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A Heavy Burden: The Cardiovascular Health Consequences of Having a Family Member Incarcerated
Abstract
Objectives:
We examined the association of family member incarceration with cardiovascular risk factors and disease by gender.
Methods:
We used a sample of 5470 adults aged 18 years and older in the National Survey of American Life, a 2001-2003 nationally representative cross-sectional survey of Blacks and Whites living in the United States, to examine 5 self-reported health conditions (diabetes, hypertension, heart attack or stroke, obesity, and fair or poor health).
Results:
Family member incarceration was associated with increased likelihood of poor health across all 5 conditions for women but not for men. In adjusted models, women with family members who were currently incarcerated had 1.44 (95% confidence interval [CI] = 1.03, 2.00), 2.53 (95% CI = 1.80, 3.55), and 1.93 (95% CI = 1.45, 2.58) times the odds of being obese, having had a heart attack or stroke, and being in fair or poor health, respectively.
Conclusions:
Family member incarceration has profound implications for women's cardiovascular health and should be considered a unique risk factor that contributes to racial disparities in health.
... Consequently, our analyses extend research that identifies spillover mental health consequences of the legal system. Despite research showing that incarceration of self Sugie & Turney, 2017;Turney et al., 2012) and family members is associated with poorer mental health Lee et al., 2014;Patterson et al., 2021;Talbert & Patterson, 2023;Turney, 2021;, studies simultaneously examining both forms of incarceration are rare. Exceptions tend to focus on self-rated or generalized measures of psychological distress (Brown et al., 2016;Turney, 2021). ...
... Multivariate models included age, education, self-reported physical health, employment, and marital status, which are typically used in research examining the deleterious effects of incarceration (Brown et al., 2016;Lee et al., 2014;. Age was measured in years. ...
... The present study suggests that race-gender status and direct and indirect punishment factor into patterns of psychiatric disorders among African American adults. Examination of the intersection of personal and familial incarceration reinforces the notion that incarceration has gendered health consequences (Lee et al., 2014;Talbert & Patterson, 2023;, and that by combining women and men together, research may obscure unique gendered health risks (Talbert, 2023). By drawing critical attention to the intersection of personal and familial incarceration and its differing associations with mental health for African American men and women, this study has extended research identifying the scope of incarceration's association with mental health. ...
Mass imprisonment is a key contributor to U.S. racial health disparities, but less research considers whether intersections of personal and familial incarceration factor into the patterning of mental illness for African Americans—a group disproportionately affected by mass imprisonment. This study examines gender variation in associations between personal and familial incarceration and psychiatric disorders among African Americans. Utilizing the National Survey of American Life (n = 3390), this study regressed (1) 12-month and (2) lifetime diagnoses of (a) any, (b) mood, (c) anxiety, or (d) substance-use disorder on mutually exclusive combinations of incarceration experience (i.e., none, personal incarceration, familial incarceration, or both). Personal/familial imprisonment was associated with higher odds of 12-month and lifetime mental illness with notable increases in anxiety for women, and substance-use for both groups. Personal incarceration was associated with greater likelihood of 12-month any, mood, and substance-use disorders for women and 12-month any, anxiety, and substance-use for men.
... Además, se detectó que estas mujeres tenían una posibilidad 41 % mayor de tener enfermedad cardiovascular con respecto a aquellas mujeres sin un pariente en prisión (Connors et al., 2020). Otros estudios realizados en Estados Unidos han encontrado también que tener a un familiar en prisión aumenta los factores de riesgo para la enfermedad cardiovascular (Lee et al., 2014(Lee et al., , 2015. Bruns y Lee (2020) mostraron además que el encarcelamiento de la pareja se asocia al consumo de sustancias ilícitas. ...
... 62.4 % de las personas participantes afirmó tener problemas con su salud a partir de la detención de su familiar. Si bien se trata de problemas de salud autorreportados, otros estudios muestran que el encarcelamiento de un familiar está ligado con ciertos padecimientos y enfermedades (Connors et al., 2020;Lee et al., 2014;Sundaresh et al., 2021;Van de Weijer et al., 2021;Wildeman et al., 2012Wildeman et al., , 2019. ...
... Además, frecuentemente significa un detrimento en la salud mental y física de las personas. Los estudios existentes muestran que quienes visitan las cárceles son principalmente mujeres y que este grupo de mujeres sufre mayores afectaciones a su salud que sus contrapartes hombres (Lee et al., 2014). Los datos de este estudio permiten entender cómo el encarcelamiento de un familiar contribuye a generar una desventaja social y una desigualdad en la salud de las mujeres que cuidan a quien es puesto en prisión. ...
Este estudio cualitativo presenta los resultados de una encuesta no representativa realizada a personas con un familiar privado de la libertad en México. El objetivo fue entender cómo las principales medidas adoptadas por las autoridades para mitigar contagios dentro de los reclusorios afectaron a familiares que cuidan de las personas encarceladas. La encuesta recibió 234 respuestas que fueron procesadas en el software R (R, 2022). Si bien los resultados no son representativos de la población estudiada, ilustran cómo la adopción de ciertas políticas, tales como la suspensión de las visitas o la suspensión de los procesos legales, agravaron los problemas que tienen quienes cuidan de las personas privadas de la libertad y contribuyeron a hacer de la cárcel un factor de desigualdad social, económica y de salud. El estudio apunta a la importancia de tomar en cuenta a las familias de las personas privadas de la libertad al adoptar políticas públicas en los centros penitenciarios.
... There is some evidence that police killings impact cardiovascular health differently for men and women [9,12,16,38]. Lethal police force is a leading cause of death for young Black men [5]. Research points to men experiencing worse mental health when residing in areas where police are more likely to use force [13]. ...
... Sewell and colleagues [16] found that women in neighborhoods with more police killings had a greater risk of diabetes, hypertension, and obesity relative to men. Furthermore, Black women face a disproportionate burden of indirect contact with the criminal legal system (e.g., network members hassled by police, arrested, or incarcerated), and the social, economic, and psychological strains stemming from indirect contact is linked to poorer health [9,12,13,16,38]. Germane to the present study, Lee and colleagues showed that women, but not men, experienced worse cardiovascular health when a family member was incarcerated [12]. ...
... Furthermore, Black women face a disproportionate burden of indirect contact with the criminal legal system (e.g., network members hassled by police, arrested, or incarcerated), and the social, economic, and psychological strains stemming from indirect contact is linked to poorer health [9,12,13,16,38]. Germane to the present study, Lee and colleagues showed that women, but not men, experienced worse cardiovascular health when a family member was incarcerated [12]. While the present study does not examine incarceration, such research is valuable because it highlights gendered health effects that spillover from exposure to the criminal legal system. ...
This study uses insights from social stress theory to examine associations between exposure to police killings of Black Americans and cardiovascular health among Black women and men. Data on lethal police encounters come from the Mapping Police Violence (MPV) database, which allows for examination of total exposures to police killings of Black people and exposures to events when decedents were unarmed. MPV data are merged with the Behavioral Risk Factor Surveillance System (n = 26,086) and state-level information from multiple federal databases. Four cardiovascular health outcomes are examined—hypertension, diabetes, heart attack, and stroke. After adjusting for important risk factors, results from gender-stratified multilevel logistic regressions reveal a positive association between exposures to police killings of unarmed Black people and odds of hypertension among Black women and stroke among Black men. Total exposures to police killings of Black people are also associated with greater likelihood of stroke for Black men. Findings from this study demonstrate that stress exposures generated by the quantity and injustice of police killings have important implications for cardiovascular health among Black Americans. Furthermore, adverse cardiovascular health associated with exposure to police violence tends to manifest differently for Black men and women.
... Recent studies have found that depression and anxiety mediate the association between ACEs (including PI) and cardiovascular disease [32,33]. The associations between increased adversity and mental health issues may help to explain a growing body of research linking parental or familial imprisonment and subsequent cardiovascular and metabolic disease risk in later life [9,10,[34][35][36]. ...
... The link between PI and cardiometabolic risk may also vary by sex or gender. Research on parental and familial incarceration also suggests that cardiometabolic risk markers and diseases are concentrated in females and women [9,10,34,36,37,44], with only one study linking familial incarceration with ischemic heart disease in men at mid-life [35]. Using a stress paradigm may be helpful for understanding potential variations, given PI is recognized as a stressor which has been found to vary in magnitude by biological sex for a a range of adverse behaviors and outcomes, including internalizing behaviors and delinquency, substance use, poor social outcomes, and health [15,[45][46][47][48]. ...
Objectives
Recent studies have demonstrated that parental imprisonment (PI) is associated with cardiometabolic risk later in life. However, underlying risk factors for these associations have not previously been explored. The present study examines how early childhood behaviors and parental imprisonment may be associated with cardiometabolic risk in adulthood.
Methods
The study follows a subset of 7,223 live, singleton births from 1981–1984 in Brisbane, Australia where data was collected on parental imprisonment at ages 5 & 14 and behaviors from the Child Behavioral Checklist (CBCL) at age 5. Our sample examines 1884 males and 1758 females whose mothers completed prenatal, age 5, and age 14 interviews and respondents completed one or more interviews at ages 14, 21, and 30. Multivariate regression was used to examine cross-sectional results, while individual growth models examined longitudinal patterns.
Results
Dividing analysis by sex, we examined how parental imprisonment was potentially mediated or moderated by CBCL subscale measures for aggression, social-attention-thought disorders and general internalizing. No associations were found among male respondents. Among female respondents, controlling for these behaviors, there was a significant association between parental imprisonment and higher systolic blood pressure at age 30, while all CBCL measures were found to moderate waist circumference at age 30 and BMI at ages 14, 21, and 30. Using individual growth curve modelling, we observed the increased CBCL aggression and SAT scores were more strongly associated with higher BMI in adulthood.
Conclusions
Using prospective cohort data, our results suggest that PI and high levels of behavioral problems are associated with significantly increased cardiometabolic risk in women, with potentially increasing risk in adulthood.
... Parents have been found to experience multiple hardships as a consequence of having a criminal justice-involved offspring. 29,30 These difficulties include emotional, psychological, and health problems. 8,29,30 A qualitative metasynthesis on the experience of prisoners' parents identified grief as an emergent theme: "it's like you're grieving for somebody that's not dead, but it's like they are dead" (Ref. ...
... 29,30 These difficulties include emotional, psychological, and health problems. 8,29,30 A qualitative metasynthesis on the experience of prisoners' parents identified grief as an emergent theme: "it's like you're grieving for somebody that's not dead, but it's like they are dead" (Ref. 6, p 936). ...
Collateral interviews can be an integral source of third-party information used in a range of forensic mental health assessments. Although family members and spouses often have the most knowledge about the evaluee, research suggests that they may also experience distress related to the legal proceedings. This article discusses the nature and purpose of collateral interviewing with close collateral contacts, comparing collateral interviews with direct interviews with evaluees. The secondary consequences of having a justice-involved family member are considered, including the possibility of vicarious trauma. Finally, the responsibilities of evaluators are considered, especially in the context of trauma-informed principles applied to collateral interviewing. Recommendations regarding consent, the use of empathy, and feedback to collateral are provided.
... More general research on child adversity and disadvantage is linked with increased BMI and obesity in adulthood among female populations (Khlat et al., 2009;Lee et al., 2009). The concentration of BMI gain associated with PI or familial incarceration is also consistent with research findings demonstrating that imprisonment leads to chronic health issues and health disparities among former prisoners and those who experience PI or familial imprisonment, with disproportionate effects on female and minority populations (Gjelsvik et al., 2013;Lee et al., 2014;Trotter et al., 2018;van de Weijer et al., 2021;Wildeman & Wang, 2017). ...
... For females, our study provides evidence that PI and related factors contribute to early BMI gain and obesity among those not engaged in delinquency. These outcomes, in turn, may increase risks of diabetes, hypertension, and cardiovascular diseases, as Roettger et al. (2022) and Lee et al. (2014) found when examining PI and familial incarceration. The broader research literature has also linked criminal behavior, imprisonment, and PI with poor or risky health behaviors, lack of health care access, health problems, and early mortality (Heard-Garris et al., 2018;Massoglia & Pridemore, 2015;Massoglia & Remster, 2019;Semenza et al., 2020;Van De Weijer et al., 2018). ...
Children who experience parental imprisonment report greater mental and physical health adversities in adolescence and adulthood relative to comparable individuals whose parents did not serve time in prison. Research has linked BMI gain with parental imprisonment among females, but other studies have shown null or negative associations between parental imprisonment and weight increases for their offspring. Using longitudinal data from the National Longitudinal Study of Adolescent to Adult Health, this study attempts to resolve these differential findings by examining the interrelationship between delinquent behavior and BMI associated with parental imprisonment as individuals progress from adolescence into adulthood (ages 12–32). We show that higher delinquency levels are associated with lower BMI among men and women. With the transition from adolescence to adulthood, parental imprisonment is linked with increased BMI gain and obesity among females who are not delinquent. These findings highlight the need to consider how the decline in delinquent behavior and increasing health disparities between adolescence and adulthood may intersect as individuals experiencing parental imprisonment transition from adolescence to adulthood.
... Beyond screening practices, inadequate healthcare can have other serious impacts on the well-being of an incarcerated person and their familial network. For women, having an incarcerated family member increases their risk for heart disease, stroke, and obesity [75]. Moreover, women with incarcerated husbands are more likely to experience deterioration in their mental health [76]. ...
