Incarceration Exposure Research Articles

Prenatal incarceration exposure and adverse COVID-19 related experiences during pregnancy

ABSTRACT This study examines the relationship between exposure to incarceration and stressful experiences endured during the initial months of the COVID-19 pandemic (June-December 2020). Using data from the 2020 Pregnancy Risk Assessment Monitoring System (PRAMS), multiple Poisson and logistic regression models were used to assess the association between incarceration of a woman or her partner in the year before birth and the likelihood of experiencing 13 different types of adverse experiences due to the COVID-19 pandemic between June and December 2020. Results indicate that women’s incarceration exposure – either personally or vicariously through a partner – was associated with more total COVID-19 experiences. Additionally, women with incarceration exposure encountered several adverse experiences, including problems paying rent, mortgage, or bills, worried food would run out, felt more anxious, felt more depressed, had more verbal augments or conflicts with husband/partner, and husband/partner was more physically, sexually, or emotionally aggressive, than their non-incarceration-exposed counterparts. Implications of the findings for theory and public policy are discussed.

Multiple risks for children of incarcerated mothers: A descriptive study

Objectives and ApproachSurvey data suggests that children of incarcerated mothers are exposed to a range of risk factors that can have negative impacts on life-course outcomes. This retrospective cohort study uses a population sample to describe the extent and mix of risk factors to which children of incarcerated mothers are exposed. Administrative data from health, justice, child protective services, births, and deaths were merged for 9,380 children exposed to maternal incarceration and an unexposed comparison group of 22,716 children. Risk ratios and 95% confidence intervals were calculated for birth complications and adverse childhood experiences (ACEs) for children exposed to maternal incarceration compared to those not exposed, adjusted for sociodemographic risk factors. A multiple risk score summed the number of recorded risk factors (0-17) for children with and without maternal incarceration exposure. ResultsCompared to unexposed children, children of incarcerated mothers had a higher risk of preterm birth, low birthweight, and all ACEs, including a 15-times (95%CI 14.2, 16.3) higher risk of exposure to maternal substance use disorders and 18-times (95%CI 16.8, 20.7) higher risk of placement in out-of-home care. Only 1% of children of incarcerated mothers did not experience any of the included risk factors, compared to 26% of unexposed children (p<0.001). ConclusionsChildren of incarcerated mothers disproportionately experience multiple risks, especially maltreatment, placement in out-of-home care, and maternal substance use. ImplicationsThere is a significant public health opportunity to identify and address the needs of children of incarcerated mothers at the points of maternal arrest, sentencing, and incarceration.

Community and household-level incarceration and its association with mental health in a racially/ethnically diverse sample of families

This study examines the association between community incarceration rates, household incarceration, and the mental health of parents and children. Participant families had children ages 5–9 (n = 1307) from the African American, Latinx, Hmong, Somali/Ethiopian, Native American, and White communities in the Twin Cities, Minnesota. Linear mixed models were used to estimate associations between parent and child mental health, household incarceration exposure, and census tract race, ethnicity and gender-specific incarceration rates matched to the family's home address and race/ethnicity. Findings indicated that living in census tracts with elevated incarceration rates of men from your same racial or ethnic group was significantly associated with psychological distress in parents and externalizing behaviors in boys, regardless of household exposure to incarceration. The association between incarceration rates and externalizing behaviors was only observed among girls with exposure to household incarceration. Policies that deconstruct pervasive racism in penal systems are needed to improve population mental health.

Cancer incidence among incarcerated and formerly incarcerated individuals: A statewide retrospective cohort study.

