Incarceration as a unique social stressor during pregnancy: Implications for maternal and newborn health

Assessing the acute effects of exposure to community violence among adolescents: A strategic comparison approach

This paper examines whether exposure to spatially proximate homicide affects norms, attitudes, and the adaptive strategies adolescents take to insulate themselves from violent victimization. Drawing on survey data from a large sample of urban youth (n = 3195), we assess the impact of homicides occurring within a one-mile radius of respondents' homes on a variety of psychosocial outcomes. We exploit random variation in the timing of survey administration to compare the survey responses of youths who were exposed to a homicide in the immediate vicinity of their homes in the one-month period leading up the administration of the survey with students who did not experience a homicide near their homes during that period but would the following month. This strategic comparison approach minimizes the confounding influence of endogenous processes that funnel children and families into places where homicides tend to concentrate.

Black-white differences in chronic stress exposures to predict preterm birth: interpretable, race/ethnicity-specific machine learning model

BACKGROUND

Differential exposure to chronic stressors by race/ethnicity may help explain Black-White inequalities in rates of preterm birth. However, researchers have not investigated the cumulative, interactive, and population-specific nature of chronic stressor exposures and their possible nonlinear associations with preterm birth. Models capable of computing such high-dimensional associations that could differ by race/ethnicity are needed. We developed machine learning models of chronic stressors to both predict preterm birth more accurately and identify chronic stressors and other risk factors driving preterm birth risk among non-Hispanic Black and non-Hispanic White pregnant women.

METHODS

Multivariate Adaptive Regression Splines (MARS) models were developed for preterm birth prediction for non-Hispanic Black, non-Hispanic White, and combined study samples derived from the CDC's Pregnancy Risk Assessment Monitoring System data (2012-2017). For each sample population, MARS models were trained and tested using 5-fold cross-validation. For each population, the Area Under the ROC Curve (AUC) was used to evaluate model performance, and variable importance for preterm birth prediction was computed.

RESULTS

Among 81,892 non-Hispanic Black and 277,963 non-Hispanic White live births (weighted sample), the best-performing MARS models showed high accuracy (AUC: 0.754-0.765) and similar-or-better performance for race/ethnicity-specific models compared to the combined model. The number of prenatal care visits, premature rupture of membrane, and medical conditions were more important than other variables in predicting preterm birth across the populations. Chronic stressors (e.g., low maternal education and intimate partner violence) and their correlates predicted preterm birth only for non-Hispanic Black women.

CONCLUSIONS

Our study findings reinforce that such mid or upstream determinants of health as chronic stressors should be targeted to reduce excess preterm birth risk among non-Hispanic Black women and ultimately narrow the persistent Black-White gap in preterm birth in the U.S.

Exploration of the effects of incarceration on the health of Latina women and their children using the life course theory

OBJECTIVE

Use the Life Course Theory (LCT) to explore the effects of involvement with the justice system on the health of Latina women and their children.

DESIGN

A supplementary analysis was conducted using data collected from the original study to answer a new research question.

SETTING

South Central Texas.

PARTICIPANTS

A primary qualitative data set from 12 Latina women involved with the justice system.

METHODS

We applied LCT principles and used thematic content analysis as such we employed categoric distinction: lifespan development, time and place in individuals' lives, the timing of lives, human agency, and linked lives to analyze participants' narratives.

RESULTS

Five themes emerged that aligned with LCT principles: (1) It feels like I'm living in my own prison; (2) What do I have to live for now; (3) It is like double punishment; (4) They made my choices; and (5) People didn't really understand. Participants felt helpless with few options to overcome their prior adversities, which affected their ability to make positive future choices.

CONCLUSIONS

Findings highlight the potential, long-term, negative health consequences that may result from incarceration. Considering that justice system involvement can lead to more profound maternal and child health disparities, our findings suggest that greater advocacy from the nursing profession would increase accessibility to equitable and respectful maternity and women's health care services. Key points Involvement with the justice system can result in negative health consequences for women and their children. Maternal and child health disparities are often more profound after involvement with the justice system. Greater advocacy is needed from the nursing profession to ensure access to equitable and respectful maternity and women's health care services.

Solitary confinement and the well-being of people in prison

BACKGROUND

Solitary confinement and mental well-being has been researched extensively, with a significant increase in studies over the last ten years. These recent studies produce mixed evidence for whether placement in solitary confinement is associated with psychological distress. We advance our understanding of these relationships in two critical ways. First, we conduct both between- and within-person analyses within the same data to better understand the relationship of solitary confinement and mental well-being relative to the well-being of people in less restrictive prison settings. Second, we ask the men in our sample questions about their personality style, coping strategies, and interactions with staff, which allows us to explore how individual characteristics and prison experiences matter, alongside isolation, in understanding mental well-being.

