The Effects of Domestic Violence on Violent Prison Misconduct,Health Status,and Need for Post-Release Assistance Among Female Drug Offenders in Taiwan

Abstract

Although much research has documented the fact that a high percentage of female inmates serving sentences for drug offenses have experienced domestic violence prior to incarceration, little research has been done to explore the potential long-term impact of domestic violence on prison misconduct, health status, and the need for post-release assistance. Based on survey data for 633 female drug offenders collected from Taiwanese correctional facilities in 2014, about one third (32%) of the offenders reported experienced domestic violence at least once prior to their incarceration. In all, 27% of them experienced being violently abused by a spouse/coinhabitant. Multivariate regression analyses indicate that a prior history of domestic violence victimization contributes significantly to inmates’ violent misconduct even after controlling for a set of potential intervening variables. In addition, female drug offenders who were the victims of domestic violence reported higher levels of health problems in the prison setting, and perceived need for greater after-release assistance.

Keywords

domestic violence violent misconduct inmate health status after-release assistance female drug offenders physical/sexual abuse

Introduction

Drug offenses are one of the most common crimes committed by women incarcerated in Taiwanese prisons, as is the case in many developed countries (Taylor, 2004; United Nations Office on Drugs and Crime [UNODC], 2009). Over four in 10 female prisoners in Taiwan are drug offenders, with lower incidence of fraud, theft, public safety crimes (e.g., driving while intoxicated), and counterfeiting offenders (Chen, Lai, & Lin, 2013). Moreover, female drug offenders’ readmissions currently account for 87.5% of all admissions (Tsai & Lai, 2014). Clearly, female drug offenders are an important target population for criminological studies.

It is well established in the literature that most female drug offenders have experienced physical and/or sexual abuse during youth, often accompanied by drug or alcohol dependence in adulthood (Browne, Miller, & Maguin, 1999; McClellan, Farabee, & Crouch, 1997; Messina & Grella, 2006; Mullings, Hartley, & Marquart, 2004; UNODC, 2009). Some corrections researchers have suggested that prior physical and sexual victimizations significantly contribute to female offenders’ maladjustment to incarceration (Chen, Lai, & Lin, 2014; Kruttschnitt, Gartner, & Miller, 2000; Steiner & Wooldredge, 2009). To make matters worse, most female victims of abuse have received little professional evaluation and/or treatment before going to prison (Hochstetler, Murphy, & Simons, 2004). Consequently, upon incarceration many women offenders are diagnosed with health problems such as sexually transmitted diseases (STDs), mental health issues, gynecological disorders, and chronic health problems such as hepatitis, HIV, diabetes, and hypertension (Messina & Grella, 2006; Staton, Leukefeld, & Webster, 2003). Furthermore, many women inmates are dislocated from families and from conventional social support networks. The amount of post-release assistance required (e.g., vocational training, employment, housing, health care) is a fit topic for study and a public policy discussion (Covington, 2001; UNODC, 2009).

A review of the extant literature suggests that three important issues worthy of study have been largely overlooked to date. First, little research on the prevalence of and the long-term impact of domestic violence experiences among the large population of female drug-affected offenders. Second, while prior research has documented that a history of physical and/or sexual abuse prior to prison is associated with institutional misconduct by the inmates (e.g., Chen et al., 2014; Slotboom, Kruttschnitt, Bijleveld, & Menting, 2011; Steiner & Wooldredge, 2009), little research has been done to investigate the independent effect of domestic violence victimization on female prisoner misconduct. Third, the possible link between prior domestic violence victimization and inmate physical and mental health status among female drug-affected offenders remains unexamined. Relatedly, the aftercare assistance needs of domestic violence-affected female inmates constitutes a major question worthy of investigation by corrections scholars.

Using data collected from 633 Taiwanese female drug offenders in the year of 2014, this study attempts to achieve the following major goals: (a) to describe the prevailing health conditions and the prevalence of prior domestic violence experiences among a sample of incarcerated female drug offenders in Taiwan, (b) to identify the effect of domestic violence victimization on violent misconduct among female drug offenders in Taiwanese correctional facilities, and (c) to examine the relationship between domestic violence, inmate health, and the perceived needs for post-release assistance after controlling for other pertinent factors.