Background
Research on carceral institutions and mortality finds that people in prisons and jails have a high risk of death immediately following release from custody and that while incarcerated, racial disparities in prisoner mortality counter observed death patterns among similarly situated non-incarcerated, demographic groups. Yet, many of these studies rely on data prior to the millennium, during the COVID-19 pandemic, or are relegated to a small number or select group of states. In this paper, we explore changes in mortality and life-expectancy among different demographic groups, before and after the Great Recession, across forty-four states that reported deaths in custody to the federal government between 2000 and 2014.
Methods
Drawing on a novel dataset created and curated, we calculate standard, age- specific quantities (death rates and life-expectancy) using period lifetable methods, disaggregated by race and sex, across three different periods (2000–2004, 2005–2009, and 2010–2014) for each state. Ordinary least squares regression models with state and year fixed-effects are included to examine state-level factors that may explain differences in prisoner mortality rates between 2000 and 2014. We also benchmark death counts reported to federal agencies with official state reports to cross-validate general mortality patterns.
Results
Among imprisoned men, age-specific trends in mortality have shifted across the three periods. Following the Great Recession and the push for criminal justice reforms, prisoner mortality dropped significantly and is concentrated at older ages among men during 2010–2014; the shifting pattern of mortality means that men age 30 in 2010–2014 had similar death rates as men in their early 20s during 2000–2004, representing a 7.5 year shift in age-specific mortality rates. Gains in the mortality decline were disproportionately experienced by Non-Hispanic White and Non-Hispanic Black men, with the latter experiencing the greatest gains in life-expectancy of any demographic group. State-level violent crime rates are strongly and positively associated with prison mortality rates across states, net of socioeconomic and political factors. The large and significant disappearance of deaths in prisons from official data reported to federal agencies calls into question the narrowing gap in racial disparities among people in carceral facilities.
Conclusions
Legal decisions and social policies aimed at reducing mortality may be most effective in the short-run; however, the effects of these policy changes may fadeout over time. Research should clearly discern whether changes in mortality rates across states are due to diminished gains in social policies or increases in the disappearance (or underreporting) of deaths in custody. Understanding how and why gains in survivorship may stall is important for aligning health initiatives with social policy to facilitate maximal and consistent mortality declines for all demographic groups.
... Parental incarceration impacts children's health (H. Lee et al., 2014), which, in turn, affects academic outcomes and life trajectories. Children with incarcerated parents face higher rates of mental illnesses, particularly anxiety and depression (R. D. Lee et al., 2013). ...
Although the school-to-prison pipeline and mass incarceration arose in the United States at the same time, scholars have addressed them separately. In this article, we show that both systems rose due to an overreliance on policing in society and are justified through shared racist characterizations of Black and Brown people. They apply the same logics of discipline and control and set Black and Brown individuals on a path to prison. We address how the systems reinforce each other. As Black and Brown students are policed in school, they are similarly more likely to face incarceration. Meanwhile, as Black and Brown parents are incarcerated at high rates, their children suffer the consequences and are susceptible to school pushout through exclusionary punishment, and even subsequent incarceration. The twin systems of mass incarceration and the school-to-prison pipeline create an intergenerational transmission of criminalization. We argue that dismantling these systems must be integrated processes.
... Indeed, the negative consequences of family member incarceration extend to health issues, which have been studied in quantitative research as well. It has been found that family member incarceration has profound implications for women's cardiovascular healt (Lee et al., 2014). (2021), incarceration can amalgamate and intensify several problems for offenders and their families, such as economic loss and educational, health and mental health problems. ...
... Still, a growing body of evidence suggests that members of this population are at increased risk of several adverse health conditions compared to the general population, including 6 cardiovascular issues (DeHart et al., 2018;Lee et al., 2014;Wildeman et al., 2013), sexually transmitted infections (STIs; Adams et al., 2018;Comfort et al., 2005;Cooper et al., 2015;Dauria, Oakley, et al., 2015;Harman et al., 2007;Johnson & Raphael, 2009;Khan et al., 2007Khan et al., , 2011Wise et al., 2019), and intimate partner violence (IPV) victimization Oliver & Hairston, 2008;Stansfield et al., 2022). Pregnant women experiencing partner incarceration may be especially susceptible to adverse health consequences regarding themselves or the fetus or child (Dumont et al., 2014(Dumont et al., , 2015Lee et al., 2023;Testa & Jackson, 2020b;Testa et al., 2020Testa et al., , 2022. ...
... Parental incarceration puts children at heightened risk for a host of physical health conditions (Turney 2014a) as well as attentional problems and internalizing and externalizing behavior (Geller et al. 2012, Murray et al. 2012, Wildeman 2010. Experiencing the incarceration of one's co-parent or partner compromises women's cardiovascular health (Lee et al. 2014), increases their chances of a major depressive episode (Wildeman et al. 2012), and puts them at higher risk for a range of other stress-related health behaviors and conditions . ...
A rich empirical literature documents the consequences of mass incarceration for the wealth, health, and safety of Black Americans. Yet it often frames such consequences as a regrettable artifact of racially disproportionate criminal legal system contact, rather than situating the impetus and functioning of the criminal legal system in the wider context of White political and economic domination. Revisiting a quarter century of mass incarceration research through a stratification economics lens, we highlight how mass incarceration shapes Black–White competition for education, employment, and financial resources and contributes to Black–White disparities in well-being. Highlighting persistent research gaps, we propose a research agenda to better understand how mass incarceration contributes to systematic White advantage. To address mass incarceration's consequences and transform the conditions of White political and economic domination under which it arose, we call for legislative and judicial intervention to remedy White hyper-enfranchisement and reparations to eliminate the Black–White wealth gap.
... Specific to this paper, we will focus our attention on highlighting the impacts on mothers with an incarcerated son and then women with incarcerated male partners respectively. In regards to physical health, the stress of having a family member incarcerated has been linked to increased risk factors for cardiovascular disease in women, such as a heart attack or stroke (Durante et al., 2024;Lee et al., 2014;Wildeman et al., 2019). Other stress-related physical illnesses include heart failure or chronic headaches (Massoglia, 2008) that can be generational . ...
... In the case of veterans, this stigma conflicts with military values of honor and duty, causing veterans to feel shame and guilt, potentially leading to a withdrawal from support networks and exacerbating feelings of loneliness, as they may feel pressured to cope independently (Brown et al., 2013). Third, the psychological strain stemming from familial incarceration can also heighten feelings of loneliness (Arditti, 2016;Fahmy & Testa, 2021;Lee, Wildeman, et al., 2014;Wildeman et al., 2019). Ultimately, the emotional toll of grappling with a family member's imprisonment can lead to distress, depression, and anxiety, which can last even years after the incarceration ends (Gifford, 2019;Wildeman et al., 2012Wildeman et al., , 2019. ...
Exposure to incarceration can have significant ramifications for one’s social relationships. However, the study of how the incarceration of a family member influences loneliness, including among specific segments of the population that experience elevated levels of loneliness, such as U.S. military veterans, has gone understudied. This study aimed to examine the relationship between family member incarceration and perceptions of loneliness among a sample of low-income U.S. military veterans. Data are from the National Veteran Homeless and Other Poverty Experiences Study—a national survey of low-income U.S. veterans collected in December 2022 and January 2023. Multiple Poisson is used to assess the relationship between family member incarceration and a loneliness index, and multinomial logistic regression was used to estimate the relationship with specific constructs in the loneliness index. The results indicate that respondents who ever experienced the incarceration of a family member reported significantly more loneliness (incidence risk ratio = 1.189, 95% CI [1.035, 1.366]). Further, analyses of the specific items in the loneliness index revealed that family member incarceration was related to an increased risk of reporting feelings of often lacking companionship (relative risk ratio = 1.598, 95% CI [1.077, 2.370]) and often feeling isolated from others (1.711, 95% CI [1.014, 2.886]). Given the potential adverse consequences of loneliness and family member incarceration for well-being, the results from this study emphasize the need for increased attention and coordinated approaches in addressing feelings of loneliness, developing efforts to mitigate the harms of family member incarceration within the U.S. veteran community.
... Además, estas mujeres tenían más posibilidades, con un 41%, de tener alguna enfermedad cardiovascular (Connors et al., 2020). Otros estudios realizados en Estados Unidos han encontrado también que tener a un familiar en prisión aumenta los factores de riesgo para la enfermedad cardiovascular (Lee et al., 2014). Bruns y Lee (2020) mostraron además que el encarcelamiento de la pareja se asocia al consumo de sustancias ilícitas. ...
En el artículo se exponen casos de la manera en la que los jóvenes reaccionan cuando son agredidos en su escuela, pretendiendo así describir y especificar alrededor del concepto de “autodefensa”. Se delibera sobre las funas, las respuestas institucionales, la indiferencia y el morbo de la comunidad escolar que, en su conjunto, da cuenta de todo lo social en torno a una situación de violencia escolar desde el enfoque de lo complejo.
... Además, estas mujeres tenían más posibilidades, con un 41%, de tener alguna enfermedad cardiovascular (Connors et al., 2020). Otros estudios realizados en Estados Unidos han encontrado también que tener a un familiar en prisión aumenta los factores de riesgo para la enfermedad cardiovascular (Lee et al., 2014). Bruns y Lee (2020) mostraron además que el encarcelamiento de la pareja se asocia al consumo de sustancias ilícitas. ...
Las políticas punitivas son estrategias creadas por el Estado para sancionar a las personas que infringen la ley, pero este castigo daña de igual manera a sus familias. En este artículo nos referiremos a las políticas punitivas que se despliegan en los centros de reinserción social. La manera en que el Estado realiza su acción punitiva en busca de mantener un “orden” impacta fuertemente en las familias de las personas que se encuentran privadas de su libertad. Esta reflexión fue elaborada con la intención de dar a conocer la manera en que el Estado, en su afán de castigar “el delito”, afecta a las familias y comunidades a las que pertenecen, sometiéndolas a vivir un proceso desgastante y con afectaciones de larga duración porque son familias que ya tenían desventajas antes de que su familiar estuviera privado de la libertad, generando más violencia sobre aquellos sectores que no pueden integrarse a una sociedad neoliberal que los excluye.
... While there are documented sleep health disparities among minoritized racial and ethnic groups, incarceration is an unexplored factor contributing to these disparities. Prior studies have shown that exposure to incarceration ranging from being incarcerated, [20][21][22] to having a family member incarcerated [23], and even living in a neighborhood with high incarceration rates is associated with worse CVD outcomes. CVD is a major reason for hospitalization among people with a history of incarceration and is a leading cause of death during incarceration and after release [24][25][26]. ...
Background
An estimated 11 million individuals are released from U.S. jails and prisons each year. Individuals with a history of incarceration have higher rates of cardiovascular disease (CVD) events and mortality compared to the general population, especially in the weeks following release from carceral facilities. Healthy sleep, associated with cardiovascular health, is an underexplored factor in the epidemiology of CVD in this population. Incarcerated people may have unique individual, environmental, and institutional policy-level reasons for being sleep deficient. The social and physical environment within carceral facilities and post-release housing may synergistically affect sleep, creating disparities in sleep and cardiovascular health. Since carceral facilities disproportionately house poor and minoritized groups, population-specific risk factors that impact sleep may also contribute to inequities in cardiovascular outcomes.
Methods
This study is ancillary to an ongoing prospective cohort recruiting 500 individuals with known cardiovascular risk factors within three months of release from incarceration, the Justice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE) study. The Sleep Justice study will measure sleep health among participants at baseline and six months using three validated surveys: the Pittsburgh Sleep Quality Index (PSQI), the STOP-Bang, and the Brief Index of Sleep Control. In a subsample of 100 individuals, we will assess sleep over the course of one week using wrist actigraphy, a validated objective measure of sleep that collects data on rest-activity patterns, sleep, and ambient light levels. Using this data, we will estimate and compare sleep health and its association with CVD risk factor control in individuals recently released from carceral facilities.
Discussion
The incarceration of millions of poor and minoritized groups presents an urgent need to understand how incarceration affects CVD epidemiology. This study will improve our understanding of sleep health among people released from carceral facilities and its potential relationship to CVD risk factor control. Using subjective and objective measures of sleep will allow us to identify unique targets to improve sleep health and mitigate cardiovascular risk in an otherwise understudied population.
... In addition, losing a household member to incarceration can increase women's caretaking responsibilities, financially and otherwise [51]. Women have reported frustration and fear of police neglect and misbehavior, and having an incarcerated family member has been associated with women's reduced cardiovascular health [52]. ...
How police bias and low relatability may contribute to poor dietary quality is poorly understood. In this cross-sectional study, we analyzed data from 2021 from a cohort of n = 724 adults living in predominantly Black communities in Pittsburgh, Pennsylvania; these adults were mostly Black (90.6%), low-income (median household income .$ . Police bias and low relatability may play a role in community connection, social status, and ultimately dietary disparities for Black Americans. Addressing police bias and low relatability is a continuing and pressing public health issue.
... Mass incarceration leads to health inequities both directly -harming the physical and mental health of the incarcerated-and indirectly -affecting communities and families that are disproportionately affected by incarceration [2,3]. While incarcerated individuals are guaranteed healthcare as a constitutional right, there are persistent gaps in healthcare access that call into question whether the US is satisfying this obligation. ...
