Short- and long-term effects of imprisonment on future felony convictions and prison admissions.

A substantial contributor to prison admissions is the return of individuals recently released from prison, which has come to be known as prison's "revolving door." However, it is unclear whether being sentenced to prison itself has a causal effect on the probability of a subsequent return to prison or on criminal behavior. To examine the causal effect of being sentenced to prison on subsequent offending and reimprisonment, we leverage a natural experiment using the random assignment of judges with different propensities for sentencing offenders to prison. Drawing on data on all individuals sentenced for a felony in Michigan between 2003 and 2006, we compare individuals sentenced to prison to those sentenced to probation, taking into account sentence lengths and stratifying our analysis by race. Results show that being sentenced to prison rather than probation increases the probability of imprisonment in the first 3 years after release from prison by 18 percentage points among nonwhites and 19 percentage points among whites. Further results show that such effects are driven primarily by imprisonment for technical violations of community supervision rather than new felony convictions. This suggests that more stringent postprison parole supervision (relative to probation supervision) increases imprisonment through the detection and punishment of low-level offending or violation behavior. Such behavior would not otherwise result in imprisonment for someone who had not already been to prison or who was not on parole. These results demonstrate that the revolving door of prison is in part an effect of the nature of postprison supervision.

Trajectories of neighborhood attainment after prison.

A potentially important but understudied aspect of prisoner reentry is the neighborhood environments experienced by formerly incarcerated people. We know that many formerly incarcerated people return to very disadvantaged neighborhood environments and that returning to disadvantaged neighborhoods after prison increases the risk of recidivism and reduces employment. Yet very little is known about the social, economic, and institutional processes that sort formerly incarcerated people into different neighborhoods after release or their trajectories of neighborhood attainment over time. Motivated by a conceptualization of prisoner reentry and reintegration as a process that unfolds over time, we examine trajectories of neighborhood environments after release. Motivated by the literature on neighborhood attainment, social capital, and the role of criminal justice institutions in structuring the lives of former prisoners, we examine sources of variation in neighborhood attainment. We use administrative data from the Michigan Department of Corrections on formerly incarcerated people paroled in 2003 and followed for two years after release. Descriptive results from a latent class trajectory model show that most white and black formerly incarcerated people experience flat trajectories, with little upward or downward residential mobility over time. Findings from multi-level growth curve models suggest that institutional factors are particularly important for the neighborhood attainment of whites, while human capital and social ties are particularly important for blacks. Among both blacks and whites, pre-prison and first post-prison neighborhood conditions exhibit a strong association with post-prison neighborhood attainment, although these associations are larger for blacks than whites.

Health Insurance Trends and Access to Behavioral Healthcare Among Justice-Involved Individuals-United States, 2008-2014.

BACKGROUND: A large proportion of justice-involved individuals have mental health issues and substance use disorders (SUD) that are often untreated due to high rates of uninsurance. However, roughly half of justice-involved individuals were estimated to be newly eligible for health insurance through the Affordable Care Act (ACA). OBJECTIVE: We aimed to assess health insurance trends among justice-involved individuals before and after implementation of the ACA's key provisions, the dependent coverage mandate and Medicaid expansion, and to examine the relationship between health insurance and treatment for behavioral health conditions. DESIGN: Repeated and pooled cross-sectional analyses of data from the National Survey on Drug Use and Health (NSDUH). PARTICIPANTS: Nationally representative sample of 15,899 adults age 19-64 years between 2008 and 2014 with a history of justice involvement during the prior 12 months. MAIN MEASURES: Uninsurance rates between 2008 and 2014 are reported. Additional outcomes include adjusted treatment rates for depression, serious mental illness, and SUD by insurance status. KEY RESULTS: The dependent coverage mandate was associated with a 13.0 percentage point decline in uninsurance among justice-involved individuals age 19-25 years (p < 0.001). Following Medicaid expansion, uninsurance declined among justice involved individuals of all ages by 9.7 percentage points (p < 0.001), but remained 16.3 percentage points higher than uninsurance rates for individuals without justice involvement (p < 0.001). In pooled analyses, Medicaid, relative to uninsurance and private insurance, was associated with significantly higher treatment rates for illicit drug abuse/dependence and depression. CONCLUSION: Given the high prevalence of mental illness and substance use disorders among justice-involved populations, persistently elevated rates of uninsurance and other barriers to care remain a significant public health concern. Sustained outreach is required to reduce health insurance disparities between individuals with and without justice involvement. Public insurance appears to be associated with higher treatment rates, relative to uninsurance and private insurance, among justice-involved individuals.

