Solitary Confinement Tied to Greater Risk of Death After Prison Release

Prisoners who are held in restrictive housing (i.e., solitary confinement) face an increased risk of death after their release, according to a new study led by researchers from the University of North Carolina (UNC) at Chapel Hill.

The findings show that incarcerated individuals who were placed in restrictive housing in North Carolina from 2000 to 2015 were 24% more likely to die in the first year after their release, compared to those who were not held in restrictive housing.

In addition, those held in restrictive housing were 78% more likely to die from suicide, 54% more likely to die from homicide, and 127% more likely to die from an opioid overdose in the first two weeks after their release.

Further, the number of restrictive housing placements and spending more than 14 consecutive days in restrictive housing were associated with an even greater increase in the risk of death and reincarceration.

“For the first time ever, using data shared with us from our partners at the North Carolina Department of Public Safety, we’ve been able to demonstrate a connection between restrictive housing during incarceration and increased risk of death when people return to the community,” said lead author Lauren Brinkley-Rubinstein, PhD, an assistant professor of social medicine in the UNC School of Medicine.

“In addition, our study found that the more time people spent in restrictive housing the higher the risk of mortality after release. This study provides empirical evidence to support ongoing nationwide reforms that limit the use of restrictive housing.”

“North Carolina is a leader in this thinking as the Department of Public Safety has preemptively implemented multiple reforms that have resulted in the limited use of restrictive housing.”

“We appreciate this research collaboration and recognize the importance of these results in shaping policy and practice,” said Gary Junker, PhD, Director of Behavioral Health for the N.C. Department of Public Safety Adult Correction and Juvenile Justice.

“Since 2015, the department has initiated several programs to divert people from restrictive housing, including Therapeutic Diversion Units for those with mental illness. While safety and security must remain our top priority, we recognize that reduced use of restrictive housing will likely improve post-release outcome.”

These findings, published in the journal JAMA Network Open, are from a retrospective cohort study conducted by Brinkley-Rubinstein and co-authors from UNC, Emory University, the N.C. Department of Public Safety and the N.C. Department of Public Health.

Incarceration data for people who were confined in North Carolina between 2000 and 2015 were matched with death records from 2000 to 2016.

“We also found that non-white individuals were disproportionately more likely to be assigned to restrictive housing than their white counterparts,” said co-author Shabbar Ranapurwala, PhD, MPH, an assistant professor of epidemiology in the UNC Gillings School of Global Public Health and a core faculty member of the UNC Injury Prevention Research Center.

“In fact, the mortality and reincarceration outcomes after release were also quite different between these racial groups. The post-release opioid overdose and suicide death outcomes among those receiving restrictive housing were more pronounced among white individuals compared to non-whites, while the all-cause and homicide death and reincarceration outcomes were higher among non-white Americans compared to whites.”

Given the observational nature of the study, establishing cause and effect may be difficult, yet, the strength and consistency of the findings points to the fact that restrictive housing is an important marker of increased mortality risk among formerly incarcerated individuals.

Source: University of North Carolina Health Care

Exposure to Violence Tied to Loneliness, Hypervigilance, Health Issues

Exposure to community and police violence can negatively impact a person’s physical and psychosocial health, according to new research published in the journal Health Affairs.

The research involved two studies based on in-person surveys of more than 500 adults living in Chicago neighborhoods with high rates of violent crime, and mostly comprising racial and ethnic minority groups. Of the study participants, 77% were age 50 and up.

Elizabeth L. Tung, M.D., a social epidemiologist from the University of Chicago Medicine and coauthor of both studies, was inspired to conduct this research after she noticed that more of her patients from violent neighborhoods were struggling to follow their prescribed health regimens.

“They would be hesitant to join walking groups because they were afraid to walk in their neighborhoods. Or I’d ask, ‘Why didn’t you get your medications on time?’ And they’d say, ‘Well, I could only get a ride at night, and I don’t want to leave the house at night.’ That kind of thing was coming up a lot more,” Tung said.

In the first report, researchers found that social isolation and loneliness were linked to limited physical activity, not taking medication properly, poor nutrition, binge drinking and smoking.

The results reveal that the more violence people experienced in their own community, the lonelier they were likely to be. The greatest risk for loneliness was found among those who were exposed to community violence and screened positive for post-traumatic stress disorder (PTSD).

The findings are particularly troublesome for older adults who live in violent neighborhoods, who are more prone to loneliness and might already have chronic health issues like diabetes, obesity or heart disease. Loneliness is a growing health concern, and a key predictor of mortality in the U.S.

“The association between violence exposure and loneliness is a really interesting one, because there’s such a strong link,” said Tung. “The pervasiveness of violence seems to be more evident now than ever. What does that sense of violence in our culture do more broadly to loneliness?”

