Journal of Urban Health: Bulletin of the New York Academy of Medicine, Vol. 83, No. 3
* 2006 The New York Academy of Medicine
Release from Jail: Moment of Crisis or Window
of Opportunity for Female Detainees?
Rachel L. McLean, Jacqueline Robarge, and
Susan G. Sherman
ABSTRACT Despite extensive documentation of the reentry challenges facing female
prisoners, few such studies have focused on women exiting jails. The Window Study
investigated factors associated with the perceived availability of stable housing upon
release from detention. Anonymous surveys were conducted with a random sample
(n = 148) of female detainees at the Baltimore City Detention Center from January 21
to March 17, 2005. Interviews focused on socio-demographic background, health
status, recent drug use and sexual behavior history, and material and social resource
availability upon release. The median age of female detainees was 37 (interquartile
range [IQR]: 29, 41), 69% were African-American, and 33% identified as lesbian or
bisexual. The median income in the 30 days prior to arrest was $145 (IQR: 0, 559),
and the median number of prior arrests was 5 (IQR: 3, 11). In the presence of other
variables familial support (Adjusted Odds Ratio [AOR] 2.57; 95% Confidence
Interval [CI] 1.21, 5.47) and a monthly income of $400–799 (AOR 3.18; 95% CI
1.00, 10.07) were positively associated with perceived housing stability upon release;
wanting a support group for having traded sex for money, drugs or a place to stay
(AOR 0.25; 95% CI 0.10, 0.63) was significantly negatively associated with perceived
housing stability upon release. This study suggests the importance of pre-release
planning and continuity of care for female detainees. Interventions should emphasize
access to housing, economic opportunity and family reunification. Special attention is
warranted to those who have engaged in sex work, who may be marginalized from
family and service-based support networks.
KEYWORDS Commercial sex workers, Detainees, Female, HIV, Housing stability,
Injection drug users, Jail.
The number of females incarcerated in the United States rose by nearly 50% from
68,468 in 1995 to 101,179 in 2003.1Since 1995, the average annual growth rate of
female imprisonment has grown 5%, exceeding that of 3.4% for males during the
same period.2Rising rates of incarceration among females have prompted the exam-
ination of gender specific factors related to imprisonment. Females are significantly
more likely than males to be in jail for non-violent offenses,3,4such as larceny,
fraud and theft, and drugs possession and sales.4Females are more likely than
McLean and Sherman are with the Bloomberg School of Public Health, Department of Epidemiology,
Johns Hopkins University, Baltimore, MD, USA; McLean and Robarge are with Power Inside, Baltimore,
Correspondence: Rachel L. McLean, 615 N. Wolfe St., E6543, Baltimore, MD 21205, USA. (E-mail:
This project was made possible by funding from the Albert Schweitzer Fellowship Program, the V.
Louis Stuckey Family and the Abell Foundation.
males to be unemployed at time of arrest4and to be diagnosed with substance abuse
disorders.5Almost half of female detainees in a national survey of local jails report
histories of childhood sexual abuse; over 10% report experiencing intimate partner
violence.4Seventy percent of women in local jails have children under 18, making
childcare and custody a primary concern.4As with males, large racial disparities in
incarceration rates persist among female prisoners, with black females Bmore than
twice as likely as Hispanic females and nearly five times more likely than white
females^ to have been in prison at the end of 2003.1
In addition to differing from incarcerated men, female prisoners also differ
from their non-incarcerated counterparts. Compared with adult females in the gen-
eral population, incarcerated women are more likely to experience substance use,
mental illness, intimate partner violence, HIV risk behaviors,6HIV, hepatitis B and
hepatitis C infection7and homelessness.8–10Furthermore, female detainees who
report being homeless upon arrest also report higher numbers of previous arrests,
substance abuse, prostitution-related charges, and difficulty accessing drug treatment.8
Upon release, female prisoners face numerous challenges including housing,
employment and family reunification.11–13Evidence suggests that female prisoners
entering the community having maintained strong familial ties while incarcerated
have improved re-entry outcomes and reduced recidivism.14,15However this pro-
tective effect can be mitigated by the inability of areas heavily concentrated with
poverty to effectively integrate high volumes of recently released prisoners;
particularly in cities such as Baltimore.16
Jails detain people for under 1 year, often prior to sentencing, whereas prisons
incarcerate people for longer terms. The experiences of prisoners upon reentry
cannot be generalized to detainees exiting jail because Bjail inmates are housed for
relatively short periods of time, are not eligible for prison programming, and are
not subject to post-release supervision.^17Consequently, little is known about
whether the predictors of successful reentry for females leaving long prison terms
are the same for female detainees leaving jails settings.13
This study sought to examine factors associated with perceived social and
material resource availability upon release. Specifically, this study sought to
examine female detainees’ anticipated availability of stable housing upon release.