Literature Review

Misconduct, Health Status, and After-Release Need Among Female Drug Offenders

Misconduct is one key domain of institutional maladjustment in the inmate management field (Chen et al., 2014; Hochstetler et al., 2004; Islam-Zwart & Vik, 2004; Lindquist & Lindquist, 1997; Thompson & Loper, 2005; Warren, Hurt, Loper, & Chauhan, 2004). It refers to inmates’ antisocial behaviors (e.g., physical assaults, disobeying orders, possessing contraband, etc.) considered to be maladjustments to prison life (French & Gendreau, 2006). With regard to drug offenders, existing research based on data collected from 833 Taiwanese incarcerated women conducted by Chen et al. (2014) found that drug offenders are much less likely to engage in institutional misconduct than other inmates. However, prior research also indicates that female inmates with co-occurring mental disorders and substance use history are disproportionately likely to engage in prison misconduct (see Houser, Belenko, & Brennan, 2012; Steiner & Wooldredge, 2009; Wright, Salisbury, & van Voorhis, 2007). Bloom, Owen, and Covington (2003) noted that female inmates with co-occurring mental and health problems often experience flashbacks, have nightmares, experience recurring frightening thoughts, and are prone to hyperarousal; these conditions leave them to have poor sleep, experience stress, and become angry quite easily, all of which makes adjustment to a correctional setting difficult. For those experiencing withdrawal symptoms, the smuggling of contraband such as prescription drugs, alcohol, and cigarettes to satisfy cravings is resorted to oftentimes (Huang & Lai, 2015; UNODC, 2009). Although such previous research is highly informative, the potential effects of prior domestic violence victimizations on prison misconduct and on health conditions in prison remain largely unknown (Chen et al., 2014).

Research has established clearly that female prisoners tend to have more health problems than their male counterparts; the male/female comparison is even more alarming among the subgroup of female drug-affected offenders (Green, Miranda, Daroowalla, & Siddique, 2005; UNODC, 2009). Covington (2007) found that drug-dependent female offenders have a higher prevalence rate of gynecological problems, toxemia, anemia, hypertension, diabetes, and obesity. At the same time, Messina and Grella (2006) have indicated that drug-abusing female offenders also tend to suffer from infectious diseases such as hepatitis (B and C types), STDs, and HIV/AIDS, often as a result of their participation in prostitution prior to incarceration. Specifically, women inmates who engaged in drug injection faced a considerably greater risk of contracting HIV and C-type hepatitis through sharing needles (Reyes, 2000). In terms of mental illness, prior research reveals that women in prison often suffer from posttraumatic stress disorder (PTSD), depression, anxiety, phobias, self-mutilation, and suicide associated with victimization experiences (UNODC, 2009). For example, Zlotnick (1997) noted that 80% of female drug offenders have mental disorders and two thirds have PTSD.

The serious shortage of adequate drug treatment programs before, during, and after incarceration is a significant factor leading to high rates of recidivism among drug-involved women inmates (Belknap, 2007; Carlson, Shafer, & Duffee, 2010). Post-release job placement, vocational and job training programs, and post-release care must be combined with drug treatment services to smooth transition to postprison life (Richie, 2001). Sadly, it is estimated that about 50% of female drug offenders need intensive residential treatment for drug abuse disorders (Belenko & Peugh, 2005). Holtfreter, Reisig, and Morash (2004) noted that women parolees are 83% less likely to reoffend if they have access to essential needs after imprisonment.

Domestic Violence Impacts on Misconduct, Health Status, and Need for After-Release Assistance

The term domestic violence (n.d.) refers to “a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner” (Dictionary.com website). The term applies to acts of violence or abuse against a person living in one’s household, especially a member of one’s immediate family. Domestic violence can involve physical, sexual, emotional, economic, or psychological actions or threats of actions intended to control another person. As a criminal matter, domestic violence traditionally has entailed physical and/or sexual abuse. It is distinguished from other forms of violence in that it occurs in the context of an intimate relationship. While physical and sexual abuse can occur in many areas, domestic violence pertains only to such acts of perpetrated by persons living in the victim’s household.

Due to its highly private nature, the true prevalence of domestic violence among female offenders is very difficult to ascertain. Some researchers report the rate of physical abuse among women offenders to be as high as 75% (e.g., Browne et al., 1999; Wright et al., 2007) and sexual abuse as high as 65% (e.g., Browne et al., 1999; Islam-Zwart & Vik, 2004), but other researchers have reported lower rates. For instance, Browne et al. (1999) differentiated six separate types of interpersonal violence, noting that approximately 70% of women inmates reported having experienced severe physical violence from a parent or an adult during childhood and/or adolescence, and 59% reported sexual abuse involving vaginal, anal, or oral penetration.