Cancer incidence among individuals with incarceration exposure has been rarely studied due to the absence of linked datasets. This study examined cancer incidence during incarceration and postincarceration compared to the general population using a statewide linked cohort. We constructed a retrospective cohort from a linkage of state tumor registry and correctional system data for Connecticut residents from 2005 to 2016, and identified cancers diagnosed during and within 12 months postincarceration. We estimated incidence rates (including for screen-detectable cancers) and calculated the standardized incidence ratios (SIR) for the incarcerated and recently released populations, relative to the general population. We also examined cancer incidence by race and ethnicity within each group. Cancer incidence was lower in incarcerated individuals (SIR = 0.64, 95% CI 0.56-0.72), but higher in recently released individuals (SIR = 1.34, 95% CI 1.23-1.47) compared with the general population, and across all race and ethnic strata. Similarly, nonscreen-detectable cancer incidence was lower in incarcerated and higher in recently released populations compared to the general population. However, non-Hispanic Black individuals had elevated incidence of screen-detectable cancers compared with non-Hispanic White individuals across all three populations (incarcerated, SIR = 1.66, 95% CI 1.03-2.53; recently released, SIR = 1.83, 95% CI 1.32-2.47; and general population, SIR = 1.18, 95% CI 1.16-1.21). Compared with the general population, incarcerated persons have a lower cancer incidence, whereas recently released persons have a higher cancer incidence. Irrespective of incarceration status, non-Hispanic Black individuals have a higher incidence of screen-detectable cancers compared with non-Hispanic White individuals. Supplemental studies examining cancer screening and diagnoses during incarceration are needed to discern the reasons for observed disparities in incidence.

The Incarceration Penalty and Black-White Economic Inequality: The Case of Baltimore

This paper investigates income and wealth gaps by household incarceration history within and across racial groups using the Blinder-Oaxaca decomposition. We study this in the context of 2017 Baltimore. We find that households exposed to incarceration have lower levels of income and wealth and that these differences are largest for White households. Additionally, we find that Black households without incarceration exposure fare no better in household income than White households with exposure but have higher levels of wealth (driven by lower debt levels). These results highlight the importance of studying the relationship between the criminal legal system and economic inequality.

Incarceration exposure and women's oral health experiences during pregnancy

RationalePrior research has documented an association between incarceration and poor oral health outcomes. Likewise, recent scholarship has also detailed that women exposed to incarceration either directly or vicariously through a partner during pregnancy incur worse health outcomes. However, no previous research has assessed the connection between incarceration exposure and oral health during pregnancy. ObjectiveThe current study assesses the link between maternal incarceration exposure and oral health during pregnancy. MethodsData are from the Pregnancy Risk Assessment Monitoring System (PRAMS) from years 2016–2019 (N = 60,342). Logistic regression was used to assess the relationship between incarceration and oral health. ResultsWomen exposed to incarceration exhibited worse oral health outcomes in the form of being more likely to report not knowing the importance of oral care, not having an oral health discussion with a provider, not getting a teeth cleaning, as well as being likely to report needing to see a dental provider, having visited a dental provider for a problem during pregnancy, and having more unmet dental care needs. ConclusionsThese findings add to a burgeoning literature that demonstrates a woman's prenatal exposure to incarceration poses risk for overall health and wellbeing. Given the influence of both incarceration exposure and oral health during pregnancy for maternal and infant health, the findings suggest that coordination between criminal justice, public health, and oral health experts can develop programmatic efforts that expand access to oral health care and improve oral health literacy among incarceration-exposed pregnant women.

Incarceration exposure and epigenetic aging in neighborhood context

ObjectiveResearch has implicated incarceration exposure as a social determinant of health, with recent work suggesting incarceration may trigger a stress response that accelerates physiological deterioration. The objective of the current study is to assess whether neighborhood stressors intensify the health consequences of incarceration exposure. MethodsWe test whether two neighborhood context measures – socioeconomic disadvantage and perceived crime – moderate the association between incarceration exposure and a measure of accelerated epigenetic aging based on the GrimAge index. Our sample included 408 African American young adults from the Family and Community Health study. ResultsResults from regression analyses with inverse probability of treatment weights suggest that incarceration exposure and neighborhood disadvantage are independently associated with accelerated biological aging. The results also show that the impact of incarceration exposure on accelerated aging is amplified for individuals in neighborhoods with higher levels of perceived crime. ConclusionsThese findings indicate that the neighborhood contexts where formerly incarcerated individuals return have a substantial impact on their pace of biological aging. Policies aimed at reducing ambient stressors after release may promote healthy aging among formerly incarcerated African American adults.

