As teenage girls, they were enmeshed in the dangerous world of gangs in some of San Antonio’s rougher neighborhoods.

Now approximately 15 years later, what effect has that experience had on the lives of young Hispanic women?

Researchers at the USC School of Social Work will explore that question in a new $3 million study funded by the National Institute on Drug Abuse.

Led by Alice Cepeda, an associate professor and principal investigator of the project, the research team will examine how intimate partner violence, drug use, and other forms of trauma have affected the physical and mental health of 300 women who were affiliated with male gang members during their adolescence.

“We know that trauma like partner violence has been associated with depression and anxiety, but we don’t know the extent of the consequences for women who experience chronic, long-term exposure to this victimization,” Cepeda said.

She first became aware of this unique group of gang-affiliated girls as an undergraduate research assistant studying the risks of gang involvement among adolescent Hispanic boys as part of a project led by Avelardo Valdez, then a faculty member at the University of Texas at San Antonio and now a professor with the USC School of Social Work.

At that time, most research on gangs had focused on men or adolescent boys, Valdez said. The few studies on women involved in the gang lifestyle also centered on full-fledged gang members rather than affiliates.

“These gangs were embedded in the community in family-based networks,” he said. “They drew girls in those communities into their networks — girlfriends, sisters, neighbors and schoolmates. These girls were being exposed to the same kinds of risk behaviors.”

In particular, many of these girls experienced intimate partner violence, engaged in criminal or delinquent behavior, had histories of childhood trauma and used various illicit substances. At an average age of 16, approximately 30 percent of study participants were teen mothers.

Business as usual

In her master’s thesis, "Homegirls and Chicks: High-Risk Mexican American Gang Associated Females," Cepeda noted that these young women seemed to accept their circumstances as a normal part of life in their communities.

“Many of these girls are unaware of their susceptibility to these high-risk behaviors, often times accepting them as part of their social reality,” she wrote. “In many instances, these girls are simply seeking acceptance, love, respect and prestige.”

Now nearly a decade and a half later, preliminary interviews with a subset of these women have indicated they are still facing challenges. Of 32 women who participated in the original study and were recently contacted, Cepeda said 64 percent reported recent intimate partner violence, 63 percent had been incarcerated, and approximately 50 percent reported being unemployed.

Cepeda and her fellow researchers, including Valdez and Hortensia Amaro, dean’s professor of social work and preventive medicine and associate vice provost for community research initiatives, are interested in how experiences during adolescence may have contributed to negative life trajectories among these women.

They will explore rates of obesity, prediabetes, sexually transmitted infections, cardiovascular and metabolic dysregulation and other health problems. The research team also plans to examine mental health factors such as depression, post-traumatic stress disorder, anxiety and stress.

“Hopefully, we will also be able to identify factors that led some of these women to lead more conventional lives,” Valdez said. “That’s the payoff of this research.”

A history of violence

Intimate partner violence is a major focus of the study, given its prevalence in the study population. Noting that women of color tend to go underreported in studies of domestic and partner violence, Cepeda said she suspects that cultural factors may affect whether Hispanic women seek services or report victimization.

Latino culture tends to be male dominated and influenced by value of machismo, she said, and these girls were embedded in families and communities in which violence was relatively common.

“It’s something that is not seen as unusual,” Cepeda said, describing how some participants in the original study responded when asked to talk about the last time they fought with their partner.

“They would say, ‘oh yeah, he got mad because he thought I was dissing him, and he hit me,’” she said. “‘He kind of slapped me or punched me, but that was it — it was nothing serious.’ It was obvious these young women didn’t view punching or slapping or strong holding as violence. They defined violence only if they had to go to the hospital or something more serious.”

This type of trauma not only can lead to physical injuries but also has been linked to negative biological outcomes and other risk factors.

Amaro, who has specialized in research on the effects of relationship power and interpersonal violence, said a previous study revealed that trauma is a common thread running through the lives of women who use substances and engage in risky sexual behaviors.

“Close to 100 percent of the women we saw had not only a history of interpersonal violence but also really complex trauma and multiple traumatic experiences throughout their lives,” she said. “The issue of violence was really a driving force behind their mental health disorders, including depression, anxiety and post-traumatic stress disorder.”

Reaching out

Although it has been more than a decade since the research team has interacted with participants from the original study, Cepeda said she is confident that they will be able to reconnect with many of the women, who are now in their early 30s. During a previous follow-up study with men, they located and interviewed 122 of 160 original participants.

Cepeda said some men in the original study had died, others were in federal prison and could not interact with the researchers, and a few declined to participate. She expects that it may be more difficult to convince women who have led more conventional lives to participate in the new study.

“Those who have moved on may not want to be associated with the lifestyle they had as adolescents,” she said. “They may just feel that it is behind them, that they aren’t involved with gangs anymore.”

However, she also expects to find many original participants in the same neighborhoods as they were 15 years ago. In a recent study, two researchers unearthed data from the 1960s that featured interviews with individuals in San Antonio; they were able to locate many of the original participants or their descendants living in the same neighborhoods.

A key finding of that study was the lack of upward mobility among Mexican Americans, Cepeda said, largely due to various social and economic factors.

“People don’t really leave these communities,” she said. “I was born and raised in those same communities. I could have easily been one of these young girls. I want to know why my trajectory took me to where I am now, compared to these young women.”

Valdez, also a native of San Antonio, said he has noted an increasing polarization of the Hispanic community, especially during the recent economic upheaval in the United States.

“Some people have been able to take advantage of changes in civil rights and new opportunities, but there are still large segments of the population that remain at the bottom of the social hierarchy,” he said. “This study is a great opportunity to look at this highly disenfranchised, marginalized population and what happens to these people over time.”

Turning the tide

Ultimately, the researchers are hopeful that the study will help them identify certain factors that protect against negative outcomes for not only these women but also others in similar circumstances, including individuals living in Southern California. That information could be used to build interventions to prevent future generations from engaging in similar risk behaviors.

For instance, Cepeda said findings might indicate that strong mother–daughter relationships are particularly critical to preventing adolescent girls from getting involved with the gang lifestyle. Perhaps interventions that focus on building resilient and supportive families will prove most useful.

“But you can’t do that if you have an environment or community with no resources or opportunities,” she said, arguing for larger policy changes that help lift these communities out of poverty. “I hope what we do here will make some contribution to reducing the health disparities that exist in this population and have gone underreported.”