A number of researchers have confirmed that physical and sexual abuse victimization prior to imprisonment increases the likelihood of institutional misconduct by female prisoners (see Chen et al., 2014; Steiner & Wooldredge, 2009; Warren et al., 2004; Wright et al., 2007). However, to date no study has reported the specific effect of domestic violence on misconduct among female offenders. According to Flowers (2001), women who were abused in childhood may unconsciously seek out an abusive environment in their adult life. Female offenders with a long-term exposure to a violent subculture prior to imprisonment were found to be more noncompliant once incarcerated. Accordingly, we hereby hypothesize that there is a significant association between domestic violence victimization and misconduct among imprisoned female drug offenders.

There is strong evidence of a linkage between physical/sexual abuse victimization and mental illness among female inmates (Browne et al., 1999; McClellan et al., 1997), as well as evidence of linkage between violence and mental illness (McClellan et al., 1997). Messina and Grella (2006) found that drug-dependent women prisoners who have also experienced physical and/or sexual abuse in childhood have an elevated risk of adverse health outcomes such as depression, eating disorders, alcoholism, gynecological problems, STDs, and hepatitis (see also, Moloney, van den Berg, & Moller, 2009). Browne et al. (1999) further noted that girls from physically or sexually abusive homes are also more at risk of separation from their families of origin before reaching adulthood due to either runaways or out-of-home placements. As such, they are at increased risk of becoming involved in dangerous life styles such as drug- or prostitution-related activities, and at risk of not engaging in appropriate nutrition and hygiene and receiving adequate health care before their incarceration (Canadian HIV/AIDS Legal Network, 2006). We hereby hypothesize that there is a significant association between domestic violence victimization and inmate health status among imprisoned female drug offenders.

Violence, abuse, and exploitation of females at the hands of family members or close friends at an early age are often triggers of runaway status among teen victims, and subsequent substance abuse (Chesney-Lind, 2000; Wright et al., 2007). The reestablishment of protective social relationships and networks and engagement with needed medical services typically becomes the primary challenge for those seeking to help drug-affected women inmates with reentry. Ideally, the three-legged stool of (a) resettlement and replacement, (b) vocational and job training, and (c) medical and counseling services (UNODC, 2009) are all awaiting the drug-involved female offenders. Sadly, evidence indicates that most female drug offenders come from low-income and impoverished backgrounds whereby few family resources are likely to be available to assist in resettlement and replacement of lost material and social assets (Belknap, 2007; Browne et al., 1999; Wright et al., 2007). Moreover, most ties to family members, close friends, and relatives are either weak or entirely broken by the incarceration experience (Tsai & Lai, 2014). With respect to productive employment, while some vocational and job training programs are offered in prison, precious few such programs are available for women outside the prison. Timely access to medical treatment and counseling services is essential to successful reentry given that female drug offenders have alarmingly high rates of physical and mental health problems occasioned by their domestic violence victimization (Covington, 2007). Thus, we hypothesize that there is a significant association between domestic violence victimization and need for after-release assistance among female drug offenders.

Other Factors Affecting Misconduct, Health Status, and Need for After-Release Assistance

When predicting female institutional misconduct, inmate health, and aftercare needs, researchers have employed a list of key control variables—namely, age, education level, marital status, employment status prior to incarceration, drug dependence, time served, and treatment, therapy, and rehabilitation programs participated in (Casey-Acevedo & Bakken, 2001; Chen et al., 2014; Houser et al., 2012; Islam-Zwart & Vik, 2004; Slotboom et al., 2011; Steiner & Wooldredge, 2009; Warren et al., 2004; Wright et al., 2007). We group these control variables into two clusters, importation and deprivation factors. Those attributes inmates bring with them to prison (pre-incarceration experiences) are viewed as the former, and inmates’ activities and experiences while they were incarcerated are characterized as the latter.

Methods

Sample and Data Collection

The research from which this analysis derives was sponsored by the Taiwan Ministry of Justice (MOJ). It was conducted between July and August of 2014. The study population is the female drug-affected inmates who were either housed in jails (for physical detoxification), in drug abuse treatment centers, or in female prisons operated by the Agency of Corrections (AOC) within the MOJ. According to MOJ’s (2014) Justice Statistics Year Book, a total of 3,525 female drug-related offenders at the end of 2013 were housed in Taiwan’s correctional facilities. Survey data were to be collected at random from 20% of these drug-affected female offenders for analysis. Accordingly, researchers distributed a total of 705 self-administered printed questionnaires to female inmates in those several types of correctional facilities.

