The community health effects of incarceration James C. Thomas, MPH, PhD University of North Carolina Associate Professor of Epidemiology Director, Program.

The community health effects of incarceration

James C. Thomas, MPH, PhD

University of North Carolina

Associate Professor of Epidemiology

Director, Program in Public Health Ethics

Research funding

National Institute of Allergy and Infectious Disease (NIAID)

National Institute of Mental Health (NIMH) Agency for Healthcare Research and Quality (AHRQ) Soros Foundation University of North Carolina Program on Ethnicity,

Culture, and Health Outcomes (ECHO)

South African diamond mines

James Thomas, PhD


Reported syphilis in North Carolina and Wilson (aka Step) County, 1922-1997

0.0

200.0

400.0

600.0

800.0

1000.0

1200.0

1400.0

1600.0

1920 1930 1940 1950 1960 1970 1980 1990 2000

Year

Rat

e (C

ases

per

100

,000

per

son

-yea

rs)

Step County

North Carolina

James Thomas, PhD


STD Rates in the US, 2000

0

400

800

1200

Chlamydia Gonorrhea

White

Hispanic

Black

James Thomas, PhD


Social Forces: Post Depression

James Thomas, PhD


“Get big or get out”

James Thomas, PhD


Unbalanced effects

James Thomas, PhD


Klan march, Wilson County,1993

James Thomas, PhD


Creation of the rural ghetto

James Thomas, PhD


Black-white income dualism

0

Low High

North Carolina* (5.8)

Wilson County (13.5)

*SE=4.27

James Thomas, PhD


Thomas JC, Thomas K. Soc Sci & Med 1999;49:1075-84.

“The Great Migration”

James Thomas, PhD


Loss of social capital

James Thomas, PhD


I-95 and syphilis, 1989

James Thomas, PhD


Cook RL, Royce RA, Thomas JC, Hanusa BH. Am J Public Health 1999; 89:369-73

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

YEAR

200

300

400

500

600

700

800

900

Dru

g A

rrate

Rate

(per

100,0

00 p

ers

on

s)

counties withlarge cities

I-95 counties

non I-95 counties

FIGURE 2

Cook et. al

Drug Arrest Rates by County Type, North Carolina, 1985-94

James Thomas, PhD


Cook RL, Royce RA, Thomas JC, Hanusa BH. Am J Public Health 1999; 89:369-73

The incarceration boom

James Thomas, PhD


0

50

100

150

200

250

300

350

400

0 50 100 150 200 250 300

Incarceration Rate/100,000 pop

Gon

orrh

ea R

ate/

100,

000

pop

Source: Sampson LA, Thomas JC - UNC Chapel

Rates of Incarceration and Gonorrhea for North Carolina Counties, 1999

James Thomas, PhD


Thomas JC, Torrone E , Am J Public Health 2006;96:1762-5.

Incarceration and health outcomes

James Thomas, PhD



James Thomas, PhD



James Thomas, PhD



James Thomas, PhD



James Thomas, PhD


Census-tract-level associations

Thomas JC, Levandowski B, Torrone E, Isler MR. J Urban Health (in press)James Thomas, PhD


Census tract-level associations

James Thomas, PhD


Thomas JC, Levandowski B, Torrone E, Isler MR. J Urban Health (in press)

Potential Relations Between Incarceration and STD Rates

Dual outcomes of another cause Direct effects (on prisoners) Indirect effects (on communities)

James Thomas, PhD


Dual outcomes of another cause

Illicit Drug Use

Incarceration

STDs

James Thomas, PhD


Direct effects of incarceration

D D

E

E

__

__

a b

c d

James Thomas, PhD


Sexual behavior

Two out of three men had more than one partner in the previous three months

Concurrency facilitates epidemic transmission

James Thomas, PhD


Sex while in prison

You know what, I'm going to tell you what shocked me to see some of the guys I knew here from years, knowing them years, and they're on state [in state prison] now and they're messing with, you know, gays. And I'm looking at them like, you know, ain’t no way and sleep with that man and then you going to come out here and you got kids and you got your wife or your girlfriend comes to see you and you're doing it. Can't, you can't do that. But that's, you know, it’s goin’ all come to the light someday.

Ex-offender, Durham County

James Thomas, PhD



Sex upon release from prison

They trying to get serious, but I tell them all before I do anything, before I touch them in any kind of way. When I first talk to them, I just got out of prison and I ain't looking for no girlfriend, ain't looking for no wife, ain't looking for no baby momma. I would like, you can keep all your drama, I would like, cause if we do anything, as two consenting adults and if you agree to this, you agree to it, so don't look for me to hold your hand the next morning and tell you I love you and nothing like that. And you got one or two that just won't listen.

Ex-offender, Durham County

James Thomas, PhD



Indirect effects of incarceration

D D

E

E

__

__

a b

c d

James Thomas, PhD


Absence from relationships Sex ratio Social control, collective efficacy


James Thomas, PhD


0

500

1000

1500

2000

2500

3000

3500

Females Males

White Black

Sentenced State and Federal Prisoners per 100,000 U.S. Residents by Gender and Race, 1997

Uneven rates of incarceration

James Thomas, PhD


Prisoners with children

Mumola, C. Special Report: Incarcerated Parents and Their Children. In: US Department of Justice, Bureau of Justice Statistics. Washington, DC, 2000.

James Thomas, PhD


Intergenerational effects

Wenink E, Thomas JC (under review)James Thomas, PhD




James Thomas, PhD


Scarcity of black males

U.S. Whites

U.S. Blacks

NC Blacks aged 15-44 years

Wilson County Blacks, 15-44 years

0.5 1.0

0.95

0.88

0.90

0.80

EquityJames Thomas, PhD

University of North Carolina Thomas JC, Thomas K. Soc Sci & Med 1999;49:1075-84.



James Thomas, PhD


Social control

James Thomas, PhD


Thomas JC, Torrone E, Browning C (under review)

Homicides and social control

James Thomas, PhD



Social control and STDs

James Thomas, PhD; University of North Carolina Thomas JC, Torrone E, Browning C (under review)

Homicide and STDs

James Thomas, PhD; University of North Carolina Thomas JC, Torrone E, Browning C (under review)

Neighborhood characteristics and STDs in Chicago

James Thomas, PhD



Where next?

Ethnography Multi-level quantitative analysis Agency interactions

James Thomas, PhD


The community health effects of incarceration James C. Thomas, MPH, PhD University of North Carolina Associate Professor of Epidemiology Director, Program.

Documents

outjames thomas

post depressionjames

rural ghettojames thomas

wilson county

wilson aka step county

healthcare research