Clustering of health burdens in solitary confinement: A mixed-methods approach.

Research on the mental health consequences of solitary confinement has contributed to restrictions on its use, particularly for people with serious mental illness. However, solitary confinement continues to isolate people with physical and mental health problems, even where its use has been restricted. This mixed-methods analysis seeks to evaluate the practice of solitary confinement on mental and physical health using data from a sample of 99 men in Pennsylvania. We first describe patterns of multimorbidity among men in solitary confinement using a latent class analysis to group individuals with shared demographic attributes and mental and physical health conditions. We then use thematic analysis to explore how men from each of these groups experienced and managed health concerns in solitary confinement. Our findings describe significant physical and mental health burdens and unmet healthcare needs. Over three-quarters of respondents reported a physical health diagnosis such as heart disease or diabetes, and over half reported a mental health diagnosis, including anxiety, depression, and schizophrenia. Those with pre-existing, often multiple, health issues struggled to maintain their health given restrictions to daily living, isolated idle time, and limited healthcare access in solitary confinement. These aspects of solitary confinement also challenged those who entered solitary in relatively good health. These findings demonstrate the struggle for self-advocacy in maintaining health and healthcare access under extreme conditions of confinement and point to the need to prevent the health harms of solitary confinement by further restricting its use.

The population prevalence of solitary confinement.

Solitary confinement is a severe form of incarceration closely associated with long-lasting psychological harm and poor post-release outcomes. Estimating the population prevalence, we find that 11% of all black men in Pennsylvania, born 1986 to 1989, were incarcerated in solitary confinement by age 32. Reflecting large racial disparities, the population prevalence is only 3.4% for Latinos and 1.4% for white men. About 9% of black men in the state cohort were held in solitary for more than 15 consecutive days, violating the United Nations standards for minimum treatment of incarcerated people. Nearly 1 in 100 black men experienced solitary for a year or longer by age 32. Racial disparities are similar for women, but rates are lower. A decomposition shows that black men's high risk of solitary confinement stems primarily from their high imprisonment rate. Findings suggest that harsh conditions of U.S. incarceration have population-level effects on black men's well-being.

The cumulative risk of jail incarceration.

Research on incarceration has focused on prisons, but jail detention is far more common than imprisonment. Jails are local institutions that detain people before trial or incarcerate them for short sentences for low-level offenses. Research from the 1970s and 1980s viewed jails as "managing the rabble," a small and deeply disadvantaged segment of urban populations that struggled with problems of addiction, mental illness, and homelessness. The 1990s and 2000s marked a period of mass criminalization in which new styles of policing and court processing produced large numbers of criminal cases for minor crimes, concentrated in low-income communities of color. In a period of widespread criminal justice contact for minor offenses, how common is jail incarceration for minority men, particularly in poor neighborhoods? We estimate cumulative risks of jail incarceration with an administrative data file that records all jail admissions and discharges in New York City from 2008 to 2017. Although New York has a low jail incarceration rate, we find that 26.8% of Black men and 16.2% of Latino men, in contrast to only 3% of White men, in New York have been jailed by age 38 y. We also find evidence of high rates of repeated incarceration among Black men and high incarceration risks in high-poverty neighborhoods. Despite the jail's great reach in New York, we also find that the incarcerated population declined in the study period, producing a large reduction in the prevalence of jail incarceration for Black and Latino men.

Drug use in the year after prison.

With poor health and widespread drug problems in the U.S. prison population, post-prison drug use provides an important measure of both public health and social integration following incarceration. We study the correlates of drug use with data from the Boston Reentry Study (BRS), a survey of men and women interviewed four times over the year after prison release. The BRS data allow an analysis of legal and illegal drug use, and the correlation between them. We find that illegal drug use is associated with histories of drug problems and childhood trauma. Use of medications is associated with poor physical health and a history of mental illness. Legal and illegal drug use are not strongly correlated. Results suggest that in a Medicaid expansion state where health coverage is widely provided to people leaving prison, formerly-incarcerated men and women use medications, not illegal drugs, to address their health needs.

Social capital in the creation of cultural capital: Family structure, neighborhood cohesion, and extracurricular participation.

Past research has found that participation in extracurricular activities helps develop children's cultural capital that is crucial to both education and career successes. Previous studies have examined various determinants of extracurricular participation, but mostly focused on social class, demographics, and school characteristics. In this paper we renew the Coleman tradition by putting social capital (as measured by family structure and neighborhood cohesion) in the spotlight and studying the effect of social capital on youth participation in organized extracurricular activities. By using longitudinal data from the 2004 panel of the Survey of Income and Program Participation of representative households in the U.S. and conducting various robust statistical analyses, we provide updated results on the subject. We find that a two-parent household (especially in relative to households with cohabiting parents) and neighborhood cohesion (i.e., a set of cohesive relationships among parents in the neighborhood) both have a positive and significant association with extracurricular participation. We also find such associations vary somewhat by child's sex, age, race, and the type of extracurricular activity. We conclude that to equalize children's participation in extracurricular activities future social policies should consider interventions that target low-income families and families with single-parent or cohabiting parents, that can improve neighborhood cohesion, and that are tailored by the type of extracurricular activity.