After receiving approval of survey content from the AOC and correctional program administrators from 11 women facilities, a research team of two professors and two trained graduate students traveled to each facility to administer the survey. The research team recruited volunteer inmates at random on scheduled dates, and they administered the survey in either a prearranged private room or in a factory where prisoners were between jobs. All correctional officials were kept away from the survey completion setting while under way.

The purpose of the study project, the right to refuse participation, and provisions for the maintenance of anonymity and information security were explained to the survey participants, and questions from them were fielded. The research team distributed the self-administered questionnaires along with an official letter of assurance from the AOC guaranteeing that all respondents would remain anonymous. As respondents filled out the questionnaires, only the research team remained on the scene to answer questions or address concerns that arose as surveys were being filled out. Survey participants were informed that they could terminate participation in the survey at any time, and they were asked not to discuss the survey questions with other inmates until the researchers had completed their work in that facility. Approximately 1 hr was provided for filling out the questionnaire; all survey participants were able to complete the survey process within that time. A total of 633 respondents in 11 facilities returned their completed questionnaires, resulting in a response rate of 90%.

Dependent Variables

Three dependent variables are examined. Institutional misconduct was measured by self-report questionnaire items such as “violating visiting and corresponding regulations,” “possessing contraband,” “fighting with/assaulting other inmates,” “fighting with/assaulting staff members,” and “other nonviolent violations” since admission to prison. Responses were recorded on a frequency continuum: 1 (never), 2 (1 time), 3 (2 times), and 4 (3+ times). This variable was subdivided into three categories: (a) violent misconduct, (b) nonviolent misconduct, and (c) no misconduct. No misconduct was used as a reference group in multivariate analyses. In terms of health status indicators, each study participant was asked to respond to the following statement: “Please report any medical problems you currently have.” A list of 10 common ailments was provided, including diabetes, hyperthyroidism, HIV, urinary system problems, mental illness, B-type hepatitis, C-type hepatitis, cardiac problems, gynecological disease, and accidental injury. An additive scale represents the sum of scores on these items; the total score ranges from 0 to 10. Given that approximately 42% of the sample reported having no medical problems at the time of the interview, and that few inmates reported having multiple medical problems, this additive variable was transformed into a dichotomous variable with 0 being none and 1 at least one illness.

The third dependent variable, need for after-release assistance, is a scale that includes five items as follows—“to introduce jobs or to be referred to job positions,” “to be referred to vocational training centers,” “for help in resettlement services,” “to be referred to counseling services,” and “to improve the association with family members.” Response categories range from 1 = strongly disagree to 4 = strongly agree. This variable is the average of the responses on these five items. A higher score indicates the respondent needs after-release assistance provided by relevant agencies. The mean score was 1.95, with a standard deviation of 0.82, a Cronbach’s alpha of a robust .87, and a strong eigenvalue of 3.28.

Independent Variables

Reflecting the research literature, 11 independent variables were classified into three groups: family dynamics, importation, and deprivation. The group family dynamics includes the measurement of domestic violence, violent family setting, and strength of family attachment. Two items are used to capture domestic violence experiences prior to prison: “I had been beaten or assaulted by a family member (e.g., a parent or a sibling) in childhood” and “I had been beaten or assaulted by a spouse or a cohabitant.” The response categories ranged on a frequency continuum from 0 = 0 times, to 5 = five or more times; however, both variables featured considerable positive skewness. As a result, the responses were summed and transformed into a dichotomous variable such that “never” was re-coded as 0 and “had at least one experience” was re-coded as 1. The variable violent family setting was measured by asking, “Do you believe that family members beat up or assault each other?” The subjects covered are as follows: (a) father, (b) mother, (c) spouse/cohabitant, (d) sisters, (e) brothers, and (f) children. A higher score indicates that a respondent would rate her family as being a violent family. The mean score on this scale was 0.12, with a standard deviation of 0.43 and considerable positive skewness. Consequently, this measure too was treated as a dichotomous variable wherein “not a violent family” was re-coded as 0, and “a violent family” was re-coded as 1. A seven-item scale was created to capture the respondents’ perception of family attachment when family members (father, mother, or siblings) were visiting or writing: “They listen to me”; “They console and encourage me”; “They do care about my life and behaviors in prison”; “They provide some helpful and useful opinions”; “They show their respect for my thoughts”; “We have a harmonious relationship”; and “They can be my consultants when I get in trouble.” Responses were recorded on a continuum ranging from 1 = strongly disagree to 4 = strongly agree. The scale represents the average score on these seven items. A higher score indicates a strong attachment to family. The mean score was 3.13, with a standard deviation of 0.57; the Cronbach’s alpha was a robust .92, with a strong eigenvalue of 4.45.