Purpose of Review
To review the current literature on care of hypertension and chronic kidney disease for people who are currently and formerly incarcerated, and to make recommendations for improving outcomes.
Recent Findings
There is a growing body of literature describing care for kidney disease and hypertension for incarcerated and formerly incarcerated individuals that documents the provision of care itself, notably that many jails contract with private companies; the system is not designed to provide sustained, chronic disease care; and the transition from incarceration to community is fraught with gaps in care. However, deficiencies in data collection and regulation still limit our understanding of the quality of care provided in jails and prisons. Furthermore, more data is needed to understand the impact of structural racism in the criminal legal system on overall disparities in care for hypertension and kidney disease. Insurance coverage rates for people who were formerly incarcerated continue to be lower than the general population despite Medicaid expansion in many states. There is little recent data regarding kidney replacement therapy for this population despite known variation in dialysis modalities and transplant programs by state. Transitions clinics, which connect people who were formerly incarcerated with care in the community upon release, are growing and are important avenues by which to deliver care.
Summary
People who are incarcerated are disproportionately affected by hypertension and kidney disease, yet data regarding the extent of these inequities and availability of quality care is lacking. More work is needed to understand the care of individuals with kidney disease and hypertension in prisons and to improve outcomes for these common chronic conditions. Both providing effective treatment of kidney disease and hypertension in prisons and jails and providing coordinated, quality transition to community care upon release represents an important opportunity for reform in care for a marginalized population.
... Consequently, given the social context of African-American women's lives, the "cost of caring" in a given year may be especially pronounced. Prior studies have examined individual network stressors as contributors to poor health in African-American women (e.g., partner legal problems/incarceration and health; Lee et al., 2014), but to date, there has been limited research on whether the accumulation of multiple types of network stressors is associated with physical health outcomes in this group. Thus, the current findings fill an important gap in the literature, by documenting linkages between a greater number of network stressors and higher levels of BP in a disproportionately impacted group of women. ...
Objetivo: Los factores estresantes de la vida se han relacionado con el riesgo cardiovascular; sin embargo, los estudios generalmente se enfocan en los factores estresantes que impactan directamente al individuo, es decir, los factores estresantes personales. La investigación sugiere que las mujeres, en particular las mujeres afroamericanas, pueden ser más vulnerables a los factores estresantes de la red que involucran a familiares y amigos, posiblemente debido a las normas sobre la necesidad de ser una “supermujer.” Sin embargo, pocos estudios han examinado estos fenómenos. Métodos: Examinamos las asociaciones entre los factores estresantes de la red y personales, y la presión arterial (PA) elevada en N = 392 mujeres afroamericanas de 30 a 46 años. Los eventos vitales negativos evaluados por el cuestionario se clasificaron en perturbadores de la red o estresores personales. La PA se evaluó en la clínica y mediante monitorización ambulatoria de 48 horas. Los modelos de regresión lineal y logística examinaron las asociaciones entre el tipo de factores estresantes y la PA sistólica (PAS) y PA diastólica (PAD), diurna y nocturna de 48 horas, y la hipertensión sostenida después de ajustar las covariables relevantes. Las interacciones con el esquema de supermujer (SWS por sus siglas en inglés) evaluado por cuestionario se probaron en análisis exploratorios. Resultados: En modelos ajustados por edad y sociodemográficos, los estresores de la red se asociaron significativamente con la PAS diurna (b (Error Estándar) = 2.01 (0.51), p ≤ .0001)) y la PAD durina (b (Error Estándar) = 1.59 (0.37), p ≤ .0001), pero los estresores personales no (valores p > .10). Las asociaciones persistieron después del ajuste por factores de riesgo cardiovascular y psicosocial. Los patrones fueron similares para la PA nocturna y la hipertensión sostenida. No hubo interacciones con SWS. Conclusiones: Los factores estresantes de la red, pero no los personales, se asociaron con tasas elevadas de PAS y PAD diurnas, así como con hipertensión sostenida en mujeres afroamericanas, independientemente del respaldo de SWS. Se necesita investigación futura para determinar si las intervenciones de manejo del estrés centradas en los factores estresantes de la red podrían afectar la PA en esta población de alto riesgo.
... This work finds that incarceration is associated with negative impacts on the physical and mental health of parents, children, and other support network members of those who are imprisoned (Mouzon et al., 2016). For instance, Lee et al. (2014) found that among African American women, family member incarceration was associated with higher odds of obesity, heart attack, or stroke. ...
James S. Jackson (1944–2020) is remembered as a groundbreaking social psychologist whose career contributions in scholarship, research, and service were fundamental to the field of psychology. This article briefly outlines his career-long work and contributions. A strong believer in interdisciplinary work, his research spanned other related social science disciplines (e.g., sociology, political science), as well as health and social welfare professions (public health, social work, medicine). As the founding director of the Program for Research on Black Americans at the Institute for Social Research, James Jackson initiated and led a long-standing program with a dual focus on research and training and mentoring doctoral students, postdoctoral scholars, and early career scientists. Jackson’s efforts in the development of several nationally representative surveys of the Black population in the United States (e.g., National Survey of Black Americans, National Survey of American Life) revolutionized research focusing on the lives of Black Americans. James Jackson’s international influence and reputation included numerous prestigious positions within national science organizations and honors and awards for his scientific contributions. Among James S. Jackson’s most enduring legacies is the vast network of current scientists, researchers, and academics who were trained under his direction and leadership.
... Findings further describe outcomes of intergenerational crime, detention, and incarceration among youth and adults of incarcerated parents (Wildeman 2020). Intergenerational incarceration affects stress levels, mental health, chronic health conditions, and substance use, in addition to poverty, stigma, discrimination, and housing instability (Davis and Shlafer 2017;Geller et al. 2012; Lee et al. 2014;Breaking Generational Curses • 3 Muhammad 2018;Schnittker and John 2007;Turney and Haskins 2014;Wakefield and Wildeman 2013;Wildeman 2020). ...
Black children are disproportionately represented among the children of incarcerated mothers and fathers in the United States. Research has largely focused on negative life outcomes (e.g., incarceration, negative behaviors, school dropout rates) of these children. Recently, studies have begun to look at success; however, children of incarcerated parents are typically placed into a homogenous group without considering racial implications. Using a critical race theoretical perspective, this study highlights the counternarrative of success by analyzing 59 in-depth interviews. Findings center on the ways adult Black children of incarcerated parents define success, which differs from middle-class, Eurocentric definitions of economic success, college graduation, marriage, and children as the success indicators. Success in relationships, community, education, and mental health emerged as the themes that define success. Findings show that their relationship with others (including their incarcerated parent), giving back to the community, educational experiences, and improving their mental health were indicators that they have “made it.” With support from their personal networks, they can succeed despite institutional and structural barriers. This study may assist policymakers, organizations, and schools with shifting societal perceptions to tailor resources for Black children of incarcerated parents to help invest in their futures.
... Alcala et al.(Alcala et al., 2018) in their study of the effects of ACEs on cancer screening found that each increase in ACEs decreased the odds of individuals performing PSA tests, Pap tests, and colorectal cancer screening.Stratification analysis suggested that there were more types of ACEs associated with HIV testing among males with high-risk behaviours. A study byLee et al. (Lee et al., 2014) found that females living with an incarcerated family member frequently reported poor health conditions. A possible explanation for this result is that females have attempted to access more social support after experiencing ACEs(Wan et al., 2019). ...
Adverse childhood experiences (ACEs) have been associated with poor HIV testing in adulthood yet, they have not been extensively described in those at increased risk for HIV. Cross-sectional analysis data (n = 204,231) on ACEs and HIV testing were obtained from the 2019-2020 Behavioural Risk Factor Surveillance Survey. Weighted logistic regression models were used to access the association of ACEs exposure, ACEs score, and ACEs type with HIV testing among adults with HIV risk behaviours, and stratified analysis was also performed to examine gender differences. The results indicated the overall rate of HIV testing was 38.8% and was higher among those with HIV risk behaviours (64.6%) than those without (37.2%). In populations with HIV risk behaviours, the negative association of HIV testing with ACEs exposure, ACEs score, and ACEs type was identified. Relative to those without ACEs, adults who were exposed to ACEs might decrease the rate of HIV testing, participants with ≥4 ACEs scores were less likely to have HIV testing, and childhood exposure to sexual abuse had the greatest impact on HIV testing. For both males and females, childhood exposure to ACEs was associated with lower odds of HIV testing and ACEs score ≥4 had the most robust associations with HIV testing. For males, those who experienced witnessed domestic violence had the lowest odds of HIV testing but the odds of engaging in HIV testing for females were the lowest among those who experienced childhood sexual abuse.
... The prevalence of these adversities is particularly high among incarcerated women (Bartlett and Hollins, 2018). There is growing evidence that the stressors associated with incarceration not only directly impact the individual incarcerated but also directly and/or indirectly impact other family members, including children (Lee et al., 2014;Turney, 2014;Wildeman et al., 2012). These stressors are not confined to periods of incarceration. ...
Aims:
Children of incarcerated mothers are at increased risk of experiencing multiple adversity such as poverty, mental illness and contact with child protection services (CPS), including being taken into out of home care (OOHC). However, little is known about whether these children are at increased risk of suicide or self-harm compared to children not exposed to maternal incarceration or about the factors that may contribute to this. We aimed to investigate differences in the risk of suicide and self-harm between children exposed to maternal incarceration and those not exposed and examine how socio-demographic factors, maternal mental illness and CPS contact (with or without OOHC) may affect these outcomes.
Methods:
We used a retrospective matched cohort study design, comparing 7674 children exposed to maternal incarceration with 7674 non-exposed children. We used multivariable Cox proportional hazards regression to compare the risk of suicide and self-harm between exposed and non-exposed groups, controlling for geographical remoteness, CPS contact and maternal mental illness.
Results:
There was no significant difference in the rate of suicide (rate ratio [RR] = 1.49; 95% confidence interval [CI]: 0.78, 2.87) or risk of suicide (adjusted hazard ratio [aHR] = 0.92; 95% CI: 0.43, 1.96) between the two groups. However, the exposed group had a significantly higher rate of self-harm (RR = 2.83; 95% CI: 2.50, 3.21) and a significantly higher risk of self-harm (aHR = 1.74; 95% CI: 1.45, 2.09) compared to those non-exposed. CPS contact with or without OOHC was independently associated with an increased risk of self-harm for both groups.
Conclusion:
Children exposed to maternal incarceration are at an increased risk of self-harm and should be prioritized to receive targeted, multimodal support that continues after the mother's release from prison. The association between CPS contact and self-harm warrants further research.
... Rather, they travel readily from one life domain to others, from earlier to later stages in the life course, and from affected individuals across their family systems (Jones et al. 2018;Pearlin, Aneshensel, and Leblanc 1997;Wickrama, O'Neal, and Klopack 2020). From arrest to incarceration, the stress of criminal legal system contact does appear to proliferate from affected individuals to their children, partners, and households (Arditti 2016;Lee et al. 2014;Lee and Wildeman 2013;Poehlmann-Tynan and Arditti 2018;Turney 2014b;Turney and Sugie 2021). Paternal incarceration, in particular, can bring greater parenting stress, harsh parenting, and child maltreatment (Austin 2016;Turney 2014a;Wakefield 2015). ...
Life course theories suggest that fathers' lifetime criminal legal system contact could contribute to poor parent-child outcomes via deterioration in couple relationship quality and fathers' behavioral health. Using paired, longitudinal data from the Multi-site Family Study (N = 1,112 couples), the current study examines the influence of three dimensions of fathers' life course legal system contact on individual and parent-child outcomes. In fitted models, accumulated system contact in adulthood predicts fathers' later depressive symptoms and drug misuse, which in turn predict diminished father-child relationship quality (as reported by both co-parents). Fathers who were older at the time of their first arrest had poorer relationships with their children's mothers and, in turn, poorer behavioral health and parent-child outcomes. Conditions of confinement during fathers' most recent prison stay do not significantly predict later parent-child outcomes, net of the influence of age at first arrest and accumulated criminal legal system contact in adulthood.
... In our study, we were interested in exploring the spillover mental health consequences of county jail incarceration rates. Previous research suggests that because of the effect of low socioeconomic status, chronic stress, and social isolation on health, the incarceration of a family member may contribute to a new type of weathering (Lee et al., 2014). The weathering hypothesis asserts that Black people are burdened by an early physiological deterioration because of the cumulative impact of repeated exposures to social or economic adversity and political marginalization (Geronimus et al., 2006). ...
Introduction
Mass incarceration has mental health consequences on those directly affected; some studies have also shown spillover effects on the physical health of the surrounding population. There is a dearth of research on the spillover mental health consequences of mass incarceration. This study aimed to quantify a consequence of mass incarceration which may adversely affect the population’s health and widen health disparities.
Methods
Using data from the Vera Institute’s Incarceration Trends 2.2 and the Robert Wood Johnson County Health Rankings, the association between county-level (n = 2823) counts of jail incarceration and reported number of poor mental health days within the past 30 days in the United States in 2018 was examined. To conduct the analysis, a negative binomial regression model was fit, adjusting for State and key demographic covariates.