METHODS

We gather data from interviews at three time points with 122 men in solitary confinement and 204 men in other conditions of confinement in Arizona from 2017 to 2019. We merge these interview data with administrative data on study sample and population sample to include critical measures such as mental health score, risk level, and visitation status. Our interviews contain a Global Severity Index (GSI), created from 90 self-reported psychopathological symptoms experienced, that we use to assess well-being. We estimate cross-classified multilevel models to assess between-person differences and within-person change in well-being over time.

RESULTS

There was a small relationship between solitary confinement and worsening well-bring (longitudinal, within-person) and a small relationship between solitary confinement and worse well-being (cross-sectional, between-person), with this between-person association reduced significantly upon inclusion of additional individual characteristics and prison experiences.

CONCLUSIONS

Our results suggest that the incarceration experience, including conditions of confinement, is associated with mental well-being in different ways for different people. We believe that collective confinement and well-being could receive the same scholarly attention and public concern as solitary confinement.

Sleep duration among adults exposed to family member incarceration during childhood

OBJECTIVES

The current study examines the association between family member incarceration during childhood and sleep duration among a national sample of adults (ages 18-80+).

METHODS

We employ data from the 2020 Behavioral Risk Factor Surveillance System (N = 116,631). We use stepwise, multinomial logistic regression to examine associations between exposure to family member incarceration during childhood and sleep duration during adulthood. We also utilize the Karlson-Holm-Breen method to investigate whether indicators of socioeconomic disadvantage, and poor mental and physical health attenuate this relationship. Finally, to examine the robustness of associations between family member incarceration and sleep duration, we used a strategic comparison approach in which participants experiencing family member incarceration were compared to participants experiencing alternative adverse childhood experiences in the absence of family member incarceration.

RESULTS

Findings demonstrate a significant association between family member incarceration and sleep duration, with particularly strong associations with short and long sleep durations (relative to optimum sleep duration). However, poor mental and physical health during adulthood and socioeconomic disadvantage significantly attenuated these associations. Strategic comparison models also revealed that the association between family member incarceration during childhood and sleep duration is robust to the accumulation of other childhood adversities.

CONCLUSIONS

Findings suggest that strategies are needed among public health practitioners, physicians, and sleep professionals to mitigate the potential adverse effects of family member incarceration during childhood on sleep duration among adults.

The intergenerational effects of paternal incarceration on children's social and psychological well-being from early childhood to adolescence

The present study sought to unravel the psychological processes through which mass incarceration, specifically paternal incarceration, is negatively affecting the next generation of children. Data came from 4,327 families from 20 cities who participated in a 10-year longitudinal study. Parents and children reported on children's rule-breaking behaviors and depressive symptoms when they were on average ages 5 (2003-2006), 9 (2007-2010), and 15 (2014-2017). Parental surveys and disposition information were combined to assess paternal incarceration at each age. Results showed that children who experienced paternal incarceration at age 5 also demonstrated more rule-breaking behaviors at age 15. Children's age-9 depressive symptoms partially mediated our finding, such that children who experienced paternal incarceration at age 5 also showed greater depressive symptoms at age 9, which in turn predicted greater rule-breaking behaviors at age 15. Paternal incarceration predicted future rule-breaking behaviors more strongly than did other forms of father loss. Because we found paternal incarceration during childhood is associated with worsened adjustment into adolescence, we discussed the need for developmentally appropriate practices in the criminal justice system.

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

OBJECTIVE

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Incarceration exposure and women's oral health experiences during pregnancy

RATIONALE

Prior 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.

OBJECTIVE

The current study assesses the link between maternal incarceration exposure and oral health during pregnancy.

METHODS

Data 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.

RESULTS

Women 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.

CONCLUSIONS

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

BACKGROUND

Extant 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.

METHODS

The 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.

RESULTS

Among 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).

CONCLUSIONS

Women 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.

