Correlates of crack abuse among drug-using incarcerated women: psychological trauma, social support, and coping behavior

Transgenerational Cycle of Traumatization and HIV Risk Exposure among Crack Users

The aim of this manuscript is to understand the impact of childhood sexual abuse on the development of Post-Traumatic Stress Disorder (PTSD), Human Immunodeficiency Virus (HIV) exposure. and parental neglect in crack cocaine users, considering the role of gender. This study is a secondary database analysis of a sample from a multicenter cross-sectional study with 715 crack cocaine users receiving outpatient treatment in public mental health networks in six Brazilian capitals. Prevalence ratios were estimated by Poisson regression. In crack cocaine users with childhood sexual abuse, traumatic experiences seem to remain fixed through the development of Post Traumatic Stress Disorder (PTSD) in adulthood. Crack cocaine users with childhood abuse and PTSD in adulthood showed more sexual risk behaviors, including outcomes such as HIV (PR = 3.6 p < 0.001 for childhood abuse and PR = 3.7 p < 0.001 for PTSD). Furthermore, this traumatic trajectory affects the functional ability of crack cocaine users, especially women, to work thus impacting their inclusion and sense of social belonging. Such a chain seems to be reflected in the establishment of a circle of transgenerational transmission, to the extent that subjects with a history of abuse and PTSD reported more parental neglect towards their children. This study reinforces the importance of preventive public policies regarding early socio-emotional vulnerabilities and the need to support families, especially women, to avoid HIV and self-destructive outcomes such as crack cocaine use.

The effectiveness of a group-based computerized HIV/STI prevention intervention for black women who use drugs in the criminal justice system: study protocol for E-WORTH (Empowering African-American Women on the Road to Health), a Hybrid Type 1 randomized controlled trial

BACKGROUND

This paper describes the study protocol of a hybrid type I randomized controlled trial that evaluates the effectiveness and cost-effectiveness of implementing Empowering African-American Women on the Road to Health (E-WORTH), an Afrocentric, group-based, computerized human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention intervention for controlled substance-using black women in community corrections settings in New York City.

METHODS/DESIGN

We provide an overview of E-WORTH's hybrid type I design, which is guided by the Consolidated Framework for Implementation Research (CFIR). E-WORTH combines HIV/STI and intimate partner violence (IPV) prevention components and tests the comparative effectiveness of E-WORTH and streamlined HIV testing versus streamlined HIV testing alone in decreasing biologically confirmed HIV and STI incidence, sexual risk, and IPV, as well as in improving access to HIV and STI prevention services and care.

DISCUSSION

This paper provides an overview of E-WORTH's intervention protocol and serves as a framework for using hybrid type I designs, guided by the CFIR conceptual framework, to evaluate HIV/STI and IPV prevention interventions in community corrections settings. We discuss how E-WORTH's hybrid type I design advances implementation science through its effectiveness and cost-effectiveness aims as well as through a mixed-methods study that evaluates multilevel theory-driven factors (structural, organizational, staffing, and client) guided by the CFIR that influences the implementation of E-WORTH in a criminal justice setting. This study also addresses the novel challenges and opportunities of implementing an intervention that targets specific racial subgroup(s) in a community corrections setting that services all populations, implementing a group-based intervention with technological components in such settings, and employing community-based participatory research strategies to guide recruitment and retention efforts.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02391233 . Registered on 17 March 2015.

A longitudinal analysis of the impact of child custody loss on drug use and crime among a sample of African American mothers

This study examines the influence of child custody loss on drug use and crime among a sample of African American mothers. Two types of custody loss are examined: informal custody loss (child living apart from mother but courts not involved), and official loss (child removed from mother's care by authorities).

METHODS

Using data from 339 African American women, longitudinal random coefficient models analyzed the effects of each type of custody loss on subsequent drug use and crime.

RESULTS

indicated that both informal and official custody loss predicted increased drug use, and informal loss predicted increased criminal involvement. Findings demonstrate that child custody loss has negative health implications for African American mothers, potentially reducing their likelihood of regaining or retaining custody of their children.

CONCLUSIONS

This study highlights the need to integrate drug treatment and other types of assistance into family case plans to improve reunification rates and outcomes among mothers, children, and families. Additionally, the finding that informal loss predicts increased drug use suggests that community-based efforts within the mother's social network could be implemented to intervene before child welfare system involvement becomes necessary.

Health outcomes associated with crack-cocaine use: Systematic review and meta-analyses

BACKGROUND

Crack-cocaine use is prevalent largely in socio-economically marginalized populations in the Americas. Its use has been associated with diverse health outcomes, yet no recent or systematic reviews of these exist.