Results
A change in jail incarceration rate from the first to the second and third tertiles was associated with 10.14% and 14.52% increases, respectively. For every 1% increase in the rate of mass incarceration, there was a statistically significant 15% increase in the average number of reported poor mental health days over the past 30 days.
Discussion
Mass incarceration is a threat to mental health as well as the well-being of the surrounding population. This can be attributed to the spillover effects that extend beyond those who are directly affected by mass incarceration.
Interventions to reduce jail incarceration as well as address the mental health needs of those living in high-incarceration rate areas should be prioritized in order to reduce health inequities and augment health outcomes for all residents of the United States.
... However, no research has assessed the extent to which incarceration exposure of a romantic partner may be connected to worse oral health. This is a notable gap considering that a growing body of research shows women with an incarcerated male partner incur a range of health consequences (Lee et al., 2014b;Wildeman and Lee, 2021), and these health sequelae may be particularly profound when experienced in the context of pregnancy (Dumont et al., 2015;Testa et al., 2020;Testa and Jackson, 2020a). Specifically, a partner's incarceration may be linked to women's oral health status vis-à-vis the extreme stress felt by their daily absence, which may enable adverse coping strategies (Testa and Fahmy, 2021), leading to a lack of care for one's own health status. ...
Rationale
Prior research has documented an association between incarceration and poor oral health outcomes. Likewise, recent scholarship has also detailed that women exposed to incarceration either directly or vicariously through a partner during pregnancy incur worse health outcomes. However, no previous research has assessed the connection between incarceration exposure and oral health during pregnancy.
Objective
The current study assesses the link between maternal incarceration exposure and oral health during pregnancy.
Methods
Data are from the Pregnancy Risk Assessment Monitoring System (PRAMS) from years 2016–2019 (N = 60,342). Logistic regression was used to assess the relationship between incarceration and oral health.
Results
Women exposed to incarceration exhibited worse oral health outcomes in the form of being more likely to report not knowing the importance of oral care, not having an oral health discussion with a provider, not getting a teeth cleaning, as well as being likely to report needing to see a dental provider, having visited a dental provider for a problem during pregnancy, and having more unmet dental care needs.
Conclusions
These findings add to a burgeoning literature that demonstrates a woman's prenatal exposure to incarceration poses risk for overall health and wellbeing. Given the influence of both incarceration exposure and oral health during pregnancy for maternal and infant health, the findings suggest that coordination between criminal justice, public health, and oral health experts can develop programmatic efforts that expand access to oral health care and improve oral health literacy among incarceration-exposed pregnant women.
... Lowenstein (1986) for example, concluded that there are emotional, interactional, and behavioral difficulties that prisoners' children experience due to incarceration; and that children's ability to adjust is related to mothers' familial and personal resources, as well as the degree of associated stigmatization. Intersectionality of lone parenthood and being a romantic partner (or ex-partner) increases women's vulnerability through increased and intensified family, work, and caregiving demands (Lee et al. 2014;Souza et al., 2019). ...
... For example, paternal incarceration has been associated with increased risk of obesity (Roettger & Boardman, 2012) and mortality (Wildeman, 2012) in dependent children. Mothers of imprisoned adult children and women with incarcerated spouses are significantly more likely than the general population to have obesity, have had a heart attack or stroke, contract sexually transmitted infections, and be in poor general health (Dauria et al., 2015;Goldman, 2019;Lee et al., 2014). Beyond the individual's immediate social ties, concentrated incarceration rates at the neighborhood, zip-code, county, and state levels, have been positively associated with a range of physical and mental morbidities (Dauria et al., 2015;Escobar & Taheri, 2020;Frank et al., 2013;Hatzenbuehler et al., 2015;Holaday et al., 2021;Kajeepeta et al., 2020Kajeepeta et al., , 2021Nowotny et al., 2020;Ojikutu et al., 2018;Porter, Thomas, & Emch, 2010;Topel et al., 2018), including adverse birth outcomesthe focal health outcome in this paper (Chambers et al., 2018;Conway, 2021;Dyer et al., 2019;Sealy-Jefferson et al., 2020;Wallace et al., 2015Wallace et al., , 2017Wildeman, 2012). ...
Structural racism represents a key determinant of the racial health disparities that has characterized the U.S. population throughout its existence. While this reality has recently begun to gain increasing acknowledgment and acceptance within the health sciences, there are still considerable challenges related to defining the concept of structural racism and operationalizing it in empirical study. In this paper, building on the existing evidence base, we propose a comprehensive framework that centers structural racism in terms of its historical roots and continued manifestation in most domains of society, and offer solutions for the study of this phenomenon and the pathways that connect it to population-level health disparities. We showcase our framework by applying it to the known link between spatial and racialized clustering of incarceration – a previously cited representation of structural racism – and disparities in adverse birth outcomes. Through this process we hypothesize pathways that focus on social cohesion and community-level chronic stress, community crime and police victimization, as well as infrastructural community disinvestment. First, we contextualize these mechanisms within the relevant extant literature. Then, we make recommendations for future empirical pathway analyses. Finally, we identify key areas for policy, community, and individual-level interventions that target the impact of concentrated incarceration on birth outcomes among Black people in the U.S.
... For instance, Wildeman and colleagues [24] observe that recent paternal incarceration increases a mother's risk for a major depressive episode and diminishes overall life satisfaction. In the same manner, Lee and colleagues [27] demonstrate that, among a national sample of women, family member (not just partner) incarceration increases cardiovascular disease risk factors, including obesity, prior heart attack or stroke, and poor self-reported health. ...
Background:
Although increased attention has been placed on the potential deleterious consequences of paternal incarceration on maternal health, little empirical research has attempted to understand the physiological processes that might underlie this relationship. Moreover, exposure to incarceration and access to resources that shape family incarceration patterns are unequally distributed across racial and ethnic lines, yet few studies utilize analytic frameworks that account for this social reality. Using a within race/ethnicity analytic framework, the present study addresses these gaps by examining relationships between paternal incarceration and telomere length for Black, Latina/o, and White mothers.
Methods:
Data were drawn from the Fragile Families and Child Wellbeing Study, a longitudinal, stratified multistage probability sample of couples and children in 20 large U.S. cities. The final analytic sample consisted of 2174 mothers that were followed from pregnancy to age 9 of the focal child.
Results:
Findings revealed exposure to paternal incarceration was negatively associated with telomere length for Black mothers, but not for Latina/o and White mothers. Mediation analysis also showed paternal incarceration-telomere length relationships did not operate through secondary stressors, such as economic instability, poor mental health, and parenting stress.
Conclusion:
Overall, results demonstrated that the detrimental physiological consequences of paternal incarceration for mothers depended on racial and ethnic background. Findings from this study can provide a foundation upon which health scholars and criminal justice stakeholders may better understand whether and how paternal incarceration shapes deleterious health patterns for the mothers who remain to care for the children of those incarcerated.
Based on 32 in-depth interviews with black women, this paper analyzes the racialized and gendered impact of vicarious exposure to police encounters on social media. We draw from Smith’s (2016) sequelae to describe the lingering effects of anti-black state violence, particularly grief and mourning. For Black women, the manifestation of sequelae from online exposure includes: a) amplification of police brutality, b) identification with victims, c) expressions of grief, and d) prolonged mourning. We argue research should contend with the digital landscape when examining psychological effects of police violence to understand anti-black police violence’s impact on gendered racial mental health disparities.
Existing research provides conflicting accounts of whether indirect exposure to the American carceral state mobilizes geographically proximate community voters. One possible reason for these mixed findings may be a missing connection between electoral participation and expectations of change in criminal legal policies. To remedy this problem, I leverage the inclusion of a well‐publicized ballot initiative in California, Proposition 47. The 2014 measure would substantially reduce the incarcerated population in the state and lower sanctions for non‐violent criminal offenses. Using census tract‐level vote returns and incarceration rates, I show that increasing levels of tract incarceration are associated with an increase in turnout during the year of Proposition 47 (3.8 to 6.9 pp) relative to past turnout levels. In addition, I show that higher tract incarceration rates are associated with more support for the Proposition (6.9 pp. difference). These results suggest that carceral state exposure may affect community political engagement differently based on the direct policy relevance of a given election for changing carceral state functioning.
Scholars have reached different conclusions about the relationship between carceral contact and community engagement and civic participation. We offer a theoretical account that aims to synthesize this work to argue that incarceration should depress trust in the state but may increase, decrease, or produce no substantial effect on community or civic engagement, leading to no overall average association. We use data from the Family History of Incarceration Survey (FamHIS), a nationally representative survey of adults in the United States (n = 2,703) to conduct an expansive test of associations between direct (own) and indirect (family member) incarceration and trust in the state, civic participation, and community engagement. Our findings show that incarceration may not uniformly depress political and civic behaviors, on average. Furthermore, they inform our understanding of seemingly divergent conclusions in prior research, underscoring potential variability of prosocial actions and their enabling and constraining conditions in the wake of carceral contact.
Background
Early vascular ageing (EVA) contributes to elevated risk of cardiovascular disease (CVD), which disproportionately affects African American women. Incarceration, an event disproportionately impacting African Americans, may be a stressor contributing to EVA in African American women. Further, the subjective perspective, commonly referred to as appraisal, of incarceration may also be important for health. We hypothesised that having family and/or friends incarcerated and appraising the incarceration as upsetting would be associated with indices of EVA.
Methods
In a community-based cohort of African American women aged 30–46 living in Atlanta, Georgia (n=391), participants were asked, at baseline, about family and/or friend incarceration and to appraise how upsetting the incarceration was. Multivariable linear regression examined associations between: (1) family and/or friend incarceration and indices of EVA (pulse wave velocity, augmentation index, central systolic blood pressure (SBP) and pulse pressure amplification) and (2) appraisal of incarceration and EVA indices.
Results
45% of participants (n=174) reported having a loved one incarcerated, and 59% (n=102) reported the incarceration as upsetting. Having a loved one incarcerated was associated with a higher central SBP (b=4.30; 95% CI 1.61, 6.99) and augmentation index (b=2.29; 95% CI 0.26, 4.33). Appraisal of incarceration was only associated with central SBP.
Conclusions
Family or friend incarceration was highly prevalent in this cohort of African American women and associated with indices of EVA. Mass incarceration of others may affect the physical health of African American women which may contribute to CVD disparities.
This article reviews the literature on mothers of victims and mothers of offenders through a feminist criminological lens. Results of our analysis of 52 articles from a twenty-year period indicated that, though situated on opposite sides of the criminal justice system, aspects of the experiences of mothers of victims and offenders were similar. Specifically, the mothers shared perceived accountability for their offspring’s involvement in crime, the burden of care for their offspring, and the negotiation strategies they employed. Our analysis makes visible these mothers as a unique sub-category in the study of crime and proposes a matricentric feminist criminology model.
Many Black young adults engage in their communities through critical action, or activism, as they transition into adulthood. However, knowledge about predictors of critical action remain sparse. The present longitudinal study addresses this gap by exploring links between critical action, ethnic-racial identity, and racial discrimination among 143 Black youth who were surveyed as adolescents ( M age = 15; 66% female) and again as young adults ( M age = 20). Using hierarchical logistic regression, we found that young adult experiences of racial discrimination were related to increased odds of critical action, accounting for adolescent racial discrimination, gender, caregiver education, and postsecondary enrollment. We also found that criminalizing discriminatory experiences (e.g., being stopped by the police) during young adulthood were related to increased odds of critical action. Our findings document changes in racial discrimination and ethnic-racial identity during the transition to adulthood and suggest that some marginalized youth may transform adverse experiences into critical action.
Women tend to be more vulnerable to the adverse psychological effects of “network events” (stressors that occur to loved ones). The cost-of-caring hypothesis is regarded as the primary mechanism for this vulnerability and posits that women’s relatively high level of emotional involvement in the lives of network members causes women to experience greater empathetic reactions when loved ones encounter stressors. Drawing on the stress process model, gender theory, and research on the collateral consequences of incarceration, we theorize stress proliferation, the process by which an initial stressor induces secondary stressors, as an additional mechanism and empirically test our theoretical propositions using the case of African Americans with an incarcerated family member. Using data from the National Survey of American Life, we ask: are African American women more vulnerable to the depressive effects of familial incarceration compared to African American men? If so, to what extent might African American women’s heightened vulnerability be explained by their greater susceptibility to stress proliferation? Results suggest that familial incarceration is associated with greater chronic strains, financial strain, and family conflict only among African American women. Further, the magnitude of the association between familial incarceration and depressive symptoms is significantly larger among African American women; however, after adjusting for stress proliferation variables, the gender difference in vulnerability attenuates and becomes statistically nonsignificant. We conclude that the emotional cost of caring may be compounded by social and economic costs of caregiving, heightening women’s vulnerability to depression following disruptive network events.
Importance:
Parental incarceration is an adverse childhood experience that disproportionately affects racially minoritized individuals and has been associated with long-term health risks. Although cardiovascular disease remains the primary cause of mortality differences between Black and White individuals in the US, the association between parental incarceration and cardiovascular risk remains poorly understood.
Objective:
To examine the association between parental incarceration during childhood and incident cardiovascular risk in adulthood.
Design, setting, and participants:
This population-based cohort study included data from waves IV (2008-2009) and V (2016-2018) of the US National Longitudinal Study of Adolescent to Adult Health. Participants represented US adults transitioning from young adulthood to adulthood. Data were analyzed from October 28, 2021, to May 1, 2023.
