Policy solutions to eliminate racial and ethnic child health disparities in the USA.

Societal systems act individually and in combination to create and perpetuate structural racism through both policies and practices at the local, state, and federal levels, which, in turn, generate racial and ethnic health disparities. Both current and historical policy approaches across multiple sectors-including housing, employment, health insurance, immigration, and criminal legal-have the potential to affect child health equity. Such policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. Policy efforts that do not directly address structural racism will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism. In Paper 2 of this Series, we build on Paper 1's summary of existing disparities in health-care delivery and highlight policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improve the health of racially and ethnically minoritised children.

Facilitators and barriers to COVID-19 vaccination among incarcerated people and staff in three large, state prisons: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic has disproportionately impacted individuals in carceral facilities - both incarcerated people and staff. Vaccination is an important tool in reducing the risk of COVID-19 infection, hospitalization, and death. While the importance of promoting vaccination is clear, there are considerable barriers to doing so. This study aims to better understand: (1) why individuals chose to receive the COVID-19 vaccine; (2) why individuals were hesitant to vaccinate; (3) what motivators might influence a person's decision to get vaccinated; and (4) what sources of information about COVID-19 vaccination people trust. METHODS: We conducted a survey of incarcerated people and facility staff in three, large state prisons in Minnesota to identify barriers and facilitators to COVID-19 vaccination. Facilities were recruited to participate through purposive sampling, and surveys were administered between November and December 2021. Descriptive statistics were calculated using Stata. RESULTS: Findings demonstrate that, for incarcerated individuals (N = 1,392), the most common reason for getting vaccinated was to return to normal activities in prison (61%, n = 801); the most common reason for being hesitant to get vaccinated was "other" (41%, n = 342), with individuals citing a variety of concerns. For staff (N = 190), the most common reason for getting vaccinated was to protect the health of family and friends (79%, n = 114); the most common reasons for being hesitant were disbelief that vaccination is necessary (55%, n = 23) and distrust of healthcare and public health systems (55%, n = 23). Incarcerated individuals reported that monetary and programmatic incentives would help motivate them to get vaccinated, while staff members said speaking with healthcare professionals and monetary incentives would help motivate them. Lastly, trusted sources of information for incarcerated individuals were healthcare professionals outside of prisons and jails, along with friends and family members. Staff members reported that they trusted healthcare professionals and national health organizations for information about COVID-19 vaccination. CONCLUSIONS: While considerable barriers to COVID-19 vaccination persist among both incarcerated individuals and staff members, these findings also highlight areas of intervention to increase COVID-19 vaccine confidence and promote health equity among those disproportionately impacted by the COVID-19 pandemic.

Linking Adverse Experiences to Pregnancy and Birth Outcomes: A Life Course Analysis of Racial and Ethnic Disparities Among Low-Income Women.

Racial and ethnic disparities in birth outcomes have persisted in the United States for decades, though the causes remain poorly understood. The life course perspective posits that poorer outcomes of Black birthing people stem from heightened exposure to stressors early in life and cumulative exposure to stressors over time. Despite its prominence, this perspective has seldom been investigated empirically. We analyzed longitudinal data gathered from 1319 women in low-income households in Wisconsin who received perinatal home visiting services. Variable- and person-centered analyses were performed to assess whether 15 adverse childhood experiences (ACEs) and 10 adverse adult experiences (AAEs) were associated, alone and in combination, with pregnancy loss, preterm birth, and low birth weight among Hispanic (i.e., Latinx) and non-Hispanic Black and White participants. As expected, there were disparities in preterm birth and low birth weight, and both ACEs and AAEs were linked to poorer pregnancy and birth outcomes. Unexpectedly, bivariate and multivariate analyses showed that the associated effects of ACEs and AAEs were most robust for non-Hispanic White women. A latent class analysis produced four patterns of life course adversity, and multigroup latent class analyses confirmed that, compared to White women, higher-adversity class assignments were associated with less robust effects for Hispanic women, and even less robust effects for Black women. We discuss interpretations of the paradoxical findings, including the possibility that alternative sources of stress such as interpersonal and structural racism may better account for the reproductive disparities that disproportionately affect Black birthing people.