The importation variables are age, education attainment, marital status, job status, and history of drug abuse. The variable of age was respondent’s natural age at the time of the survey. Educational attainment was measured by two options: 1 = junior high school or less and 2 = senior high school level and above. Marital status options were (a) single, (b) married/remarried/cohabitant, and (c) divorced/separated. Single was used as the reference group in multivariate analysis. Job status was (a) stable job, (b) part-time job/unstable job, and (c) no job (or searching for a job); stable job was treated as the reference group. History of drug abuse was measured by the item “how long have you been abusing illicit drugs in the years prior to prison admission?”

Three variables were created to capture the deprivation group of measures. These include time served, treatment participated in, and group activities. The time served item read, “How long have you been admitted to this correctional facility prior to the survey?” A two-item scale was created to capture the respondents’ treatment participated in by asking them “Have you ever participated in health and medical education classes?” and “Have you ever received any medical treatment while in prison (e.g., prescription medication)?” Response categories ranged from 1 = never participated to 5 = quiet often. The two questions’ responses were averaged for the variable treatment participated in. The mean score was 2.54, with a standard deviation of 1.3, and Cronbach’s alpha was a moderate .56 with an eigenvalue of 1.39.

Finally, the variable group activities comes from asking, “How often did you participate in any kind of group activities provided by facilities” featuring (a) religious counseling, (b) reading books, (c) health classes, (d) parenting skill classes, (e) group counseling for specific clients (i.e., drug users and victims of domestic and sexual violence), (f) Chinese calligraphy and painting workshop, and (g) recreational activities. Response categories ranged from 1 = never to 5 = participated quiet often. The index for group activities is the average scores across the seven items. The mean score was 2.30, with a standard deviation of 0.89, and Cronbach’s alpha was .68.

Results

Descriptive Statistics

Respondents’ descriptive statistics are set forth in Table 1. Nearly two thirds (63.5%) of the female drug-affected inmates reported that they had never been disciplined for any prison misconduct, and a little over a third (36.2%) reported they had at least one. A bit over a quarter (26%) of the women reported they engaged in violent prison misconduct, while 10% of reported having engaged in nonviolent misconduct. Those who reported committing both violent and nonviolent misconduct are categorized in the violent misconduct group. The distributions of these two misconduct categories are similar to those found in the Chen et al.’s (2014) study.

Table 1.

Descriptive Statistics for All Variables (N = 633).

Variables	Description; frequency (%)	M	SD	Minimum	Maximum
Dependent variable
Institutional misconduct	Violent misconduct = 166 (26.2) Nonviolent misconduct = 63 (10.0) None = 402 (63.5)
Health status	None = 267 (42.2)At least one = 363 (57.3)	0.57	0.49	0.00	1.00
Need for after-release assistance	Five-item scale, Cronbach’s alpha = .87	1.95	0.82	1.00	4.00
Family dynamic variables
Domestic violence	None = 414 (65.4)At least one = 205 (32.4)
Violent family	None = 526 (83.1)Yes = 107 (16.9)
Family attachment	Seven-item scale, Cronbach’s alpha = .92	3.13	0.57	1.00	4.00
Importation variables
Age at interview	In years	34.11	9.10	18.00	62.00
Education	Junior high level and below = 327 (51.7)Senior high level and above = 306 (48.3)	0.48	0.50	0.00	1.00
Marital status	Single = 227 (36.0)Married/cohabitant = 240 (37.9)Separated/divorced = 163 (25.9)
Job status	Stable job = 198 (31.3)Part-time job/unstable job = 325 (51.3)No job = 103 (16.3)
History of drug abuse	In years	10.93	7.61	0.00	34.00
Deprivation variables
Time served	In months	24.48	25.56	0.00	162.00
Treatment participated	Two-item scale, Cronbach’s alpha = .56	2.54	1.30	1.00	5.00
Group activities	Seven-item scale, Cronbach’s alpha = .68	2.30	0.89	1.00	5.00

With respect to health status, more than half of the respondents (57.3%) reported having at least one of the 10 illnesses listed. Figure 1 presents the distribution of results collected on the 10 health indicators. Among the health indicators, accidental injury (n = 159) is found to be the most serious risk—approximately 25% of respondents reported that they have suffered from accidental injuries in prison. Other health problems, of prevalence, are C-type hepatitis (18.5%), gynecology disease (12.6%), HIV infection (12.3%), urinary system problem (12.0%), mental illness (11.7%), hypertension (10.3%), B-type hepatitis (5.1%), hyperthyroidism (4.4%), and diabetes (1.9%). The distribution pattern obtained in the current study is in line with Chen et al.’s (2013) results drawn from 833 incarcerated women in Taiwan.

