ANN ARBOR—More people live behind bars in the United States than in any other country, but the American prison system punishes more than just its inmates?it also takes a toll on the health of friends and loved ones left behind.

In the first known study of its kind, University of Michigan researchers found that people with a family member or friend in prison or jail suffer worse physical and mental health and more stress and depressive symptoms than those without a loved one behind bars. Moreover, these symptoms worsen the closer the relationship to the person incarcerated.

The study results could help explain health disparities between minorities and whites, says Daniel Kruger, research professor at the U-M School of Public Health and lead researcher on the study.

African Americans are more likely to know someone in prison and to feel closer to the person incarcerated than whites do, Kruger says.

“It’s like a double whammy,” he said.

Forty-nine percent of African Americans in the study report having a friend or relative in prison during the past five years, compared to just 20 percent of whites.

According to the study, those who knew someone in prison had 40 percent more days where poor physical health interfered with their usual activities, including work, and 54 percent more days where poor mental or emotional health interfered with these activities.

Others have examined the health effects of incarceration on inmates and a few studies have investigated the health of children whose mothers are in prison, but those studies focused on people already in the system, says Kruger.

“We actually took a representative sample of people in the community and asked them whether they had a friend or relative incarcerated in the last five years,” Kruger said. “We also included a powerful array of known health predictors as control variables.”

For instance, Kruger and colleagues considered whether a person smoked tobacco, drank alcohol heavily, was overweight or obese, or had adequate nutrition and physical exercise.

The study consisted of 1,288 adults from Flint, Mich., an urban area with high unemployment and crime rates, and surrounding areas of Genesee County. In the study, 67 percent of respondents were white and 26 percent were African American.

“Our study demonstrates that incarceration is not only enormously expensive economically, it also has public health costs and these should be taken into consideration,” Kruger said. “In the last 30 years or so, we have seen a more and more punitive system, one where judges no longer have discretion for sentencing.”

Moving toward a rehabilitation model may benefit both the offending individuals and society, he says.

“The vast majority of people incarcerated are nonviolent drug offenders,” Kruger said. “We should shift oversight of substance use and abuse to the health care sector.”

One out of every 100 adults in the United States is incarcerated and more than three times as many African Americans and Latinos live in jails or prisons than college dorms, Kruger says. This particular study looked only at African Americans, not Latinos, because there is not a large population of Latinos in Flint and Genesee County.

The paper, “The Association of Incarceration with Community Health and Racial Health Disparities,” is in the April issue of Progress in Community Health Partnerships.

The University of Michigan School of Public Health has been working to promote health and prevent disease since 1941 and is consistently ranked among the top five public health schools in the nation. Whether making new discoveries in the lab or researching and educating in the field, SPH faculty, students and alumni are deployed around the globe to promote and protect our health.

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