MATERIALS AND METHODS
We conducted a cross-sectional study of 148 adult female detainees in the Baltimore
City Detention Center between January 21 and March 17, 2005.
The Baltimore City Detention Center
In 2004, BCDC housed 8,351 female detainees, released 8,300 female detainees,
and had an average daily population of 661 female detainees with an average length
of stay of 29 days (personal communication, Cortez Rainey, April 19, 2005).
Detainees are classified according to health needs and security risk. High risk
detainees are housed in the protective custody unit; detainees with acute health
conditions are housed in the medical infirmary units; those sentenced to drug
treatment are housed in a separate, acupuncture facility; pregnant women are
housed in the maternity dorm. In addition, there is a Therapeutic Community dorm
which houses 33 detainees, who are drawn from the general population by
RELEASE FROM JAIL: MOMENT OF CRISIS OR WINDOW OF OPPORTUNITY FOR FEMALE DETAINEES?383
request. Female detainees are housed in the quarantine unit for an initial period
pending health assessments by medical personnel, who must provide clearance
before for each detainee may join the general population. The general population is
divided into ten dorms, with an average of 42 detainees per dorm. Individual cells
are allotted to detainees who have special needs or adjustment problems.
Women were eligible for study inclusion if they were 18 years of age or older and
detained in the Baltimore City Detention Center’s general female population,
Therapeutic Community and maternity dorms, or individual cells. Detainees in the
quarantine, medical clinic, juvenile, acupuncture, and protective custody units were
excluded due to security restrictions.
Subjects were recruited using randomly generated numbers from a sampling frame
of 450 eligible beds distributed between 11 dorms (ten general population dorms
and the Therapeutic Community) and individual cells. Random numbers were
generated in Microsoft Excel (2003) and matched to a list of eligible bed numbers.
The list was then inspected to eliminate repeats. Interviewers approached correc-
tional officers for permission to speak with detainees by bed number beginning at
the top of the random bed numbers list. Refusals and empty beds were recorded,
and the next number on the list approached. Failed attempts to approach detainees
were repeated three times before detainees were declared unavailable for interview.
Out of 450 potentially eligible beds, 70% (n = 314) were approached. Of those,
128 beds were then deemed ineligible because 115 beds were empty, eight detainees
were unavailable for interview despite repeated attempts, and five detainees had
already participated and changed bed numbers since their initial interview. Of the
remaining 186 detainees approached, 80% (n = 149) consented to be interviewed.
Reasons for refusal included feeling sick (n = 4), self-reported lack of need for
participation due to having sufficient resources (n = 4), facing long prison sentences
(n = 2), correctional officer denying permission (n = 1), and not stated (n = 23). One
participant terminated her interview early, stating that she would prefer discussing
sensitive issues in a community setting. Her interview was discarded, and 148
subjects were included in the final analysis.
Once selected, female detainees were approached at the door of their dorm or cell
and asked if they wanted to participate in an anonymous survey. Everyone ap-
proached was compensated with a comprehensive resource packet, irrespective of
participation. Interviewers accompanied participants to a private setting outside the
sight and hearing range of correctional officers for the consent and interview.
Interviewers obtained written informed consent. The consent was read aloud to
ensure comprehension for those with limited literacy skills. To protect identity,
participants initialed the consent and were informed that they could use fake initials
if they chose. Additionally, no identifying information was collected or attached to
the interview. Interviews were not tape-recorded and at no time did jail personnel
overhear or view the contents of interviews. Interviews were conducted by trained
public health graduate students. Institutional Review Board approval for the project
was obtained from the Committee on Human Subject Research at the Johns
MCLEAN ET AL.384
Hopkins University Bloomberg School of Public Health. Institutional approval was
also obtained from the Commissioner of the Baltimore City Detention Center.
The survey instrument included a range of measures, such as socio-demographic
background, income, education, recent (30 days prior to incarceration) drug use
and sexual risk behaviors, drug treatment utilization, and material and social
resource availability upon release. Family support and neighborhood disorder
questions were used with permission from the Urban Institute survey of prisoner re-
entry in Illinois,18which had Chronbach’s alpha coefficients of 0.797 and 0.726,
respectively. Questions regarding barriers to accessing drug treatment were used
from the National Institutes of Drug Abuse Risk Behavior Assessment.19
Composite family and neighborhood scores were calculated on a scale of one to
four, with one representing high family support or neighborhood stability and four
representing low family support or neighborhood stability. Negative items were
reverse coded and items were summed; the sum was divided by the total number of
items on the scale. Composite neighborhood stability and family support scores
were dichotomized into high and low scores above or below their respective
medians, which were skewed to the left (3) and right (1.6), respectively.
