Enduring stigma: The long-term effects of incarceration on health

Although incarceration rates have risen sharply since the 1970s, medical soci-ology has largely neglected the health effects of imprisonment. Incarceration might have powerful effects on health, especially if it instills stigma, and it could provide sociologists with another mechanism for understanding health dispari-ties. This study identifies some of incarceration’s direct and indirect effects and rigorously tests them using the National Longitudinal Survey of Youth. It finds that incarceration has powerful effects on health, but only after release. A his-tory of incarceration strongly increases the likelihood of severe health limita-tions. Furthermore, any contact with prison is generally more important than the amount of contact, a finding consistent with a stigma-based interpretation. Although this relationship is partly attributable to diminished wage growth and marital instability, the bulk of the effect remains even under the most stringent of specifications, including controls for intelligence and the use of fixed effects, suggesting a far-reaching process with a proliferation of risk factors. The study also finds that incarceration contributes only modestly to racial disparities, that there are few synergistic interactions between incarceration and other features of inequality, including schooling, and that the evidence for a causal effect is much weaker among persistent recidivists and those serving exceptionally long sentences. These study findings are inconsistent with recent speculation; never-theless, incarceration is an important addition to sociology’s research agenda. Exploring incarceration could lead to, among other things, a fruitful synergy among studies on fundamental causes, stigma, and stress. 115 Medical sociology has a deep and multilay-ered interest in the sources and consequences of stigma. This interest originates in Goffman’s (1963) work on total institutions, as well as Scheff’s (1966) exposition of labeling theory. Stigma remains a key concern for those inter-ested in the social forces that shape life chances. Research on stigma has, in fact, ex-panded since the 1960s, addressing topics as diverse as disability, welfare use, and the par-ents of deviant children (Link and Phela