Mass Incarceration and Aggressive Policing: Contextual and Direct Determinants of Population Health

Abstract

Rates of jail and prison incarceration, arrests and police surveillance, have grown explosively during the past several decades in the U.S.. Despite the vast scope and reach of the criminal legal system, and its unjust and disproportionate impact on communities of color, very few epidemiologic studies have investigated health consequences for those directly affected, their families, and communities. This dissertation examines health impacts associated with three carceral exposures: county-level jail incarceration rates, youth police stops, and county-level exposure to police killings. I apply the theoretical frames of structural racism and ecosocial theory to hypothesize about how these exposures act as stressors during sensitive periods in lifecourse development, birth and adolescence, and have distinct effects across race/ethnicity. In the first chapter, I link together novel sources of jail incarceration data at the county-level with individual-level birth certificate records for the entire U.S. from 1999-2015. I found that women living in counties with the highest quintile of jail incarceration rates, >99% of whom were not incarcerated, had 1.08 (95% Confidence Interval (CI): 1.07-1.09) times greater odds of preterm birth, adjusting for covariates, compared to women living in counties with the lowest quintile of jail incarceration rates. In the second chapter, I examine whether frequent police stops put adolescents at greater risk for depressive symptoms and worse subjective well-being in a nationally representative sample of adolescents ages 12-18 years in the Panel Study of Income Dynamics Child Development Supplement 2002 and 2007. Despite fewer police stops compared to boys, Black and White girls who were stopped at least twice in the last six months had higher average depression scores relative to girls who were not stopped (Black: 2.13 (95% CI: 0.73, 3.53), White: 2.17 (95% CI: 1.07, 3.27)) and these associations were stronger among girls whose parents had been incarcerated. Black and White boys who were stopped at least twice versus never had lower levels of emotional well-being (Black: -0.40 (95% CI: -0.75, -0.04), White: -0.36 (95% CI: -0.68, -0.04). In the third chapter, I examine whether gestational exposure to county-level police killings decreased the number of live births in a county, which is reflective of a rise in lost pregnancies. To do so, I linked birth certificate data for all full-term births in counties with at least one police killing (2013-2015) to a database that prospectively identified police killings. For each additional police killing that occurred in the second through fourth months of gestation, I observed a slight decrease in the total number of live births within counties (RR for the 4th month: 0.99, 95% CI: 0.99, 0.99). In race-specific models, this association was similar for Black women, but null for White women. The studies in this dissertation propose ways to use the limited data available to study the harmful health effects of carceral systems while also calling for improved data. Together, these chapters argue for a more expansive conceptualization of who is harmed by carceral systems, one that includes and extends beyond those who are directly affected. In doing so, this research challenges the laws, policies, and practices that perpetuate the growth of carceral systems because of harms to population health and well-being.