Figure 1.

Indicators of health and illnesses among imprisoned Taiwanese female drug offenders (N = 633).

Regarding domestic violence victimization, nearly one third (32.4%) of the incarcerated female drug offenders experienced at least one domestic violence victimization prior to her incarceration. More than one in 10 (13%) of the women experienced being beaten or assaulted by family members, while over a quarter (27%) reported being beaten or assaulted by a spouse or coinhabitant. The prevalence reported here is right in line with that reported in McClellan et al.’s (1997) study based on 500 adult women inmates in Texas (i.e., 30%).

Approximately 17% of our study participants came from a violent family, similar to the findings (14%) from the Messina and Grella (2006) California prison survey. The mean score for family attachment is an encouraging 3.13 out of a possible 4. The average age of our respondents was around 34 years, and 51.7% of the women indicated that senior high school was their highest educational level. These findings were consistent with those reported in the Chen et al.’s (2013) study. About 38% of the participants reported their own marital status as either married or coinhabitant prior to prison admission, followed by the categories of “never married/single” (36.0%) and “separated/divorced” (25.9%). Approximately 82.6% reported that they were employed either part-time (51.3%) or full-time (31.3%) prior to incarceration, while 16.3% reported that they were unemployed. The average history of self-reported drug abuse was about 11 years. With regard to time served, the mean value is 24.8 months.

Multivariate Analyses

Three regression models were employed in our multivariate analyses—namely, a multinomial logistic regression on prison misconduct, a binary logistic regression on inmate health, and an ordinary least squares (OLS) regression on perceived needs for after-release assistances, respectively. Table 2 displays the results of the multinomial logistic regression on prison misconduct, with non-misconduct serving as the reference category.

Table 2.

Multinomial Logistic Regressions for Institutional Misconduct (N = 633).

Variable	Violent misconduct^a			Nonviolent misconduct^a
Variable	Coefficient	SE	Odds ratio	Coefficient	SE	Odds ratio
Constant	2.012***	0.818	7.475	1.342	0.803	3.827
Family dynamic variables
Domestic violence	0.469*	0.237	1.598	0.285	0.233	1.329
Violent family	−0.221	0.294	0.802	−0.169	0.287	0.844
Family attachment	−0.772***	0.200	0.462	−0.473*	0.192	0.623
Importation variables
Age	−0.083***	0.019	0.920	−0.073***	0.018	0.930
Education	0.021	0.224	1.021	0.313	0.220	1.367
Married/cohabitant^b	−0.501	0.271	0.606	0.034	0.265	1.035
Divorced/separated^b	−0.120	0.322	0.887	0.156	0.321	1.169
Part-time/unstable job^c	0.678*	0.266	1.971	0.134	0.252	1.143
No job^c	0.500	0.345	1.649	−0.125	0.340	0.882
History of drug abuse	0.019	0.019	1.019	0.039*	0.019	1.040
Deprivation variables
Time served	0.011*	0.005	1.011	0.009*	0.005	1.010
Treatment participated	0.208*	0.105	1.231	0.275**	0.104	1.317
Group activities	0.293*	0.147	1.340	−0.125	0.148	0.883
Chi-square	79.584***			38.510***
Nagelkerke R²	.211			.109

Note. Table entries include binary logistic regression coefficients, followed by standard errors, and the log odds.

The omitted reference category is none misconduct.

The omitted reference is single.

The omitted reference category is stable job.

p < .05. **p < .01. ***p < .001.

In the first column, all the independent and control variables were regressed on violent misconduct. The results indicated that among the family dynamic variables domestic violence victimization produced a positive association with violent misconduct. Female drug-affected offenders who experienced domestic violence victimization tended to report higher levels of violent misconduct by a substantial margin. In addition, those who reported lower levels of family attachment reported higher levels of violent misconduct in correctional facilities. As expected, being a younger drug abuser increased the odds of becoming a violent disciplined inmate, whereas the variable part time/unstable job was significantly and positively related to violent misconduct among the importation variables. In terms of deprivation variables, those who served sentence longer and participated in treatment and group activities more frequently were more likely to be disciplined for violent misconduct. Finally, approximately 21% of the variance observed on the violent misconduct scale was accounted for by all variables based on the Nagelkerke R² value.

