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![Page 1: The community health effects of incarceration James C. Thomas, MPH, PhD University of North Carolina Associate Professor of Epidemiology Director, Program.](https://reader035.fdocuments.us/reader035/viewer/2022081519/56649e2c5503460f94b1acb0/html5/thumbnails/1.jpg)
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
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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)
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South African diamond mines
James Thomas, PhD
University of North Carolina
![Page 4: The community health effects of incarceration James C. Thomas, MPH, PhD University of North Carolina Associate Professor of Epidemiology Director, Program.](https://reader035.fdocuments.us/reader035/viewer/2022081519/56649e2c5503460f94b1acb0/html5/thumbnails/4.jpg)
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
University of North Carolina
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STD Rates in the US, 2000
0
400
800
1200
Chlamydia Gonorrhea
White
Hispanic
Black
James Thomas, PhD
University of North Carolina
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Social Forces: Post Depression
James Thomas, PhD
University of North Carolina
![Page 7: The community health effects of incarceration James C. Thomas, MPH, PhD University of North Carolina Associate Professor of Epidemiology Director, Program.](https://reader035.fdocuments.us/reader035/viewer/2022081519/56649e2c5503460f94b1acb0/html5/thumbnails/7.jpg)
“Get big or get out”
James Thomas, PhD
University of North Carolina
![Page 8: The community health effects of incarceration James C. Thomas, MPH, PhD University of North Carolina Associate Professor of Epidemiology Director, Program.](https://reader035.fdocuments.us/reader035/viewer/2022081519/56649e2c5503460f94b1acb0/html5/thumbnails/8.jpg)
Unbalanced effects
James Thomas, PhD
University of North Carolina
![Page 9: The community health effects of incarceration James C. Thomas, MPH, PhD University of North Carolina Associate Professor of Epidemiology Director, Program.](https://reader035.fdocuments.us/reader035/viewer/2022081519/56649e2c5503460f94b1acb0/html5/thumbnails/9.jpg)
Klan march, Wilson County,1993
James Thomas, PhD
University of North Carolina
![Page 10: The community health effects of incarceration James C. Thomas, MPH, PhD University of North Carolina Associate Professor of Epidemiology Director, Program.](https://reader035.fdocuments.us/reader035/viewer/2022081519/56649e2c5503460f94b1acb0/html5/thumbnails/10.jpg)
Creation of the rural ghetto
James Thomas, PhD
University of North Carolina
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Black-white income dualism
0
Low High
North Carolina* (5.8)
Wilson County (13.5)
*SE=4.27
James Thomas, PhD
University of North Carolina
Thomas JC, Thomas K. Soc Sci & Med 1999;49:1075-84.
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“The Great Migration”
James Thomas, PhD
University of North Carolina
![Page 13: The community health effects of incarceration James C. Thomas, MPH, PhD University of North Carolina Associate Professor of Epidemiology Director, Program.](https://reader035.fdocuments.us/reader035/viewer/2022081519/56649e2c5503460f94b1acb0/html5/thumbnails/13.jpg)
Loss of social capital
James Thomas, PhD
University of North Carolina
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I-95 and syphilis, 1989
James Thomas, PhD
University of North Carolina
Cook RL, Royce RA, Thomas JC, Hanusa BH. Am J Public Health 1999; 89:369-73
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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
University of North Carolina
Cook RL, Royce RA, Thomas JC, Hanusa BH. Am J Public Health 1999; 89:369-73
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The incarceration boom
James Thomas, PhD
University of North Carolina
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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
University of North Carolina
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Thomas JC, Torrone E , Am J Public Health 2006;96:1762-5.