Contextualizing nativity status, Latino social ties, and ethnic enclaves: an examination of the 'immigrant social ties hypothesis'.

OBJECTIVES: Researchers have posited that one potential explanation for the better-than-expected health outcomes observed among some Latino immigrants, vis-à-vis their US-born counterparts, may be the strength of social ties and social support among immigrants. METHODS: We examined the association between nativity status and social ties using data from the Chicago Community Adult Health Study's Latino subsample, which includes Mexicans, Puerto Ricans, and other Latinos. First, we used ordinary least squares (OLS) regression methods to model the effect of nativity status on five outcomes: informal social integration; social network diversity; network size; instrumental support; and informational support. Using multilevel mixed-effects regression models, we estimated the association between Latino/immigrant neighborhood composition and our outcomes, and whether these relationships varied by nativity status. Lastly, we examined the relationship between social ties and immigrants' length of time in the USA. RESULTS: After controlling for individual-level characteristics, immigrant Latinos had significantly lower levels of social ties than their US-born counterparts for all the outcomes, except informational support. Latino/immigrant neighborhood composition was positively associated with being socially integrated and having larger and more diverse social networks. The associations between two of our outcomes (informal social integration and network size) and living in a neighborhood with greater concentrations of Latinos and immigrants were stronger for US-born Latinos than for immigrant Latinos. US-born Latinos maintained a significant social ties advantage over immigrants - regardless of length of time in the USA - for informal social integration, network diversity, and network size. CONCLUSION: At the individual level, our findings challenge the assumption that Latino immigrants would have larger networks and/or higher levels of support and social integration than their US-born counterparts. Our study underscores the importance of understanding the contexts that promote the development of social ties. We discuss the implications of these findings for understanding Latino and immigrant social ties and health outcomes.

Home is Hard to Find: Neighborhoods, Institutions, and the Residential Trajectories of Returning Prisoners.

Poor urban communities experience high rates of incarceration and prisoner reentry. This paper examines the residences where former prisoners live after prison, focusing on returns to pre-prison social environments, residential mobility, and the role of intermediate sanctions. Drawing on a unique dataset that follows a cohort of Michigan parolees released in 2003 over time using administrative records, we examine returns to pre-prison environments, both immediately after prison and in the months and years after release. We then investigate the role of intermediate sanctions - punishments for parole violations that are less severe than returning to prison - in residential mobility among parolees. Our results show low rates of return to former neighborhoods and high rates of residential mobility after prison, a significant portion of which is driven by intermediate sanctions resulting from criminal justice system supervision. These results suggest that, through parole supervision, the criminal justice system generates significant residential mobility.

MICEAL Black and Latinx Perspectives on COVID-19 Vaccination: A Mixed-Methods Examination.

OBJECTIVES: To describe the differences and similarities in perceptions and attitudes regarding COVID-19 vaccination among Black and Latinx Michiganders. METHODS: Utilizing a convergent mixed-methods approach, forty interviews were conducted with 24 Black and 16 Latinx community members between December 2020 and June 2021 across four Michigan counties disproportionately affected by COVID-19. Survey data were collected from a representative sample of 1598 individuals living in Detroit between January and March 2021. RESULTS: Vaccine hesitancy was a more prevalent theme among Black interview participants than Latinx participants. Trust in experts and vaccine access were significantly more influential in the decision to vaccinate for Latinx residents compared to Black residents. Latinx individuals reported greater intention to receive a COVID-19 vaccine compared to Black respondents. Multinomial logit models revealed that 30% of Black participants expressed hesitancy about the COVID-19 vaccine compared to 10% of Latinx respondents. CONCLUSIONS AND IMPLICATIONS: This study provides a deeper understanding of key differences and similarities in vaccine acceptance/hesitancy across race/ethnicity. The findings can enhance health interventions and outcomes by informing the development of culturally responsive practices tailored to specific communities.