In the second column of Table 2, the results revealed that the variables of family attachment, age at interview, history of drug abuse, time served, and treatment participation were highly associated with nonviolent misconduct among these female drug offenders. It is worth noting that while domestic violence victimization had a significant impact on violent misconduct, it has no impact on nonviolent misconduct. Around 11% of the variance observed on the nonviolent misconduct scale was accounted for by all variables based on the Nagelkerke R² coefficient.

Table 3 displays the results of health status and the need for post-release assistance as the dependent variables. In the first column of the binary logistic regression model, five out of 13 variables—domestic violence victimization, divorced/separated, history of drug abuse, treatment participated, and group activities—produced a significant association with the dependent variable inmate health. The divorced or separated women, longer time abusers, and domestic violence victims reported more health problems. While treatment participation is highly associated with the inmate health variable, the group activities variable seems to reduce the probability of health problems. Based on the Nagelkerke R² coefficient, approximately 16% of the variance was explained by the predictive variables shown in Table 3.

Table 3.

Multivariate Regressions for Health Status and Need for After-Release Assistance (N = 633).

Variables	Health status			Need for after-release assistance
Variables	B	SE	Exp (B)	B	SE	β
Constant	−0.458	0.720	0.633	2.615***	0.265
Family dynamic variables
Domestic violence	0.463*	0.213	1.589	0.172*	0.078	0.097
Violent family	−0.147	0.263	0.863	0.108	0.095	0.049
Family attachment	−0.158	0.174	0.853	−0.346***	0.064	−0.238
Importation variables
Age	−0.025	0.015	0.976	0.006	0.005	0.069
Education	0.136	0.196	1.146	0.086	0.072	0.052
Married/cohabitant^a	0.314	0.236	1.369	−0.051	0.086	−0.030
Divorced/separated^a	0.575*	0.284	1.777	0.037	0.104	0.019
Part-time/unstable job^b	0.330	0.225	1.390	0.145	0.082	0.087
No job^b	0.363	0.296	1.437	0.181	0.109	0.082
History of drug abuse	0.045**	0.015	1.046	0.016**	0.006	0.142
Deprivation variables
Time served in prison	0.001	0.004	1.001	−0.001	0.002	−0.034
Treatment participated	0.535***	0.095	1.707	−0.039	0.034	−0.061
Group activities	−0.396**	0.135	0.673	−0.001	0.048	−0.001
	Chi-square = 64.93***			F = 5.493***
	Nagelkerke R² = .162			Adjusted R² = .104

Note. The first column presents the outcome of binary logistic regression, whereas the second presents the outcomes of OLS regression. OLS = ordinary least squares.

The omitted reference category is single.

The omitted reference category is stable job.

p < .05. **p < .01. ***p < .001.

In the second column of the OLS model, only three variables—domestic violence victimization, family attachment, and history of drug abuse—demonstrated a statistically significant association with the need for post-release assistance. Female drug-affected inmates who were the victims of domestic violence and those who were a long-time drug abuser prior to prison were more likely to report needs for post-release assistance. Moreover, those female inmates with weaker attachment to their families are in greater need for assistance upon reentry. Based on the adjusted R² coefficient, around 10% of the variance observed in the need for post-release assistance was accounted for by all the predictive variables arrayed in Table 3. In sum, domestic violence victimization is consistently shown to be a significant predictor of violent misconduct, health status, and needs for aftercare services right alongside other statistically significant explanatory variables such as level of family attachment and history of drug abuse.

Conclusion

Discussion

The rapidly increasing population of incarcerated female drug offenders in Taiwan has generated interest in studying their institutional adjustment, health in prison, and the needs for post-release assistance (Chen et al., 2013, 2014; Tsai & Lai, 2014). This study investigates those important issues by assessing the prevalence of prior domestic violence and the degree to which violent misconduct, health status, and the need for post-release assistance could be explained by the history of domestic violence victimization, after controlling for other relevant variables. Some noteworthy observations were brought to light here.

First, more than half (57%) of incarcerated female drug offenders reported that they have suffered at least one health problem at the time of the interview, among which accidental injuries sit atop the list. Infectious diseases such as C-type hepatitis and HIV are also in strong presence among the female drug offenders. Compared with the findings derived from the research done in some Western countries, mental illness only accounts for 12% of the cases in Taiwan, and is not a serious problem among the incarcerated Taiwanese female drug offenders. For example, James and Glaze (2006) indicated that approximately three quarters of the U.S. female inmates they studied reported mental problems (see also, Covington, 2007). We also found that one third (32%) of the incarcerated women experienced domestic violence at least once, either by a family member or by spouse/coinhabitant. McClellan et al.’s (1997) investigation of the relationship between childhood and adulthood experience of maltreatment and criminality revealed that 23% of the women were physically abused as children and 53% were physically assaulted by a partner/spouse in adulthood. The prevalence of domestic violence among this group of drug-abusing incarcerated women in Taiwan is lower (see also, Bloom, Chesney-Lind, & Owen, 1994; Browne et al., 1999; Warren et al., 2004) than those reported in the McClellan et al. (1997) study.

