Previous Incarceration, Health Insurance, and the Affordable Care Act in the U.S.

INTRODUCTION: This study examines the association between prior incarceration and health insurance status and whether living in a state adopting the Affordable Care Act (ACA) Medicaid expansion moderates this relationship. METHODS: Data are from the National Longitudinal Study of Adolescent to Adult Health (Wave I [1993-1994], Wave IV [2008], and Wave V [2016-2018]; N=8,965). Multiple logistic regression with multiplicative interaction terms were performed to assess the relationship between previous incarceration and ACA Medicaid expansion on (1) being insured and (2) being on public health insurance. Analyses were performed in 2023. RESULTS: Findings demonstrate a positive and statistically significant interaction in the association between previous incarceration and living in a state with ACA Medicaid expansion on having public health insurance (OR=2.402; 95% CI=1.257, 4.588). CONCLUSIONS: The ACA Medicaid expansion was associated with a greater likelihood of public health insurance coverage for formerly incarcerated persons in the U.S. These findings suggest that Medicaid expansion could be critical in improving health insurance coverage among formerly incarcerated individuals who are a population that is more likely to be uninsured.

"I got so much on my plate": Understanding care discontinuity for HIV and HCV among formerly incarcerated persons.

OBJECTIVE: To explore barriers to care continuity among formerly incarcerated persons with HIV and/or hepatitis C. DATA SOURCES AND STUDY SETTING: We draw on data from semi-structured interviews conducted in 2018-2019 with 30 formerly incarcerated persons and 10 care providers. Data were collected across two clinics in Baltimore, Maryland, and Washington, D.C. STUDY DESIGN: We recruited participants using a combination of nonprobability sampling techniques. Participants completed closed-ended questionnaires and took part in semi-structured interviews related to treatment barriers and incentives. DATA COLLECTION/EXTRACTION METHODS: Interviews were transcribed using Express Scribe software and transcriptions were open coded using NVivo 12 software. An iterative process was used to relate and build upon emergent themes in interviews. PRINCIPAL FINDINGS: Our study illuminates both internal and external barriers to care continuity. The most common external barriers were system navigation and housing instability. Internal barriers consisted of overlapping issues related to mental health, substance use, and feelings of shame and/or denial. CONCLUSION: An overarching theme is that formerly incarcerated persons with HIV and/or HCV are grappling with numerous challenges that can threaten their health and health care. These barriers are cumulative, intersecting, and reciprocal.

Proliferation or adaptation? Differences across race and sex in the relationship between time served in prison and mental health symptoms.

Guided by stress proliferation and adaptation perspectives, this study investigates competing hypotheses for the relationship between time served in prison and mental health symptoms. Drawing on data from the Survey of Inmates in State Correctional Facilities in 2004 (N = 12,118), our findings suggest that time served is correlated with mental health symptoms, but that the association differs across race and sex. White males exhibit fewer mental health symptoms at longer exposures to prison, while black males and black females exhibit more symptoms. We conclude that both incarceration dosage (treatment heterogeneity) and differences across groups (effect heterogeneity) may be important considerations in understanding the relationship between incarceration and mental health.

The contribution of age structure to the international homicide decline.

BACKGROUND: Since 1990, the world's homicide rate has declined by nearly 20%. While prior research has documented parallel homicide declines across many individual countries, the causes of a shared international homicide decline remain unknown. Drawing on a worldwide process of population ageing, and on research linking age to criminal activity, this study investigates the contribution of global demographic shifts to the international homicide decline. METHODS: We draw from (1) a High Coverage Sample of 126 countries since 1990, and (2) a Long Series Sample of 26 countries since 1960 and utilize fixed-effect regressions to evaluate the impact of age structure on homicide trends. In addition, we use a quantile regression to explore variations in the relationship between age structure and homicide conditional on homicide levels. FINDINGS: Results using the High Coverage Sample suggest no relationship between age structure and homicide. However, results from the Long Series Sample suggest that changes in the relative size of countries' youth population is a major predictor of homicide trends since 1960. In exploring this divergence, we find that the influence of age structure on homicide becomes less evident as other risk factors for violence gain prominence. Thus, while high homicide countries had the most to gain from falling homicide rates, the safety benefits of an ageing population have been concentrated among the least violent countries. INTERPRETATION: While the homicide declines of individual countries have often been attributed to domestic policies, the universality of international homicide trends suggests the influence of broader global phenomenon. We find that countries' homicide trends are strongly associated with changes in the size of their youth populations, particularly where there are few competing criminogenic forces. Based on these results, we propose an explanation for the international homicide decline, while highlighting the importance of demographic patterns in explaining homicide trends.

The Consequences of Contact with the Criminal Justice System for Health in the Transition to Adulthood.

