Parental incarceration affects health behaviors of children in adulthood

A new study published in Pediatrics found that young adults who had a parent incarcerated during their childhood are more likely to skip needed healthcare, smoke cigarettes, engage in risky sexual behaviors, and abuse alcohol, prescription and illicit drugs. These findings have a potentially broad impact, as more than five million U.S. children have had a parent in jail or prison.

Strikingly, incarceration of a mother during childhood, as opposed to a father, doubled the likelihood of young adults using the emergency department instead of a primary care setting for medical care. Young adults whose mothers had been incarcerated were also twice as likely to have sex in exchange for money, while those with histories of father incarceration were 2.5 times more likely to use intravenous drugs.

"The United States has the highest incarceration rates in the world. With the climbing number of parents, especially mothers, who are incarcerated, our study calls attention to the invisible victims - their children," says lead author Nia Heard-Garris, MD, MSc, a pediatrician at Ann & Robert H. Lurie Children's Hospital of Chicago and Instructor of Pediatrics at Northwestern University Feinberg School of Medicine. "We shed light on how much the incarceration of a mother versus father influences the health behaviors of children into adulthood."

Dr. Heard-Garris and colleagues, including co-authors University of Minnesota Medical School Assistant Professors Tyler Winkelman, MD, Internal Medicine and Pediatrics and Rebecca Shlafer, PhD, MPH analyzed national survey data from more than 13,000 young adults (ages 24-32), finding that 10 percent have had a parent incarcerated during their childhood. Participants were on average 10 years old the first time their parent was incarcerated.

Additionally, young Black adults had a much higher prevalence of parental incarceration. While Black participants represented less than 15 percent of the young adults surveyed, they accounted for roughly 34 percent of those with history of an incarcerated mother and 23 percent with history of an incarcerated father.

"This data points out that children are the invisible victims of mass incarceration, and our country has not thought about the indirect costs," said Dr. Winkelman. "This study is another step in understanding the impact of our criminal justice systems."

Previous research shows that individuals with a history of parental incarceration have higher rates of asthma, HIV/AIDS, learning delays, depression, anxiety and post-traumatic stress disorder.

"It's possible that because these young adults are more likely to forgo medical care and engage in unhealthy behaviors, they are at higher risk to develop these physical and mental health conditions," says Dr. Heard-Garris. "By pinpointing the specific health-harming behaviors that these young adults demonstrate, this study may be a stepping stone towards seeking more precise ways to mitigate the health risks these young adults face. Hopefully, future studies will teach us how to prevent, screen for, and target negative health behaviors prior to adulthood."

The authors also stress that more research is needed to identify specific barriers to healthcare, targeting this population's under-utilization of care.

"When we see results like this, our tendency is to want to immediately jump to action to remedy the impacts," said Dr. Winkelman. "But before implementing interventions, we need to understand the unintended consequences to acting without careful thought."

Winkelman noted that he and his University of Minnesota Medical School colleague, Rebecca Shlafer, an expert on the impact of the criminal justice system and incarceration on health and families, are currently engaged in a University Grand Challenges grant with colleagues at the Law School and in the Department of Sociology to understand the impact of probation or community supervision on families and children.

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