The Consequences Are Black and White: Race and Poor Health Following Incarceration

• Published date: 01 July 2023
• DOI: http://doi.org/10.1177/2153368721998053
• Author: Julie L. Kuper,Jillian J. Turanovic
• Date: 01 July 2023
• Subject Matter: Articles

Article

The Consequences Are

Black and White: Race and

Poor Health Following

Incarceration

Julie L. Kuper

1

and Jillian J. Turanovic

1

Abstract

Incarceration is a health damaging experience that disproportionately impacts Black

Americans. Although existing research has explored broader racial disparities in the

health consequences of imprisonment, little research has examined within-individual

changes in health declines following incarceration. Accordingly, in this study, we

examine whether the negative health effects of incarceration are more pronounced

for Black versus White individuals. Data from Waves I through IV of the National

Longitudinal Study of Adolescent to Adult Health (Add Health) and hierarchical

generalized linear models (HGLM) are used to estimate within-person changes to

self-rated health following first incarceration (N¼23,627 person-waves) for

non-Hispanic Black and non-Hispanic White individuals. Findings indicate that Black

respondents reported within-person health declines that were more substantial than

those of Whites after first incarceration. Additional analyses revealed that these race

differences were more pronounced among Black males. Taken together, this study

adds to the literature highlighting the racialized and negative health impacts of

incarceration. Efforts to reduce imprisonment and increase access to quality health

care in Black communities are needed.

Keywords

race, health disparity, incarceration, poor health, self-rated health

1

College of Criminology and Criminal Justice, Florida State University, Tallahassee, FL, USA

Corresponding Author:

Julie L. Kuper, College of Criminology and Criminal Justice, Florida State University, 112 S.Copeland Street,

Tallahassee, FL 32306, USA.

Email: jkuper@fsu.edu

Race and Justice

ªThe Author(s) 2021

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/2153368721998053

journals.sagepub.com/home/raj

2023, Vol. 13(3) 324–\ 345

The United States is a global leader in its rate of incarceration (Wike et al., 2018). In

fact, the phenomenon of mass incarceration is so widespread that nearly half of all

Americans have had an immediate family member behind bars (Enns et al., 2019).

There are currently more than 2.2 million people confined in U.S. institutions and

enough people admitted to jails each year to fill a line of prison buses bumper to

bumper from New York City to San Francisco (Boen, 2020; Sawyer & Wagner, 2019).

Understanding the health consequences of incarceration has never been so important,

given that recent decades have seen more people in correctional facilities than ever in

history (Sundaresh et al., 2020).

Research suggests that any contact with the criminal justice system is consequential

for health and well-being (Wildeman & Wang, 2017). Therefore, individuals do not

need to be housed in correctional settings for lengthy periods of time to experience

health declines, and even the first incarceration can create health challenges (Sugie &

Turney, 2017). Correctional housing is linked to poor health because it exposes people

to diseases such as HIV, tuberculosis, hepatitis C, and sexually transmitted infections

(Kamarulzaman et al., 2016), and it affects those previously incarcerated over the

long-term by aggravating chronic conditions like diabetes, hypertension, and asthma

(Pew Charitable Trusts, 2017; Wang et al., 2009).

However, these health risks are not the same for everyone. Incarceration dis-

proportionately affects people of color, and Black persons often experience harsher

treatment within prisons and jails (Alexander, 2010; Schnittker et al., 2011). Relative

to incarcerated Whites, incarcerated Black persons are at greater risk of discrimina-

tion, segregated housing, and barred program access—all of which can heighten the

negative health consequences that they experience (Andrews et al., 1990; Cochran

et al., 2016; Olson, 2016). Further, upon reentry, released Black individuals return to

places with very different social conditions compared to those that White persons

return to. While Black communities are the most negatively affected by mass incar-

ceration, they are also the most medically underserved places (Obasogie et al., 2017)

and are unlikely to be able to support the heightened medical needs of reentering

citizens (Wildeman & Wang, 2017). The stigma of incarceration may also be felt more

strongly among previously incarcerated Black individuals (Pager, 2003; Patterson &

Wildeman, 2015), which can worsen health even further by contributing to social

exclusion and poor job prospects. Accordingly, the health damaging effects of

incarceration may be felt more strongly among Black persons than White persons.

Highlighting racial differences in incarceration rates and health disparities is not a

new line of inquiry (Nowotny & Kuptsevych-Timmer, 2018; Wike et al., 2018).

Nevertheless, more research is needed that examines within-individual changes in

health after incarceration to better account for preexisting differences in well-being

(Massoglia & Pridemore, 2015; Schnittker & John, 2007). Accordingly, the purpose of

this study is to assess whether the effect of incarceration on health differs for Black

and White individuals. Using Waves I through IV of the National Longitudinal Study

of Adolescent to Adult Health (Add Health), we examine within-person changes in

self-rated health for Black and White individuals following their first incarceration. In

carrying out this research, the broader goal is to shed light on the disparate impacts of

325

Kuper and Turanovic