Formerly Incarcerated Parents and Their Children.

The negative effects of incarceration on child well-being are often linked to the economic insecurity of formerly incarcerated parents. Researchers caution, however, that the effects of parental incarceration may be small in the presence of multiple-partner fertility and other family complexity. Despite these claims, few studies have directly observed either economic insecurity or the full extent of family complexity. We study parent-child relationships with a unique data set that includes detailed information about economic insecurity and family complexity among parents just released from prison. We find that stable private housing, more than income, is associated with close and regular contact between parents and children. Formerly incarcerated parents see their children less regularly in contexts of multiple-partner fertility and in the absence of supportive family relationships. Significant housing and family effects are estimated even after we control for drug use and crime, which are themselves negatively related to parental contact. The findings point to the constraints of material insecurity and the complexity of family relationships on the contact between formerly incarcerated parents and their children.

Study retention as bias reduction in a hard-to-reach population.

Collecting data from hard-to-reach populations is a key challenge for research on poverty and other forms of extreme disadvantage. With data from the Boston Reentry Study (BRS), we document the extreme marginality of released prisoners and the related difficulties of study retention and analysis. Analysis of the BRS data yields three findings. First, released prisoners show high levels of "contact insecurity," correlated with social insecurity, in which residential addresses and contact information change frequently. Second, strategies for data collection are available to sustain very high rates of study participation. Third, survey nonresponse in highly marginal populations is strongly nonignorable, closely related to social and economic vulnerability. The BRS response rate of 94% over a 1-y follow-up period allows analysis of hypothetically high nonresponse rates. In this setting, nonresponse attenuates regression estimates in analyses of housing insecurity, drug use, and unemployment. These results suggest that in the analysis of very poor and disadvantaged populations, methods that maximize study participation reduce bias and yield data that can usefully supplement large-scale household or administrative data collections.

Trends in Income Insecurity Among U.S. Children, 1984-2010.

Has income insecurity increased among U.S. children with the emergence of an employment-based safety net and the polarization of labor markets and family structure? We study the trend in insecurity from 1984-2010 by analyzing fluctuations in children's monthly family incomes in the Survey of Income and Program Participation. Going beyond earlier research on income volatility, we examine income insecurity more directly by analyzing income gains and losses separately and by relating them to changes in family composition and employment. The analysis provides new evidence of increased income insecurity by showing that large income losses increased more than large income gains for low-income children. Nearly one-half the increase in extreme income losses is related to trends in single parenthood and parental employment. Large income losses proliferated with the increased incidence of very low incomes (less than $150 per month). Extreme income losses and very low monthly incomes became more common particularly for U.S. children of nonworking single parents from the mid-1990s.

Stress and Hardship after Prison.

The historic increase in U.S. incarceration rates made the transition from prison to community common for poor, prime-age men and women. Leaving prison presents the challenge of social integration--of connecting with family and finding housing and a means of subsistence. The authors study variation in social integration in the first months after prison release with data from the Boston Reentry Study, a unique panel survey of 122 newly released prisoners. The data indicate severe material hardship immediately after incarceration. Over half of sample respondents were unemployed, two-thirds received public assistance, and many relied on female relatives for financial support and housing. Older respondents and those with histories of addiction and mental illness were the least socially integrated, with weak family ties, unstable housing, and low levels of employment. Qualitative interviews show that anxiety and feelings of isolation accompanied extreme material insecurity. Material insecurity combined with the adjustment to social life outside prison creates a stress of transition that burdens social relationships in high-incarceration communities.

How health care reform can transform the health of criminal justice-involved individuals.

Provisions of the Affordable Care Act offer new opportunities to apply a public health and medical perspective to the complex relationship between involvement in the criminal justice system and the existence of fundamental health disparities. Incarceration can cause harm to individual and community health, but prisons and jails also hold enormous potential to play an active and beneficial role in the health care system and, ultimately, to improving health. Traditionally, incarcerated populations have been incorrectly viewed as isolated and self-contained communities with only peripheral importance to the public health at large. This misconception has resulted in missed opportunities to positively affect the health of both the individuals and the imprisoned community as a whole and potentially to mitigate risk behaviors that may contribute to incarceration. Both community and correctional health care professionals can capitalize on these opportunities by working together to advocate for the health of the criminal justice-involved population and their communities. We present a set of recommendations for the improvement of both correctional health care, such as improving systems of external oversight and quality management, and access to community-based care, including establishing strategies for postrelease care and medical record transfers.

