Black Women's Physical, Mental, and Sexual Health in the Criminal Legal System: Influences of Victimization, Healthcare Access, and Living Conditions

Abstract

This study examines pathways from gender-based, racialized violence to health outcomes among formerly incarcerated Black women. We frame violence as gender-based and racialized, with a theoretical stance that we live in a male-dominated society characterized by historic and contemporary race-based oppression. This secondary analysis focused on a subsample of Black women ( N = 288) from three U.S. cities (Oakland, CA; Kansas City, KS, MO; and Birmingham, AL) from March 2019 to June 2020 for the Tri-City Cervical Cancer Prevention Study among Women in the Justice System. Confirmatory factor analysis evaluated psychometric properties of hypothesized latent variables—violence victimization, living conditions, and healthcare access—and their observed indicators. Structural equation modeling estimated their relationships with physical, mental, and sexual health, controlling for sampling location. Violence victimization was associated with mental (β = 0.37, p = .000) and sexual health concerns (β = 0.31, p = .000). Healthcare access was associated with physical health concerns (β = 0.45 , p = .004). Although there were no direct relationships between living conditions and health concerns, mediation analysis indicated worse living conditions were associated with more violence victimization and less healthcare access, with violence victimization fully mediating a relationship with mental and physical health concerns. Regarding control variables, women in Kansas City reported more sexual health concerns (β = 0.19, p = .005). Findings have important implications for treatment and care for Black women with incarceration and violence victimization histories.