Crack-using Women Research Articles

“This Is What's Real”: The Pathology of Black Addiction in the Hood Films of the 1990s

“This Is What's Real”: The Pathology of Black Addiction in the Hood Films of the 1990s

Cerebral ultrasound findings in infants exposed to crack cocaine during gestation

Prenatal exposure to cocaine has been associated with a wide spectrum of structural abnormalities in infant brains. The growing use of crack, a smokable and extremely addictive form of cocaine, could exacerbate the situation. The purpose of this study was to determine the frequency, type and severity of cerebral lesions detected by transfontanellar US in newborns exposed to crack during gestation. This was a retrospective study, involving a review of the medical records of children who were born to crack-using women and who were subjected to transfontanellar US imaging during their first days of life. Transfontanellar US revealed abnormalities in 45/129 newborns examined (34.9%). The changes detected were subependymal cysts in 24 infants (18.6%), lenticulostriate vasculopathy in 18 infants (14%), subependymal hemorrhage in 9 infants (7%), and choroid plexus cysts in 9 infants (7%). All of the abnormalities found by US examination were discrete and likely without clinical significance for the babies. However, prospective studies with a long period of tracking are needed to determine whether there are later consequences on the neurodevelopment of children with prenatal exposure to crack.

Cumulative Victimization, Psychological Distress, and High-Risk Behavior Among Substance-Involved Women

This research addressed two questions: (a) What is the relationship between different patterns of cumulative victimization and psychological distress? And (b) How does the pattern of cumulative victimization and psychological distress influence women's engagement in substance- and sex-related risk behavior? Data were analyzed from interviews with 149 sexually active, crack-using women who completed a follow-up interview after participating in the Kentucky National Institute on Drug Abuse (NIDA) AIDS Cooperative Agreement. Findings from the multivariate analyses indicated that victimization accounted for 5% and 39% of the variance in psychological distress and high-risk behavior, respectively; cumulative victimization and psychological distress accounted for 6% to 11% of the variance in the high-risk behaviors. Results highlight the affects of childhood and adult victimization on psychological distress and the associations between different types of psychological distress and risk behavior.

Case Management Outcomes for Women Who Use Crack

Women who use crack are at risk for HIV in addition to problems surrounding their drug use. In this study, 149 crack using women participated in a case management intervention. The sample was predominantly African-American and Hispanic and averaged 42 years old. At follow-up, significant improvements were reported on drug and alcohol use, mental and emotional health, and employment. The results indicate that case management services are useful to help crack-using women improve their lives.

Lifetime Victimization and Psychological Distress: Cluster Profiles of Out of Treatment Drug-Involved Women

K-means clustering techniques were used to identify four cluster profiles characterized by unique patterns of victimization and psychological distress and further differentiated by distinct patterns of risk and protection across multiple life domains among a sample of 149 crack-using women. Results of this study suggest that important differences exist in patterns of victimization and psychological distress among drug-involved women. Identification of this variation can be used to tailor intervention strategies to the particular needs of different subgroups within the population of crack-using women.

Violence, Homelessness, and HIV Risk Among Crack-Using African-American Women

This study compares the characteristics of out-of-treatment, homeless, crack-using African-American women with those who are not homeless to determine what risks and protective factors differentiate the two groups. From 1999 to 2001, 683 out-of-treatment, African-American crack-using women (of whom 219 were categorized as homeless) were interviewed and serologically tested. Risk factors that were examined include adverse childhood experiences, psychological distress, physical health, violence and victimization, drug use, and risky sex behaviors. Protective factors that were examined include marital status, education, public assistance, and the responsibility of caring for children. Overall, both groups of women started crack use in their mid-twenties and started drug use with alcohol in their teenage years, though differed significantly on each risk factor examined. Logistic regression analysis found that variables associated with increased odds of being homeless are physical abuse before age 18, crack runs greater than 24 hours, income less than $500 in the last 30 days, depression, and current cigarette smoking. Protective factors found are marital status, living with children under 18, having had a physical in the past year, and receiving money from welfare in the last 30 days. Being sexually assaulted in the past 90 days was marginally associated with homelessness in the model. These findings, specific to crack-using African-American women, suggest that not only do these women overall report painful histories and currently stressful lives, but homeless women are more likely than women who are not homeless to have experienced childhood abuse and are more involved with drug use. Interventions designed for these women need to consider gender, cultural, and contextual issues that not only incorporate aspects of risk reduction related to violence, alcohol use, and comorbid conditions, but also linkages that will address housing issues, education, and skills for independence.