As expected, our study results indicated that women who experienced domestic violence are more likely to be disciplined for violent misconduct, which is consistent with the findings from Warren et al.’s (2004) study. Islam-Zwart and Vik (2004) likewise suggest that women with a history of physical and sexual abuse and violence in their youth might have less ability to make accurate judgments regarding the dangerousness of people and situations as adults. Similarly, consistent with the “cycle of violence hypothesis,” Flowers (2001) has argued that women who were abused in childhood may be more noncompliant when incarcerated.

At the same time, our findings also supported the hypothesis that incarcerated women with domestic violence victimization experiences register significantly higher level of health problems in prison, and demonstrate greater need for postprison assistance. Researchers have indeed observed the connections among multiple factors affecting female drug offenders’ lives such as history of abuse and victimization, inadequate transportation and resources, and limited access to community-based health systems (Belknap, 2007; Carlson et al., 2010; McClellan et al., 1997; Messina & Grella, 2006). Upon release, one of the many challenges faced by the women studied here is to reestablish healthy relationships once again (Petersilia, 2003). If failure to provide reentry programs in prisons takes place, the long-term negative effects of domestic violence may increase the risk of further criminality after release (Chen et al., 2013; Covington, 2001).

Similar to domestic violence, family attachment significantly affects misconduct, inmate health, and the need for post-release assistance alike. According to Wright et al. (2007), institutional misbehavior can be alleviated by the nature and range of women’s relationship with significant others on the outside. Support from family members and significant others make it less likely for female drug-affected offenders to require formal post-release assistance from government agencies and social organizations (Chen et al., 2013; Green et al., 2005).

Finally, there is ample evidence of a close linkage between female drug-affected inmates’ historical drug dependence and the likelihood of reoffending after a stint in prison (Belknap, 2007; Covington, 2001). Our study reveals that drug-affected women inmates strongly desire postprison support in the seeking of jobs, housing placement, health maintenance, and counseling in while they seek to heal relationships with partners and family members upon leaving prison.

Policy Implications

History of domestic violence victimization clearly should be assessed at the intake stage of incarceration, with high-risk inmates being identified and specific medical treatment and counseling services being assigned accordingly. Anger management and de-escalation skills could mute a tendency toward use of violence in the inevitable conflicts present in prison settings. At-risk women inmates likewise need to preserve their family and social ties as best they can, especially if they are law-abiding and willing to engage. The existing family support program for women created in 2011 is well received in Taiwan (Huang & Lai, 2015). In addition, telephone access policies, conjugal visiting programs, and furloughs could serve more drug-affected women prisoners (Chen et al., 2014). Importantly, after-release assistance with housing, employment, medical services, and counseling must be carried out as fully as possible (Carlson et al., 2010; Green et al., 2005). More NGOs and volunteers need to be recruited for reentry programs.

As with any research, our study is not without limitations. Some variables are weak approximations of what they seek to measure. For example, more comprehensive measures of domestic violence victimization and family violence would be great improvements over work presented here (see McClellan et al., 1997). Similarly, the measures of health problems could be improved by using an established psychological diagnostic inventory such as the Brief Symptom Inventory (see Warren et al., 2004). In addition, the weak Cronbach alpha values of treatment participated in (only .56) raise concern of reliability. While the impact of trauma (e.g., PTSD), specifically from sexual abuse victimizations, may exert a great impact on women offenders prior to, during, and after prison, we were not able to include this important variable in the current study. Like other researchers (e.g., Islam-Zwart & Vik, 2004), we would advocate the inclusion of variables measuring the impact of trauma in future studies.

Footnotes

Acknowledgements

Grateful acknowledgement is also made to the talented research assistants, the dedicated administrators and staffs from the correctional facilities, and especially to the brave female inmates who voluntarily participated in this research. In addition, the authors thank Dr. Nicholas P. Lovrich for editing the paper.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by a grant #PG10304-0085 from the Ministry of Justice (MOJ) to the Central Police University in Taiwan, R.O.C. Points of view expressed in this article are those of the authors and do not necessarily represent the official position of the MOJ nor the Agency of Corrections.

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