Main outcomes and measures:
Parental incarceration was defined as a parent or parent-like figure going to jail or prison when participants were aged younger than 18 years. Outcome measures included self-reported diagnoses of obesity, hyperlipidemia, hypertension, diabetes, or heart disease as well as serum elevations in non-high-density lipoprotein cholesterol (≥160 mg/dL) and high-sensitivity C-reactive protein (hsCRP >3 mg/L), a marker of inflammation used to estimate risk of future coronary events. Using sampling weights, incident development of each outcome was modeled as a function of parental incarceration, adjusting for participant- and neighborhood-level characteristics.
Results:
This study included 9629 participants representing 16 077 108 US adults. Approximately half of participants were women (5498 [weighted 50.3%]) and the majority (5895 [weighted 71.4%]) were White. The mean participant age was 37.8 years (95% CI, 37.5 to 38.0 years) in wave V compared with 28.9 years (95% CI, 28.6 to 29.1 years) in wave IV. In wave V, those with childhood exposure to parental incarceration had lower educational attainment (91 [weighted 8.2%] vs 245 [weighted 4.2%] completing less than high school), had higher rates of public insurance (257 [weighted 20.6%] vs 806 [weighted 11.0%]), and were disproportionately Black (374 [weighted 22.5%] vs 1488 [weighted 13.6%]). Parental incarceration was associated with 33% higher adjusted odds (95% CI, 1.05 to 1.68) of developing hypertension and 60% higher adjusted odds (95% CI, 1.03 to 2.48) of developing elevated hsCRP. Associations between childhood parental incarceration and other diagnoses (ie, obesity, hyperlipidemia, diabetes, or heart disease) and serum lipid levels were not observed.
Conclusions and relevance:
In this cohort study of US adults transitioning from young adulthood to adulthood, an increased incidence of hypertension and high-risk hsCRP, but not other cardiovascular risk factors, was observed among those exposed to parental incarceration during childhood. These findings suggest possible transgenerational health consequences of mass incarceration.
Building on historical and contemporary efforts to eliminate police and other forms of state violence, and on the understanding that police violence is a social determinant of health, we conducted a systematic review in which we synthesize the existing literature around 1) racial disparities in police violence; 2) health impacts of direct exposure to police violence; and 3) health impacts of indirect exposure to police violence. We screened 336 studies and excluded 246, due to not meeting our inclusion criteria. Forty-eight additional studies were excluded during the full text review, resulting in a study sample size of 42 studies. Our review showed that Black people in the US are far more likely than white people to experience a range of forms of police violence: from fatal and nonfatal shootings, to assault and psychological violence. Exposure to police violence increases risk of multiple adverse health outcomes. Moreover, police violence may operate as a vicarious and ecological exposure, producing consequences beyond those directly assaulted. In order to successfully eliminate police violence, scholars must work in alignment with social justice movements.
This chapter explores the common trope that people must “pay their debt to society” when individuals are convicted of crimes. What is generally meant by this trope is that an individual should suffer prison or jail incarceration, state supervision after release in the form of parole or probation, and directly “giving back” whether in the form of community service or the payment of legal fines and fees. In this chapter, we develop the concept of being indebted by proxy, focusing on how adult women connected to men who experience prison and jail incarceration end up also paying their own debt to society. This is done by examining the frequency, the disruption, and the consequences women suffer because of family member incarceration.
Police violence shapes the lives of racial and ethnic minorities, and while much has been written about strategic responses to police, missing is an examination of how black women navigate interactions with officers. Based on 32 interviews with black women, we find that they use witnessing, or the mobilization of others as observers to police encounters. Research demonstrates the rising role of videos and smartphones in documenting encounters with officers. We find that black women adapt witnessing techniques based on their surroundings, available resources, and network contacts. Three forms of witnessing are observed: physical witnessing, mobilizing others in close proximity to interactions with officers; virtual witnessing, using cellphone or social media technology to contact others or record interactions with officers; and institutional witnessing, leveraging police or other institutional contacts as interveners to interactions with officers. Black women mobilize witnessing to deescalate violence, gather evidence, and promote accountability. Attuned to both the inter-actional and structural dynamics of police encounters, black women conceptualize witnessing as a way to survive police encounters and navigate their legal estrangement within the carceral system. We theorize black women's witnessing as a form of resistance as they work to reconfigure short-and long-term power relations between themselves, their communities , and police.
Purpose
Researchers have chronicled a complex relationship between incarceration exposure and health, yet prior studies do not account for reciprocal dynamics or cycles of reentry over time.
Methods
We analyzed bi-directional relationships between incarceration exposure and mental and general health over twenty five years using data from the National Longitudinal Study of Youth - 1997. We employed lagged autoregressive panel and lagged latent growth models to assess between- and within-individual dynamics of incarceration, health, and reentry. We then tested for differences in patterns of incarceration exposure and health among two high relative health risk groups, Black men and those with limited access to health insurance.
Results
Symptoms of depression and anxiety predict subsequent incarceration exposure in both between- and within- individual change models. Within-individual change in self-rated general health is positively and reciprocally associated with incarceration exposure. This relationship is substantially greater for Black men and those with limited access to health insurance.
Conclusions
The findings underscore key issues of relative health risk that influence the dynamics of incarceration exposure and health inequities. Programmatic efforts to address mental health concerns like depression and anxiety in the community and within correctional settings may be useful in reducing cycles of incarceration.
This chapter describes the academic, behavioral, and mental health impact incarceration has on youth. It describes ways school counselors, school psychologists, and teachers can offer support for students during and post incarceration, as well as ways school personnel can support students with incarcerated parents. Implications for schools to intervene on behalf of the student impacted by incarceration and areas for future research are offered. Understanding educationally based supports available to children who are incarcerated or who have incarcerated parents can enhance outcomes for those youth. Counselors working with these youth in mental health settings can share knowledge of school-based supports with the families of affected youth. Counselors can also consult with school personnel to ensure affected youth are receiving appropriate services.
Purpose of Review
Traumatic injury sits at the nexus of law enforcement and structural racism. This narrative review aims to explore the major impacts of law enforcement on health, its intersections with US structural racism, and their joint impacts on traumatic injury and injury care.
Recent Findings
Many of the same forces of systemic disadvantage that put Black people, other people of color, and other marginalized groups at risk for violent injury also expose these same individuals and communities to intensive policing. Recent evidence speaks to the broad impact of police exposure and police violence on individual and community physical and mental health. Moreover, injured patients who are exposed to law enforcement during their care are at risk for erosion of trust in and relationships with their healthcare providers. To optimize the role of law enforcement agencies in injury prevention, collaboration across sectors and with communities is essential.
Summary
A broad approach to the prevention of injury and violence must incorporate an understanding of the intersecting impacts of law enforcement and structural racism on health and traumatic injury. Clinicians who seek to provide trauma-informed injury care should incorporate an understanding of the role of law enforcement in individual and community health.
Objective:
This study documents life course patterns of vicarious exposure to the criminal legal system among parents and siblings in the United States.
Background:
The criminal legal system shapes family outcomes in important ways. Still, life course patterns of vicarious exposure to the system-especially to lower-level contacts-among parents and siblings are not well documented.
Method:
Using longitudinal data from the Panel Study of Income Dynamics, Kaplan-Meier survival curves, and Cox regression models, we estimate cumulative risks of vicarious exposure to arrest, probation, and incarceration among parents (n=3,885 parents; 185,444 person-years) and siblings (n=1,875; 44,766 person-years) and examine disparities by race-ethnicity, gender, and education, and at their intersections.
Results:
Vicarious exposure to the system is common-but highly unequal-among parents and siblings. Racially minoritized parents and siblings had greater levels and earlier risks of exposure. For example, by age 50, an estimated one in five Black parents experienced having a child incarcerated, a risk about twice as high as White and 50% higher than Latinx parents. By age 26, an estimated six in 10 Black young people with brothers experienced having a brother arrested; more than four in 10 experienced a brother on probation; and more than three in 10 experienced brother incarceration. For many estimates, racialized inequities in risks of vicarious system exposure widened at higher levels of education.
Conclusion:
These findings provide essential context for understanding the role of the criminal legal system in maintaining and exacerbating family inequality.
Introduction:
Cardiovascular disease is the leading cause of deaths and illnesses in US adults, and the prevalence is disproportionately high in underserved populations. In this study, we assessed respondents' understanding of context-specific differences in knowledge and perceptions of disease, risk, and prevention in 6 underserved communities, with the longer-term goal of developing appropriate interventions.
Methods:
Thirty-nine small-group sessions and 14 interviews yielded data from 318 adults. Each site's researchers coded, analyzed, and extracted key themes from local data. Investigators from all sites synthesized results and identified common themes and differences.
Results:
Themes clustered in 3 areas (barriers to cardiovascular health, constraints related to multiple roles, and suggestions for effective communications and programs). Barriers spanned individual, social and cultural, and environmental levels; women in particular cited multiple roles (eg, competing demands, lack of self-care). Programmatic suggestions included the following: personal, interactive, social context; information in language that people use; activities built around cultural values and interests; and community orientation. In addition, respondents preferred health-related information from trusted groups (eg, AARP), health care providers (but with noticeable differences of opinion), family and friends, and printed materials.
Conclusion:
Interventions to decrease barriers to cardiovascular health are needed; these strategies should include family and community context, small groups, interactive methods, culturally sensitive materials, and trusted information sources. New-immigrant communities need culturally and linguistically tailored education before receiving more substantive interventions.
High rates of incarceration among American men, coupled with a high prevalence of fatherhood among the incarcerated, have led to millions of children and families whose fathers are, or have been, in the nation’s jails and prisons. This study uses data from the Fragile Families and Child Wellbeing Survey to estimate the extent to which paternal incarceration increases family material hardship. Analyses from a series of longitudinal regression models suggest that material hardship is statistically significantly and positively associated with paternal incarceration. These hardships are found to reflect not only a reduction in fathers’ income and financial contributions but also an increase in financial and other family strains. The findings underscore the challenges facing families with incarcerated fathers. They also emphasize the need for efforts by criminal justice agencies and social service providers to help mitigate the risks associated with paternal incarceration.
This longitudinal study examines the effect of sons’ incarceration on their mothers’ psychological distress. Interviews were conducted over the life course with a community cohort of African American mothers who had children in first grade in 1966 – 1967 when the study began (N =615). Thirty years later, their sons had significant rates of incarceration (22.4%). Structural equation modeling showed that the more recent the incarceration, the greater the mothers’ psychological distress, even controlling for earlier socioeconomic status and psychological well-being. Financial difficulties and greater burden of grandparenting are associated with having a son incarcerated and they mediate the relationship between the incarceration and a mother’s psychological distress. Results suggest that incarceration has important effects on family members’ well-being.
Although recent studies suggest that 13% of young adults, including at least one-fourth of African Americans, experience parental
incarceration, little research has examined links between parental incarceration and physical health. Using data from the
National Longitudinal Study of Adolescent Health (1994–2008) and gender-based theories of stress, the authors examined whether
parental incarceration is associated with increased body mass index among women but not men. Panel analysis spanning adolescence
and adulthood, controlling for stressful life events, internalizing behaviors, and a range of individual, familial, and neighborhood
characteristics, reveals that body mass index for women who have experienced parental incarceration is 0.49 units (P < 0.004) higher than that for women whose parents have never been incarcerated. This association is not evident among men.
Similarly, in change score models between waves II and IV, women experiencing parental incarceration have a 0.92-unit increase
in body mass index (P < 0.026) relative to women who did not have a parent undergo incarceration. In supplemental analysis examining if gender
differences in incarceration stress response (externalizing vs. internalizing) explain these findings, the authors found that
obesity status moderates the relation between depression and parental incarceration. Results suggest a stress internalization
process that, for the first time, links parental incarceration with obesity among women.
Among persons with substance use disorders, those from racial-ethnic minority groups have been found to receive substance abuse treatment at rates equal to or higher than those of non-Latino whites. Little is known about factors underlying this apparent lack of disparities. This study examines racial-ethnic disparities in treatment receipt and mechanisms that reduce or contribute to disparities.
Black-white and Latino-white disparities in any and in specialty substance abuse treatment were measured among adult respondents with substance use disorders from the 2005-2009 National Survey on Drug Use and Health (N=25,159). Three staged models were used to measure disparities concordant with the Institute of Medicine definition, assess the extent to which criminal history and socioeconomic indicators contributed to disparities, and identify correlates of treatment receipt.
Treatment was rare (about 10%) for all racial-ethnic groups. Odds ratios for black-white and Latino-white differences decreased and became significantly less than 1 after adjustment for criminal history and socioeconomic status factors. Higher rates of criminal history and enrollment in Medicaid among blacks and Latinos and lower income were specific mechanisms that influenced changes in estimates of disparities across models.
The greater likelihood of treatment receipt among persons with a criminal history and lower socioeconomic status is a pattern unlike those seen in most other areas of medical treatment and important to the understanding of substance abuse treatment disparities. Treatment programs that are mandated by the criminal justice system may provide access to individuals resistant to care, which raises concerns about perceived coercion.