Reducing violence by transforming neighborhoods: a natural experiment in Medellín, Colombia.

Neighborhood-level interventions provide an opportunity to better understand the impact that neighborhoods have on health. In 2004, municipal authorities in Medellín, Colombia, built a public transit system to connect isolated low-income neighborhoods to the city's urban center. Transit-oriented development was accompanied by municipal investment in neighborhood infrastructure. In this study, the authors examined the effects of this exogenous change in the built environment on violence. Neighborhood conditions and violence were assessed in intervention neighborhoods (n = 25) and comparable control neighborhoods (n = 23) before (2003) and after (2008) completion of the transit project, using a longitudinal sample of 466 residents and homicide records from the Office of the Public Prosecutor. Baseline differences between these groups were of the same magnitude as random assignment of neighborhoods would have generated, and differences that remained after propensity score matching closely resembled imbalances produced by paired randomization. Permutation tests were used to estimate differential change in the outcomes of interest in intervention neighborhoods versus control neighborhoods. The decline in the homicide rate was 66% greater in intervention neighborhoods than in control neighborhoods (rate ratio = 0.33, 95% confidence interval: 0.18, 0.61), and resident reports of violence decreased 75% more in intervention neighborhoods (odds ratio = 0.25, 95% confidence interval 0.11, 0.67). These results show that interventions in neighborhood physical infrastructure can reduce violence.

Variations in hypertension-related outcomes among Blacks, Whites and Hispanics in two large urban areas and in the United States.

OBJECTIVE: This study compared the hypertension prevalence, awareness, treatment and control in Chicago, Illinois and Detroit, Michigan to that of the general United States population (aged > or = 25 years) for the period 2001-2003. We examined whether and how much 1) urban populations have less favorable hypertension-related outcomes and 2) the rates of racial/ethnic minorities lag behind those of Whites in order to determine if the national data understate the magnitude of hypertension-related outcomes and racial/ethnic disparities in two large cities in the Midwestern region of the United States and perhaps others. METHODS: Unstandardized and standardized hypertension-related outcome rates were estimated. RESULTS: The hypertension-related outcomes among Chicago and Detroit residents lag behind the United States by 8%-14% and 10%-18% points, respectively. Additionally, this study highlights the complexity of the racial/ethnic differences in hypertension-related outcomes, where within each population, Blacks were more likely to have hypertension and to be aware of their hypertension status than Whites, and no less likely to be treated. Conversely, Hispanics were less likely to have hypertension and also less likely to be aware of their status when they do have hypertension when compared to Whites. CONCLUSION: At a time when efficacious treatment for hypertension has been available for more than 50 years, continued racial/ethnic differences in the prevalence, awareness, treatment and control of hypertension is among public health's greatest challenges. To achieve the proposed national hypertension-related goals, future policies must consider the social context of hypertension within central cities of urban areas.

Neighborhood context and social disparities in cumulative biological risk factors.

OBJECTIVE: This study examines the role of neighborhood context in the accumulation of biological risk factors and racial/ethnic and socioeconomic disparities. METHODS: Data came from face-to-face interviews and blood sample collection on a probability sample of adults (n = 549) in the 2002 Chicago Community Adult Health Study. Following the approach of prior studies, we constructed an index of cumulative biological risk (CBR) by counting how many of eight biomarkers exceeded clinically defined criteria for "high risk": systolic and diastolic blood pressure, resting heart rate, hemoglobin A(1c), C-reactive protein, waist size, and total and high-density lipoprotein cholesterol. Data are presented as incidence rate ratios (IRRs) based on generalized linear models with a Poisson link function and population-average estimates with robust standard errors. RESULTS: Non-Hispanic blacks (n = 200), Hispanics (n = 149), and people with low (n = 134) and moderate (n = 275) level of education had significantly higher numbers of biological risks than their respective reference groups (IRR = 1.48, 1.59, 1.62, and 1.48, respectively, with p < .01). Black-white (p < .001) and Hispanic-white (p < .003) disparities in CBR remained significant after adjusting for individual-level socioeconomic position and behavioral factors, whereas individual-level controls substantially diminished the low/high (p < .069) and moderate/high (p < .042) educational differences. Estimating "within-neighborhood" disparities to adjust for neighborhood context fully explained the black-white gap in CBR (p < .542) and reduced the Hispanic-white gap to borderline significance (p < .053). Neighborhood affluence predicted lower levels of CBR (IRR = 0.82, p < .027), but neighborhood disadvantage was not significantly associated with CBR (IRR = 1.00, p < .948). CONCLUSIONS: Neighborhood environments seem to play a pivotal role in the accumulation of biological risk and disparities therein.