Cocaine exposure and developmental outcome from birth to 6 months

The theoretical framework for many of the early studies of prenatal cocaine exposure has been rooted in the basic concepts of teratology/developmental toxicology. Few have published longitudinal analyses of the complex interplay between the relative effects of prenatal cocaine exposure and perinatal and environmental factors on development. The purpose of this paper was to use structural equation modeling to describe the direct and indirect effects of prenatal drug exposure on developmental outcome from birth to age 6 months. Key variables considered for study include prenatal drug exposure, perinatal medical characteristics, maternal/caregiver/family characteristics, the home environment, and neurobehavioral outcomes. We prospectively enrolled 154 predominantly crack-using women. A priori exclusion criteria included: <18 years old, major illnesses diagnosed prior to pregnancy, chronic use of legal drugs, and any use of illicit drugs other than cocaine and marijuana. From the pool of noncocaine users, 154 subjects were matched to users on pregnancy risk, parity, race, and socioeconomic status. At the end of each trimester, experienced staff conducted private interviews prompting memory of amount and timing of past drug use. Urine specimens were collected at two unanticipated times; positive screens were confirmed by gas chromatography/mass spectroscopy. Measures analyzed include medical (birth) and developmental (birth, 1 month, 6 months) assessments, all performed by blinded evaluators, as well as caregiver characteristics and environmental factors (birth, 1 month). A series of four theoretical models was tested, one for each time point (birth, 1 month, 6 months) and a longitudinal model spanning birth to 6 months. Key findings include direct effects of prenatal cocaine exposure on development at birth in the birth model and on development at birth and 6 months in the longitudinal model. In addition, indirect effects of prenatal cocaine exposure were identified on development at birth, 1 month, and 6 months, mediated through the prenatal use of alcohol and tobacco and the birth head circumference. Implications of these and other findings, including the advantages and limitations of structural equation modeling, are discussed.

