Kathi L.H. Harp

Racial and Gender Discrimination in the Stress Process: Implications for African American Women's Health and Well-Being.

In recent decades, sociologists have increasingly adopted an intersectionality framework to explore and explain the complex and interconnected nature of inequalities in the areas of race, class, and gender. Using an inclusion-centered approach and a sample of 204 low-socioeconomic-status (SES) African American women, the authors theorize and explore the role of racial and gender discrimination in the stress process. Analyses examine relationships between social stressors (racial and gender discrimination) and individual stressors occurring in each of six distinct social contexts. Furthermore, the authors evaluate the effects of racial and gender discrimination as compared to individual stressors on three indicators of mental health and well-being. Findings suggest that racial and gender discrimination increases risk for poor health and low well-being, working both directly and indirectly through increased vulnerability to individual stressors. This research demonstrates the value of a more comprehensive study of stressors that influence the health of low-SES African American women and other multiply disadvantaged groups.

An exploratory study of mental health and HIV risk behavior among drug-using rural women in jail.

OBJECTIVE Rural women, particularly those in the criminal justice system, are at risk for HIV related to the increasing prevalence of injection drug use as well as limited services. Research on HIV risk correlates, including drug use and mental health, has primarily focused on urban women incarcerated in prisons. The purpose of this exploratory study is to examine dual HIV risk by 3 different mental health problems (depression, anxiety, and posttraumatic stress disorder [PTSD]) among drug-using women in rural jails. METHOD This study involved random selection, screening, and face-to-face interviews with 136 women in 1 Appalachian state. Analyses focused on the relationship between mental health and HIV risk. RESULTS Nearly 80% of women self-reported symptoms of depression, and more than 60% endorsed symptoms consistent with anxiety and PTSD symptoms. Mental health significantly correlated with severity of certain types of drug use, as well as risky sexual activity. In addition, for women experiencing anxiety and PTSD, injection drug use moderated the relationship between mental health and risky sexual activity. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Based on these rates of drug use, mental health problems, and the emergence of injection drug use in rural Appalachia, the need to explore the relationships between these issues among vulnerable and understudied populations, such as rural women, is critical. Because of service limitations in rural communities, criminal justice venues such as jails provide opportune settings for screening, assessment, and intervention for drug use, mental health, and HIV education and prevention. (PsycINFO Database Record

Racism and Illicit Drug Use Among African American Women: The Protective Effects of Ethnic Identity, Affirmation, and Behavior

Though recent evidence indicates that rates of illicit drug use among African American women are now higher than the national average, little is known about the etiology of substance use in this population. In addition, the effects of racism and other cultural factors are understudied and may be unique among African American women. This cross-sectional study explores risk and protective factors for drug use among 204 African American women. More specifically, associations between racism experiences and drug use are investigated in the context of potential moderating influences (i.e., psychosocial resources, social safety net variables, and cultural identity and practices). Findings suggest that racism is associated with drug use, but that its effects diminish with age. In addition, results suggest that psychosocial resources, social safety net factors and culturally specific factors such as ethnic community membership and engagement in cultural practices afford African American women some protection against the detrimental effects of racism.

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 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.

Treatment Outcomes for Prescription Drug Misusers: The Negative Effect of Geographic Discordance

This is the first known study to examine geographic discordance (traveling from ones home residence to a county with a different socio-cultural context to receive substance abuse treatment) as a predictor of clinical and social functioning treatment outcomes (i.e., relapse, self-help attendance, anxiety, and incarceration) among a sample of prescription drug misusers. Treatment entry and 12-month follow-up client-level survey data were collected from 187 clients who misused prescription drugs, and center-level survey data were collected from the supervisors at treatment centers attended by the clients. Multivariate models reveal that geographic discordance significantly increased the odds that prescription drug misusers would report relapse to prescription opioid misuse, anxiety, and any incarceration at follow-up. Moreover, geographically discordant clients were significantly less likely to have attended a self-help group, net of the effect of other individual- and center-level factors. Implications for clinical practice and substance abuse treatment policy are provided.