Social withdrawal might be a survival strategy in violent neighborhoods, but it’s not a good long-term option, said study coauthor Monica E. Peek, M.D., an associate professor at the University of Chicago and the associate director of the Chicago Center of Diabetes Translation Research.

“Someone who is socially isolated and lonely has a higher risk for cardiovascular disease, just like someone who has a history of smoking. Loneliness is a public health issue with real health implications,” Peek said.

“Violence impacts more than just the victims, but the whole community. Everyone’s health is potentially affected.”

The new findings tie into a bigger conversation happening nationwide about how issues like loneliness, food insecurity and housing impact a person’s physical and psychological health, Peek added.

“Our health care system is changing and evolving, and we’re starting to think not just about medical care but the social needs of our patients, and trying to use the medical system as a way to integrate those needs. Having a more holistic approach will better help our health outcomes,” she said.

The second report, led by Nichole A. Smith, a medical student at the University of Chicago Pritzker School of Medicine, quantified a connection between exposure to community and police violence and hypervigilance.

Hypervigilance — defined as a heightened emotional state of always feeling “on guard” — can prevent people from making healthy lifestyle choices. Chronic hypervigilance can lead to hypertension, cardiovascular disease, memory impairment, anxiety disorders and difficulty regulating emotions.

“It’s a very well-studied phenomenon, mostly in veterans. But it’s so poorly studied in community-based settings where you have this chronic exposure to violence,” Tung said.

The study found a surprisingly strong link between hypervigilance and exposure to police violence more than community violence.

Exposure to community violence was linked to a 5.5% increase in the hypervigilance score, while exposure to police violence was associated with a 9.8% increase. Respondents who experienced a traumatic event during a police stop had a 20% increase in hypervigilance scores.

The findings suggest a complex association between police violence and the mental and physical health of community members. It raises the question of whether hypervigilance, both among residents and police officers, could possibly lead to harmful escalations during police stops.

The study suggests that more trauma-informed policing and opportunities for community-building activities between police and community members, such as the CAPS police baseball league with community members, could help reduce hypervigilance on both sides and prevent situations from escalating into harmful ones.

Source: University of Chicago Medical Center

Autism Rates Increasing Fastest Among Black, Hispanic Youth

Autism rates among racial minorities in the U.S. have spiked in recent years, with black rates now exceeding those of whites in most states and Hispanic rates increasing faster than any other group, according to a new study published in the Journal of Autism and Developmental Disorders.

The researchers from the University of Colorado Boulder also found that the prevalence of autism among white youth is ticking up again, after flattening in the mid-2000s.

Although some of the increases are due to more awareness and better detection among minority groups, other environmental factors are likely at play, the authors conclude.

“We found that rates among blacks and Hispanics are not only catching up to those of whites — which have historically been higher — but surpassing them,” said lead author Dr. Cynthia Nevison, an atmospheric research scientist with the Institute of Arctic and Alpine Research.

“These results suggest that additional factors beyond just catch-up may be involved.”

For the study, Nevison worked with co-author Dr. Walter Zahorodny, an autism researcher and associate professor of pediatrics at Rutgers New Jersey Medical School, to analyze the most recent data available from the Individuals with Disabilities Education Act (IDEA) and the Autism and Developmental Disabilities Monitoring (ADDM) Network.

IDEA tracks prevalence, including information on race, among 3-to-5-year-olds across all 50 states annually. ADDM tracks prevalence among 8-year-olds in 11 states every two years.

The findings show that between birth year 2007 and 2013, autism rates among Hispanic children, ages 3 to 5, rose 73%, while rates among blacks rose 44% and rates among whites rose 25%.

In 30 states, prevalence among blacks was higher than among whites by 2012.

In states with “high prevalence,” 1 in 79 whites, 1 in 68 blacks and 1 in 83 Hispanics born in 2013 had been diagnosed with autism between ages 3 and 5.

Other states, including Colorado, fell in a “low-prevalence” category, but the authors warn that the differences between states likely reflect differences in how well cases are reported in preschool-age children. They also said the real prevalence is substantially higher, as many children are not diagnosed until later in life.

“There is no doubt that autism prevalence has increased significantly over the past 10 to 20 years, and based on what we have seen from this larger, more recent dataset it will continue to increase among all race and ethnicity groups in the coming years,” said Zahorodny.

In 2018, the Centers for Disease Control reported that about 1 in 59 children of all races have been diagnosed with autism and that rates had risen 15 percent overall from the previous two year period, largely due to better outreach and diagnosis among historically underdiagnosed minority populations.

“Our data contradict the assertion that these increases are mainly due to better awareness among minority children,” said Zahorodny. “If the minority rates are exceeding the white rates that implies some difference in risk factor, either greater exposure to something in the environment or another trigger.”

