Objectives: The number of female prison inmates has increased rapidly. Yet, little is known about possible factors contributing to high-risk behaviors in this population that lead not only to crimes, but also to their high rates of health problems. Findings of the parent study of this secondary analysis, reported by these investigators, included high rates of substance abuse and histories of physical and sexual abuse perpetrated against the subjects. Neurologic problems were reported in 95% of the population. The objective of this secondary analysis was to describe high-risk behaviors of female prison inmates potentially contributing to criminal behavior, neurologic and other health problems such as the spread of HIV. Correlations between these high-risk behaviors and potential factors contributing them were also investigated.
Design: A secondary analysis of data from the parent descriptive cross-sectional study of neurologic and neuroendocrine correlates of violent criminal behavior in female prison inmates was undertaken to explore high-risk behaviors of these subjects and correlations with potential contributing factors. The purpose of the parent study was to investigate differences between female inmates convicted of violent and nonviolent crimes in order to identify correlates of violent behavior.
Population, Sample, Setting, Years: A sample of 120 female prison inmates convicted of violent and nonviolent crimes who were incarcerated in a women's prison in a Mid-Atlantic state of the United States were studied between January and December of 2000. A sample of 12 non-criminal female employees was also studied for comparison.
Variables: History of having been physically or sexually abused, neurologic history and physical examination, basal salivary cortisol, and associated variables were studied in female prison inmates to investigate differences between inmates convicted of violent versus nonviolent crimes in the parent study. Neurologic histories and examinations were conducted and information was collected about health-related problems and possible contributory factors. Violence was measured as the type of crime convictions, which were determined to be violent or nonviolent, based on standards used by prior researchers. Muenzenmaier's scale was used to assess childhood sexual and physical abuse before age 18. Other data collection included abuse that resulted in hospital treatment and years since last abuse. Depression was measured with the Beck Depression II, in order to statistically control for it, if necessary, because of its known correlations with cortisol.
Methods: Data from the parent study collected during private interviews with female prison inmates were reanalyzed. Relationships were explored between histories of having been a victim of physical and sexual abuse, neurologic history and physical findings, current salivary cortisol levels, related variables, and crime convictions.
Findings: The secondary analysis revealed that substance abuse including needle sharing and multiple sexual partners were recurrent high-risk behaviors precipitating neurologic problems and crimes. Statistical correlations were found between the variables of substance abuse including alcohol, cigarette smoking, and street drugs; neurologic problems including brain injuries with loss of consciousness, histories of physical and sexual abuse perpetrated against the subject, depression, multiple changing caregivers during childhood, suicide attempts, and criminal behaviors including murder. Correlations of these variables with each other describe the complicated inter-related nature of these behaviors.
Conclusions: Causation can not be determined by this design because it can not be determined with certainty if high-risk behaviors were antecedents or consequences of the correlating variables. However, this study links high-risk behaviors for crime, neurologic problems, and HIV with other potentially contributing variables.
Implications: Nurses can play an important role in research and practice to limit high-risk behaviors of female prison inmates that could lead to further violent crimes, increased neurologic problems and the spread of infectious diseases such as HIV. Prevention of childhood physical and sexual abuse and support services for victimized individuals could potentially decrease the associated problems. Because female prison inmates often receive short sentences, they are frequently back in the community where their high-risk behaviors affect others. These subjects had a mean of 15 crime convictions during their lifetime, while one was convicted of 72 crimes. The prison setting is an important place where nurses can intervene not only in breaking the cycle of crime, but also in decreasing the multiple problems correlated with high-risk behaviors in this vulnerable population.
Funding/Awards: National Institutes of Health T32 NR07036; Sigma Theta Tau/Rehabilitation Nursing Foundation of the Association of Rehabilitation Nurses Research Grant; The Baxter Foundation; Marion R. Gregory Award for the proposal that holds significant promise as a contribution to the profession, University of Pennsylvania; Dr Ann W. Burgess Distinguished Dissertation Award in Mental Health, University of Pennsylvania; and Sigma Theta Tau, XI Chapter Research Grant.
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