Stuck in the cycle? Assessing a reciprocal model of incarceration, health, and relative risk over twenty-five years

PurposeResearchers have chronicled a complex relationship between incarceration exposure and health, yet prior studies do not account for reciprocal dynamics or cycles of reentry over time. MethodsWe analyzed bi-directional relationships between incarceration exposure and mental and general health over twenty five years using data from the National Longitudinal Study of Youth - 1997. We employed lagged autoregressive panel and lagged latent growth models to assess between- and within-individual dynamics of incarceration, health, and reentry. We then tested for differences in patterns of incarceration exposure and health among two high relative health risk groups, Black men and those with limited access to health insurance. ResultsSymptoms of depression and anxiety predict subsequent incarceration exposure in both between- and within- individual change models. Within-individual change in self-rated general health is positively and reciprocally associated with incarceration exposure. This relationship is substantially greater for Black men and those with limited access to health insurance. ConclusionsThe findings underscore key issues of relative health risk that influence the dynamics of incarceration exposure and health inequities. Programmatic efforts to address mental health concerns like depression and anxiety in the community and within correctional settings may be useful in reducing cycles of incarceration.

Incarceration Exposure during Pregnancy and Father’s Acknowledgment of Paternity

Abstract Incarceration carries consequences for families, including negative impacts on female partners and children of incarcerated men. Whether incarceration that occurs around the time of pregnancy influences a father’s acknowledgement of paternity (AOP) of a newborn has been overlooked. The present study investigates the role of recent incarceration largely of male partners for AOP. Drawing on pooled-cross sectional data from the Pregnancy Risk Assessment Monitoring System for 2012–2018 (N = 178,131 in pooled analyses), multinomial logistic regression is used to assess significant differences in the association between incarceration exposure and three possible AOP statuses: married (tacit and automatic AOP), unmarried with voluntary in-hospital AOP, and unmarried without AOP. Findings demonstrated that incarceration-exposed women were approximately twice as likely to be unmarried with voluntary in-hospital AOP and over four times as likely to be unmarried without AOP. Results showed that among unmarried women, incarceration exposure still doubles the odds of unmarried without AOP compared to being unmarried with voluntary in-hospital AOP. Study findings highlight the novel ways that incarceration impacts family structure from the earliest stages of the life course by increasing the chances that recent mothers and their newborn children will be without legal recourse to paternal resources and support.

Incarceration exposure during pregnancy and maternal disability: findings from the Pregnancy Risk Assessment Monitoring System

BackgroundExtant research reveals that currently and formerly incarcerated individuals exhibit higher rates of disability. Moreover, recent research highlights that women exposed to incarceration during pregnancy —either personally or vicariously through a partner— face poorer health. However, prior research has not detailed the connection between incarceration exposure and risk for maternal disability.MethodsThe aim of this study is to evaluate the association between a women’s exposure to incarceration during pregnancy and disability including difficulty with: communication, hearing, remembering, seeing, self-care, or walking. Data are from Pregnancy Risk Assessment Monitoring System (PRAMS), 2019 (N = 12,712). Logistic and negative binomial regression were used to assess the relationship between incarceration exposure and maternal disability.ResultsAmong the sample of women who delivered a recent live birth, approximately 3.3% of the sample indicated they were personally or vicariously exposed to incarceration in the 12 months before birth. Compared to those who did not have incarceration exposure, women with incarceration exposure have elevated odds of several disabilities, including difficulty remembering (Adjusted Odds Ratio [AOR] = 1.971; 95% Confidence Interval [CI] = 1.429, 2.718), difficulty seeing (AOR = 1.642, 95% CI = 1.179, 2.288), difficulty walking (AOR = 1.896, 95% CI = 1.413, 2.544), and a greater number of cumulative disabilities (Incidence Risk Ratio [IRR] = 1.483; 95% CI = 1.271, 1.731).ConclusionsWomen personally or vicariously exposed to incarceration during pregnancy endure greater odds of having a disability. Considering both incarceration and disability are important public health issues with implications for maternal and child well-being, these findings highlight the need for further research that can better understand the connection between incarceration and disability.

