Breaking the Cycle/Mending the Hoop Adverse Childhood Experiences Among Incarcerated American Indian/Alaska Native Wo

1. Breaking the Cycle/Mending the HoopAdverse Childhood Experiences Among Incarcerated American Indian/Alaska Native Women in New Mexico Lori de Ravello, MPH CDC Assignee to IHS December 2006

2. Acknowledgements • Co-Authors • Jessica Abeita, MPH – Tulane University Graduate Student (formerly) • Pam Brown, MPH – Epidemiologist, NM Dept. of Corrections • NM DOC • NM Women’s Correctional Facility/Corrections Corporation of America • AI/AN women who shared their stories with us Opinions or points of view expressed are those of the authors and do not necessarily reflect the official position or policies of the Centers for Disease Control and Prevention or the New Mexico Department of Corrections.

4. Project Objectives • Identify health conditions and needs of incarcerated AI/AN women in NM. • Make recommendations to NM DOC and CCA to better address them. • Determined to be public health practice (not research) Adverse childhood experiences (ACE) Associated behaviors and outcomes in adulthood

5. Adverse Childhood Experiences Definition: A complex set of related childhood experiences that include abuse and neglect and growing up with parental alcohol or drug abuse, domestic violence, parental marital discord, mental illness among family members, and incarcerated family members. The ACE Study Large study designed to describe the long-term relationship between childhood experiences and important medical and public health problems in adulthood.

6. Methods • 217-item survey tool developed, piloted, modified • Population: female inmates who self identified as AI/AN at intake to NMWCF (46) • All invited to attend information session • 78% gave consent and participated (N=36) • Survey administered by a sole Native American female interviewer • Surveys entered into EpiInfo for basic analysis • STATA used for more complex multivariate analyses

7. Select Participant Characteristics • Median age = 36 (range= 20-60) • 59% ≥ high school diploma/GED • 50% employed fulltime at arrest • 39% married/living as married • 50% were teen mothers • 81% had a minor child at the time of the interview • 163 livebirths between them (4.5 ea.)

8. High Rates of ACE

9. High Rates of Risk Behaviors and Associated Outcomes in Adulthood • Alcohol and drug use • Mental health problems • Suicide ideation and attempts • Domestic violence • Criminal behavior • Teen pregnancy • Unintended pregnancy

10. Is the number of reported ACE reported associated with risk behaviorsand poor outcomes?Would knowing an AI/AN inmate’s ACE at intake improve NMWCF’s ability to address specific needs?

11. 5-point ACE Score(range: 0-5) • physical neglect perceived shortage of health care, clothing, or adequate housing • dysfunctional family member at least one person in the immediate family had a drug or alcohol problem, had been incarcerated, or had a history of mental illness • violence witnessed in the home • physical abuse by a family member/loved one • sexual abuse by a family member/loved one

12. 0-2 = “Lo” ACE 4-5 = “Hi” ACE ACE Scores

13. ACE scores, by severity and select adult outcomes * p value < .05; ** p value < .0001

14. Conclusions • Participants experienced high levels of ACE. • Participants have many high risk behaviors in adulthood. • Difficult to determine the relationship between ACE and high risk behaviors. • Small sample size hampered ability to identify statistically significant differences. • The value of knowing an inmate’s ACE at intake is unclear.