Risk factors associated with autism include advanced parental age, challenges to the immune system during pregnancy, genetic mutations, premature birth and being a twin or multiple.

The authors said that, based on current research, they cannot determine what other environmental factors might be playing into the higher rates, but they would like to see more work done in the field.

Source: University of Colorado Boulder


Teens of Color Shy Away from Peers with Mental Health Issues

New research has found that students identifying as black or Latino are more likely to say they would socially distance themselves from peers with a mental illness. This partiality is a key indicator of mental illness stigma, according to research published by the American Psychological Association.

Researchers believe the findings reinforce how stigma may prevent teens who face prejudice and discrimination from seeking help for a mental health problem when they need it.

“Even as the need for mental health care among youth is rising, stigma can significantly impede access,” said Melissa DuPont-Reyes, PhD, MPH, of the Latino Research Institute at the University of Texas at Austin and lead author on the study.

“Our research shows that race, ethnicity and gender identities can affect how adolescents perceive mental illness in themselves and in others.”

Researchers examined how mental illness stigma varies across race, ethnicity and gender in students ages 11 to 13 — a developmental period when stigmatizing attitudes and behaviors can become cemented and last into adulthood. Study results appear in the American Journal of Orthopsychiatry.

DuPont-Reyes and her coauthors surveyed 667 sixth graders from an urban school system in Texas on their knowledge, positive attitudes, and behaviors about mental illness, representing critical measures of mental illness stigma.

The students were also asked to react to two stories of hypothetical peers diagnosed with a mental illness: Julia, living with bipolar disorder, and David, with social anxiety disorder.

After each vignette, participants were asked whether they believed Julia or David was a bad person, whether his or her condition would improve with treatment, and whether they would socially interact with Julia or David such as sit at lunch or work on a class project together.

In general, girls and white boys appeared to have more knowledge of and positive attitudes and behaviors toward mental illness than boys and teens of color. Moreover, when race, ethnicity and gender identities were assessed together, the study revealed a significant difference.

Investigators discovered black boys exhibited less knowledge of and positive attitudes toward people with mental illness, including bipolar disorder and social anxiety disorder, than white girls, and at times compared with black girls.

Similar patterns were observed for Latina girls and Latino boys, particularly regarding the David vignette (social anxiety). Finally, black boys believed less often than boys of other races and ethnicities that David could improve with treatment.

While most young teens of color said they were less likely to socially interact with peers exhibiting mental illness, black and Latino boys also reported greater feelings of discomfort and intention to avoid people with mental illness than white girls.

Black girls demonstrated mental health knowledge and awareness similar to white girls, at least in this sample and at this age, according to DuPont-Reyes, but Latina girls were significantly more likely to avoid the David character compared with girls of other races and ethnicities.

“We found differences in mental illness knowledge and attitudes among boys and members of racial and ethnic minority groups, as anti-stigma efforts reach these populations less often,” she said.

“These differences in early life, prior to the onset of most common and major mental illness, can contribute to the disparities in mental health service utilization and recovery by people of color.”

These findings suggest that boys of color, as well as Latina girls, may particularly benefit from targeted, tailored anti-stigma interventions, according to DuPont-Reyes.

“The racial, ethnic and gender patterns we find in mental illness stigma mirror previous findings among adults, indicating that mental illness stigma crystalizes early in life and persists into adulthood,” DuPont-Reyes said.

“Understanding how members of racial and ethnic minority groups differ in their views of mental illness and how gender affects these perceptions can help us better grasp how stigma impedes use of mental health services in underserved populations.”

Source: American Psychological Association/EurekAlert

Food Insecurity Common Among US College Students

Many university and college students across the U.S. experience food insecurity — lacking access to a reliable supply of nutritious food — which can affect their ability to learn, according to new findings presented at the annual convention of the American Psychological Association.

The study, conducted by the Hope Center for College, Community, and Justice, surveyed nearly 86,000 students from 123 U.S. educational institutions and found that 41% of university and 48% of two-year college students reported food insecurity.

“Food insecure students were more likely to fail assignments and exams, withdraw from classes or the university, and had lower grade point averages than their counterparts,” said Yu-Wei Wang, PhD, of the University of Maryland-College Park, who presented at the meeting.

“Additionally, they reported missing out on professional development opportunities, such as internships, which may affect their future career ambitions.”

“With increasing wealth inequality and student loan debt in the United States, we need to address the food insecurity problem on college campuses and make sure it does not restrict a student’s ability to succeed,” she said.

Wang also presented data from a study in which she and her colleagues surveyed 4,901 students at the University of Maryland-College Park during the fall 2017 semester.