Addressing health disparities in the criminal legal system: Translational benefits, challenges, and facilitators of impactful research with incarcerated pregnant women.

This in-depth analysis illuminates a translational journey of a community-university research collaboration that examined health disparities among incarcerated pregnant women and spanned the translational spectrum, with the initial collaboration in 2011 paving the way for consequent research grants, publications, practices, programs, and legislation passed years later. The case study utilized data from interviews with research stakeholders, institutional and governmental sources, peer-reviewed publications, and news stories. Identified research and translational challenges included cultural differences between research and prison system; the prison system's lack of transparency; politics of using and translating research to policy change; and issues of capacity, power, privilege, and opportunity when doing community-engaged research/science. Among the facilitators of translation were the Clinical and Translational Science Award and institutional support; engagement of key stakeholders and influencers; authentic collaboration and team science; researchers as translation catalysts; pragmatic scientific approach; and policies and legislative activities. The research contributed to a variety of community and public health, policy/legislative, clinical/medical, and economic benefits. The case study findings enhance our understanding of translational science principles and processes leading to improved wellbeing and serve as a call for advancing the research agenda addressing health disparities related to criminal and social justice issues.

Applying a Reproductive Justice Lens to Enhance Research Engagement Among Systematically Underrepresented Childbearing Women.

BACKGROUND: Historically, childbearing women from diverse and systematically hard-to-reach populations have been excluded from nursing research. This practice limits the generalizability of findings. Maximizing research strategies to meet the unique needs of these populations must be a priority. OBJECTIVES: The aim of this study was to provide methodological context for the comprehensive application of reproductive justice strategies to guide research methods and promote engagement of underrepresented childbearing women while decreasing systemic bias. METHODS: In this article, we use a reproductive justice lens to characterize and define strategies for enhancing ethical and equitable engagement in research involving childbearing women who are often systematically underrepresented using a case study approach. Using a specific case study exemplar, the core tenets of reproductive justice are outlined and affirm the need to advance research strategies that create ethical engagement of diverse populations, transform oppressive social structures, and shift research paradigms so research objectives intentionally highlight the strengths and resiliency inherent to the targeted communities. RESULTS: We begin by describing parallels between the tenets of reproductive justice and the ethical principles of research (i.e., respect for persons, beneficence, and justice). We then apply these tenets to conceptualization, implementation (recruitment, data management, and retention), and dissemination of research conducted with childbearing women from diverse backgrounds who are systemically underrepresented. We highlight our successful research strategies from our case study example of women with histories of incarceration. DISCUSSION: To date, outcomes from our research indicate the need for multilevel strategies with a focus on respectful, inclusive participant and key community partner engagement; the time investment in local communities to promote equitable collaboration; encouragement of the patient's autonomous right to self-determination; and mitigation of power imbalances. Nurse researchers are well positioned to advance research justice at the intersection of reproductive justice and ethics to fully engage diverse populations in advancing health equity to support the best health outcomes.

Jail Provision of Pregnancy and Sexual Health Services in Four Midwestern States.

