• incarcerated women;
  • syndemic;
  • women's health



The purpose of this study was to test whether variations in substance abuse, mental health diagnoses, individual experiences of violence, community experiences of violence, and incarceration history may be reduced to a single underlying syndemic factor for a sample of women incarcerated in three Midwestern U.S. jails.

Design and Sample

Secondary data analysis of a cross-sectional study of a medical utilization survey; initial confirmatory factor analysis tested fit of model; modification indexes provided confirmatory fit. 290 women incarcerated in three urban Midwestern U.S. jails.


Demographics and variables associated with women's criminal justice experience and sexual health risk were assessed. The analysis included women's mental health, drug dependence, childhood sexual and physical abuse, and partner violence.


The final model had four variables with significant pathways: childhood sexual abuse, childhood physical abuse, domestic violence, and mental health diagnoses. The fit of this model was very good (χ2 (1) = 0.6; CFI = 1.00; standardized RMR = 0.0147), strongly suggesting the intertwined nature of the variables.


Clarification of the specific components in a syndemic model for this population will allow for the implementation of interventions with the appropriate inclusion of content. In interventions and clinical practice, public health nurses should consider these interrelationships.