The impact of incarceration on young people's health

Her latest research examines health records and health care utilization among youth under the age of 21 who may have been involved in the justice system or whose family members may have been. The challenge was identifying youth affected by mass incarceration because most health systems don't routinely ask about incarceration. Families may not disclose that information due to stigma, fear of child protective services involvement, or judgment.

“There have been few to no large-scale community-level studies using medical records of youth and their families affected by incarceration,” explains Bock, an assistant professor in the University of Cincinnati School of Nursing. “Despite the large numbers of youth and families affected by incarceration, gaps remain in our understanding of its prevalence and outcomes. There are many reasons for this, including a lack of awareness among health care providers, inadequate curricula for training health care providers, inadequate funding for this research, and a lack of routine, sensitive screening for exposure.”

To examine the effects of incarceration, Bock and her team searched electronic medical records for justice-related keywords, such as “prison,” “jail,” “sentencing,” “probation,” and “parole.” The researchers used data collected from Cincinnati Children's Hospital over an 11-year period.

Their research is Academic PediatricsOf the more than 1.7 million records examined, they found that 38,263 (2.2%) of youth seen between January 2009 and December 2020 were likely to have had a parent incarcerated or faced some form of incarceration as minors. This small percentage also accounted for a disproportionate number of physical and mental health diagnoses and medical visits at Cincinnati Children's Hospital. They were compared to a sociodemographically matched sample without justice keywords and the overall sample population of youth.

About 63.3% of behavioral health admissions, 23.7% of all inpatient days and 45.5% of foster care visits were attributable to the 2.2% of youth who were documented as having potential personal or family involvement with the justice system.The findings complement another study led by Bock, published in 2021, using data from Nationwide Children's Hospital in Columbus, Ohio.

Young people with the justice keyword on their record had 1.5 to 16.2 times the prevalence of the various physical and mental health disorder groups studied compared with matched young people without the justice keyword but from similar socio-economic backgrounds, and had 428.2 more physical health diagnoses and 269.2 more mental health diagnoses per 100 young people than matched young people.

The study found that youth with justice keywords made up a large percentage of those diagnosed with health disorders and conditions at Cincinnati Children's Hospital between 2009 and 2020. This included 42.9% of schizophrenia spectrum disorders and other psychotic disorders, 42.1% of bipolar disorder and related disorders, 38.3% of suicide and self-harm disorders, 24.5% of trauma and stress-related disorders, 44.9% of shaken baby syndrome, 13.9% of infectious diseases, 12.5% ​​of speech disorders, and 12.8% of adolescent pregnancy.

Nationwide, about 7 percent of young people in the U.S. have an incarcerated parent. The findings from Cincinnati Children's Hospital and Nationwide Children's Hospital in Columbus are a huge underestimate of the number of young people affected by incarceration or incarceration, Bock said.

“Our data reflects families who disclosed and providers who recorded,” Bock said, “and does not include families who did not disclose or whose information was not recorded, which is a major limitation. This study is an attempt to shed light on the magnitude of the impact of mass incarceration on the health of Cincinnati's youth. Our health care and correctional systems clearly overlap and impact children's lives.”

“Replicating these findings in other communities would further strengthen the case for prison diversion and other reforms, especially if we want all American children and families to thrive,” Bock said. “If America continues to lead on prisons, health care disparities will continue and we will continue to have some of the poorest health outcomes in the world.”

Other co-authors on the study include Joshua Lambert, PhD, of the University of Cincinnati, Christopher Wilderman, PhD, of Duke University, and Judith Dexheimer, PhD, Robert Kahn, MD, and Sarah Beal, PhD, of the University of Cincinnati and Cincinnati Children's Hospital.

The research study among Cincinnati youth was supported by Dr. Bock's awards, including the Agency for Healthcare Research and Quality and Patient-Centered Outcomes Institute (AHRQ/PCORI) K12 PEDSnet Scholars Learning Health Systems Career Development Program, internal funding from the University of Cincinnati College of Nursing Dean's New Investigator Award, internal funding from the Cincinnati Children's Hospital Medical Center James M. Anderson Center for Health System Excellence, and an NIH/NIMHD Loan Repayment Award for Clinician Scientists from Disadvantaged Backgrounds.

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