OBJECTIVE: Women incarcerated in local jails have pregnancy and sexual health needs, yet little information is available about what services are provided and how jail administrators prioritize this care. Our objective was to document jails' provision of pregnancy and sexual health services in four states in the Midwest. METHODS: We invited all jail administrators (N = 347) in Kansas, Missouri, Iowa, and Nebraska to participate in a web-based survey conducted from November 2017 to October 2018. We asked administrators which pregnancy and sexual health services they offered and to rate the importance of offering services. Results were analyzed using descriptive statistics and logistic regression. RESULTS: The survey response rate was 55% (192/347). Jails most often provided pregnancy testing (n = 116 [60%]) and distribution of prenatal vitamins (n = 85 [44%]). Sexually transmitted infection treatment was offered at 23% of jails (n = 45). Larger, accredited jails located in urban areas and with high numbers of clinical providers on staff were more likely to provide sexual health services. Jails with privately contracted health care were more likely to provide pregnancy services compared with other entities providing medical care. The most prioritized sexual health service was sexually transmitted infection testing, with 39% of administrators believing it was important. Only 6% of administrators responded that contraception was important. CONCLUSIONS: Local jails in the Midwest do not meet the basic reproductive and sexual health needs of women. Provision of these services is not a priority for jail administrators. Appropriate partnerships could engage administrators and increase the availability of services to meet the needs of women in jail.

Youth at the intersection of parental incarceration and foster care: Examining prevalence, disparities, and mental health.

BACKGROUND: While there are various pathways by which children experience parental incarceration or foster care, involvement in either system is associated with adverse health outcomes. Despite co-occurring risk factors for parental incarceration and foster care, little is known about the prevalence or characteristics of youth navigating both of these experiences. OBJECTIVES: This study details the prevalence of youth at the intersection of parental incarceration and foster care, their demographic characteristics, and heterogeneity in their mental health. PARTICIPANTS AND SETTING: Data come from the 2019 Minnesota Student Survey with 112,157 eighth-, ninth-, and eleventh-grade students. METHODS: Logistic regression with interactions between parental incarceration and foster care predict associated odds of youth's anxiety and depression; self-injurious behavior, suicidal ideation and attempt; and mental health diagnoses and treatment. RESULTS: Nearly 2 % of students experienced both parental incarceration and foster care, with a disproportionate number of those identifying as youth of color, experiencing poverty, and/or living in rural communities. Both parental incarceration and foster care were separately linked with poor mental health, yet experiencing both was associated with higher odds of anxiety, depression, self-injury, suicidal ideation, suicide attempt, diagnosis, and treatment. Youth with proximal multiplicative exposure (recent foster care and current parental incarceration) reported the most adverse mental health symptoms. CONCLUSION: The study emboldens what is known about the inequitable distribution of parental incarceration and foster care. These findings highlight the association between dual-systems-impacted youth and mental health indicators, with important implications for increasing access to mental health services while simultaneously calling for systems change.

Justice for Incarcerated Moms Act of 2021: Reflections and recommendations.

In the last five decades, the number of women behind bars in the United States has risen exponentially. It is now estimated that there are nearly 58,000 admissions of pregnant people-disproportionately women of color-to jails and prisons each year. Recognizing the urgency and consequences of mass incarceration on pregnant people, their families, and communities, House Resolution 948: Justice for Incarcerated Moms Act of 2021 was introduced to Congress as a part of the Black Maternal Health Momnibus. The Justice for Incarcerated Moms Act aims to improve health care and promote dignity for incarcerated pregnant and parenting people through an array of policies and oversight. In this article, we review and reflect on the components of this bill within their broader public health and reproductive justice contexts. We close with recommendations for policymakers and professionals committed to promoting equity and justice for pregnant and postpartum incarcerated people.

Health profiles and racial disparities among individuals on probation in Hennepin County, Minnesota, 2016: a cross-sectional study.

