Testing Associations Between Childhood Sexual Abuse and Risk of Arrest and Incarceration Among Women In Methadone Treatment

Background and Purpose: Over the last three decades, the number of women incarcerated in the U.S. has grown dramatically, with an estimated 198,600 women in jails and prisons at the end of 2009. While prior research has documented associations between childhood sexual abuse (CSA) and behaviors that increase incarceration risk, including drug use and exchanges of sex for money or drugs, there is a dearth of research that examines the relationship between CSA and risk of arrest and incarceration among women in substance use treatment. To address this gap in knowledge and to strengthen practices to reduce these risks, this study examined relationships between CSA and experiences of arrest and incarceration among a random sample of 416 women in urban methadone treatment.

Methods: Interviews were conducted in English and Spanish by trained female interviewers. CSA was measured with the 11-item Childhood Sexual Abuse Interview which assesses sexual activities that occurred before age 16 and involved someone 5 or more years older, force, or a relative. Single questions inquired about arrest and incarceration history in participants' lifetimes and in the past 6 months, as well as participants' involvement in sexual exchanges for money or drugs and use of specific drugs in their lifetimes and in the past 6 months. Bivariate and multivariate logistic regression analyses were conducted with PASW Statistics 17.0 to examine relationships between CSA and risk of arrest and incarceration.

Results: Participants were from Latina (47.8%), African American (30.8%), White (16.8%), and other (4.6%) racial/ethnic backgrounds. Their mean age was 39.9 years (SD=6.7), mean level of education was 11.0 years (SD=2.5), and mean annual income was $10,143 (SD=9,571). There was a statistically significant association between CSA and lifetime history of both arrest and incarceration at the bivariate level; however, these relationships became insignificant in multivariate models controlling for age, ethnicity, education, lifetime history of drug use, and lifetime history of sexual exchanges for money or drugs. Based on Baron and Kenny's (1986) criteria, the CSA-lifetime arrest relationship was mediated by lifetime history of injecting cocaine and engaging in sexual exchanges for money or drugs; lifetime history of speedball (heroin and cocaine) injection also predicted increased lifetime risk of arrest. The same mediators were present in the CSA-lifetime incarceration relationship; lifetime history of smoking crack also predicted lifetime incarceration risk. CSA was not associated with recent arrest or incarceration in bivariate or multivariate models; however, smoking crack in the past 6 months and being widowed were associated with increased risk of both. Smoking marijuana and sniffing cocaine were associated with increased risk of recent arrest and incarceration, respectively.

Conclusions and Implications: While relationships between CSA and lifetime risk of arrest and incarceration among women in methadone treatment are mediated by injection cocaine use and sexual exchanges, neither CSA nor sexual exchanges are associated with recent arrest or incarceration. The findings suggest that interventions which target cocaine use, particularly smoking crack, and address issues related to widowhood may reduce the risk of arrest and incarceration among women in methadone treatment.