Identifying Discrimination at Work: The Use of Field Experiments.

Antidiscrimination law offers protection to workers who have been treated unfairly on the basis of their race, gender, religion, or national origin. In order for these protections to be invoked, however, potential plaintiffs must be aware of and able to document discriminatory treatment. Given the subtlety of contemporary forms of discrimination, it is often difficult to identify discrimination when it has taken place. The methodology of field experiments offers one approach to measuring and detecting hiring discrimination, providing direct observation of discrimination in real-world settings. In this article, we discuss the findings of two recent field experiments measuring racial discrimination in low wage labor markets. This research provides several relevant findings for researchers and those interested in civil rights enforcement: (1) it produces estimates of the rate of discrimination at the point of hire; (2) it yields evidence about the interactions associated with discrimination (many of which reveal the subtlety with which contemporary discrimination is practiced); and (3) it provides a vehicle for both research on and enforcement of antidiscrimination law.

Paternal incarceration and support for children in fragile families.

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.

Incarceration in fragile families.

Since the mid-1970s the U.S. imprisonment rate has increased roughly fivefold. As Christopher Wildeman and Bruce Western explain, the effects of this sea change in the imprisonment rate--commonly called mass imprisonment or the prison boom--have been concentrated among those most likely to form fragile families: poor and minority men with little schooling. Imprisonment diminishes the earnings of adult men, compromises their health, reduces familial resources, and contributes to family breakup. It also adds to the deficits of poor children, thus ensuring that the effects of imprisonment on inequality are transferred intergenerationally. Perversely, incarceration has its most corrosive effects on families whose fathers were involved in neither domestic violence nor violent crime before being imprisoned. Because having a parent go to prison is now so common for poor, minority children and so negatively affects them, the authors argue that mass imprisonment may increase future racial and class inequality--and may even lead to more crime in the long-term, thereby undoing any benefits of the prison boom. U.S. crime policy has thus, in the name of public safety, produced more vulnerable families and reduced the life chances of their children. Wildeman and Western advocate several policy reforms, such as limiting prison time for drug offenders and for parolees who violate the technical conditions of their parole, reconsidering sentence enhancements for repeat offenders, and expanding supports for prisoners and ex-prisoners. But Wildeman and Western argue that criminal justice reform alone will not solve the problems of school failure, joblessness, untreated addiction, and mental illness that pave the way to prison. In fact, focusing solely on criminal justice reforms would repeat the mistakes the nation made during the prison boom: trying to solve deep social problems with criminal justice policies. Addressing those broad problems, they say, requires a greater social commitment to education, public health, and the employment opportunities of low-skilled men and women. The primary sources of order and stability--public safety in its wide sense--are the informal social controls of family and work. Thus, broad social policies hold the promise not only of improving the wellbeing of fragile families, but also, by strengthening families and providing jobs, of contributing to public safety.

Sequencing Disadvantage: Barriers to Employment Facing Young Black and White Men with Criminal Records.

In this article, the authors report the results of a large-scale field experiment conducted in New York City investigating the effects of race and a prison record on employment. Teams of black and white men were matched and sent to apply for low-wage jobs throughout the city, presenting equivalent resumés and differing only in their race and criminal background. The authors find a significant negative effect of a criminal record on employment outcomes that appears substantially larger for African Americans. The sequence of interactions preceding hiring decisions suggests that black applicants are less often invited to interview, thereby providing fewer opportunities to establish rapport with the employer. Furthermore, employers' general reluctance to discuss the criminal record of an applicant appears especially harmful for black ex-offenders. Overall, these results point to the importance of rapport-building for finding work, something that the stigmatizing characteristics of minority and criminal status make more difficult to achieve.

Discrimination in a Low-Wage Labor Market: A Field Experiment.

Decades of racial progress have led some researchers and policymakers to doubt that discrimination remains an important cause of economic inequality. To study contemporary discrimination, we conducted a field experiment in the low-wage labor market of New York City, recruiting white, black, and Latino job applicants who were matched on demographic characteristics and interpersonal skills. These applicants were given equivalent résumés and sent to apply in tandem for hundreds of entry-level jobs. Our results show that black applicants were half as likely as equally qualified whites to receive a callback or job offer. In fact, black and Latino applicants with clean backgrounds fared no better than white applicants just released from prison. Additional qualitative evidence from our applicants' experiences further illustrates the multiple points at which employment trajectories can be deflected by various forms of racial bias. These results point to the subtle yet systematic forms of discrimination that continue to shape employment opportunities for low-wage workers.