OBJECTIVES: To estimate the health characteristics and racial/ethnic health disparities among a probation cohort in Hennepin County. We hypothesised the probation population would have higher health needs compared with the general population as well as significant racial/ethnic health disparities. DESIGN: Cross-sectional study using linked administrative records. PARTICIPANTS: Of 7992 eligible individuals, 5873 met inclusion criteria of 6 or more months of eligibility for a full-benefit Minnesota healthcare plan. SETTING: Probation system in Hennepin County in 2016. OUTCOMES: We compared health condition prevalence among our probation cohort with survey data from the general population and analysed by race/ethnicity. We also measured sociodemographic characteristics, including the use of safety-net services. RESULTS: Individuals were predominantly male (80.5%), young (mean age: 35.5 years), and disproportionately black or African American (52.9%). A majority of individuals enrolled in Medicaid were eligible via Medicaid expansion (65.9%). Compared with the general population, individuals on probation had higher rates of substance use disorders (66.5% vs 8.1%), mental illness (55.3% vs 14.4%) and many physical conditions (eg, asthma: 17.0% vs 12.5%, chronic kidney disease: 5.8% vs 0.2%). White individuals on probation were significantly more likely than black or African American individuals to have a diagnosed substance use disorder (71.6% vs 62.0%) or mental health disorder (64.9% vs 48.5%), but fewer chronic physical health conditions (average: 0.52 vs 0.73 chronic physical conditions). CONCLUSIONS: Individuals on probation have high health needs, which vary substantially by race/ethnicity. Without attention to this variation, interventions to address health conditions in this population could worsen racial/ethnic disparities.

Oral health needs among youth with a history of foster care: A population-based study.

BACKGROUND: Children and youth in foster care are considered to have special health care needs, including oral health care needs. This study compares the self-identified oral health care needs and access to oral health care among youth who have and have not experienced foster care. METHODS: Data were drawn from the 2019 Minnesota Student Survey, a statewide survey of public school students in the 5th, 8th, 9th, and 11th grades (N = 169,484). Youth with a history of foster care (3%) were compared with youth with no history of foster care for 7 oral health indicators. RESULTS: Youth with a history of foster care reported more oral health problems and less access to oral health care than their peers with no history of foster care. Using logistic regression to control for key covariates, the odds of an oral health problem for youth with a history of foster care were 1.54 higher (95% confidence interval, 1.44 to 1.65) than for their peers. CONCLUSIONS: Youth with a history of foster care report more oral health problems than their peers. Dentists should recognize the oral health concerns of these youth in the context of their special health care needs and be prepared to render appropriate care. Future studies should explore barriers to oral health care among this vulnerable population. PRACTICAL IMPLICATIONS: Youth in foster care have self-identified oral health care needs that should be assessed by dental professionals.

Differences in Sexual Health Outcomes Between Adolescents in Public Schools and Juvenile Correctional Facilities.

Data from a statewide, anonymous survey were used to test for differences between adolescents' sexual health behaviors and their outcomes across settings. Youth in juvenile correctional facilities (JCFs) were disproportionally male and Black compared to their peers in public schools. Youth in JCFs were significantly more likely than their peers to report that they had ever had sex, used substances prior to last sex, or been involved in a pregnancy. They were less likely to have used condoms or contraception at last sex, or to report having talked with their partners about sexually transmitted infections or birth control. The results highlight the importance of comprehensive sexual health education and access to a reproductive health provider for students in JCFs.

Care for Incarcerated Pregnant People With Opioid Use Disorder: Equity and Justice Implications.

With the simultaneous rise in maternal opioid use disorder (OUD) and the incarceration of pregnant people in the United States, we must ensure that prisons and jails adequately address the health and well-being of incarcerated pregnant people with OUD. Despite long-established, clear, and evidence-based recommendations regarding the treatment of OUD during pregnancy, incarcerated pregnant people with OUD do not consistently receive medication treatment and are instead forced into opioid withdrawal. This inadequate care raises multiple concerns, including issues of justice and equity, considerations regarding the legal and ethical obligations of the provision of health care, and violations of the medical and legal rights of incarcerated people. We offer recommendations for improving care for this often-ignored group.

Medications for opioid use disorder among pregnant women referred by criminal justice agencies before and after Medicaid expansion: A retrospective study of admissions to treatment centers in the United States.