Language of interview, self-rated health, and the other Latino health puzzle.

OBJECTIVES: We investigated whether the conventional Spanish translation of the self-rated health survey question helps explain why Latinos' self-rated health is worse than Whites' despite more objective health measures showing them to be as healthy as or healthier than are Whites. METHODS: We analyzed the relationship between language of interview and self-rated health in the Chicago Community Adult Health Study (2001-2003) and the 2003 Behavioral Risk Factor Surveillance System. RESULTS: Being interviewed in Spanish was associated with significantly higher odds of rating health as fair or poor in both data sets. Moreover, adjusting for language of interview substantially reduced the gap between Whites and Latinos. Spanish-language interviewees were more likely to rate their health as fair (regular in Spanish) than as any other choice, and this preference was strongest when compared with categories representing better health (good, very good, and excellent). CONCLUSIONS: Our findings suggest that translation of the English word "fair" to regular induces Spanish-language respondents to report poorer health than they would in English. Self-rated health should be interpreted with caution, especially in racial/ethnic comparisons, and research should explore alternative translations.

Effect of vaccine effectiveness and safety on COVID-19 vaccine acceptance in Detroit, Michigan, July 2020.

This study examined whether future COVID-19 vaccine acceptance differed based on an experimental manipulation of the vaccine safety and effectiveness profile. Data come from the Detroit Metro Area Community Study, a population-based study conducted July 15-20, 2020. Participants were asked whether they would get a new COVID-19 vaccine after being randomly assigned information about the vaccine's effectiveness (50% or 95%) and chance of fever (5% or 20%). Among 1,117 Detroiters, 51.3% would accept a COVID-19 vaccine that is 50% effective and 77.1% would accept a vaccine that is 95% effective. Women and adults ≥65 were more accepting of a vaccine; Black Detroiters were less accepting. Believing vaccines to be important, effective, and safe was associated with higher acceptance. Uptake of a COVID-19 may be limited, depending on perceived vaccine effectiveness and general attitudes toward vaccines. Public health approaches to modifying these attitudes will be especially important in the Black community.

Mediators of Racial Differences in COVID-19 Vaccine Acceptance and Uptake: A Cohort Study in Detroit, MI.

Despite their disparate rates of infection and mortality, many communities of color report high levels of vaccine hesitancy. This paper describes racial differences in COVID-19 vaccine uptake in Detroit, and assesses, using a mediation model, how individuals' personal experiences with COVID-19 and trust in authorities mediate racial disparities in vaccination acceptance. The Detroit Metro Area Communities Study (DMACS) is a panel survey of a representative sample of Detroit residents. There were 1012 respondents in the October 2020 wave, of which 856 (83%) were followed up in June 2021. We model the impact of race and ethnicity on vaccination uptake using multivariable logistic regression, and report mediation through direct experiences with COVID as well as trust in government and in healthcare providers. Within Detroit, only 58% of Non-Hispanic (NH) Black residents were vaccinated, compared to 82% of Non-Hispanic white Detroiters, 50% of Hispanic Detroiters, and 52% of other racial/ethnic groups. Trust in healthcare providers and experiences with friends and family dying from COVID-19 varied significantly by race/ethnicity. The mediation analysis reveals that 23% of the differences in vaccine uptake by race could be eliminated if NH Black Detroiters were to have levels of trust in healthcare providers similar to those among NH white Detroiters. Our analyses suggest that efforts to improve relationships among healthcare providers and NH Black communities in Detroit are critical to overcoming local COVID-19 vaccine hesitancy. Increased study of and intervention in these communities is critical to building trust and managing widespread health crises.

Measurement of the local food environment: a comparison of existing data sources.