Incarceration exposure and prescription opioid use during pregnancy

BackgroundPrior research demonstrates a high prevalence of substance use, including opioid use, among those who have had personal or vicarious contact with the correctional system. Relatedly, alongside patterns of rising opioid use in general, opioid use during pregnancy is becoming a growing public health concern. Still, risk factors for prescription opioid use during pregnancy remain understudied. This study is the first to assess the connection between a women’s personal or vicarious exposure to incarceration in the 12 months prior to birth and patterns of prenatal opioid use. MethodsData are from the Pregnancy Risk Assessment Monitoring System (PRAMS) in 2019 (N = 17,551 mothers). Logistic and multinomial logistic regression are used to assess the association between incarceration exposure and patterns of opioid use during pregnancy. ResultsIncarceration-exposed women were more likely to use all eight types of prescription opioids assessed in this study (Hydrocodone, Codeine, Oxycodone, Tramadol, Hydromorphone/Meperidine, Oxymorphone, Morphine, and Fentanyl). After adjustment for control variables, incarceration-exposed women were significantly more likely to report any prescription opioid use during pregnancy (OR = 1.745, 95% CI = 1.194, 2.554). Furthermore, relative to no opioid use, incarceration exposure was also associated with illicit prescription opioid use (RRR = 2.979, 1.533, 5.791). ConclusionsIncarceration exposure in the year prior to birth is associated with higher odds of prescription opioid use. These findings add to the burgeoning literature that details a women’s exposure to incarceration is a risk marker for substance use and engagement in health risk behaviors that can jeopardize maternal and infant wellbeing.

Recent Incarceration Exposure Among Parents of Live-Born Infants and Maternal and Child Health.

Women who have direct exposure to incarceration or indirect exposure through their partner are at high risk for poor health behaviors and outcomes, which may have lasting impacts on their children. The objectives of this study were to estimate the prevalence of recent incarceration exposure among women with a recent live birth and assess the relationship between incarceration exposure and maternal and child health. We used data from the Pregnancy Risk Assessment Monitoring System (36 states and New York City, 2012-2015; N = 146 329) to estimate the prevalence of women reporting that they or their husband/partner spent time in jail during the 12 months before giving birth. We used multivariable logistic regression to assess associations between incarceration exposure and maternal and infant health conditions. The prevalence of incarceration exposure shortly before or during pregnancy was 3.7% (95% CI, 3.6%-3.9%). Women with incarceration exposure had increased odds of prepregnancy hypertension (adjusted odds ratio [aOR] = 1.51; 95% CI, 1.26-1.81), prepregnancy and postpartum depressive symptoms (aOR = 1.95 [95% CI, 1.73-2.19] and 1.49 [95% CI, 1.32-1.67], respectively), and having an infant admitted to the neonatal intensive care unit (aOR = 1.18; 95% CI, 1.04-1.33). Because a parent's incarceration exposure is an adverse childhood experience with the potential to disrupt important developmental periods and have negative impacts on the socioemotional and health outcomes of children, it is critical for researchers and health care providers to better understand its impact on maternal and infant health. Prenatal and postnatal care may provide opportunities to address incarceration-related health risks.