METHODS

A systematic review of health outcomes associated with crack-cocaine use was performed, using MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and LILACS up to October 2016. Search terms included crack-cocaine and health outcome-related keywords, targeting peer-reviewed studies on quantified health outcomes associated with crack-cocaine use. Random effects meta-analyses produced pooled odds ratios. Levels of evidence for major results were assessed using the GRADE approach. A review protocol was registered with PROSPERO (CRD42016035486).

RESULTS

Of 4700 articles returned, 302 met eligibility criteria, reporting on health outcomes for 14 of 22 ICD-10 chapters. Conclusive evidence and meta-analyses showed positive associations between crack-cocaine use and blood/sexually transmitted diseases (HIV and hepatitis C virus, others); moderate evidence and meta-analyses supported associations with neonatal health, and violence. There were mixed associations for mental and other health outcomes, yet insufficient evidence to perform meta-analyses for many categories (e.g., mortality). Most underlying research was of limited or poor quality, with crack-cocaine commonly assessed as a secondary covariate.

CONCLUSIONS

Crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. Rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions.

Psychological distress among victimized women on probation and parole: A latent class analysis

Latent class analysis was used to identify subgroups of victimized women (N = 406) on probation and parole differentiated by levels of general psychological distress. The 9 primary symptom dimensions from the Brief Symptom Inventory (BSI) were used individually as latent class indicators (Derogatis, 1993). Results identified 3 classes of women characterized by increasing levels of psychological distress; classes were further differentiated by posttraumatic stress disorder symptoms, cumulative victimization, substance use and other domains of psychosocial functioning (i.e., sociodemographic characteristics; informal social support and formal service utilization; perceived life stress; and resource loss). The present research was effective in uncovering important heterogeneity in psychological distress using a highly reliable and easily accessible measure of general psychological distress. Differentiating levels of psychological distress and associated patterns of psychosocial risk can be used to develop intervention strategies targeting the needs of different subgroups of women. Implications for treatment and future research are presented.

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.

Indicators of social capital in prison: a systematic review

Background

Social capital theory encapsulates multidisciplinary principles and is measured across numerous social entities. However, there is a paucity of literature exploring the benefits of social capital for sentenced prisoners.

Methods

A qualitative systematic review was conducted using the PRISMA Guidelines. Eight databases were searched; thirty-one articles met the inclusion criteria.

Results

Social capital was found to exist across a number of themes/dimensions for sentenced prisoners. The benefits gained were sometimes gender-specific and differed between social capital available in prison and that provided externally.

Conclusion

Social capital is a valuable resource among prisoners and has the capacity to improve quality of life outcomes. Further research exploring the causality of social capital and improved outcomes among prisoners is needed.

PREDICTORS OF RECIDIVISM OVER 3 YEARS AMONG SUBSTANCE-USING WOMEN RELEASED FROM JAIL

This study examines predictors of recidivism over 3 years for 624 women released from a county jail using a comprehensive range of standardized measures derived from gender-responsive and gender-neutral criminogenic recidivism models. Although more than a dozen factors were related to recidivism in the univariate analysis, the multivariate analysis shows that recidivism can be reliably predicted (area under the curve = 0.90) with just four factors: age, no custody of children, substance use frequency, and number of substance problems. Exploratory analysis of women who recidivated in post-release months 1 to 3, 4 to 12, and 13 to 36 revealed that the effects of several variables (age, super optimism, and number of weeks in the jail treatment program) were dependent on the time elapsed since release from jail, whereas others (substance use and custody) had persistent effects over time. These findings support the development of re-entry services tailored for female offenders who address both gender-responsive and gender-neutral criminogenic risk factors.

Substance use among victimized women on probation and parole

Victimized women within the criminal justice system are an important group and understanding their substance use is critical. Substance use was examined among 406 victimized women on probation and parole in an urban community from 2010 to 2013. Ninety-three percent reported lifetime use of an illicit substance, whereas 58% and 45% reported use of at least one illicit substance in the past 2 years and 12 months, respectively. Among probationers, having been in a controlled environment was associated with a higher prevalence of illicit substance use as compared to parolees. Implications for practice, policy, and future research are discussed.

The first 90 days following release from jail: findings from the Recovery Management Checkups for Women Offenders (RMCWO) experiment

OBJECTIVES

(1) To examine the impact of monthly Recovery Management Checkups (RMC) vs. control in the first 90 days post-release from jail on receipt of community-based substance abuse treatment, and (2) To explore the impact of RMC, treatment, and abstinence on HIV risk behaviors and recidivism.