In this study, they found that nearly 20% of students said they were concerned about their ability to access nutritious food. For example, the students were asked questions such as “Do you worry whether food would run out before you got money to buy more?” and “In the last 12 months, did you lose weight because there was not enough money for food?”

Approximately 13% of students reported experiencing low food security (they could not afford to eat balanced meals or relied on a few kinds of low-cost food because they ran out of money to buy food), while 7% reported experiencing very low food security (they were hungry but did not eat, or cut the size of or skipped meals because there was not enough money for food).

Of those students, 23 were chosen for in-depth interviews to better understand the issue, and were asked additional questions, such as “Could you tell us about the last time you did not have enough money for food?” and “Which specific issues with food access do you feel that you face as a student with children?”

Another study presented at the meeting, involving 91 students from the University of California-Santa Cruz, also found access to nutritious food to be an issue, according to Heather Bullock, PhD, of the University of California-Santa Cruz.

Focus groups were organized with food insecure students to learn about their experiences of food insecurity on campus, barriers to food access, consequences for academic performance and recommendations for improving support services.

“Three core themes emerged from the focus groups,” said Bullock. “Students confront multiple barriers to food security, including difficulty accessing benefits and stigma, they engage in complex, time consuming strategies to secure food and they suffer negative academic consequences, including reduced focus on class work.”

Bullock also referenced findings from other studies showing that among almost 9,000 University of California system students surveyed across 10 campuses, 23% said they lacked reliable access to a quality, varied, nutritious diet and 19% had experienced reduced food intake due to limited resources at some point.

In both studies, food insecurity disproportionately affected certain groups of students: first-generation college students, racial/ethnic minority students, international students, those from immigrant backgrounds, those who identified as transgender/gender non-conforming and those from lower socioeconomic backgrounds.

To cope, students reported cutting down on portion sizes, finding lower cost or free food, skipping class to attend free food events, sharing food with other students in need and participating in other activities, such as smoking or napping, to distract them from feeling hungry, said Wang.

The stigma of food insecurity negatively affected students’ sense of self-worth and kept them from accessing programs and services, said Bullock.

“Students reported poorer general health and experienced higher levels of depression, anxiety, distress, anger and loneliness than their peers who were not food insecure,” said Wang. “Some students did not use resources they are eligible for because they felt embarrassed, ashamed or believed that other students were in greater need.”

In the follow-up interviews, Maryland students suggested increasing access to healthy food on campus, enhancing awareness of food insecurity to reduce stigma, and providing financial support for those lacking access to food, according to Wang.

“Programs such as Campus Pantry, which provides emergency food to university students, faculty and staff in need are crucial to help curb food insecurity,” said Wang. “It is critical to increase awareness of food insecurity on campus to let students know they are not alone.”

Source: American Psychological Association


Language Skills in Young Kids Tied to Maternal Education, Not Race

A new study published in the journal Child Development shows that a mother’s race plays no role in the amount and quality of the words she uses with her children or with the language skills her children later develop.

However, the researchers found that a mother’s education does play a significant role in both the quality of her language and in the child’s subsequent language development.

The findings are important because previous studies have shown that children of parents with lower socioeconomic backgrounds and education levels have lower language skills when entering school. However, those studies included parents with higher incomes who were primarily white and parents with lower incomes who were primarily black.

As a result, educators and other child professionals were not able to distinguish between race, income or education as the cause of the language gap until now.

“Over time, there were summaries of this early research that misrepresented the data. Many of these summaries suggested that black and African American mothers, especially those with lower-incomes, provided less and lower quality language to their children than white mothers,” said Lynne Vernon-Feagans, Ph.D., from the University of North Carolina at Chapel Hill’s Frank Porter Graham Child Development Institute.

“Our findings represent a big shift from previous thinking that race-based differences in maternal language play a significant role in children’s language outcomes,” said Mary Bratsch-Hines, Ph.D., of the Frank Porter Graham Child Development Institute.

The study, which is part of the Family Life Project, tracked 1,292 children from birth. The researchers evaluated the language use of similarly-educated black and white mothers to measure the amount and complexity of words they use with their infants and young children.

The team assessed the interactions between mothers and their children during four picture book sessions in the home between the ages of 6 and 36 months. They found that mothers with more education were more likely to use a greater quantity and complexity of language with their young children compared to those with less education.

Overall, maternal education was strongly associated with children’s later language at school age regardless of maternal race, and the mothers’ early language input quality and complexity were even more related to children’s later language at school age.

The new findings will help improve parent, teacher and school system efforts by shaping their understanding of the importance of maternal education for both black and white children and allowing experts to focus available efforts and resources in better ways to improve child outcomes.

Source: University of North Carolina at Chapel Hill