High U.S. incarceration rates have motivated recent research on the negative effects of imprisonment on later employment, earnings, and family relationships. Because most men in jail and prison are fathers, a large number of children may be placed at considerable risk by policies of incarceration. This article examines one dimension of the economic risk faced by children of incarcerated fathers: the reduction in the financial support that they receive. We use a population-based sample of urban children to examine the effects of incarceration on this support. Both cross-sectional and longitudinal regressions indicate that formerly incarcerated men are less likely to contribute to their families, and those who do contribute provide significantly less. The negative effects of incarceration on fathers' financial support are due not only to the low earnings of formerly incarcerated men but also to their increased likelihood to live apart from their children. Men contribute far less through child support (formal or informal) than they do when they share their earnings within their household, suggesting that the destabilizing effects of incarceration on family relationships place children at significant economic disadvantage.
The life expectancy of persons cycling through the prison system is unknown. The authors sought to determine the 15.5-year survival of 23,510 persons imprisoned in the state of Georgia on June 30, 1991. After linking prison and mortality records, they calculated standardized mortality ratios (SMRs). The cohort experienced 2,650 deaths during follow-up, which were 799 more than expected (SMR = 1.43, 95% confidence interval (CI): 1.38, 1.49). Mortality during incarceration was low (SMR = 0.85, 95% CI: 0.77, 0.94), while postrelease mortality was high (SMR = 1.54, 95% CI: 1.48, 1.61). SMRs varied by race, with black men exhibiting lower relative mortality than white men. Black men were the only demographic subgroup to experience significantly lower mortality while incarcerated (SMR = 0.66, 95% CI: 0.58, 0.76), while white men experienced elevated mortality while incarcerated (SMR = 1.28, 95% CI: 1.10, 1.48). Four causes of death (homicide, transportation, accidental poisoning, and suicide) accounted for 74% of the decreased mortality during incarceration, while 6 causes (human immunodeficiency virus infection, cancer, cirrhosis, homicide, transportation, and accidental poisoning) accounted for 62% of the excess mortality following release. Adjustment for compassionate releases eliminated the protective effect of incarceration on mortality. These results suggest that the low mortality inside prisons can be explained by the rarity of deaths unlikely to occur in the context of incarceration and compassionate releases of moribund patients.
This paper investigates the connection between incarceration dynamics and acquired immune deficiency syndrome (AIDS) infection rates, with particular emphasis on the black-white AIDS rate disparity. Using case-level U.S. data spanning 1982-96, we model the dynamic relationship between AIDS infection rates and the proportion of men in the age-, state-, and race-matched cohort that are incarcerated. We find strong effects of male incarceration rates on male and female AIDS rates. The dynamic structure of this relationship parallels the incubation time between human immunodeficiency virus infection and the onset of full-blown AIDS. These results persist after controlling for year fixed effects; a fully interacted set of age, race, and state fixed effects; crack cocaine prevalence; and flow rates in and out of prison. The results reveal that higher incarceration rates among black males over this period explain the lion's share of the racial disparity in AIDS infection among women. (c) 2009 by The University of Chicago. All rights reserved..
Cardiovascular disease is the leading cause of deaths and illnesses in US adults, and the prevalence is disproportionately high in underserved populations. In this study, we assessed respondents' understanding of context-specific differences in knowledge and perceptions of disease, risk, and prevention in 6 underserved communities, with the longer-term goal of developing appropriate interventions.
Thirty-nine small-group sessions and 14 interviews yielded data from 318 adults. Each site's researchers coded, analyzed, and extracted key themes from local data. Investigators from all sites synthesized results and identified common themes and differences.
Themes clustered in 3 areas (barriers to cardiovascular health, constraints related to multiple roles, and suggestions for effective communications and programs). Barriers spanned individual, social and cultural, and environmental levels; women in particular cited multiple roles (eg, competing demands, lack of self-care). Programmatic suggestions included the following: personal, interactive, social context; information in language that people use; activities built around cultural values and interests; and community orientation. In addition, respondents preferred health-related information from trusted groups (eg, AARP), health care providers (but with noticeable differences of opinion), family and friends, and printed materials.
Interventions to decrease barriers to cardiovascular health are needed; these strategies should include family and community context, small groups, interactive methods, culturally sensitive materials, and trusted information sources. New-immigrant communities need culturally and linguistically tailored education before receiving more substantive interventions.
Incarceration is associated with increased cardiovascular disease mortality, but prospective studies exploring mechanisms of this association are lacking.
We examined the independent association of prior incarceration with incident hypertension, diabetes, and dyslipidemia using the Coronary Artery Risk Development in Young Adults (CARDIA) study-a cohort of young adults aged 18 to 30 years at enrollment in 1985-1986, balanced by sex, race (black and white), and education (high school education or less). We also examined the association of incarceration with left ventricular hypertrophy on echocardiography and with barriers to health care access.
Of 4350 participants, 288 (7%) reported previous incarceration. Incident hypertension in young adulthood was more common among former inmates than in those without incarceration history (12% vs 7%; odds ratio, 1.7 [95% confidence interval {CI}, 1.2-2.6]), and this association persisted after adjustment for smoking, alcohol and illicit drug use, and family income (adjusted odds ratio [AOR], 1.6 [95% CI, 1.0-2.6]). Incarceration was significantly associated with incident hypertension in those groups with the highest prevalence of prior incarceration, ie, black men (AOR, 1.9 [95% CI, 1.1-3.5]) and less-educated participants (AOR, 4.0 [95% CI, 1.0-17.3]). Former inmates were more likely to have left ventricular hypertrophy (AOR, 2.7, [95% CI, 0.9-7.9]) and to report no regular source for medical care (AOR, 2.5, [95% CI, 1.3-4.8]). Cholesterol levels and diabetes rates did not differ by history of incarceration.
Incarceration is associated with future hypertension and left ventricular hypertrophy among young adults. Identification and treatment of hypertension may be important in reducing cardiovascular disease risk among formerly incarcerated individuals.
Many African-American women are affected by diabetes and its complications, and culturally appropriate lifestyle interventions that lead to improvements in glycemic control are urgently needed. The aim of this qualitative study was to identify culturally relevant psychosocial issues and social context variables influencing lifestyle behaviors--specifically diet and physical activity--of southern African-American women with diabetes.
We conducted 10 focus group interviews with 70 southern African-American women with type 2 diabetes. Group interviews were audiotaped and transcripts were coded using qualitative data analysis software. A panel of reviewers analyzed the coded responses for emerging themes and trends.
The dominant and most consistent themes that emerged from these focus groups were 1) spirituality as an important factor in general health, disease adjustment, and coping; 2) general life stress and multi-caregiving responsibilities interfering with daily disease management; and 3) the impact of diabetes manifested in feelings of dietary deprivation, physical and emotional "tiredness," "worry," and fear of diabetes complications.
Our findings suggest that influences on diabetes self-management behaviors of African-American women may be best understood from a sociocultural and family context. Interventions to improve self-management for this population should recognize the influences of spirituality, general life stress, multi-caregiving responsibilities, and the psychological impact of diabetes. These findings suggest that family-centered and church-based approaches to diabetes care interventions are appropriate.
In an effort to deepen our understanding of how circumstances of forced separation and the interdiction of physical contact affect women's sexual behavior, we investigated the development and maintenance of heterosexual couples' intimacy when the male partner is incarcerated. As HIV-prevention scientists who work with women visiting men at a California state prison, we recognize that correctional control extends to these women's bodies, both when they are within the facility's walls visiting their mates and when they are at home striving to remain connected to absent men. This paper analyzes the impact of a peculiar public "place", a penitentiary, on couples' romantic and sexual interactions, drawing out the implications of imprisonment for relationship decision making, sexual health, and HIV risk. Using qualitative interviews with 20 women who visit their incarcerated partners and 13 correctional officers who interact with prison visitors, we examined how institutional constraints such as the regulation of women's apparel, the prohibition of physical contact, and the lack of forums for privacy result in couples forging alternative "spaces" in which their relationships occur. We describe how romantic scripts, the build-up of sexual tension during the incarceration period, and conditions of parole promote unprotected sexual intercourse and other HIV/STD risk behavior following release from prison.
We considered whether US Blacks experience early health deterioration, as measured across biological indicators of repeated exposure and adaptation to stressors.
Using National Health and Nutrition Examination Survey data, we examined allostatic load scores for adults aged 18-64 years. We estimated probability of a high score by age, race, gender, and poverty status and Blacks' odds of having a high score relative to Whites' odds.
Blacks had higher scores than did Whites and had a greater probability of a high score at all ages, particularly at 35-64 years. Racial differences were not explained by poverty. Poor and nonpoor Black women had the highest and second highest probability of high allostatic load scores, respectively, and the highest excess scores compared with their male or White counterparts.
We found evidence that racial inequalities in health exist across a range of biological systems among adults and are not explained by racial differences in poverty. The weathering effects of living in a race-conscious society may be greatest among those Blacks most likely to engage in high-effort coping.
We investigated the contributions of gender, caste, and standard of living to inequalities in mortality across the life course in India.
We conducted a multilevel cross-sectional analysis of individual mortality, using the 1998-1999 Indian National Family Health Survey data for 529321 individuals from 26 states.
Substantial mortality differentials were observed between the lowest and highest standard-of-living quintiles across all age groups, ranging from an odds ratio (OR) of 4.61 (95% confidence interval [CI]=2.98, 7.13) in the age group 2 to 5 years to an OR of 1.97 (95% CI=1.68, 2.32) in the age group 45 to 64 years. Excess mortality for girls was evident only for the age group 2 to 5 years (OR=1.33, 95% CI=1.13, 1.58). Substantial caste differentials were observed at the beginning and end stages of life. Area variation in mortality is partially a result of the compositional effects of household standard of living and caste.
The mortality burden, across the life course in India, falls disproportionately on economically disadvantaged and lower-caste groups. Residual state-level variation in mortality suggests an underlying ecology to the mortality divide in India.
The purpose of this study was to examine the prevalences of diagnosed and undiagnosed diabetes, and impaired fasting glucose (IFG) in U.S. adults during 1999-2002, and compare prevalences to those in 1988-1994.
The National Health and Nutrition Examination Survey (NHANES) contains a probability sample of adults aged > or =20 years. In the NHANES 1999-2002, 4,761 adults were classified on glycemic status using standard criteria, based on an interview for diagnosed diabetes and fasting plasma glucose measured in a subsample.
The crude prevalence of total diabetes in 1999-2002 was 9.3% (19.3 million, 2002 U.S. population), consisting of 6.5% diagnosed and 2.8% undiagnosed. An additional 26.0% had IFG, totaling 35.3% (73.3 million) with either diabetes or IFG. The prevalence of total diabetes rose with age, reaching 21.6% for those aged > or =65 years. The prevalence of diagnosed diabetes was twice as high in non-Hispanic blacks and Mexican Americans compared with non-Hispanic whites (both P < 0.00001), whereas the prevalence of undiagnosed diabetes was similar by race/ethnicity, adjusted for age and sex. The prevalence of diagnosed diabetes was similar by sex, but prevalences of undiagnosed diabetes and IFG were significantly higher in men. The crude prevalence of diagnosed diabetes rose significantly from 5.1% in 1988-1994 to 6.5% in 1999-2002, but the crude prevalences were stable for undiagnosed diabetes (from 2.7 to 2.8%) and IFG (from 24.7 to 26.0%). Results were similar after adjustment for age and sex.
Although the prevalence of diagnosed diabetes has increased significantly over the last decade, the prevalences of undiagnosed diabetes and IFG have remained relatively stable. Minority groups remain disproportionately affected.
We estimated the effects of high incarceration rates on rates of sexually transmitted infections and teenage pregnancies.
We calculated correlations between rates of incarceration in state prisons and county jails and rates of sexually transmitted infections and teenage pregnancies for each of the 100 counties in North Carolina during 1995 to 2002. We also estimated increases in negative health outcomes associated with increases in incarceration rates using negative binomial regression analyses.
Rates of sexually transmitted infections and teenage pregnancies, adjusted for age, race, and poverty distributions by county, consistently increased with increasing incarceration rates. In the most extreme case, teenage pregnancies exhibited an increase of 71.61 per 100000 population (95% confidence interval [CI]=41.88, 101.35) in 1996 after an increase in the prison population rate from 223.31 to 468.58 per 100000 population in 1995.
High rates of incarceration can have the unintended consequence of destabilizing communities and contributing to adverse health outcomes.
I have summarized in this article data on the magnitude of health challenges faced by men in the United States. Across a broad range of indicators, men report poorer health than women. Although men in all socioeconomic groups are doing poorly in terms of health, some especially high-risk groups include men of low socioeconomic status (SES) of all racial/ethnic backgrounds, low-SES minority men, and middle-class Black men. Multiple factors contribute to the elevated health risks of men. These include economic marginality, adverse working conditions, and gendered coping responses to stress, each of which can lead to high levels of substance use, other health-damaging behaviors, and an aversion to health-protective behaviors. The forces that adversely affect men's health are interrelated, unfold over the life course, and are amenable to change.
Although growth in the U.S. prison population over the past twenty-five years has been widely discussed, few studies examine changes in inequality in imprisonment. We study penal inequality by estimating lifetime risks of imprisonment for black and white men at different levels of education. Combining administrative, survey, and census data, we estimate that among men born between 1965 and 1969, 3 percent of whites and 20 percent of blacks had served time in prison by their early thirties. The risks of incarceration are highly stratified by education. Among black men born during this period, 30 percent of those without college education and nearly 60 percent of high school dropouts went to prison by 1999. The novel pervasiveness of imprisonment indicates the emergence of incarceration as a new stage in the life course of young low-skill black men.