METHODS

Of the 480 women randomized, 100% completed the intake and release interviews, and over 90% completed the 30-, 60-, and 90-day post-release interviews. Of the 915 times women assigned to RMC were interviewed (at release, 30, 69 and 90 days post release), 885 (97%) times they attended linkage meetings, 429 (47%) times they were identified as in need of substance abuse treatment, 271 (30%) times they agreed to go to treatment, 149 (16%) times they showed to the treatment intake, and 48 (5%) times they stayed in treatment at least two weeks.

RESULTS

During the 90 days following release from jail, women in the RMC condition (vs. control) were significantly more likely to return to treatment sooner and to participate in substance abuse treatment. Women who received any treatment were significantly more likely than those who did not to be abstinent from any alcohol or other drugs. Those who were abstinent were significantly more likely to avoid HIV risk behaviors and recidivism.

CONCLUSIONS

These results demonstrate the feasibility of conducting monthly Recovery Management Checkups with women offenders post-release and provide support for the effectiveness of using RMC to successfully link women offenders to treatment.

Social support and crack/cocaine use among incarcerated mothers and nonmothers

Limited research shows that correlates of substance use differ for mothers and nonmothers. This study compares mothers and nonmothers by examining the relationship between perceived social support and frequency of crack/cocaine use. Data for the 307 female prisoners in this sample were collected between 2007 and 2008 in four US states during the Criminal Justice-Drug Abuse Treatment Studies' (CJ-DATS) Reducing Risky Relationships for HIV protocol. Ordinary least squares regression models revealed that greater social support was significantly associated with less frequent crack/cocaine use among mothers but not nonmothers. Implications are discussed. This research was supported by the National Institute on Drug Abuse.

Childhood trauma, impulsivity, and executive functioning in crack cocaine users

BACKGROUND

The use of crack cocaine is a major public health concern in Brazil and internationally. Recent data suggest that childhood trauma is associated with worse outcomes among cocaine users. This study had the objective of evaluating the relationship of childhood trauma with executive functioning and impulsivity in outpatients with crack cocaine use disorders.

METHODS

This is a cross-sectional study of 84 consecutive outpatients with a primary crack cocaine use disorder who sought treatment in Porto Alegre, Brazil. Childhood trauma was evaluated with the Childhood Trauma Questionnaire; executive functioning, with the Wisconsin Card Sorting Test; and impulsivity, with the Barratt Impulsivity Scale.

RESULTS

Childhood trauma was strongly associated with executive dysfunction and impulsivity, even when controlled for possible confounders.

CONCLUSIONS

Childhood trauma may be associated with executive dysfunction and impulsivity in crack cocaine users. The full impact of trauma needs to be further investigated in longitudinal studies.

Relationship influence and health risk behavior among re-entering women offenders

BACKGROUND

Studies have shown that relationships can influence health risk behaviors such as drug use among women offenders. This study takes an exploratory look at the positive and negative influences of parents, peers, and partners for women prisoners to better understand their health risk behavior for HIV, including risky sex and drug use.

METHODS

The current study includes secondary analysis of cross-sectional data from women offenders enrolled in three protocols of the National Institute on Drug Abuse-funded Criminal Justice Drug Abuse Treatment Studies cooperative agreement. Baseline interviews were completed with incarcerated women preparing for community re-entry and focused on behaviors during the 6 months before incarceration. Relationship influences during the 6 months before prison were categorized as "positive" or "negative" for the women offenders.

FINDINGS

Multivariate regression models suggested that positive parental influence was significantly associated with reduced HIV risk and reduced drug use in the 6 months before incarceration. However, negative peer influence increased drug use including both risky needle behavior and any drug use in the 6 months before incarceration.

CONCLUSION

These data suggest that, although relationships are generally important to women, particular types of relationship influences may be related to risky behavior. Implications for targeting re-entry interventions for women offenders are discussed.

A longitudinal study of incarceration and HIV risk among methadone maintained men and their primary female partners

This study examines the longitudinal relationship between personal and sexual partner incarceration and subsequent HIV risk behaviors among drug-involved men and their primary female sexual partners. A random sample of 356 men in methadone treatment in New York City were interviewed at baseline, 6 and 12 months; these men also reported information on their primary female sexual partners. Female partner recent incarceration was associated with subsequent increase in multiple partnerships for the male participants (AOR: 3.31; 95% C.I.: 1.26-8.72, P < .05). Female partner incarceration was also associated with reduced likelihood of subsequent unprotected sex between primary partners (AOR: .13; 95% C.I.: .05-.40, P < .01); this finding is somewhat unique and warrants further investigation. Findings support the notion of mutual influence in the case of female partner incarceration, which is associated with both female partner and male partner risk behaviors. HIV prevention implications are discussed, including the need for couple-based HIV prevention interventions targeting couples affected by incarceration.