Studying the relation between the residential environment and health requires valid, reliable, and cost-effective methods to collect data on residential environments. This 2002 study compared the level of agreement between measures of the presence of neighborhood businesses drawn from 2 common sources of data used for research on the built environment and health: listings of businesses from commercial databases and direct observations of city blocks by raters. Kappa statistics were calculated for 6 types of businesses-drugstores, liquor stores, bars, convenience stores, restaurants, and grocers-located on 1,663 city blocks in Chicago, Illinois. Logistic regressions estimated whether disagreement between measurement methods was systematically correlated with the socioeconomic and demographic characteristics of neighborhoods. Levels of agreement between the 2 sources were relatively high, with significant (P < 0.001) kappa statistics for each business type ranging from 0.32 to 0.70. Most business types were more likely to be reported by direct observations than in the commercial database listings. Disagreement between the 2 sources was not significantly correlated with the socioeconomic and demographic characteristics of neighborhoods. Results suggest that researchers should have reasonable confidence using whichever method (or combination of methods) is most cost-effective and theoretically appropriate for their research design.

The association of criminal justice supervision setting with overdose mortality: a longitudinal cohort study.

BACKGROUND AND AIMS: Despite the high prevalence of substance use among people in the US criminal justice system, little is known about the incidence of overdose mortality by use patterns, drug convictions and supervision setting. We examined the associations between these characteristics and overdose mortality. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Individuals sentenced to prison, jail, probation or jail plus probation for a felony conviction in Michigan, USA from 2003 to 2006. MEASUREMENTS: Using the National Death Index, we assessed overdose mortality to December 2012. We calculated overdose mortality rates by pre-sentence opioid use, drug convictions and supervision setting. Multivariable analyses were conducted using competing risks regression with time-varying covariates. FINDINGS: Among 140 266 individuals followed over a mean of 7.84 years [standard deviation (SD) = 1.52], 14.9% of the 1131 deaths were due to overdose (102.8 per 100 000 person-years). Over the follow-up, more than half of overdose deaths occurred in the community (57.7%), nearly a third (28.8%) on probation and 12.8% on parole. The adjusted risk of overdose death was lower on probation [hazard ratio (HR) = 0.71, 95% confidence interval (CI) = 0.60, 0.85] than in the community without probation or parole (HR = 1.00) but not significantly different on parole (HR = 1.13, 95% CI = 0.87, 1.47). Pre-sentence daily opioid use (HR = 3.54, 95% CI = 3.24, 3.87) was associated with an increased risk. Drug possession (HR = 1.11, 95% CI = 0.93, 1.31) and delivery convictions (HR = 0.92, 95% CI = 0.77, 1.09) were not significantly associated with overdose mortality. CONCLUSIONS: Based on the absolute or relative risk, parole, probation and community settings are appropriate settings for enhanced overdose prevention interventions. Ensuring that individuals with pre-sentence opioid use have access to harm reduction and drug treatment services may help to prevent overdose among people involved with the criminal justice system.

Author Correction: A natural experiment study of the effects of imprisonment on violence in the community.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

A natural experiment study of the effects of imprisonment on violence in the community.

One of the goals of imprisonment is to reduce violence1. Although imprisonment has risen dramatically since the 1970s, its effects on future violent crime are poorly understood2. This study's objective was to examine the effect of imprisonment on violent crime in the community among individuals on the policy margin between prison and probation sentences. Drawing on data from a population-based cohort of individuals convicted of a felony in Michigan between 2003 and 2006 (n = 111,110) and followed through June 2015, we compared the rates of commission of violent crime committed by individuals sentenced to prison with those of individuals sentenced to probation using a natural experiment based on the random assignment of judges to criminal cases. Being sentenced to prison had no significant effects on arrests or convictions for violent crimes after release from prison, but imprisonment modestly reduced the probability of violence if comparisons included the effects of incapacitation during imprisonment. These results suggest that for individuals on the current policy margin between prison and probation, imprisonment is an ineffective long-term intervention for violence prevention, as it has, on balance, no rehabilitative or deterrent effects after release.

Mobility disability and the urban built environment.

