Race, Age, and Health Outcomes Among the Incarcerated: Implications for Preventive Healthcare in Prison

Background: When racial health disparities among the incarcerated are explored, differences are revealed between the incarcerated and non-incarcerated populations. Once in prison, there is evidence for a reduction or reversal in the direction of health disparities, particularly between Blacks and Whites, such as mortality rates (Mumola, 2007), rates of chronic illness (Harzke et al., 2010), mental health treatment seeking (Youman et al., 2010), and mental and physical well-being (Merten et al., 2012). The current study contributes to this area of research by examining a variety of physical and mental health indicators among an older cohort of prisoners. It was hypothesized that race has a moderating effect on the association between emotional health and individual characteristics, use of services, social supports and overall health status among this population.

Methods: This cross-sectional study was conducted in September 2010 in the New Jersey Department of Corrections (NJDOC). The sample consisted of 625 English speaking incarcerated males aged 50 and older. Data was collected using a self-administered, mailed survey. The major outcome variable is self-reported stress (“In the past month, how stressed have you felt while in prison?). A 15-item self report checklist of health conditions was captured using the CDC HRQOL-14 Healthy Days measure and the following question: “Would you say that in general your health is…” and were given five choices, ranging from Excellent to Poor. A composite of health conditions was created to reflect the aggregate number of reported health conditions.

Chi-square tests were used to compare health outcomes between Blacks and Whites. males residing in a Northeastern state prison system. Race was introduced into a multivariate regression analysis to determine whether race has a moderating effect on current emotional health.

Results:  The results showed differences between Whites and Black in access to prison services and health issues. Whites were more likely to have received mental health services (41%) than Blacks (26%). Eye/vision problems were reported less among Whites than Blacks (15% and 24%, respectively) and hypertension was reported less by Whites (11%) than by Blacks (22%). Also statistically significant was HIV/AIDS, which 2% of Whites reported having compared to 6% of Blacks. Multivariate analyses suggested that older black men appear to be more resilient than older white men. Race was found to moderate the association between current emotional health and individual characteristics, use of services, social supports and overall health status among this population.

Conclusion: Blacks in this study appeared to cope better with stress related to incarceration, which may in turn impact other physical and mental health outcomes.  The etiology for this ability to cope may be embedded, for some, in the possession of resilience based on prior social and developmental experiences. These findings suggest that prison programming should include stress and coping interventions to promote better physical, mental, and emotional health. Access to health and mental health services should also be part of reintegration programming to address racial disparities in access to healthcare before, during, and or after prison.