Justice for Incarcerated Moms Act of 2021: Reflections and recommendations

In the last five decades, the number of women behind bars in the United States has risen exponentially. It is now estimated that there are nearly 58,000 admissions of pregnant people—disproportionately women of color—to jails and prisons each year. Recognizing the urgency and consequences of mass incarceration on pregnant people, their families, and communities, House Resolution 948: Justice for Incarcerated Moms Act of 2021 was introduced to Congress as a part of the Black Maternal Health Momnibus. The Justice for Incarcerated Moms Act aims to improve health care and promote dignity for incarcerated pregnant and parenting people through an array of policies and oversight. In this article, we review and reflect on the components of this bill within their broader public health and reproductive justice contexts. We close with recommendations for policymakers and professionals committed to promoting equity and justice for pregnant and postpartum incarcerated people.

Adverse childhood experiences and maternal disability: Findings from the North Dakota and South Dakota PRAMS, 2019

RATIONALE

Prior research has found adverse childhood experiences (ACEs) to be a risk factor for disability in adulthood. Moreover, accumulating evidence highlights that both ACEs and disability during pregnancy are a risk factor for both maternal and infant wellbeing. Yet, no previous work has assessed whether ACEs increase the risk of maternal disability.

OBJECTIVE

The current study assesses the link between maternal ACE exposure and disability.

METHODS

Data are from the North Dakota and South Dakota Pregnancy Risk Assessment Monitoring System (PRAMS), 2019 (N = 1775). Logistic regression was used to assess the relationship between accumulating ACEs and maternal disability.

RESULTS

Mothers with exposure to a greater number of ACE-notably, 4 or more ACEs- had elevated rates of several disabilities including difficulty communicating, difficulty remembering, difficulty seeing, and difficulty walking.

CONCLUSIONS

Understanding the long-term health repercussions of ACEs for pregnant women and mothers is important to help inform the design and implementation of health care interventions. This study can be used to better understand the prevalence of disabilities among mothers and corroborate early life experiences as an important risk factor for disability.

The Process of Becoming a Mother in French Prison Nurseries: A Qualitative Study

BACKGROUND

Many variables can influence the process of motherhood, including environmental precarity and personal adversity. One about which little is known is the impact of incarceration on women during or after pregnancy. In France, pregnant women or those with children up to 18 months old can be incarcerated with their child in specific units called nurseries. We sought to explore incarcerated women's experience of motherhood in prison environments and its potential consequences on the construction of their identity as mothers.

METHOD

We conducted semi-structured interviews to collect the experience of the process of motherhood among 25 mothers and 5 pregnant women in 13 different prison nurseries in France and used interpretative phenomenological analysis to explore the data.

RESULTS

Four different themes emerged: prison conflates their status as inmates and as mothers; it limits their freedom as mothers; it disrupts their family structure; and motherhood may help distinguish them from other inmates.

CONCLUSION

Incarceration of pregnant women or young mothers in prison nurseries might disrupt the process involved in becoming mothers, causing their identities as prisoners to englobe their identities as mothers and resulting in inappropriate parenting support by prison staff. A professional specialized in peripartum issues should help each woman disentangle her identity as inmate and mother and enable her placement at the facility best adapted to her individual needs as a mother. In any case, if prison must continue to be possible, it must always be a last alternative for women with young children.

Maternal stress during pregnancy and children's diet: Evidence from a population of low socioeconomic status

OBJECTIVES

This study examined the relationship between maternal exposure to stress during pregnancy and children's food preferences and diet in a population of low socioeconomic status.

METHODS

Indices of exposure to stress were constructed based on retrospective self-reported experience of stressful events during pregnancy (e.g., death of close family member, relationship difficulties, legal issues, health issues, financial issues, or other potentially stressful event[s]). Data were collected for >200 mothers of a low socioeconomic status with a child age 2 to 12 y. Data on mothers' body mass index, current exposure to stress, current diet, and diet during pregnancy were collected at the same time, as well as data on children's food preferences and current diet as reported by the mothers. Indices of the healthiness of food preferences and diet were constructed and used as outcome variables.

RESULTS

Maternal exposure to stress during pregnancy significantly predicts children's food and taste preferences, as well as their diet, in regression models controlling for maternal diet, current maternal stress, and demographic characteristics of both the child and mother. Higher average stress during pregnancy is linked with significantly less healthy food preferences and diet, as well as with weaker preferences for sour and bitter foods. This relationship is observed across different age groups.

CONCLUSIONS

Maternal exposure to stress during pregnancy could have long-term detrimental effects on dietary outcomes and thereby on health conditions related to diet. Prenatal care and preconception counseling could be critical to develop preventive strategies to improve public health.

Maternal Adverse Childhood Experiences, Paternal Involvement, and Infant Health

OBJECTIVES

To assess the interplay between maternal exposure to adverse childhood experiences (ACEs) and father's acknowledgment of paternity (AOP; a proxy for paternal involvement) in the risk of low birth weight (<2500 grams) and preterm birth (<37 weeks) among offspring.