A prospective cohort study examining exposure to incarceration and cardiovascular disease (Justice-Involved Individuals Cardiovascular Disease Epidemiology \u2013 JUSTICE study): a protocol paper

BackgroundPeople who have been incarcerated have high rates of cardiovascular risk factors, such as hypertension and smoking, and cardiovascular disease (CVD) is a leading cause of hospitalizations and mortality in this population. Despite this, little is known regarding what pathways mediate the association between incarceration exposure and increased rates of CVD morbidity and especially what incarceration specific factors are associated with this risk. The objective of this study is to better understand CVD risk in people exposed to incarceration and the pathways by which accumulate cardiovascular risk over time.Methods and AnalysisThe Justice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE) study is a prospective cohort study of individuals released from incarceration with known cardiovascular risk factors. We are recruiting 500 individuals within three months after release from jail/prison. At baseline we are assessing traditional risk factors for CVD, including diet, exercise, and smoking, and exposure to incarceration-related policies, psychosocial stress, and self-efficacy. Cardiovascular risk factors are measured at baseline through point of care testing. We are following these individuals for the 12 months following the index release from incarceration with re-evaluation of psychosocial factors and clinical risk factors every 6 months. Using these data, we will estimate the direct and indirect latent effects of incarceration on cardiovascular risk factors and the paths via which these effects are mediated. We will also model the anticipated 10-year burden of CVD incidence, health care use, and mortality associated with incarceration.DiscussionOur study will identify factors associated with CVD risk factor control among people released from incarceration. Our measurement of incarceration-related exposures, psychosocial factors, and clinical measures of cardiovascular risk will allow for identification of unique targets for intervention to modify CVD risk in this vulnerable population.

Abstract P5-14-10: Examining inequities associated with incarceration among patients with breast cancer

Abstract Background: As of 2020, approximately 2.3 million people were incarcerated in federal and state prisons across the United States (US). Both the total number of individuals experiencing incarceration and the average age of this population have been increasing steadily, raising concerns over the criminal legal system’s capacity to ensure adequate healthcare for this aging and expanding population. People who experience incarceration carry a heavy burden of disease and are more likely to belong to racial and ethnic minority groups. Despite known risk factors, little data exist with regards to treatment patterns and quality of care for breast cancer among these individuals. We sought to examine disease and treatment characteristics among individuals diagnosed with and treated for breast cancer during an episode of incarceration. Methods: We derived our analytic population from patients ≥14 years old who received a breast-cancer diagnosis at the University of North Carolina Hospitals (a tertiary care center) between 4/14/2014 and 12/30/2020. Patient demographics including incarceration status during diagnosis, disease characteristics, and treatment details were summarized with N (%) for categorical variables and median (interquartile range, IQR) for continuous variables. Comparisons were made according to incarceration exposure: never incarcerated (NI) vs diagnosis before incarceration (BI) vs diagnosis during time of incarceration (DI). Differences were tested using the chi-square or Fisher’s exact test for categorical variables and Wilcoxon rank sum or Kruskal-Wallis test for continuous variables. Linear regression was used to estimate the association of incarceration status with time to treatment, modeled separately by treatment sequence (neoadjuvant or upfront surgery). Results: Of the 4332 patients with analyzable data, 34 (0.8%) were either actively incarcerated at time of diagnosis (DI n=24, 70.6%) or were diagnosed before incarceration (BI n=10, 29.4%). Compared to those who were NI or BI, DI patients were more likely to be single (%, DI (50%) vs NI (16.8%) vs BI (10%), p<0.001), more likely to be using illicit drugs at time of diagnosis (%, DI (12.5%) vs NI (1.9%) vs BI (0%), p=0.01), and more likely to have a family history of breast cancer (%, DI (66.7%) vs NI (41.5%) vs BI (30%), p=0.03). There were no differences between DI, NI, and BI patients with regards to race/ethnicity, tumor receptors, or clinical or pathological stage at diagnosis. However, DI patients were less likely to receive neoadjuvant therapy than those who were NI or BI (%, DI (0%) vs NI (8.2%) vs BI (20%), p=0.01). Among patients who received upfront surgery, being incarcerated at time of diagnosis was associated with a time-to-treatment that was 23.4 days longer than that of patients who were never incarcerated (95% CI, 9.5-37.3 days, p=0.001). Conclusion: None of the individuals who were diagnosed with breast cancer during incarceration received neoadjuvant treatment. Among all women who received surgery as their first treatment, diagnosis during incarceration was associated with longer time-to-surgery compared to those never incarcerated. These findings are concerning for missed treatment opportunities within the carceral system. Further research is necessary to understand the full scope of disparities and the systemic factors that contribute to them. Citation Format: Oluwadamilola Motunrayo Fayanju, Yoshiko Iwai, Alice YunziL Yu, Samantha M Thomas, Andrea K Knittel, Kelly E Westbrook. Examining inequities associated with incarceration among patients with breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-14-10.