Cumulative victimization, psychological distress, and high-risk behavior among substance-involved women

This research addressed two questions: (a) What is the relationship between different patterns of cumulative victimization and psychological distress? And (b) How does the pattern of cumulative victimization and psychological distress influence women's engagement in substance- and sex-related risk behavior? Data were analyzed from interviews with 149 sexually active, crack-using women who completed a follow-up interview after participating in the Kentucky National Institute on Drug Abuse (NIDA) AIDS Cooperative Agreement. Findings from the multivariate analyses indicated that victimization accounted for 5% and 39% of the variance in psychological distress and high-risk behavior, respectively; cumulative victimization and psychological distress accounted for 6% to 11% of the variance in the high-risk behaviors. Results highlight the affects of childhood and adult victimization on psychological distress and the associations between different types of psychological distress and risk behavior.

Intimate partner violence and HIV among drug-involved women: contexts linking these two epidemics--challenges and implications for prevention and treatment

Intimate partner violence (IPV) and HIV are two serious overlapping public health epidemics that disproportionately affect drug-involved women. This article reviews research that has identified a number of contexts that may explain the links between IPV and HIV transmission risks. These contexts include sexual coercion, fear of violence, negotiation of condom use, extradyadic relationships, disclosure of sexually transmitted infections or HIV seropositivity to intimate partners, drug involvement of women and their male partners, low social status of drug-involved women, relationship dependencies, and sex ratio imbalances. The article focuses on how the bidirectional relationship between IPV and HIV risks may be mediated by a history of childhood sexual abuse and post-traumatic stress disorder. Also addressed are the challenges that substance user treatment programs face in dealing with female clients who experience IPV and the implications for HIV prevention.

Assessing criminal justice involvement as an indicator of human immunodeficiency virus risk among women in methadone treatment

This study examines the relationship between criminal justice involvement and high-risk sexual partnerships among a random sample of 416 women in methadone treatment in New York City. Logistic regression models were used to estimate the associations between recent criminal justice involvement (arrest or incarceration in the past 6 months) and recent high-risk partnerships (multiple sex partners, sex trading, or sex with a risky partner in the past 6 months) when adjusting for sociodemographic factors and recent regular drug use. Women with recent criminal justice involvement demonstrated higher odds of engaging in high-risk sex partnerships. Although regular drug use was a significant confounder of several of these relationships, recent arrest or incarceration remained significantly associated with multiple sex partnerships, sex with a risky partner, and engaging in unprotected sex and a high-risk partnership even after controlling for regular drug use and other social stressors. This study highlights the vulnerability of drug-involved women offenders to human immunodeficiency virus (HIV) risk and points to the need for investigation into the role of arrest and incarceration as factors that may contribute to HIV infection.

Lack of awareness of partner STD risk among heterosexual couples

CONTEXT

Individuals' accurate assessment of their exposure to the risk of HIV and other STDs requires awareness of their sexual partners' risk behaviors and disease status.

METHODS

In a sample of 217 couples enrolled in a risk intervention trial in 1997-2002, both partners reported on their own risk behaviors and their perceptions of their partner's behavior; concordance of partners' reports was examined using kappa statistics. Individual and relationship characteristics predicting lack of awareness of a partner's risk behavior were explored using multivariate logistic regression.

RESULTS

Three percent of women and 14% of men were unaware that their partner had recently had a concurrent partner. Eleven percent and 12%, respectively, were unaware that their partner had ever injected drugs; 10% and 12% were unaware that their partner had recently received an STD diagnosis; and 2% and 4% were unaware that their partner was HIV-positive. Women's lack of awareness of partner risk was associated with increasing age (odds ratio, 1.1), being of a race or ethnicity other than black or Latina (15.8) and having a Latino partner (3.7); it was positively associated with a man's report that he was married (4.4) and with relationship satisfaction as reported by both the woman and her partner (1.2 for each). Among men, lack of awareness was positively associated with partner's age (1.1) and with having a partner who was formerly married (8.2).

CONCLUSIONS

Couple-based interventions that assess each partner's awareness of the other's risk behavior may help programs better target couples' STD prevention needs.