BACKGROUND: Criminal justice involvement is common among pregnant women with opioid use disorder (OUD). Medications for OUD improve pregnancy-related outcomes, but trends in treatment data among justice-involved pregnant women are limited. We sought to examine trends in medications for OUD among pregnant women referred to treatment by criminal justice agencies and other sources before and after the Affordable Care Act's Medicaid expansion. METHODS AND FINDINGS: We conducted a serial, cross-sectional analysis using 1992-2017 data from pregnant women admitted to treatment facilities for OUD using a national survey of substance use treatment facilities in the United States (N = 131,838). We used multiple logistic regression and difference-in-differences methods to assess trends in medications for OUD by referral source. Women in the sample were predominantly aged 18-29 (63.3%), white non-Hispanic, high school graduates, and not employed. Over the study period, 26.3% (95% CI 25.7-27.0) of pregnant women referred by criminal justice agencies received medications for OUD, which was significantly less than those with individual referrals (adjusted rate ratio [ARR] 0.45, 95% CI 0.43-0.46; P < 0.001) or those referred from other sources (ARR 0.51, 95% CI 0.50-0.53; P < 0.001). Among pregnant women referred by criminal justice agencies, receipt of medications for OUD increased significantly more in states that expanded Medicaid (n = 32) compared with nonexpansion states (n = 18) (adjusted difference-in-differences: 12.0 percentage points, 95% CI 1.0-23.0; P = 0.03). Limitations of this study include encounters that are at treatment centers only and that do not encompass buprenorphine prescribed in ambulatory care settings, prisons, or jails. CONCLUSIONS: Pregnant women with OUD referred by criminal justice agencies received evidence-based treatment at lower rates than women referred through other sources. Improving access to medications for OUD for pregnant women referred by criminal justice agencies could provide public health benefits to mothers, infants, and communities. Medicaid expansion is a potential mechanism for expanding access to evidence-based treatment for pregnant women in the US.

Are We Meeting Their Needs? Well-child, Dental, and Mental Health Care for Youth in Juvenile Correctional Facilities in Minnesota.

Compared with the general population, justice-involved youth have substantially higher rates of several health conditions. Less is known about their use of health services to address these conditions. Using data from a statewide survey of 217 youth in juvenile correctional facilities and 164,832 youth in public schools, we examined selfreported health (health overall, weight status, disability, asthma, allergy, mental health) and receipt of care. Justice-involved youth reported a high number of physical health concerns; however, physical health conditions were not related to receipt of care. Youth who reported experiencing depressive symptoms with or without suicidal ideation, and those who had attempted suicide, were more likely than their peers without these mental health issues to have received mental health treatment in the past year. However, many youth with serious mental health concerns had not received treatment. Results from this study demonstrate unmet health care needs among a sample of youth in juvenile correctional facilities.

Adverse Childhood Experiences and Youth Cigarette Use in 2013 and 2016: Emerging Disparities in the Context of Declining Smoking Rates.

INTRODUCTION: Cigarette use has dropped dramatically among youth since 2013, but smoking-related disparities persist. We examine who still smokes in the context of declining smoking rates. Using the Minnesota Student Survey, we examine adverse childhood experiences (ACEs) and cigarette use in 2013 and 2016. We assess how cigarette use rates changed, how ACEs relate to cigarette use, and the degree to which youth with ACEs comprise the current smoking population. METHODS: Data came from the 2013 and 2016 Minnesota Student Survey. We assessed past 30-day any and daily cigarette use statewide and among youth with no ACEs, high cumulative ACEs, and seven separate ACEs. We used descriptive statistics and multivariate logistic regression analyses. RESULTS: Cigarette use significantly declined for all groups from 2013 to 2016. Youth with no ACEs exhibited the highest percent decrease in any and daily cigarette use. Youth with ACEs were more likely to report any and daily cigarette use in 2013 and 2016, adjusting for demographics. Among youth with any 30-day use, the rate of ACEs increased from 2013 to 2016. Youth with ACEs disproportionately accounted for youth smoking populations in 2013 and 2016. For example, although 16% of all youth experienced parental incarceration, approximately 43% and 55% of youth with any and daily cigarette use experienced parental incarceration in 2016, respectively. CONCLUSIONS: Cigarette use declined from 2013 to 2016 for all Minnesota youth, but the decline among youth with no ACEs was faster than those with ACEs. Youth with ACEs now account for an increasingly high percent of youth smokers. IMPLICATIONS: Even though cigarette use is declining among Minnesota youth, the decline among youth without ACEs is faster than the decline among youth with ACEs. Youth with ACEs disproportionately account for all youth smokers, and this disproportionality has increased since 2013. Tobacco control efforts should focus on youth with ACEs, and parental incarceration is a specific ACE that warrants attention. Rates of parental incarceration remain high in the United States and youth who experience parental incarceration now account for a near majority of current youth smokers. Future research should consider mechanisms for the ACE-smoking relationship and emerging tobacco products (eg, electronic cigarettes).