Losing Years Doing Time: Incarceration Exposure and Accelerated Biological Aging among African American Adults

Losing Years Doing Time: Incarceration Exposure and Accelerated Biological Aging among African American Adults

Losing Years Doing Time: Incarceration Exposure and Accelerated Biological Aging among African American Adults.

Research suggests that incarceration exposure increases the prevalence of morbidity and premature mortality. This work is only beginning to examine whether the stressors of the incarceration experience become biologically embedded in ways that affect physiological deterioration. Using data from a longitudinal sample of 410 African American adults in the Family and Community Health Study and an epigenetic index of aging, this study tests the extent to which incarceration accelerates epigenetic aging and whether experiences with violence moderate this association. Results from models that adjust for selection effects suggest that incarceration exposure predicted accelerated aging, leaving formerly incarcerated African American individuals biologically older than their calendar age. Direct experiences with violence also exacerbated the effects of incarceration. These findings suggest that incarceration possibly triggers a stress response that affects a biological signature of physiological deterioration.

Genomic Update of Phenotypic Prediction Rule for Methicillin-Resistant Staphylococcus aureus (MRSA) USA300 Discloses Jail Transmission Networks with Increased Resistance.

ABSTRACTMethicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of health care-associated (HA) and community-associated (CA) infections. USA300 strains are historically CA-MRSA, while USA100 strains are HA-MRSA. Here, we update an antibiotic prediction rule to distinguish these two genotypes based on antibiotic resistance phenotype using whole-genome sequencing (WGS), a more discriminatory methodology than pulsed-field gel electrophoresis (PFGE). MRSA clinical isolates collected from 2007 to 2017 underwent WGS; associated epidemiologic data were ascertained. In developing the rule, we examined MRSA isolates that included a population with a history of incarceration. Performance characteristics of antibiotic susceptibility for predicting USA300 compared to USA100, as defined by WGS, were examined. Phylogenetic analysis was performed to examine resistant USA300 clades. We identified 275 isolates (221 USA300, 54 USA100). Combination susceptibility to clindamycin or levofloxacin performed the best overall (sensitivity 80.7%, specificity 75.9%) to identify USA300. The average number of antibiotic classes with resistance was higher for USA100 (3 versus 2, P < 0.001). Resistance to ≤2 classes was predictive for USA300 (area under the curve (AUC) 0.84, 95% confidence interval 0.78 to 0.90). Phylogenetic analysis identified a cluster of USA300 strains characterized by increased resistance among incarcerated individuals. Using a combination of clindamycin or levofloxacin susceptibility, or resistance to ≤2 antibiotic classes, was predictive of USA300 as defined by WGS. Increased resistance was observed among individuals with incarceration exposure, suggesting circulation of a more resistant USA300 clade among at-risk community networks. Our phenotypic prediction rule could be used as an epidemiologic tool to describe community and nosocomial shifts in USA300 MRSA and quickly identify emergence of lineages with increased resistance.IMPORTANCE Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of health care-associated (HA) and community-associated (CA) infections, but the epidemiology of these strains (USA100 and USA300, respectively) now overlaps in health care settings. Although sequencing technology has become more available, many health care facilities still lack the capabilities to perform these analyses. In this study, we update a simple prediction rule based on antibiotic resistance phenotype with integration of whole-genome sequencing (WGS) to predict strain type based on antibiotic resistance profiles that can be used in settings without access to molecular strain typing methods. This prediction rule has many potential epidemiologic applications, such as analysis of retrospective data sets, regional monitoring, and ongoing surveillance of CA-MRSA infection trends. We demonstrate application of this rule to identify an emerging USA300 strain with increased antibiotic resistance among incarcerated individuals that deviates from the rule.

