摘要：Objectives. We sought to describe the prevalence of childhood traumatic events among incarcerated women in substance abuse treatment and to assess the relation between cumulative childhood traumatic events and adult physical and mental health problems. Methods. The study was modeled after the Adverse Childhood Events study’s findings. In-depth baseline interview data for 500 women participating in the Female Offender Treatment and Employment Program evaluation were analyzed. Results. Hypotheses were supported, and regression results showed that the impact of childhood traumatic events on health outcomes is strong and cumulative (greater exposure to childhood traumatic events increased the likelihood of 12 of 18 health-related outcomes, ranging from a 15% increase in the odds of reporting fair/poor health to a 40% increase in the odds of mental health treatment in adulthood). Conclusions. Our findings suggest a need for early prevention and intervention, and appropriate trauma treatment, within correctional treatment settings. A considerable amount of research over the past decade has focused on assessing the treatment needs of drug-dependent women offenders compared with their male counterparts. One key finding from this research is that incarcerated women are more likely to report extensive histories of emotional, physical, and sexual abuse—between 77% and 90%. 1 – 7 Prevalence rates of childhood abuse among incarcerated women also are elevated when compared with women in the general population. 2 , 8 – 12 The trauma that results from such abuse is a key contributor to adolescent conduct problems, subsequent delinquency, substance abuse, and criminality among women. Furthermore, surveys conducted among incarcerated women have consistently shown a strong link between childhood abuse and adult mental health problems, particularly depression, posttraumatic stress, panic, and eating disorders. The costs of failing to diagnose and treat psychiatric disorders among offenders are high and can include unemployment, homelessness, and loss of custody of children. 13 – 16 Research also has shown that drug-dependent female offenders are more likely than male counterparts to suffer from chronic physical health problems, including tuberculosis (TB), hepatitis, toxemia, anemia, hypertension, diabetes, and obesity. Furthermore, female offenders have reproductive health needs, including those related to gynecological problems and prenatal and postpartum care. Women are also at greater risk than men of entering prison with sexually transmitted diseases (STDs) and HIV/AIDS because of their greater participation in prostitution. Incarcerated women’s health problems are compounded by the limited health care that they received before incarceration. Previous literature on incarcerated women has consistently shown that female offenders have very poor health services utilization in the community and that, while incarcerated, women seek medical services to a greater extent than men. 7 , 10 , 17 – 19 Women offenders are typically impoverished, with inadequate transportation and resources, limiting their access to community-based health systems. Moreover, access to adequate health care while incarcerated is often limited because of the costs of providing these services, as well as the relative invisibility of the health needs of female inmates. 20 , 21 The association of childhood abuse, substance abuse, comorbidity, and crime among female offenders has led many researchers to propose comprehensive treatment interventions that address these issues; however, the cumulative toll on women’s physical health is often excluded as a focal point of these interventions. Few efforts have provided explanatory models that outline factors that contribute to the disproportionate prevalence of mental and physical health problems among female offenders. Assessing potential predictors of the mental and physical health problems among drug-dependent female offenders can greatly inform criminal justice policy, especially within a correctional system whose responsibility it is to house and treat them. Our study built upon a series of reports from the Adverse Childhood Experiences (ACE) study, which demonstrates a link between childhood trauma and physical health problems. The ACE study found a strong relation between the cumulative number of events of childhood abuse and household dysfunction and multiple risk factors for the leading causes of death in adults, including chronic drug dependency and histories of attempted suicide and depression. ACE studies were conducted with individuals sampled from a large health maintenance organization (HMO) in a metropolitan area. Hence, the sample comprised individuals who were more socially integrated than are individuals in the criminal justice system. There is a strong likelihood that the link between childhood trauma and adult physical and mental health problems is substantially more pronounced among a female offender population, owing to their elevated histories of childhood trauma, substance abuse, and HIV risk behaviors, as well as the barriers they face in accessing health services. Yet this relation has not been empirically tested with this population. Following the analytic model described in the ACE studies, we described the prevalence of multiple types of childhood traumatic events among women in prison-based treatment. Because the ACE study findings indicated that these events rarely occur in isolation and are highly correlated, we were interested in examining the cumulative number of different types of childhood traumatic events as related to a variety of adult physical and mental health problems and behaviors. On the basis of previous findings on female offenders and from the ACE studies, we formulated 2 hypotheses: (1) greater exposure to childhood traumatic events among drug-dependent female offenders would be associated with greater histories of problem behaviors in adolescence and adulthood (e.g., conduct disorder, teen childbirth, homelessness, previous substance abuse treatment, involvement with children’s protective services, and earlier criminal and drug-using behaviors), and (2) greater exposure to childhood traumatic events, combined with the preexisting substance abuse and criminal histories among this sample, would increase the likelihood of adult mental and physical health problems.