STUDY DESIGN

Data come from the 2018 North Dakota and South Dakota Pregnancy Risk Assessment Monitoring System (n = 1896). Logistic regression models were used to assess low birth weight and preterm birth outcomes. Moderation analyses are conducted to assess the interaction between maternal ACEs and father's AOP.

RESULTS

Moderation analyses demonstrated a positive interaction between an accumulating number of maternal ACEs and being unmarried without AOP for low birth weight and preterm birth. Upon comparing newborns of unmarried women without AOP, those whose mothers were exposed to 4 or more ACEs had a 3.74 times greater probability of low birth weight (0.050 vs 0.187) and a 1.74 times greater probability of preterm birth (0.085 vs 0.148) than those whose mothers reported no ACE exposure.

CONCLUSIONS

Exposure to accumulating ACEs substantially increases the risk of deleterious infant health outcomes, but only for newborns of unmarried women without AOP. Future research should assess the efficacy of interventions that can mitigate the impact of maternal ACEs in the absence of father's AOP.

Paternal Jail Incarceration and Birth Outcomes: Evidence from New York City, 2010-2016

OBJECTIVES

To examine population-level associations between paternal jail incarceration during pregnancy and infant birth outcomes using objective measures of health and incarceration.

METHODS

We use multivariate logistic regression models and linked records on all births and jail incarcerations in New York City between 2010 and 2016.

RESULTS

0.8% of live births were exposed to paternal incarceration during pregnancy or at the time of birth. After accounting for parental sociodemographic characteristics, maternal health behaviors, and maternal health care access, paternal incarceration during pregnancy remains associated with late preterm birth (OR = 1.34, 95% CI = 1.21, 1.48), low birthweight (OR = 1.39, 95% CI = 1.27, 1.53), small size for gestational age (OR = 1.35, 95% CI = 1.17, 1.57), and NICU admission (OR = 1.14, 95% CI = 1.05, 1.24).

CONCLUSIONS

We found strong positive baseline associations (p < 0.001) between paternal jail incarceration during pregnancy with probabilities of all adverse outcomes examined. These associations did not appear to be driven purely by duration or frequency of paternal incarceration. These associations were partially explained by parental characteristics, maternal health behavior, and health care. These results indicate the need to consider paternal incarceration as a potential stressor and source of trauma for pregnant women and infants.

The Health and Development of Young Children Who Witnessed Their Parent's Arrest Prior to Parental Jail Incarceration

Most U.S. incarceration occurs in jails, with more than 10 million annual admissions, and most individuals in jail are parents of minor children. In this short-term longitudinal study, we examined the health and development of young children who did or did not witness their parent's arrest prior to parental jail incarceration. 228 individuals in 76 triads (incarcerated parents, children, at-home caregivers) were enrolled from four jails in two states. Jailed parents and caregivers reported on whether the child witnessed the parent's arrest or crime. Children's caregivers completed questionnaires about children's emotional symptoms during the prior 6 months and demographics, as well as children's emotional reactions to separation from the parent and child health at the initial assessment and 2 weeks later. Trained researchers conducted a developmental assessment with children while waiting to visit parents. Results of regression-based moderated mediation analyses indicated that when their emotional symptoms were high, children who witnessed parental arrest were more likely to have poorer health initially and more intense negative reactions to the parent leaving for jail. In addition, when children's general emotional symptoms were low, children who witnessed their parent's arrest were more likely to exhibit developmental delays, especially in their early academic skills, compared to children who did not witness the arrest. Witnessing the parent's crime related to missed milestones in social and adaptive development. Findings have implications for policies regarding safeguarding children during parental arrest and referrals for health- and development-promotion services following parental criminal justice system involvement.

Assessing the relationship between parental imprisonment in childhood and risk of sexually transmitted infections: a cohort study of US adults in early adulthood

OBJECTIVES

One in six young adults in the USA experiences parental imprisonment in childhood. Prior studies have associated parental imprisonment with risk of sexually transmitted infection (STI); however, potential data and methodological issues may have limited the reliability and accuracy of prior findings. Examining cumulative and longitudinal risk, we address several methodological limitations of prior studies and also examine comparative risk by respondent sex and ethnicity. We assess these associations using a range of control variables.