Incarceration exposure and food insecurity during pregnancy: Investigating the moderating role of social support

This study examines the relationship between exposure to incarceration and maternal food insecurity during pregnancy, and the moderating role of social support in this process. Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS), logistic regression models were used to assess the association between incarceration of a woman or her partner in the year before birth and the likelihood of experiencing food insecurity. Moderation analyses were conducted by interacting levels of social support and incarceration exposure. Results indicate that exposure to incarceration either personally or vicariously through a partner increased the odds of food insecurity, while women with higher levels of social support were at lower risk for food insecurity. Moreover, study findings demonstrate a negative interaction between social support and incarceration, indicating that social support buffers against the harmful effects of incarceration for maternal food insecurity during pregnancy. Implications of the findings for theory and public policy are discussed

Incarceration exposure and electronic cigarette use during pregnancy: Findings from the pregnancy risk assessment monitoring system, 2016–2018

Smoking during pregnancy is a serious public health concern that poses risks for maternal and infant health. Considering the rise of electronic cigarette use in recent years, there is also growing concern about electronic cigarette use during pregnancy. Recent research has begun to explore correlates of electronic cigarette use among pregnant women. While research has revealed a strong connection between incarceration and smoking, scholars have yet to examine the connection between a woman's exposure to incarceration in the year prior to birth – either personally or vicariously through her husband or partner – and prenatal electronic cigarette use. The current study uses data from 74,554 recent mothers from the 2016–2018 Pregnancy Risk Assessment Monitoring System. Logistic regression and multinomial logistic regression models were used to assess the association between incarceration exposure and electronic cigarette use. The findings indicate a robust association between incarceration exposure and electronic cigarette use during pregnancy. Specifically, analyses demonstrate that incarceration-exposed women were approximately 2.7 times (AOR = 2.699, 95% CI = 1.939, 3.755) as likely to use electronic cigarettes after adjusting for a host of demographic, economic, health, and pregnancy related characteristics. Additional analyses reveal this association remains after accounting for conventional cigarette use during pregnancy. Considering the potential harmful health ramifications for electronic cigarette use during pregnancy, these findings suggest a need for interventions targeting electronic cigarette use among incarceration-exposed populations and point to electronic cigarette use among pregnant women in particular as an important area of focus for both criminal justice and public health practitioners.

Incarceration Exposure and Barriers to Prenatal Care in the United States: Findings from the Pregnancy Risk Assessment Monitoring System.

Previous research demonstrates that exposure to incarceration during pregnancy – either personally or vicariously through a partner – worsens parental care. However, little is known about the specific barriers to parental care that are associated with incarceration exposure. Using data from the Pregnancy Risk Assessment Monitoring System (years 2009–2016), the current study examines the relationship between exposure to incarceration during pregnancy and barriers to prenatal care in the United States. Negative binomial and logistic regression models were used to assess the association between the recent incarceration of a woman or her partner (i.e., incarceration that occurred in the 12 months prior to the focal birth) and several barriers to prenatal care. Findings indicate that exposure to incarceration, either personally or vicariously through a partner, increases the overall number of barriers to prenatal care and this association operates through several specific barriers including a lack of transportation to doctor’s appointments, having difficulty finding someone to take care of her children, being too busy, keeping pregnancy a secret, and a woman not knowing she was pregnant. Policies designed to help incarceration exposed women overcome these barriers can potentially yield benefits for enhancing access to parental care.