicating updated recommendations to improve cervical health understanding, beliefs, and practices among high-risk women.

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By:  Ramaswamy M, Kelly PJ.

 

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Long-Acting Reversible Contraceptives for Incarcerated Women: Feasibility and Safety of On-Site Provision

Many incarcerated women have an unmet need for contraception. Providing access to long-acting reversible contraceptive (LARC) methods-IUDs and implants-before release is one strategy to meet this need and potentially prepare them for reentry to the community, but the safety and feasibility of providing these methods in this setting have not been described.

A retrospective descriptive study of all LARC insertions at the San Francisco County Jail in 2009-2014 was conducted. Data from community clinic and jail clinic databases were assessed to examine baseline characteristics of LARC initiators, complications from insertion, method continuation, and pregnancy and reincarceration rates. Correlates of method discontinuation were assessed in multivariate logistic regression analyses.

Eighty-seven LARC devices were inserted during the study period-53 IUDs and 34 implants. There were no cases of pelvic inflammatory disease or other insertion complications in IUD users and no serious complications in implant users. Median duration of known use was 11.4 months for IUDs and 12.9 months for implants. Women who discontinued a LARC method most commonly cited a desire to get pregnant (32%). Black women were more likely than whites to discontinue use (odds ratio, 4.4).

It is safe and feasible to provide LARC methods to incarcerated women. Correctional facilities should consider increasing access to all available contraceptives, including LARC methods, in a noncoercive manner as a strategy to reduce reproductive health disparities among marginalized women at high risk of unplanned pregnancies.

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By: Sufrin C1, Oxnard T2, Goldenson J3, Simonson K4, Jackson A5.

• 1Assistant professor, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore. carolynsufrin@gmail.com.
• 2Student at the School of Medicine, University of California, San Francisco.
• 3Director, Jail Health Services, San Francisco Department of Public Health.
• 4Assistant director of program management, Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco.
• 5Assistant professor, Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco.  

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Mothering at a Distance: What Incarcerated Mothers Value About a Parenting Program

Children with incarcerated mothers experience a range of adverse health, social, emotional and economic circumstances, and are a particularly vulnerable group within the Australian community. Mothers in custody face significant challenges to their capacity to parent their children. This study presents findings from a mixed-methods evaluation of a parenting support program for incarcerated mothers in NSW Australia. It examines responses to open and closed questions on a questionnaire to identify participants' views on the program's impact on their parenting role. 

Quantitative data indicated that participants found the program worthwhile and relevant, and that it helped build their parenting knowledge and confidence. Qualitative responses highlighted the aspects of the program which participants valued, specifically gaining support for their parenting role in complicated circumstances, a greater understanding of child development and perspectives, and a range of practical strategies for enhancing relationships with their children during their incarceration. Respondents reported feeling validated as mothers due to improved self-perception and feeling more confident and hopeful in their mothering role.

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By: Rossiter C1, Power T1, Fowler C1,2, Jackson D3,4, Hyslop D5, Dawson A1.

• 1a Faculty of Health , University of Technology Sydney , Australia.
• 2b Tresillian Family Care Centres.
• 3c Oxford Brookes University , UK.
• 4d University of New England , NSW , Australia.
• 5e Corrective Services New South Wales.  

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Feasibility of an HIV/STI Risk-Reduction Program for Incarcerated Women Who Have Experienced Interpersonal Violence

HIV and other sexually transmitted infections (STIs) and interpersonal violence (IV; e.g., childhood abuse, partner violence, and rape) victimization are significant and interconnected public health problems facing incarcerated women. We adapted a best-evidence HIV-prevention intervention for women (the Women's CoOp) to address sexual safety among incarcerated women with histories of interpersonal violence victimization. 

The standard Women's CoOp teaches safe sex, substance use harm reduction, and violence prevention information and skills needed to empower women to make more intentional decisions about their safety. We also incorporated strategies to increase affect management, social support, and access to community resources. This resulted in the first trauma-focused HIV-prevention intervention for women that directly addresses the sequelae of IV (such as affect dysregulation in sexual situations) within the context of HIV harm reduction. 

This manuscript describes the rationale, feasibility, acceptability, and pre-post outcomes of this intervention among 14 women nearing release from prison in two state prison systems. Assessments took place at baseline, prior to release, and at 2-, 5-, and 8 months after release. The intervention overall and each of its components were feasible and acceptable. Participants' number of unprotected sexual occasions, post-traumatic stress disorder symptoms, and depressive symptoms decreased significantly from baseline to post-release. Effectiveness in obtaining resources increased significantly from baseline to post-release. 

Because pre-post measurements of outcomes are confounded with incarceration and subsequent release in this preliminary study, a randomized controlled trial is needed to establish the efficacy of this tailored intervention.

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By:  Johnson JE1, Peabody ME2, Wechsberg WM3, Rosen RK4, Fernandes K2, Zlotnick C5.

• 1Brown University, Providence, RI, USA
• 2Brown University, Providence, RI, USA.
• 3RTI International, Durham, NC, USA.
• 4Brown University, Providence, RI, USA Miriam Hospital, Providence, RI, USA.
• 5Brown University, Providence, RI, USA Butler Hospital, Providence, RI, USA Women and Infants Hospital, Providence, RI, USA University of Cape Town, South Africa. 

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