The prevalence of childhood trauma among those seeking buprenorphine treatment

In this study, the authors examined the prevalence of five types of childhood trauma among a sample of adult patients who were addicted to opioids and seeking treatment with buprenorphine. Using a survey methodology, the authors examined a consecutive sample of 113 participants and found that 20.4% reported having experienced sexual abuse, 39.8% reported having experienced physical abuse, 60.2% reported having experienced emotional abuse, 23.0% reported having experienced physical neglect, and 65.5% reported having witnessed violence. Only 19.5% of the sample denied having experienced any of the five forms of childhood trauma. Most respondents (60.2%) reported having experienced one, two, or three different forms of childhood trauma. A minority reported having experienced four (13.3%) or all five (7.1%) forms of childhood trauma. These data indicate that among individuals with opioid dependence who are seeking treatment with buprenorphine, the prevalence rates of various types of childhood trauma are quite high.

Psychosocial and behavioral factors related to the post-partum placements of infants born to cocaine-using women

OBJECTIVE

One objective was to determine if cocaine-using women who did not maintain infant custody (NMC) would report more psychological distress, domestic violence, negative coping skills, lower social support and more childhood trauma than cocaine-using women who maintained custody (MC) of their infant. A second objective was to evaluate the relative contribution of psychosocial factors to infant placement.

METHODS

Psychosocial profiles of MC women (n=144) were compared with NMC (n=66) cocaine-using women. Subjects were low income, urban, African-American women who delivered an infant at a county teaching hospital. The Brief Symptom Inventory (BSI), an assessment of coping strategies (COPE), Multidimensional Scale of Perceived Social Support (MSPSS), Conflict Tactics Scale (CTS) and Childhood Trauma Questionnaire (CTQ) were administered. The associations of infant placement status to demographic factors, drug use and psychosocial measures were evaluated.

RESULTS

The NMC group reported greater overall psychological distress, psychoticism, somatization, anxiety and hostility than the MC group. The NMC group had more childhood neglect and physical abuse and used more negative coping strategies than the MC group. Lack of prenatal care [OR=.83, CI (.75-.91), p<.0001], heavier prenatal cocaine use [OR=2.55, CI (1.13-4.34), p<.007], greater psychological distress [OR=2.21, CI (1.13-4.34), p<.02] and a childhood history of emotional neglect [OR=1.10, CI (1.02-1.19), p<.02] were associated with increased likelihood of loss of infant custody after control for other substance use and demographic variables.

CONCLUSIONS

NMC women have more negative psychological and behavioral functioning post-partum than MC women. Less prenatal care and greater cocaine use, psychological distress and maternal childhood emotional neglect are associated with the post-partum placement of infants born to cocaine-using women.

PRACTICE IMPLICATIONS

Results of this study indicate that poor, urban women who use cocaine prenatally display several measurable differences on psychosocial and behavioral risk factors based on child placement status. Among these risk factors heavier cocaine use, lack of prenatal care, more severe psychological symptoms and early childhood experiences of emotional neglect increase the likelihood of loss of infant custody. Routine, objective assessments of psychosocial and behavioral characteristics of women who use cocaine during pregnancy can aid Child Protective Service workers and clinicians by providing baseline data from which to tailor interventions and set improvement criteria for mother-child reunification.

The elusive romance of motherhood:drugs, gender, and reproduction in inner-city distressed households

This paper explores the social contexts of reproductive decision making among poor African-American women in inner-city distressed households by focusing on women's narratives of their reproductive and maternal experiences. We explore the hidden agendas and motivations that underpin women's reproductive decisions and perceived choices within the turmoil of poverty, domestic instability, economic uncertainty, and addiction. The political economy of reproduction, within which birthing and motherhood in distressed inner-city households take place, generates the conditions for absent fathers, brittle unions, and a highly skewed gendered division of parenting. Locally constituted notions of gender, agency and autonomy are key dimensions in the cultural constructions of motherhood in these female headed households. Woven into the local maternal experiences is also the desire to 'give and receive love'. By focusing on women's own formulations of responsibility and agency in their reproductive decisions, we can see how they make sense of their reproductive histories and maternal experiences amidst the constraints of poverty, class, race, and substance abuse.

Conducting research as a visiting scientist in a women's prison

Incarcerated populations have disparities in health risks and illness conditions meriting study, but the history of prison research is marred by unethical conduct. Ethical participation strategies are discussed in the context of studies implemented by the author in a state prison system. This study used ethnographic approaches, observed adherence to federal and institutional review board regulations and corrections department directives, and maintained continuous communication with vested interests to provide entry and long-term access for studies on female prisoners and their civilian infants. A culture clash between the punitive restrictive environment that serves the custody-control-care mission of corrections systems and the open inquiry environment needed for conduct of health research exists. Federal regulations protect prisoners as human subjects but additional vigilance and communication by researchers are required. Gaining and maintaining access to prison inmates for nursing research are leadership challenges that can be met within the caring and collaborative paradigm of nursing.