At Law: The Rights of Pregnant Women: The Supreme Court and Drug Testing

During last two decades, states have sought to punish pregnant women for behavior that endangers their fetuses, often without success. (1) Prosecutors have used various novel legal theories, including child abuse and neglect, delivery and distribution of controlled substances, and involuntary manslaughter. Some states have enacted laws criminalizing prenatal drug use. (2) Other states have authorized necessary to protect fetus. (3) These measures include civil commitment for pregnant women who use drugs and cash incentives for crack-using women to become sterilized. (4) During height of concern for fetal rights, in late 1980s, Medical University of South Carolina (MUSC) devised a policy, in cooperation with law enforcement officials, for screening pregnant patients for cocaine use. Women who tested positive would be turned over to police and threatened with prosecution to provide the necessary leverage to force them into treatment. The policy specified criteria for determining which pregnant women should be tested (targeting, for example, women who had obtained no prenatal care or late or incomplete prenatal care, and women known to have previously abused drugs or alcohol abuse). It also required urine samples to be handled through an appropriate chain of custody to ensure that they could be used as evidence in a criminal trial; and it detailed offenses with which woman could be charged, depending on age of fetus. The charges included simple possession, possession and distribution to a minor, and child neglect. The policy made no mention of any change in woman's prenatal care and did not prescribe any treatment for newborns. More than forty women were arrested under MUSC program, and some who tested positive for cocaine during labor were taken to jail in handcuffs or leg shackles shortly after giving birth. Under South Carolina law, a viable fetus historically has been regarded as a person; on this basis, state's Supreme Court has held that ingestion of cocaine during third trimester of pregnancy constitutes criminal child neglect. (5) Ferguson v. City of Charleston In 1999, U.S. Court of Appeals for Fourth Circuit (well-known for its conservative judicial activism), held that regardless of whether women provided informed consent, MUSC testing program was justified by special of stopping drug use by pregnant women. This year, in Ferguson v. City of Charleston, (6) Supreme Court overturned Fourth Circuit, holding that a public hospital's policy of subjecting pregnant women to nonconsensual drug tests without a warrant, and turning positive test results over to police, violates Fourth Amendment's proscription against unreasonable searches. Although Fourth Amendment is popularly perceived as applying solely to personal or residential searches, Supreme Court has long recognized that collection and subsequent analysis of biological samples is a search. (7) In most criminal cases, a search is unreasonable unless it is accomplished pursuant to a judicial warrant issued upon probable cause, and if a warrant is impracticable, then courts require, minimally, suspicion based on an individualized assessment. The Supreme Court has held, however, that when state has special needs beyond normal need for law enforcement, warrant and probable or reasonable cause requirements may not be applicable. (8) In three drug testing cases, Court applied needs exception to sustain drug tests for railway employees involved in train accidents, Customs Service employees seeking promotion to certain sensitive positions, and high school students participating in interscholastic sports. (9) In a fourth case, Court struck down drug testing for candidates for certain state offices. (10) The Supreme Court in Ferguson held that MUSC screening program did not fit within closely guarded category of constitutionally permissible suspicionless searches. …

The Epidemiology of Physical Attack and Rape Among Crack-Using Women

This prospective study examines the epidemiology of physical attack and rape among a sample of 171 not-in-treatment, crack-cocaine using women. Since initiating crack use, 62% of the women reported suffering a physical attack. The annual rate of victimization by physical attack was 45%. Overall, more than half of the victims sought medical care subsequent to an attack. The prevalence of rape since crack use was initiated was 32%, and the annual rate was 11%. Among those women having been raped since they initiated crack use, 83% reported they were high on crack when the crime occurred as were an estimated 57% of the perpetrators. Logistic regression analyses showed that duration of crack use, arrest for prostitution, and some college education were predictors of having experienced a physical attack. Duration of crack use and a history of prostitution were predictors of suffering a rape. Drug abuse treatment programs must be sensitive to high levels of violence victimization experienced by crack-cocaine using women. Screening women for victimization, and treating the problems that emanate from it, may help make drug abuse treatment more effective.

Crack and Prostitution: Gender, Myths, and Experiences

This paper presents the results from in-depth interviews with 30 crack-using women also working in the sex trade to support their drug use. The gender roles perspective highlights traditional beliefs from past decades about the appeal of cocaine to women, its effects on their sexuality, and the reasons they become prostitutes. These are contrasted with the harsh realities of the dangers and marginalization faced by female crack users who work the streets in the contemporary sex trade. These women operate at the lowest levels of street drug use and prostitution, experience a considerable amount of violence and sexual exploitation, and are subject to riskier practices in their sex work. Their crack addiction fuels this extreme vulnerability and contributes to their highly deviant and stigmatized social image. We conclude that, similar to findings in other studies, the increase in crack consumption and availability has had serious negative repercussions for poor women who were, or became, involved in the sex trade. Moreover, the powerful appeal of crack to these women poses a challenge for harm reduction alternatives and other services that might improve their health and safety.

Falling through the cracks. Crack-exposed children in the US public schools: an educational policy issue

This paper discusses the research on crack-exposed children, their development and its implications for educational policy. It details the medical community's lack of consensus how, or if, crack-cocaine effects the cognitive development of children born pre-exposed to the drug. The article gives attention to some of the prevailing questions about crack-exposed children at school age and their educational needs. It addresses the question of whether crackexposed children are really doomed for failure, why educational policies and programmes designed specifically for crack children are necessary, and explores the implications for early intervention programmes and school-based programmes. At the heart of this paper lies a policy paradox. In the US one set of (health and social service) policies have targeted crack-exposed children and in so doing, have constructed the ‘problem’ as a public health issue. Other policies to address the ‘crack-baby crisis’ defined the ‘problem’ as a criminal issue, and thus punitive policies toward crack-using women became the focus of policy initiatives. This policy trajectory has thus masked and displaced the need for policy work in other areas; here, educational work.

