How Incarceration Affects the Health of Communities and Families

Communities

Community characteristics such as feeling safe, trusting one's neighbors, and having access to resources are important determinants of health and well-being. Incarceration disproportionately affects disadvantaged communities and communities with a predominantly Black population. There is little evidence to support that the dramatic increase in incarceration rates has improved the safety of the individuals who live in the community [6]; because incarceration affects parent- and working-age adults from disadvantaged communities, loss of these individuals to incarceration can exact an economic toll and disrupt social ties within their communities.

High community-level incarceration rates affect the children from those communities. In North Carolina, higher county-level incarceration rates increased child poverty rates, particularly in counties with a high proportion of non-White residents [7]. For children, high neighborhood incarceration rates were linked to worse cognitive outcomes in reading comprehension, math problem solving, and memory- and attention-related tasks [8].

Negative health consequences of high community-level incarceration rates in adults have been observed, including impacts on sexual health, cardiometabolic and lung health, and mental/behavioral health. One of the most well studied effects of community-level incarceration is increased risk of contracting a sexually transmitted infection (STI), including HIV/AIDS [9]. This effect is particularly salient for Black women, partly due to the increased exposure of men to STIs while incarcerated and the smaller sexual partner network that results from removing men from the community for incarceration [9]. Incarceration also impacts cardiometabolic and lung health at the community level. For example, non-incarcerated Black individuals in Atlanta, Georgia who lived in neighborhoods with high incarceration rates had worse cardiometabolic health profiles, even after controlling for neighborhood crime and poverty and other factors [10]. In New York City, asthma was more prevalent in neighborhoods with higher incarceration rates [11]. High community-level incarceration rates have also been associated with poor mental health outcomes. Evidence from Detroit found that individuals living in neighborhoods with high, relative to low, prison admission rates were more likely to meet criteria for major depressive disorder and generalized anxiety disorder [12]. Together, the mounting evidence suggests that individuals living in communities where a relatively high percentage of the population has experienced incarceration may experience detrimental health consequences.

Children of Incarcerated Parents

Pathways by which parental incarceration may affect child development include separation, reduced family material resources, additional conflict between caregivers, stigma, and shame [13, 14]. A recent review of the literature highlighted findings indicating that men with incarceration histories gave 25% less in financial contributions to the mothers of their children than similar men who had not been incarcerated; moreover, post-release wages of men were reduced by 10%-20% [15]. This loss of income is often coupled with increased costs associated with incarceration (eg, court fees, fines, visitation costs) and ultimately families with an incarcerated household member are more likely to receive welfare benefits, have unstable housing, and experience more material hardship [15]. Paternal incarceration has also been identified as a contributor to children experiencing food insecurity [16] and homelessness [17].

A systematic review of literature published between 2000 and 2017 found negative effects of parental incarceration across a variety of domains [18]. These consequences were seen as early as the prenatal period, including initiating prenatal care later in the pregnancy, fewer prenatal visits, and a higher chance of the mother experiencing partner abuse and stressors that could harm fetal health. Analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS; 1990-2003), found a 30% increase in the odds of mortality for infants of recently incarcerated fathers who were not abusive, relative to other infants [18, 19]. States with higher levels of prison rates also had higher infant mortality rates [19].

Parental incarceration is associated with harmful effects on childhood cognitive, mental, and behavioral health. For instance, residential parental incarceration was associated with learning disabilities, attention problems, behavioral or conduct problems, developmental delays, and speech or language problems [20]. Also, the incarceration of a father has been associated with aggressive and problematic behaviors in childhood and with internalizing and externalizing problems during the teenage years [18]. The effects of maternal incarceration on child mental health are less well established, with the two published studies showing contrasting findings. While one study found no statistically significant effects on 21 measures of behavior and mental health problems, the other found that maternal incarceration was more detrimental than paternal incarceration, particularly for depression risk [18].

For young adults, emerging evidence suggests that parental incarceration is a risk factor for forgoing health care, engaging in risky behaviors (eg, prescription drug misuse, having many sexual partners) [21], and worse health outcomes (eg, high cholesterol, asthma, HIV/AIDS, serious injuries) [22, 23]. Similarly, experiencing parental incarceration is a risk factor for a host of poor outcomes during the transition to adulthood including criminality [24, 25], not completing high school or college [23, 26, 27], early parenthood [28], receiving welfare [23], and lower earnings or income [23, 29].

Adult Family Members of Incarcerated People

The incarceration of a family member affects several domains of adult health and well-being. Detrimental health effects experienced by adult family members may result from disruptions in household functioning such as separation from—and relationship dissolution between—romantic/sexual partners, co-parents, and/or contributors to household finances and/or management, which can lead women to single parenthood and associated material hardships. Additionally, the family of an incarcerated individual may experience other costs associated with the incarceration and related shame and stigma. Parents of adult children who are imprisoned may become the primary or secondary caregivers for their grandchildren.

According to a recent review, having a family member incarcerated has clear negative physical and mental health effects for women, while the effects on men are less clear [15]. For example, for women but not for men, family member incarceration has been associated with increased risk of obesity, heart attack or stroke, and fair or poor self-reported health [30]. Similarly, family member incarceration is more consistently associated with detrimental mental health effects for women than for men [15]. Qualitative studies have documented heightened stress, depression, and anxiety felt by mothers and/or sexual partners who care for men during and after their incarceration [15]. Quantitatively, both mothers of adult children who are incarcerated and mothers of children with incarcerated fathers experience psychological distress and added financial burdens [15]. Incarceration of a romantic partner has been linked to increased engagement in risky sexual behaviors and risk for contracting an STI [15].