Do alternatives to incarceration mitigate the health effects of criminal justice involvement? An examination of the effects of probation on chronic disease risk and access to care

Criminal justice involvement is harmful to physical and mental health. However, research has focused primarily on the health effects of incarceration without investigating other, more common, forms of justice-involvement such as probation. This dissertation aimed to compare the impact of probation with incarceration on metabolic syndrome and access to health care, using data from the National Longitudinal Study of Adolescent to Adult Health (AddHealth). A scoping literature review found few studies have explored this topic, with a relatively greater number of studies focused on health care access than metabolic syndrome. The studies in the review mainly presented descriptive statistics and unadjusted analyses, did not formally test causal mechanisms, and highlighted how lack of standard definitions for exposure limits comparison of forms of justice involvement. Following the review, two empirical aims tested the relationship between probation, incarceration, or no justice involvement and metabolic syndrome or access to health care among young adults ages 24-32. The findings from the first empirical aim suggest that metabolic syndrome risk was not higher among young adults with incarceration or probation experiences, and this relationship was not causally mediated by lack of access to normal credentials such as housing, employment, or education. In addition, some, but not all, of the mediators were related to criminal justice exposure and metabolic syndrome. The results of the second empirical aim aligned with the hypothesis that incarceration or probation experiences reduce access to health care (i.e., unmet need for health care and lack of insurance). The findings showed individuals with incarceration or probation experiences had increased risk of unmet need and uninsurance, compared with no justice involvement, though there was no discernible difference between the two forms of justice involvement. In sum, the results of this dissertation support the hypothesis that criminal justice involvement negatively impacts access to health care and some normal credentials (educational attainment and financial stress) but does not increase risk for metabolic syndrome. Methodological factors such as timing, lack of longitudinal follow-up data, exposure measurement, and common outcomes may have contributed to the inconsistent findings