Factors Associated with Recidivism among Corrections-Based Treatment Participants in Rural and Urban Areas

The majority of corrections-based treatment outcome studies focus on individuals paroling to urban areas; thus there is a significant gap in the literature on outcomes, including recidivism, among individuals paroling to non-urban and rural communities. This study examines differences in factors associated with recidivism among former corrections-based treatment participants living in urban and rural communities following release. Analyses focused on secondary data collected from treatment participants in one southeastern state over a four year period between July 2006 and June 2010 including both baseline (treatment intake) and follow-up data (12-months post-release). Findings indicated that individuals in urban areas were 2.4 times more likely to recidivate than rural individuals. Other factors identified in separate rural and urban analyses also emerged as significant predictors in the overall model including age, gender, race, employment and drug use. Overall, these findings suggest that corrections-based treatment participants living in urban and rural areas following release may share similar risk factors for recidivism. However, rural areas may be protective for returning to custody despite the presence of some of these risks.

Substance Abuse Problem Severity Among Rural and Urban Female DUI Offenders

Objectives: Although there has been an overall decline in the rates of driving under the influence (DUI) over the past two decades, this decrease has not occurred uniformly across all groups of DUI offenders. For example, the proportion of female DUI offenders has significantly increased. Furthermore, DUI arrest rates remain higher in less populated areas of the country. The present study examines indicators of problem severity among female DUI offenders across graduated levels of rurality. Methods: A total of 19,094 substance abuse assessment records from females convicted of DUI between 2002 and 2006 in Kentucky were examined. Beale codes were used to define the extent to which the county of conviction was rural. Results: Rurality was significantly and positively associated with multiple DUI offenses, being underage, drug problems, prevalence of DSM-IV-TR substance dependence and abuse criteria, being referred to substance abuse treatment rather than an education only intervention, and referral noncompliance. Blood alcohol concentration and alcohol problems were inversely related to rurality. Conclusion: The study suggests that problem severity among female DUI offenders may be greater in rural areas and could produce challenges for practitioners who assess and treat rural female DUI offenders.

The Influence of Rural and Urban Substance Abuse Treatment Counselor Characteristics on Client Outcomes

ABSTRACT Focus group data were collected from 28 substance abuse treatment counselors employed in rural and urban areas to examine their perceptions of factors influencing treatment outcomes. The influence of the counselor characteristics (i.e., education, experience, and recovery status) on client outcomes and geographic differences is explored. Focus group data were analyzed by three raters using line-by-line coding, focused coding, and memoing. This analytic approach revealed geographic differences in the counselors’ perceptions of the effect of counselor education, experience, and recovery status on client outcomes. Recommendations for treatment planning and future research are provided.

Factors associated with two types of child custody loss among a sample of African American mothers: a novel approach

African American families are overrepresented in the Child Welfare System; however, extant research on this phenomenon has (1) focused mostly on Caucasian or mixed-race samples and (2) has not examined informal custody arrangements alongside official child custody loss. This research addresses these gaps in the literature by examining factors associated with both official and informal child custody loss among a sample of African American mothers. Multinomial regression results show that having ever been incarcerated following a conviction increases the odds of experiencing both types of custody loss relative to no loss. Additionally, mothers experiences of childhood victimization increase the likelihood of informal custody loss relative to no loss, while being older, past year homelessness, number of minor children, being lesbian or bisexual, crack/cocaine use, and more family social support increase the odds of official loss versus no loss. Finally, increases in social support from friends decrease the odds of official loss. Implications are discussed.

Drug Abuse HIV/AIDS Interventions in Criminal Justice Settings

The U.S. prison population is disproportionately affected by HIV/AIDS as compared to the general population. The high prevalence of HIV/AIDS among incarcerated individuals can be attributed to several risk factors both in their environments prior to incarceration and also within the prison environment. In particular, the large number of inmates with drug use and risky sexual behavior histories place this population at risk. This chapter provides an overview of the most effective HIV interventions that work in criminal justice setting to date and their theoretical underpinnings. Promising interventions for criminal justice populations and recommendations for improving them are also discussed. While many HIV interventions have demonstrated significant promise in reducing risk behaviors, the majority of correctional facilities in the U.S. have yet to implement such interventions.