Behavior Changes among Crack-Using Rural and Urban Women

This study compared rural and urban crack-using women and examined their responses to two interventions. A prospective cohort study design was employed to assess the effectiveness of standard and innovative HIV prevention interventions on 541 urban and 268 rural women in Florida. Generalized estimating equation analysis, accounting for repeated measures, found that for combined urban and rural samples, the innovative intervention was more effective than the standard for a number of drug and sexual risk behaviors. However, the analysis indicated no significant differences in intervention efficacy between rural and urban women. The results imply that there is a need for similar HIV prevention services in both areas. [Translations are provided in the International s Section of this issue.]

Differences in Condom Behaviors and Beliefs Among Female Drug Users Recruited from Two Cities

SUMMARY This paper examines predictors of condom cognitions and condom use for vaginal sex within women's main and paying partnerships. The sample consisted of active injection drug and crack-using women recruited from two cities with disparate HIV rates. A total of 338 drug-using women who reported vaginal sex with a main and/or paying partner in the prior 30 days were recruited for this study. Recruitment site was a significant predictor for several of the variables examined, for both main and paying partners. Ethnicity and prior HIV test result were also significant predictors, but only for main sex partners. Findings support previous research and suggest that the factors which predict condom beliefs, intention, and behaviors are different for main versus paying partners. Interventions designed to increase condom use must recognize that cognitive factors associated with condom use may vary by partner type, ethnicity, and recruitment site, particularly when important contextual variables, such as local seroprevalence, vary.

Cluster Analysis of HIV Intervention Outcomes Among Substance-Abusing Women

The study described here presents an innovative approach to analyzing intervention outcomes among women substance abusers participating in a national HIV prevention research study funded by the National Institute on Drug Abuse. We used cluster analysis to divide the women in our sample (N = 557) into four distinct subgroups predominantly characterized by differences in drug use, injecting risk, sexual behaviors, and drug and sexual risk combined. The four subgroups resulting from this process were primary crack-using women, primary needle-using women, high-frequency needle-using women, and women with multiple drug and sex risk behaviors. Our analysis focuses on change; in self-reported risk behaviors from baseline to 6-month follow-up.In general, the results clearly indicate that the women are heterogeneous; that is, the subgroups exhibit varying patterns of drug use, injecting risk, sexual behavior, and HIV serop-The two smaller subgroups of women-high-frequency needle users and those in the multiple-risk behavior subgroup-reported the highest rate of high-risk behaviors and seropositivity but also showed the greatest change at follow-up. A particularly important finding resulting from our analytical approach is that well over half the women in our sample were primary crack users (n = 313). This finding is even more significant in light of the fact that the Cooperative Agreement specifically tried to include 70% or more participants who were injectors. Although the rate of HIV seropositivity is not as high for this crack-using subgroup as for the two smaller needle-using subgroups, a greater number of “women who are HIV positive” are in this primary crack-using subgroup than in all the other subgroups. Most of the crack-using women reported that they were not currently injecting drugs and never shared needles, but 10% were seropositive for HIV, suggesting that their risk comes primarily from sexual behaviors. Behaviors in this larger subgroup of women did not change as dramatically as those of women in the smaller subgroups; however, the women did show improvement in areas related to indirect risk (e.g., alcohol and crack use) and in several areas where change is most needed (e.g., trading sex for drugs and using condoms). The results demonstrate a promising alternative approach to analyzing substance abuse and HIV risk behaviors, and they suggest the need for further research on alternative interventions for women with different patterns of risk behaviors. ositivity. Significant outcomes were found in many areas, indicating positive changes in risk behaviors.