Research on the effects of the built environment in the pathway from impairment to disability has been largely absent. Using data from the Chicago Community Adult Health Study (2001-2003), the authors examined the effect of built environment characteristics on mobility disability among adults aged 45 or more years (n = 1,195) according to their level of lower extremity physical impairment. Built environment characteristics were assessed by using systematic social observation to independently rate street and sidewalk quality in the block surrounding each respondent's residence in the city of Chicago (Illinois). Using multinomial logistic regression, the authors found that street conditions had no effect on outdoor mobility among adults with only mild or no physical impairment. However, among adults with more severe impairment in neuromuscular and movement-related functions, the difference in the odd ratios for reporting severe mobility disability was over four times greater when at least one street was in fair or poor condition (characterized by cracks, potholes, or broken curbs). When all streets were in good condition, the odds of reporting mobility disability were attenuated in those with lower extremity impairment. If street quality could be improved, even somewhat, for those adults at greatest risk for disability in outdoor mobility, the disablement process could be slowed or even reversed.

Neighborhood characteristics and hypertension.

BACKGROUND: : The goal of this study was to investigate cross-sectional associations between features of neighborhoods and hypertension and to examine the sensitivity of results to various methods of estimating neighborhood conditions. METHODS: : We used data from the Multi-Ethnic Study of Atherosclerosis on 2612 individuals 45-85 years of age. Hypertension was defined as systolic blood pressure above 140 mm Hg, diastolic pressure above 90 mm Hg, or use of antihypertensive medications. Neighborhood (census tract) conditions potentially related to hypertension (walking environment, availability of healthy foods, safety, social cohesion) were measured using information from a separate phone survey conducted in the study neighborhoods. For each neighborhood we estimated scale scores by aggregating residents' responses using simple aggregation (crude means) and empirical Bayes estimation (unconditional, conditional, and spatial). These estimates of neighborhood conditions were linked to each study participant based on the census tract of residence. Two-level binomial regression methods were used to estimate adjusted associations between neighborhood conditions and hypertension. RESULTS: : Residents of neighborhoods with better walkability, availability of healthy foods, greater safety, and more social cohesion were less likely to be hypertensive (relative prevalence [95% confidence interval] for 90th vs. 10th percentile of conditional empirical Bayes estimate = 0.75 [0.64-0.88], 0.72 [0.61-0.85], 0.74 [0.63-0.86], and 0.69 [0.57-0.83]), respectively, after adjusting for site, age, sex, income, and education. Associations were attenuated and often disappeared after additional adjustments for race/ethnicity. CONCLUSION: : Neighborhood walkability, food availability, safety, and social cohesion may be mechanisms that link neighborhoods to hypertension.

Understanding social disparities in hypertension prevalence, awareness, treatment, and control: the role of neighborhood context.

The spatial segregation of the US population by socioeconomic position and especially race/ethnicity suggests that the social contexts or "neighborhoods" in which people live may substantially contribute to social disparities in hypertension. The Chicago Community Adult Health Study did face-to-face interviews, including direct measurement of blood pressure, with a representative probability sample of adults in Chicago. These data were used to estimate socioeconomic and racial-ethnic disparities in the prevalence, awareness, treatment, and control of hypertension, and to analyze how these disparities are related to the areas in which people live. Hypertension was significantly negatively associated with neighborhood affluence/gentrification, and adjustments for context eliminated the highly significant disparity between blacks/African-Americans and whites, and reduced the significant educational disparity by 10-15% to borderline statistical significance. Awareness of hypertension was significantly higher in more disadvantaged neighborhoods and in places with higher concentrations of blacks (and lower concentrations of Hispanics and immigrants). Adjustment for context completely eliminated blacks' greater awareness, but slightly accentuated the lesser awareness of Hispanics and the greater levels of awareness among the less educated. There was no consistent evidence of either social disparities in or contextual associations with treatment of hypertension, given awareness. Among those on medication, blacks were only 40-50% as likely as whites to have their hypertension controlled, but context played little or no role in either the level of or disparities in control of hypertension. In sum, residential contexts potentially play a large role in accounting for racial/ethnic and, to a lesser degree, socioeconomic disparities in hypertension prevalence and, in a different way, awareness, but not in treatment or control of diagnosed hypertension.