A rapidly growing literature has documented the adverse social, economic and, recently, health impacts of experiencing incarceration in the United States. Despite the insights that this work has provided in consistently documenting the deleterious effects of incarceration, little is known about the specific timing of criminal justice contact and early health consequences during the transition from adolescence to adulthood-a critical period in the life course, particularly for the development of poor health. Previous literature on the role of incarceration has also been hampered by the difficulties of parsing out the influence that incarceration exerts on health from the social and economic confounding forces that are linked to both criminal justice contact and health. This paper addresses these two gaps in the literature by examining the association between incarceration and health in the United States during the transition to adulthood, and by using an analytic approach that better isolates the association of incarceration with health from the multitude of confounders which could be alternatively driving this association. In this endeavor, we make use of variable-rich data from The National Longitudinal Study of Adolescent to Adult Health (n = 10,785) and a non-parametric Bayesian machine learning technique- Bayesian Additive Regression Trees. Our results suggest that the experience of incarceration at this stage of the life course increases the probability of depression, adversely affects the perception of general health status, but has no effect on the probability of developing hypertension in early adulthood. These findings signal that incarceration in emerging adulthood is an important stressor that can have immediate implications for mental and general health in early adulthood, and may help to explain long lasting implications incarceration has for health across the life course.

Toward a Demographic Understanding of Incarceration Disparities: Race, Ethnicity, and Age Structure.

OBJECTIVES: Non-Hispanic blacks and Hispanics in the United States are more likely to be incarcerated than non-Hispanic whites. The risk of incarceration also varies with age, and there are striking differences in age distributions across racial/ethnic groups. Guided by these trends, the present study examines the extent to which differences in age structure account for incarceration disparities across racial and ethnic groups. METHODS: We apply two techniques commonly employed in the field of demography, age-standardization and decomposition, to data provided by the Bureau of Justice Statistics and the 2010 decennial census to assess the contribution of age structure to racial and ethnic disparities in incarceration. FINDINGS: The non-Hispanic black and Hispanic incarceration rates in 2010 would have been 13-20 % lower if these groups had age structures identical to that of the non-Hispanic white population. Moreover, age structure accounts for 20 % of the Hispanic/white disparity and 8 % of the black/white disparity. CONCLUSION: The comparison of crude incarceration rates across racial/ethnic groups may not be ideal because these groups boast strikingly different age structures. Since the risk of imprisonment is tied to age, criminologists should consider adjusting for age structure when comparing rates of incarceration across groups.

HOW THE U.S. PRISON BOOM HAS CHANGED THE AGE DISTRIBUTION OF THE PRISON POPULATION.

This article provides a demographic exposition of the changes in the U.S prison population during the period of mass incarceration that began in the late twentieth century. By drawing on data from the Survey of Inmates in State Correctional Facilities (1974-2004) for inmates 17-72 years of age (N = 336), we show that the age distribution shifted upward dramatically: Only 16 percent of the state prison population was 40 years old or older in 1974; by 2004, this percentage had doubled to 33 percent with the median age of prisoners rising from 27 to 34 years old. By using an estimable function approach, we find that the change in the age distribution of the prison population is primarily a cohort effect that is driven by the "enhanced" penal careers of the cohorts who hit young adulthood-the prime age of both crime and incarceration-when substance use was at its peak. Period-specific factors (e.g., proclivity for punishment and incidence of offense) do matter, but they seem to play out more across the life cycles of persons most affected in young adulthood (cohort effects) than across all age groups at one point in time (period effects).

Incarceration and Post-release Health Behavior.

This study investigates the link between incarceration and health behavior among a sample of young adults from the National Longitudinal Study of Adolescent Health (N = 1,670). The association is analyzed using propensity score methods and a strategic comparison group: respondents who have been convicted of crimes, but not incarcerated. Findings suggest that former inmates consume more fast food and have a higher likelihood of smoking than do similarly situated peers. These associations operate partly through increased financial strife and decreased social standing. Given the role of health behavior in predicting future health outcomes, poor health behavior may be a salient force driving health and mortality risk among the formerly incarcerated population.

Consequences of Family Member Incarceration: Impacts on Civic Participation and Perceptions of the Legitimacy and Fairness of Government.

Political participation and citizens' perceptions of the legitimacy and fairness of government are central components of democracy. In this article, we examine one possible threat to these markers of a just political system: family member incarceration. We offer a unique glimpse into the broader social consequences of punishment that are brought on by a partner's or parent's incarceration. We argue that the criminal justice system serves as an important institution for political socialization for the families of those imprisoned, affecting their attitudes and orientations toward the government and their will and capacity to become involved in political life. We draw from ethnographic data collected by one of the authors, quantitative data from the National Longitudinal Study of Adolescent Health, and interviews with recently released male prisoners and their female partners. Our findings suggest that experiences of a family member's incarceration complicate perceptions of government legitimacy and fairness and serve as a barrier to civic participation.