Reproductive justice for incarcerated mothers and advocacy for their infants and young children.

The United States has seen unprecedented growth in the number of incarcerated women, most of whom are mothers with minor children. Major public health concerns relate to the reproductive health of women in prisons and jails and the well-being of their infants and young children. In the current article, we use a reproductive justice framework to examine the intersection of incarceration and maternal and child health. We review (a) current research on the reproductive health of incarcerated women, (b) characteristics and experiences of pregnant incarcerated women, (c) outcomes of infants and young children with incarcerated parents, (d) implications of research findings for policy and practice, and (e) the need for increased research, public education, and advocacy. We strongly recommend that correctional policies and practices be updated to address the common misconceptions and biases as well as the unique vulnerabilities and health needs of incarcerated women and their young children.

Estados Unidos ha visto un crecimiento sin precedentes en el número de mujeres encarceladas, la mayoría de las cuales son madres con niños menores. Mayores preocupaciones de salud pública conciernen a la salud reproductiva de mujeres en prisiones y cárceles y el bienestar de sus infantes y niños pequeños. En el presente artículo, usamos un marco de trabajo de justicia reproductiva para examinar la intersección del encarcelamiento y la salud materno-infantil. Revisamos 1) la investigación actual sobre la salud reproductiva de mujeres encarceladas, 2) las características y experiencias de mujeres embarazadas encarceladas, 3) lo que resulta de infantes y niños pequeños con progenitores encarcelados, 4) las implicaciones de los resultados de la investigación en cuanto a políticas y prácticas, y 5) la necesidad de aumentar la investigación, la educación pública y la defensoría. Recomendamos fuertemente que se actualicen las políticas y prácticas correccionales para incluir los conceptos erróneos y prejuicios acerca de mujeres encarceladas y sus niños pequeños, así como también sus distintivas vulnerabilidades y necesidades de salud.

Les Etats-Unis d'Amérique ont été les témoins d'une augmentation sans précédent dans le nombre de femmes incarcérées, la plupart étant des mères avec des enfants mineurs. De grands problèmes de santé publique sont liés à la santé reproductive des femmes en prison et au bien-être de leurs nourrissons et de leurs jeunes enfants. Dans cet article nous utilisons une structure de justice reproductive afin d'examiner l'intersection de l'incarcération et de la santé maternelle et de l'enfant. Nous passons en revue: 1) les recherches actuelles sur la santé reproductive des femmes incarcérées, 2) les caractéristiques et les expériences de femmes incarcérées enceintes, 3) les résultats de nourrissons et de jeunes enfants avec des parents incarcérés, 4) les implications des résulats de recherche pour les lois et la pratique, et 5) le besoin de plus de recherches, plus d'éducation publique, plus de promotion et défense. Nous recommandons fortement que les lois correctionnelles et les pratiques correctionnelles soient mises à jour afin de traiter et de faire face aux conceptions erronées et à la partialité communes, ainsi qu'aux vulnérabilités uniques et aux besoins de santé des femmes incarcérées et de leurs jeunes enfants.