Perceived housing stability was defined as a dichotomous variable coded as one
when respondents reported knowing where they would be staying when they got
out and knowing they could stay there for at least 30 days. Perceived housing
stability was coded as zero when respondents reported not knowing where they
were going to stay when they got out, or being able to stay less than 30 days, or not
knowing how long they would be able to stay at their destination. The definition of
stable housing was derived using the criterion for being Bat-imminent-risk-of-
homelessness^ developed by the Center for Disease Control—Housing and Urban
Development Housing Health Study for Baltimore City and cited in the definition of
client eligibility for Baltimore Services, Inc.*20Recent sexual and drug using
behaviors were defined as having occurred within 30 days prior to a detainee’s most
Bivariate comparisons of proportions were compared by conducting #2Fisher’s
exact tests and simple logistic regression analyses. Independent variables with
p values less than 0.10 were carried into forward and backwards stepwise multiple
logistic regression models to predict the odds of having perceived housing stability
immediately upon release. For items that were highly correlated, the item with the
*As utilized by Baltimore Homeless Services, Inc., Bthe term Fat-imminent-risk-of-homelessness_ means
a person/family who does not hold a lease and does not own their property, and he/she is experiencing
one of the circumstances as follows:
a. Are moving frequently from relatives’ or friends’ homes at least once a month within a period of at
least 3 months;
b. Are doubled/tripled up with relatives or friends and are being asked to leave;
c. Are living in an overcrowded setting with two or more people in sleeping/living areas;
d. Are living in a dangerous situation due to domestic violence.^20
RELEASE FROM JAIL: MOMENT OF CRISIS OR WINDOW OF OPPORTUNITY FOR FEMALE DETAINEES?385
lowest p value that best fit the model represented the other variables in the scale.
Independent variables with p values less than 0.05 were included in the final
multivariate model. Hosmer–Lemeshow goodness-of-fit and likelihood ratio tests
were used to choose the most parsimonious model. Data were analyzed using Stata
Satistical Software 8.21
More than half (54%) of female detainees anticipated stable housing upon release.
The median age of female detainees was 37 (interquartile range [IQR]: 29, 41);
69% self-identified as African-American, and 33% identified as lesbian or bisexual.
The median income in the 30 days prior to arrest was $145 (IQR: 0, 559), and the
median number of prior arrests was 5 (IQR: 3, 11). The median number of days
detained was 46.5 (IQR: 29, 97.5). The 29% of respondents who knew their release
date had a mean of 28 days until release (standard deviation [SD] = 35).
One in four participants did not know where she would be staying when she got
out. Among those who knew where they would be staying, 38% anticipated staying
with a family member, 16% at their own home, 13% in a residential treatment
program, and 8% with friends. One participant anticipated staying in an abandoned
house. Over half (56%) anticipated being able to stay at their destination per-
manently; however, 2% anticipated being able to stay less than 7 days, 5% between
one and 3 months, 12% 4 months to a year, and 26% did not know how long they
would be able to stay.
Infectious diseases were common: 5% of respondents reported being infected with
HIV, 14% with HCV, and 40% reported ever having an STI. Mental health issues
were common: 59% reported having been diagnosed with depression, 33% with
bipolar disorder, 28% with anxiety, and 9% with schizophrenia. At the time of
interview, 4% of participants reported being pregnant.
HIV Risk Behaviors
Regarding trading sex for money, drugs or a place to stay (Bsex work^), one third of
the female detainees interviewed reported at least one recent sex trade partner, 74%
always using condoms during oral sex with trade partners, and 24% reported always
using condoms during recent vaginal sex with their primary male partners. Fifteen
percent of participants reported having a female primary partner.
Heroin use was common, with 55% of respondents reporting recent heroin use.
Among recent heroin users, 44% reported injection as their route of drug admin-
istration. In contrast, only 2% of recent cocaine users reported recent cocaine
injection. Of those who reported recent injection, 33% reported recently borrowing
or sharing needles, and 59% reported Bborrowing or sharing cookers, cottons,
waters, crack pipes or other tools with other people.^ Thirty percent had ever
overdosed, and 60% reported ever having witnessed an overdose.
MCLEAN ET AL. 386