HIV and intimate partner violence among methadone-maintained women in New York City

Intimate partner violence (IPV) has been recognized as a risk factor for HIV and sexually transmitted infections (STIs) among women, particularly among those who are drug involved. This study examines the temporal relationships between sexual and/or physical partner violence (IPV) and sexual risk of HIV/STI transmission in a longitudinal study with a random sample of 416 women enrolled in methadone maintenance treatment programs in New York City. Two hypotheses are tested: whether sexual risk-related factors or risk reduction behavior leads to subsequent IPV (H1); and whether IPV decreases likelihood of subsequent risk reduction behavior (i.e., requesting to use condoms) or increases likelihood of certain sexual risk-related factors (i.e., inconsistent condom use, having unprotected anal sex, having more than one partner, exchanging sex for drugs or money, having had an STI, being HIV positive, having a partner who engaged in HIV risk) (H2). Participants were interviewed at three waves: baseline, six months and twelve months. Hypotheses were examined using propensity score matching and multiple logistic regression analyses. The prevalence rate of any physical or sexual IPV was 46% at baseline. Findings for H1 indicate that women who reported always using condoms at wave 2 were significantly less likely than women who reported inconsistent or no condom use to experience subsequent IPV at wave 3. Similarly, increased risk of IPV at wave 3 was associated with self-reported STIs (OR=2.0, p=.03), and unprotected anal sex (OR= 2.0, p<.01); always requesting that partners use condoms was associated with a significant decrease in subsequent IPV (OR=.18, p<.01). Findings for H2 suggest that IPV at wave 2 decreased the subsequent likelihood of always using condoms at wave 3 (OR=.41, p<.01) and always requesting that a partner use condoms (OR=.42, p=.02). The implications of the findings for HIV prevention interventions for women on methadone are discussed.

Efficacy of a woman-focused intervention to reduce HIV risk and increase self-sufficiency among African American crack abusers

OBJECTIVES

This study compares 3- and 6-month outcomes of a woman-focused HIV intervention for crack abusers, a revised National Institute on Drug Abuse standard intervention, and a control group.

METHODS

Out-of-drug-treatment African American women (n = 620) who use crack participated in a randomized field experiment. Risk behavior, employment, and housing status were assessed with linear and logistic regression.

RESULTS

All groups significantly reduced crack use and high-risk sex at each follow-up, but only woman-focused intervention participants consistently improved employment and housing status. Compared with control subjects at 6 months, woman-focused intervention participants were least likely to engage in unprotected sex; revised standard intervention women reported greatest reductions in crack use.

CONCLUSIONS

A woman-focused intervention can successfully reduce risk and facilitate employment and housing and may effectively reduce the frequency of unprotected sex in the longer term.

The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples

OBJECTIVES

This study examined the efficacy of a relationship-based HIV/sexually transmitted disease prevention program for heterosexual couples and whether it is more effective when delivered to the couple or to the woman alone.

METHODS

Couples (n = 217) were recruited and randomized to (1) 6 sessions provided to couples together (n = 81), (2) the same intervention provided to the woman alone (n = 73), or (3) a 1-session control condition provided to the woman alone (n = 63).

RESULTS

The intervention was effective in reducing the proportion of unprotected and increasing the proportion of protected sexual acts. No significant differences in effects were observed between couples receiving the intervention together and those in which the woman received it alone.

CONCLUSIONS

This study demonstrates the efficacy of a relationship-based prevention program for couples at risk for HIV infection.

Predictors of sharing drugs among injection drug users in the South Bronx: implications for HIV transmission

HIV may be transmitted in the process of sharing injected drugs, even if all participants have their own syringes. In an effort to gain understanding of the extent and predictors of drug sharing, data were obtained via personal interviews with 1,024 injection drug users from four neighborhoods in the South Bronx. The relationship between drug-sharing and demographic, sexual, and drug-related variables was first examined in a bivariate analysis, and then via multiple logistic regression. Individuals who split drugs were more likely to be female, have had sex with a casual partner, exchanged sex for drugs or other needs, recently smoked crack cocaine, and shared needles. They were less likely to live or inject at their own home or have used a new needle the last time they injected. In a final logistic model, correlates of drug sharing included trading sex, injecting outside one's home, and using borrowed, rented or shared needles. Despite the lack of significance for gender in the final logistic model, females were at high risk of drug sharing because they constituted the great majority of those who exchanged sex. Continuing research is needed to understand how drug-sharing contributes to the spread of HIV and other infections, as are studies of approaches to reducing drug sharing. Prevention strategists and outreach organizations should be aware of the HIV risks inherent in the widespread practice of drug sharing.