Incarceration and health outcomes
James Thomas, PhD
University of North Carolina
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Incarceration and health outcomes
James Thomas, PhD
University of North Carolina
![Page 20: The community health effects of incarceration James C. Thomas, MPH, PhD University of North Carolina Associate Professor of Epidemiology Director, Program.](https://reader035.fdocuments.us/reader035/viewer/2022081519/56649e2c5503460f94b1acb0/html5/thumbnails/20.jpg)
Incarceration and health outcomes
James Thomas, PhD
University of North Carolina
![Page 21: The community health effects of incarceration James C. Thomas, MPH, PhD University of North Carolina Associate Professor of Epidemiology Director, Program.](https://reader035.fdocuments.us/reader035/viewer/2022081519/56649e2c5503460f94b1acb0/html5/thumbnails/21.jpg)
Incarceration and health outcomes
James Thomas, PhD
University of North Carolina
![Page 22: The community health effects of incarceration James C. Thomas, MPH, PhD University of North Carolina Associate Professor of Epidemiology Director, Program.](https://reader035.fdocuments.us/reader035/viewer/2022081519/56649e2c5503460f94b1acb0/html5/thumbnails/22.jpg)
Incarceration and health outcomes
James Thomas, PhD
University of North Carolina
![Page 23: The community health effects of incarceration James C. Thomas, MPH, PhD University of North Carolina Associate Professor of Epidemiology Director, Program.](https://reader035.fdocuments.us/reader035/viewer/2022081519/56649e2c5503460f94b1acb0/html5/thumbnails/23.jpg)
Census-tract-level associations
Thomas JC, Levandowski B, Torrone E, Isler MR. J Urban Health (in press)James Thomas, PhD
University of North Carolina
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Census tract-level associations
James Thomas, PhD
University of North Carolina
Thomas JC, Levandowski B, Torrone E, Isler MR. J Urban Health (in press)
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Potential Relations Between Incarceration and STD Rates
Dual outcomes of another cause Direct effects (on prisoners) Indirect effects (on communities)
James Thomas, PhD
University of North Carolina
![Page 26: The community health effects of incarceration James C. Thomas, MPH, PhD University of North Carolina Associate Professor of Epidemiology Director, Program.](https://reader035.fdocuments.us/reader035/viewer/2022081519/56649e2c5503460f94b1acb0/html5/thumbnails/26.jpg)
Dual outcomes of another cause
Illicit Drug Use
Incarceration
STDs
James Thomas, PhD
University of North Carolina
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Direct effects of incarceration
D D
E
E
__
__
a b
c d
James Thomas, PhD
University of North Carolina
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Sexual behavior
Two out of three men had more than one partner in the previous three months
Concurrency facilitates epidemic transmission
James Thomas, PhD
University of North Carolina
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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
University of North Carolina
Thomas JC, Levandowski B, Torrone E, Isler MR. J Urban Health (in press)
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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
University of North Carolina
Thomas JC, Levandowski B, Torrone E, Isler MR. J Urban Health (in press)
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Indirect effects of incarceration
D D
E
E
__
__
a b
c d
James Thomas, PhD
University of North Carolina
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Absence from relationships Sex ratio Social control, collective efficacy
Indirect effects of incarceration
James Thomas, PhD
University of North Carolina
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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
University of North Carolina
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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
University of North Carolina
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Intergenerational effects
Wenink E, Thomas JC (under review)James Thomas, PhD
University of North Carolina
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Absence from relationships Sex ratio Social control, collective efficacy
Indirect effects of incarceration
James Thomas, PhD
University of North Carolina
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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.
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Indirect effects of incarceration
Absence from relationships Sex ratio Social control, collective efficacy
James Thomas, PhD
University of North Carolina
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Social control
James Thomas, PhD
University of North Carolina
Thomas JC, Torrone E, Browning C (under review)
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Homicides and social control
James Thomas, PhD
University of North Carolina
Thomas JC, Torrone E, Browning C (under review)
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Social control and STDs
James Thomas, PhD; University of North Carolina Thomas JC, Torrone E, Browning C (under review)
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Homicide and STDs
James Thomas, PhD; University of North Carolina Thomas JC, Torrone E, Browning C (under review)
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Neighborhood characteristics and STDs in Chicago
James Thomas, PhD
University of North Carolina
Thomas JC, Torrone E, Browning C (under review)
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Where next?
Ethnography Multi-level quantitative analysis Agency interactions
James Thomas, PhD
University of North Carolina