Mass incarceration is disproportionately concentrated among men, African Americans, and those with low education. Yet our national data systems and the social facts they produce are based on information that excludes inmates and former inmates. This presentation show that because these populations differ in systematic ways from those living in households, data gathered through household-based surveys offer a biased glimpse into the American experience and obscures accounts of racial inequality.
Coronary heart disease is the leading cause of mortality in adult women, and recent trends indicate that risk for women, particularly working mothers, has worsened during the last decade. The absence of a biological explanation for this gender discrepancy has led some to look to psychosocial risk factors. This literature review examines the effect of multiple roles on women's cardiovascular health. Further, a conceptual model of heart disease risk is proposed, which introduces background stress, a chronic stress burden, as a potential pathway between multiple roles and heart disease. Trends in the literature largely support the proposed conceptual model. Multiple roles that often place conflicting demands on women may affect health outcomes through an increase in total background stress.
As the American imprisonment rate has risen, researchers have become increasingly concerned about the implications of mass imprisonment for family life. The authors extend this research by examining how paternal incarceration is linked to perceived instrumental support among the mothers of inmates' children. Results from the Fragile Families and Child Wellbeing Study (N = 4,132) suggest that recent, but not current, paternal incarceration is independently associated with less maternal perceived instrumental support and that this association persists after adjusting for a rich set of control variables, including prior perceived instrumental support. For families of recently incarcerated men, incarceration may be a double strike, simultaneously increasing the need for instrumental support while decreasing its availability when incarcerated fathers return to the community.
Released in 1965, the Moynihan Report traced the severe social and economic distress of poor urban African Americans to high rates of single-parenthood. Against Moynihan's calls for social investment in poor inner-city communities, politics moved in a punitive direction, driving massive growth in the prison population. The authors document the emergence of mass incarceration and describe its significance for African American family life. The era of mass incarceration can be understood as a new stage in the history of American racial inequality. Because of its recent arrival, the social impact of mass incarceration remains poorly understood. The authors conclude by posing several key research questions that can illuminate the effects of dramatic growth in the American penal system.
In this article, we examine the possible impact of mass imprisonment on the physical health of African American women. Specifically, we focus on a variety of mechanisms through which mass imprisonment may increase the risk of having three major chronic health conditions that are risk factors for cardiovascular disease (CVD): hypertension, diabetes, and obesity. This approach is distinctive in that it provides a broad theoretical framework through which mass imprisonment might harm the physical health of African American women in ways separate from the pathways linking mass imprisonment to their risk of contracting infectious diseases (especially HIV and other STIs), which has been the emphasis of most research in this area. In order to draw these connections, we begin by briefly discussing what mass imprisonment is and its social consequences. We then discuss our three CVD risk factors, documenting disparities between white and African American women in these risk factors and discussing mechanisms through which mass imprisonment might contribute to these disparities. We close by discussing the data needed to test our hypotheses and suggesting some avenues for future research.
A burgeoning literature considers the consequences of mass imprisonment for the well-being of adult men and—albeit to a lesser degree—their children. Yet virtually no quantitative research considers the consequences of mass imprisonment for the well-being of the women who are the link between (former) prisoners and their children. This article extends research on the collateral consequences of mass imprisonment by considering the association between paternal incarceration and maternal mental health using data from the Fragile Families and Child Wellbeing Study. Results show that recent paternal incarceration increases a mother’s risk of a major depressive episode and her level of life dissatisfaction, net of a variety of influences including prior mental health. The empirical design lends confidence to a causal interpretation: effects of recent incarceration persist even when the sample is limited to mothers attached to previously incarcerated men, which provides a rigorous counterfactual. In addition, the empirical design is comprehensive; after isolating key mechanisms anticipated in the literature, we reduce the relationship between recent paternal incarceration and maternal mental health to statistical insignificance. These results imply that the penal system may have important effects on poor women’s well-being beyond increasing their economic insecurity, compromising their marriage markets, or magnifying their risk of divorce.
This article addresses two basic questions. First, it examines whether incarceration has a lasting impact on health functioning. Second, because blacks are more likely than whites to be exposed to the negative effects of the penal system—including fractured social bonds, reduced labor market prospects, and high levels of infectious disease—it considers whether the penal system contributes to racial health disparities. Using the National Longitudinal Survey of Youth and both regression and propensity matching estimators, the article empirically demonstrates a significant relationship between incarceration and later health status. More specifically, incarceration exerts lasting effects on midlife health functioning. In addition, this analysis finds that, due primarily to disproportionate rates of incarceration, the penal system plays a role in perpetuating racial differences in midlife physical health functioning.
This article extends research on the consequences of parental incarceration for child well-being, the effects of mass imprisonment on black-white inequalities in child well-being, and the factors shaping black-white inequalities in infant mortality by considering the relationship between imprisonment and infant mortality, using individual- and state-level data from the United States, 1990 through 2003. Results using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) show that parental incarceration is associated with elevated early infant mortality risk and that partner violence moderates this relationship. Infants of recently incarcerated fathers who are not abusive have twice the mortality risk of other infants, but there is no association if the father was abusive. Results from state-level analyses show a positive association between the imprisonment rate and the total infant mortality rate, black infant mortality rate, and black-white inequality in the infant mortality rate. Assuming a causal effect, results show that had the imprisonment rate remained at its 1990 level, the 2003 infant mortality rate would have been 3.9 percent lower, black-white inequality in the infant mortality rate 8.8 percent lower. Thus, results imply that imprisonment may have health consequences that extend beyond ever-imprisoned men to their social correlates and that these health spillover effects are not limited to infectious disease.
In the United States, lawbreakers are treated as social isolates, and the sentences imposed upon them are conceived of as affecting a discrete individual. However, people who commit or are suspected of committing crimes are generally embedded in kinship webs and social networks that draw others into the ambit of the state's punishment apparatus. Through their association with someone convicted of a crime, legally innocent people have firsthand and often intense contact with criminal justice authorities and correctional facilities, they experience variants of the direct and indirect consequences of incarceration, and they are confronted by the paradox of a penal state that has become the primary distributor of social services for the poor in the United States. Collectively, studies investigating punishment beyond the offender contribute to the understanding of the wide and multi-faceted impact of punitive sanctions and spotlight the importance of considering this full range of repercussions when evaluating the scope of the nation's policing, judicial, and correctional policies.
We compared mortality rates among state prisoners and other state residents to identify prisoners' health care needs.
We linked North Carolina prison records with state death records for 1995-2005 to estimate all-cause and cause-specific death rates among black and white male prisoners ages 20-79 years and used standardized mortality ratios (SMRs) to compare these observed deaths with the expected number on the basis of death rates among state residents.
The all-cause SMR of black prisoners was 0.52 (95% confidence interval, 0.48-0.57), with fewer deaths than expected from accidents, homicides, cardiovascular disease, and cancer. The all-cause SMR of white prisoners was 1.12 (95% confidence interval, 1.01-1.25) with fewer deaths than expected for accidents but more deaths than expected from viral hepatitis, liver disease, cancer, chronic lower respiratory disease, and HIV.
The mortality of black prisoners was lower than that of black state residents for both traumatic and chronic causes of death. The mortality of white prisoners was lower than that of white state residents for accidents but greater for several chronic causes of death. Future studies should investigate the effect of prisoners' preincarceration and in-prison morbidity, the prison environment, and prison health care on prisoners' patterns of mortality.
Forty decades of sociological stress research offer five major findings. First, when stressors (negative events, chronic strains, and traumas) are measured comprehensively, their damaging impacts on physical and mental health are substantial. Second, differential exposure to stressful experiences is a primary way that gender, racial-ethnic, marital status, and social class inequalities in physical and mental health are produced. Third, minority group members are additionally harmed by discrimination stress. Fourth, stressors proliferate over the life course and across generations, widening health gaps between advantaged and disadvantaged group members. Fifth, the impacts of stressors on health and well-being are reduced when persons have high levels of mastery, self-esteem, and/or social support. With respect to policy, to help individuals cope with adversity, tried and true coping and support interventions should be more widely disseminated and employed. To address health inequalities, the structural conditions that put people at risk of stressors should be a focus of programs and policies at macro and meso levels of intervention. Programs and policies also should target children who are at lifetime risk of ill health and distress due to exposure to poverty and stressful family circumstances.
In September 2010, the National Institutes of Health formalized a commitment to ending health disparities by establishing a 27th institute, the National Institute on Minority Health and Health Disparities, with priorities that include “improving the participation of health disparity populations in clinical research.”1 Accomplishment of this important goal will require recognition of the disproportionate incarceration of individuals from racial/ethnic minority populations and reassessment of the federal near prohibition on the participation of current and former prisoners in clinical research.
Although much research has focused on how imprisonment transforms the life course of disadvantaged black men, researchers have paid little attention to how parental imprisonment alters the social experience of childhood. This article estimates the risk of parental imprisonment by age 14 for black and white children born in 1978 and 1990. This article also estimates the risk of parental imprisonment for children whose parents did not finish high school, finished high school only, or attended college. Results show the following: (1) 1 in 40 white children born in 1978 and 1 in 25 white children born in 1990 had a parent imprisoned; (2) 1 in 7 black children born in 1978 and 1 in 4 black children born in 1990 had a parent imprisoned; (3) inequality in the risk of parental imprisonment between white children of college-educated parents and all other children is growing; and (4) by age 14, 50.5% of black children born in 1990 to high school dropouts had a father imprisoned. These estimates, robustness checks, and extensions to longitudinal data indicate that parental imprisonment has emerged as a novel-and distinctively American-childhood risk that is concentrated among black children and children of low-education parents.
More than 6 million men and 1 million women are under US correctional control, be it jail, prison, probation, or parole. On any given day, about 250,000 women and adolescent girls are behind bars, a number well in excess of those documented for all other sovereign nations. Moreover, women and girls represent the fastest-growing segment of the prison and jail populations. Approximately 75% of these women are mothers of minor children (leaving 200,000 children "motherless") and as many as 10,000 may be pregnant. Primarily designed for male offenders, the US correctional system is struggling to meet the specialized needs of its female inmates. Although incarceration during pregnancy is both stressful and dehumanizing, most studies paradoxically document better outcomes for pregnancies managed behind bars than for women of similar socioeconomic status whose pregnancies are managed in the community. Using the case of Ms A as a springboard for discussion, the issues, benefits, and challenges of caring for an incarcerated pregnant woman are addressed, as is the importance of family planning services to those about to be released.
More than 10 million people are incarcerated worldwide; this number has increased by about a million in the past decade. Mental disorders and infectious diseases are more common in prisoners than in the general population. High rates of suicide within prison and increased mortality from all causes on release have been documented in many countries. The contribution of prisons to illness is unknown, although shortcomings in treatment and aftercare provision contribute to adverse outcomes. Research has highlighted that women, prisoners aged 55 years and older, and juveniles present with higher rates of many disorders than do other prisoners. The contribution of initiatives to improve the health of prisoners by reducing the burden of infectious and chronic diseases, suicide, other causes of premature mortality and violence, and counteracting the cycle of reoffending should be further examined.
American crime policy took an unexpected turn in the latter part of the twenty-first century, entering a new penal regime. From the 1920s to the early 1970s, the incarceration rate in the United States averaged 110 inmates per 100,000 persons. This rate of incarceration varied so little in the United States and internationally that many scholars believed the nation and the world were experiencing a stable equilibrium of punishment.1 But beginning in the mid-1970s, the U.S. incarceration rate accelerated dramatically, reaching the unprecedented rate of 197 inmates per 100,000 persons in 1990 and the previously unimaginable rate of 504 inmates per 100,000 persons in 2008.2 Incarceration in the United States is now so prevalent that it has become a normal life event for many disadvantaged young men, with some segments of the population more likely to end up in prison than attend college.3 Scholars have broadly described this national phenomenon as mass incarceration.4
"Stigma, shame and hardship---this is the lot shared by families whose young men have been swept into prison. Braman reveals the devastating toll mass incarceration takes on the parents, partners, and children left behind." -Katherine S. Newman "Doing Time on the Outside brings to life in a compelling way the human drama, and tragedy, of our incarceration policies. Donald Braman documents the profound economic and social consequences of the American policy of massive imprisonment of young African American males. He shows us the link between the broad-scale policy changes of recent decades and the isolation and stigma that these bring to family members who have a loved one in prison. If we want to understand fully the impact of current criminal justice policies, this book should be required reading." -Mark Mauer, Assistant Director, The Sentencing Project "Through compelling stories and thoughtful analysis, this book describes how our nation's punishment policies have caused incalculable damage to the fabric of family and community life. Anyone concerned about the future of urban America should read this book." -Jeremy Travis, The Urban Institute In the tradition of Elijah Anderson's Code of the Street and Katherine Newman's No Shame in My Game, this startling new ethnography by Donald Braman uncovers the other side of the incarceration saga: the little-told story of the effects of imprisonment on the prisoners' families. Since 1970 the incarceration rate in the United States has more than tripled, and in many cities-urban centers such as Washington, D.C.-it has increased over five-fold. Today, one out of every ten adult black men in the District is in prison and three out of every four can expect to spend some time behind bars. But the numbers don't reveal what it's like for the children, wives, and parents of prisoners, or the subtle and not-so-subtle effects mass incarceration is having on life in the inner city. Author Donald Braman shows that those doing time on the inside are having a ripple effect on the outside-reaching deep into the family and community life of urban America. Braman gives us the personal stories of what happens to the families and communities that prisoners are taken from and return to. Carefully documenting the effects of incarceration on the material and emotional lives of families, this groundbreaking ethnography reveals how criminal justice policies are furthering rather than abating the problem of social disorder. Braman also delivers a number of genuinely new arguments. Among these is the compelling assertion that incarceration is holding offenders unaccountable to victims, communities, and families. The author gives the first detailed account of incarceration's corrosive effect on social capital in the inner city and describes in poignant detail how the stigma of prison pits family and community members against one another. Drawing on a series of powerful family portraits supported by extensive empirical data, Braman shines a light on the darker side of a system that is failing the very families and communities it seeks to protect.