Double trouble: violent and non-violent traumas among women at sexual risk of HIV infection

BACKGROUND

This study examines the association between trauma and HIV risk behaviors among women at sexual risk for HIV infection.

METHODS

From April to August 1998, high-risk HIV negative women were recruited in the South Bronx into a year-long cohort study. At the 12-month visit, 116 women were interviewed face-to-face about recent and lifetime violent and non-violent traumas.

RESULTS

The women reported a substantial prevalence of sexual risk behaviors associated with the acquisition of HIV. At baseline, almost two-thirds (64%) reported unprotected vaginal sex in the previous six months, and in the previous year, 62% had smoked crack, 52% reported sex-for-money-or-drugs exchanges, and 47% had five or more male sex partners. The lifetime prevalence of trauma was high: 81% had experienced one or more violent traumas and 97% had experienced one or more non-violent traumas. Women who had experienced violent trauma--physical assault by a partner (OR = 2.88; 95% CI 1.12; 7.41)--and those who had experienced non-violent trauma--loss of a child to foster care (OR = 3.34; 95% CI 1.04; 10.65)--were more likely to use crack than others. Those who had experienced non-violent trauma, by witnessing a physical assault (OR = 2.31; 95% CI 0.99; 5.40), were also more likely than others to have exchanged sex.

CONCLUSIONS

Both violent and non-violent traumas appear to play a role in the behaviors that place women at risk of HIV infection, particularly using crack and exchanging sex.

Victimization and Substance Abuse among Women: Contributing Factors, Interventions, and Implications

Although the literature indicates that there is an association of victimization with substance abuse, there has been limited research focused on understanding and synthesizing the factors that have been identified as contributing to victimization and substance abuse and on interventions designed to address these contributing factors. The purposes of this article are to (a) review the literature on factors related to victimization and substance abuse, (b) review interventions and outcomes, and (c) discuss clinical implications for interventions and research. Results suggest that there is a high rate of co-occurrence of victimization and substance abuse among women, that the factors contributing to victimization and substance abuse are complex, and that there is a lack of treatment models addressing victimization and substance abuse.

Women, sex, and HIV: social and contextual factors, meta-analysis of published interventions, and implications for practice and research

This article is focused on examining social and contextual factors related to HIV-risk behavior for women. Specifically, this article has three main purposes: to review the literature on selected social and contextual factors that contribute to the risk for the heterosexual transmission of HIV and AIDS, to review and conduct a meta-analysis of HIV-prevention interventions targeting adult heterosexual populations, and to suggest future directions for HIV-prevention intervention research and practice. Results suggest that the HIV-prevention interventions reviewed for this article had little impact on sexual risk behavior, that social and contextual factors are often minimally addressed, and that there was a large gap between research and the practice of HIV-prevention intervention.

HIV and AIDS risk behaviors among female jail detainees: implications for public health policy

OBJECTIVES

We examined the sexual and injection drug use HIV and AIDS risk behaviors of female jail detainees.

METHODS

The sample (n = 948) was stratified by charge type (felony vs misdemeanor) and race/ethnicity (African American, non-Hispanic White, Hispanic, other).

RESULTS

Non-Hispanic White women, women arrested for less serious charges, women who had prior arrests, women arrested on drug charges, and women with severe mental disorders were at especially high risk for sexual and injection drug transmission of HIV and AIDS.

CONCLUSIONS

Many women at risk for HIV and AIDS--women who use drugs, women who trade sex for money or drugs, homeless women, and women with mental disorders--eventually will cycle through jail. Because most jail detainees return to their communities within days, providing HIV and AIDS education in jail must become a public health priority.

Characteristics of women in jail and treatment orientations. A review

Women who have been incarcerated are a high-risk group for criminal recidivism, and criminal justice statistics indicate that females are increasing in numbers more rapidly than the male detainee population. According to data from epidemiologic studies, incarcerated women are often young, single, mothers from ethnic minority backgrounds who have little education and poor work histories. Mental illness, drug abuse, and risky behaviors relating to contracting HIV/AIDS are common problems among female detainees. In this report, research into characteristics of women in jail and literature relating to treatment programs for incarcerated women are reviewed. Implications relating to treatment needs, program development, and further research are discussed. A case example and treatment intervention are presented based on this review.

