To date, studies of the criminal justice system and health have generally focused on disease transmission and health care services among incarcerated populations;however, incarcerated individuals account for only 3.5% of the 65 million adults with a criminal conviction in the U.S. When individuals are charged or convicted of a crime, a set of legal and social collateral consequences typically follow. These consequences may include life-long restrictions in employment opportunities and public benefit eligibility, and occur regardless of criminal offense severity or whether a person was imprisoned as part of their criminal sentence. These consequences disproportionately, and more adversely, affect disadvantaged women (i.e., those who are racial/ethnic minorities, and/or poor, and/or lower-educated), who typically commit misdemeanor-level crimes (e.g., non- payment for bad checks, traffic violations), rely on public benefits and low-wage, service-sector jobs to support themselves and their children, and have extremely poor mental and physical health. A large body of findings indicate that: (1) employment has an overall positive impact on health, (2) the primary welfare program for women in the U.S. (Temporary Assistance for Needy Families, or TANF) provides critical income support and job-placement assistance, and (3) women without stable sources of income often increase their health-risk behaviors to meet their food, shelter, and other basic needs. However, no research, to our knowledge, has integrated into one empirical analysis the interrelated relationships among the criminal justice system, the welfare system, and the labor market, to evaluate how they impact health disparities. Specifically, applying a systems science dynamic modeling approach consistent with the goals of PAR-11-315, we will explore the how the inability to access TANF and/or find employment due to having a prior criminal record may contribute to the persistently poor health status of this group. The proposed study addresses this gap based on a secondary analysis of a nationally representative, 9- year longitudinal panel survey data set of 4,898 women from the Fragile Families Study. It is the first to explore whether, and how, collateral consequences operate across criminal justice, welfare, and labor market systems to influence women's health. Motived by our prior community-engaged research, we will explore whether the presence, level of severity (charge, conviction, incarceration), and type (drug-, violence-, theft/fraud-, and traffic related) of a criminal offense history affects employment patterns and health (psychological distress, depression, general health, and limited functioning) for women over time, and the extent to which TANF receipt moderates these relationships. Using the dynamic model to conduct a series of simulations, findings from this study will include projected health trajectorie for women over time based on TANF and employment policy and program change scenarios. These findings could inform public health-oriented interventions to reduce adverse health outcomes for women with a criminal offense history.

Public Health Relevance

Criminal conviction-related collateral consequences disproportionately affect socioeconomically disadvantaged women, as they: (1) are more likely to commit the types of crime that result in a criminal conviction rather than incarceration, (2) rey more heavily on the types of jobs and welfare benefits negatively affected by collateral consequences, and (3) have a far higher rate of health problems than the general population of women. The purpose of this study is to apply novel analytic methods using a systems-science approach to examine the complex relationships (both concurrent and dynamic) among criminal histories, welfare use, employment, and health in a national sample of over 4,500 predominantly disadvantaged women followed over multiple years.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-HDM-Q (58))
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Castille, Dorothy M
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University of North Carolina Chapel Hill
Schools of Nursing
Chapel Hill
United States
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Sheely, Amanda; Kneipp, Shawn M (2015) The Effects of Collateral Consequences of Criminal Involvement on Employment, Use of Temporary Assistance for Needy Families, and Health. Women Health 55:548-65
Kneipp, Shawn M; Gilleskie, Donna; Sheely, Amanda et al. (2014) Nurse scientists overcoming challenges to lead transdisciplinary research teams. Nurs Outlook 62:352-61