Study offers insight into incarceration’s toll on youth health

Researcher Samantha Boch has studied the impact of incarceration on child and family health for more than a decade.

Her most recent research examines the health records and health care utilization of youth, people under the age of 21, who are likely to have been involved or whose families have been involved in the justice system. The challenge was to identify youth affected by mass incarceration, as most health care systems do not routinely ask about incarceration. Families may withhold this information due to stigma, fear of involvement with child protective services, or judgment.

There are few, if any, large community-level studies of the health of youth affected by incarceration or their family’s incarceration using medical records. Despite the many youth and families affected by incarceration, gaps remain in understanding its prevalence and consequences. There are many reasons for this, some include lack of provider awareness, lack of curriculum in provider training, lack of funding for this research, and lack of routine sensitive screening for exposure.”

Boch, Assistant Professor, University of Cincinnati College of Nursing

Boch and her research team searched electronic medical records for justice-related keywords such as “prison,” “imprisonment,” “conviction,” “suspension,” “parole,” and others to identify the impact of imprisonment. The researchers used data from Cincinnati Children’s Hospital collected over an 11-year period.

Their study, published in Academic Pediatrics, found that of more than 1.7 million records reviewed, 38,263 (or 2.2%) of youth seen between January 2009 and December 2020 likely had a parent who had been incarcerated or faced some type of juvenile detention. This small percentage was also responsible for a disproportionate number of physical and mental health diagnoses and health care visits at Cincinnati Children’s. They were compared to a sociodemographically matched sample without the justice keyword and to the total youth sample population.

Nearly 63.3% of all behavioral health inpatient admissions, 23.7% of all hospital days, and 45.5% of all foster care visits were attributable to the 2.2% of youth who had documented probable involvement in the justice system in a personal or family system. The findings complement another study led by Boch, published in 2021 using data from Nationwide Children’s Hospital in Columbus, Ohio.

Youth with a justice keyword on their record had 1.5 to 16.2 times the prevalence of various groups of physical and mental health disorders studied compared to matched youth who did not have a justice keyword but had a similar socioeconomic background. They also had 428.2 more physical health diagnoses and 269.2 more mental health diagnoses per 100 youth than matched youth.

According to the study, youth with the keyword justice made up a large percentage of all those diagnosed with disorders or health conditions at Cincinnati Children’s from 2009-2020. This includes 42.9% of all schizophrenia spectrum and other psychotic disorders, 42.1% of all bipolar and related disorders, 38.3% of all suicidal and self-harm disorders, 24.5% of all related to trauma and stress, 44.9% of all fussy baby syndrome cases, 13.9% of all infectious diseases, 12.5% ​​of speech disorders and 12.8% of all young pregnancies.

Nationally, about 7% of youth in the U.S. have a parent imprisoned. The findings at Cincinnati Children’s and Nationwide Children’s Hospital in Columbus grossly underestimate the number of youth affected by incarceration or restraint, Boch says.

“Our data reflect families who disclosed and health providers who documented,” says Boch. “Families who do not disclose or whose information is not documented were not represented, which is a key limitation. This study is an attempt to reveal the magnitude of the impact of mass incarceration on the health of young people in Cincinnati. The health care systems and our prison systems are clearly overlapping and affecting the lives of children.

“Replication of these findings in other communities would strengthen the growing justification for parole and other reform efforts, especially if we want all US children and families to thrive,” says Boch. “We will continue to have health care disparities and lead the world in poor health outcomes if we continue to lead in incarceration.”

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

The Cincinnati Youth Research Study was supported by Boch awards, including the Agency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute (AHRQ/PCORI) K12 PEDSnet Scholars Learning Health Systems Career Development Program, internal funding by 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 Systems Excellence, and the NIH/NIMHD Loan Repayment Award for Clinicians from Disadvantaged Backgrounds.