A Punishment Beyond Sentencing: Incarceration's Impact on Overall Quality of Health

Abstract

In this dissertation I use Agnew’s General Strain Theory as a frame and examine whether criminal justice involvement, specifically ever being arrested, ever incarcerated, or paroled, is related to the overall physical health and livelihood. I test for relationships between criminal justice involvement and two outcomes: respondents’ self-reported fair/poor health and respondent stating that health affects their ability to work. A third outcome tests how criminal justice involvement in the last 12 months, specifically being paroled and being arrested, is related to using negative coping strategies, specifically illicit substance use and prescription opioid misuse, over this time period. First, I examine how the self-reported health is shaped by incarceration using the National Longitudinal Survey of Youth (NLSY97). I find that ever being incarcerated has a significant negative effect on self-reported health outcomes; however, once access to health insurance and other social inclusion variables are introduced, the probability of reporting worse health outcomes is reversed, suggesting that there is an underlying relationship between having worse health and the social inclusion variables, and that the relationship between ever being incarcerated and worse health is mitigated by social inclusion factors. Being socially excluded is associated with worse self-reported health. These findings provide support for the health disenfranchisement hypothesis as well as the social exclusion hypothesis. Next, I use the NLSY97 to examine the independent effects that incarceration and social inclusion have on respondents’ self-reported ability to work. As predicted, I find that the experience of being arrested is associated with a higher likelihood of respondents reporting that their health affected their ability to work. While the number of incarcerations and arrests in the last 12 months variables both share positive bivariate relationships with reporting that their health affects their ability to work, these relationships do not hold once demographic and social inclusion variables are included in the models. I also find that African Americans and females have a higher likelihood to self-report an inability to work due to their health. These findings for African Americans and females support the social exclusion hypothesis, but the relationship only holds for women once the social inclusion variables are included. Last, I use the National Survey of Drug Usage and Health (NSDUH, 2021) to test whether being arrested and being on parole is associated with using the negative coping strategies of illicit substance use and prescription opioid misuse, while testing for the moderating effects of social inclusion factors. I find that experiencing an arrest and being paroled in the last 12 months are both associated with using negative coping strategies, which lends support to the social exclusion hypothesis. I find support for Agnew’s general strain theory in that formerly incarcerated people are more likely to be vulnerable to negative stimuli, resulting in higher odds of using negative coping strategies. This aspect of general strain theory supports social exclusion due to the limited life chances that formerly incarcerated people can cultivate during the reentry process. Overall, this dissertation provides evidence that criminal justice involvement negatively affects the life chances and coping behaviors of formerly incarcerated or paroled people. However, social inclusion factors provide a salient countering influence to the negative health effects of being arrested, incarcerated, or paroled.

Keywords: Incarceration, arrest, parole, health, life chances, stigma, reentry, health care access, negative coping strategies, opioid, cocaine, methamphetamine, heroin, social inclusion, social exclusion