By quadrupling the number of people behind bars in two decades, the United States has become the world leader in incarceration. Much has been written on the men who make up the vast majority of the nationâs two million inmates. But what of the women they leave behind? Doing Time Together vividly details the ways that prisons shape and infiltrate the lives of women with husbands, fiancés, and boyfriends on the inside. Megan Comfort spent years getting to know women visiting men at San Quentin State Prison, observing how their romantic relationships drew them into contact with the penitentiary. Tangling with the prisonâs intrusive scrutiny and rigid rules turns these women into âquasi-inmates,â eroding the boundary between home and prison and altering their sense of intimacy, love, and justice. Yet Comfort also finds that with social welfare weakened, prisons are the most powerful public institutions available to women struggling to overcome untreated social ills and sustain relationships with marginalized men. As a result, they express great ambivalence about the prison and the control it exerts over their daily lives. An illuminating analysis of women caught in the shadow of Americaâs massive prison system, Comfortâs book will be essential for anyone concerned with the consequences of our punitive culture.
Over the last thirty years, the prison population in the United States has increased more than sevenfold to over 2 million people, including vastly disproportionate numbers of minorities and people with little education. For some racial and educational groups, incarceration has become a depressingly regular experience, and prison culture and influence pervade their communities. Almost 60 percent of black male high school drop-outs in their early thirties have spent time in prison. In Punishment and Inequality in America, sociologist Bruce Western explores the recent era of mass incarceration and the serious social and economic consequences it has wrought. Punishment and Inequality in America dispels many of the myths about the relationships among crime, imprisonment, and inequality. While many people support the increase in incarceration because of recent reductions in crime, Western shows that the decrease in crime rates in the 1990s was mostly fueled by growth in city police forces and the pacification of the drug trade. Getting "tough on crime" with longer sentences only explains about 10 percent of the fall in crime, but has come at a significant cost. Punishment and Inequality in America reveals a strong relationship between incarceration and severely dampened economic prospects for former inmates. Western finds that because of their involvement in the penal system, young black men hardly benefited from the economic boom of the 1990s. Those who spent time in prison had much lower wages and employment rates than did similar men without criminal records. The losses from mass incarceration spread to the social sphere as well, leaving one out of ten young black children with a father behind bars by the end of the 1990s, thereby helping perpetuate the damaging cycle of broken families, poverty, and crime. The recent explosion of imprisonment is exacting heavy costs on American society and exacerbating inequality. Whereas college or the military were once the formative institutions in young men's lives, prison has increasingly usurped that role in many communities. Punishment and Inequality in America profiles how the growth in incarceration came about and the toll it is taking on the social and economic fabric of many American communities.
Incarceration has been identified as a key variable to be addressed in halting the HIV epidemic among African Americans. Our research team has been conducting and evaluating HIV prevention interventions for prisoners and their families since the early 1990s, including interventions specifically tailored to the needs of women with incarcerated partners. This article describes the development and implementation of a multicomponent HIV prevention intervention for women with incarcerated partners, and presents qualitative data from women who participated as peer educators in this intervention. Women with incarcerated partners reported low rates of condom use and HIV testing combined with a lack of information about prison-related HIV risks. We found that peer education is a feasible intervention to reach women with incarcerated partners and that flexibility and inclusiveness are important factors in designing intervention programs for this population.
Observed variation between populations in fertility-timing distributions has been thought to contribute to infant mortality differentials. This hypothesis is based, in part, on the belief that the 20s through early 30s constitute "prime" childbearing ages that are low-risk relative to younger or older ages. However, when stratified by racial identification over the predominant first child-bearing ages, maternal age patterns of neonatal mortality vary between groups. Unlike non-Hispanic white infants, African-American infants with teen mothers experience a survival advantage relative to infants whose mothers are older. The black-white infant mortality differential is larger at older maternal ages than at younger ages. While African Americans and non-Hispanic whites differ on which maternal ages are associated with the lowest risk of neonatal mortality, within each population, first births are most frequent at its lowest-risk maternal ages. As a possible explanation for racial variation in maternal age patterns of births and birth outcomes, the "weathering hypothesis" is proposed: namely, that the health of African-American women may begin to deteriorate in early adulthood as a physical consequence of cumulative socioeconomic disadvantage.
Over the last several decades, epidemiological studies have been enormously successful in identifying risk factors for major diseases. However, most of this research has focused attention on risk factors that are relatively proximal causes of disease such as diet, cholesterol level, exercise and the like. We question the emphasis on such individually-based risk factors and argue that greater attention must be paid to basic social conditions if health reform is to have its maximum effect in the time ahead. There are two reasons for this claim. First we argue that individually-based risk factors must be contextualized, by examining what puts people at risk of risks, if we are to craft effective interventions and improve the nation's health. Second, we argue that social factors such as socioeconomic status and social support are likely "fundamental causes" of disease that, because they embody access to important resources, affect multiple disease outcomes through multiple mechanisms, and consequently maintain an association with disease even when intervening mechanisms change. Without careful attention to these possibilities, we run the risk of imposing individually-based intervention strategies that are ineffective and of missing opportunities to adopt broad-based societal interventions that could produce substantial health benefits for our citizens.
Population-based, person-specific health surveys, with concomitant biological measures, should provide important information about the processes by which socioeconomic and psychosocial factors embed themselves in human health. Questionnaire responses allow for assessment of the perceived psychosocial environment, but biological measurements will measure the status of the psychoneuroimmunology/ psychoneuroendocrinology (PNI/PNE) pathways and may allow us to identify people who have "adapted" to their stress because of experience, expectations, stoicism, etc. This review sets criteria to evaluate potential physiological markers of chronic stress. Because population health surveys involve a massive number of samples, special consideration must be given to the laboratory analysis method and transportation time of the markers chosen. We reviewed five areas: glycosylated proteins, the immune system, hemostasis peripheral benzodiazepine receptors, and the waist-hip ratio.
The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described.
A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. Logistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0-7) and risk factors for the leading causes of death in adult life.
More than half of respondents reported at least one, and one-fourth reported > or = 2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P < .001). Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, > or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.
We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.
There is mounting evidence that inflammation plays a role in the development of coronary heart disease (CHD). Observations have been made linking the presence of infections in the vessel wall with atherosclerosis, and epidemiological data also implicate infection in remote sites in the aetiology of CHD. In this article we propose a key role for the proinflammatory cytokine interleukin-6 (IL-6) in several mechanisms that contribute to the development of CHD. IL-6 is a powerful inducer of the hepatic acute phase response. Elevated concentrations of acute phase reactants, such as C-reactive protein (CRP), are found in patients with acute coronary syndromes, and predict future risk in apparently healthy subjects. The acute phase reaction is associated with elevated levels of fibrinogen, a strong risk factor for CHD, with autocrine and paracrine activation of monocytes by IL-6 in the vessel wall contributing to the deposition of fibrinogen. The acute phase response is associated with increased blood viscosity, platelet number and activity. Furthermore, raised serum amyloid A lowers HDL-cholesterol levels. IL-6 decreases lipoprotein lipase (LPL) activity and monomeric LPL levels in plasma, which increases macrophage uptake of lipids. In fatty streaks and in the atheromatous 'cap' and 'shoulder' regions, macrophage foam cells and smooth muscle cells (SMC) express IL-6, suggesting a role for this cytokine along with interleukin-1 (IL-1) and tumour necrosis factor-alpha (TNF-alpha), in the progression of atherosclerosis. Both these cytokines induce the release of IL-6 from several cell types, including SMC. During vascular injury SMC are exposed to platelets or their products, and cytokine production by SMC further contributes to vascular damage. Furthermore, circulating IL-6 stimulates the hypothalamic-pituitary-adrenal (HPA) axis, activation of which is associated with central obesity, hypertension and insulin resistance. Thus we propose a role for IL-6 in the pathogenesis of CHD through a combination of autocrine, paracrine and endocrine mechanisms. This hypothesis lends itself to testing using interventions to influence IL-6 secretion and actions.
Is involvement in multiple roles beneficial for women's health or do the often noted health benefits of multiple roles reflect an ongoing process of role management? We address this question by looking at two roles, caregiving and employment, and by investigating changes in women's health as they move into and out of both roles. We examine changes in physical health limitations and psychological distress over a two-year period with data from a nationally representative sample of 2,929 late-midlife women. Looking first at health changes associated with caregiving, we find that psychological distress increases as women move into and continue caring for an ill or disabled person in their household. Caregiving has a weaker effect on physical health, but increases in physical limitations prompt exists from caregiving. Increases in physical limitations also appear to be greater for non-employed women, but some or all of this difference reflects selection out of the labor force for women having difficulty combining both roles. Our findings provide further evidence that care work has implications for women's health, while also suggesting a need for further attention to the ways that women actively manage problematic role combinations.
I have summarized in this article data on the magnitude of health challenges faced by men in the United States.
Across a broad range of indicators, men report poorer health than women. Although men in all socioeconomic groups are doing poorly in terms of health, some especially high-risk groups include men of low socioeconomic status (SES) of all racial/ethnic backgrounds, low-SES minority men, and middle-class Black men. Multiple factors contribute to the elevated health risks of men. These include economic marginality, adverse working conditions, and gendered coping responses to stress, each of which can lead to high levels of substance use, other health-damaging behaviors, and an aversion to health-protective behaviors.
The forces that adversely affect men’s health are interrelated, unfold over the life course, and are amenable to change.
This paper provides an overview of the conceptualization and methods used in the National Survey of American Life (NSAL). The objectives of the NSAL are to investigate the nature, severity, and impairment of mental disorders among national samples of the black and non-Hispanic white (n = 1,006) populations in the US, including African American (N = 3,570), and Afro-Caribbean (N = 1,623) immigrant and second and older generation, populations. National multi-stage probability methods were used in generating the samples and race/ethnic matching of interviewers and respondents were employed in the largely face-to-face interview, lasting on average 2 hours and 20 minutes. Two methodological approaches are described for addressing sampling coverage of individuals attached to, but not residing in, selected households at the time of the study. The paper also describes two approaches used to address concerns about the interpretations of standard symptom probe information in assessing serious mental disorders. This included a clinical reappraisal study designed to ascertain differences in symptom responding and ascertainment of cases (N = 677) in a subset of the same NSAL respondents. Finally, an abbreviated, novel method for estimating the prevalence of mental disorders in first-degree family members is described and the preliminary results from this new approach are reported.
This paper provides an overview of the probability sample designs and sampling methods for the Collaborative Psychiatric Epidemiology Studies (CPES): the National Comorbidity Survey Replication (NCS-R), the National Study of American Life (NSAL) and the National Latino and Asian American Study of Mental Health (NLAAS). The multi-stage sample design and respondent selection procedures used in these three studies are based on the University of Michigan Survey Research Center's National Sample designs and operations. The paper begins with a general overview of these designs and procedures and then turns to a more detailed discussion of the adaptation of these general methods to the three specific study designs. The detailed discussions of the individual study samples focus on design characteristics and outcomes that are important to analysts of the CPES data sets and to researchers and statisticians who are planning future studies. The paper describes how the expected survey cost and error structure for each of these surveys influenced the original design of the samples and how actual field experience led to changes and adaptations to arrive at the final samples of each survey population.
The objectives of the National Survey of American Life (NSAL) are to investigate the nature, severity, and impairment of mental disorders among national samples of the black and non-Hispanic white (n = 1,006) populations in the US. Special emphasis in the study is given to the nature of race and ethnicity within the black population by selecting and interviewing national samples of African-American (N = 3,570), and Afro-Caribbean (N = 1,623) immigrant and second and older generation populations. National multi-stage probability methods were used in generating the samples and race/ethnic matching of interviewers and respondents were used in the largely face-to-face interview, which lasted on average 2 hours and 20 minutes. The Diagnostic and Statistical Manual (DSM) IV World Mental Health Composite Interview (WHO-CIDI) was used to assess a wide range of serious mental disorders, potential risk and resilience factors, and help seeking and service use patterns. This paper provides an overview of the design of the NSAL, sample selection procedures, recruitment and training of the national interviewing team, and some of the special problems faced in interviewing ethnically and racially diverse national samples. Unique features of sample design, including special screening and listing procedures, interviewer training and supervision, and response rate outcomes are described.