DESIGN

A national cohort study from the National Longitudinal Study of Adolescent to Adult Health using (1) a cross-sectional sample of adults at ages 24-32 years and (2) a longitudinal sample between ages 18 and 32 years. Both analyses estimate ORs for STI associated with parental imprisonment and examine variation by parent/child gender and respondent ethnicity.

SETTING

In-home interviews in the USA at wave 1 (1994-1995), wave 3 (2001-2003) and wave 4 (2007-2009).

PARTICIPANTS

15 684 respondents completing interviews at wave 1 (ages 12-18 years) and wave 4 (ages 26-32 years), including 8556 women, 3437 black and 2397 respondents reporting parental imprisonment.

RESULTS

Father-only imprisonment is associated with 1.22 higher odds (95% CI: 1.09 to 1.37) of lifetime STI and 1.19 higher odds (95% CI: 1.01 to 1.41) of STI in the past 12 months between ages 18 and 32 years, adjusting for familial, neighbourhood, individual and sexual risk factors. Maternal imprisonment is not associated with higher risk of lifetime STI after adjusting for confounders (95% CI: 0.90 to 1.61). Examining predicted probabilities of STI, our findings show additive risks for women, black people and parental imprisonment.

CONCLUSION

Adjusting for confounders, only paternal imprisonment is associated with slightly elevated risk of annual and lifetime risk of STI. Additive effects show that parental imprisonment modestly increases ethnic and female risk for STI.

Parental Incarceration, Child Adversity, and Child Health: A Strategic Comparison Approach

Background: Research points to parental incarceration as an important social determinant of child health. Even so, studies examining the health impact of parental incarceration in the context of diverse childhood stressors and adversities are lacking. Methods: The present study uses a large, nationally representative sample to compare U.S. children who were exposed to parental incarceration to a strategic comparison group of U.S. children who were not exposed to parental incarceration, but were nonetheless exposed to alternative family stressors and adversities. Results: The initial findings generally reveal worse health among children exposed to parental incarceration compared to those who are not exposed. Even so, these differences were partially or completely attenuated when comparing the incarceration-exposed group to more comparable groups of children exposed to a varying degree of alternative stressors/adversities. Conclusions: Programmatic efforts targeting parental incarceration as a means of promoting child health may be enhanced by adequately addressing co-occurring family stressors and child adversities.

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 During Pregnancy and Infant Health: Moderation by Public Assistance

OBJECTIVES

To assess the relationship between exposure to incarceration during pregnancy and adverse infant health outcomes: low birth weight (<2500 g), very low birth weight (<1500 g), preterm birth (<37 weeks), and very preterm birth (≤33 weeks), and to evaluate the moderating role of receiving public assistance benefits (Special Supplemental Nutrition Program for Women, Infants, and Children and Medicaid) during pregnancy in this process.

STUDY DESIGN

The current study employs data from the Pregnancy Risk Assessment Monitoring System, 2009-2017. Logistic regression models were used to assess the association between incarceration of a woman or her partner in the year before birth, the receipt of public assistance during pregnancy, and postpartum infant health. Moderation analyses were conducted by interacting forms of public assistance and incarceration exposure.

RESULTS

Exposure to incarceration either personally or vicariously through a partner increased all 4 adverse infant health outcomes. However, moderation analyses demonstrated that public assistance benefits and incarceration have a negative interaction, indicating that public assistance might buffer against the harmful effects of incarceration exposure during pregnancy on infant health.

CONCLUSIONS

Incarceration exposure during pregnancy poses a significant risk for adverse infant health outcomes. However, the receipt of public assistance benefits including Special Supplemental Nutrition Program for Women, Infants, and Children and Medicaid may mitigate this risk. Expanded access to public assistance for women exposed to incarceration during pregnancy holds promise to improve infant health outcomes.

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.

Incarceration rates and hospital beds per capita: A cross-national study of 36 countries, 1971-2015

RATIONALE

Incarceration carries several negative ramifications for population health, while diverting scarce resources from other public goods. At a time when health care systems around the world are strained, the current study investigates the long-term relationship between incarceration and health care infrastructure.

OBJECTIVE

We investigated the longitudinal association between incarceration rates and hospital beds per capita for 36 countries between 1971 and 2015.

METHOD

Fixed effects regression analyses were employed to examine the effect of within-country changes in incarceration rates on hospital beds per capita.

RESULTS

Findings demonstrated that increases in national incarceration rates over time were associated with declines in hospital beds per capita, net of controls for socio-demographic and economic factors.

CONCLUSIONS

Increased incarceration negatively impacts hospital bed availability at the cross-national level.