Sexual Trauma, Substance Abuse, and Treatment Success in a Sample of African American Women Who Smoke Crack Cocaine

The purpose of this descriptive study was to examine the relationship among sexual trauma, severity of substance use, and treatment success for African American women who smoke crack cocaine. Using a convenience sample of 208 African American women with a history of crack smoking, participants were interviewed for 2 to 4 hr and asked a variety of questions about their health, relationships, sexuality, and drug use. Women with a history of sexual trauma (N = 134) reported being addicted to more substances than women who had not been sexually traumatized (N = 74), despite the fact that the two groups did not differ on the number of substances used. Differences in the self-reported level of substance abuse was corroborated with external evidence of group differences in substance abuse severity. Women with a history of sexual trauma, compared to women without such a history, were admitted to the hospital or emergency room more often for health issues related to their substance use and were more likely to be negligent in caring for their children because of their drug use. We also found evidence to suggest that there are differences in treatment success between the two groups; women with a history of sexual trauma reported having been to substance abuse treatment programs more often than women without such a history. These findings are discussed in light of the particular treatment needs of women with a history of sexual trauma.

Psychosocial predictors of current drug use, drug problems, and physical drug dependence in homeless women

We examined risk and protective factors associated with three qualitatively different drug use constructs describing a continuum of drug use among a sample of 1,179 homeless women. Relationships among positive and negative sources of social support, positive and negative coping strategies, depression, and the drug constructs of current drug use, drug problems, and physical drug dependence were assessed using structural equation models with latent variables. Current drug use was predicted by more negative social support (from drug-using family/friends), depression, and less positive coping. Drug Problems were predicted by more negative coping, depression, and less positive coping. Physical Drug Dependence was predicted by more negative social support and depression, and less positive social support. Results highlighted the importance of investigating both the positive and negative dimensions of psychosocial functioning, while suggesting that empowering homeless women and offering tangible resources for coping with the stress of being homeless may be beneficial to them.

Influence of negative childhood experiences on psychological functioning, social support, and parenting for mothers recovering from addiction

OBJECTIVE

This study was conducted with mothers recovering from drug and alcohol addiction and had three aims: first, to understand the range of negative childhood events these mothers experienced; second, to understand their current level of distress and their parenting experiences; and third, to examine the relationships between negative childhood events and parenting experiences.

METHOD

Forty-six mothers participated in a cross-sectional exploratory study and completed a range of self-report measures, including the Child Abuse & Trauma Scale, Social Support Inventory, CES-D, Parenting Stress Index, and the Parenting Scale.

RESULTS

When compared to norming samples these mothers reported significantly higher levels of aversive childhood experiences, psychological distress, parenting stress and use of problematic parenting behaviors along with lower levels of social support. Higher levels of neglect and growing up in a negative home environment were significantly correlated with lower levels of social support from the family, higher levels of distress and parenting stress, and greater use of problematic parenting behaviors.

CONCLUSION

For this sample there is a greater incidence of aversive childhood experiences and greater problems with maternal functioning. Mothers recovering from addiction have an additional need for clinical attention towards issues of recovery from childhood abuse and responding to parenting difficulties with their own children.

Women inmates' risky sex and drug behaviors: are they related?

The large concentration of female illicit drug users in state correctional facilities prompted an examination of the associations among different types of drug use and sexual risk factors related to human immunodeficiency virus (HIV) among women inmates. A consecutive sample of 805 women felons admitted to the North Carolina Correctional Institution for Women between July 1991 and November 1992 was interviewed. Of these inmates, 651 had complete information on relevant characteristics. Of the women inmates, 73% had used drugs prior to incarceration; most women were crack smokers only (33%), followed by non-drug users (27%), other drug users (19%), crack-smoking injecting drug users (15%), and injecting drug users only (6%). Inconsistent condom use with multiple sex partners, a history of a diagnosed sexually transmitted disease (STD), a drug-injecting sex partner, or exchanging sex for money or drugs prior to incarceration were reported by 55% of the women. Sexual risk factors differed across different types of drug users, with crack-smoking injectors being placed at greatest potential risk for exposure to heterosexually transmitted HIV, followed by injecting drug users, crack smokers, and then other drug users. Given the differential associations between sexual risk factors and types of drug use, prison-based sexual-risk reduction strategies should be tailored to specific types of drug users. In times of limited resources, special attention should be given to crack smokers and/or drug injectors.