Adaptive Recruitment and Parenting Interventions for Immigrant Latino Families with Adolescents.

Parenting programs are an effective strategy to prevent multiple risky outcomes during adolescence. However, these programs usually enroll one caregiver and have low attendance. This study evaluated the preliminary results, cost, and satisfaction of adaptive recruitment and parenting interventions for immigrant Latino families. A mixed methods study was conducted integrating a pre-post design with embedded qualitative and process evaluations. Fifteen immigrant Latino families with an adolescent child aged 10-14 were recruited. Two-caregiver families received a home visit to increase enrollment of both caregivers. All families participated in an adaptive parenting program that included group sessions and a one-to-one component (online videos plus follow-up telephone calls) for those who did not attend the group sessions. The intervention addressed positive parenting practices using a strengths-based framework. Primary outcomes were the proportion of two-parent families recruited and intervention participation. Secondary outcomes were change in parenting self-efficacy, practices, fidelity, costs, and satisfaction. Participants completed questionnaires and interaction tasks before and after participating in the intervention. In addition, participants and program facilitators completed individual interviews to assess satisfaction with the program components. Overall, 23 parents participated in the intervention; 73% of two-parent families enrolled with both parents. Most participants completed 75% or more of the intervention. Fathers were more likely to use the one-to-one component of the intervention than mothers (p = .038). Participants were satisfied with program modifications. In sum, adaptive recruitment and parenting interventions achieved high father enrollment and high participation. These findings warrant further evaluation in randomized trials.

Adolescent Connectedness with Parents Promotes Resilience among Homeless Youth.

Youth who experience homelessness have worse health and well-being than housed youth. Internal assets, including social competency and positive self-identity, are factors that promote healthy development. This study compared internal assets between homeless and housed youth, and examined whether connectedness with parents moderates the association between homelessness and internal assets. Using data from a large population-based survey of middle- and high-school aged youth, we found that homelessness was associated with lower levels of internal assets. However, having high connectedness with a parent significantly predicted the strength of these assets, suggesting opportunities to promote health equity among homeless youth.

Health Care Use and Health Behaviors Among Young Adults With History of Parental Incarceration.

OBJECTIVES: To determine if longitudinal associations exist between parental incarceration (PI) and health care use or health behaviors among a national sample of young adults. METHODS: We used the National Longitudinal Survey of Adolescent to Adult Health to examine associations between history of mother incarceration (MI) and father incarceration (FI), health care use, and 3 dimensions of health behaviors (eg, general health behaviors, substance use, and other risky behaviors) (N = 13 084). Multivariable logistic regression models accounted for individual, family, and geographic factors and generated adjusted odds ratios (aORs). RESULTS: Over 10% of the sample had a history of PI before the age of 18. History of MI and FI were both associated with forgone health care (aOR = 1.65 [95% confidence interval (CI), 1.20-2.27], aOR = 1.22 [95% CI, 1.02-1.47], respectively), prescription drug abuse (MI aOR = 1.61 [95% CI, 1.02-2.55], FI aOR = 1.46 [95% CI, 1.20-1.79]), and 10 or more lifetime sexual partners (MI aOR = 1.55 [95% CI, 1.08-2.22], FI aOR = 1.19 [95% CI, 1.01-1.41]). MI was associated with higher likelihood of emergency department use (aOR = 2.36 [95% CI, 1.51-3.68]), and FI was associated with illicit injection drug use (aOR = 2.54 [95% CI, 1.27-5.12]). CONCLUSIONS: The effects of incarceration extend beyond incarcerated individuals. PI histories are associated with lower health care use and unhealthy behaviors in young adulthood. By addressing barriers to health care and health-harming behaviors, health care providers and policy makers may reduce health disparities among this population.